Despite their undeniable effectiveness, the spectacular increase in the number of antitumor immunotherapies (IT) in recent years has resulted in a substantial organizational and financial challenge on healthcare systems, and prolonged treatments can be burdensome for patients as well. There is an ongoing debate about how long it is optimal to continue palliative IT, or it can be discontinued after 2 years without an increased risk of relapse. Conclusively, it could be especially justified in complete tumor remission, however stable disease does not preclude it, and the decision may be strengthened by chronic complications, comorbidity state, patient preference, and PET/CT negativity, double IT, and lack of prior oligo- progression. Nevertheless, all this requires individual consideration, tumor-board discussion, and it is recommended to gradually prepare patients psychologically. In summary, while maintaining the possibility of reinduction, the discontinuation of palliative IT should always be considered after 2 years application (even after 1 year in melanoma), aiming for the longest treatment-free survival of our patients and minimizing the feeling of having a chronic and incurable disease.

The radiotherapy (RT) expert panel revised and updated the RT guidelines accepted in 2020 at the 4th Hungarian Breast Cancer Consensus Conference, based on new scientific evidence. Radiotherapy after breast-conserving surgery (BCS) is indicated in ductal carcinoma in situ (St. 0), as RT decreases the risk of local recurrence (LR) by 50-60%. In early stage (St. I-II) invasive breast cancer RT remains a standard treatment following BCS. However, in elderly (≥70 years) patients with stage I, hormone receptor positive tumour hormonal therapy without RT can be considered. Hypofractionated (15×2,67 Gy) or ultra-hypofractionated (5×5,2 Gy) whole breast irradiation (WBI) and for selected cases accelerated partial breast irradiation are validated treatment alternatives of conventional WBI. Following mastectomy RT significantly decreases the risk of LR and improves overall survival of patients having 1 to 3 or ≥4 positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes, meeting the ACOSOG Z0011 study criteria, axillary dissection can be substituted with axillary RT. After neoadjuvant chemotherapy (NAC) followed by BCS WBI is mandatory, while after NAC followed by mastectomy RT should be given in cases of initial stage IIB-IV, and locoregional RT indicated in cases of ypN1-2-3 axillary status.

The current treatments for advanced prostate adenocarcinoma (PAC) include the androgen receptor antagonist enzalutamide and docetaxel-based chemotherapy. Elevated monoamine oxidase-A (MAO-A) mRNA expression and activity in tumorous prostate positively correlate with disease progression and therapy resistance. While MAO-B mRNA expression was also demonstrated in PAC cell lines, its role remained unclear. Therefore, this study evaluates the effects of the irreversible MAO-B inhibitor selegiline and rasagiline and their combinations with conventional therapies on androgen-insensitive (PC-3, DU145) and androgen-sensitive (22Rv1, LNCaP, VCaP) PAC cell lines. MAO activity was determined by the MAO-Glo luminescence assay, viability by the ATP-based chemiluminescence method, proliferation by the Luna-II automated cell counter, and mRNA expressions by RT-qPCR. MAO-B mRNA was stably expressed by all PAC cell lines, with the highest expression in 22Rv1 and LNCaP cells. Selegiline reduced MAO-B activity by 75%-80% and decreased cell counts by 40%-50% at 100 μM in PC-3 and 22Rv1 cells. Selegiline concentration-dependently inhibited cell proliferation (100 μM-10 mM) and reduced viability (1-10 mM) similar to rasagiline in all cell lines. Combination with enzalutamide in 22Rv1, and with docetaxel in PC-3 demonstrated potentiating and additive effects, respectively. Selegiline reduced FOXA1 and GLUT1 mRNA expressions related to cancer progression and metabolism in both cell lines, increased the apoptosis-related BAX in PC-3, and decreased AR, EGFR, and SNAI2 in 22Rv1 linked to proliferation and metastasis. These findings suggest potential for selegiline repurposing in both androgen-sensitive and -insensitive PAC therapy by promoting apoptosis and inhibiting cancer growth and survival signals, respectively.

The spectacular development of radiotherapy technology in the twenty-first century and the everyday availability of this modern technique have founded the possibility of combining radiotherapy with various systemic oncological treatments with increasing safety and effectiveness. The most novel systemic treatment modality, the modern immunotherapy, which is also the achievement of the present century, and the latest milestone in its rapid spread across the therapeutic spectrum in cancer care is the step forward to the treatment of earlier tumor stages with curative intent. The inevitable meeting point of these rapidly developing treatment modalities is the care of locally advanced tumors, achieving the theory and practice of the combination of immunotherapy with definitive radiotherapy. The success of the PACIFIC, ADRIATIC or KEYNOTE-A18 studies proves that further progress is possible in the definitive, curative treatment of locally advanced cancer diseases. In this paper, we describe this combination therapy algorithm, the biological background and the successful or less successful clinical trial results in the most relevant and important tumor types and indications.

Aim: The complex medical care of synchronous metastatic colorectal (smCRC) patients requires prudent multidisciplinary planning and treatments due to various challenges caused by the primary tumor and its metastases. The role of primary tumor resection (PTR) is currently uncertain; strong arguments exist for and against it. We aimed to define its effect and find its best place in our therapeutic methodology. Method: We performed retrospective data analysis to investigate the clinical course of 449 smCRC patients, considering treatment modalities and the location of the primary tumor and comparing the clinical results of the patients with or without PTR between 1 January 2013 and 31 December 2018 at the Institute of Oncotherapy of the University of Pécs. Results: A total of 63.5% of the 449 smCRC patients had PTR. Comparing their data to those whose primary tumor remained intact (IPT), we observed significant differences in median progression-free survival with first-line chemotherapy (mPFS1) (301 vs. 259 days; p < 0.0001; 1 y PFS 39.2% vs. 26.6%; OR 0.56 (95% CI 0.36–0.87)) and median overall survival (mOS) (760 vs. 495 days; p < 0.0001; 2 y OS 52.4 vs. 26.9%; OR 0.33 (95% CI 0.33–0.53)), respectively. However, in the PTR group, the average ECOG performance status was significantly better (0.98 vs. 1.1; p = 0.0456), and the use of molecularly targeted agents (MTA) (45.3 vs. 28.7%; p = 0.0005) and rate of metastasis ablation (MA) (21.8 vs. 1.2%; p < 0.0001) were also higher, which might explain the difference partially. Excluding the patients receiving MTA and MA from the comparison, the effect of PTR remained evident, as the mOS differences in the reduced PTR subgroup compared to the reduced IPT subgroup were still strongly significant (675 vs. 459 days; p = 0.0009; 2 y OS 45.9 vs. 24.1%; OR 0.37 (95% CI 0.18–0.79). Further subgroup analysis revealed that the site of the primary tumor also had a major impact on the outcome considering only the IPT patients; shorter mOS was observed in the extrapelvic IPT subgroup in contrast with the intrapelvic IPT group (422 vs. 584 days; p = 0.0026; 2 y OS 18.2 vs. 35.9%; OR 0.39 (95% CI 0.18–0.89)). Finally, as a remarkable finding, it should be emphasized that there were no differences in OS between the smCRC PTR subgroup and metachronous mCRC patients (mOS 760 vs. 710 days, p = 0.7504, 2 y OS OR 0.85 (95% CI 0.58–1.26)). Conclusions: The role of PTR in smCRC is still not professionally justified. Our survey found that most patients had benefited from PTR. Nevertheless, further prospective trials are needed to clarify the optimal treatment sequence of smCRC patients and understand this cancer disease’s inherent biology.

Hereditary breast and ovarian cancer is a well-known genetic condition, inherited mainly in an autosomal dominant way, which elevates the risk of developing malignancies at a young age in heterozygous carriers. Advances in new generation sequencing have enabled medical professionals to determine whether a patient is harbouring mutations in moderate- or high penetrance susceptibility genes. We conducted a retrospective analysis among 275 patients who underwent genetic counselling and multigene panel testing for hereditary breast and ovarian cancer syndrome in our department. From these patients 74.5% (205/275) were affected by some type of malignancy, while the remaining 25.5% (70/275) had a positive family history of different cancers, suggesting a genetic predisposition. These tests confirmed a genetic variant in 29.8% and 28.6% of these patient groups respectively. The results also mirrored our general knowledge concerning the genetic background of hereditary breast and ovarian cancer, as variants in either one of the BRCA1 and BRCA2 genes proved to be the most common cause among our patients with 41.5%. Our test also detected a novel mutation in the CDH1 gene and three patients with double heterozygosity in two different susceptibility genes. This study demonstrates the relevance of genetic counselling and non-BRCA gene sequencing among cancer patients and patients who fulfil the criteria for genetic testing, while also providing important details about the genetic profile of Hungarian patients.

Bevezetés: A daganatos megbetegedésekre jellemzőek a megnövekedett pszichés terhek. A jelentős fizikai tüneti terhek, a multimorbiditás, a szorongás és a depresszió kialakulásának kockázati tényezői lehetnek daganatos betegekben, mely összefüggések vizsgálatára tudomásunk szerint eddig még nem került sor Magyarországon. Célkitűzés: Célunk volt (1) felmérni a szorongás és (2) a depresszió szintjét daganatos betegek körében, (3) megvizsgálni, hogy milyen fizikai tüneti terhek jelennek meg leginkább az onkológiai betegek között, (4) megismerni a szorongás, a depresszió és a fizikai tüneti terhek és (5) a multimorbiditás összefüggéseit. Módszer: Keresztmetszeti vizsgálatunkba 18. életévüket betöltött, daganatos megbetegedés diagnózisával rendelkező betegeket vontunk be. A kvantitatív adatok feldolgozása során az eredményeket 0,05 alatti p-érték esetén tekintettük szignifikánsnak. Eredmények: A vizsgálatban 113 beteg vett részt. A válaszadók 29,2%-ában a normális határértéknél magasabb szintű szorongást mértünk, a depresszió pedig 36,2%-ban volt jelen különböző súlyosságban. Alvási nehézségekről a megkérdezettek 69,5%-a, fáradtságról 66,3%, fájdalomról 52,2% számolt be. A normálérték feletti szorongást és depressziót mutatók átlagosan több fizikai tüneti terhet említettek. Szignifikáns összefüggés volt kimutatható a normálérték feletti depressziót mutatók és a fáradtság, valamint a fájdalom között. A multimorbiditást tekintve a normálérték feletti szorongást mutatók átlagosan több krónikus betegséggel rendelkeztek. Megbeszélés: Vizsgálatunkban a szorongás szintje magasabb, a depresszió szintje azonban egyezik a nemzetközi adatokkal. Az alvási nehézségek nagyobb arányban fordulnak elő vizsgálatunkban, a fáradtság és a fájdalom előfordulása azonban összhangban áll a nemzetközi kutatások eredményeivel. Az eddig publikált nemzetközi vizsgálatokhoz hasonlóan vizsgálatunk is a multimorbiditás, a megnövekedett fizikai tüneti terhek, továbbá a szorongás és a depresszió közötti jelentős összefüggésre utal. Következtetés: A szorongás és a depresszió nagy arányban van jelen onkológiai betegekben. A legnagyobb arányban az alvási nehézségek fordulnak elő, ezt követi a fáradtság és a fájdalom. A szorongás és depresszió mértéke összefüggést mutat a fizikai tüneti terhekkel, valamint a multimorbiditás is fokozza a betegek szorongásszintjét. Orv Hetil. 2024; 165(8): 309–317.

Bevezetés: A de novo, áttétes, hormonszenzitív prosztatarák (M1HSPC) a prosztatarákok (PC) mintegy 5-10%-át teszi ki, azonban a PC-hez kapcsolódó halálesetek közel 50%-áért felelős. Az áttétek elsősorban a csontrendszert érintik, azonban a csontvelő-érintettség igen ritka. Anyag és módszer: Egy 71 éves férfi beteg néma, makroszkópos, alvadékos vérvizeléssel jelentkezett egyetemünk sürgősségi ambulanciáján. A vérvizsgálat thrombocytopeniát, emelkedett májfunkciós értékeket, veseelégtelenséget, enyhe elektrolitegyensúly-zavart, mérsékelt anémiát és enyhe gyulladásos érték eltérést mutatott. A konzervatív kezelés ellenére nem javuló vérvizelés hátterében diszszeminált intravaszkuláris coagulopathia (DIC) igazolódott. Kivizsgálása során konvencionális CT-vizsgálat parailiacalis, supraclavicularis lymphadenopathiát igazolt, emellett fizikális vizsgálat során (rektális digitális vizsgálat, RDV) felmerült a prosztatarák lehetősége is. Kiegészítő tumormarker, PSA-vizsgálat (totál PSA) történt, amely jelentős eltérést, emelkedett értéket, 159 ng/ml igazolt, majd protokoll szerinti transrectalis ultrahang-vezérelte prosztatabiopszia történt, amely Gleason Grade 4+4, ISUP 4 adenokarcinomát igazolt. Androgén deprivációs terápia (ADT), majd később abirateron-acetát kezelés indult. A jelentős PSA-eltérés, illetve a konvecionális staging vizsgálati eredmények ismeretében kiegészítő PSMA PET CT-vizsgálat elvégzését kezdeményeztük. Hematológusokkal folytatott konzultációt követően csontvelő-biopszia történt, amelynek eredménye prosztata-adenocarcinoma metasztázisának felelt meg (PSA-, AR+ fenotípus). Az alkalmazott kombinált ADT- és ARTA-kezelések mellett kasztrációrezisztens állapot alakult ki, majd a diagnózis felállítását követően 5 hónappal a beteg alapbetegségének szövődményei következtében elhunyt. Következtetés: A beteg klinikai tünetei, döntően a makroszkópos, alvadékos néma vérvizelés, illetve a negatív urológiai kórelőzmény, egyéb vizsgálati eredmények hiánya nehezítették a korai, pontos diagnózis felállítását. A fizikális vizsgálat (RDV), férfiaknál a PSA, mint szervspecifikus tumormarker, további képalkotó vizsgálatok, valamint esetünkben a PSMA PET CT, és a társszakmák bevonása segítették a beteg diagnózishoz történő jutását, illetve annak birtokában a viszonylag gyors szisztémás kezelés megkezdését. A DIC mögötti másodlagos folyamatok, mint például esetünkben a prosztatakarcinóma feltérképezése komplex feladat. A kezdeti tüneti terápia (a vérvizelés konzervatív módon történő uralása, vérkészítmények adása) átmeneti javulást ugyan eredményezett, de a beteg általános állapotában történő radikális javulást az új generációs ARTA (abirateron-acetát) és ADT-kezelések hoztak. Jelenleg nincs magas szintű evidenciával bíró és széles körben elfogadott kezelési terv csontvelő-érintettséggel együtt járó metasztatikus prosztatadaganat kezelésére. A rendelkezésre álló irodalmi adatok következetesen az ADT-, majd kemoterápia/ARTA-kezelést ajánlanak, triplet terápia (ADT + ARTA + kemoterápia) a betegek általános állapota miatt általában nem javasolt.

Gliomas are considered as locally aggressive diseases, consequently, surgery and radiotherapy are the basic therapies of the glial tumors. Nevertheless, the long-term ineffectiveness of the local treatment modalities and the frequently observed relapses explain the unmet medical need for the elaboration of effective systemic treatment regimes. In the last few decades of the 20th century, the use of different chemotherapeutic agents and their combinations, and the alternative administration of drugs have been in the therapeutic forefront of gliomas, whereas, later, in the first years of this century temozolomide was introduced to the everyday clinical practice as the most effective "anti-glioma" medicine, and it is still widely used both in monotherapy and in different combinations. Nevertheless, in the last two decades, considering the recognition of different predictive molecular markers, different targeted therapies, e.g. VEGFR inhibitor agents were also introduced into the routine clinical practice, and there have been promising results published in immunotherapy trials in the recent years, as well. Besides the promising results with the novel systemic therapies, it should be emphasized that both in the primary and the salvage care of the glial tumors the most effective treatment options are the individualized combinations of local and systemic treatment modalities, with the proper interpretation of brain imaging data and patient-centered clinical management.

Introduction: Cancer is characterized by increased psychological burdens. Significant physical symptoms and multimorbidity can be risk factors for the development of anxiety and depression in cancer patients, the correlations of which have not yet been investigated in Hungary. Objective: Our aim was to (1) assess the level of anxiety and (2) depression among cancer patients, (3) examine which physical symptoms are the most common in oncology patients, (4) learn about anxiety, depression and physical symptoms, (5) observe the relationships of multimorbidity in cancer patients. Methods: In our cross-sectional study, we included patients over the age of 18 diagnosed with cancer. During the processing of the quantitative data, the results were considered significant if the p value was below 0.05. Result: 113 patients participated in the study. In 29.2% of the respondents, we measured a level of anxiety higher than the normal limit, and depression was present in 36.2% in varying degrees of severity. Sleep difficulties were reported by 69.5% of those interviewed, fatigue by 66.3%, and pain by 52.2%. Those showing anxiety and depression above the normal value reported having more physical symptoms on average. A significant correlation was demonstrated between those showing depression above the normal value and fatigue and pain. In terms of multimorbidity, those showing a higher level of anxiety suffered from more chronic diseases on average. Discussion: The level of anxiety in our study is higher, but the level of depression is in line with international data. Sleep difficulties occur more frequently in our study, but the occurrence of fatigue and pain is consistent with the results of international research. Similar to international studies published so far, our study also points to a significant correlation between multimorbidity, increased physical symptoms, and anxiety and depression. Conclusion: Anxiety and depression are present in high proportion of oncology patients. Among these patients, sleep difficulties occur in the highest proportion, followed by fatigue and pain. Not only do the levels of anxiety and depression show a direct correlation with the physical symptoms experienced by the patients, but in addition it has been observed that multimorbidity also increases the level of anxiety in patients.

The aim of our analysis was to evaluate the efficacy of cabozantinib in patients with metastatic renal cell carcinoma. Cabozantinib therapy initiated between 01/01/2019 and 31/12/2022 was evaluated based on a retrospective review of data from 14 renal centers in Hungary. The starting dose was 60 or 40 mg. Physical examinations and laboratory tests were performed every 4 weeks and imaging studies 3-monthly. Tumor response was assessed according to RECIST 1.1, and toxicity according to NCI CTCAE 4.0. A total of 230 patient records were evaluated, 201 (87.4%) of them had clear cell RCC. Cabozantinib was administered as third, second and first-line treatment in 48.7%, 38.3% and <5% of cases, respectively. Dose reductions occurred in 62.6% and treatment interruption in 6.5%. Duration of therapy was 10.03 months, which was independent of dose reduction. Overall tumor response rate was 39.2% and clinical benefit was 82.8%. The duration of first-, second-, third- and fourth-line treatment was 11.47, 8.03, 11.57 and 10.13 months, respectively. Overall survival from the start of therapy was 22.0 months. Cabozantinib therapy in daily practice was more beneficial than according to registry study results. Dose reduction did not affect efficacy.

Aim: The key purposes of the treatment of metastatic malignancies are to extend survival and maintain the quality of life. Recently it has been emphasized in the scientific literature that the maintenance of maximal dose intensity is not always beneficial. Method: We examined the effectiveness of first-line mFOLFIRI-based treatments used in mCRC indication in 515 patients, treated between 1 January 2013 and 31 December 2018 at the Department of Oncotherapy of the University of Pécs, on a basis of real-world retrospective data analysis. We studied the effect of decreased dose intensity treatment modifications on patient survival. Results: 45% of all patients achieved the optimal relative dose intensity (RDI) of 85%, and the median progression-free and overall survival (mPFS, mOS) were 199 and 578 days, compared to 322 and 743 days, (mPFS p < 0.0002, 1 y (year) PFS OR (odds ratio) 0.39 (95% CI: 0.26–0.56) and mOS p = 0.0781, 2 yrs OS OR 0.58 (95% CI: 0.39–0.85), respectively) in the group of patients not achieving the RDI of 85%. Conclusions: Decreased dose intensity did not reduce the effectiveness of treatment; in fact, there was a significant improvement in most of the analyzed parameters. The option of reduced dose intensity, which shows the same or even better results with less toxicity, should definitely be considered in the future palliative treatment of mCRC patients.

The evolution of radiotherapy (RT) technologies in the last two decades has changed the RT treatment attitude, and the routine application of novel stereotactic methods has opened new avenues in the complex cancer care. To prove the clinical consequences of this paradigm shift, a good example is the transformation of the renal cell carcinoma (RCC) treatment strategy. RCC was originally considered as a radioresistant disease, however, the introduction of new RT technologies has provided a risk-free focal dose escalation, so RT in primary or metastatic RCCs has become a more efficient method. Meanwhile, there has also been a spectacular development in the medical treatment of advanced RCC, thus the treatment strategy has radically changed in this field of oncology, resulting in a remarkably increased effectiveness. In the present communication, we summarize the steps of recent RT evolution, the new fields of indications and possibilities of combination therapies in RCC.

BACKGROUND:Bevacizumab (BV) plus paclitaxel (PTX) is a treatment option in patients with HER2-negative metastatic breast cancer (mBC). We conducted an international pooled analysis with individual patient data to evaluate the effectiveness of BV + PTX as a first-line treatment for HER2-negative mBC patients under routine practice. METHODS:A total of 2,474 mBC patients treated with BV + PTX from four prospective observational studies were analyzed. The primary endpoint was overall survival (OS). The other endpoints including identifying independent prognostic factors and validation of the modified Prognostic Factor Index (PFI) developed in the ATHENA trial. RESULTS:Median follow-up time was 10.9 months (M). Median OS were 21.4 M (95% confidential interval 19.8-22.7 M). The seven independent prognostic factors (tumor subtype, age, ECOG performance status (PS), disease-free interval (DFI), liver metastases, number of metastatic organs, and prior anthracycline and/or taxane treatment) for OS found in this analysis included the five risk factors (RFs [DFI < 24 months, ECOG PS 2, liver metastases and/or > 3 metastasis organ sites, TNBC, prior anthracycline and/or taxane therapy]). High- (> 3 RFs [median OS 12.6 M]) and intermediate-risk groups (2 RFs [median OS 18.0 M]) had a significantly worse prognosis than the low-risk group (< 1 RF [median OS 27.4 M]), (p < 0.0001). CONCLUSIONS:This international pooled analysis showed the effectiveness of first-line BV + PTX for HER2-negative mBC patients identifying seven independent prognostic factors as real-world evidence. The usefulness of the modified PFI developed in the ATHENA trial in predicting OS among patients receiving BV + PTX was also verified.

The prognosis of pancreatic cancer is one of the worst of all cancers. Though the routine use of modern targeted and immunotherapy is still pending, the recently applied new chemotherapy combinations resulted in obvious improvement in the clinical management of pancreatic cancer. Adjuvant treatment followed by radical operation can increase the survival of the patients, moreover, neoadjuvant therapy for locally advanced tumors is associated with higher resectability rate. However, in metastatic disease only palliative chemotherapy could be indicated due to the dismal prognosis. The introduction of new chemotherapy combinations produced a major evolution by extending the median survival time of these patients. According to recent publications, even complete remission of the metastases can be achieved by the palliative chemotherapy, justifying a radical operation. This approach can be more advantageous, compared to patients treated with chemotherapy only. Reporting our two primary metastatic cases, we also endorse this new approach. The clinical significance of complex management is justified in the case of oligopersistence which is traditionally treated only with palliative systemic therapy. Orv Hetil. 2023; 164(43): 1712-1718.

A pancreasrák prognózisa a mai napig az egyik legrosszabb a daganatos betegségek között. Bár a modern célzott és immunterápiák rutinszerű alkalmazása még várat magára, az elmúlt években bevezetett új kemoterápiás kombinációk egyértelmű javulást eredményeztek a hasnyálmirigy-daganatok rutin klinikai ellátásában. A radikális műtét után alkalmazott adjuváns kezelés megnövelte a betegek várható túlélését, illetve a lokálisan előrehaladott tumoroknál alkalmazott neoadjuváns kezelés pedig a reszekabilitási arányt emelte meg. Ezzel szemben áttétes pancreasráknál már csak palliatív kemoterápia indikálható, sajnos az ilyenkor tapasztalt rövid túlélési eredménnyel. Az új kemoterápiás szerek, kombinációk azonban itt is előrelépést hoztak, meghosszabbítva a betegek medián élettartamát. A közelmúltban megjelent több közlemény szerint a palliatív kemoterápiával akár az áttétek teljes regressziója elérhető, lehetővé és indokolttá téve radikális műtét végzését. Az így elért klinikai eredmények kedvezőbbek is lehetnek, mint a csak kemoterápiával kezelt betegekéi. Két saját, elsődlegesen áttétes esetünk ismertetésével is ezt az új szemléletet képviseljük, az oligoperzisztencia esetében indokolható komplex ellátás klinikai jelentőségének bemutatásával, egy hagyományosan csak palliatív szisztémás kezeléssel ellátott kórképnél. Orv Hetil. 2023; 164(43): 1712–1718.

Aim: The oncologic treatment of elderly patients is going on with a lack of evidence due to their underrepresentation in clinical trials. Many data suggest that certain groups of elderly patients, like their younger counterparts, may benefit from the systemic treatment of their metastatic colorectal tumors (mCRC). Method: We performed retrospective data analysis to investigate the clinical course of care and clinical outcomes of 515 patients who received first-line mFOLFIRI-based chemotherapy for mCRC between 1 January 2013 and 31 December 2018 at the Institute of Oncotherapy of the University of Pécs, focusing on a comparison of patients over and under 70 years of age, defined as the cut-off value. Results: 28.7% of the 515 patients were 70 years old and older (median age 73.5 years). Compared to the data of the elderly patients, the younger group (median age 61.1 years) had a performance status that was significantly better (average ECOG 1.07 vs. 0.83, p < 0.0001), and significantly more patients received molecularly targeted agents (MTA) (21.6% vs. 51.8%, p < 0.0001); nevertheless, mPFS (241 vs. 285 days, p = 0.3960) and mOS (610 vs. 698 days, p = 0.6305) results did not differ significantly. Considering the 1y PFS OR and the 2ys OS OR values (0.94 [95%CI 0.63–1.41] and 0.72 [95%CI 0.47–1.09], respectively), only a non-significant trend was observed in OS favouring the younger population. Additional analysis of our data proved that the survival in patients over 70 years was positively affected by the addition of MTAs to the doublet chemotherapies, and the reasonable modifications/reductions in dose intensity and the addition of local interventions had similar positive effects as observed in the younger patients’ group. Conclusions: Age stratification of mCRC patients is not professionally justified. Patients over 70 years of age with good performance status and controlled co-morbidities benefit from systemic therapy, its modifications and local treatment to the same extent as younger patients. With the increasing incidence of age-related cancers due to the rising average lifespan, prospective randomised clinical trials are needed to determine the real value of systemic therapy in the elderly and the rational, objective methods of patient selection.

Introduction: Malignant pleural effusion is a complication of tumors heralding poor outcome. It may be life-threat- ening, so advanced cases should be treated as an oncological emergency. Objective: We aimed to provide complex care to patients with malignant pleural effusion during the COVID-19 pandemic at the University of Pecs Medical School, in the Department of Oncotherapy. During the pandemic, we introduced the thoracocentesis as a routine method in our department without previous experiences. Method: Results of diagnosing and treating pleural effusion of patients between March 18th of 2020 and May 31st of 2021 were summarized. Results: We have analyzed data of 45 patients, two-thirds (66.7%) of them were women, the median age was 67 years. 57.8% of patients received systemic anticancer therapy during the study. The total number of thoracocentesis was over 120, one-third of the patients required more than five interventions. Only three iatrogenic pneumothorax cases were detected, no other serious complications were experienced. The procedures - that were aimed to mitigate symptoms in most cases (80%) - were considered successful. However, 48.9% of the patients were no longer alive at the end of the study period indicating very poor prognosis of pleural carcinosis. Discussion and conclusion: Clinical care of oncological patients was continuous during the pandemic; patients treated as part of emergency care were often seen in advanced disease state. Treatment of malignant pleural effusion requires oncological foresight as well as implementing an invasive approach. Our study has shown that discussion of the topic is relevant, may reveal difficulties and need for improvement. Our results are consistent with literature data, we have experienced less complications than reported in the literature.

Oncology has evolved to a great extent over the last quarter of century. The significant success is multifactorial, including primary and secondary prevention, the development of diagnostics, new methods of chemo-and radiotherapy, and the integration of basic research results into practice. From the point of view of surgery, the establishing and widespread practical application of the principles of preoperative oncotherapy played a major role in this development. Between 1997 and 2005, 44 patients with gastric cancer and 102 patients with borderline resectable or irresectable esophageal cancer received perioperative treatment at the Department of Surgery of the University of Pecs. The response rate was above 50% in both groups and complete pathological remission was achieved in 3 patients with gastric cancer and 17 patients with esophageal cancer. Based on our own experience and literature data, the development of seven new principles in surgical oncology were observed as the result of a very successful preoperative oncologic treatment. The desired free resection margin was reduced to the millimeter dimension in many cancer cases. Thus so-called organ-preserving procedures were made possible. Regarding the prognosis, the stage after the treatment became determinant. Complete histopathological remission could also be achievable in patients with oligometastases. In the case of a complete remission, the "watch and wait" tactics emerged as an option. Along the preoperative treatment of resectable colorectal liver metastases, there is no need to strive for complete remission. The treatment order of the primary tumor and its metastases can be reversed. Based on the improving results of oncology treatments, a reduction in surgical activity in the treatment of cancer patients is expected.