[Show abstract][Hide abstract] ABSTRACT: Biliary tract cancer is rare and has dismal prognosis. Chemotherapy has its role in inoperable disease but the role of targeted agents like cetuximab remains to be defined. On the basis of high epidermal growth factor receptor expression of biliary tract cancers this study aims to investigate the efficacy of cetuximab, gemcitabine and capecitabine in an exploratory phase 2 trial.
Inoperable biliary tract cancer patients were treated with the combination of gemcitabine (1000mg/m(2) on day 1 and 8), capecitabine (1300mg/m(2)/d on day 1-14) and weekly cetuximab (400mg/m(2) loading and 250mg/m(2) maintenance dose) in 21-d cycles until progression or the appearance of intolerable side-effects.
Out of 34 patients (mean age 59.7years) accrued in this study 16 had intrahepatic, eight extrahepatic cholangiocarcinoma and 10 gall bladder cancer. The best overall response rate was 17.6% (two complete responses and four partial responses) and the clinical benefit rate was 76.5%. After a median of 15.4months follow-up the median progression free survival was 34.3weeks and the median overall survival was 62.8weeks. The performance status and chemotherapy efficacy were independent and significant markers of survival. Only moderate side-effects were registered in this study. KRAS mutation was evaluable in 24 tumours, all of these were of wild type.
The efficacy of cetuximab, gemcitabine and capecitabine combination is encouraging and a well tolerated treatment of inoperable biliary tract cancers.
European journal of cancer (Oxford, England: 1990) 09/2013; 49(18). DOI:10.1016/j.ejca.2013.07.143 · 5.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Autologous fat transplantation is often used in aesthetic plastic surgery, and is recently becoming increasingly popular in the reconstruction of soft tissue defects following oncological surgery. A still not standardized technique of fat transplantation for breast cancer reconstruction is rapidly getting popular. The procedure is not a passive volume replacement, but transplantation of biologically active tissue bearing endocrine, paracrine, exocrine functions and containing fat-derived stem cells, which in the tumorous environment raises many questions in relation to the oncological safety and diagnostic follow-up. Although long-term results based on prospective, randomized studies are not yet available, published clinical experience is promising and reveals an effective and surgically safe procedure if used with appropriate indications and techniques. The authors conducted a broad review of the literature, presenting indications, technique, molecular interactions, and potential risks of the clinical results of autologous fat transplantation in the breast cancer reconstructive surgery. The authors initiated that breast and plastic surgeons should promote adequate long term follow-up of breast cancer patients who underwent breast reconstruction with autologous fat transplantation by the establishment of national registries. Orv. Hetil., 2012, 153, 1816-1831.
Orvosi Hetilap 11/2012; 153(46):1816-31. DOI:10.1556/OH.2012.29487
[Show abstract][Hide abstract] ABSTRACT: The authors present the diverse etiology of nipple discharge, which background may be a tumor. They discuss the checkup ways of nipple discharge and review in detail the galactographic technique and evaluation. The examination of pathologic nipple discharge is essentially based on contact cytology, x-ray-, and ultrasound mammography. Consequently, galactography is applied by filling the ducts with contrast material. The final diagnosis is rendered by histologic examination, following the operation. The authors demonstrate the application and role of galactography through various cases.
[Show abstract][Hide abstract] ABSTRACT: The purpose of our work was to evaluate the efficacy of second breast-conserving surgery (BCS) and reirradiation with interstitial high-dose-rate (HDR) brachytherapy (BT) for the management of local recurrences. Between 1999 and 2010, fifteen patients initially treated for breast carcinoma by BCS and radiation therapy who had isolated intra-breast recurrence underwent second BCS and perioperative HDR multicatheter BT. Breast cancer related events, late side effects, and cosmetic results were assessed. At a median follow-up of 62 months (range: 11-127) second local recurrence has not occurred, yielding a 100% mastectomy-free survival. Four patients (27%) developed subsequent distant metastasis and died of breast cancer. The 5-year actuarial rate of disease-free and overall survival was 69% and 85%, respectively. Cosmetic results were rated excellent, good, fair, poor, and unknown in 1 (7%), 10 (66%), 2 (13%), 1 (7%), and 1 (7%) patients, respectively. Grade 2 fibrosis and skin toxicity occurred in 1 (7%) and 1 (7%) patients. Asymptomatic fat necrosis was detected in 9 (60%) women. No patient developed grade 3-4 late side effects. Second BCS followed by partial breast reirradiation is a safe and effective option for the management of selected patients developing intra-breast recurrence after previous breast-conserving therapy. Perioperative HDR BT may decrease the risk of second local relapse with acceptable cosmetic results and low rate of late side effects.
[Show abstract][Hide abstract] ABSTRACT: Early diagnosis and prevention have the most significant effect on overall disease specific outcome; 90% of all breast cancer cases could be cured if diagnosed early and treated accurately. As for all diagnostic methods the most important requirement for diagnostic imaging is to detect breast cancer in its early stage, and to determine accurate tumor staging, in order to select the appropriate therapy. Its role is to monitor the effectiveness of therapy, to follow up patients reliably for early detection of recurrent disease. The spectrum of radiological imaging methods in breast cancer became broader in the past two decades; imaging that provides functional or metabolic data and whole body information such as CT, MRI and PET-CT are now available besides common X-ray and ultrasound mammography. The MRI is getting more and more important for the detection and characterization of breast cancer. Multimodal imaging techniques provide more accurate analysis, which is confirmed by increasing statistics authentically, but none of the imaging methods was specific enough to provide histological diagnosis. However, imaging-guided biopsies enable precise histological or cytological confirmation.
Orvosi Hetilap 01/2012; 153(1):3-13. DOI:10.1556/OH.2012.29250
[Show abstract][Hide abstract] ABSTRACT: Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.
Orvosi Hetilap 10/2011; 152(42):1679-91. DOI:10.1556/OH.2011.29189
[Show abstract][Hide abstract] ABSTRACT: Mammary ductoscopy is a modern, minimally invasive procedure that enables direct, in vivo observation of the mammary ductal system, primarily by nipple discharge. The rapidly developing device is suitable for aimed biopsy for further cytological or molecular examinations. High-tech equipments facilitate polypectomy or laser vaporization of certain intraluminal lesions, and play an important role in the direct surgical excision of the duct or the so-called terminal duct-lobular unit. The above listed facilitate the early diagnosis of malignancies even before imaging could detect them, and the control of high risk patients. Ductoscopy can foster surgical removal of ductal in situ tumors as anatomical units, thus enabling the optimization of radicality of breast conserving surgeries. Authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in the Hungarian language. Orv. Hetil., 2011, 152, 1284-1293.
Orvosi Hetilap 08/2011; 152(32):1284-93. DOI:10.1556/OH.2011.29163
[Show abstract][Hide abstract] ABSTRACT: Breast screening programs along with advances in diagnostic methods and oncologic treatment have resulted in full recovery for a decisive number of patients diagnosed with early-stage breast cancer. The results of the ultra-radical-, followed by the breast conserving era pose new opportunities and challenges for the oncologic breast surgeon. The focus of oncoplastic surgery is not only on the tumor, but also on the female patient, allowing for individualized immediate breast reconstruction with acceptable esthetic result following radical tumor exstirpation. Modern procedures differ both in concept and technique from that of traditional breast surgery. This paper provides a comprehensive and detailed overview of reconstructive and oncoplastic breast surgery.
[Show abstract][Hide abstract] ABSTRACT: The National Public Health Program has established the organized mammography screening in Hungary. The aim of this study was to conduct an audit of "gray zone" smears of the organized mammography screening in comparison with histopathological diagnoses.
Cytology results were rated to C3 atypia probably benign and C4 suspicious of malignancy.
1361 women had aspiration cytology performed from a total of 47,718 mammography non-negative lesions. 105 (7.8%) were diagnosed as C3, whereas 78 (5.7) as C4. Of the 105 patients with C3 diagnosis 61 (58%) patients underwent surgical biopsy. Histology proved malignancy in 20 (32.8%) cases, and benign lesion in 41 (67.2%) cases. All (100%) of the 78 patients with C4 diagnosis had open biopsies; 69 (88.4%) cases were histologically malignant and 9 (11.6%) cases were benign lesions.
The auditing results of fine needle aspiration cytology of "gray zone" in organized mammography screening meet the proposed threshold values. Authors conclude that the "gray zone" category in breast cytology is useful and of value if used judiciously.
Orvosi Hetilap 02/2011; 152(8):292-5. DOI:10.1556/OH.2011.29023
[Show abstract][Hide abstract] ABSTRACT: Desmoids are borderline tumors of the connective tissue, and they account for 0.03 percent of all neoplasms.(1) Arising in the musculoaponeurotic structures, they occur most frequently in the abdominal wall, mesentery, and extremities.(1-3) These locally invasive tumors do not metastasize, but they are associated with high recurrence rates (24 to 65 percent in 10 years) and complication rates (60 percent).(1,2,4) Although the etiology of desmoid tumors is poorly defined, genetic predisposition (germ-line mutations of the adenomatous polyposis coli gene in familial adenomatous polyposis), physical traumas, and hormonal effects (estrogen) are known to be strongly associated with their development.(1-4)
Plastic and Reconstructive Surgery 01/2011; 127(1):1e-4e. DOI:10.1097/PRS.0b013e3181f958ba · 2.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Central breast neoplasms account for 5 to 20% of breast cancer cases. For decades, they have been traditionally treated with mastectomy. The high incidence of involvement associated with these tumors necessitates nipple and areola resection. Oncoplastic surgical techniques, in well selected cases, enable the achievement of adequate cosmetic results following a radical central quadrantectomy along with the Nipple-Areola Complex. The present paper summarizes the indications, techniques and results of breast conserving surgeries of central breast tumors.
Orvosi Hetilap 12/2010; 151(51):2105-12. DOI:10.1556/OH.2010.29017
[Show abstract][Hide abstract] ABSTRACT: The National Public Health Program has established the organized mammography screening in Hungary.
The aim of our study was to determine the quality assurance of breast aspiration cytology.
Cytology results were rated to 5 categories (C1, C2, C3, C4 and C5). All cytology reports were compared with the final histology diagnosis.
1361 women had aspiration cytology diagnosis performed from a total of 47718 mammography non-negative lesions. There were 805 (59.1%) benign and 187 (13.7%) malignant alterations. Sensitivity was 91%, specificity 88%, positive predictive value 96.6% and negative predictive value turned to be 71% (p<0.001).
The auditing values of fine needle aspiration cytology in our laboratory meet, or in certain aspects exceed the proposed minimum threshold values.
Orvosi Hetilap 08/2010; 151(32):1295-8. DOI:10.1556/OH.2010.28929
[Show abstract][Hide abstract] ABSTRACT: Granular cell tumours (GCTs) are uncommon rare neoplasms that may occur in any part of the body. Approximately 5-8% of granular cell tumours occur within the breast. Although nearly always benign in behaviour, granular cell tumours of the breast can often mimic breast malignancies both clinically and on the basis of imaging techniques. This article reports five cases of benign granular cell tumours appearing in the breast, mimicking a malignant breast lesion. In addition to reporting the cases, the relevant literature was reviewed.
European journal of gynaecological oncology 01/2010; 31(6):636-40. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this work is to report the preliminary results of the Hungarian multicentric randomised DCIS study. Between 2000 and 2007, 278 patients with ductal carcinoma in situ (DCIS) treated by breast-conserving surgery were randomised according to predetermined risk groups. Low/intermediate-risk patients (n=29) were randomised to 50 Gy whole-breast irradiation (WBI) or observation. High-risk cases (n=235) were allocated to receive 50 Gy WBI vs. 50 Gy WBI plus 16 Gy tumour bed boost. Very high-risk patients (patients with involved surgical margins; n=14) were randomised to 50 Gy WBI plus 16 Gy tumour bed boost or reoperation (reexcision plus radiotherapy or mastectomy alone). Immunohistochemistry (IHC) was performed to detect the expression of potential molecular prognostic markers (ER, PR, Her2, p53, Bcl-2 and Ki-67). At a median follow-up of 36 months no recurrence was observed in the low/intermediate- and very high-risk patient groups. In the high-risk group, 4 (1.7%) local recurrences and 1 (0.4%) distant metastasis occurred. No patient died of breast cancer. In the high-risk group of patients, the 3- and 5-year probability of local recurrence was 1.1% and 3.1%, respectively. The positive immunostaining for Her2 (38%), p53 (37%) and Ki-67 (44%) correlated with a high nuclear grade. Significant inverse correlation was found between the expression of ER (77%), PR (67%), Bcl-2 (64%) and grade. Preliminary results suggest that breast-conserving surgery followed by radiotherapy yields an annual local recurrence rate of less than 1% in patients with DCIS. IHC of molecular prognostic markers can assist to gain insight into the biologic heterogeneity of DCIS.
Magyar Onkológia 10/2008; 52(3):269-77. DOI:10.1556/MOnkol.52.2008.3.4
[Show abstract][Hide abstract] ABSTRACT: Breast-conserving surgery (BCS) followed by radiotherapy (RT) has become the standard of care for the treatment of early-stage (St. I-II) invasive breast carcinoma. However, controversy exists regarding the value of RT in the conservative treatment of ductal carcinoma in situ (DCIS). In this article we review the role of RT in the management of DCIS. Retrospective and prospective trials and meta-analyses published between 1975 and 2007 in the MEDLINE database, and recent issues of relevant journals/handbooks relating to DCIS, BCS and RT were searched for. In retrospective series (10,194 patients) the 10-year rate of local recurrence (LR) with and without RT was reported in the range of 9-28% and 22-54%, respectively. In four large randomised controlled trials (NSABP-B-17, EORTC-10853, UKCCCR, SweDCIS; 4,568 patients) 50 Gy whole-breast RT significantly decreased the 5-year LR rate from 16-22% (annual LR rate: 2.6-5.0%) to 7-10% (annual LR rate: 1.3-1.9%). In a recent meta-analysis of randomised trials the addition of RT to BCS resulted in a 60% risk reduction of both invasive and in situ recurrences. In a multicentre retrospective study, an additional dose of 10 Gy to the tumour bed yielded a further 55% risk reduction compared to RT without boost. To date, no subgroups have been reliably identified that do not benefit from RT after BCS. In the NSABP-B-24 trial, the addition of tamoxifen (TAM) to RT reduced ipsilateral (11.1% vs. 7.7%) and contralateral (4.9% vs. 2.3%) breast events significantly. In contrast, in the UKCCCR study, TAM produced no significant reduction in all breast events. Based on available evidence obtained from retrospective and prospective trials, all patients with DCIS have potential benefit from RT after BCS. Further prospective studies are warranted to identify subgroups of low-risk patients with DCIS for whom RT can be safely omitted. Until long-term results of ongoing studies on outcomes of patients treated with BCS alone (with or without TAM or aromatase inhibitors) are available, RT should be routinely recommended after BCS for all patients except those with contraindication.
[Show abstract][Hide abstract] ABSTRACT: To examine the incidence and clinical relevance of fat necrosis after accelerated partial-breast irradiation (PBI) using interstitial high-dose-rate brachytherapy (HDR-BT) in comparison with partial-breast electron irradiation (ELE) and whole-breast irradiation (WBI).
Between 1998 and 2004, 258 early-stage breast cancer patients were randomized to receive 50 Gy WBI (n = 130) or PBI (n = 128). The latter consisted of either 7 x 5.2 Gy HDR-BT (n = 88) or 50 Gy ELE (n = 40). The incidence of fat necrosis, its impact on cosmetic outcome, accompanying radiologic features, and clinical symptoms were evaluated.
The 4-year actuarial rate of fat necrosis was 31.1% for all patients, and 31.9%, 36.5%, and 17.7% after WBI, HDR-BT and ELE, respectively (p(WBI/HDR-BT) = 0.26; p(WBI/ELE) = 0.11; p(ELE/HDR-BT) = 0.025). The respective rate of asymptomatic fat necrosis was 20.2%, 25.3%, and 10% of patients. The incidence of symptomatic fat necrosis was not significantly different after WBI (8.5%), HDR-BT (11.4%), and ELE (7.5%). Symptomatic fat necrosis was significantly associated with a worse cosmetic outcome, whereas asymptomatic fat necrosis was not. Fat necrosis was detectable with mammography and/or ultrasound in each case. Additional imaging examinations were required in 21% of cases and aspiration cytology in 42%.
Asymptomatic fat necrosis is a common adverse event of breast-conserving therapy, having no significant clinical relevance in the majority of the cases. The incidence of both symptomatic and asymptomatic fat necrosis is similar after conventional WBI and accelerated partial-breast HDR-BT.
International Journal of Radiation OncologyBiologyPhysics 12/2007; 69(3):724-31. DOI:10.1016/j.ijrobp.2007.03.055 · 4.26 Impact Factor