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Kelemen G, Együd Z, Dobi Á, Varga L, Kószó R, Borzási E, Paczona V, Végváry Z, Borzák F, Fodor E, Ócsai H, Baltás E, Oláh J, Hideghéty K. Survival Benefit of Stereotactic Radiotherapy in the Complex Management of Metastatic Melanoma. Anticancer Res 2024; 44:205-212. [PMID: 38159978 DOI: 10.21873/anticanres.16803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/AIM Targeted therapy and immunotherapy, with additional stereotactic radiation therapy (SRT) have revolutionized the management of metastatic malignant melanoma (mMM). We aimed to analyze the effectiveness and safety of SRT and determine its role in the complex management of mMM. PATIENTS AND METHODS We treated 24 patients with solitary metastasis, 15 with oligometastatic disease and one with multiple metastases. The primary endpoint was to investigate the possible effect of stereotactic radiotherapy for metastatic lesions on patients' survival taking the systemic therapy into consideration. RESULTS The median overall survival (OS) for the entire group was 30.07 months; 50% of them received immunotherapy, 32% received targeted therapy. Complete remission of the irradiated lesions was observed in six patients, partial tumor response was achieved in 13, while stable disease was detected in 10; tumor progression occurred in four cases. Compartmental recurrence (recurrence in the brain in a not previously irradiated region) developed in seven patients. OS was significantly longer in those with extracranial metastases treated with stereotactic body radiotherapy in comparison to brain SRT. We found a strong correlation between tumor response and mean OS (42.5 months after complete or partial remission versus 11.8 months in those with stable or progressive disease). No OS difference was observed according to the number of irradiated lesions or type of systemic therapy before SRT (no therapy: 43.6 months, with therapy: 25.7 months). Significant OS advantage was shown when immunotherapy was administered post-SRT (mean OS: with immunotherapy: 39.6 months, no immunotherapy: 18.5 months). CONCLUSION In the case of oligometastatic MM, SRT can be used safely and with good efficiency in addition to targeted therapy/anti-programmed cell death protein 1 therapy. Improved survival warrants including SRT in the complex management of mMM, however, further studies are needed for SRT optimization.
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Affiliation(s)
- Gyöngyi Kelemen
- Department of Oncotherapy, University of Szeged, Szeged, Hungary;
| | - Zsófia Együd
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Ágnes Dobi
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Linda Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Emőke Borzási
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Viktor Paczona
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Végváry
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Ferenc Borzák
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Henrietta Ócsai
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Eszter Baltás
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Judit Oláh
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Katalin Hideghéty
- Department of Oncotherapy, University of Szeged, Szeged, Hungary;
- ELI-ALPs Non-profit Ltd., Szeged, Hungary
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Nagy-Mikó B, Németh-Szatmári O, Faragó-Mészáros R, Csókási A, Bognár B, Ördög N, Borsos BN, Majoros H, Ujfaludi Z, Oláh-Németh O, Nikolényi A, Dobi Á, Kószó R, Sántha D, Lázár G, Simonka Z, Paszt A, Ormándi K, Pankotai T, Boros IM, Villányi Z, Vörös A. Predictive Potential of RNA Polymerase B (II) Subunit 1 (RPB1) Cytoplasmic Aggregation for Neoadjuvant Chemotherapy Failure. Int J Mol Sci 2023; 24:15869. [PMID: 37958852 PMCID: PMC10650411 DOI: 10.3390/ijms242115869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
We aimed to investigate the contribution of co-translational protein aggregation to the chemotherapy resistance of tumor cells. Increased co-translational protein aggregation reflects altered translation regulation that may have the potential to buffer transcription under genotoxic stress. As an indicator for such an event, we followed the cytoplasmic aggregation of RPB1, the aggregation-prone largest subunit of RNA polymerase II, in biopsy samples taken from patients with invasive carcinoma of no special type. RPB1 frequently aggregates co-translationally in the absence of proper HSP90 chaperone function or in ribosome mutant cells as revealed formerly in yeast. We found that cytoplasmic foci of RPB1 occur in larger sizes in tumors that showed no regression after therapy. Based on these results, we propose that monitoring the cytoplasmic aggregation of RPB1 may be suitable for determining-from biopsy samples taken before treatment-the effectiveness of neoadjuvant chemotherapy.
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Affiliation(s)
- Bence Nagy-Mikó
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Orsolya Németh-Szatmári
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Réka Faragó-Mészáros
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Aliz Csókási
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Bence Bognár
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Nóra Ördög
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Barbara N. Borsos
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Hajnalka Majoros
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
- Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér 13, H-6720 Szeged, Hungary
| | - Zsuzsanna Ujfaludi
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
- Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér 13, H-6720 Szeged, Hungary
| | - Orsolya Oláh-Németh
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Aliz Nikolényi
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - Ágnes Dobi
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - Dóra Sántha
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - György Lázár
- Department of Surgery, Albert Szent-Györgyi Health Centre, University of Szeged, 8 Semmelweis Street, H-6725 Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, Albert Szent-Györgyi Health Centre, University of Szeged, 8 Semmelweis Street, H-6725 Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, Albert Szent-Györgyi Health Centre, University of Szeged, 8 Semmelweis Street, H-6725 Szeged, Hungary
| | - Katalin Ormándi
- Department of Radiology, Albert Szent-Györgyi Health Centre, University of Szeged, 6 Semmelweis Street, H-6725 Szeged, Hungary
| | - Tibor Pankotai
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
- Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér 13, H-6720 Szeged, Hungary
- Genome Integrity and DNA Repair Core Group, Hungarian Centre of Excellence for Molecular Medicine (HCEMM), University of Szeged, Budapesti út 9, H-6728 Szeged, Hungary
| | - Imre M. Boros
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Zoltán Villányi
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - András Vörös
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
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Priskin K, Pólya S, Pintér L, Jaksa G, Csányi B, Enyedi MZ, Sági-Zsigmond E, Sükösd F, Oláh-Németh O, Kelemen G, Nikolényi A, Uhercsák G, Sántha D, Dobi Á, Szilágyi É, Valicsek E, Tordai L, Tóth R, Kahán Z, Haracska L. BC-Monitor: Towards a Routinely Accessible Circulating Tumor DNA-Based Tool for Real-Time Monitoring Breast Cancer Progression and Treatment Effectiveness. Cancers (Basel) 2021; 13:3489. [PMID: 34298704 PMCID: PMC8305126 DOI: 10.3390/cancers13143489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
Circulating tumor DNA (ctDNA) is increasingly employed in the screening, follow-up, and monitoring of the continuously evolving tumor; however, most ctDNA assays validated for clinical use cannot maintain the right balance between sensitivity, coverage, sample requirements, time, and cost. Here, we report our BC-monitor, a simple, well-balanced ctDNA diagnostic approach using a gene panel significant in breast cancer and an optimized multiplex PCR-based NGS protocol capable of identifying allele variant frequencies below 1% in cell-free plasma DNA. We monitored a cohort of 45 breast cancer patients prospectively enrolled into our study receiving neoadjuvant chemotherapy or endocrine therapy or palliative therapy for metastatic diseases. Their tumor mutation status was examined in the archived tumor samples and plasma samples collected before and continuously during therapy. Traceable mutations of the used 38-plex NGS assay were found in approximately two-thirds of the patients. Importantly, we detected new pathogenic variants in follow-up plasma samples that were not detected in the primary tumor and baseline plasma samples. We proved that the BC-monitor can pre-indicate disease progression four-six months earlier than conventional methods. Our study highlights the need for well-designed ctDNA monitoring during treatment and follow-up, integrated into a real-time treatment assessment, which could provide information on the active tumor DNA released into the blood.
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Affiliation(s)
- Katalin Priskin
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Sára Pólya
- Visal Plus Ltd., 6726 Szeged, Hungary; (S.P.); (B.C.)
| | - Lajos Pintér
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Gábor Jaksa
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | | | - Márton Zsolt Enyedi
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Eszter Sági-Zsigmond
- Delta Bio 2000 Ltd., 6726 Szeged, Hungary; (K.P.); (L.P.); (G.J.); (M.Z.E.); (E.S.-Z.)
| | - Farkas Sükösd
- Department of Pathology, University of Szeged, 6701 Szeged, Hungary;
| | - Orsolya Oláh-Németh
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Gyöngyi Kelemen
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Alíz Nikolényi
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Gabriella Uhercsák
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Dóra Sántha
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Ágnes Dobi
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Éva Szilágyi
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Erzsébet Valicsek
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - László Tordai
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Rozália Tóth
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, 6720 Szeged, Hungary; (O.O.-N.); (G.K.); (A.N.); (G.U.); (D.S.); (Á.D.); (É.S.); (E.V.); (L.T.); (R.T.); (Z.K.)
| | - Lajos Haracska
- HCEMM-BRC Mutagenesis and Carcinogenesis Research Group, Biological Research Centre, Institute of Genetics, 6726 Szeged, Hungary
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VÉgvÁry Z, DarÁzs B, Paczona V, Dobi Á, Reisz Z, Varga Z, Fodor E, CserhÁti A, OlÁh J, Kis DÁ, BarzÓ PÁ, HideghÉty K. Adaptive Radiotherapy for Glioblastoma Multiforme - The Impact on Disease Outcome. Anticancer Res 2020; 40:4237-4244. [PMID: 32727750 DOI: 10.21873/anticanres.14425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To study the changes of glioblastoma multiforme during chemoradiotherapy (CRT) and to evaluate the impact of changes on dosimetry and clinical outcomes. PATIENTS AND METHODS Forty-three patients underwent volumetric imaging-based replanning. Prognostic factors and gross tumor volume changes in relation to overall survival and the effect of adaptive replanning were statistically analyzed. RESULTS Patients with total tumor removal, with shorter time to CRT (<27 days), with methylated O-6 methylguanine DNA methyltransferase and good performance status (>60%) had better survival. Tumor shrinkage in 24 patients resulted in improved survival compared to 19 in whom tumor was unchanged or progressed (25.3 vs. 11.1 months, p=0.04). Adapted planning target volume allowed a reduction in irradiated volume, while increasing survival (12.06 vs. 28.98 months, p=0.026). CONCLUSION Tumor response during CRT has significant impact on the outcome. Adaptation of the planning target volume to the tumor changes proved to be beneficial and warrants further investigation.
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Affiliation(s)
- ZoltÁn VÉgvÁry
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Barbara DarÁzs
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Viktor Paczona
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Ágnes Dobi
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zita Reisz
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - ZoltÁn Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Adrienn CserhÁti
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Judit OlÁh
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - DÁvid Kis
- Department of Neurosurgery, University of Szeged, Szeged, Hungary
| | - PÁl BarzÓ
- Department of Neurosurgery, University of Szeged, Szeged, Hungary
| | - Katalin HideghÉty
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.,ELI-ALPS Non-profit Ltd, Szeged, Hungary
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Dobi Á, Darázs B, Fodor E, Cserháti A, Együd Z, Maráz A, László S, Dodd L, Reisz Z, Barzó P, Oláh J, Hideghéty K. Low Fraction Size Re-irradiation for Large Volume Recurrence of Glial Tumours. Pathol Oncol Res 2020; 26:2651-2658. [PMID: 32648211 PMCID: PMC7471107 DOI: 10.1007/s12253-020-00868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to evaluate the efficacy of re-irradiation (re-RT) in patients with advanced local relapses of glial tumours and to define the factors influencing the result of the hyper-fractionated external beam therapy on progression after primary management. We have analysed the data of 55 patients with brain tumours (GBM: 28) on progression, who were re-irradiated between January 2007 and December 2018. The mean volume of the recurrent tumour was 118 cm3, and the mean planning target volume (PTV) was 316 cm3, to which 32 Gy was delivered in 20 fractions at least 7.7 months after the first radiotherapy, using 3D conformal radiotherapy (CRT) or intensity modulated radiotherapy (IMRT). The median overall survival (mOS) from the re-RT was 8.4 months, and the 6-month and the 12-month OS rate was 64% and 31%, respectively. The most important factors by univariate analysis, which significantly improved the outcome of re-RT were the longer time interval between the diagnosis and second radiotherapy (p = 0.029), the lower histology grade (p = 0.034), volume of the recurrent tumour (p = 0.006) and Karnofsky performance status (KPS) (p = 0.009) at the re-irradiation. Our low fraction size re-irradiation ≥ 8 months after the first radiotherapy proved to be safe and beneficial for patients with large volume recurrent glial tumours.
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Affiliation(s)
- Ágnes Dobi
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary.
| | - Barbara Darázs
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Adrienne Cserháti
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zsófia Együd
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Szilvia László
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Leopold Dodd
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Zita Reisz
- Department of Pathology, University of Szeged, Állomás utca 1, Szeged, H-6725, Hungary
| | - Pál Barzó
- Department of Neurosurgery, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary
| | - Judit Oláh
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
| | - Katalin Hideghéty
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, H-6720, Hungary
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Darázs B, Ruskó L, Végváry Z, Ferenczi L, Dobi Á, Paczona V, Varga Z, Fodor E, Hideghéty K. Subventricular zone volumetric and dosimetric changes during postoperative brain tumor irradiation and its impact on overall survival. Phys Med 2019; 68:35-40. [PMID: 31733404 DOI: 10.1016/j.ejmp.2019.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this retrospective study was to investigate the relationship between the dose to the subventricular zone (SVZ) and overall survival (OS) of 41 patients with glioblastoma multiforme (GBM), who were treated with an adaptive approach involving repeated topometric CT and replanning at two-thirds (40 Gy) of their course of postoperative radiotherapy for planning of a 20 Gy boost. METHODS We examined changes in the ipsilateral lateral ventricle (LV) and SVZ (iLV and iSVZ), as well as in the contralateral LV and SVZ (cLV and cSVZ). We evaluated the volumetric changes on both planning CT scans (primary CT1 and secondary CT2). The survival of the GBM patients was analyzed using the Kaplan-Meier method; the multivariate Cox regression was also performed. RESULTS Median follow-up and OS were 34.5 months and 17.6 months, respectively. LV and SVZ structures exhibited significant volumetric changes on CT2, resulting in an increase of dose coverage. At a cut-off point of 58 Gy, a significant correlation was detected between the iSVZ2 mean dose and OS (27.8 vs 15.6 months, p = 0.048). In a multivariate analysis, GBM patients with a shorter time to postoperative chemoradiotherapy (<3.8 weeks), with good performance status (≥70%) and higher mean dose (≥58 Gy) to the iSVZ2 had significantly better OS. CONCLUSIONS Significant anatomical and dose distribution changes to the brain structures were observed, which have a relevant impact on the dose-effect relationship for GBM; therefore, involving the iSVZ in the target volume should be considered and adapted to the changes.
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Affiliation(s)
- Barbara Darázs
- Department of Oncotherapy, University of Szeged, Szeged, Korányi fasor 12, Zip Code: 6720, Hungary.
| | - László Ruskó
- General Electric Healthcare Company, Budapest, Bence u. 3, Zip Code: 1131, Hungary.
| | - Zoltán Végváry
- Department of Oncotherapy, University of Szeged, Szeged, Korányi fasor 12, Zip Code: 6720, Hungary.
| | - Lehel Ferenczi
- General Electric Healthcare Company, Budapest, Bence u. 3, Zip Code: 1131, Hungary.
| | - Ágnes Dobi
- Department of Oncotherapy, University of Szeged, Szeged, Korányi fasor 12, Zip Code: 6720, Hungary.
| | - Viktor Paczona
- Department of Oncotherapy, University of Szeged, Szeged, Korányi fasor 12, Zip Code: 6720, Hungary.
| | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Szeged, Korányi fasor 12, Zip Code: 6720, Hungary.
| | - Emese Fodor
- Department of Oncotherapy, University of Szeged, Szeged, Korányi fasor 12, Zip Code: 6720, Hungary.
| | - Katalin Hideghéty
- Department of Oncotherapy, University of Szeged, Szeged, Korányi fasor 12, Zip Code: 6720, Hungary.
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Rusz O, Kószó R, Dobi Á, Csenki M, Valicsek E, Nikolényi A, Uhercsák G, Cserháti A, Kahán Z. Clinical benefit of fulvestrant monotherapy in the multimodal treatment of hormone receptor and HER2 positive advanced breast cancer: a case series. Onco Targets Ther 2018; 11:5459-5463. [PMID: 30233207 PMCID: PMC6129034 DOI: 10.2147/ott.s170736] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Fulvestrant is a pure estrogen receptor (ER) antagonist approved for the treatment of metastatic ER positive breast cancer in postmenopausal women with disease progression following antiestrogen therapy. The clinical results of fulvestrant demonstrated encouraging activity in tumors in spite of HER2 positivity, but data about its use after progression on anti-HER2 agents are limited. Partial responses and durations of response of 12, 25, and 38 months in three cases with multiple metastases of ER positive and HER2 positive breast cancer were observed; all patients had been treated with 1–4 regimens of an anti-HER2 agent in combination with chemotherapy or an aromatase inhibitor before the initiation of fulvestrant. Fulvestrant is a valuable option with limited toxicity and durable response in metastatic HER2 and ER positive breast cancer after progression on anti-HER2 agents as well. Therapeutic benefit even in extensive skin metastases and (irradiated) brain metastases may be expected. Further investigations are warranted to establish where it fits into the multimodal management of ER and HER positive breast cancer.
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Affiliation(s)
- Orsolya Rusz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,
| | - Ágnes Dobi
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,
| | - Melinda Csenki
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,
| | | | - Alíz Nikolényi
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,
| | | | | | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,
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Valicsek E, Kószó R, Dobi Á, Uhercsák G, Varga Z, Vass A, Jebelovszky É, Kahán Z. Cardiac Surveillance Findings During Adjuvant and Palliative Trastuzumab Therapy in Patients with Breast Cancer. Anticancer Res 2015; 35:4967-4973. [PMID: 26254396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Trastuzumab therapy, the standard treatment for human epidermal growth factor receptor type-2 (HER2)-positive breast cancer, is associated with possible cardiotoxicity. We set out to retrospectively analyze the cardiac follow-up data of patients with breast cancer receiving trastuzumab treatment. PATIENTS AND METHODS The study involved 47 and 31 patients receiving adjuvant or palliative chemotherapy plus trastuzumab, respectively. Cardiovascular system assessments including echocardiography were regularly performed. RESULTS A significant heart abnormality was detected in 44.7% of the operable and 41.9% of metastatic cases. In the adjuvant setting, left ventricular ejection fraction changes occurred mostly during treatment and less frequently after its completion (40.4% vs. 19.4%), while in the palliative setting, 35.5% and 40% in the first and the second year of therapy. An asymptomatic atrial septum aneurysm was detected in 8.5% and 13% of the patients in the two groups. CONCLUSION Trastuzumab-related cardiotoxicity is mostly manifested in an asymptomatic decrease in left ventricular ejection fraction; hypertension, a high body mass index and left-sided irradiation are its predictors.
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Affiliation(s)
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Ágnes Dobi
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Andrea Vass
- Second Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Éva Jebelovszky
- Second Department of Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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Hideghéty K, Cserháti A, Besenyi Z, Zag L, Gaál S, Együd Z, Mózes P, Szántó E, Csenki M, Rusz O, Varga Z, Dobi Á, Maráz A, Pávics L, Lengyel Z. [Role of 18FDG-PET/CT in the management and gross tumor volume definition for radiotherapy of head and neck cancer; single institution experiences based on long-term follow-up]. Magy Onkol 2015; 59:103-110. [PMID: 26035157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/11/2015] [Indexed: 06/04/2023]
Abstract
The purpose of our work is evaluation of the impact of 18FDG-PET/CT on the complex management of locoregionally advanced (T3-4N1-3) head and neck squamous cell cancer (LAHNSC), and on the target definition for 3D conformal (3DCRT) and intensity-modulated radiotherapy (IMRT). 18FDG-PET/CT were performed on 185 patients with LAHNSC prior to radiotherapy/chemoradiation in the treatment position between 2006 and 2011. Prior to it 91 patients received induction chemotherapy (in 20 cases of these, baseline PET/CT was also available). The independently delineated CT-based gross tumor volume (GTVct) and PET/CT based ones (GTVpet) were compared. Impact of PET/CT on the treatment strategy, on tumor response evaluation to ICT, on GTV definition furthermore on overall and disease-specific survival (OS, DSS) was analysed. PET/CT revealed 10 head and neck, 2 lung cancers for 15 patients with carcinoma of unknown primary (CUP) while 3 remained unknown. Second tumors were detected in 8 (4.4%), distant metastasis in 15 (8.2%) cases. The difference between GTVct and GTVpet was significant (p=0.001). In 16 patients (14%) the GTVpet were larger than GTVct due to multifocal manifestations in the laryngo-pharyngeal regions (4 cases) or lymph node metastases (12 cases). In the majority of the cases (82 pts, 72%) PET/CT-based conturing resulted in remarkable decrease in the volume (15-20%: 4 cases, 20-50%: 46 cases, >50%: 32 cases). On the basis of the initial and post-ICT PET/CT comparison in 15/20 patients more than 50% volume reduction and in 6/20 cases complete response were achieved. After an average of 6.4 years of follow-up the OS (median: 18.3±2.6 months) and DSS (median: 25.0±4.0 months) exhibited close correlation (p=0.0001) to the GTVpet. In cases with GTVpet <10 cm3 prior to RT, DSS did not reach the median, the mean is 82.1±6.1 months, while in cases with GTVpet 10-40 cm3 the median of the DSS was 28.8±4.9 months (HR = 3.57; 95% CI: 1.5-8.3), and in those with GTVpet >40 cm3 the median DSS was 8.4±0.96 months (HR= 11.48; 95% CI: 5.3-24.9). Our results suggest that 18FDG-PET/CT plays an important role for patient with LAHNSC, by modifying the treatment concept and improving the target definition for selective RT modalities. Volumetric PET/CT-based assessment of the tumor response after ICT gives valuable contribution to further therapy planning.
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Affiliation(s)
| | | | - Zsuzsanna Besenyi
- Nukleáris Medicina Tanszék, Szegedi Tudományegyetem, Szeged, Hungary
| | - Levente Zag
- Sürgõsségi Betegellátó Osztály, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary
| | - Szilvia Gaál
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zsófia Együd
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Petra Mózes
- Klinikum rechts der Isar, Technische Universität München, Department of Radiation Oncology, München, Germany
| | - Erika Szántó
- Klinikai Központ, Debreceni Egyetem, Onkológiai Intézet, Debrecen, Hungary
| | - Melinda Csenki
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Orsolya Rusz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Zoltán Varga
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Ágnes Dobi
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Szeged, Hungary.
| | - László Pávics
- Nukleáris Medicina Tanszék, Szegedi Tudományegyetem, Szeged, Hungary
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