memo - Magazine of European Medical Oncology

Kostron, H.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0213-8

Nussbaumer, K.; Kleiser, R.; Wimmer, S.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0198-3

The role of imaging of a tumour is to analyse the anatomical situation and the most likely diagnosis with tumour type and grading. Furthermore, the preoperative evaluation of the tumour border, the trajectory for biopsy and the therapeutic options are important. Postoperative and follow up MRs should indicate a residual tumour and its extent, progression or reduction and complications after therapy. Modern advanced MR methods should be combined with conventional structural sequences for imaging diagnosis and for therapy monitoring of brain tumours. In our opinion a feasible imaging tumour protocol consists in axial T1, T2, FLAIR, DWI, DTI, MR perfusion (DSCI, ev. DCE), MR spectroscopy, T1 3D with Gadolinium and possibly fMRI and MRA.

Dolenc, V. V.; Kocijančič, I. J.; Pregelj, R.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0199-2

The largest possible and safe removal of the lesion (also malignant) is the best first step of treatment. The extra-axial benign lesions do require the best possible surgical treatment, ideally a complete resection of the lesion without endangering the surrounding neural and/or vascular structures. The most frequent extra-axial intracranial tumours are: pituitary tumours, craniopharyngiomas, central skull base meningiomas, chordomas, chondrosarcomas, trigeminal schwannomas, and schwannomas of the CNs VIII. The outmost surgical reduction of the size of the lesion is highly welcome regardless of whether the tumour is intra-axial and/or extra-axial. Complementary treatment can be much more effective following a successful surgical resection of the lesion. There is no doubt that biological treatments will eventually replace the present day surgical interventions. But at the moment, this is still most effective and the only treatment which can be offered to the patients with intracranial tumours.

Wolbers, J. G.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0200-0

Various brain tumours show an increase of incidence owing largely to an elderly growing population. Prominent amongst them are brain metastases and meningioma. The treatment of brain metastases serves the upholding of good quality of life, as survival benefit is mainly determined by the systemic disease status. Out-patient radiosurgery with approximately 2% morbidity is best positioned to do so in case of a limited cranial tumour load. There are no surgical and anaesthesiological complications and no limitations due to multiplicity, location, co-morbidity or high age. Several of these advantages also pertain to benign meningioma. The 5-year survival approaches 85% and compares with outcome of malignancies like breast carcinoma and melanoma. Treatment, particularly in the elderly, exhibits high morbidity as made explicit by 25% of patients over 60 years old that will not return to home after surgery. Contrastingly, radiosurgery provides 10-year progression free survival in over 90% without major, invalidating, complications. Furthermore, in symptomatic, large tumours the availability of radiosurgery does allow surgeons to be more conservative in their approach. These practices lead to an ongoing shift from tumour removal towards tumour control by radiosurgery.

Dieckmann, K. U.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0208-5

Glioblastoma is the most common primary malignant brain tumour in adults with dismal prognosis. The current standard therapy includes maximal safe surgical resection followed by a combination of a concomitant radio/chemotherapy (temozolomide) and a long time temozolomide therapy after completion of radiotherapy. The aim of modern radiotherapy is to improve the conformity of the high-dose region with respect to the tumour while decreasing dose administered to surrounding normal tissue and avoid local necrosis and other long-term sequel based on the combined treatment. Modern radiotherapy planning of glioblastoma relies on three-dimensional conformal technique based on MRI and CT fused data sets. Treatment schemes include dosage of 60 Gy given in 2 Gy daily fractions. Hypo-fractionated radiation schemes may be used in patients with a low performance index. Other techniques such as stereotactic radiosurgery (RS) and brachytherapy have not been be beneficial and are not recommended in the routine management of newly diagnosed glioblastoma. With the beginning of the Temozolomide era, the survival time of some of the patients with glioblastoma improved; however the risk of pseudoprogression has increased due to a postulated radio sensitizing effect of this drug. To improve radiotherapy techniques follow-up will become more important to learn about the post-treatment effects in the treated tissue.

Marosi, C.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0201-z

Neuro-oncology has become one of the liveliest sub-disciplines in oncology. More than forty compounds are currently investigated. The amount of neuro-oncologic publications and of their readers is steadily increasing. The image-change from the everlasting exception with special features in every category to a model for dynamic interdisciplinary research has occurred within the last ten years and is tightly related with Temozolomide (TMZ). One could even get the impression that the modern development of Neuro-oncology would not have been possible without Temozolomide.

Sizoo, E. M.; Taphoorn, M. J. B.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0202-y

Until date, patients with high-grade glioma (HGG) cannot be cured from their disease. Maintaining quality of life as long as possible is an important issue in this patient category. Little is known about the end-of-life phase, when the neurological condition declines and no further tumour treatment is possible. In the Netherlands, a retrospective study is being conducted interviewing relatives and physicians of a cohort of deceased high-grade glioma patients regarding the end-of-life phase of glioma patients. Preliminary results of this study are reported.

Putzer, D.; Gabriel, M.; Donnemiller, E.; Kostron, H.; Stockhammer, G.; Virgolini, I. J.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0203-x

We present the case report of a 23-year-old female patient suffering from a glioblastoma multiforme. Neurosurgery in combination with temozolomide and fractionated external beam radiation, though a fundamental part of therapy, did not prevent progression in this patient. The tumour showed stable regression under the application of peptide-receptor-radionuclide-therapy. Receptor-mediated radionuclide therapy by locally injected 90Y-DOTA-TOC is feasible and well tolerated. This approach represents an attractive strategy for the treatment of locally recurring or progressing glioblastoma.

Buchroithner, J.; Nußbaumer, K.; Pichler, R.; Weis, S.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0204-9

We present the case of a 33-year-old man, who was diagnosed with a cerebellar medulloblastoma in October 2000. Surgery with complete resection followed by craniospinal fractionated radiation therapy. The recurrences were treated according to HIT 2000 and the 3rd recurrence was treated by a metronomic anti-angiogenetic therapy. Technical advances in diagnostics, surgery and radiotherapy increased prognoses for patients with brain tumours. Case reports in the literature show encouraging results with second and third line chemotherapy, anti-angiogenic drugs and targeted therapy for example with somatostatin analogues. These therapies may further improve prognosis and enable "living with cancer" for years even for patients with fatal prognosis like disseminated spinal metastases of adult medulloblastoma.

Nowosielski, M.; Hutterer, M.; Putzer, D.; Stockhammer, G.; Recheis, W.; Gotwald, T.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0205-8

This is a case report of a 62-year-old male patient diagnosed with an anaplastic astrocytoma WHO III, which was treated with anti-angiogenic therapy upon recurrence and further on developed gliomatosis cerebri. This case report demonstrates that during the course of anti-angiogenic therapy conventional MacDonalds MRI criteria are insufficient to assess tumour response. Advanced MRI sequences with MR-perfusion should be incorporated for response evaluation. 18F-FET-PET imaging may be an additional valuable tool to detect early tumour progression. At present, the value of such advanced imaging techniques is prospectively studied within the "AVIRMA trial" for patients with recurrent malignant glioma treated by Bevacizumab/Irinotecan.

Rössler, K.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0206-7

A 55-year-old male was operated upon a cervico-thoracic primary malignant melanoma of the dura mater. The recurrence free period of 2.5 years and the clinical course of our patient justified aggressive therapy by using a combination of local irradiation and dissemination prophylaxis by concomitant intrathecal liposomal cytarabin. Nevertheless, one must be aware of severe side effects of such therapeutic approach, as our patient developed a severe but reversible toxic polyneuropathy.

Anghel, R.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0210-y

Anghel, R.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0209-4

Dittrich, C.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0212-9

Undoubtedly, enormous progress has been made in the field of oncology in general and in the development of new systemic therapies in particular. Due to competing societal needs, (pharmaco-) economic deliberations for the most equitable allocation of the always limited financial resources have to be used. It is this author's conviction that no other segment of society is better qualified to address the question what counts as a benefit in cancer treatment and how much costs are justified to be taken over by the society as the global payer to cover that progress than the oncologists themselves, provided they are willing to take over this task on an educated, rational and transparent basis.

Bodner, J.; Schmid, T.; Wykypiel, H.; Augustin, F.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0216-5

PURPOSE: Recently introduced robotic surgical systems were developed to overcome the limitations of conventional minimally invasive surgery. We analyzed the impact of the da Vinci™ surgical robot on general (non-cardiac) thoracic oncologic surgery, especially for pulmonary lobectomy in NSCLC patients. MATERIAL AND METHODS: A systematic review of the literature was performed by accessing the MEDLINE database for entries on robotic surgery for thoracic cancer. RESULTS AND DISCUSSION: The da Vinci™ robotic system is currently the only commercially available robotic surgical system. There is no role for the robot in pulmonary metastasectomy. Several retrospective analyses and case series prove safety and feasibility of robotic-assisted lobectomy for early-stage NSCLC. Strictly spoken, however, this is a hybrid procedure of robotic and conventional thoracoscopic surgical techniques. For no oncologic long-term follow-up data are available by now, an oncologic valuation of the robotic approach is not appropriate yet.

Amann, A.; Ligor, M.; Ligor, T.; Bajtarevic, A.; Ager, C.; Pienz, M.; Denz, H.; Fiegl, M.; Hilbe, W.; Weiss, W.; Lukas, P.; Jamnig, H.; Hackl, M.; Haidenberger, A.; Sponring, A.; Filipiak, W.; Miekisch, W.; Schubert, J.; Troppmair, J.; Buszewski, B.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0219-2

The fast development of analytical techniques in the field of gas analysis can be compared to that of computers during the last two decades. Not only speed but also sensitivity of analysis has been greatly improved, sometimes by a factor of 100 or more. This technological development has fostered the analysis of exhaled breath. Since this can be done in real-time, very fast biological processes can be monitored. Also simulation and modelling of haemodynamics and lung mechanics become possible. During the next decade we will see miniaturized equipment (of the size of a cigarette box) appear. Here we review and illustrate the rich diversity of compounds observed in exhaled breath with a particular focus on lung cancer patients. Each of the many volatile compounds has its own particular biochemical background, and cell types with different genetic background have been shown to have a different pattern of released and consumed volatile compounds. Nevertheless we still lack an understanding, if and how genetic alterations, which are seen as the underlying cause of the transformation process, control the VOC phenotype observed in patients or cancer cell lines. The concentration pattern of volatile compounds in exhaled breath may be used in the future for phenotyping individuals in large-scale screening approaches. Also changes in VOC patterns may provide disease-relevant information (e.g. on the activity of metabolizing enzymes). Future applications will also include the follow-up of exogenous compounds which are ingested or inhaled as drugs, food components or components in cigarette smoke and metabolic products of these compounds.

Popescu, I.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0220-9

PURPOSE: Hepatocellular carcinoma is one of the most common malignant tumours in the world and the fourth most common cause of mortality, with ongoing changes in what epidemiology, diagnosis and treatment are concerned. This paper summarizes current strategies and new trends in HCC diagnosis and treatment. MATERIAL AND METHODS: A review of literature integrating personal experience. RESULTS: This review emphasizes the epidemiological trends, diagnostic developments and new treatment strategies for HCC, with its particularities for various world regions. Early diagnosis continues to be the key for effective therapy. CONCLUSION: In the era of personalized molecular therapies, the development of molecular classification of HCC using gene signature is urgently needed, allowing the tailoring of HCC medical therapy. Novel molecular targeted therapy should be evaluated in randomized clinical trials as adjuvant therapy to surgery, ablation or TACE.

Vasilescu, C.; Anghel, R.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0214-7

PURPOSE: Laparoscopic surgery has been shown to be safe and feasible whilst treating patients with the same efficacy as traditional open procedures representing an acceptable approach in treating gynaecologic malignancies. However, the laparoscopic approach encountered some limitations: counterintuitive hand movements, two-dimensional visualization and limited degrees of instrument motion within the body. Robotic surgery overcomes many of the difficulties associated with conventional laparoscopy and allows surgeons to perform more complex procedures, whilst providing patients the benefits of minimally invasive surgery: radical hysterectomy with pelvic lymphadenectomy, trachelectomy and pelvic exenteration. MATERIAL AND METHODS: From March 2008 to April 2009, in our institution 19 patients underwent robotic radical hysterectomy with pelvic lymphadenectomy. Twelve patients were diagnosed with advanced cervical cancer, the rest of them with endometrial cancer. RESULTS: The mean operative time was 180 ± 23.45 min., the oral intake was started the next day after the operation and the patients were discharged 3.5 (±1.2) days postoperatively. CONCLUSION: As with any new procedure, careful patient selection is critical during the initial learning phase in order to progress through the learning curve with low morbidity and good outcomes. Robotic surgery is a viable option for many patients diagnosed with gynaecological cancers.

Klocker, J.; Schumer, J.; Kanatschnig, M.; Forsthuber, E. P.; Likar, R.; Geissler, D.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0221-8

PURPOSE: Granulocyte-colony stimulating factors (G-CSFs) can effectively protect cancer patients receiving chemotherapy from neutropenic complications. To increase the efficacy, an individualised algorithm for the administration of G-CSF and anti-infectives was developed. Its impact on the neutropenic complications and entailed dose modifications in breast cancer patients receiving FEC-100 or TAC was evaluated. PATIENTS AND METHODS: Supportive therapy comprised G-CSF (filgrastim, lenograstim or pegfilgrastim), antibiotics and antimycotics. During each chemotherapy cycle, leukocyte/granulocyte counts were repeatedly evaluated and the type, dosing and application frequency of supportive therapies immediately adjusted as soon as the cell counts changed. Medical charts of early breast cancer patients who had received FEC-100 or TAC and supportive therapy according to the individualised protocol between 2004 and 2009, were retrospectively evaluated at the Oncology Department of the General Hospital Klagenfurt, Austria. RESULTS: Sixty-two FEC-100 and 56 TAC patients were evaluated. Of the 696 chemotherapy cycles, 693 included G-CSF support. Overall proportions of cycles with grade 4 neutropenia (FEC-100, 1.7%; TAC, 1.2%) and febrile neutropenia (FN) (FEC-100, 1.7%; TAC, 0.9%) as well as dose reductions (FEC-100, 0.6%; TAC, 1.5%) and delays (FEC-100, 4.2%; TAC, 5.1%) were very low. This was true also for elderly patients (>50 years). No patient developed FN in the first cycle. Although more toxic, TAC was associated with less neutropenic complications than FEC-100. CONCLUSION: Close-meshed monitoring of leukocyte/granulocyte counts and immediate adjustment of dosing and application frequencies of G-CSF and anti-infectives, also during the chemotherapy cycles, are highly effective in preventing neutropenic complications and their consequences in the clinical practice.

Kühr, T.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0211-x

In the advent of tyrosine kinase inhibitors (TKIs) it seems that CML has been converted into a chronic, manageable condition for most patients. Although Imatinib is currently still regarded as the standard of care in newly diagnosed patients, second-line TKIs (e.g. nilotinib) strongly add to the therapeutic armamentarium in this setting which could modify the disease management algorithms in the near future. The present report summarizes current developments reported at ASH 2009.

Hoeller, S.; Tzankov, A.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0215-6

Trephine bone marrow biopsy is a frequent routine investigation, particularly important in cases with an unsuccessful aspirate. In addition to a representative trephine biopsy length and quality, the patient's clinical history is of critical importance. Especially drug-induced bone marrow changes are often difficult to interpret without prior knowledge of exposure to respective agents. Since some of these changes mimic malignancies, this can lead to serious misinterpretations. Drugs in general can induce a wide spectrum of bone marrow reactions. Immunosuppressants such as Azathioprine and Methotrexate cause morphological bone marrow changes that can not be distinguished from myelodysplastic syndromes, while cytokines and growth factors induce an overall increase in cellularity and, in particular, a left shift of myelopoiesis with increased myeloblasts and monoblasts, mimicking acute myeloid leukaemia. Moreover, drugs with immuno-allergic- (such as Allopurinol, Carbimazole, Crabamazepine, Clozapine, non-steroidal anti-rheumatics, Phenytoin, Sulfonamides) or direct myelotoxic potential can lead either to T-cell-mediated bone marrow stem cell destruction with the morphological pattern of aplastic anaemia, to direct toxic or immunological burst- or colony-forming units' destruction with isolated erythro- or myelopoietic hypoplasias or to other changes such as eosinophilia, (haemo)phagocytosis, T-cell lymphocytosis (which can be very severe, resembling lymphoma/leukaemia), perivascular plasmacytosis, siderosis or stromal oedema. In summary, clinical information on drug exposure is at least as important as a good quality biopsy for comprehensive histology-based bone marrow diagnostics, helping to avoid not only misinterpretation but also expensive additional examinations.

Sobhani, M. E.; Molla, Md. A. W.; Rahman, Md. S.

2010 memo - Magazine of European Medical Oncology

doi: 10.1007/s12254-010-0217-4

Over recent years there has been great progress in the scientific knowledge of health and well-being and the body's response to stress and the relationship to the development of cancer. This paper reviews the interrelationship between stress and cancer. The immune system is a specialized network whose activity is highly affected by stress. Stress activates the body's endocrine (hormone) system, which in turn can cause changes in the immune system, the body's defense against infection and disease including cancer. Under stressful conditions the body increases the production of catecholamines via sympathetic nervous system (SNS). Catecholamines suppress certain parts of the immune system and reduce the production of molecules that create inflammation. Catecholamines suppress the cell-mediated immunity (CMI) by reducing macrophages and Th production of type 1 cytokines (e.g. IL-12, TNF-α and IFN-γ), and by stimulating the release of immunosuppressive factors including IL-10 and TGF-α. Hormones associated with SNS activation may favour angiogenic mechanisms in human tumours. In response to chronic stress, catecholamines such as epinephrine and norepinephrine released from the sympathetic nervous system activate b-adrenergic receptors on tumour cells and enhance expression of vascular endothelial growth factor (VEGF), IL-6 and matrix metalloproteinases (MMPs). Stress can also activate the cAMP response element-binding (CREB) protein and create a hypoxic condition. CREB protein and hypoxia regulated genes, e.g. endothelin-1, adrenomedullin, Bcl-2 has been found that are involved in mitogenesis, tumour progression, angiogenesis and apoptosis. Psychosocial stressors and distress have been shown to have direct effects on intracellular processes that are implicated in cancer initiation. Stress may alter cellular DNA repair abilities, may increase the likelihood of retention of damaged DNA, and therefore increase the likelihood of development of malignant cells.