TY - JOUR AU - Pécsi, Balázs AU - Mangel, László Csaba TI - The Real-Life Impact of Primary Tumor Resection of Synchronous Metastatic Colorectal Cancer-From a Clinical Oncologic Point of View JF - CANCERS J2 - CANCERS VL - 16 PY - 2024 IS - 8 PG - 19 SN - 2072-6694 DO - 10.3390/cancers16081460 UR - https://m2.mtmt.hu/api/publication/34825012 ID - 34825012 N1 - Export Date: 6 May 2024 Correspondence Address: Pécsi, B.; Institute of Oncotherapy, Hungary; email: pecsi.balazs@t-online.hu AB - 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.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.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)).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. LA - English DB - MTMT ER - TY - JOUR AU - Mangel, László Csaba TI - A felnőttkori gliómák gyógyszeres kezelése JF - MAGYAR ONKOLÓGIA J2 - MAGYAR ONKOLÓGIA VL - 68 PY - 2024 IS - 1 SP - 67 EP - 75 PG - 9 SN - 0025-0244 UR - https://m2.mtmt.hu/api/publication/34742430 ID - 34742430 N1 - Review; English Abstract; Journal Article AB - 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. LA - Hungarian DB - MTMT ER - TY - JOUR AU - Varga, Gergely AU - Horváth, Rita AU - Busa, Csilla AU - Virág, Edit AU - Mangel, László Csaba AU - Csikós, Ágnes TI - Szorongás, depresszió, valamint fizikai tüneti terhek felmérése és összefüggéseik megismerése daganatos betegek körében JF - ORVOSI HETILAP J2 - ORV HETIL VL - 165 PY - 2024 IS - 8 SP - 309 EP - 317 PG - 9 SN - 0030-6002 DO - 10.1556/650.2024.32984 UR - https://m2.mtmt.hu/api/publication/34723989 ID - 34723989 N1 - Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Pécsi Tudományegyetem, Általános Orvostudományi Kar, Rákóczi út 2. Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Export Date: 11 March 2024 AB - 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. LA - Hungarian DB - MTMT ER - TY - JOUR AU - Locsei, Z. AU - Nagy, B. AU - Brunner, T. AU - Mangel, László Csaba TI - Effect of radiotherapy in deep inspiration in patients with left breast cancer: Does the size of the target area affect the dose for the most crucial organs at risk? JF - ANNALS OF ONCOLOGY J2 - ANN ONCOL VL - 34 PY - 2023 SP - S315 EP - S315 PG - 1 SN - 0923-7534 DO - 10.1016/j.annonc.2023.09.526 UR - https://m2.mtmt.hu/api/publication/34486698 ID - 34486698 N1 - Supplement: 2 LA - English DB - MTMT ER - TY - JOUR AU - Pécsi, Balázs AU - Mangel, László Csaba TI - The Real-Life Impact of mFOLFIRI-Based Chemotherapies on Elderly Patients-Should We Let It or Leave It? JF - CANCERS J2 - CANCERS VL - 15 PY - 2023 IS - 21 PG - 14 SN - 2072-6694 DO - 10.3390/cancers15215146 UR - https://m2.mtmt.hu/api/publication/34377797 ID - 34377797 N1 - Export Date: 28 November 2023 Correspondence Address: Pécsi, B.; Institute of Oncotherapy, Hungary; email: pecsi.balazs@t-online.hu AB - 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).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.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.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. LA - English DB - MTMT ER - TY - GEN AU - Kovács-Ábrahám, Zoltán AU - Rézmán, Barbara AU - Fenyvesi, Nikolett AU - Bartos, Barbara AU - Boda, Kamilla AU - Aczél, Timea AU - Mangel, László Csaba AU - Almási, Róbert Gyula TI - THE USE OF ORAL KETAMINE IN PATIENTS WITH CHRONIC PAIN CAN PREVENT OPIOID ESCALATION – A RETROSPECTIVE STUDY PY - 2023 UR - https://m2.mtmt.hu/api/publication/34229573 ID - 34229573 LA - English DB - MTMT ER - TY - JOUR AU - Kelemen, Dezső AU - Mangel, László Csaba AU - Szabó, Zsolt AU - Varga, Ádám AU - Palkovics, András AU - Vereczkei, András TI - Májáttétes pancreasrák: meghosszabbítható-e a túlélés az oligoperzisztens primer daganat neoadjuváns kemoterápiát követő reszekciójával? JF - ORVOSI HETILAP J2 - ORV HETIL VL - 164 PY - 2023 IS - 43 SP - 1712 EP - 1718 PG - 7 SN - 0030-6002 DO - 10.1556/650.2023.32900 UR - https://m2.mtmt.hu/api/publication/34167217 ID - 34167217 LA - Hungarian DB - MTMT ER - TY - JOUR AU - Maráz, Anikó AU - Nagyiványi, Krisztián András AU - Balogh, Ingrid AU - Bodoky, György AU - Mangel, László Csaba AU - Küronya, Zsófia AU - Géczi, Lajos AU - Torday, László AU - Dudás, Szilvia AU - Szűcs, Miklós AU - Nagy, Zsófia AU - Hornyák, Lajos AU - Zolcsák, Zita AU - Bassam, Ali AU - Kocsis, Judit AU - Keresztes, Tamás AU - Kullmann, Tamás AU - Máhr, Károly AU - Solymosi, Tibor AU - Rozsvai, Tímea AU - Szabó, Imre AU - Varga, Zoltán AU - Bíró, Krisztina TI - Áttétes vesedaganatos betegek kabozantinibterápiájának multicentrikus magyarországi eredményei JF - MAGYAR ONKOLÓGIA J2 - MAGYAR ONKOLÓGIA VL - 67 PY - 2023 IS - 1 SP - 73 EP - 83 PG - 11 SN - 0025-0244 UR - https://m2.mtmt.hu/api/publication/33791187 ID - 33791187 N1 - Szegedi Tudományegyetem, Onkoterápiás Klinika, Szeged, Hungary Országos Onkológiai Intézet, Urogenitális Tumorok és Klinikai Farmakológiai Osztály, Budapest, Hungary Debreceni Egyetem Klinikai Központ, Onkológiai Klinika, Debrecen, Hungary Dél-pesti Centrumkórház, Onkológiai Centrum, Budapest, Hungary Pécsi Tudományegyetem, Onkoterápiás Intézet, Pécs, Hungary Semmelweis Egyetem, Urológiai Klinika, Budapest, Hungary Észak-pesti Centrumkórház, Onkológiai Osztály, Budapest, Hungary Veszprém Megyei Csolnoky Ferenc Kórház, Közép-dunántúli Regionális Onkológiai Centrum, Veszprém, Hungary Uzsoki Utcai Kórház, Onkoradiológiai Osztály, Budapest, Hungary Békés Megyei Központi Kórház Pándy Kálmán Tagkórház, Megyei Onkológiai Központ, Gyula, Hungary Bács-Kiskun Megyei Oktatókórház, Onkoradiológia, Kecskemét, Hungary Petz Aladár Egyetemi Oktató Kórház, Onkoradiológiai Osztály, Győr, Hungary Zala Megyei Szent Rafael Kórház, Onkológiai Osztály, Zalaegerszeg, Hungary Borsod-Abaúj-Zemplén Megyei Központi Kórház, Klinikai Onkológiai és Sugárterápiás Centrum, Miskolc, Hungary Export Date: 13 February 2024 CODEN: MGONA Correspondence Address: Anikó, M.; Szegedi Tudományegyetem, Korányi fasor 12., Hungary; email: dr.aniko.maraz@gmail.com AB - 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. LA - Hungarian DB - MTMT ER - TY - JOUR AU - Mangel, László Csaba TI - A vesedaganatok sugárkezelése: a megváltozott sugárterápiás szemlélet és klinikai gyakorlat példázata JF - MAGYAR ONKOLÓGIA J2 - MAGYAR ONKOLÓGIA VL - 67 PY - 2023 IS - 1 SP - 43 EP - 51 PG - 9 SN - 0025-0244 UR - https://m2.mtmt.hu/api/publication/33770173 ID - 33770173 AB - 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. LA - Hungarian DB - MTMT ER - TY - JOUR AU - Pécsi, Balázs AU - Mangel, László Csaba TI - Real-Life Effectivity of Dose Intensity Reduction of First-Line mFOLFIRI-Based Treatment of Metastatic Colorectal Cancers: Sometimes Less Is More JF - CURRENT ONCOLOGY (TORONTO) J2 - CURR ONCOL VL - 30 PY - 2023 IS - 1 SP - 908 EP - 922 PG - 15 SN - 1198-0052 DO - 10.3390/curroncol30010069 UR - https://m2.mtmt.hu/api/publication/33560488 ID - 33560488 AB - 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. LA - English DB - MTMT ER -