A Retrospective Analysis of the First 41 mCRPC Patients with Bone Pain Treated with Radium-223 at the National Institute of Oncology in Hungary.

Radium-223 dichloride is an alpha-emitting radiopharmaceutical which significantly prolongs overall survival in patients with castration-resistant prostate cancer (CRPC) and symptomatic bone metastases. This was a retrospective analysis of the efficacy and safety of Radium-223 in the first 41 patients treated at a single center in Hungary. Radium-223 was given at a dose of 50 kBq/kg intravenously every 4 weeks for up to 6 cycles. Between 23rd July 2014 and 23rd February 2016, 41 patients were treated. Patient demographics, laboratory values, treatment outcomes and adverse events were collected from medical records. The mean age was 72.2 years (SD: 7.1). 24 patients received Radium-223 as first-line treatment (58%), 7 patients as second (17%), 3 as third (7.3%), 6 as (14.6%), and 1 as fifth-line therapy (2.4%). The mean number of cycles administered was 5.5 (SD: 1.1). The most common side effects were anemia (32% grade 1-3), nausea (28%, grade 1), diarrhea (4%, grade 2), thrombocytopenia (4%, grade 3). The mean baseline PSA level was 307.2 ng/ml (SD: 525.7), which increased to a mean value of 728.5 ng/ml (SD: 1277) by the end of treatment. The baseline mean ALP of 521.1 U/L (SD: 728) decreased to 245.1 U/L (SD: 283.5). The majority of patients experienced a decrease (37%) or complete cessation (43%) of bone pain intensity. In our symptomatic prostate cancer patient population, Radium-223 proved to be efficient in terms of pain relief, with moderate side effects. No PSA response was detected, while alkaline phosphatase levels significantly decreased.

Immunohistochemistry and reverse transcriptase polymerase chain reaction on sentinel lymph nodes can improve the accuracy of nodal staging in breast cancer patients.

In this study the nodal staging sensitivity of sentinel lymph node biopsy (SLNB) with detailed pathological and molecular biological examination has been investigated and compared to that of axillary lymph node dissection (ALND) with routine histological evaluation. Sentinel lymph nodes (SLNs) were removed by the dual-agent injection technique in 68 patients with primary, clinically node-negative breast cancer. Forty-seven patients had negative SLNs according to hematoxylin and eosin (H&E) staining. These H&E-negative SLNs were serially sectioned and examined at 250 microm levels by anticytokeratin immunohistochemistry (IHC). In 14 patients the SLNs were also investigated by cytokeratin 20 (CK20) reverse transcriptase polymerase chain reaction (RT-PCR). SLNB with IHC increased the node-positive rate by 26% (by 40% in tumors less than or equal to 2 cm in size (pT1) and by 9% in tumors more than 2 cm but less than or equal to 5 cm in size (pT2)). The sensitivity of SLNB with IHC was superior to that of ALND with routine histology in pT1 tumors and identical in pT2 tumors. The concordance between histology and RT-PCR was only 21%, and in two of three cases with positive histological results RT-PCR was negative. In conclusion, SLNB with detailed pathological and/or molecular biological evaluation can improve the sensitivity of regional staging. ALND can probably be abandoned in patients with pT1 SLN-negative breast cancer. Further prospective studies are required to determine the clinical significance of these detailed SLN evaluation techniques, but at present these methods are still investigational.

Inguinal sentinel lymph node biopsy for staging anal cancer.

BACKGROUND AND AIMS: The optimal treatment of clinically negative inguinal lymph nodes in patients with primary anal cancer has not yet been clearly defined. The presence of metastases in the inguinal lymph nodes is an adverse prognostic factor for anal cancer. In the present study the feasibility of sentinel lymph node biopsy (SLNB) for staging anal cancer was investigated. PATIENTS AND METHODS: From September 1999 to March 2002, 8 patients with biopsy proven primary anal cancer underwent lymphoscintigraphy and dual-agent guided inguinal SLNB for nodal staging before starting multimodality treatment. RESULTS: Inguinal SLNB was successful in all 8 patients (13 groins). A total of 20 hot and blue SLNs (mean 1,5 (1-2) per groins) were removed. In 2 patients (25%) the SLN was positive for metastasis. CONCLUSIONS: Lymphoscintigraphy followed by dual-agent guided inguinal SLNB is technically feasible for staging patients with primary anal cancer. The detection of metastases in the removed sentinel lymph node(s) may alter the treatment and thus may improve the locoregional control and overall survival of these patients.

[Possibilities of the use of lymphoscintigraphy in head and neck surgery: introductory studies]. / A lymphoscintigraphia fej-nyaksebészeti alkalmazásának lehetöségei: bevezetö vizsgálatok.

The results of a pilot study of head and neck lymphoscintigraphy are presented. The study was performed in 35 cases with technetium-99m-labelled microcolloid. The scintigraphic observations of the intact and tumorous neck are presented. The results of this pilot study suggest that this method might create the base of a nonspecific additional diagnostic tool.

[Possibilities of lymphoscintillography in head and neck surgery (II): results of clinical evaluation]. / A lymphoscintigraphia fej-nyaksebészeti alkalmazásának lehetöségei (II.): a klinikai értékelés eredményei.

In order to determine the value of lymphoscintigraphy the clinical results were compared to the lymphoscintigraphic findings. The latter were further compared to the histological results and to the isotope activity of single lymph nodes. The examination was performed in 31 cases of head and neck malignancies before neck dissection (in 29 cases radical neck dissection was done because of palpable lymph nodes; in 2 further cases elective neck dissection was performed on the NO neck). Lymphoscintigraphy yielded evaluable results in 28 cases. Lymphoscintigraphy correlated with the clinical results in 21 cases. Lymphoscintigraphy, histopathology and clinical examination showed correlation in 19 cases. Further application of head and neck lymphoscintigraphy is warranted.

[The role of intraoperative gamma-probe-guided sentinel lymph node biopsy in the treatment of malignant melanoma and breast cancer]. / Az intraoperatív gamma-próba által vezérelt örszem nyirokcsomó-biopszia jelentösége a melanoma malignum és az emlörák kezelésében.

In the treatment of malignant tumors regional lymphadenectomy is used for two purposes. It is used partly for staging the regional lymph nodes which is a significant and independent prognostic factor and determines the need for adjuvant oncologic treatment and partly for achieving locoregional disease control. Removal of tumor-free lymph nodes by regional lymph node clearance is unnecessary according to our current knowledge. Since the sensitivity and specificity of non-invasive clinical examinations are insufficient in predicting the nodal status the histological study of the regional lymph nodes cannot be abandoned. A new and minimally invasive surgical procedure, the mapping and removal of the first tumor draining lymph node, the sentinel node provides the possibility of pathological nodal staging without performing formal lymphadenectomy. Mapping of the sentinel node can be performed by the use of a radioisotope and intraoperative hand-held gamma-probe or a vital blue dye or a combination of these two. This latter method was used by the authors in 73 patients (25 with malignant melanoma and 48 with breast cancer). Sentinel lymph node biopsy was performed successfully in 92% of patients with melanoma and 90% of patients with breast cancer. In three breast cancer patients the sentinel node inaccurately predicted the axillary status as negative, but is was in 93% accurate in predicting the histologic nodal state. According to our preliminary experiences intraoperative gamma-probe guided sentinel lymph node biopsy is considered a feasible procedure in both malignant melanoma and breast cancer. More experiences are needed before introducing this method in the routine clinical practice.

Ifosfamide chemotherapy of metastatic renal cell cancer.

In view of the divergent reports on the efficacy of ifosfamide in metastatic renal cell cancer, we tested this drug as monotherapy in nine patients on a dosage schedule of intravenous infusion of 40 mg/kg per day on days 1-5, repeated every 4 wk. The drug was administered in 1 liter saline dextrose over 2 hr, with hydration, alkalization of the urine, and mesna. No objective response was registered and subjective response in three patients was of short duration. The number of patients in this series is too small to draw definitive conclusions. However, the results obtained in this study does not prove antitumor activity for ifosfamide in renal cell cancer.

Fine-needle biopsy of thyroid gland.

Critical analysis is provided by the authors on cytologic examination combined with histology of 131 patients with thyroid alterations. Cytologic examination yielded seven false-negative and four false-positive findings. Sensitivity of the procedure was 0.78 and the specificity 0.97. Aspiration cytology of the thyroid gland combined with other methods of examination can be considered an advance in the diagnostics of thyroid diseases.

Postoperative thyroglobulin level determination to follow up patients with highly differentiated thyroid cancer.

The highly differentiated thyroid tumours account for 0.80% of all human malignancies. The papillary and follicular tumour tissues of this tumour type are relatively benign, hormone-dependent and beside their treatment specificity they secrete the tumour-specific thyroglobulin. This it becomes possible to follow the development of metastases, the effectiveness of therapy applied as well as the history of the disease. The authors studied the change of thyroglobulin level in 153 patients with highly differentiated thyroid cancer. In 29 of 32 metastatic patients a pathologically elevated (70-100 ng/ml) thyroglobulin level was observed. This proves the 91% specificity of the method in verified metastatic tumours. Compared to the total body scintigraphy 3 false-negative and 6 false-positive cases were found. The authors establish that, irrespective of the site of metastasis, the thyroglobulin level is higher in the follicular than in the papillary subtype. It is concluded that the measurement of the serum thyroglobulin level is a suitable marker of the highly differentiated thyroid cancer since it indicates local recurrence or distant metastases by a significant increase while therapy-resultant tumour diminution is accompanied by a marked decrease.