Search

Introduction: Decision making in surgical oncology of the breast has increased its complexity over the last twenty years. This Delphi survey investigates the opinion of an expert panel about the decision making process in surgical procedures on the breast for oncological purposes. Methods: Twenty-seven experts were invited to partake into a Delphi Survey. At the first round they have been asked to provide a list of features involved in the decision making process (patient's characteristics; disease characteristics; surgical techniques, outcomes) and comment on it. Using text-mining techniques we extracted a list of mono-bi-trigrams potentially representative of decision drivers. A technique of “natural language processing” called Word2vec was used to validate changes to texts using synonyms and plesionyms. Word2Vec was also used to test the semantic relevance of n-grams within a corpus of knowledge made up of books edited by panel members. The final list of variables extracted was submitted to the judgement of the panel for final validation at the second round of the Delphi using closed ended questions. Results: 52 features out of 59 have been approved by the panel. The overall consensus was 87.1% Conclusions: Text mining and natural language processing allowed the extraction of a number of decision drivers and outcomes as part of the decision making process in surgical oncology on the breast. This result was obtained transforming narrative texts into structured data. The high level of consensus among experts provided validation to this process.

Összefoglaló. Bevezetés: A komplementer és alternatív medicina (KAM) egyre népszerűbb a daganatos betegek körében világszerte. Az emlőrákkal diagnosztizált nők 45%-a használ KAM-ot, a fiatalabb betegek 62,5%-a. Magyarországon eddig egyetlen tanulmány jelent meg a témában, mely szerint a magyar, emlődaganattal küzdő nők 84,4%-a használ valamilyen komplementer terápiát. Egyes KAM-modalitások alkalmazása a gyógyszerkölcsönhatások miatt kockázatot hordoz. Fontos megismernünk a magyar páciensek igényeit és szokásait a KAM-használattal kapcsolatban, mely ismeret a klinikai gyakorlatban közvetlenül hasznosítható. Célkitűzés: Vizsgálatunk célja a magyar emlőrákos nők körében felmérni a KAM alkalmazásának mértékét, megvizsgálni ennek okait és az ezzel összefüggő demográfiai, pszichológiai és klinikai faktorokat. Módszer: Kérdőíves vizsgálatunkat az Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztályán végeztük az osztályon bent fekvők körében (n = 146). Felmértük a szociodemográfiai adatokat, a KAM-használat jellemzőit, a KAM iránti attitűdöt és az egészségkontroll-igényt. A kérdőív adatait klinikai adatokkal egészítettük ki. Eredmények: A válaszadók 36%-a felkeresett KAM-szolgáltatót, 71%-a használ KAM-készítményt, és 64%-a alkalmaz önsegítő gyakorlatot. Ezekről a betegek többsége egészségügyi szakembertől tájékozódik. A mintában a holisztikus szemlélet, valamint a belső és a társas külső kontroll dominál. A KAM-szolgáltatókat felkeresőknek és a KAM-készítményt alkalmazóknak erősebb a belsőkontroll-igényük. A KAM-szolgáltatást vagy önsegítő gyakorlatot alkalmazók kedvezőbben ítélik meg saját egészségi állapotukat. Következtetés: A betegeknek a számukra fontos személyektől, elsősorban a kezelőszemélyzettől kapott információ döntő az egészségükkel kapcsolatos viselkedésben, közöttük a KAM-választásban. Fontos látnunk a páciensek nagyfokú bizalmát az egészségügyi szakemberek iránt és erős igényét a KAM-mal kapcsolatos információk megbeszélésére, valamint az egészségük iránt érzett felelősségvállalásra és a kezelésben való aktív részvételre. Orv Hetil. 2022; 163(9): 350–361. Summary. Introduction: The popularity of complementary and alternative medicine (CAM) is increasing among cancer patients worldwide. 45% of women diagnosed with breast cancer use CAM, 62.5% of younger patients do so. So far, only one study has been published in Hungary, according to which 84.4% of Hungarian women with breast cancer use some form of complementary medicine. The utilization of some CAM modalities carries risks due to drug interactions. It is important to get to know the needs and habits of Hungarian patients in relation to CAM, which knowledge can be directly used in clinical practice. Objective: The aim of our study was to assess the extent of CAM utilization among Hungarian breast cancer patients, to examine the reasons behind this choice, and to see the relating/connecting demographic, psychological and clinical factors. Method: In a cross-sectional survey, a self-administered questionnaire was used among inpatients at the Department of Breast and Soft Tissue Surgery in the National Institute of Oncology (n = 146). We assessed socio-demographic data, characteristics of CAM use, attitudes toward CAM, and the need for health control. Clinical data were added to the questionnaire data. Results: 36% of the respondents visited some CAM providers, 71% used CAM preparation and 64% utilized self-help practices. Most patients are informed about these by a healthcare professional. The holistic approach is dominant in the sample as well as internal and social external control. Visitors to CAM providers and CAM preparation users have a stronger need for internal control. Visitors to CAM providers and self-help practitioners judge their own health status more favorable. Conclusion: The information that patients receive from people who are important to them, especially the caregiver, is crucial in their health-related behavior, including the choice of CAM. It is important to see such a high level of patient trust in health professionals and a strong need to discuss information about CAM, as well as a sense of responsibility for their health and active participation in treatment. Orv Hetil. 2022; 163(9): 350–361.

Összefoglaló. Bevezetés: A daganatellenes kezelések egy része gonadotoxikus hatású, ezért létrejött egy viszonylag új, interdiszciplináris terület, mely a fiatal onkológiai betegek termékenységének megőrzésével foglalkozik: ez a fertilitásprezerváció, más néven onkofertilitás. A nemzetközi irányelvek ellenére Magyarországon jelenleg nincs országos fertilitásprezervációs hálózat, a betegek irányítása és tájékoztatása nem szervezetten történik. Célkitűzés: Tanulmányunk célja, hogy felmérjük a hazánkban dolgozó onkológusok fertilitásprezervációval kapcsolatos ismereteit, és megismerjük azokat a tényezőket, amelyek a fiatal daganatos betegek termékenységmegőrzési programhoz való hozzáférését segíthetnék. Módszer: A Magyar Onkológus Társaság (MOT) tagjainak online kérdőívet küldtünk ki a fertilitásprezerváció témakörében 2020 novemberében. A felmérést 94 onkológus szakorvos töltötte ki teljes egészében, majd a beérkezett adatokat statisztikai módszerekkel elemeztük. Eredmények: A válaszoló magyar onkológusok többsége (77%) a daganatellenes kezelés fertilitásra gyakorolt hatását megbeszéli a páciensével, ténylegesen azonban csak kis számban kerülnek beutalásra a termékeny korban lévő páciensek. A válaszolók fele nyilatkozott úgy, hogy betegeit nem vagy csak ritkán irányítja tovább meddőségi centrumba; ennek hátterében a fertilitásprezervációs hálózat, a megfelelő képzés és a hazai irányelvek hiányát jelölik meg. A válaszadók többsége (86%) véli úgy, hogy az onkológus és meddőségi szakemberek szorosabb együttműködésének megszervezése szükségszerű Magyarországon. Következtetés: Tanulmányunk egy nemzeti onkofertilitás-hálózat létrehozásához szükséges teendők felmérésének első lépése. Eredményeink szerint szükséges a betegeket kezelő onkológusok és a fertilitásprezervációval foglalkozó reproduktív szakemberek közötti megfelelő együttműködés kialakítása, valamint az onkológus kollégák ismereteinek bővítése ezen a szakterületen. Orv Hetil. 2022; 163(6): 246–252. Summary. Introduction: Fertility preservation or oncofertility is a relatively new interdisciplinary field dealing with the preservation of female and male reproductive functions before the administration of gonadotoxic therapy. Despite recommendations from different international scientific bodies, Hungary still does not have a national fertility preservation network, patient referral is unorganised. Objective: As the first step towards establishing a national fertility preservation program, a study was designed to evaluate the Hungarian oncologists’ knowledge, attitudes and practice in the field of oncofertility. Method: A national online survey was sent to the physician members of the Hungarian Society of Clinical Oncology between November 2020 and February 2021. The survey was completed by 94 physicians and the results were analysed statistically. Results: The majority of the oncologists (77%) discusses reproductive health issues before starting gonadotoxic therapy. However, almost half of these physicians do not refer patients for fertility preservation consultation or treatment. Physicians report lack of organised fertility preservation network, lack of knowledge and clinical practice guidelines as major barriers in referring their patients for fertility preservation. The majority (86%) proposes that a better collaboration between cancer and fertility centers needs to be organized in Hungary. Conclusion: This study is the first nationwide survey to assess oncologists’ attitude, knowledge and practice in the field of oncofertility in Hungary. It highlights the need for more education and increased collaboration between oncologists and reproductive specialists. This is an important step towards the establishment of a national fertility preservation network which is our ultimate goal. Orv Hetil. 2022; 163(6): 246–252.

This is the first large-scale cross-country analysis of patients with chronic lymphocytic leukemia (CLL) aimed to evaluate the incidence, types, and key prognostic factors of secondary malignancies, and to assess the impact on overall survival based on retrospective claims data from three Central European countries. We analyzed 25,814 newly diagnosed CLL patients from Czechia, Hungary, and Poland; 10,312 (39.9%) patients were treated for CLL in study periods between 2004 and 2016. Out of the treated patients, 1986 (19.3%) received the FCR therapy in the first line and 779 (7.6%) received FCR in subsequent lines. We observed that 33.7% of treated patients developed secondary malignancies during the study. Based on country estimates, the probability to develop a secondary malignancy within 4 years since starting the first-line FCR therapy ranged between 28.0% and 36.8%. We found the age at diagnosis, male gender, any malignancy prior to the CLL diagnosis, and the CLL treatment to be the key risk factors for developing secondary malignancies. Specifically, the FCR therapy was a statistically significant (p 0.001) prognostic factor for risk increase with the hazard ratio between 1.46 and 1.60. Across the three Central European countries, we observed consistent results indicating FCR increased the risk of secondary malignancies in CLL patients. We conclude that secondary malignancies are clearly an undervalued burden for CLL patients, caregivers, and the healthcare system. When evaluating new therapies in regulatory and reimbursement decision making, the factor of secondary malignancies deserves deeper considerations.

The purpose of this study was to investigate the dose coverage of sentinel lymph nodes (SLN), level I, II and III axillary volumes from tangent fields for breast cancer patients with positive SLN without axillary dissection.In 30 patients with cN0 invasive breast cancer treated with breast conserving surgery and SLN biopsy, the SLN area was intraoperatively marked with a titanium clip. Retrospectively, the SLN area and axillary target volumes were contoured, and three plans [standard tangent fields (STgF), high tangent fields (HTgF), and STgF + axillary-supraclavicular field] were generated for each patient. The prescribed dose was standardized to 50 Gy in 2 Gy fractions to the isocenter.The mean dose with STgF or HTgF was 33.1 and 49.1 Gy (p = 0.0001) in the SLN area, 25.7 and 45.1 Gy (p0.0001) in the volume of level I, 7.2 and 28.9 Gy (p0.0001) in the level II and 3.5 and 12.7 Gy (p = 0.0003) in the level III. Adequate therapeutic doses to the level II or III volumes were delivered only with STgF + axillary-supraclavicular field. The mean dose of ipsilateral lung was the highest with the three-field-technique, 9.9 Gy. SLN area, level I, II or III were completely included in the HTgF with 93.3%, 73.3%, 13.3% and 0%, respectively.SLN area should be marked by surgical clip and axillary target volumes should be contoured to obtain accurate dose estimations. The use of HTgF improve axillary coverage.

Introduction Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). Methods Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. Results A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. Conclusions Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.