{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T11:14:36Z","timestamp":1698491676381},"reference-count":19,"publisher":"Akademiai Kiado Zrt.","issue":"50","license":[{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["OH"],"published-print":{"date-parts":[[2021,12,12]]},"abstract":"<jats:p><jats:bold>\u00d6sszefoglal\u00f3.<\/jats:bold> Az izominvaz\u00edv vagy nagyon nagy kock\u00e1zat\u00fa, fel\u00fcletes\n                    h\u00f3lyagdaganatok kezel\u00e9s\u00e9nek arany standardja a radik\u00e1lis h\u00fagyh\u00f3lyag-elt\u00e1vol\u00edt\u00e1s\n                    (cystectomia). V\u00e1logatott betegek eset\u00e9ben hasonl\u00f3 hat\u00e9konys\u00e1g\u00fa kezel\u00e9s lehet az\n                    osztott d\u00f3zis\u00fa (split-course) trimod\u00e1lis ter\u00e1pia, az endoszk\u00f3pos tumorreszekci\u00f3\n                    \u00e9s a kemoirradi\u00e1ci\u00f3 megszak\u00edtott ciklusokkal t\u00f6rt\u00e9n\u0151 alkalmaz\u00e1sa. A split-course\n                    trimod\u00e1lis ter\u00e1pia a radik\u00e1lis cystectomi\u00e1hoz hasonl\u00f3 eredm\u00e9nyess\u00e9g\u0171, a k\u00e9s\u0151bbi\n                    \u00e9letmin\u0151s\u00e9g szempontj\u00e1b\u00f3l pedig \u00edg\u00e9retes kezel\u00e9si lehet\u0151s\u00e9g lehet megfelel\u0151en\n                    kiv\u00e1lasztott betegek eset\u00e9ben. Haz\u00e1nkban els\u0151 alkalommal v\u00e9gzett kezel\u00e9st\n                    ismertet\u00fcnk a t\u00e9ma szakirodalmi \u00e1ttekint\u00e9se mellett. A h\u00fagyh\u00f3lyagtumor\n                    transurethralis reszekci\u00f3ja, maxim\u00e1lis eradik\u00e1ci\u00f3ja ut\u00e1n kemoirradi\u00e1ci\u00f3\n                    kezd\u0151dik, melyet 45 Gy sug\u00e1rd\u00f3zis el\u00e9r\u00e9sekor ism\u00e9telt sz\u00f6vettani mintav\u00e9tel\n                    szak\u00edt meg. Negat\u00edv sz\u00f6vettani eredm\u00e9ny eset\u00e9n a megkezdett ter\u00e1pia a teljes\n                    d\u00f3zis el\u00e9r\u00e9s\u00e9ig folytatand\u00f3. Amennyiben a reszekci\u00f3 sor\u00e1n \u00e9l\u0151 tumor \u00e9szlelhet\u0151,\n                    a radik\u00e1lis m\u0171t\u00e9t elv\u00e9gz\u00e9se javasolt. A kor\u00e1bban transurethralis\n                    daganatreszekci\u00f3n n\u00e9gyszer \u00e1tesett 54 \u00e9ves beteg lok\u00e1lis immunter\u00e1pia ut\u00e1ni\n                    recid\u00edv\u00e1j\u00e1nak sz\u00f6vettana pT1, \u2019high grade\u2019 urothelialis carcinoma volt. A j\u00f3l\n                    inform\u00e1lt, kiv\u00e1l\u00f3 fizik\u00e1lis status\u00fa beteg k\u00e9r\u00e9s\u00e9t figyelembe v\u00e9ve split-course\n                    trimod\u00e1lis kezel\u00e9st v\u00e9gezt\u00fcnk. Negat\u00edv \u2019staging\u2019 vizsg\u00e1latok ut\u00e1n maxim\u00e1lis\n                    endoszk\u00f3pos reszekci\u00f3, majd kemoirradi\u00e1ci\u00f3 k\u00f6vetkezett. A 45 Gy besug\u00e1rz\u00e1s\n                    el\u00e9r\u00e9sekor elv\u00e9gzett ism\u00e9telt mintav\u00e9tel azonnal feldolgozott sz\u00f6vettana negat\u00edv\n                    eredm\u00e9nyt mutatott, \u00edgy k\u00e9sedelem n\u00e9lk\u00fcl folytat\u00f3dott a kemoirradi\u00e1ci\u00f3s kezel\u00e9s.\n                    Az eddigi kontrollvizsg\u00e1latok alapj\u00e1n a beteg komplett remisszi\u00f3ban van. A\n                    split-course trimod\u00e1lis ter\u00e1pia a radik\u00e1lis h\u00f3lyagelt\u00e1vol\u00edt\u00e1s megfelel\u0151\n                    alternat\u00edv\u00e1ja j\u00f3l inform\u00e1lt, gondosan megv\u00e1logatott betegek eset\u00e9ben. A\n                    szervmegtart\u00f3 elj\u00e1r\u00e1s jobb \u00e9letmin\u0151s\u00e9get eredm\u00e9nyezhet, ugyanakkor a beteget\n                    felt\u00e9tlen\u00fcl t\u00e1j\u00e9koztatni kell, hogy sikertelens\u00e9g eset\u00e9n a radik\u00e1lis m\u0171t\u00e9t is\n                    sz\u00fcks\u00e9gess\u00e9 v\u00e1lhat. A kezel\u00e9s sikeres menedzsel\u00e9se csak a t\u00e1rsszakm\u00e1k szoros,\n                    j\u00f3l tervezett egy\u00fcttm\u0171k\u00f6d\u00e9s\u00e9vel lehets\u00e9ges. Orv Hetil. 2021; 162(50):\n                    2017\u20132022.<\/jats:p>\n                <jats:p><jats:bold>Summary.<\/jats:bold> While radical cystectomy remains the gold standard to treat\n                    muscle-invasive or very high risk superficial bladder cancer, well selected\n                    patients can be offered split-course multimodal treatment as a similarly\n                    effective alternative, combining endoscopic tumor resection and split-course\n                    chemoradiotherapy. In highly selected patients, split-course trimodality therapy\n                    can lead to survival rates comparable to radical cystectomy with better quality\n                    of life outcomes. We present our experience with split-course trimodality\n                    treatment used for the very first time in Hungary. Maximal transurethral\n                    resection of bladder neoplasm is followed by chemoradiotherapy with repeated\n                    bladder biopsy after 45 Gy of irradiation. With negative biopsy results,\n                    chemoirradiation should be continued until full dose given. Salvage cystectomy\n                    is recommended if viable tumor is detected. Our patient (54), who previously\n                    underwent four transurethral bladder tumor resections and local immunotherapy,\n                    presented with pT1, high grade urothelial carcinoma recurrence. The\n                    well-informed, high performance status patient opted for split-course\n                    trimodality treatment. After negative staging scan results, the patient\n                    underwent complete endoscopic tumor eradication, followed by chemoradiotherapy.\n                    After 45 Gy of irradiation, repeated bladder biopsy was performed. The immediate\n                    histopathological examination found no viable tumor, therefore chemoradiotherapy\n                    was completed. Follow-up examinations suggest our patient in complete remission.\n                    Split-course trimodality treatment can be offered to well-informed and selected\n                    patients as a reasonable alternative to radical cystectomy. Though the\n                    bladder-sparing approach results in better quality of life, patients must know\n                    that in the case of treatment failure, radical cystectomy will likely be\n                    offered. Excellent multidisciplinary cooperation is a key to conduct this\n                    treatment alternative successfully. Orv Hetil. 2021; 162(50): 2017\u20132022.<\/jats:p>","DOI":"10.1556\/650.2021.32224","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T13:25:11Z","timestamp":1639401911000},"page":"2017-2022","update-policy":"http:\/\/dx.doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":2,"title":["Az osztott d\u00f3zis\u00fa trimod\u00e1lis kezel\u00e9s els\u0151 hazai alkalmaz\u00e1sa nagy kock\u00e1zat\u00fa h\u00fagyh\u00f3lyagdaganat eset\u00e9ben"],"prefix":"10.1556","volume":"162","author":[{"given":"Fruzsina","family":"Fazekas","sequence":"first","affiliation":[{"name":"P\u00e9terfy K\u00f3rh\u00e1z-Rendel\u0151int\u00e9zet \u00e9s Manninger Jen\u0151 Orsz\u00e1gos Traumatol\u00f3giai Int\u00e9zet, Urol\u00f3giai-Seb\u00e9szeti Oszt\u00e1ly Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krisztina","family":"B\u00edr\u00f3","sequence":"additional","affiliation":[{"name":"Orsz\u00e1gos Onkol\u00f3giai Int\u00e9zet, Urogenit\u00e1lis Tumorok \u00e9s Klinikai Farmakol\u00f3giai Oszt\u00e1ly Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P\u00e9ter","family":"\u00c1goston","sequence":"additional","affiliation":[{"name":"Orsz\u00e1gos Onkol\u00f3giai Int\u00e9zet, Sug\u00e1rter\u00e1pi\u00e1s Centrum Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kriszti\u00e1n","family":"Nagyiv\u00e1nyi","sequence":"additional","affiliation":[{"name":"Orsz\u00e1gos Onkol\u00f3giai Int\u00e9zet, Urogenit\u00e1lis Tumorok \u00e9s Klinikai Farmakol\u00f3giai Oszt\u00e1ly Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00e1bor","family":"Gonda","sequence":"additional","affiliation":[{"name":"P\u00e9terfy K\u00f3rh\u00e1z-Rendel\u0151int\u00e9zet \u00e9s Manninger Jen\u0151 Orsz\u00e1gos Traumatol\u00f3giai Int\u00e9zet, Patol\u00f3giai Oszt\u00e1ly Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Istv\u00e1n","family":"Buzog\u00e1ny","sequence":"additional","affiliation":[{"name":"P\u00e9terfy K\u00f3rh\u00e1z-Rendel\u0151int\u00e9zet \u00e9s Manninger Jen\u0151 Orsz\u00e1gos Traumatol\u00f3giai Int\u00e9zet, Urol\u00f3giai-Seb\u00e9szeti Oszt\u00e1ly Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tam\u00e1s","family":"Be\u00f6the","sequence":"additional","affiliation":[{"name":"P\u00e9terfy K\u00f3rh\u00e1z-Rendel\u0151int\u00e9zet \u00e9s Manninger Jen\u0151 Orsz\u00e1gos Traumatol\u00f3giai Int\u00e9zet, Urol\u00f3giai-Seb\u00e9szeti Oszt\u00e1ly Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"ref0","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s12253-014-9748-z","article-title":"Accurate determination of the pathological stage with gross dissection protocol for radical cystectomy","volume":"20","author":"1 S\u00fck\u00f6sd","year":"2014","unstructured":"1 S\u00fck\u00f6sd F, Iv\u00e1nyi B, Pajor L. 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