bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Combined Therapies on the Survival of Pleural Mesothelioma Patients Treated in Brescia, 1982–2006
Authors: Barbieri Pietro Gino , Marinaccio Alessandro , Ferrante Pierpaolo , Scarselli Alberto , Pinelli Valentina , Tassi Gianfranco
Published: February 2018

Aims and background

During the 1990's, the traditional unimodal treatments (surgery, radiotherapy, chemotherapy, immunotherapy) for malignant pleural mesothelioma started to be combined in bimodal or multimodal strategies. However, recent population-based analyses of the survival of patients with malignant pleural mesothelioma indicate that even these treatments have not led to significant improvements in prognosis, which remains very poor. The present study assessed the survival of patients given combined treatments and multimodal therapies in a specialized hospital department.

Methods

The study population comprised 530 patients diagnosed with malignant pleural mesothelioma from 1982 to 2006: 343 of them were residents in the province of Brescia (Lombardy, Northern Italy) and 187 were residents outside the province, with a follow-up to 31 December 2009. Kaplan-Meier survival analyses and Cox proportional risks model were used to test sex, age at diagnosis, histological type and treatments, as prognostic factors.

Results

The estimated median survival for the whole group of patients was 317 days (257 for residents and 398 for non-residents), and respectively 310 and 340 days in the groups diagnosed in the periods 1982–2000 and 2001–2006. Multivariate analysis confirmed that the prognosis was better for younger patients and cases of epithelioid type malignant pleural mesothelioma, whereas for patients receiving any single treatment the prognosis was not significantly better than for those given palliative care alone. However, patients receiving combined treatments or the multimodality approach had significantly longer median survival and the relative risk of death was respectively 0.57 and 0.61 compared to untreated patients (or those only given symptomatic therapy).

Conclusions

This is the first study in Italy to assess the effectiveness of different treatment approaches in a significant number of patients treated in one hospital. Further studies are needed to confirm the improvement in prognosis – even if modest – on larger numbers of patients and taking into account the different stages of the disease.
Reactivation of Hepatitis B Virus Replication Due to Cytotoxic Therapy: A Five-Year Prospective Study
Authors: Francisci Daniela , Falcinelli Flavio , Schiaroli Elisabetta , Capponi Monia , Belfiori Barbara , Cecchini Enisia , Baldelli Franco
Published: February 2018

Background and aims

In hepatitis B virus (HBV) carriers receiving chemotherapy, the risk of reactivation is high, particularly if rituximab is given alone or in combination with steroids. The aim of this study was to assess the incidence, prevalence, and clinical course of HBV infection in a cohort of patients with hematological malignancies receiving cytotoxic therapy as well as to propose a strategy for managing HBV reactivation.

Methods

This is a prospective observational study. All consecutive patients with hematological malignancies receiving intravenous cytotoxic chemotherapy between October 2005 and June 2010 and followed up for at least six months were enrolled in the study. Viral hepatitis markers and liver function indexes were monitored prospectively.

Results

We enrolled 478 patients, including 263 males (55%) and 465 (97.3%) Italians. Non-Hodgkin's lymphoma was the most frequent diagnosis (66%). At least one HBV marker was positive in 96 patients (20%): 21 (4.4%) patients were HBsAg positive, 17 (3.5%) were anti-HBc positive, and 58 (12.1%) were anti-HBc/anti-HBs positive. All but one HBsAg-positive patient received therapy with nucleoside/nucleotide analogs prior to chemotherapy. All but three reached complete virological suppression at six months from the start of treatment. Of the 17 HBsAg-negative/anti-HBc-positive patients, three (18%) had reactivation with seroreversion. All three obtained viral suppression with adefovir. Regarding the 58 anti-HBc/anti-HBs-positive patients, two (3.4%) experienced seroreversion and were treated successfully with nucleoside analogs; both were taking rituximab. No severe ALT flares were observed during or after antiviral therapy.

Conclusion

Our data suggest that pre-treatment screening of patients at risk of viral reactivation yields benefit and therefore should be practiced by clinicians treating patients with malignancies.
SET Oncogene is Upregulated in Pediatric Acute Lymphoblastic Leukemia
Authors: Ekmekci Sema Sirma , Ekmekci Cumhur G , Kandilci Ayten , Gulec Cagri , Akbiyik Meral , Emrence Zeliha , Abaci Neslihan , Karakas Zeynep , Agaoglu Leyla , Unuvar Aysegul , Anak Sema , Devecioglu Omer , Ustek Duran , Grosveld Gerard , Ozbek Ugur
Published: February 2018

Aims and background

The SET gene is a target of chromosomal translocations in acute leukemia and encodes a widely expressed multifunctional phosphoprotein. It has been shown that SET is upregulated in BCR-ABL1-positive cell lines, patient-derived chronic myeloid leukemia CD34-positive cells, and some solid tumors.

Methods and study design

We determined the expression level of SET in 59 pediatric acute lymphoblastic leukemia patients who were BCR-ABL-negative using quantitative real-time reverse-transcriptase-polymerase chain reaction.

Results

We showed that SET expression was significantly upregulated in 96.5% of B-acute lymphoblastic leukemia (28 of 29; 16.6 fold) and 93% of T-acute lymphoblastic leukemia (28 of 30; 47.6 fold) patients. This upregulation was not associated with any clinical features or overall and relapse-free survival.

Conclusions

Our results showed that SET is significantly overexpressed in pediatric acute lymphoblastic leukemia samples, and an increased level of SET might contribute to leukemic process.
Solitary Plasmacytoma of the Larynx Treated with Radiotherapy: A Case Report
Authors: Ravo Vincenzo , Calvanese Maria Grazia , Manzo Roberto , Cuomo Maria Grazia , Cammarota Fabrizio , Murino Paola , Muto Paolo
Published: February 2018

Aims and background.

Solitary plasmacytomas are rare tumors accounting for less than 10% of plasma cell neoplasms. On initial presentation they must be differentiated from multiple myeloma. This can be difficult because a high percentage of these tumors may be associated with subsequent development of multiple myeloma. We present a case of plasmacytoma of the larynx treated with surgery and radiotherapy.

Case report.

A 56-year-old man presented a solitary plasmacytoma of the larynx. The diagnosis was made by biopsy and the presence of a mass on the right side of the larynx was confirmed by computed tomography and whole-body positron-emission tomography. Soon after the biopsy the patient underwent a CO2 laser cordectomy. After the definitive histological confirmation, the patient was referred to our department for three-dimensional conformal radiotherapy (3DCRT) to the involved site with curative intent. The prescribed dose was 50 Gy.

Results.

Five months after the 3DRTE treatment there was no CT or PET evidence of tumor, and examination by the otorhinolaryngologist confirmed the success of laser cordectomy and 3DRTE treatment. There were no long-term side effects of the treatment.

Conclusion.

Radiation therapy following CO2 laser cordectomy can achieve excellent locoregional control of solitary plasmacytoma of the larynx.
Electrochemotherapy for the Treatment of Recurrent Head and Neck Cancers: Preliminary Results
Authors: Mevio Niccolò , Bertino Giulia , Occhini Antonio , Scelsi Daniele , Tagliabue Marta , Mura Federica , Benazzo Marco
Published: February 2018

Aims and background

Electrochemotherapy is a tumor ablation modality providing delivery into the cell interior of impermeant or poorly permeant chemotherapeutic drugs such as cisplatin and bleomycin. A locally applied electrical field enhances the membrane permeability allowing intracellular accumulation of the chemotherapeutic agent. The aim of the study was to evaluate the effectiveness of ECT for the treatment of a group of patients affected by recurrent of extended primary head and neck cancer and not suitable for standard therapeutic options.

Methods and study design

From April 2009 to January 2011, we treated with electrochemotherapy a total of 15 patients with head and neck cancers, 13 with squamous cell carcinoma, 1 with basaloid carcinoma and 1 with Merkel cell carcinoma. Electrical pulses were delivered to 33 lesions (3 primaries, 30 recurrences) after an intravenous bolus injection of a dose of 15,000 IU/m2 of bleomycin. In 3 cases, the lesion treated was a pathologic lymph node.

Results

Of the 31 lesions assessable for the study, 19 (61.5%) showed a complete response, 10 (32.5%) a partial response, 1 (3%) stable disease and 1 (3%) progression of the disease. The objective response 2 months after the procedure was 94%. All the lesions that underwent complete regression were less than 3 cm in their maximum diameter. The 2 assessable cases of pathologic lymph nodes showed a partial or no response. After a follow-up of 2 to 20 months, 29% of the patients were alive and free of disease, 50% were alive with disease, 14% died for disease and 7% died for other causes.

Conclusions

Our study confirms the effectiveness of electrochemotherapy in the treatment or local control of recurrent or extended primary head and neck cancer in patients not suitable for standard therapeutic options.
Axillary Lymph Node Dissection in Patients with Breast Cancer and Sentinel Lymph Node Micrometastasis or Isolated Tumor Cells: Is it Necessary?
Authors: Attene Federico , Paliogiannis Panagiotis , Scognamillo Fabrizio , Trignano Emilio , Pala Carlo , Trignano Mario
Published: February 2018

Aims and background

Sentinel lymph node biopsy is the standard method for axillary lymph node staging in patients with early stage breast cancer. The aim of the study was to evaluate the necessity of axillary lymph node dissection in patients with breast cancer and sentinel lymph node micrometastasis or isolated tumor cells.

Methods

Sentinel lymph node biopsy was performed in 136 patients for breast cancer staging: 16 of them (11.7%) were found to have micrometastasis or isolated tumor cells and underwent axillary lymph node dissection. Micrometastases were considered when tumor invasion was <2 mm and >0.2 mm in diameter and isolated tumor cells when detected alone or in clusters of <0.2 mm in diameter. The dissection of the three axillary lymph node levels of Berg was performed in all cases.

Results

Two patients (12.5%) presented isolated tumor cells and 14 (87.5%) micrometastasis in the sentinel lymph node. Among them, 25% presented nonsentinel axillary lymph node tumor invasion, whereas 75% had no further nodal involvement.

Conclusions

Results suggest that micrometastasis or isolated tumor cells of the sentinel lymph node represent the only site of cancer involvement of the axilla, especially in patients with early breast tumors, and that axillary lymph node dissection may be unnecessary in these cases and represent an overtreatment.
Long-Term Side Effects and Cosmetic Outcome in a Pool of Breast Cancer Patients Treated with Intraoperative Radiotherapy with Electrons as Sole Treatment
Authors: Leonardi Maria Cristina , Ivaldi Giovanni Battista , Santoro Luigi , Lazzari Roberta , Ferrari Annamaria , Morra Anna , Caldarella Pietro , Burgoa Loredana , Bassi Fabio Domenico , Sangalli Claudia , Rotmensz Nicole , Luini Alberto , Veronesi Umberto , Orecchia Roberto
Published: February 2018

Aims

To evaluate late toxicity and cosmetic outcome after intraoperative radiotherapy using electrons (ELIOT) as sole treatment modality in early breast cancer patients.

Methods

A total of 119 patients selected randomly among 1200 cases was analyzed. Late toxicities were documented using the LENT-SOMA scoring system, cosmesis was evaluated with the Harvard scale, and a numeric rating scale was used to assess symptoms.

Results

After a median follow-up of 71 months, grade II fibrosis was observed in 38 patients (31.9%) and grade III fibrosis in 7 patients (5.9%). Postoperative complications (12.6%) did not correlate with late toxicity. Physicians and patients scored cosmesis as excellent or good in 84% and 77.3% of the cases, respectively. Patient satisfaction was higher than 90%.

Conclusions

In the study, ELIOT gives low and acceptable long-term toxicity. A longer follow-up and a larger number of patients are needed to confirm these promising results.
Use of Volumetric Modulated arc Radiotherapy in Patients with Early Stage Glottic Cancer
Authors: Atalar Banu , Gungor Gorkem , Caglar Hale , Aydin Gokhan , Yapici Bulent , Ozyar Enis
Published: February 2018

Aims and background

We compared conformal, intensity-modulated radiotherapy (IMRT) and intensity-modulated arc therapy (IMAT) in early stage glottic cancer in terms of dosimetric features as target coverage, dose to the organs at risk and total treatment time.

Methods and materials

Five consecutive T1 glottic squamous cell carcinoma patients were selected for the study. Three-dimensional conformal radiotherapy (3D-CRT), 3-field or 5-field intensity-modulated radiotherapy (3F-IMRT and 5F-IMRT), or IMAT, which was in 2 different forms – a regular IMAT (R-IMAT) and an alternative IMAT (A-IMAT) with an unirradiated section, was planned for each patient. The prescribed dose was 63 Gy in 28 fractions. The minimum dose for 95% of the clinical target volume (D95), maximum dose point at clinical target volume (Dmax), total monitor units, left and right carotid artery doses (V35 and V50 – percentage of volume receiving 35 Gy and 50 Gy), and total treatment time were calculated for each plan.

Results

Median D95 values in the 5 plans studied with each technique ranged between 63 and 63.3 Gy (P = NS). Median Dmax values for each technique ranged between 65.4 and 70.8 Gy. The number of hot spots with IMRT and IMAT was significantly higher than with 3D-CRT plans. Conformal radiotherapy plans median V35 (93.6%) and V50 (76.6–83.3%) values for carotid arteries were significantly higher than with IMRT and IMAT (2.9%-11.4% and 0.0%). Average treatment times for 3D-CRT, 3F-IMRT, 5F-IMRT, R-IMAT and A-IMAT techniques were calculated as 64, 119, 147, 39 and 32 seconds, respectively.

Conclusions

IMAT has significantly decreased the treatment time compared to IMRT and 3D-CRT with acceptable homogeneous clinical target volume coverage and low carotid dose.
Gastrointestinal Stromal Tumors: Prognostic Factors and Therapeutic Implications
Authors: Rosa Fausto , Alfieri Sergio , Tortorelli Antonio Pio , Di Miceli Dario , Papa Valerio , Doglietto Giovanni Battista
Published: February 2018

Background

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the digestive tract. They have recently been recognized as a separate nosological entity and the literature on these stromal tumors has rapidly expanded.

Materials and methods

The surgical records of 50 patients with primary GISTs treated at the Digestive Surgery Department of the Catholic University of Rome from January 1993 to December 2010 were reviewed and the prognostic factors were analyzed.

Results

Surgery was performed in all patients with curative intent. The median age at presentation was 66.5 years (range, 28–81). Adjuvant therapy was administered in 26 (52%) cases. Median follow-up was 71 months (range, 5–208). There was an 8% recurrence rate. The actuarial 5-year overall and disease-free survival rates were 66.3% and 57.2%, respectively. High mitotic rate (P <0.001), tumor size greater than 10 cm (P = 0.007) and tumor rupture (P = 0.05) were the only prognostically significant negative factors for overall survival in multivariate analysis.

Conclusions

The present study confirmed the important role of aggressive surgical management of GISTs to offer these patients the most appropriate treatment for long-term survival.
Increased Diagnostic Yield of Small Bowel Tumors with Pillcam: The Role of Capsule Endoscopy in the Diagnosis and Treatment of Gastrointestinal Stromal Tumors (GISTs). Italian Single-Center Experience
Authors: Urgesi Riccardo , Riccioni Maria Elena , Bizzotto Alessandra , Cianci Rossella , Spada Cristiano , Pelecca Giorgio , Ricci Riccardo M , Costamagna Guido
Published: February 2018

Background

Gastrointestinal stromal tumors (GISTs) are rare tumors, accounting for 1–3% of all gastrointestinal malignancies; they are, however, the most common gastric and small bowel mesenchymal tumors. The length and relative inaccessibility of the small bowel have long constrained the diagnosis of GISTs mainly presenting with chronic or intermittent bleeding as the sole clinical manifestation.

Aim

To report on the prevalence of small bowel GISTs in a prospectively recorded series of patients undergoing capsule endoscopy (CE).

Patients and methods

Between 2001 and 2007 five hundred patients were referred to our endoscopy unit for small bowel evaluation with capsule endoscopy. We retrospectively evaluated all charts. The main indications for CE were obscure-occult or obscure-overt bleeding. Two hundred eighty-nine patients underwent CE for either obscure-occult or obscure-overt bleeding and 211 for other indications. Patient outcome and care processes were measured by follow-up telephone interviews and chart review. Statistical computations were performed using Fisher's exact test and Student's t-test.

Results

CE identified a small bowel tumor in 20 patients (4.0%) and 9 tumors turned out to be GISTs (45.0%). Traditional endoscopic and radiological imaging failed to detect the GIST in all these cases. In one case a small bowel GIST was diagnosed by angiography and CE proved false negative. Overall, CE was able to diagnose a small bowel GIST in 9 out of 10 cases. All patients underwent surgical treatment and showed normalized hemoglobin levels at follow-up. The main limitation of this study is the small number of cases.

Conclusions

CE is an effective and sensitive diagnostic device compared with conventional radiology and plays an important role in the algorithm for the diagnostic work-up of suspected small bowel tumors.
Downregulating PRL-3 Inhibit Migration and Invasion of Lung Cancer Cell via RhoA and mDia1
Authors: Jian Ming , Nan Liu , Guocheng Jiang , Qingfu Zhang , Xueshan Qiu , Enhua Wang
Published: February 2018

Aims and background

The overexpression of phosphatase of regenerating liver-3 (PRL-3) affects the migration and invasion of epithelial cells. Little is known about the substrates or pathways that PRL-3 interacts with.

Methods

We studied the action and the mechanism of PRL-3 in migration and invasion of lung cancer. We detected the expression of PRL-3 in lung cancer cell lines and normal human bronchial epithelial cell.

Results

We found that PRL-3 expression was high in lung cancer cells. Knockdown of PRL-3 by siRNA inhibited cell migration and invasion and reorganizated the cytoskeleton. Furthermore, blocking PRL-3 decreased RhoA activity and mDia1 expression. Blocking RhoA or mDia1 showed the similar changes of cytoskeleton and suppression of migration and invasion as inhibiting PRL-3 expression. Blocking RhoA inhibited the expression of mDia1.

Conclusions

These data indicate that downregulating PRL-3 inhibit cell migration and invasion by inactivating RhoA to downregulate mDia1 to reorganizate cytoskeleton of lung cancer cells.
Temperament and Character Traits Associated with Health-Related Quality of Life in Cancer Patients
Authors: Bonacchi Andrea , Miccinesi Guido , Guazzini Monica , Rossi Alessandra , Bacci Silvia , Toccafondi Alessandro , Martire Mariangela , Bellotti Laura , Perfetto Roberta , Catanzaro Paolo , Adamo Vincenzo , Cascinu Stefano , Doni Laura , Di Costanzo Francesco , Rosselli Massimo
Published: February 2018

Background

There is an increase in the attention to factors influencing the quality of life of cancer patients. The aim of the present study was to evaluate temperament and character traits related to health-related quality of life (HRQoL) in patients with cancer.

Methods

Two hundred and three inpatients from three Italian oncology departments filled in the Temperament Character Inventory (TCI-140) based on Cloninger's personality model, the SF-36 questionnaire assessing HRQoL, and the Hospital Anxiety and Depression Scale (HADS). Eighty percent of patients were undergoing chemotherapy.

Results

Lower levels of harm avoidance and higher levels of self-directedness were significantly correlated with a better HRQoL. Regression analysis controlling for psychopathology (anxiety and depression symptoms) showed that the influence of temperament and character traits on quality of life seemed to add little to the influence of psychopathology.

Conclusions

The present study demonstrates the existence of some relations between HRQoL and temperament and character traits assessed using the TCI-140 questionnaire. However, among the psychological factors, psychopathology seems to retain more influence on HRQoL of cancer patients.
Sarcomatoid Carcinoma of the Stomach with Osteoclast-Like Giant Cells
Authors: Jing Hongbiao , Geng Ming , Meng Qingda , Tai Yanhong
Published: February 2018

Carcinomas with osteoclast-like giant cells (OGCs) are a rare type of malignant tumor that is histologically characterized by the presence of multinucleated giant cells that resemble osteoclasts mixed with poorly differentiated adenocarcinoma cells. In this study, we report the clinicopathological and immunohistochemical features of a gastric sarcomatoid carcinoma with OGCs in a 37-year-old male. An abdominal CT scan demonstrated a large mass, measuring 15 cm × 10 cm, in the lesser curvature of the stomach. Microscopic examination revealed that the tumor was composed of sarcomatoid and carcinomatous elements with infiltrating OGCs. Immunohistochemical analysis showed that the sarcomatoid and carcinomatous elements were both variably positive for CK7 and EMA. The sarcomatoid components were also vimentin and SMA positive. This is the first report of a gastric sarcomatoid carcinoma with OGCs. The present tumor has progressed rapidly with extensive perigastric involvement and multiple intrahepatic metastases.
Jejunal Obstruction Caused by Metastasis from an Undiagnosed Breast Cancer: A Case Report
Authors: Calò Pietro Giorgio , Fanni Daniela , Ionta Maria Teresa , Medas Fabio , Faa Gavino , Atzori Francesco
Published: February 2018

Solitary metastasis from breast carcinoma to the gastrointestinal tract is an uncommon finding. We describe a female patient with a solitary jejunal metastasis from an undiagnosed breast cancer who presented to the emergency department with a bowel obstruction. Abdominal surgery was performed, revealing a jejunal stenosis from a metastatic lobular carcinoma. The primary tumor in the left breast was subsequently diagnosed and surgically removed.
The Management of Skin Toxicity during Cetuximab Treatment in Advanced Colorectal Cancer: How much does it Cost? A Retrospecive Economic Assessment from a Single-Center Experience
Authors: Giuliani Jacopo , Indelli Monica , Marzola Marina , Raisi Elena , Frassoldati Antonio
Published: February 2018

Aims and background

Skin rash is a predictable and manageable side effect of anti-EGFR therapy such as cetuximab. The aim of this study is to estimate the costs for the foreseeable management of skin toxicity in patients treated with cetuximab in our institute in order to assess the direct medical economic impact.

Methods and study design

We retrospectively analyzed all consecutive patients with advanced colorectal cancer treated with cetuximab at our institute from June 2006 to May 2011. We evaluated the severity and mean duration of skin rash for each grade and we identified the costs for the different therapeutic interventions. Patients were treated according to the general consensus management of skin toxicity associated with cetuximab treatment.

Results

We evaluated 31 patients. The median follow-up was 28.95 months (range, 1.84–75.49). At last follow-up 10 patients (32.3%) were alive with metastases, 18 patients (58.1%) had died, 1 patient (3.2%) was alive without evidence of disease, and 2 patients (6.5%) were lost to follow-up. The median progression-free survival was 8.26 months and the median overall survival 32.89 months. Nineteen patients (61.3%) developed skin toxicities: 7 patients (22.6%) grade 1, 9 patients (29.0%) grade 2, 3 patients (9.7%) grade 3; no grade 4 skin toxicity was observed. The median duration of grade 1 toxicity was 79 days (no specific treatments were started), of grade 2 toxicity 95 days (cost range, € 199.50–294.50) and of grade 3 toxicity 64 days (cost range, € 159.42–233.90).

Conclusions

Our experience, through the analysis of nonselected cases, showed that the management of skin toxicities related to cetuximab is not so expensive. We recommend proper care of low-grade toxicities in order to reduce progression to highgrade toxicities and the resulting risk of hospitalization, which really impacts on costs.
Sentinel Node Biopsy in Early Breast Cancer: Lessons Learned from More than 1000 Cases at a Single Institution
Authors: Fancellu Alessandro , Cottu Pierina , Feo Claudio F , Bertulu Daniele , Giuliani Giuliana , Mulas Silvia , Sanna Valeria , Mura Silvia , Madeddu Giuseppe , Spanu Angela
Published: February 2018

Aims

The aims of this paper are to report the development of sentinel node biopsy (SNB) in breast cancer at a single institution and to discuss the relevant issues on SNB still to be elucidated.

Patients and methods

From 1998 to 2010, 1021 SNBs with frozen section examination were carried out in patients with breast cancer. In the early period (1998–2002) SNB was always combined with axillary lymph node dissection (ALND). From 2002 onwards, only patients with a positive SNB result underwent ALND (late period). The characteristics of patients with infiltrating carcinoma (IC) and ductal carcinoma in situ (DCIS) and the histological status of the sentinel nodes were examined. The survival outcomes of node-negative patients were compared between patients submitted to SNB and ALND (ALND group) during the early period and patients who underwent only SNB during the late period (SNB group).

Results

The sentinel node was identified intraoperatively in 98.3% of cases. During the early period the overall accuracy of SNB was 97.0%. During the late period, 700 patients with IC and 140 with DCIS underwent SNB. In the IC group, 149 patients (21.3%) had sentinel node macrometastases and 36 (5.1%) micrometastases; of that subgroup, 21 underwent ALND and no other metastatic lymph nodes were found, and 15 underwent SNB only. Axillary recurrences were observed in 4 patients (0.77%) with negative SNB; none of these were among the patients with micrometastatic SNB. Two patients (1.4%) with DCIS had a positive SNB. In node-negative patients the 5-year overall survival was 96.7% in the ALND group and 96.5% in the SNB group (P = 0.63). The 5-year disease-free survival was 93.8% and 93.2% in the ALND and SNB groups, respectively (P = 0.77).

Conclusions

Overall and disease-free survival in patients with a negative SNB result and no further axillary surgery were equal to those in patients with negative ALND. Intraoperative assessment of the sentinel node in expert hands has a low false-negative rate and allows immediate ALND in patients with sentinel node metastases, avoiding the need for a second operation. ALND for sentinel node micrometastases may be safely omitted in most patients with early stage breast cancer.
The Impact of Multiple Recurrences in Disease-Free Survival of Breast Cancer: An Extended Cox Model
Authors: Gohari Mahmood Reza , Khodabakhshi Reza , Shahidi Javad , Fard Zeinab Moghadami , Foadzi Hossein , Soleimani Farin , Biglarian Akbar
Published: February 2018

Aims and background

Identifying the risk factors of recurrence of breast cancer is important for both the physician and patient. Analysis of the first recurrence may lead to an inaccurate evaluation of the factor's effects because it does not completely reflect the history of the disease and may result in the loss of valuable information. The present study aimed to determine the factors that influence breast cancer recurrence and to estimate disease-free survival, adjusting for multiple metastases in breast cancer patients.

Methods and study design

Patients were selected from a longitudinal study carried out at Fayazabakhsh Hospital in Tehran, Iran. Women who were diagnosed with breast cancer and who underwent either modified radical mastectomy or breast-conserving surgery between January 2006 and April 2008 were recruited to take part in the study. Breast cancer recurrence was defined as the occurrence of a tumor in the contralateral breast, local-regional relapse, or distant metastasis to other organs. Using an extended Cox model, the effect of age, tumor size, estrogen receptors, HER2, progesterone receptors as well as lymph node ratio was analyzed.

Results

Over a 5833 person-month follow-up, 25 of 133 patients (18.8%) had died and 108 patients (81.2%) were still alive, 9 of them with metastasis. Thirty-four patients (25.6%) experienced their first disease recurrence. A total of 11 patients had a second metastasis. The mean time to first metastasis was 19.93 months, and mean gap time between two metastases was 7.15 months. Risk of experiencing a metastasis or death in the third and fifth year after surgery was approximately 22% and 28%, respectively. Fitting multiple recurrent regression shows that high lymph node ratio, high histologic grade, large tumor size and HER2-positive tumors are prognostic factors for shorter disease-free survival.

Conclusions

Our novel approach might be helpful in clinical practice to predict breast cancer recurrence after surgery and might be adapted to be used in other malignancies as well.
Retrospective Analysis of Patients with Esophageal Cancer Treated with Radiotherapy and/or Chemoradiotherapy
Authors: Kandaz Mustafa , Ertekin Mustafa Vecdi , Bilici Mehmet
Published: February 2018

Aims and background

Esophageal cancer consists of 5% of all cancers. In Eastern Anatolia region of Turkey, the rate was found to be 16%. The primary aim of the study was to evaluate effect of the localization and histologic type of tumor, stage of cancer and treatment modality, patient's sex, age and smoking status, Karnofsky performance score, and family history on survival.

Methods and study design

A total of 135 patients with locally advanced esophagus cancer were enrolled into the study. The factors (sex, age, Karnofsky performance status, localization, histology, stage of the disease, treatment modality) on survival were evaluated.

Results

After the end of treatment, overall survival was 20 months, median survival period was 13 months. The survival rates at 1, 3 and 5 years were 51.3%, 20.1% and 13.4%, respectively.

Conclusions

For patients with esophageal cancer, age, Karnofsky performance score, stage, treatment modality applied, chemotherapy protocol, number of cures and general survival rate were found to be the prognostic factors related to survival (P <0.05) in univariate analysis. At the same time, the study showed that gender, smoking status, family history, localization of the tumor and histologic type had no effect on the survival. The best survival in patients with esophageal cancer which cannot be operated is obtained by 50.4 Gray radiotherapy with concurrent chemotherapy.
Vinorelbine-Based Chemo-Radiotherapy in Non-Small Cell Lung Cancer
Authors: Scotti Vieri , Saieva Calogero , Di Cataldo Vanessa , Bruni Alessio , Desideri Isacco , Bertocci Silvia , Meattini Icro , Livi Lorenzo , Simontacchi Gabriele , De Luca Cardillo Carla , Bendinelli Benedetta , Bastiani Paolo , Mangoni Monica , Agresti Benedetta , Biti Giampaolo
Published: February 2018

Aims and background

Concomitant radio-chemotherapy improves survival of patients with locally advanced non-small cell lung cancer, with a better local-regional control.

Methods and study design

We report our experience with vinorelbine-based chemotherapy in neoadjuvant and radical settings in 43 patients. Regimens consisted of cisplatin plus vinorelbine in 74.4% patients and carboplatin plus vinorelbine in 14.0%; 11.6% underwent mono-chemotherapy with oral vinorelbine. We estimated the crude probability of death or local recurrence by the Kaplan-Meier method. Cox regression models were used to identify the main significant predictors of death or local recurrence.

Results

A significant effect of the response to treatment was shown on both local disease free-survival (P = 0.004) and overall survival (P <0.0001). Patients with progressive disease after primary treatment had a significantly higher risk of further relapse at both univariate (P = 0.046) and multivariate regression analysis (P = 0.014) than patients with a complete response. They also showed a significantly higher risk of death at both univariate (P = 0.0005) and multivariate regression analysis (P <0.0001) than patients with a complete response. The most common toxicity was hematologic and gastroenteric. We recorded grade III/IV leukopenia in 11%, anemia in 6%, and esophagitis in 14% of the patients.

Conclusions

Our experience showed that vinorelbine-based chemotherapy is an effective and safe regimen, in association with a platinum compound and thoracic radiotherapy.
High-Dose-Rate Interstitial Brachytherapy in Early Stage Buccal Mucosa and Lip Cancer: Report on the Consecutive 12 Patients and Review of the Literature
Authors: Vavassori Andrea , Gherardi Federica , Colangione Sarah Pia , Fodor Cristiana , Cattani Federica , Lazzari Roberta , Calabrese Luca , Bruschini Roberto , Alterio Daniela , Jereczek-Fossa Barbara Alicja , Orecchia Roberto
Published: February 2018

Aims and background

To evaluate clinical outcome and toxicity using high-dose-rate brachytherapy as monotherapy in head and neck carcinomas.

Methods

Between September 2004 and April 2010, a series of 12 patients with lip (7 patients) or buccal mucosa (5 patients) cancers were treated by exclusive interstitial high-dose-rate brachytherapy. The median age of the patients was 71.5 years (range, 47–87). Stages were T1N0M0 and T2N0M0 in 6 and 6 patients, respectively. A dose of 27 to 54 Gy in 9 to 16 fractions, 3 to 4.5 Gy per fraction, 2 fractions per day with a minimal gap of 6 h in between was delivered.

Results

After a median follow-up of 46 months (range, 10–85), the disease-free and overall survival was 83% (10 of 12 patients) and 50% (6 of 12 patients), respectively. The crude local control in the lip cancer patients was 100% and in the buccal mucosa cancer patients was 60%. No severe toxicity was registered.

Conclusions

High-dose-rate brachytherapy is feasible and safe and offers the possibility to treat patients in an outpatient regimen.
Comparative Analysis of Immunohistochemical Markers for Differential Diagnosis of Hepatocelluar Carcinoma and Cholangiocarcinoma
Authors: Ryu Han Suk , Lee Kyounbun , Shin Eun , Kim Soo Hee , Jing Jin , Jung Hae Yeon , Lee Hyebin , Jang Ja-June
Published: February 2018

Aims and background

Differential diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma is sometimes difficult to accurately perform.

Methods

Eight markers including cytokeratin 7 (CK7), cytokeratin 19 (CK19), MOC31, CD10, glypican 3 (GPC3), claudin 4, biglycan and high mobility group A1 (HMGA1) were immunohistochemically stained in samples from 179 surgically resected hepatocellular carcinomas and 127 intrahepatic cholangiocarcinomas, and the rates of marker expression were statistically compared.

Results

With the exception of biglycan, 7 of the 8 markers were found to have significantly different expression patterns when comparing the two types of cancer (P <0.05). In intrahepatic cholangiocarcinomas, the expression rates of CK7, CK19, MOC31, claudin 4 and HMGA1 were 83.4%, 89.0%, 88.2%, 69.2%, and 31.5%, respectively. These rates of expression in intrahepatic cholangiocarcinomas were all higher than in those in hepatocellular carcinomas (CK7, 31.3%; CK19, 10.1%; MOC31, 34.0%; claudin 4, 11.2%; and HMGA1, 19.5%). The expression rates of GPC3, CD10, and biglycan were 72.6%, 39.7% and 10.0%, respectively, in hepatocellular carcinoma. These were higher than the rates found in intrahepatic cholangiocarcinomas (GPC3, 7.0%; CD10, 18.1%; and biglycan, 7.0%). In a multivariate logistic regression analysis, GPC3, CK19, MOC31 and claudin 4 were found to be independent markers for differentially diagnosing intrahepatic cholangiocarcinoma.

Conclusions

Based on our results, GPC3 and CK19 can be used as first-line markers for differential diagnoses of hepatocellular carcinoma and intrahepatic cholangiocarcinoma (accuracy rate, 73.5%), and additional combined screening for claudin 4 and MOC31 markers in GPC3(-) and CK19(-) tumors might increase the accuracy rate for distinguishing hepatocellular carcinoma from intrahepatic cholangiocarcinoma to 88.5%.
Patient Dignity Inventory (PDI) Questionnaire: The Validation Study in Italian Patients with Solid and Hematological Cancers on Active Oncological Treatments
Authors: Ripamonti Carla Ida , Buonaccorso Loredana , Maruelli Alice , Bandieri Elena , Pessi M Adelaide , Boldini Stefania , Primi Caterina , Miccinesi Guido
Published: February 2018

Backgrounds

In Oncology, little is known about dignity-related distress and the issues that influence the sense of dignity for patients. We validated the Patient Dignity Inventory (PDI) questionnaire in Italian patients on oncological active treatments.

Methods

After the translation procedures, the PDI was administered to 266 patients along with other questionnaires to assess the psychometric properties of the Italian version of PDI. Factor structure was tested by both explorative and confirmatory factor analyses. Concurrent validity was tested through convergent and divergent validity with validated questionnaires inquiring about physical and psychological symptoms, and religiosity. The test/retest reliability was assessed through the concordance coefficient of Linn (two-week interval, 80 patients).

Results

The explorative analysis suggested one factor only loading highly on all the 25 items (>.45) and explaining the 48% variance; confirmative analysis and Cronbach alpha (0.96) confirmed the adequacy of the one-factor model. In the 2-week test-retest study, a concordance coefficient of 0.73 (95% CI, 0.64–0.83) was found. High correlations of problems with dignity were found with both physical and psychological symptoms (0.52 and 0.64 rho coefficient, respectively), and a moderate inverse correlation with spiritual well being (-.40). The dignity construct, as measured by PDI, proved to be orthogonal to that of religiosity (-.02).

Conclusions

The Italian version of PDI is a valid and reliable tool to evaluate the dignity related-distress in out-patients with solid and hematological cancers, on active oncological treatments, in non advanced stages of the disease.
Mutational and Expressional Analyses of NRF2 and KEAP1 in Sarcomas
Authors: Mi Je Eun Mi , An Chang Hyeok , Yoo Nam Jin , Lee Sug Hyung
Published: February 2018

Aims and background

Nuclear factor erythroid 2-related factor 2 (NRF2) activates expression of cytoprotective proteins such as GCLC and enhances cancer cell survival, whereas KEAP1 inhibits NRF2 by mediating NRF2 degradation. Somatic mutation of NRF2 and KEAP1 genes and loss of KEAP1 expression are detected in many carcinomas and contribute to cancer development. The aim of this study was to see whether mutational and expressional alterations of NRF2 and KEAP1 genes are features of human sarcomas as well.

Methods

We analyzed somatic mutations of NRF2 and KEAP1 genes in 108 sarcoma tissues from malignant fibrous histiocytomas, rhabdomyosarcomas, osteosarcomas, malignant peripheral nerve sheath tumors, leiomyosarcomas, synovial sarcomas, liposarcomas, angiosarcomas, chondrosarcomas and Ewing sarcomas by single-strand conformation polymorphism. Also, we analyzed expressions of NRF2, KEAP1 and GCLC in sarcoma tissues by immunohistochemistry.

Results

Tissue expressions of NRF2 and GCLC were found in 93% and 76% of the sarcomas, respectively, indicating that NRF2 signaling might be activated in most sarcomas. Loss of KEAP1 expression was observed in 24% of the sarcomas, whereas neither NRF2 nor KEAP1 somatic gene mutation was seen in the sarcomas.

Conclusions

Our data suggest a possible activation of the NRF2/KEAP1 system in sarcomas and a possible contribution to cytopretection of sarcoma cells.
EML4-ALK-Positive Non-Small Cell Lung Cancer in a Patient Treated with Azathioprine for Ulcerative Colitis
Authors: Lazarev Irena , Sion-Vardy Netta , Ariad Samuel
Published: February 2018

EML4-ALK-positive lung cancer is a novel cancer entity associated with light or never smoking, younger age, and adenocarcinoma with acinar or signet-ring cell type histology. Another mutation of ALK with NPM, resulting in NPM-ALK fusion mutation, was described in patients with anaplastic large cell lymphoma (ALCL). It was subsequently reported in organ transplant recipients and patiens undergoing immunosuppressive therapy. We describe a case of lung cancer in a 36-year-old nonsmoking woman with ulcerative colitis treated with azathioprine, who was diagnosed with EML4-ALK-positive, metastatic lung cancer two months postpartum. Crizotinib 300 mg/day has been effective in maintaining response after chemotherapy failed. The resemblance of this case to ALK-positive ALCL in organ transplant recipients suggests that similar mechanisms may be responsible for the development of both ALK-positive lung cancer and ALCL in patients receiving immunosuppressive therapy.
Stem Cell Tracking: Toward Clinical Application in Oncology?
Authors: Mangoni Monica , Livi Lorenzo , Biti Giampaolo , Di Cataldo Vanessa , Capaccioli Neri , Castier Yves , Loriot Yohann , Mordant Pierre , Deutsch Eric
Published: February 2018

Noninvasive cellular imaging allows the tracking of grafted cells as well as the monitoring of their migration, suggesting potential applications to track both cancer and therapeutic stem cells. Cell tracking can be performed by two approaches: direct labeling (cells are labeled with tags) and indirect labeling (cells are transfected with a reporter gene and visualized after administration of a reporter probe). Techniques for in vivo detection of grafted cells include optic imaging, nuclear medicine imaging, magnetic resonance imaging, microCT imaging and ultrasound imaging. The ideal imaging modality would bring together high sensitivity, high resolution and low toxicity. All of the available imaging methods are based on different principles, have different properties and different limitations, so several of them can be considered complementary. Transfer of these preclinical cellular imaging modalities to stem cells has already been reported, and transfer to clinical practice within the next years can be reasonably considered.
Should Radiotherapy after Primary Systemic Therapy be Administered with the Same Recommendations Made for Operable Breast Cancer Patients who Receive Surgery as first Treatment? A Critical Review
Authors: Allis Simona , Reali Alessia , Mortellaro Gianluca , Arcadipane Francesca , Bartoncini Sara , Grazia Ruo Redda Maria
Published: February 2018

Primary systemic therapy is not only used in patients with locally advanced inoperable non-metastatic breast cancer but also for operable stage II and III cancer aimed at breast conservation. The indications for local-regional radiotherapy for patients who receive primary systemic therapy are still evolving. The purpose of this article is to provide a comprehensive discussion of how primary systemic therapy in operable breast cancer patients could affect the indications of radiotherapy to optimize local-regional treatment. An overview of available literature data regarding neoadjuvant treatment and radiotherapy is analyzed and discussed. Considering the variability of data on this issue, an appropriate approach could still be to tailor treatment decision to the individual clinical case.
Changing Pattern of Adenocarcinoma of the Esophagogastric Junction in Recent 10 Years: Experience at a Large Tertiary Medical Center in China
Authors: Wang Kun , Yang Chang-qing , Duan Li-ping , Yang Xue-song , Xia Zhi-wei , Cui Rong-li , Jin Zhu , McNutt Michael
Published: February 2018

Aims and background

To investigate the changing pattern of adenocarcinoma of the esophagogastric junction subtypes and its time trend relationship with that of reflux esophagitis over 10 years at a tertiary medical center in China.

Methods and study design

The medical records of all patients who underwent gastroscopy from 2000 to 2009 were reviewed. Subtypes of adenocarcinoma of the esophagogastric junction according to Siewert's classification, gastric non-cardiac adenocarcinoma, esophageal squamous cell carcinoma, reflux esophagitis and Helicobacter pylori infection were diagnosed according to the results of gastroscopy and mucosal histopathology. All the patients were divided into three cohorts (cohort A [2000–2003], cohort B [2004–2006]), cohort C [2007–2009]), and the proportion of adenocarcinoma of the esophagogastric junction and its subtypes in all upper gastrointestinal tumors (adenocarcinoma of the esophagogastric junction, gastric non-cardiac adenocarcinoma and esophageal squamous cell carcinoma) in each cohort were compared. The annual percentages of adenocarcinoma of the esophagogastric junction, reflux esophagitis and H pylori in all patients were also compared.

Results

70,073 patients (cohort A, n = 20298, cohort B, n = 20443, cohort C, n = 29332) who underwent gastroscopy were reviewed. Totally there were 279 patients with adenocarcinoma of the esophagogastric junction (0.398%, M:F = 5.6:1), 794 gastric non-cardiac adenocarcinoma patients (1.133%, M:F = 2:1), 366 esophageal squamous cell carcinoma patients (0.522%, M:F = 3.4:1) and 4681 reflux esophagitis patients. Among the three subtypes of adenocarcinoma of the esophagogastric junction, only type I adenocarcinoma of the esophagogastric junction in upper GI tumors exhibited increasing trend over time (1.86%, 3.39% and 4.94% for cohort A, B and C, respectively, P = 0.009). According to the WHO classification of histological types, the tubular types of adenocarcinoma of the esophagogastric junction have decreased (P = 0.008), whereas papillary type (P = 0.001) increased. The annual detection rate of type I adenocarcinoma of the esophagogastric junction appeared to be positively correlated with reflux esophagitis (r = 0.846, P = 0.002) and negatively with H pylori infection (r = -0.785, P = 0.007) in time trend.

Conclusions

Over a recent 10-year period, the three subtypes of adenocarcinoma of the esophagogastric junction showed different changing trends, suggesting heterogeneous characteristics of the three Siewert types of adenocarcinoma of the esophagogastric junction.