bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential Diagnosis of Krukenberg Tumors Using Multivariate Analysis
Authors: La Fianza Alfredo , Alberici Elisa , Pistorio Angela , Generoso Paola
Published: April 2018

Aims and Background

Krukenberg tumors are ovarian metastases from a gastroenteric malignancy in 90% of cases. At present, diagnostic imaging techniques (US, CT, MRI) do not provide any reliable diagnostic criteria to differentiate these metastases from ovarian primaries. We tried to use multivariate analysis to distinguish malignant ovarian primaries from Krukenberg tumors based on their differential natural history.

Patients and Methods

We retrospectively compared the CT findings of Krukenberg tumors (47 patients, 79 masses, only from gastroenteric malignancy) with CT findings of primary epithelial ovarian cancers (46 patients, 67 masses). We compared the same independent variables in the two groups: age, morphology, margins, carcinomatosis, bilateral versus unilateral involvement, ascites, lymph node involvement, metastases on the basis of multivariate analysis.

Results

According to the best fitted model, clear-cut margins (OR: 3.75; 95% Cl: 1.14-9.72) and the presence of carcinomatosis (OR: 4.21; 95% Cl: 1.51-11.72) were the strongest predictors of a diagnosis of Krukenberg tumor. In contrast, the presence of ascites was more likely to be a protective factor (OR: 0.22; 95% Cl: 0.08-0.62).

Conclusions

We can try to make a differential diagnosis between a metastatic lesion from the gastroenteric tract and a primary adnexal lesion based on the multivariate statistical analysis of intraperitoneal spread of the different types of cancer rather than on morphologic findings at CT.
Acute Cytogenetic Effects of Antineoplastic Drugs on Peripheral Blood Lymphocytes in Cancer Patients Chromosome Aberrations and Micronuclei
Authors: Kopjar Nevenka , Garaj-Vrhovac Vera , Milas Ivan
Published: April 2018

Aims and Background

The aim of the present study was to evaluate the individual sensitivity of cancer patients to different antineoplastic drugs administered in standard protocols by assessing their acute cytogenetic effects on peripheral blood lymphocytes.

Methods and Study Design

In 12 patients undergoing cancer chemotherapy, acute cytogenetic effects on peripheral blood lymphocytes were evaluated by analysis of structural chromosome aberrations and micronuclei. All patients were given antineoplastic drugs, mainly as polychemotherapy. The frequencies of both cytogenetic biomarkers determined after the first chemotherapy cycle were compared with their pre-treatment (baseline) values.

Results

All chemotherapy protocols employed induced clear cytogenetic effects in both tests studied. The results obtained indicate interindividual variations between cytogenetic damage in peripheral blood lymphocytes among cancer patients. Statistically significant increases in the total number of structural chromosome aberrations and micronuclei in lymphocytes analyzed after chemotherapy compared to pre-therapy samples were observed in almost all patients studied. The highest level of chromosome damage as well as the highest incidence of micronuclei was observed following administration of the ACOP protocol (adriamycin, cyclophosphamide and vincristine). The proportions of signal-positive and signal-negative micronuclei were evaluated using DAPI staining, while silver staining revealed Ag-NOR+ and Ag-NOR− micronuclei. In some patients the incidence of signal-positive and Ag-NOR+ micronuclei after treatment was increased, indicating a more pronounced susceptibility of particular chromosomes to damage caused by antineoplastic drugs.

Conclusions

With regard to the results obtained we may conclude that both parameters used in the present study on peripheral lymphocytes are sensitive biomarkers and can be successfully employed for biomonitoring of acute cytogenetic effects induced by antineoplastic drugs in standard clinical protocols for cancer treatment.
Concurrent Boost Radiotherapy as Preoperative Treatment for Locally Advanced Rectal Carcinoma: A New Beam Arrangement
Authors: Capirci Carlo , Valvo Francesca , Salviato Simonetta , Gava Marcello , Mandoliti Giovanni , Di Russo Anna , Torrez Kevin Tapia , Polico Cesare
Published: April 2018

Purpose

To describe a new beam arrangement for preoperative concurrent boost radiotherapy in locally advanced rectal carcinoma.

Material and methods

Three different volumes, ie posterior pelvis, total mesorectal space, and gross tumor volume plus 2 cm, are selected to receive radiation doses of 47 Gy, 51 Gy, and 54 Gy, respectively, in 24 fractions. There are two prerequisites for the use of such a radiotherapy schedule: complete displacement of the small bowel outside the boost volume, and horizontal positioning of the rectal long axis. Both conditions can be attained by patient positioning on a new device, the “Up-Down Table” (UDT). The dose gradient between the three volumes is realized with two daily arc rotation fields with an isocenter that is different from the three additional multileaf collimator pelvic fields (postero-anterior + 2 laterolateral).

Results

The treatment data are reported according to the ICRU 62 criteria. A comparison was made between concurrent arc rotation and concomitant static boost techniques.

Conclusion

The new beam arrangement, with the use of the UDT, allows to administer different radiation doses to three volumes with different tumor cell density in order to obtain the same probability of local response in all target volumes without increasing the toxicity.
Symptomatic Neurological Epidural Metastasis with Interleukin-2 Therapy in Metastatic Renal Cell Carcinoma
Authors: Trufflandier Nathalie , Gille Olivier , Palussière Jean , Prié Loïc , Pointillart Vincent , Ravaud Alain
Published: April 2018

Interleukin-2 has known efficacy in the treatment of metastatic renal cell carcinoma but it also has adverse effects mediated by an inflammatory mechanism and capillary leak syndrome. The authors report the case of a patient with a metastatic renal cell carcinoma who had an asymptomatic intra-epidural metastasis in the thoracic spine, which became symptomatic during IL-2 administration without any recurrence after specific treatment by surgery and radiotherapy.
The First Report of Extraosseous Ewing's Sarcoma in the Rectovaginal Septum
Authors: Petković Marija , Zamolo Gordana , Muhvić Damir , Čoklo Miran , Štifter Sanja , Antulov Ronald
Published: April 2018

Aims and Background

To report an extremely rare case of Ewing's sarcoma located in the rectovaginal septum. Ewing's sarcoma is a highly malignant neoplasm of bone, which usually occurs during childhood. Common extraosseous localizations of Ewing's sarcoma include the trunk, extremities, uterus, cervix and vagina.

Methods

A 45-year-old woman presented to us with a six-month history of pain in the lower abdomen during intercourse. Pelvic examination was performed and a palpable mass was found. The mass had a size of 9 × 6 cm, a soft tissue consistency, was partially movable and the patient felt the pain during palpation. Examination of the inguinal lymph nodes revealed no signs of inguinal adenopathy. The results of laboratory tests, rectoscopy, chest X-rays, barium enema and bone scan were normal. Computed tomography (CT) showed an inhomogeneous expansive mass in the rectovaginal septum measuring 8.7 × 6.1 cm, without any signs of rectum or bladder invasion. The vascular structures of the pelvis were normal. At laparotomy the process was judged inoperable and only biopsy of the tumor mass was carried out. Histology showed a neoplasm with small, round to oval cells with scarce cytoplasm. Immunohistology with the monoclonal antibody CD99 (MIC-2 gene product, Ewing's sarcoma marker, clone 12E7, DAKO A/S, Glostrup, Denmark) revealed an extraosseous Ewing's sarcoma. The patient was treated with chemotherapy followed by whole-pelvis external beam radiation and intracavitary brachytherapy.

Results

A residual mass measuring 3.5 × 2.5 cm was visible on a control CT scan 18 months after treatment; however, the patient was feeling well and refused surgery to remove the residual mass.

Conclusions

To our knowledge this is the first reported case of extraosseous Ewing's sarcoma in the rectovaginal septum.
De Gramont Schedule is a Very Low Toxic and Effective Regimen in Low Performance Status Patients Affected by Metastatic Gastric Cancer: Preliminary Report
Authors: Rea Antonio , Caldarola Gennaro Gadaleta , Sandomenico Claudia , Colangelo Mauro , Filice Aldo , Mastroianni Candida Maria , Biamonte Rosalbino , Palazzo Salvatore
Published: April 2018

Treatment of patients affected by metastatic gastric cancer with low performance status (PS) is a very hard choice. It is mandatory to define a very well-tolerated schedule to be employed in these subgroup of patients.

Patients and Methods

From June 1999 to December 2001, 21 patients (pts) affected by metastatic gastric cancer with low performance status (≥2 ECOG) were treated with bimonthly “de Gramont” schedule. Treatment was planned to perform 6 courses of chemotherapy for each patient plus other 2-4 if a response had been documented.

Results

A total of 161 courses of de Gramont schedule was administered to the 21 pts enrolled. We observed 8 PD (38%), 8 SD (38%), 5 objective responses (24% – 2 MR, 3 PR). Duration of objective responses (OR) was 5 months, 3 months for 3 PRs and 2 and 1 months for two MRs respectively. At time of observation (June 2002) median overall survival (OS) was 14 months, median survival from the starting de Gramont schedule was 8 months. Toxicity was very mild: grade 3 leukopenia in 1 pt, grade 1-2 anemia and piastrinopenia in 3 pts, grade 1-2 nausea vomiting in 5 pts, grade 1 diarrhea in 4 pts, grade 3 mucositis in 2 pts. No other side effect was renowned. PS ameliorated in 12 (57%) pts, even if a major response was not noted.

Conclusions

de Gramont schedule can be safely and effectively employed in metastatic gastric cancer pts with very low performance status.
Surgically Proven Complete Response of Stage III Non-Small Cell Lung Cancer after Cisplatin-Enhanced Radiotherapy. Clinical Implications and Long-Term Results
Authors: Bedini Amedeo Vittorio , Tavecchio Luca , Delledonne Vincenzo , Andreani Stefano Michele
Published: April 2018

Aims and Background

Pathologic complete response in locally advanced non-small cell lung cancer is the main end point of combined therapies (chemotherapy and/or radiotherapy). Surgery after an induction treatment can improve local control, allowing the histologic assessment of treatment activity by means of resection or extensive biopsies.

Methods

Thirty patients surgically assessed without viable tumor after concurrent radiotherapy and continuous infusion of low-dose cisplatin, owing to an initially unresectable stage III non-small-cell lung cancer, were the object of evaluation to assess clinical implications, short- and long-term surgical results.

Results

The specificity rate of the preoperative restaging was 36.6%. The surgical procedures consisted of 22 resections and of extensive biopsies in 8 cases. The operative mortality was 4% (1/25) for procedures other than right pneumonectomy (3/5). No patient received postoperative chemotherapy. Eleven distant progressions, 4 local recurrences, and 4 new primary tumors were assessed as initial failures. The 8-year overall survival was 36%.

Conclusions

Pathologic complete response after cisplatin-enhanced radiotherapy cannot be satisfactorily assessed by clinical means. Surgery is required to obtain a reliable evaluation; however, right pneumonectomy should be contraindicated because of prohibitive risk. Although an effective local treatment can cure patients with advanced stage III disease, the addition of chemotherapy seems advisable to improve tumor relapse control.
HMB45 and Melan-A Expression in Renal Angiomyolipoma and Their Significance for the Diagnosis
Authors: Tuna Emine Burçin , Lebe Banu , Yörükoğlu Kutsal
Published: April 2018

Aims and Background

The melanosome-associated proteins, also called HMB45 and melan-A, are also present in renal angiomyolipoma. The aim of the present study was to evaluate the expression of HMB45 and melan-A in mesenchymal cells of renal angiomyolipoma and to investigate their significance in the differential diagnosis.

Methods

Twelve patients, 9 females and 3 males diagnosed with renal angiomyolipomas, were included in the present study. The most representative tumor tissue block was chosen from each case, and 5-üm sections were taken to poly-l-lysin-coated slides for immunohistochemical staining. The standard streptavidin-biotin immunoperoxidase method was used for immunostaining with HMB45 and melan-A antibodies.

Results

All of the cases showed positive cytoplasmic immunostaining for HMB45 and melan-A. Melan-A expression was shown in smooth muscle component, adipose tissue and predominantly in the perivascular cells, whereas HMB45 immunoreactivity was stronger than melan-A expression in all cases.

Conclusions

It was concluded that HMB45 and melan-A reactivity is a useful tool to distinguish renal angiomyolipomas from other primary and secondary mesenchymal and primary epithelial tumors. Melan-A and HMB45 share similar specificities for renal angiomyolipoma. In addition, such expression in renal angiomyolipomas may occur without any evidence of nevomelanocytic differentiation. Further research is required to determine the histogenesis of this entity.
Renal Metastasis from Thyroid Carcinoma 35 years after Detection of the Primary Tumor
Authors: Insabato Luigi , Di Vizio Dolores , De Rosa Gaetano , Prezioso Domenico , Corcione Franco , Terracciano Luigi M
Published: April 2018

A case of a solitary, unilateral, large metastatic renal tumor found 35 years after the detection of primary thyroid carcinoma is presented. Renal metastasis from thyroid carcinoma detected during life is extremely rare, and there may be a long latency period before the appearance of a secondary tumor. The possibility of a secondary tumor should always be considered in the differential diagnosis of renal neoplasms, even when the tumor is a large, unilateral, solitary renal mass.
Immunomodulation in a Treatment Program Including Pre- and Post-Operative Interleukin-2 and Chemotherapy for Childhood Osteosarcoma
Authors: Luksch Roberto , Perotti Daniela , Cefalo Graziella , Passerini Carlo Gambacorti , Massimino Maura , Spreafico Filippo , Casanova Michela , Ferrari Andrea , Terenziani Monica , Polastri Daniela , Gambirasio Felicita , Podda Marta , Bozzi Fabio , Ravagnani Fabrizio , Parmiani Giorgio , Bellani Franca Fossati
Published: April 2018

Aims and Background

The treatment applied in our Institution to children with localized osteosarcoma between 1991 and 1999 consisted of four interleukin 2 (IL-2) courses (9 x 106 IU/mL/daily x 4), alternated with pre- and post-operative polichemotherapy. The aims of the present study were to quantify the modifications of some immunological parameters induced by IL-2 and to verify whether polychemotherapy could reduce them. An additional aim was to assess whether any correlation between the immune modifications and the clinical outcome could be found.

Patients and Methods

We evaluated in 18 consecutive patients the following changes, induced in blood by each IL-2 course: number of lymphocyte subpopulations and natural killer (NK) cells, lymphokine activated killer (LAK) and NK activities.

Results

Chemotherapy did not influence the modifications of the number of NK and CD4+ cells and of the LAK and NK activities, induced by each of the four courses of IL-2. The magnitudo of the NK activity and the peak of the NK absolute counts significantly correlated with the clinical outcome.

Conclusions

The results show that the use of IL-2 permitted a repeated immune activation despite the intensive chemotherapy. Furthermore, although the limited number of cases precludes any definitive conclusion, the results suggest a possible role of the NK cells in the control of osteosarcoma.
Clinical Presentation of Peritoneal Mesothelioma
Authors: Acherman Yair IZ , Welch Laura S , Bromley Christina M , Sugarbaker Paul H
Published: April 2018

Aim

To describe the clinical presentation of peritoneal mesothelioma and its impact on survival.

Methods

Data was collected from 51 patients with peritoneal mesothelioma treated at the Washington Cancer Institute. The demographic, clinical and pathologic information were analyzed.

Results

Pain was the most common symptom (recorded in 33% of patients); increased abdominal girth occurred in 31%, increased abdominal girth and pain in 5%, and a new onset hernia in 12%. In an additional 14% of patients, a variety of other clinical findings led to the diagnosis. There was a statistically significant difference in survival by gender, weight loss and volume of disease.

Conclusions

Pain was the most common initial presenting symptom, with increased abdominal girth as a second. A more favorable prognosis occurred in women with a small disease volume.
The Nipple-Sparing Mastectomy: Early Results of a Feasibility Study of a New Application of Perioperative Radiotherapy (Eliot) in the Treatment of Breast Cancer When Mastectomy is Indicated
Authors: Petit Jean Yves , Veronesi Umberto , Orecchia Roberto , Rey Piercarlo , Didier Florence , Giraldo Andrea , Luini Alberto , De Lorenzi Francesca , Rietjens Mario , Garusi Cristina , Intra Mattia , Yamaguchi Satoru , Martella Stefano
Published: April 2018

Background

Breast cancer surgery has become less and less mutilating, however a mastectomy is required in the case of multicentric, large tumors or recurrences after conservative treatment. The removal of the nipple areola complex during the mastectomy dramatically increases the feeling of mutilation. To reduce this negative psychological impact, in cancers located outside of the central area of the breast, we propose a new type of nipple-sparing mastectomy associated with intraoperative electron beam radiotherapy (ELIOT) delivered on the region of the areola. The nipple-sparing mastectomy is performed leaving 5 mm of glandular tissue behind the nipple areola complex to preserve its blood supply. The reconstruction is immediately performed with a prosthesis or an autologous flap.

Patients and Methods

Twenty-five patients were included in the study; two of them had a bilateral nipple-sparing mastectomy.

Results

Pathological examinations demonstrated the presence of 19 infiltrating carcinomas and 8 ductal carcinoma in situ. Two patients had a superficial skin areolar slough followed by spontaneous healing. One necrosis of the areola occurred due to extensive retroareolar dissection. In the early follow-up, the color of the areola was preserved. All patients except one expressed their satisfaction of having kept their areola.

Conclusions

These preliminary results are encouraging but they require further studies to evaluate the long-term results, the local recurrence rate and the psychological impact.
Surgical Management of Cerebral Metastases from Non-Small Cell Lung Cancer
Authors: Koutras Angelos K , Marangos Markos , Kourelis Theodoros , Partheni Melpomeni , Dougenis Dimitrios , Iconomou Gregoris , Vagenakis Apostolos G , Kalofonos Haralabos P
Published: April 2018

Aims and Background

The objective of the study was to assess the efficacy of surgical resection of solitary brain metastasis in patients with non-small-cell lung cancer.

Methods and Study Design

We report a retrospective analysis of 32 patients with single brain metastasis surgically excised at our hospital. All but one patient underwent postoperative whole brain radiation therapy.

Results

The median survival of patients was 12.5 months postoperatively (mean, 17 months), and the overall 1-year survival was 53%. Thirteen patients had recurrence of brain metastasis: 6 of 13 underwent reoperation for the recurrent lesion, and 1 of the 6 patients had a third craniotomy. Baseline characteristics, which significantly influenced survival, included age less than 60 years, tumor histology (ie, adenocarcinoma), and treatment of the primary lung cancer. The analysis did not yield any significant differences between treatment modalities.

Conclusions

Our findings correspond well with those reported in the literature and suggest that surgical resection of single brain metastasis in patients with non-small cell lung cancer can improve survival over conservative management. Furthermore, surgical treatment of the primary tumor and the single brain metastasis, combined or not with radiotherapy and chemotherapy, represents an approach that merits further investigation with more patients and a prospective longitudinal design.
Feasibility of Intensity-Modulated Radiation Therapy in the Treatment of Advanced Cervical Chordoma
Authors: Gabriele Pietro , Macias Victor , Stasi Michele , Chauvie Stéphane , Munoz Fernando , Delmastro Elena , Scielzo Giuseppe
Published: April 2018

Aims and Background

Postoperative radiation is often given in cases of cervical chordoma because of the high incidence of local recurrence. The tumor mass usually surrounds the spinal cord and infiltrates vertebral bone. A combined technique using protons or electrons to boost the initial photon fields is generally applied. We evaluated the use of dynamic intensity-modulated radiation therapy as an alternative technique for treating advanced cervical chordoma.

Methods and Study Design

A female patient with incomplete resection of a vertebral chordoma surrounding C2-C3 was irradiated with a total dose of 58 Gy (ICRU point) in 2 Gy daily fractions for 29 days between December 2001 and January 2002. Beam arrangement consisted of seven 6 MV non-opposed coplanar fields. Pretreatment quality assurance included checking of the absolute dose at reference points and 2D dose map analysis. Treatment was delivered with a 120-leaf collimator in sliding window mode. To verify the daily setup, portal images at 0° and 90° were compared with the simulation images before treatment delivery (manual matching) and after treatment delivery (automatic anatomy matching).

Results and Conclusions

The mean dose to the planning target volume (PTV) was 57.6 ± 2.1 Gy covering 95% of the PTV per 95% isodose. The minimum dose to the PTV (D99) was 53.6 Gy in the overlapping area between the PTV and the spinal cord planning organ at risk volume (PRV). The maximum dose to the spinal cord was 42.2 Gy and to the spinal cord PRV (8 mm margin) 53.7 Gy. The mean dose to the parotid glands was 37.4 Gy (homolateral gland) and 19.5 Gy (contralateral gland). Average deviation in setup was -1.1 ± 2.5 mm (anterior-posterior), 2.4 ±1.3 mm (latero-lateral), 0.7 ± 0.9 mm (craniocaudal) and -0.43 ± 1° (rotation).

Conclusions

In the treatment of chordomas surrounding the spinal cord, intensity-modulated radiotherapy can provide high dose homogeneity and PTV coverage. Frequent digital portal image-based setup control is able to reduce random positioning errors for head and neck cancer patients immobilized with conventional thermoplastic masks.
Cisplatin may be a Valid Alternative Approach in Ovarian Carcinoma with Carboplatin Hypersensitivity. Report of Three Cases
Authors: Libra Massimo , Sorio Roberto , Buonadonna Angela , Berretta Massimiliano , Stefanovski Peter , Toffoli Giuseppe , Mazzaglia Giovanna , Cordani Nicoletta , Stivala Franca , Boiocchi Mauro
Published: April 2018

Platinum-based therapy is considered the standard treatment for patients with advanced ovarian cancer. Carboplatin has a more favorable toxicity profile than cisplatin; however, hypersensitivity reactions to carboplatin have been reported occasionally. We reviewed 112 cases of ovarian cancer treated with carboplatin at our institute to identify the hypersensitivity reactions to this chemotherapeutic agent. Hypersensitivity reactions were documented in nine cases (8%). No deaths occurred, but the reactions were judged severe in three of the 112 patients (2.6%). In our own experience with patients showing idiosyncrasy to carboplatin we observed successful resolution after retreatment with cisplatin. Since patients who relapse after initial treatment with carboplatin often respond to it a second time, it is important to continue this treatment.
Leiomyosarcoma of the Larynx
Authors: Preti Giuliana , Palonta Francesca , Vione Nicola , Rosso Paola , Cavalot Andrea Luigi
Published: April 2018

Leiomyosarcoma involving the larynx is extremely rare and may be difficult to diagnose. Because of the rarity of this tumor, little information exists on its long-term follow-up and optimal management. We present a review of the literature and report on a patient with leiomyosarcoma of the larynx treated with surgery and postoperative irradiation. In addition, the diagnosis and treatment of leiomyosarcoma are discussed. At six months’ follow-up the patient showed no signs of local recurrence but had developed metastases to both lungs.
Small Cell Carcinoma of the Urinary Bladder. A Clinicopathologic Study of Five Cases
Authors: Kanat Ozkan , Evrensel Turkkan , Adim Saduman Balaban , Yavascaoglu Ismet , Kurt Ender , Demiray Mutlu , Gonullu Guzin , Manavoglu Osman
Published: April 2018

Aims and Background

Small cell carcinoma of the bladder (SCCB) is a rare entity characterized clinically by an aggressive behavior with a high incidence of systemic metastases. We report the clinicopathologic findings of five cases.

Methods

We reviewed five consecutive patients with SCCB treated at our institute. In each case the following clinical data were recorded: age, sex, presenting symptoms, endoscopically determined location of the tumor, clinical staging, node involvement (if any), site of metastases (if any), treatment, follow-up and outcome.

Results

There were four male and one female patients, age range 42 to 68 years, mean 57.6 years. The clinical presentation was not different from conventional transitional cell carcinoma, with hematuria being the most frequent complaint (four cases). Microscopic examination revealed oat cells in three cases and an intermediate variant in one. At the time of diagnosis the tumors were staged as T3bN2M0, T2N2M0, T4N0M0, T3aN0M0, and T2N0M0. Primary therapy consisted of radical cystectomy alone (one case), transurethral resection (TUR) alone (one case), TUR with chemotherapy (two cases), or TUR with chemotherapy and radiotherapy (one case). Four patients died of progressive disease, with survival from the time of diagnosis ranging from 7 to 16 months (mean, 12.2 months). One patient died of myocardial infarction (unrelated to the primary disease) one month after diagnosis.

Conclusion

Our study indicates that primary small cell carcinoma of the urinary bladder is as aggressive as its pulmonary counterpart and the overall prognosis of this tumor is very poor.
Cancer Invasion: Watch Your Neighbourhood!
Authors: Quaranta Vito , Giannelli Gianluigi
Published: April 2018

The critical event in neoplastic diseases is the invasion of surrounding tissue by cancer cells. This event greatly reduces treatment options, and makes cancer a lethal disease. Factors that initiate cancer invasion are not well understood, neither do we have mechanistic insights in the process itself. Recently, a new concept has emerged: the tissue surrounding tumor cells, ie, the tumor microenvironment, may play an important, if not decisive role in triggering invasion. This concept is based on data from many laboratories working on the cell biology of cancer invasion. In this review, we survey several components of the tumor microenvironment, including extracellular matrix macromolecules, metalloproteinases and soluble factors, and discuss their potential involvement in stimulating cancer cell motility. These novel views may have far-reaching consequences, since “normal” tissue microenvironment components, rather than the traditional tumor cells themselves, may eventually become targets for devising new treatments that prevent, inhibit or block cancer invasion and metastasis.
Cancer Incidence in Suriname from 1980 through 2000 a Descriptive Study
Authors: Mans Dennis Ricardo August , Mohamedradja Rabia Natasha , Hoeblal Aartie Reena Debie , Rampadarath Roshnidevi , Joe Susan Soei-Len Tjin A , Wong Jennifer , Ramautar Prakash , Mahabier Roël , Vrede Martinus Albertus
Published: April 2018

Background and aims

Current data on the epidemiology of cancer in the Republic of Suriname are scant and incomplete. In this study, incidence rates of the histopathologically confirmed malignancies in the country from 1980 through 2000 were inventoried.

Patients and methods

Numbers of diagnoses, as well as patient information, were acquired from the Pathology Laboratory. The General Bureau of Statistics of Suriname provided relevant demographic information. For each year, crude incidence and sex-specific rates were calculated for: cancer overall; the most frequent cancer sites; age strata 0-19, 20-49, and 50+ years; as well as for the presumably largest, second largest, and third largest ethnic group, viz. the Hindustani, Creole, and Javanese. From these data, average rates were calculated, which were expressed as mean ± SD per 100,000 population per year, or per 100,000 males or females per year.

Results

Average yearly crude and sex-specific incidence rates for cancer overall were 70 ± 12: 59 ± 9 for men and 83 ± 12 for women. The leading cancer sites were cervix uteri (sex-specific rate of 22.1 ± 5.1) as well as gastrointestinal tract, breast, hematological system, prostate, head and neck, lung, and liver (sex-specific rates ranging from 2 to 17). The relatively high rate of cervical cancer was for an important part responsible for the 1.4-fold female over male overall cancer excess. Incidence rates of most cancers increased from age group 20-49 years on, being highest after age 50+ years, but hematological malignancies occurred in all age groups with rates of 1-3 new cases per 100,000 males or females per year. Cancer was in general 2-6 times more common in Creole than in Hindustani and Javanese. However, cervical cancer was seen as often in Hindustani as in Creole. Most cases of primary liver cancer involved, besides Creole of both genders, Javanese males. Thyroid cancer occurred more frequently in Hindustani women.

Conclusions

The data from the study suggest that the incidence profile of cancer in Suriname may resemble that of most developing countries. It was relatively low for cancer overall as well as for most individual sites, but relatively high for cervical cancer, thus producing the characteristic female over male excess. More detailed studies on the peculiarities in the ethnic distribution of cancer may help to shed more light on the etiology of certain malignancies.
A Phase I Study of Gemcitabine Combined with Vinblastine in Patients with Solid Tumors
Authors: Capuchino Izabel , Suarez Eloah Rabello , del Giglio Auro
Published: April 2018

Aims and background

Gemcitabine and vinblastine are chemotherapeutic drugs with a wide spectrum of antitumor activity. We conducted a phase I trial to define the maximal tolerated dose of this combination.

Methods

Twenty-nine patients with a variety of solid tumors with measurable disease were included. Twenty-seven of these patients had been previously treated with chemotherapy. The use of hematological growth factors was not allowed. The maximal tolerated dose was defined as the level in which WHO grades 3 or 4 non-hematological toxicity would occur in at least a third of the patients.

Results

The maximal tolerated dose was reached at level 5, which consisted of gemcitabine (1000 mg/m2) with vinblastine (3 mg/m2) given intravenously on days 1, 8 and 15 every 28 days. At this level, one patient had WHO grade 3 cerebellar toxicity and another WHO grade 4 anorexia. Furthermore, patients were able to receive all 3 weekly doses of chemotherapy in only 2 out of 10 cycles of treatment given at this level. We also observed 5 episodes of WHO grades 1 and 2 neuropathy, most of which (4/5) occurred in patients previously exposed to neurotoxic chemotherapy. We recorded 2 partial responses (one at level 3 and the other at level 4) and 8 instances of stable disease after 3 scheduled cycles of the combination.

Conclusions

We therefore recommend gemcitabine (1100 mg/m2) plus vinblastine (5.5 mg/m2) given on days 1 and 8 every 21 days (level 4) for previously treated patients with solid tumors, with special caution in patients previously exposed to neurotoxic chemotherapy.
Does Early Polypoid Colorectal Cancer with Depression Have a Pathway Other than Adenoma-Carcinoma Sequence?
Authors: Kanazawa Takamitsu , Watanabe Toshiaki , Nagawa Hirokazu
Published: April 2018

In the carcinogenesis of colorectal cancer, the concept of adenoma-carcinoma sequence is widely accepted. In this pathway, polypoid adenoma develops into early polypoid cancer and then progresses to advanced cancer. Alternatively, some groups insist that in the de novo pathway in which early cancers develop without preexisting adenoma, flat or depressed early cancers develop into advanced cancer. According to these two different concepts of carcinogenesis, early polypoid cancers may include two distinct types of lesions, early polypoid cancers without central depression via the adenoma-carcinoma sequence and early polypoid cancers with central depression via de novo carcinogenesis. We analyzed 45 submucosal cancer specimens histologically diagnosed as polypoid by clinicopathological features and K-ras mutation in early polypoid cancers with and without depression to clarify whether there was a difference between the two groups. No significant difference in clinicopathological features was found between the two groups. Also, a high incidence of K-ras mutation was observed in both groups. This suggests that early polypoid cancers with depression have a similar genetic background to polypoid cancers without depression, which follows the adenoma-carcinoma sequence. It is possible that whether or not the tumor has a depression does not indicate the distinct pathway of colorectal carcinogenesis.
Relationship between Plasma Fatty Acid Composition and Diet over Previous Years in the Italian Centers of the European Prospective Investigation into Cancer and Nutrition (EPIC)
Authors: Fusconi Elisabetta , Pala Valeria , Riboli Elio , Vineis Paolo , Sacerdote Carlotta , Del Pezzo Mariarosaria , de Magistris Maria Santucci , Palli Domenico , Masala Giovanna , Sieri Sabina , Foggetti Carmela Eugenia , Giurdanella Maria Concetta , Tumino Rosario , Krogh Vittorio
Published: April 2018

Fatty acid levels in plasma phospholipids were related to food intake over the previous year as estimated by semiquantitative food frequency questionnaires compiled by 280 men and 246 women from the EPIC centers of Varese, Turin, Florence and Ragusa (Italy). Fatty acid content was determined by gas chromatography and analyzed in relation to age, sex and center. The most important finding was that plasma monounsaturated fatty acid levels, mainly oleic acid, were associated with olive oil consumption (r = 0.28 men, r = 0.19 women, both P <0.01). To our knowledge, this is the first time that these nonessential plasma fatty acids have been related to their dietary source in a population eating a varied and freely chosen diet. We confirmed that long-chain n-3 fatty acids in plasma phospholipids are associated with fish consumption and that odd chain 15: 0 and 17: 0 fatty acid levels are associated with dairy products and pizza-with-mozzarella consumption. N-6 polyunsaturated fatty acid levels reflected dietary intake of seed oils, mayonnaise and biscuits. Alcohol intake was positively associated with palmitic and palmitoleic acid and negatively associated with linoleic acid. These associations suggest indirect relations between alcohol consumption and other features of diet, and also that ethanol has an effect on fat metabolism. We found numerous indirect relationships (ie, not due to dietary consumption of food sources of the fatty acids) between plasma fatty acids and diet, which we propose as due to the influence of complex life-style factors.
The Florence City Sample: Dietary and Life-Style Habits of a Representative Sample of Adult Residents. A Comparison with the Epic-Florence Volunteers
Authors: Masala Giovanna , Assedi Melania , Saieva Calogero , Salvini Simonetta , Cordopatri Giovanna , Ermini Ilaria , del Carmen Martinez Maria , Tanzini Donata , Zacchi Silvia , Cerati Marco , Palli Domenico
Published: April 2018

A representative sample of the general population residing in the city of Florence was invited to participate in the local section of the EPIC study with two major aims: i) to carry out a population-based survey on dietary and life-style habits in this urban area of Tuscany, Central Italy; ii) to compare these results with a large series of EPIC volunteers residing in the same municipality in order to evaluate the differences between the two groups. A random sample of 500 residents (250 women) aged 40-64 years, was invited to participate in the study; 362/500 (72.4%) accepted and followed the EPIC protocol. The distribution of selected individual characteristics (including measured weight and height) showed a high prevalence of being overweight in men (52.2%) and obesity in both sexes (17.4% in men and 12.5% in women). A dietary pattern characterized by a high consumption of red meat, processed meats, olive oil and wine emerged in both sexes; the consumption of vegetables and fresh fruit was approximately 200 and 300 g/day, respectively. The estimated mean intakes of macronutrients reflected this pattern, with a high mean intake of total fat and protein. The mean contribution to total caloric intake provided by fat was 30.9% and 33.6% in these randomly sampled men and women, respectively. The results were compared with those of 9,123 Florence residents aged 40-64 years and enrolled as EPIC volunteers. Current smokers and less educated subjects were less represented among male volunteers, who, in general, showed a healthier dietary pattern (more fresh fruit and less spirits). Female volunteers were taller and heavier and consumed more fresh fruit but also more beef and less carbohydrates. Other statistically significant differences emerged, but the absolute values of these differences were usually modest and the two groups appeared remarkably similar. Overall, our results suggest that the large EPIC-Florence cohort was not strictly selected and showed a total caloric intake and a range of dietary variability similar to that of the general population of the same area.
Case-Control Study of Anaplastic Thyroid Cancer
Authors: Zivaljevic Vladan , Vlajinac Hristina , Jankovic Radovan , Marinkovic Jelena , Diklic Aleksandar , Paunovic Ivan
Published: April 2018

Aims and background

The aim of the present study was to test some hypothetical risk factors for anaplastic thyroid cancer.

Study design

A case-control study comprised 110 patients with histologically or cytologically verified anaplastic thyroid cancer and 110 hospital controls individually matched with cases by sex, age, place of residence and time of hospitalization. Univariate and multivariate logistic regressions were used for data analysis.

Results

According to the conditional logistic regression analysis, the following factors were significantly and independently related to anaplastic thyroid cancer: history of goiter or thyroid nodules (odds ratio, OR, 37.55; 95% confidence interval, CI, 4.86–290.11), history of residence in endemic goiter area (OR, 2.56; 95% CI, 1.05–6.22), history of previous malignant non-thyroid tumor (OR, 5.51; 95% CI, 1.04–29.25), diabetes mellitus (OR, 4.06; 95% CI, 1.29–12.81) and low educational level (OR, 2.44; 95% CI, 1.17–5.06).

Conclusions

The results are in line with the current knowledge on factors related to thyroid cancer, except for the association between thyroid cancer and diabetes mellitus, which as far as we know has not yet been reported.
Contralateral Parotid-Sparing Radiotherapy in Patients with Unilateral Squamous Cell Carcinoma of the Head and Neck: Technical Methodology and Preliminary Results
Authors: Corvò Renzo , Foppiano Franca , Bacigalupo Almalina , Berretta Laura , Benasso Marco , Vitale Vito
Published: April 2018

Aims and background

Radiation-induced permanent xerostomia occurs frequently in patients affected by squamous cell carcinoma of the head and neck treated by parallel opposed lateral fields. An ipsilateral technique by using co-planar multiple-field arrangement was designed to restrict treatment to the primary tumor and neck on the same side for patients with selected lateralized squamous cell carcinoma of the head and neck.

Methods

From November 2001 till December 2002, 30 patients affected by squamous cell carcinoma of tonsillar fossa, retro-molar trigone, alveolar ridge and oropharyngeal lateral wall were included in this investigational trial and treated with an ipsilateral multiple field technique: in detail, oblique opposed two upper half fields were planned ipsilaterally to the squamous cell carcinoma site to cover PTV1 and PTV2, whereas an anterior-lower half field was planned to encompass the lower neck node area above clavicles. On CT scans, the contralateral parotid gland was outlined as organ at risk and the contralateral upper lymph node area was contoured as volume of interest. In selected cases, convergent oblique two wedge-pair half fields were added to opposed oblique two-field technique in order to cover only PTV2: generally, in these patients, PTV1 received 1.8 Gy per fraction and PTV2 2.2 Gy per fraction up to total doses of 54 Gy and 66 Gy, respectively.

Results

Ten patients received radical radiotherapy, 9 patients radical alternating chemo-radiotherapy, and 11 patients adjuvant radiotherapy. At the end of treatment, unilateral confluent mucositis was recorded in 13 (43%) patients and unilateral moist skin epidermolysis in 14 (46%) patients. Six months after the end of radiotherapy, grade 0 xerostomia was recorded in 20 (67%) patients. No patient experienced grade 2+ xerostomia. At a median follow-up of 12 months, 26 (86%) patients were alive and well; 2 patients (6%) developed contralateral neck node failure, both 4 months after the end of ipsilateral radiotherapy.

Conclusions

These results, although preliminary, suggest that by using an ipsilateral radiotherapy technique, symptomatic xerostomia may be avoided in selected patients with lateralized squamous cell carcinoma of the head and neck without an increased short-term risk of contralateral nodal failure.
Comparative Evaluation of Two Hypofractionated Radiotherapy Regimens for Painful Bone Metastases
Authors: Amichetti Maurizio , Orrù Paola , Madeddu Angela , Murtas Rita , Carau Barbara , Farigu Roberta , Carta Serena , Orrù Silvia , Nagliati Michele , Lay Giancarlo , Dessì Marina
Published: April 2018

Aims and background

In 75% of the patients with bone metastases (BM) pain is the dominant symptom. Radiotherapy (XRT) plays a major role in the palliation of pain in patients with BM. Several schedules of short and long fractionation XRT are used in clinical practice, with hypofractionated treatments being even more attractive for practical reasons. A considerable body of evidence supports the clinical use of short schedules and single-dose XRT. We retrospectively evaluated the efficacy of two short fractionated schedules of 8 Gy as a single dose and 20 Gy in 5 fractions in relieving pain in patients with multiple uncomplicated BM.

Method

From January to December 2001, 130 patients with 146 painful BM were treated with palliative localized XRT. There were 42 males and 88 females with a median age of 58 years (range 28–84). The commonest sites of treatment were the spine (59.6%) and pelvis (14.4%). The primary endpoint was clinically significant pain relief in the first six months of follow-up evaluated with the IAEA (International Atomic Energy Agency) pain measurement score measuring pain severity and pain frequency. Analgesic use was also recorded before and after treatment as drug frequency and drug severity. Patients with painful BM from any primary tumor site were irradiated. Treatment schedules consisted of a course of XRT with 4 Gy/fraction/day (total dose: 20 Gy/5 fractions) (group A, 59 lesions) or with a single dose of 8 Gy (group B, 87 lesions).

Results

There was no significant difference in complete response (CR) rates between treatment schedules: complete pain relief was achieved in 17/59 lesions (29%) in the fractionated group and in 29/87 lesions (33%) in the single-dose group. Also the overall response (complete + partial) was similar: 35/59 lesions (60%) in group A and 60/87 (69%) in group B. The minimum, maximum and median follow-up was 3, 23, and 9 months, respectively, for group A and 3, 20, and 11 months for group B. The actuarial median duration of pain relief was similar: 4.5 months in group A and 4 months in group B. No particular side effects were recorded in either group.

Conclusions

There were no differences between the two fractionation schedules used in our study with regard to pain relief and use of analgesics. Palliation of pain was obtained in approximately two thirds of patients with both schedules, providing further evidence of the similar efficacy between single and multiple fractions. With regard to pain response these data justify a recommendation for the use of a more simple and convenient 8 Gy single fraction for the palliation of uncomplicated BM.
Paraneoplastic Nephrotic Syndrome in Advanced Breast Cancer Patient. A Case Report
Authors: Valcamonico Francesca , Ferrari Vittorio , Simoncini Edda , Gregorini Gina , Vassalli Lucia , Amoroso Vito , Marpicati Patrizia , Rangoni Giovanni , Mambrini Andrea , Marini Giovanni
Published: April 2018

A case of paraneoplastic nephrotic syndrome (NS) is described five years after the diagnosis of breast cancer. A review of the literature shows that NS is a rare complication of breast carcinoma.
Persistent Human Papilloma Virus Infection as an Indicator of Risk of Recurrence of High-Grade Cervical Intraepithelial Neoplasia Treated by the Loop Electrosurgical Excision Procedure
Authors: Cecchini Silvia , Carozzi Francesca , Confortini Massimo , Zappa Marco , Ciatto Stefano
Published: April 2018

Objective

To evaluate the recurrence rate of high-grade cervical intraepithelial neoplasia (CIN) treated by the loop electrosurgical excision procedure (LEEP) according to the persistence of human papilloma virus (HPV) infection.

Design

Prospective observational study.

Setting

The Florence District screening program for cervical cancer.

Sample

Eighty-four cases of CIN2/3 consecutively treated by LEEP and actively followed up.

Method

Cases underwent HPV testing (polymerase chain reaction) prior to LEEP and after 6 months, and then cyto-colposcopic followup every 6 months.

Main outcomes measures

Recurrence was defined as histological evidence of high-grade CIN. The association of recurrence to age and CIN grade at treatment and to cytologic and HPV test findings at recurrence was determined.

Results

The average recurrence rate was 11.9% (10/84 cases; 95% CI, 5.9-20.8%). Recurrence probability was not significantly associated to age (χ2 = 0.25, df = 2, P = 0.88) or CIN grade (CIN 3 = 8/57, CIN2 = 2/27, χ2 = 0.26, df = 1, P = 0.6), whereas a significant association was evident for the cytology report (<LSIL = 6/76, HSIL ≥4/8, χ2 = 8.55, df = 1, P = 0.003) and HPV testing (absent = 1/48, present = 9/36, χ2 = 8.23, df = 1, P = 0.004).

Conclusions

Most CIN2> recurrences after LEEP occur in subjects with persistent HPV infection. Subjects with negative findings at cytology, colposcopy and HPV testing are at negligible risk of recurrence and might return safely to standard screening protocol.