bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence in the use of Complementary Medicine among Cancer Patients in Tuscany, Italy
Authors: Johannessen Helle , Von Bornemann Hjelmborg Jacob , Pasquarelli Elisa , Fiorentini Giammaria , Di Costanzo Francesco , Miccinesi Guido
Published: February 2018

Aims and Background

A previous survey by Molassiotis et al. (Ann Oncol, 16: 655–663, 2005) on the use of complementary and alternative medicines (CAM) among cancer patients in Europe reported that 73% of the Italian cancer patients had used CAM, a number well above the European average of 36%. Some national variation in preference of CAM was reported, and Italian cancer patients were reported to have high use of homeopathy, herbal medicine, and spiritual therapies. The difference between CAM use in Italy and other European countries intrigued a further investigation of CAM use among Italian cancer patients.

Methods

A survey using the same questionnaire as Molassiotis et al. was conducted at two oncology day hospitals in Tuscany and included 132 patients (55% male, 45% female, with various forms of cancer) on chemotherapy. The response rate was 71%.

Results

The incidence of CAM use after the cancer diagnosis among the Tuscan cancer patients was 17%. The most widely used forms were herbal medicine (52%), homeopathy (30%) and acupuncture (13%). Use was higher in the urban area and among women, breast cancer patients, and persons with a higher education. These results agree with results of other studies on the use of CAM among Italians and Europeans in general, as well as among cancer patients in Italy.

Conclusions

The high prevalence of CAM use among Italians reported by Molassiotis et al. cannot be regarded a national estimate on the use of CAM for cancer in Italy. Rather it may reflect a relatively high use of CAM in palliative care, in Northern Italy and in urban areas. CAM use among Italians in general as well as among Tuscan cancer patients in chemotherapy is modest compared with the overall European use and reflects a general high use of CAM among urbanites, women and those with a higher education. Most commonly used forms of CAM are herbal medicine and homeopathy.
Refractory Pleural Small Cell Carcinoma in Never Smoker. A Case Report
Authors: Tiseo Marcello , Spiritelli Elena , Capelletti Marzia , Rindi Guido , Ardizzoni Andrea
Published: February 2018

A 47-year-old woman who had never smoked was evaluated for chest wall pain, cough and dyspnea that proved to be due to neoplastic right pleural disease with effusion. Cytological examination of the pleural fluid and histological analysis of a biopsy specimen of the pleural mass obtained during thoracoscopy were consistent with a diagnosis of small cell carcinoma. The patient was treated with two lines of chemotherapy and with octreotide, but without any clinical or radiological benefit. Since there was immunohistochemical overexpression of epidermal growth factor receptor, the patient was treated with gefitinib. Despite an initial clinical improvement she died due to disease progression. This case of a refractory pleural small cell carcinoma, which is an extremely rare disease, is the first reported in a never smoker and the first to be fully characterized for EGFR status.
Carcinoma Originating from Aberrant Breast Tissue. A Case Report and Review of the Literature
Authors: Kahraman-Cetintas Sibel , Turan-Ozdemir Senem , Topal Ugur , Kurt Meral , Gokgoz Sehsuvar , Saraydaroglu Ozlem , Ozkan Lutfi
Published: February 2018

Carcinoma arising from ectopic breast tissue, either supernumerary breast or aberrant breast tissue, is extremely rare. Carcinoma occurs more frequently in the ectopic breast tissue of the axilla than in extra-axillary ectopic breast tissue. Here we report a case of an invasive lobular carcinoma arising from extra-axillary ectopic breast tissue and presenting as a subcutaneous nodule.
Radiochemotherapy with Cisplatin and Oral Tegafur in Advanced Head and Neck Cancer: Long-Term Results of a Phase II Study
Authors: De La Torre Alejandro , Romero Jesus , Montero Angel , Garcia-Berrocal M Isabel , Valcarcel Francisco J , Cordoba Sofia , Magallon Rosa
Published: February 2018

Aims and Background

To evaluate the tolerance and efficacy of an original concurrent radiochemotherapy regimen in locally advanced head and neck cancer.

Methods

Sixty-four patients with stage III or IV squamous cell carcinoma arising from a head and neck mucosal site were eligible. Simultaneous radiochemotherapy consisted of two courses of continuous infusional cisplatin (20 mg/m2/d, days 1–4 and 29–32) and oral tegafur (1200 mg/d, days 1–14 and 29–43), together with conventional radiation therapy up to a total dose of 70–75 Gy over nine weeks.

Results

All the patients were evaluated for toxicity and response. Acute mucositis was the most prevalent complication. Grade 3 toxicities were mucositis (44%), skin toxicity (10%), leukopenia (8%), and thrombocytopenia (1%). No toxic death was observed. Complete response to treatment was observed in 72% of patients. With a median follow-up of 48.5 months (range, 27–84), 5-year actuarial rate of local-regional control, disease-free survival, overall survival and disease-specific survival were 60% (95% confidence interval [CI], 40–70%), 55% (95% CI, 45–65%), 51% (95% CI, 43–59%) and 61% (95% CI, 53–69%), respectively.

Conclusions

Response, local-regional control and survival rates are equivalent to those reported from other concomitant radiochemotherapy combinations. However, the regimen offers the advantage of its tolerance and toxicity profile.
Stromal Tumors of the Stomach: A Clinicopathological Study of 15 Cases and Review of the Literature
Authors: Galateros George , Simatos George , Lakiotis Gregorios , Stathaki Martha , Volteas Spyros , Kafiri Georgia , Theologi Varvara
Published: February 2018

Aims and Background

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the digestive tract, although their incidence is low. These tumors make up a unique entity based on their molecular pathogenesis, immunohistochemical staining and responsiveness to targeted therapy. Gastrointestinal stromal tumors vary in malignant potential ranging from small incidentally detected tumors with an excellent outcome to aggressive sarcomas. Their optimal diagnostic approach and treatment remain a matter of debate. We present our experience in this rapidly moving field.

Methods

We present our experience on 15 patients presented during a 5-year period (June 2000-September 2005) with gastrointestinal stromal tumors located in the stomach.

Results

Upper gastrointestinal endoscopy and CT scan revealed the tumors in all cases. All patients underwent curative surgery. A definitive diagnosis was established after surgery.

Conclusions

Although an inverse correlation between level of risk and survival of patients with gastrointestinal stromal tumors has been observed, 6 of our patients with an intermediate risk of recurrence had a favorable outcome.
RNA Interference-Mediated Silencing of the Hsp70 Gene Inhibits Human Gastric Cancer Cell Growth and Induces Apoptosis in Vitro and in Vivo
Authors: Xiang Ting-Xiu , Li Yan , Jiang Zheng , Huang Ai-Long , Luo Cong , Zhan Bin , Wang Pi-Long , Tao Xiao-Hong
Published: February 2018

Aims and Background

The role of heat shock protein (HSP) 70 in gastric cancer has been extensively examined in many studies for the past decade. It has been demonstrated that over-expression of Hsp70 might play important role in malignant transformation and maintenance of malignant phenotypes. Therefore, silencing the Hsp70 gene could be applicable in molecular therapies of human gastric cancer. Herein, we designed a small interfering RNA targeting Hsp70 to knock down its expression and investigated its effect on cell proliferation and apoptosis in a gastric cancer cell line.

Methods

Two plasmids (phsp1-siRNA, phsp2-siRNA), along with a negative control (phsp3-siRNA), were created using a genic recombination technique. BGC823 cell lines were used to perform experiments. Western blotting and RT-PCR were used to detect Hsp70 expression in vitro and in vivo. Cell morphology was observed under light microscope. Cell cycle and apoptosis were analyzed by flow cytometry and acridine orange/ethidium bromide double stain, and cell proliferative activity was measured by alamarblue assay. In all experiments, a negative control served as a baseline measure.

Results

We successfully constructed phsps-siRNA plasmids and transfected them into BGC823 cells. RT-PCR and western blotting revealed that the expression of Hsp70 was down-regulated in transfection groups compared with the control group. Flow cytometric analysis indicated that less S-phase fraction accumulated in small interfering RNA transfected cells than in parental cells and the cells transfected with empty vector.

Conclusions

Our results demonstrated that RNAi against Hsp70 could effectively knock down gene expression, inhibit growth of cancer cells, induce cell cycle arrest and increase cell apoptosis in vitro and in vivo. Hsp70 might serve as a therapeutic target for human gastric cancer.
5-HTTLPR Polymorphism of Serotonin Transporter and Effects of Sertraline in Terminally Ill Cancer Patients: Report of Eleven Cases
Authors: Schillani Giulia , Capozzo Maria Anna , Aguglia Eugenio , De Vanna Maurizio , Grassi Luigi , Conte Maria Anna , Giraldi Tullio
Published: February 2018

Depression is difficult to detect in cancer patients, though its determination offers an opportunity to relieve patients’ suffering in palliative care. Selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice for mood disorders, but they show a highly variable response. The short allelic variants “s/s” and “s/l” of the 5-HTTLPR polymorphism in the promoter region of the serotonin transporter gene has been consistently associated with a poorer response to SSRIs. The aim of this study has therefore been to examine depression, anxiety and mental adaptation to cancer in terminally ill and depressed cancer patients, in relation to treatment with sertraline and to the 5-HTTLPR genetic polymorphism. Eleven consecutive depressed patients with different forms of advanced cancer who were admitted to the Hospice of the Casa di Cura “Pineta del Carso” (Trieste, Italy) were treated with sertraline for two weeks and their response was determined and related to 5-HTTLPR.

Sertraline significantly reduced the average depression and anxiety subscale scores of HADS, as well as the scores of the subscales of Mini-MAC. When the effects of sertraline were analyzed in relation to the 5-HTTLPR polymorphism, only patients with the “l/l” allelic variant had significantly lower scores of HADS anxiety, Mini-MAC hopelessness-helplessness and anxious preoccupation, and a higher score for the fighting spirit of Mini-MAC; the depression score was significantly reduced in patients with both allelic variants. These data indicate that sertraline is effective after two weeks of treatment in terminally ill cancer patients, acting not only on depression but also on anxiety and mental adaptation to cancer. Moreover, the effect of sertraline significantly depended on the genetic polymorphism of the serotonin transporter, being more pronounced in patients carrying the “l/l” genetic variant; these findings seem to encourage the examination of a larger sample of patients.
Hepatogastric Inflammatory Pseudotumor Presumably Deriving from Prior Amebic Infection
Authors: Alfieri Rita , Alaggio Rita , Ruol Alberto , Castoro Carlo , Cagol Matteo , Michieletto Silvia , Pomerri Fabio , Acquaviva Antonio , Ancona Ermanno
Published: February 2018

Introduction

Inflammatory pseudotumor is a rare entity with a clinical and radiographic presentation that is difficult to differentiate from malignancy. This is a case report of a large hepatogastric inflammatory pseudotumor that presumably developed from a prior amebic pseudocyst.

Case Report

A 14-year-old boy presented with increasing vomiting, epigastric pain, dysphagia, asthenia and weight loss. The clinical history included an amebic infection at the age of 2 months. Instrumental investigations revealed an 8 x 6 cm left subdiaphragmatic mass inseparable from the gastric fundus, which appeared to infiltrate the left hepatic lobe. Surgery disclosed a bulky mass adhering to the gastric fundus and left hepatic lobe that prompted total gastrectomy, resection of the second and third hepatic segments, and Roux-en-Y esophagojejunal loop anastomosis. Histology subsequently confirmed that this was a pseudocyst with a large calcified nucleus surrounded by myofibroblastic proliferation associated with a diffuse lymphoplasmacytic infiltrate affecting the gastric wall and hepatic parenchyma, hence the final diagnosis of inflammatory pseudotumor, presumably in response to a prior amebic pseudocyst.

Conclusions

Inflammatory pseudotumor is a rare entity that is seldom found in the stomach. The particular interest of the present case lies in the fact that it developed in the stomach and liver, presumably deriving from a previous amebic pseudocyst.
Unusual Presentation of Metastatic Hepatocellular Carcinoma in an HIV/HCV Coinfected Patient: Case Report and Review of the Literature
Authors: Berretta Massimiliano , Zanet Ernesto , Di Benedetto Fabrizio , Simonelli Cecilia , Bearz Alessandra , Morra Aldo , Bonanno Santo , Berretta Salvatore , Tirelli Umberto
Published: February 2018

Hepatocellular carcinoma (HCC) is an increasing cause of mortality in human immunodeficiency virus (HIV) seropositive patients. Concurrent infection with HIV may accelerate the progression from cirrhosis to HCC. Viral hepatitis and alcohol abuse are the main risk factors for HCC in developed countries. Exposure to these risk factors is common among HIV-infected patients. We report the case of a 43-year-old woman affected by HCC, with unusual soft tissue metastases (left masseter muscle) and HIV/HCV coinfection. The usual route of metastatic spread from classic HCC is hematogenous, with the most common extrahepatic site being the lung. Our case, besides the unusual distant metastatic site, showed very rapid clinical progression, as has been commonly observed in HIV-infected patients with HCC. The case series of HCC in HIV-positive individuals published to date does not cumulatively exceed 70 subjects.
Carboplatin and oral cyclophosphamide combination after temozolomide failure in malignant gliomas
Authors:   Mustafa Benekli for the Anatolian Society of Medical Oncology (ASMO), Yaman Emel , Buyukberber Suleyman , Uner Aytug , Coskun Ugur , Yamac Deniz , Ozturk Banu , Kaya Ali Osman , Yildiz Ramazan
Published: February 2018

Background

Temozolomide is a novel cytotoxic agent for malignant gliomas. However, treatment failure occurs approximately in half of patients, and the optimal regimen in this setting has yet to be defined. In the present study, we assessed retrospectively the efficacy and toxicity of the combination of carboplatin and oral cyclophosphamide in temozolomide-resistant patients.

Methods

We evaluated the medical records of 30 patients with malignant gliomas. After failure of temozolomide therapy, patients were treated with a combination of carboplatin and oral cyclophosphamide. Treatment consisted of intravenous carboplatin AUC 6 (based on the Calvert Formula) on day 1 and oral cyclophosphamide 75 mg/m2 daily on days 1 to 14, followed by 14 days of rest, with the treatment repeated every 4 weeks.

Results

All patients were evaluated for response and toxicity. The objective response rate was 30%, including 9 partial responses. Median time to disease progression and median overall survival was 7 months and 8 months, respectively. Clinically responsive patients had statistically significant longer progression-free survival and overall survival than unresponsive patients. Hematological side effects were commonly observed toxicities, with neutropenia the most frequent.

Conclusions

Our data suggest that carboplatin and oral cyclophosphamide therapy is a convenient regimen after failure of temozolomide therapy in patients with malignant gliomas because of its activity, feasibility and tolerability. Further prospective studies are needed in this setting.
Disease Presentation and Outcome in Very Young Patients with Brain Metastases from Breast Cancer
Authors: Nieder Carsten , Astner Sabrina T , Andratschke Nicolaus H , Adam Markus
Published: February 2018

Aims and background

Little information is available on disease presentation and treatment outcome in very young patients with brain metastases from breast cancer. Therefore, we evaluated our results in this group.

Methods

In our database, 7/74 breast cancer patients treated for brain metastases were <40 years old. All received whole-brain radiation therapy plus individual local or systemic measures.

Results

In patients with information available, tumors were poorly differentiated and metastatic to the axillary lymph nodes at primary diagnosis. All patients had extracranial metastases. Two died from their brain disease within 5 months. Five patients died from extracranial progression after 3–84 months (2 long-term survivors beyond 2 years, characterized by single brain lesions and high performance status).

Conclusions

Very young patients did not achieve a better outcome than intermediate age groups. Whole-brain radiation therapy plus surgery or radiosurgery provided durable CNS control in most of the patients. Improved systemic therapy appears to represent the key to a better outcome.
The Porta Hepatis as a Site of Recurrence of Mucinous Appendiceal Neoplasms Treated by Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy
Authors: Sugarbaker Paul H , Bijelic Lana
Published: February 2018

Background

A successful new treatment for a particular disease may change the natural history of that disease as patients go on to longer survival. The goal of this study was to investigate the porta hepatis as a site of recurrence of appendiceal mucinous neoplasms.

Methods

A prospective database on patients with peritoneal dissemination of mucinous appendiceal neoplasms has been maintained for 21 years. In patients with complete cytoreduction, disease progression/recurrence in and around the porta hepatis has been noted as a new manifestation of this disease.

Results

In 710 patients treated for mucinous appendiceal cancer with a complete cytoreduction, 140 developed recurrent disease. Seven patients (5%) had disease recurrence in and around the porta hepatis. Four of the seven had biliary obstruction and three had masses within the liver hilum not causing bile duct obstruction. Four of the seven patients were successfully palliated by surgical procedures within the liver and biliary tree. Two patients were successfully palliated using a biliary stent and one patient was not treated.

Conclusions

Progression of mucinous neoplasms within the porta hepatis may be related to imperfect cytoreduction technique. Reoperative surgical treatment and biliary stents were beneficial in some of these patients.
Effect of Treatment on Mononuclear Cell Migration in Cervical Cancer Patients
Authors: Garcia Cristiana Bernadelli , Fernandes Paulo Cesar , Micheli Douglas Côbo , Pereira Ana Helena Macedo , Murta Eddie Fernando Candido , Tavares-Murta Beatriz Martins
Published: February 2018

Aims and background

Our aim was to evaluate the effect of treatment on the in vitro migration of circulating mononuclear cells in cervical cancer patients at different stages.

Methods

We prospectively investigated 24 patients with cervical neoplasia, without prior treatment, submitted to surgery or chemotherapy as therapeutic conduct. Controls were healthy volunteer women (n = 23). Mononuclear cells were isolated from peripheral venous blood before and after treatment, and their migration capacity was evaluated in a microchemotaxis chamber assay towards the chemotactic stimuli fMLP, MCP-1 and RANTES, compared to basal migration. Serum levels of nitric oxide metabolites were assayed by the Griess reaction.

Results

Increased mononuclear cell migration in response to the chemotactic stimuli, compared to basal migration, was observed in controls and patients, without differences between them. After treatment (n = 14), mononuclear cell migration in response to MCP-1 and RANTES was increased compared to pre-treatment. Serum levels of nitric oxide metabolites were more elevated in patients (n = 19) than in controls (n = 17), but decreased after treatment (n = 15).

Conclusions

The results suggest that the production of soluble circulating factors by tumor cells could interfere with the functional activity of blood mononuclear cells.
A Case of Interstitial Pneumonitis Associated with Guillain-Barré Syndrome during Administration of Adjuvant Trastuzumab
Authors: Bettini Anna Cecilia , Tondini Carlo , Poletti Paola , Caremoli Elena Rota , Guerra Ugo , Labianca Roberto
Published: February 2018

Optimal treatment for HER2/neu-positive, node-positive early breast cancer should include the monoclonal antibody trastuzumab. This relatively new agent has shown very limited pulmonary toxicity. Our report describes a case of life-threatening interstitial pneumonitis associated with Guillain-Barré syndrome that occurred during the administration of adjuvant trastuzumab. The severity of the clinical presentation and the limited number of reports in the literature of acute trastuzumab-related lung injury make the description of this case of crucial interest.
A Rare Cause of Mastalgia: Dercum's Disease (Adiposis Dolorosa)
Authors: Trentin Chiara , Di Nubila Brunella , Cassano Enrico , Bellomi Massimo
Published: February 2018

Among the symptoms reported by patients undergoing breast imaging, pain is one of the most common. Mastalgia is generally classified as cyclic, noncyclic, or extramammary. A rare cause of breast pain is Dercum's disease, or adiposis dolorosa, a condition characterized by multiple, often painful subcutaneous lipomas. Painful breast lipomas have not been described in the literature so far. The diagnosis is made by clinical means supported by diagnostic imaging. We report the case of a 58-year-old postmenopausal woman affected by Dercum's disease in the breast. Ultrasound examination showed multiple oval, well-defined, hyperechoic lesions suggestive of breast lipomas. No significant features were detected by mammography.
Long-Term Survival after Salvage Surgery for Invasive Thymoma with Intracardiac Extension
Authors: Pastorino Ugo , Yang Xue Ning , Francese Massimo , Durkovic Sava , Biglioli Paolo
Published: February 2018

We report a case of successful salvage surgery for invasive thymoma initially judged to be unresectable that did not respond to sequential chemoradiotherapy. The patient underwent en bloc resection of the tumor, superior vena cava, upper portion of the right atrium (RA) and intracardiac neoplastic thrombus with the aid of a cardiopulmonary bypass without cardiac arrest. The patient is disease free 8.5 years after radical thymectomy and subsequent resection of 2 second primary lung adenocarcinomas.
Primary Duodenal Adenocarcinoma
Authors: Solej Mario , D'Amico Silvia , Brondino Gabriele , Ferronato Marco , Nano Mario
Published: February 2018

Aims and Background

Primary duodenal adenocarcinoma is a rare tumor with a poorly defined natural history and prognostic factors. It presents with nonspecific symptoms, and for this reason the diagnosis is often delayed. It is a serious problem for the surgeon because of the difficulty in obtaining an early diagnosis and standardizing basic tenets for an appropriate surgical approach. The aim of this work was to conduct a review of the literature analyzing the points most frequently debated about this pathology.

Methods and Study Design

A bibliographic search was carried out on the main search engines to find studies regarding duodenal adenocarcinoma, published in English, from January 1992 to January 2007.

Results

A total of 19 articles was selected. Results concerning symptoms, location of the tumor, diagnostic examinations, surgical treatment, histopathology of the tumor, survival and follow-up were obtained and discussed.

Conclusions

All patients who are medically fit to undergo surgery should be given the option of aggressive resection regardless of tumor size, tumor invasion or appearance of positive lymph nodes. Hopefully, an early diagnosis will correlate with improved long-term survival.
Videoconferencing to Enhance the Integration between Clinical Medicine and Teaching: A Feasibility Study
Authors: Morganti Alessio G , Pasquarelli Lino , Deodato Francesco , Digesù Cinzia , Di Falco Carlo , Dinapoli Nicola , Macchia Gabriella , Picardi Vincenzo , Tagliaferri Luca , Valentini Vincenzo , Cellini Numa
Published: February 2018

Aims and Background

The aim of the study was to analyze the feasibility of a setting up of a radiotherapy department using videoconferencing technology.

Material and Methods

A videoconferencing network was started to link an academic center of radiotherapy to a peripheral center of research at the start of its activity. Two years of data of involved professionals, subjects of links, audio, video link problems and running costs were recorded.

Results

A total of 418 links was established for an overall duration of 458 hours. The participants included all departmental staff. Videoconferencing involved teaching, ward organization, medical care and scientific subjects. In the second year of experience, the number of videoconferencing links was higher than the first (232 vs 186). Link times were reasonable for both skilled and unskilled operators. Overall, the cost per minute of link was 0.2 Euro, and the mean cost per link was 13 Euros. Videoconferencing was integrated with fax and computer networks to enhance sharing paper and electronic documents. Audio-video technical problems progressively decreased: the link was definitively interrupted or its activation unfeasible in only 1.0% of cases.

Conclusions

Our experience suggests that the establishment of a link between radiotherapy departments addressed to these aims is feasible by a videoconferencing network.
Disappearance of Gadolinium Enhancement in a Chemoresistant Astrocytoma of the Tectum after High-Dose Interferon Beta
Authors: Matsuno Akira , Fujimaki Takamitsu , Mizutani Akiko , Ide Fuyuaki , Tanaka Hideki , Asano Shuichiro , Miyawaki Satoru , Uno Takeshi , Tanaka Junichi , Nakaguchi Hiroshi , Sasaki Mitsuyoshi , Murakami Mineko , Yamazaki Kazuto , Ishida Yasuo
Published: February 2018

Interferon beta 6 million units per week was administered to a patient with an aggressive astrocytoma in the tectum that was resistant to cisplatin, etoposide, vinblastine, and the oral alkylating agent temozolomide. The tumor was immunopositive for O6-methylguanine-DNA methyltransferase (MGMT). Interferon beta caused the disappearance of the gadolinium-enhanced lesion in the tectum. Interferons have apoptotic and antiangiogenic effects on tumor cells, and the lesion's disappearance may have been induced by complexes of these effects. Administration of interferon beta might have a favorable effect on tectal gliomas that are immunopositive for MGMT and resistant to chemoradiotherapy including temozolomide.
Uterine Leiomyosarcoma Metastatic to the Brain: Case Report
Authors: Melone Graziella Angelina , D'Elia Alessandro , Brogna Christian , Salvati Maurizio
Published: February 2018

Background

We report a leiomyosarcoma of the uterus, an uncommon tumor with a very aggressive course and poor prognosis due to the fact that, despite complete resection, it recurs with micrometastases. The most common metastatic sites are the lung, intraperitoneal, pelvic and paraaortic lymph nodes, and liver. Brain and skull metastases are very rare.

Case

A 57-year-old woman underwent a hysterectomy and bilateral salpingo-oophorectomy for a grade T2N0M0 uterine leiomyosarcoma. There was no evidence of other lesions. Three months later a total-body PET scan demonstrated the presence of metastases in both lungs, and the patient was started on chemotherapy. One year later a cranial MRI demonstrated a brain metastasis to the temporal lobe. Emergency complete resection of the recurrence was performed, followed by whole-brain radiation and adjuvant chemotherapy.

Conclusions

Given the limited treatment options, the gold standard for uterine leiomyosarcoma brain metastasis is total surgical removal. Chemotherapy and radiation therapy may provide only palliative benefit.
Estimates of the Incidence and Prevalence of Renal Cell Carcinoma in Italy in 2002 and Projections for the Years 2007 and 2012
Authors: Bosetti Cristina , Bianchi Cosetta , Negri Eva , La Vecchia Carlo
Published: February 2018

Aims and background

Data on kidney cancer incidence and prevalence are not available on a national and regional level. We provided estimates of the number of incident and prevalent cases of kidney and renal cell cancer in Italy overall and in various regions in 2002 and gave projections for the years 2007 and 2012.

Methods

We derived annual numbers of incident cases combining mortality data provided by the World Health Organization and information on relative survival from kidney cancer and we subsequently derived 5-year prevalence by combining incidence with information on survival. We provided different projection estimates for the years 2007 and 2012 for incidence and prevalence, on the basis of various hypothetical scenarios, i.e., stable rates over time or steady falls by 1% per year.

Results

In 2002, there were about 8000 incident cases and 26,800 prevalent cases of kidney cancer in Italy. Of these, approximately 6800 and 22,750 were incident and prevalent cases of renal cell cancer, respectively. The most reliable estimate of incident kidney cancer cases in Italy over the period 2007–2012 is likely to range between 7000 and 9000. Of these, between 6000 and 8000 are renal cell cancer cases. The best estimate of prevalence of kidney cancer is between 20,000 and 34,000 cases and that of renal cell cancer between 17,000 and 29,000 cases.

Conclusions

Incidence and prevalence of renal cell cancer are likely to remain approximately stable between 2002 and 2007. Increased diagnostic attention due to widespread use of echography and other diagnostic techniques may, however, lead to earlier detection of kidney neoplasms and consequently to an apparent increase in the incidence of renal cell cancer.
Conformal Radiotherapy of Clinically Localized Prostate Cancer: Analysis of Rectal and Urinary Toxicity and Correlation with Dose-Volume Parameters
Authors: Ballare Andrea , Di Salvo Maurizio , Loi Gianfranco , Ferrari Gianmarco , Beldì Debora , Krengli Marco
Published: February 2018

Aims and background

Rectal and urinary toxicities are the principal limiting factors in delivering a high target dose to patients affected by prostate cancer. The verification of such toxicity is an important step before starting a dose-escalation program. The present observational study reports on the acute and late rectal and urinary toxicity in relation with dose-volume parameters in 104 patients with localized prostate cancer treated with 3-dimensional conformal radiation therapy.

Methods and study design

One hundred and four patients with stage T1b-T3b prostate cancer were treated with three-dimensional conformal radiation therapy to a total dose of 74 Gy, 2 Gy per fraction. Rigid dose constraints were applied for rectum and bladder. Acute and late rectal and urinary toxicities were analyzed also in relation to dose-volume histograms. Biochemical relapse-free survival was defined according to the American Society of Therapeutic Radiation Oncology (ASTRO) criteria and to the RTOG-ASTRO Phoenix Consensus Conference Recommendations using the Kaplan-Meier method.

Results

No grade 3 toxicity was observed. Acute and late grade 2 toxicity rates were 5.8% and 9.0% for rectum and 12.5% and 2.0% for bladder, respectively. Rectal V70 influenced the occurrence of late grade 2 toxicity. A relationship between acute and late urinary toxicity was also found. After a median follow-up of 30 months (range, 20–50), the actuarial overall and biochemical relapse-free survival rates were 84% and 77%, respectively, with a significant difference between low-intermediate and high-risk patients.

Conclusions

Conformal radiotherapy to the dose of 74 Gy was administered with good compliance. The incidence of acute and late toxicity was relatively low in accord with our dose constraints. Rectal V70 proved to be a reliable prognosticator of late toxicity. Overall survival and biochemical relapse-free survival rates were more favorable for low and intermediate-risk and significantly less favorable for high-risk patients.
Molecularly Targeted Therapy and Radiotherapy in the Management of Localized Gastrointestinal Stromal Tumor (GIST) of the Rectum: A Case Report
Authors: Ciresa Marzia , D'Angelillo Rolando Maria , Ramella Sara , Cellini Francesco , Gaudino Diego , Stimato Gerardina , Fiore Michele , Greco Carlo , Nudo Raffaele , Trodella Lucio
Published: February 2018

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The main treatment for localized gastrointestinal stromal tumors is surgical resection. These tumors respond poorly to conventional cytotoxic chemotherapy agents and to radiotherapy. Imatinib mesylate, a small-molecule kinase inhibitor, has proved useful in the treatment of recurrent or metastatic GISTs and is now being tested in the adjuvant and neoadjuvant setting. The role of radiotherapy in the management of patients with GIST is currently restricted to symptomatic palliation.

We present the case of a 54-year-old man affected by rectal GIST extending to the anal canal, with constipation, hematochezia, and anal pain. He received imatinib, 400 mg orally per day, for a week before and during radiation therapy. Irradiation was delivered to the gross tumor volume by 3D conformal therapy. The planned total dose was 50.4 Gy in fractions of 1.8 Gy daily. We observed a partial clinical response 3 weeks after the end of combination treatment. The patient then underwent a sphincter-saving surgical procedure. There was no perioperative morbidity and a complete pathological response was obtained.

At the present time, the role of radiotherapy in the management of patients with GIST is restricted to symptomatic palliation. The introduction of molecularly targeted therapy combined with radiation therapy could improve the outcomes for patients diagnosed with GIST.
Thymoma Associated with Myasthenia and Autonomic anti-Hu Paraneoplastic Neuropathy
Authors: Simonelli Matteo , Banna Giuseppe Luigi , Santoro Armando
Published: February 2018

Along with myasthenia, other paraneoplastic neurological syndromes (PNS) may occur in thymoma. Anti-Hu antibodies and a clinical “anti-Hu syndrome” characterized by encephalitis and/or painful neuropathies have been reported in only three patients at the time of the diagnosis of thymoma. We describe a severe anti-Hu-related autonomic neuropathy with gastrointestinal paresis and intestinal pseudo-obstruction with malabsorption that occurred concomitantly with the worsening of myasthenic symptoms long after the initial diagnosis of thymoma in a young patient. The clinical anti-Hu syndrome preceded the radiological diagnosis of thymoma recurrence. Treatment with plasma exchange led to a transient improvement of neurological symptoms.
Low-Grade Fibromatosis-Like Spindle Cell Metaplastic Carcinoma: A Basal-Like Tumor with a Favorable Clinical Outcome. Report of Two Cases
Authors: Podetta Michele , D'Ambrosio Gioacchino , Ferrari Alberta , Sgarella Adele , Dal Bello Barbara , Fossati Gian Silvio , Zonta Sandro , Silini Enrico , Dionigi Paolo
Published: February 2018

Fibromatosis-like spindle-cell metaplastic carcinoma (FLSpCC) is an atypical variant of spindle-cell carcinoma with a particular clinical behavior characterized by frequent local recurrence, very low potential for axillary lymph node metastasis, and uncommon distant metastases. Although it presents the typical immunoprofile of basal-like carcinomas, FLSpCC is associated with a favorable clinical outcome and conservative treatment is generally indicated. Because of the lack of specific clinical and radiological characteristics, the criteria for the differential diagnosis from other benign and malignant tumors are based only on histological findings and immunostaining. We report on two FLSpCC patients treated with wide local excision and mastectomy associated with axillary lymph node dissection. Although the biological behavior of this subtype of breast cancer has not been adequately evaluated, wide local excision or mastectomy with clear resection margins but no axillary dissection appears to be an adequate treatment approach.
Anthracycline Extravasation: A Comprehensive Review of Experimental and Clinical Treatments
Authors: Langer Seppo W , Sehested Maxwell , Jensen Peter Buhl
Published: February 2018

An accidental extravasation of anthracycline-containing chemotherapy is a feared complication that may lead to necrosis and severe tissue destruction. For four decades, much effort has been done to prevent and treat this devastating condition. Savene™ has recently been proved to be very effective, and is the only approved treatment against anthracyline extravasation. It is thus now widely recommended. The present article represents a comprehensive review of, and historical insight to, the experimental and clinical studies of surgical and non-surgical treatments of extravasation during forty years of clinical anthracycline treatment.
Multidisciplinary Approach to the Treatment of Bone Metastases: Osteo-Oncology Center, a New Organizational Model
Authors: Ibrahim Toni , Flamini Emanuela , Fabbri Laura , Serra Patrizia , Mercatali Laura , Ricci Rossana , Sacanna Emanuele , Falasconi Maria Cristina , Casadei Roberto , Galassi Riccardo , Giannini Massimo , Bazzocchi Oscar , Calzolari Filippo , Nunziatini Roberta , Gaudio Michele , Maltoni Marco , Amadori Dino
Published: February 2018

Aims and background

Bone metastases are responsible for high morbidity in cancer patients. The frequency of pain and other serious complications associated with such metastases depends on the site and type of lesions and preventive therapy. The present paper aims to inform the scientific community about a new organizational health care model specifically designed for patients with bone metastases, in the hope of stimulating the creation of similar initiatives whose goals are to decrease the high morbidity of this pathology, reduce the frequency of complications, limit psychophysical distress of patients, and improve quality of life.

Methods

In January 2005, an Osteo-Oncology Center was opened in our institute to provide multidisciplinary care (19 specialists involved) for patients with bone metastases, to train physicians, and to conduct research in the field.

Results

In its first three years of activity, 601 multidisciplinary team consultations were made and a total of 425 patients were seen. The most frequent primary tumor site was the lung in males and the breast in females. Upon presentation at the Center, 79% of patients reported experiencing a level of pain (median pain intensity, 3.69) that interfered with normal daily activities. An anonymous questionnaire was also completed on the quality of the service provided: 75% of patients were very satisfied, 23% were satisfied, 1% responded “I don't know”, and only 1% expressed dissatisfaction.

Conclusions

Our preliminary results confirm the usefulness of a multidisciplinary center for the management of patients with bone metastases, especially in terms of decreasing psychophysical suffering.
Intracellular Glycoproteins Binding Galectin-1 in Thyroid Lesions
Authors: Gaj Zuzanna , Krzeslak Anna , Pomorski Lech , Lipinska Anna
Published: February 2018

Aims and background

The increased expression of galectin-1 on the mRNA and protein level observed in malignant thyroid tumors in comparison with benign lesions suggests that this protein may be associated with malignant transformation of thyroid epithelium. Extracellular and membrane glycoproteins are the main known ligands for this galactose-binding lectin. However, immunofluorescence studies have shown that galectin-1 is found predominantly in the intracellular compartment. The aim of this study was to examine intracellular carbohydrate ligands of galectin-1 in the thyroid, with particular attention to potential differences in their expression levels between benign and malignant lesions.

Methods

Identification of cytosolic and nuclear glycoproteins binding galectin-1 was performed by affinoblotting after separation of proteins in 8% polyacrylamide slab gels and electrotransfer onto Immobilon-P membranes. For semiquantitative analysis of glycoproteins binding galectin-1, an enzyme-linked lectino-solid-phase assay (ELLSA) was used.

Results

The predominant cytosolic glycoproteins binding galectin-1 had molecular masses of 50, 55, 59, 64, 85–87, 100, and 133 kDa and nuclear glycoprotein had a molecular mass of 75 kDa. There were no evident differences in glycoprotein patterns between benign and malignant thyroid lesions. The results obtained by ELLSA did not show any significant differences in lectin binding by cytosolic and nuclear proteins of thyroid lesions either.

Conclusions

On the basis of these results it is tempting to suggest that interactions between galectin-1 and intracellular glycoconjugates are not critical for malignant transformation in the thyroid gland.
Solitary Thyroid Metastasis of Clear Cell Renal Carcinoma: Case Report
Authors: Quaglino Francesco , Beccaris Moreno , Iacopini Sara , Mazza Enrico , Suriani Adolfo , Palladin Daniela , Valli Mario
Published: February 2018

Metastases to the thyroid gland represent a rare event. Malignancies that most frequently metastasize to the thyroid vary between clinical and autopsy studies and by geographic area. In Western countries, renal carcinoma has been recorded as a frequent source of thyroid metastases. We report the case of a 66-year-old man with a thyroid metastasis from clear cell renal carcinoma and discuss its clinical, pathological and imaging features.
Therapy-Related Acute Myeloid Leukemia after Concurrent Chemoradiotherapy for Esophageal Cancer: Report of Two Cases
Authors: Chang Hung , Liaw Chuang Chi , Chang Hsien Kun
Published: February 2018

Concurrent chemoradiotherapy (CCRT) has become an important part of esophageal cancer treatment. Its efficacy has been proved and its acute adverse effects are well understood. Leukemogenesis is a potential late complication of ionizing irradiation and chemotherapy. Therapy-related acute myeloid leukemia (AML), however, has been rarely reported in esophageal cancer patients receiving CCRT. We here report two such cases. One patient received neoadjuvant CCRT and developed AML with a complex chromosome aberration 55 months after exposure to radiation- and cisplatin-based chemotherapy. The other had AML with t(8;21) twenty months following CCRT as definitive therapy. Such a severe complication of CCRT is a serious concern in esophageal cancer treatment. In the wake of the prolonged survival of some esophageal cancer patients, the treatment intensity may need to be reconsidered according to such experience.
Assessment of Influence of Smoking, Drinking, Leukoplakia and Dental Irritation on Local Control of Early Oral Tongue Carcinoma Treated with Brachytherapy: Age and Dental Factors are Potential Prognostic Factors
Authors: Yamazaki Hideya , Inoue Takehiro , Yoshida Ken , Kotsuma Tadayuki , Yoshioka Yasuo , Koizumi Masahiko , Furukawa Souhei , Kakimoto Naoya , Shimizutani Kimishige , Nishimura Tsunehiko
Published: February 2018

Background

To examine the background characteristics of elderly patients (65 years or older) with node-negative mobile tongue cancer (T1-2N0M0) who showed worse local control than a younger group.

Materials and methods

We retrospectively analyzed background data for 265 patients treated with brachytherapy with or without external radiotherapy between 1967 and 1999. We examined dental factors (such as irritation by prosthesis), leukoplakia, tobacco smoking and alcohol consumption for comparisons between the elderly (age ≥65 years; n = 83) and a control group (64 years or younger; n = 182).

Results

The elderly patients showed a worse outcome than the control group (respectively 86% and 70% at 5 years; P <0.05). Incidence of dental factors tended to be higher for elderly patients (53%) than the control group (40%, P = 0.07). Dental factors proved to have prognostic importance for local control. Five-year local control rate was 85% for patients with and 76% for patients without dental factors (P = 0.04). The elderly group positive for dental factors showed a lower 5-year local control rate (61%) than the other three groups [(elderly without the dental factor (–) group (80%), control with the dental factor (+) group (84%), and control without the dental factor (–) group (87%)] (P <0.05). Leukoplakia was found more frequently in the control (23%) than in the elderly group (5%) (P = 0.006) but had no effect on treatment outcome.

Conclusions

Age and dental factors (including prosthesis irritation) are potentially important prognostic factors for local control of oral tongue cancer treated with brachytherapy, especially for elderly patients.
Quality Assurance of a Record-and-Verify System
Authors: Baiotto Barbara , Bracco Christian , Bresciani Sara , Mastantuoni Antonella , Gabriele Pietro , Stasi Michele
Published: February 2018

Aims and background

With the introduction of more complex three-dimensional conformal radiotherapy and intensity-modulated radiotherapy techniques in clinical practice, the use of record-and-verify systems is recommended to improve the accuracy of radiotherapy treatments. The aim of the present study was to evaluate, for a commercial record-and-verify system, the efficiency, integration with the treatment planning system, and impact of manual checking of data. The most frequent errors or misses were also evaluated.

Materials and methods

The development of internal protocols to systematically implement new technologies has been identified as a priority in the departmental quality assurance process. Data electronically fed into the record-and-verify system were compared with those manually recorded in the clinical paper chart over a period of almost 6 years (October 2000 to December 2006). A total of 7768 treated patients was reviewed. The check was performed by using a homemade data base in which the errors are stratified as follows: 1) general section, 2) geometric and dosimetric section, and 3) delivered dose section.

Results

On a total of 7768 checked patients, one or more mismatches between treatment planning system data and record-and-verify system data or paper chart data were observed for 452 patients (5.8% of total number of inspected patients). The percentage of discrepancies out of the total was: 2.2% in the general section, 3.3% in the dosimetric and geometric section, and 4.2% in the delivered-dose section.

Conclusions

Although record-and-verify systems assume a crucial role in the accuracy and reproducibility of radiation treatment, their inability to eradicate all the errors requires vigilance on the part of the radiation therapy and physics team.