bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer Incidence and Mortality in the Province of Ferrara 1989-1990
Authors: Ferretti Stefano , Tassinari Davide , Albonico Giuseppe , Nenci Italo
Published: April 2018

Background

Mortality data have clearly highlighted the province of Ferrara as an area with a particular distribution of tumors strictly related with environmental factors.

Methods

The project of a tumor registry has been planned for a better description of cancer incidence and for a deeper insight into etiologic factors, considering the typical features of the province from geographic and occupational points of view.

Results

This study presents the registration results of the first 2 years, in order to verify the quality level of data recruitment and to confirm that observed in previous studies. The population covered by the registry was 151,968 males and 165,835 females, with high representation of the elderly. In this period 2,087 tumors in men and 1,778 in women were observed. Lung cancer reaches one of the highest levels in Italy, according to that observed in Lombardy and Veneto regions and the northern Adriatic coast. Incidence and mortality are, however, significantly higher than in other Emilia-Romagna areas, as pointed out by the registries of Parma, Modena and Forlì. Colon cancer also presents high frequencies in comparison with neighboring areas, whereas non-Hodgkin lymphomas reach the highest level in Italy. Gastric tumors, although well represented in males and females, show lower levels than the high-risk neighboring Romagna region. In women, a low incidence of cervix uteri tumors and high levels of breast cancer have also been observed.

Conclusions

The distribution of such neoplasms and the differences observed among neighboring areas deserve further analytical studies, with the aim of a better reading of cancer onset and diffusion. The quality of data obtained (about 70% of histocytologic confirmations, and 5% of “final” death-certificate-only cases), appears to reach satisfying levels, considering the starting phase of the registry.
Megestrol Acetate in Unresectable Hepatocellular Carcinoma
Authors: Colleoni Marco , Nelli Patrizia , Vicario Giovanni , Mastropasqua Giorgio , Manente Paolo
Published: April 2018

Aims and background

No consolidated medical treatment has yet been established for unresectable hepatocellular carcinoma (HCC). A possible interference of hormones in the pathogenesis and cellular growth of HCC has been suggested.

Methods

To evaluate the activity and tolerance of progestins in HCC, patients were treated with megestrol acetate orally at a dose of 160 mg daily until progression of disease or grade III-IV toxicity was observed.

Results

Eleven patients entered the study and were assessable for response and side effects. Median duration of treatment was 80 days (range 60-150). No major responses were observed, 4 patients had stabilization of disease for at least 2 months, and 7 had progressive disease. Median time to disease progression was 3 months (range 2-5). Three patients required interruption of treatment because of toxicity (2 patients had worsening of concomitant diabetes and 1 patient had gastric bleeding).

Conclusions

The results of the present study suggest that hormone therapy with megestrol acetate has no significant role in HCC.
Radiation and Concurrent Carboplatin Administration in Locally Advanced Head and Neck Cancer
Authors:   A Hellenic Cooperative Oncology Group Study, Fountzilas George , Skarlos Dimosthenis , Nikolaou Angelos , Kalogera-Fountzila Anna , Tzitzikas John , Kosmidis Paris , Makrantonakis Paris , Samantas Epaminontas , Karpasitis Nicholas , Bacoyiannis Haralambos , Synodinou Maria , Pavlidis Nicholas , Vritsios Aristoteles , Daniilidis John
Published: April 2018

Aims and Background

To improve local control in patients with locally advanced inoperable head and neck cancer we administered carboplatin concurrently with radiation.

Methods

Thirty-nine patients entered the study. There were 35 men and 4 women with a median age of 58 years (range, 24-74) and a median performance status of 90 (range, 60-100) of the Karnofsky scale. The primary site included nasopharynx (5 patients), oropharynx (n=10), hypopharynx (n=5), larynx (n=12), oral cavity (n=2), paranasal sinuses (n=3), salivary glands (n=1) and unknown (n=1). Histology was squamous cell carcinoma in all cases. All patients were irradiated with a 60Co unit. According to the protocol, they should receive 66-70 Gy to the tumor area and 45 Gy to the tumor-free area of the neck. Carboplatin was administered at a dose of 400 mg/m2 on days 2, 22 and 42.

Results

Totally, 112 cycles of carboplatin were administered, of which 106 (95%) were at full dose. Median dose intensity of carboplatin actually delivered was 170 mg/m2/week (range, 57-200). All patients were irradiated, although only 30 (77%) received >66 Gy. After the completion of combined treatment, 23 (59%, 95% C.I. 42-74%) achieved a CR and 10 (26%, 95% C.I. 13-42%) a PR. Grade 3-4 myelotoxicity was noticed in 60% of the patients. Other grade 3-4 toxicities included stomatitis (13%), dysphagia (5%) and weight loss (3%). Median time to progression was 18 months (range, 2-25).

Conclusions

Radiation and concurrent administration of carboplatin determined a high CR rate in patients with HNC, although the superiority of this combined modality approach over radiation alone has to be proven in phase III trials.
Endoluminal High-Dose-Rate Brachytherapy with a Palliative aim in Esophageal Cancer: Preliminary Results at the Institut Gustave Roussy
Authors: Rovirosa Angeles , Marsiglia Hugo , Lartigau Eric , Zimmermann Philippe , Chirat Eric , Delapierre Monique , Briot Edith , Gerbaulet Alain
Published: April 2018

Ten patients with advanced esophageal carcinoma were treated with endoluminal high-dose-rate brachytherapy at the Institut Gustave Roussy. Eight of them had recurrences after external beam radiotherapy. They were treated with a high-dose rate iridium-192 source. Five patients received 6 sessions of 4 Gy, 4 patients 3 sessions of 4 Gy, and 1 patient received 3 sessions of 8 Gy. The interval time between each session was 1 week. Seventy percent of patients improved their dysphagia, with 80% endoscopic tumor response. The Karnofsky index was improved in most of the patients. The mean survival was 4 months, and dysphagiafree survival was 2.5 months. Two patients had treatment toxicity but only a transitory WHO G1 esophagitis. Endoesophageal high-dose-rate curietherapy seems an effective technique in palliative treatments. We found low toxicity and an excellent tolerance to treatment in previously irradiated patients. The efficacy of the treatment is highly dependent on a precise tumor volume evaluation.
Endometrial Metastases from Gastric Adenocarcinoma: A Case Report
Authors: Pasini Andrea , Mandelli Piergiorgio , Belloni Carlo
Published: April 2018

Embolic metastases to the endometrium are unusual, especially from extragenital cancers. Metastases in the uterine corpus are generally detected at autospy. We describe a patient with abnormal vaginal bleeding in whom endometrial metastases from an inoperable gastric tumor were discovered in hysteroscopic biopsy specimens.
Adenocarcinoma of the Pancreas in Childhood (Pancreatoblastoma): Report of a Case with Good Response to Chemotherapy
Authors: Caracciolo Giuseppe , Vicedomini Danilo , Di Blasi Arturo , Indolfi Paolo , Casale Fiorina , De Dominicis Gianfranco , Saggiomo Giovanni , Greco Nicola
Published: April 2018

Here we report a case of pancreatoblastoma in a 2-year, 4-month-old girl. The child underwent surgical resection and was managed with chemotherapy (cisplatin plus doxorubicin). The patient is currently disease-free 42 months after being taken off chemotherapy.
Molecular Cytogenetics and its Applications to Soft Tissue Tumor Analysis
Authors: D'Amato Lucia
Published: April 2018

Cytogenetic analyses have demonstrated the association of specific chromosomal changes with particular types of soft tissue tomors. This work describes the molecular cytogenetic approaches to genetic analysis of these tumors. It illustrates how molecular cytogenetics may provide a rapid and sensitive method of diagnosis and can contribute to identify specific genes implied in the aetiology of soft tissue tumors.
The Relevance of VDJ PCR Protocols in Detecting B-Cell Clonal Expansion in Lymphomas and Other Lymphoproliferative Disorders
Authors: De Re Valli , De Vita Salvatore , Carbone Antonino , Ferraccioli Gianfranco , Gloghini Annunziata , Marzotto Alessandra , Pivetta Barbara , Dolcetti Riccardo , Boiocchi Mauro
Published: April 2018

Aims and background

The detection of immunoglobulin heavy chain variable (VH)-diversity (DH)-joining (JH) region gene rearrangement by polymerase chain reaction (VDJ PCR) has been recently proposed as a rapid approach to assess B-cell clonality in lymphoproliferative disorders. The aim of the present study was to determine the efficacy of VDJ PCR in a wide spectrum of lymphoproliferative disorders previously characterized by immunohistochemistry and Southern blot (SB).

Methods

83 SB-rearranged B-cell non-Hodgkin's lymphomas (NHL) of different histotype, 22 cases of SB-unrearranged classical Hodgkin's disease (HD), 18 cases of HIV-related reactive lymphadenopathy, and 4 frankly pre-lymphomatous lesions (MESA) in the course of Sjögren's syndrome were investigated by 2 different VDJ PCR protocols (FR3, FR2).

Results

The detection rate in NHL was 64% and 71% using the protocols FR3 and FR2, respectively. However, the overall VDJ PCR efficacy increased to 81% by combining the results of both protocols. In addition, differences in the combined, as well as in the single FR3 or FR2 protocol efficacy, were noted in the different NHL subgroups. B-cell clonality was also detected in 4/22 (18%) SB-unrearranged classical HD cases and in 2/18 (11%) reactive lymphadenopathy cases, whereas it was demonstrated in all the MESA lesions, 2 of them being SB-negative.

Conclusions

VDJ PCR represents a useful and rapid technique to detect B-cell clonality in NHL, although with some differences depending on the NHL histotype and the panel of primers employed. The technique may also be of value to investigate the possible progression of early B-cell clonal expansion into frankly B-cell malignancy and to contribute to the controversy about the clonal lineage origin of the putative HD malignant cells.
Radiotherapy for T1 Carcinoma of the Glottis
Authors: Tombolini Vincenzo , Zurlo Alfredo , Cavaceppi Paola , Sarro Agatina , Guidi Carlo , Osti Mattia F. , Vitturini Alessandro , Banelli Enzo
Published: April 2018

Aims and background

The management of patients with T1 carcinoma of the glottic larynx is controversial, because surgery and radiation therapy are reported to be effective treatments. Several studies have shown radiotherapy to be safe and effective, with a high percentage of voice preservation and minimal complications, but most Italian physicians prefer to surgically treat such patients.

Methods

From 1980 to 1990, 36 patients with stage I squamous cell glottic carcinoma were treated with radiotherapy alone at the Institute of Radiology of University of Rome “La Sapienza”. In all patients the irradiation fields were limited to the larynx, with field size ranging from 4 × 4 cm to 7 × 7 cm. Total tumor doses ranged between 51 and 70 Gy (median 60 Gy) with a mean number of 30 fractions of 2 to 3 Gy per fraction (3 or 5 fractions per week).

Results

After a median follow-up of 98 months, we observed an overall survival rate at 5 years of 91.4% and actuarial 10-year survival of 85.7%. Local control was achieved in 97.1% of cases, with an event-free survival of 94.2% at 5 and 10 years. No major complications like necrosis or persistent edema of the larynx were observed. Minor complications like dysphonia (8%) and dysphagia (5.5%) were temporary; laryngeal function was completely preserved at the end of therapy. Final voice quality ranged from good to excellent.

Conclusions

Our series confirms that radiation therapy has a major role in the management of early glottic cancer, with results comparable to surgical approaches and with better voice preservation.
Carboplatin and Etoposide in an Out-Patient Schedule for the Palliation of Advanced Non-Small-Cell Lung Cancer
Authors: Aitini Enrico , Cavazzini Giovanna , Cantore Maurizio , Rabbi Carla , Malaspina Riccardo , Truzzi Riccardo , Fazion Stefano , Pari Franca , Mambrini Andrea , Zamagni Donatella , Amadori Marcello , Bertuzzi Alberto , Natale Franco , Smerieri Franco
Published: April 2018

Aims and background

In Western countries, non-small-cell lung cancer is the most important cause of cancer-related death. To date, medical treatment for advanced stages remains of a palliative nature.

Methods

Forty-four patients with advanced non-small-cell lung cancer were treated in a phase II study with carboplatin and etoposide (each at 60 mg/m2 daily) in a 5-day schedule. Among 44 patients, 18 (40%) had stage IIIB disease and 26 (60%) had stage IV disease.

Results

Treatment was well tolerated, and the only significant side effect was alopecia. The overall response rate was 27% with 2 complete remissions; median survival time was 10.4 months. One of the 2 patients achieving a complete remission was still alive and disease free at 36 months from the start of therapy. An improvement of performance status was observed in 22 patients (50%).

Conclusions

The combination of carboplatin and etoposide using this schedule appears to be well tolerated and has some activity in the palliation of advanced non-small-cell lung cancer.
Diagnostic Potential of Carcinoembryonic Antigen and Ferritine in Tuberculous and Malignant Pleural Effusion
Authors: Loncar Robert , Ostojic Ljerka , Tabakovic-Loncar Vera , Roguljić Ante
Published: April 2018

The aim of the study was to determine the diagnostic value of carcinoembryonic antigen (CEA) and ferritine in malignant and tuberculous non-bloody pleural effusion. The etiology of diseases was determined by cytologic, histologic and microbiologic methods. CEA concentration above 5 ng/ml and ferritine concentration above 200 ng/ml were considered to be positive. There was significant difference in the value of CEA measured in malignant and in tuberculous pleural effusion (P < 0.005) as well as in the sera (P < 0.01) of these two groups. There was no correlation between concentration of CEA and ferritine in malignant pleural effusion. Ratio between CEA and ferritine in effusions and sera was of no help in discrminating malignant from tuberculous effusions. No correlation between examined markers and physical status of patients was observed. The sensitivity and specificity of CEA assay in malignant pleural effusion was 65% and 90%, respectively, and for ferritine 67% and 80%, respectively. A high correlation was observed between the CEA concentration in malignant pleural effusion and sera patients (r = 0.95). Combined sensitivity and specificity of CEA and ferritine was 65.9% and 85%. Bayes theorem was used to calculate the positive predictive values for CEA and ferritine, which were 53% and 37%, respectively. Results obtained in the study show the relatively good diagnostic potential of CEA.
Primary Mucosal Malignant Melanoma of the Larynx: Case Report and Review of the Literature
Authors: Mattavelli Franco , Di Palma Silvana , Guzzo Marco
Published: April 2018

We report a case of primary melanoma of the larynx in a patient who died of disseminated disease 13 months later. It is a rare malignant tumor in the head and neck, accounting for 0.4-10% of all melanomas of this site. Histologically, the presence of in situ changes within the laryngeal mucosa strongly supports our diagnosis of primary melanoma of the larynx.
Intranodal Palisaded Myofibroblastoma: Report of Three New Cases
Authors: Rossi Armando , Bulgarini Antonella , Rondanelli Erasmo , Incensati Roberto
Published: April 2018

Intranodal palisaded myofibroblastoma is a well-defined entity in the group of spindle-cell neoplasms of lymph nodes. The authors report 3 new cases of this unusual tumor. The nature of the proliferating cells is discussed.
Neutropenic Colitis Predominantly Involving the Transverse Colon: CT Aspect of an Unusual Presentation
Authors: Stein Moshe E. , Lachter Jesse , Eyal Avraham , Haim Nissim
Published: April 2018

A 62-year-old woman developed fulminant neuteopenic colitis following aggressive chemotherapy for limited-stage small cell lung cancer. An urgently performed computerized tomographic [CT] study demonstrated the predominant involvement of the transverse colon. We present a brief description of the CT features of neutropenic colitis in this unusual presentation.
Decreased Expression and Function of Vß6+ and Vß14+ T Cells is Associated with Decreased Th1 Cytokine Production in Mice with Plasma Cell Tumors
Authors: Stefanski Heather E. , Mathur Ambika
Published: April 2018

Aims and background

We have found that polyclonally stimulated T cells from mice bearing ascitic plasma cell tumors demonstrate specific decreases in Th1 cytokine production. In this study we investigated whether loss of Th1 responses in the plasma cell tumor system was associated with alterations in the Vß T cell receptor repertoire.

Methods

We examined the cell surface expression of specific Vß expressing splenic CD4+ or CD8+ T cells from normal and tumor bearing mice using direct three-color flowcytometry. In order to determine the Th phenotype of Vß expressing T cells, we enriched for Vß6, Vß14 or Vß8.1,8.2 cells, polyclonally stimulated them and measured the levels of the cytokines interleukin-4 (IL-4), IL-2 and interferon-gamma (IFN-gamma).

Results

We find that there is a statistically significant decrease in the frequency of Vß6+ and Vß14+ CD8+ T cells in mice bearing a plasma cell tumor (B53) as compared to normals (p<0.05). Stimulated Vß6+ and Vß14+ T cells exhibit an exclusively Th1 phenotype. Stimulated Vß6+ and Vß14+ T cells from B53 mice are deficient in production of the Th1 cytokines. In contrast, stimulated Vß8.1,8.2+ T cells, which are not altered in B53 mice, reveal a Th2 phenotype.

Conclusions

The significance of this study is our demonstration that decreased expression and function of Vß6+ and Vß14+ T cells may be, at least in part, responsible for the decrease in the production of IL-2 and/or IFN-gamma observed in hosts with tumors.
Breast Cancer Screening: Characteristics and Results of the Italian Programmes in the Italian Group for Planning and Evaluating Breast Cancer Screening Programmes (GISMa)
Authors: Giordano Livia , Giorgi Daniela , Fasolo Gilberto , Segnan Nereo , Del Turco Marco Rosselli
Published: April 2018

In 1990, GISMa (Italian Group for planning and evaluating Mammographic Screening - Gruppo Italiano per la pianificazione e la valutazione dei programmi di Screening Mammografico), a working group of operators (radiographers, radiologists, epidemiologists, clinicians, surgeons) involved in screening programmes ongoing in Italy, was created within the Italian School of Senology. The aim of this study is to illustrate data, presented at the GISMa meeting held in April 1994, concerning the characteristics of each programme and some early indicators of effectiveness. To assess these parameters (concerning compliance level, recall rate, benign/malignant biopsy ratio, detection rate, stage distribution, nodal involvement and number of cancers with a diameter under 1 cm, rate of cancer, etc.), ‘acceptable’ and ‘desirable’ standards obtained from Italian and North-European cancer screening experiences have been adopted. Most programmes have shown an acceptable standard for most of the indicators, and many of them have attained desirable levels. In most screening programmes the occurrence of interval cancers has not yet been measured, but all centres have (or are working to set up) a systematic active procedure to collect the data. The results indicate that common guidelines can be adopted, even when working in very heterogeneous contexts, and that it is possible to achieve a very high effectiveness and efficacy level. As regards quality control and cost/benefit issues, the goal of extending centralised, population-based screening programmes to other Italian regions becomes a priority.
Endometrial Ultrasonography - An Alternative to Invasive Assessment in Women with Postmenopausal Vaginal Bleeding
Authors: Cecchini Silvia , Ciatto Stefano , Bonardi Rita , Grazzini Grazia , Mazzotta Antonia
Published: April 2018

Aims and background

To test the reliability of endometrial sonography in selecting women with abnormal postmenopausal vaginal bleeding for further diagnostic assessment.

Methods

Endometrial thickness was measured in 368 consecutive women by abdominal or vaginal sonography prior to invasive assessment (hysteroscopy, curettage). The association of abnormal endometrial thickness (4 mm or greater) with endometrial cancer was determined.

Results

Abnormal endometrial thickness was observed in 116 of 368 women. Subsequent assessment diagnosed endometrial carcinoma in 16 subjects, 15 of whom had abnormal endometrial thickness. One case with normal endometrial thickness was suspected at sonography because of the irregular appearance of the endometrium.

Conclusions

Had it been used to select subjects for further assessment, sonography would have missed no cancer, and unnecessary invasive assessment (under general anesthesia in 20% of cases) would have been spared in 68% (251/368) of the subjects. Endometrial sonography should be routinely used to select women with postmenopausal vaginal bleeding for further investigations.
Cisplatin-Vinorelbine Combination Chemotherapy in Locally Advanced Non-Small Cell Lung Cancer
Authors: Frontini Luciano , Candido Paola , Cattaneo Maria Teresa , Zonato Sabrina , Piatto Ernesto , Scapaticci Roberto , Isa Luciano , Raina Alberto , Lanzetti Vittorio , Pavia Gianfranco , Legnani Walter , Filipazzi Virginio , Rho Benedetto , Piazza Elena
Published: April 2018

Aim

The North Milan Group presents the results of a phase II study on a cisplatin-vinorelbine combination schedule in the treatment of locally advanced non-small cell lung cancer to evaluate its activity and tolerability.

Methods

Seventy-six consecutive patients entered the study. Patients’ characteristics were the following: males/females 69/7; median age, 61.4 years (range, 40-73); ECOG performance status, 0-1; 17 stage IIIa and 59 stage IIIb. There were 49 squamous cell carcinomas, 20 adenocarcinomas, and 7 large cell carcinomas. All patients had not been previously treated and showed measurable disease. Treatment consisted of vinorelbine, 25 mg/m2 on days 1 and 8, plus cisplatin, 80 mg/m2 on day 1, administered intravenously every 21 days for three standard courses.

Results

Seventy-four patients were evaluable for response. Objective responses were documented in 42/74 patients with an overall response rate (CR+PR) of 56.7%; 18/74 patients (24.3%) showed stable disease and the remaining 14/74 (18.9%) went into progression. Twelve patients (16.2%) were suitable for a subsequent surgery. The median duration of response was 13.3 months. Survival time ranged from 4 to 36 months: it was 14.6 months for PR patients, 8.6 months for NC and 5 months for PD. Mean survival time is presently 12.85 months (SE, 1.2 months). Toxicity evaluated on 222 cycles administered was acceptable, and it was necessary to use G-CSF or delay the treatment because of severe leukopenia in only a few cases.

Conclusions

The regimen is active and safe: the slight survival increase is likely due to the small amenability to surgery achieved (16.2%). However, our results are fully comparable to others obtained with vinorelbine in two/three drug combination chemotherapy regimens.
Effects of One-Year Adjuvant Treatment with Tamoxifen on Bone Mineral Density in Postmenopausal Breast Cancer Women
Authors: Barni Sandro , Lissoni Paolo , Tancini Gabriele , Ardizzoia Antonio , Cazzaniga Marina
Published: April 2018

In this study, the authors have analyzed the possible effects of one-year adjuvant treatment with tamoxifen on bone mineral density in postmenopausal breast cancer women. Bone mineral content was studied by photon absorptiometry (I-125), whereas bone balance was analyzed indirectly by serum PTH, osteocalcin, calcitonin, calcium and alkaline phosphatase levels. Bone mineral content and serum bone-related substances were measured before starting treatment and after one year. Results were analyzed using Student's t test for paired data. No difference was found between the two measurements for bone mineral content, PTH, calcitonin, calcium and alkaline phosphatase levels. Measurements at entry and after one year of treatment showed a statistically significant difference ( P < 0.001) only for osteocalcin. In accordance with other authors, we can conclude that treatment with tamoxifen does not cause an increase in menopausal bone resorption. The finding that osteocalcin levels decreased after one year of therapy with tamoxifen is interesting, but further studies are necessary to clarify the role of such levels in predicting a turnover of bone balance towards osteoblastic activity.
Second Surgical Treatment of Retroperitoneal Persistent Disease in Epithelial Ovarian Cancer
Authors: Lupi Giovanni , Fontanelli Rosanna , Jin Rui , Grosso Giuseppe
Published: April 2018

Aims and background

This report retrospectively analyzes 9 cases of epithelial ovarian cancer with persistent retroperitoneal metastasis after intraperitoneal surgery (without systematic lymphadenectomy) and chemotherapy.

Methods

All 9 patients were diagnosed as FIGO stage I to IV at the time of primary surgery. They received combined postoperative chemotherapy (8 cases with a cisplatin-based regimen and 1 with adriamycin and endoxan). They were submitted to pelvic and paraaortic lymphadenectomy at the National Cancer Institute of Milan during the period 1990-1994.

Results

All patients presented no evidence of disease in the abdominal cavity but retroperitoneal metastasis, which was the unique metastatic site. Chemotherapy was administered as adjuvant therapy after lymphadenectomy. Six patients were free of disease for 14 to 61 months. One patient with vaginal recurrence at the 18th month was treated with radiotherapy and chemotherapy, but died of widespread disease 25 months after lymphadenectomy. Two patients with massive positive lymph nodes died of brain and lung metastasis 20 and 6 months later, respectively.

Conclusions

We conclude that retroperitoneal metastasis may be the only site of persistent disease and that systematic lymphadenectomy technically feasible in this situation to increase the opportunity for local disease control and to obtain a good result.
Descriptive Epidemiology of Hereditary Non-Polyposis Colorectal Cancer
Authors: de Leon Maurizio Ponz
Published: April 2018

Hereditary non-polyposis colorectal cancer (HNPCC or Lynch syndrome) is characterized by early occurrence of colorectal malignancies, localization of tumors in the proximal colon, frequency of multiple primaries (both synchronous and metachronous) and an autosomal dominant type of genetic transmission. HNPCC has been reported in many races and populations, including Japanese, Philipinos and American Indians. The frequency of the disease ranges between 1 and 5% of all colorectal malignancies. In northern Italy, the frequency of HNPCC has been estimated in the order of 2.8-3.0% of all registered cancers of the large bowel, while lower estimates have been recorded in southern regions. The identification of HNPCC remains difficult, mainly because the full-blown syndrome does not become manifest until several family members are affected with cancer. The recent identification of at least four genes responsible, when mutated, for the clinical spectrum of Lynch syndrome should be of considerable help in recognizing this type of tumors in the general population.
Clinical Aspects and Management of Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
Authors: Bertario Lucio , Aste Hugo , Arrigoni Arrigo , Fracasso Pierluigi , Rossini Francesco Paolo , Rossetti Carlo , Valanzano Rosa
Published: April 2018

Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomical dominant trasmitted disease phenotypically defined according to the “Amsterdam criteria” as follows: at least 3 affected relatives, one of whom first degree relative of other two, at least two successive generations affected. Important cardinal features are:

1 prevalent proximal location of cancers (above splenic flexure);

2 multiple synchronous or methachronous large bowel cancers;

3 early age of onset (<50 years);

4 presence of extracolonic cancers (endometrium, stomach, urinary tract, skin).

The treatment is essentially surgical and total colectomy with ileo-rectum anastomosis is already proposed as standard procedure with annual endoscopic examination of retained rectum. The screening of individuals at risk, so determined by the analysis of pedigree or the results of molecular tests, must be performed every 1-2 years by colonoscopy starting around the age of 25 years. In this review are described and analysed the spectrum of the disease with particular attention to the frequency and characteristics of extracolonic cancers. Moreover, the guidelines of the surveillance and screening are reported following the data of the literature and as proposed by the International Collaborative Group (ICG-HNPCC).
Genetic Counselling: Communication and Psychosocial Aspects
Authors: Borreani Claudia , Gangeri Laura
Published: April 2018

The results of genetic research have a remarkable role in medicine progress. At the same time the issues of prevention, individual attitudes and behaviour have acquired more importance, not only in relation to the illness but also regarding one's health.

For these reasons is important to consider this field of study and intervention as an area to face, not only from the medical point of view but also from ethical and psychological ones. If we agree on the importance of a global approach to this problem, psychosocial support, which is often considered a parallel intervention, becomes a component of genetic counselling: the focal point of the intervention becomes the person, and not only the problem.

The literature of the last years is rich of studies that have deepened these themes. Some studies have been analysed and reported but it is not easy to individualise a common patrimony of knowledge.

Some aspects as information, communication, risk perception and psychological consequences are presented and discussed in this paper.
A General Overview of the Process of Carcinogenesis
Authors: Parodi Silvio , Mancuso Tommaso
Published: April 2018

A general synthetic overview of the process of carcinogenesis is presented. The following points are discussed: the uniqueness of tumor disease with respect to other pathologies; tumors viewed as a pathology of the transduction system of signals that regulate the communal life of the cells of multicell organisms; the tumor as a genetic disease of somatic cells; carcinogenesis as a multistage event; the fundamental role of physiologic and pathologic rhythms of cell proliferation in the modulation of tumor incidence; mechanisms entailed in the maintenance of genome integrity; mechanisms involved in the protection of genome integrity from exogenous and endogenous causes of degradation of the genetic message.
Role of Enteral Nutrition in Advanced Cancer Patients: Indications and Contraindications of the Different Techniques Employed
Authors: Ripamonti Carla , Gemlo Brett T. , Bozzetti Federico , De Conno Franco
Published: April 2018

Over the last 20 years there has been great progress regarding total parenteral nutrition and enteral nutrition for patients who cannot take food by mouth or cannot swallow, or so that controlled feeding can be established in anorexic and malnourished patients. The use and the role of artificial nutrition is still controversial in advanced cancer patients. Such controversies often are due to the fact that these patients have a survival expectancy that varies from one to several months. The present review describes the most frequent techniques used for enteral nutrition (nasoenteral tubes, gastrostomy and jejunostomy), their indications, contraindications and complications, and gives an indication regarding which patients may really benefit from enteral nutrition taking into consideration not only the potential advantages but also the discomfort and distress related to enteral nutrition and the different techniques that are employed.
A Randomized Trial on Breast Self-Examination in Faenza (Northern-Italy)
Authors: Ferro Salvatore , Caroli Annalisa , Nanni Oriana , Biggeri Annibale , Gambi Angelo
Published: April 2018

Aims and background

The aim of this randomized controlled trial was to compare two methods for teaching breast self-examination: theoretical and practical session versus mailed material.

Methods

A random sample of women aged 20-64 years was drawn from the demographic file of the city of Faenza (Northern-Italy). Of 825 sampled eligible women, 168 declined participation, 657 were randomly assigned, after completing a pretest questionnaire aimed at evaluating practice and quality of breast self-examination. Individualised instruction was administered to the treatment group invited to be taught breast self-examination in a medical practice setting. The control group received mailed information about breast self-examination. One year later, 443 women completed the posttest questionnaire.

Results

As far as concerns the first outcome of the trial (change in practice of breast-self examination) our study showed, after adjusting for lost-to-follow-up, no difference between the treatment and the control group. The analysis performed to evaluate the second outcome (change in quality of breast self-examination practice) showed that women of the treatment group improved the quality of breast self-examination practice more than the control group (Wilcoxon test, z=2.4, P<0.01). The same results have been confirmed by multiple regression analyses taking into account all potential confoun-ders. No selection bias affected these results.

Conclusion

Theoretical and practical sessions resulted in an improved quality of examination technique than did mailed material.
Radiotherapy after High-Dose Chemotherapy Followed by Autologous Bone Marrow Transplantation in Patients with Intermediate or High-Grade Non-Hodgkin's Lymphoma
Authors: Barra Salvina , Bacigalupo Almalina , Corvò Renzo , Guenzi Marina , Scolaro Tindaro , Vitale Vito
Published: April 2018

Patients with intermediate or high-grade non-Hodgkin's lymphoma are rarely cured of their disease after the failure of conventional therapy. Autologous bone marrow transplantation (ABMT) offers such patients a new possibility of cure. Our purpose was to evaluate the usefulness of radiotherapy in these patients who did not achieve complete remission of disease after high-dose chemotherapy (HDCT) followed by ABMT or who had previous bulky disease. In this study we examined 10 patients: after HDCT+ABMT, 9 patients had persistent disease and 1 patient with previous bulky disease was in complete remission. All patients underwent involved-field radiotherapy administered by a 6-18 MV linear accelerator, total mean dose 4000 cGy (range, 3200-5000 cGy). At the end of radiotherapy we observed 6 complete responses and 4 progressions of disease outside the radiotherapy field. No serious side effects were observed. To date, of the 6 complete responses 2 have relapsed (after 9 and 11 months) and 4 are alive and disease free at 24 months (range, 8-39 months) after radiotherapy. In our opinion, radiotherapy is an effective treatment after HDCT+ABMT and may have a role in a prospective multidisciplinary approach.
Effects of Cytokines on Oxygen Radical Production by Peripheral Blood Monocytes and Alveolar Macrophages in Patients with Lung Cancer
Authors: Tohda Yuji , Iwanaga Takashi , Uejima Hisao , Nagasaka Yukio , Nakajima Shigenori
Published: April 2018

The effects of cytokines (interleukin-2, tumor necrosis factor-alpha and interferon-gamma) on the ability of peripheral blood monocytes and alveolar macrophages to produce oxygen radicals were examined by the chemiluminescence assay in patients with lung cancer. Oxygen radical production by peripheral blood monocytes before stimulation with cytokines was lower in the lung cancer group than in healthy controls, suggesting reduced immune function in lung cancer patients. However, the activity in the lung cancer group was elevated to the control level when the monocytes were stimulated by any of the three aforementioned cytokines. Oxygen radical production by alveolar macrophages did not differ significantly between nonstimulated monocytes from lung cancer patients and those from healthy controls. In the lung cancer group, stimulation of the macrophages with any of the three cytokines elevated their ability to produce oxygen radicals to the same extent as in the control group. The results suggest that stimulation of macrophages by interleukin-2, tumor necrosis factor-alpha or interferon-gamma can exert an antitumor action in patients with lung cancer.
Brain Metastases from Cervical Carcinoma
Authors: Cormio Gennaro , Pellegrino Antonio , Landoni Fabio , Regallo Michela , Zanetta Gerardo , Colombo Alessandro , Mangioni Costantino
Published: April 2018

Central nervous system (CNS) involvement by cervical carcinoma is uncommon. Out of 1,184 patients registered for invasive cervical carcinoma at our Institution between 1982 and 1994, 14 (1.18%) developed brain metastases. Median age at the time of CNS metastasis diagnosis was 52 years. Median interval between diagnosis of cervical cancer and documentation of brain involvement was 18 months. Clinical manifestation included motor weakness, headache, seizures, dizziness and visual disturbances. All lesions (8 multiple, 6 single) were contrast enhanced on computerized tomography scans and were located in the cerebrum (n=10), in the cerebellum (n=2), or in both (n=2). The CNS was the only site of detectable disease in 7 patients with recurrent disease. Eleven patients received only steroids, and 3 patients received radiotherapy. All 14 patients died, and median survival from diagnosis of brain metastases for the entire series was 4 months (range, 1-21). CNS metastases from cervical cancer are rare, and the prognosis for such patients appears poor.
Associated Olfactory Groove Meningioma and Acoustic Neurinoma
Authors: Dario Alessandro , Scamoni Carlo , Cerati Michele , Marra Antonino , Dorizzi Alberto
Published: April 2018

The authors describe the case of a 71-year-old man without signs of phacomatosis with a history of progressive psychomotory lowering and two simultaneous tumors of the olfactory groove and of the cerebellopontine angle, as demonstrated by CT scans. Histologic examinations showed the lesions to be a meningioma and a neurinoma. The rarity and the possible pathogenesis of this association are discussed.
Rhabdomyosarcoma Presenting as Acute Hematologic Malignancy: Case Report and Review of the Literature
Authors: Ambrosiani Luciana , Bellone Stefano , Betto Francesco Saverio , Cecchetti Giuseppe , Ceretti Ermanno , Dagani Regina , Morelli Alfredo , Pavia Gianfranco , Schiaffino Eugenio , Tavani Enrico , Vismara Alessandro
Published: April 2018

The authors describe a case of undifferentiated rhabdomyosarcoma from unknown primary site, presenting as an acute hematologic malignancy with generalized lymphadenopathy, extensive bone marrow involvement and clinical and laboratory features of disseminated intravascular coagulation. Such a peculiar behaviour is known for rhabdomyosarcoma but is rare and can be a serious diagnostic problem for the clinician and the pathologist. The importance of a large spectrum immunohistochemistry as first diagnostic approach to any undifferentiated small-cell malignant tumor is stressed, together with the knowledge of the different immunoreactivity patterns. Desmin, MS-actin and myoglobin are the most reliable markers of this type of myogenic sarcoma.
Novel Non-Steroidal Aromatase Inhibitors: Are There New Perspectives in the Treatment of Breast Cancer?
Authors: Bajetta Emilio , Celio Luigi , Buzzoni Roberto , Bichisao Ettore
Published: April 2018

Breast cancer is the most common malignant neoplasm affecting women in Western countries, and most new cases are manifested during the postmenopausal period. The clinical results obtained with aminoglutethimide, and later with formestane, have established aromatase inhibition as one of the major therapeutic options in hormone-dependent advanced disease. Nevertheless, the lack of specificity of aminoglutethimide and the less than optimal oral activity of formestane soon led to further efforts to find a potent, highly selective, orally active, side-effect-free aromatase inhibitor for use in postmenopausal women with advanced breast cancer. Here we review the available data on three new, competitive non-steroidal aromatase inhibitors –- letrozole, vorozole and anastrozole –- which are approaching the point of detailed pharmacologic and clinical evaluation. Preliminary data have confirmed the high potency and selectivity of these endocrine agents, but their antitumor activity still remains to be completely defined. Challenges given by these novel aromatase inhibitors are discussed taking into account the biologic implications related to their mechanism of action and their future use in the management of breast cancer.
Response to Chemotherapy of Brain Metastases from Malignant Pleural Mesothelioma
Authors: Colleoni Marco , Liessi Guido , Avventi Cesare , Pancheri Francesca , Sgarbossa Gigliola , Vicario Giovanni , Manente Paolo
Published: April 2018

Brain metastases represent an uncommon complication in malignant pleural mesothelioma. A 55-year-old male suffering from malignant mesothelioma and pretreated with intracavitary chemotherapy and radiotherapy was submitted to systemic chemotherapy including lomustine, carboplatin, vinorelbine, fluorouracil and folates after diagnosis of bilateral cerebral deposits. The patient had an impressive response to chemotherapy, with complete regression of related symptoms. This case report represents the first on response to chemotherapy of brain metastases from mesothelioma. It points out that chemotherapy should be further explored in this subset of patients.
Isolated Pelvic Perfusion for the Treatment of Unresectable Primary or Recurrent Rectal Cancer
Authors: Vaglini Maurizio , Cascinelli Federico , Chiti Arturo , Deraco Marcello , Inglese Maria Grazia , Rebuffoni Giacomo , Rizzi Maurilia , Sala Barbara , Santoro Nicola , Santinami Mario
Published: April 2018

Between May 1990 and December 1995, 16 patients with primary or recurrent unresectable rectal cancer were treated by isolated pelvic perfusion. All patients had been previously treated and were considered unsuitable for surgery or further systemic chemotherapy or radiotherapy. The treatment was based on a perfusion lasting 90 min at 40.5 C° with 5-fluorouracil, mitomycin-C and mitoxantrone. Whenever technically feasible (10 cases), continuous intraarterial chemotherapy (through a Medtronic device with a catheter in the inferior mesenteric artery) was administered postoperatively. Two complete responses and 2 partial responses were observed; 8 other patients showed stable disease. One patient did not show any response. Finally, 3 patients for various reasons were not assessable. All patients experienced immediate relief of pain. No major side effects directly related to isolated pelvic perfusion were recorded; a transitory bone marrow depletion was observed in all cases. In conclusion, isolated pelvic perfusion is useful in inoperable disease of the pelvis by reliably relieving pain and thereby improving the patients quality of life.
Neoadjuvant CMV Chemotherapy plus Radical Cystectomy in Locally Advanced Bladder Cancer: The Impact of Pathologic Response on Long-Term Results
Authors: Scattoni Vincenzo , Bolognesi Angelo , Cozzarmi Cesare , Francesca Francesco , Grasso Marco , Galli Laura , Torelli Tullio , Campo Biagio , Villa Eugenio , Rigatti Patrizio
Published: April 2018

Aims and Background

Neoadjuvant systemic chemotherapy in infiltrating transitional cell carcinoma of the bladder has proved to be effective and to provide a pathologic complete response in about 30% of patients. No survival benefit has yet been proved.

Methods

We analyzed the outcome of 75 patients with advanced bladder cancer (stages T2-T4 N+/N0 M0) treated from 1985 to 1993 at two institutions in the same geographic area with 2 or 3 cycles of neoadjuvant CMV (cisplatin, methotrexate and vinblastine) chemotherapy plus cystectomy. Transurethral resection of the tumor was expressly avoided in order to keep the tumor intact as a marker lesion to evaluate response to chemotherapy.

Results

At the time of analysis, the median follow-up of 67 assessable patients was 51.5±3.9 (SE) months. Forty-six patients (69%) had clinical evidence of extravesical spread of the bladder tumor and 6 of lymph node metastases at presentation. After cystectomy, a pathologic complete response (pT0, pN0) was achieved in only 6 cases (9%) and a pathologic partial response in 32 patients (48%). The overall 5-year survival rate of all patients was 61 ±6%. Those patients who had a major response to chemotherapy (pCR + pPR) had a 5-year disease-free survival rate of 74%, which was statistically higher (P=0.0021) than the 44% for the remaining nonresponding patients (pNR). Overall, 43% of the patients with stage T2-T3a disease achieved tumor downstaging (CR, 5%; PR, 38%) compared with 63% of the patients with T3b-T4 (CR, 11%; PR, 52%), although there was no significant difference in 5-year survival curves between the two groups.

Conclusions

A pathologic complete response was achieved in less than 10% of the cases without a preoperative tumor resection. Unfortunately, most of the responses were only partial. Even though the study appears to suggest a survival advantage for those patients who achieved a downstaging, CMV chemotherapy had a limited curative potential in most of the patients. It seems unlikely that determinant proof will be obtained that neoadjuvant chemotherapy may improve survival over a nontreatment control arm. The intrinsic chemoresistance or the suboptimal response to chemotherapy of bladder cancer remains the most adverse prognostic factor.
Immunohistochemistry of Complement Response on Human Renal Cell Carcinoma Biopsies
Authors: Magyarlaki Tamás , Mosolits Szilvia , Baranyay Ferenc , Buzogány István
Published: April 2018

The goal of the study was to characterize the complement humoral and cellular antitumor responses on primary renal cell carcinoma biopsies. As an original observation, complement activation was found on 11/22 cases. Classical complement pathway activation was characterized by tumor C1q complement protein and IgG deposition (5/22 cases). Alternative or nonimmune complement pathway activation was seen as tissue deposition of C3 (6/22 cases). The membrane attack complex was present in cases with alternative complement pathway activation at the sites of tumor necrosis. Renal cell carcinomas with complement activation overexpressed at least one of the complement regulatory factors (membrane cofactor protein, decay accelerating factor, membrane attack complex inhibitor) and major histocompatibility complex class II molecules. Tumor infiltrating lymphocytes were present in most of the renal cell carcinomas with complement activation (8/11). However, the number of tumor-infiltrating lymphocytes was correlated with the intensity of major histocompatibility complex-ll expression in 18/22 cases. Detection of complement activation and immune cell infiltrates on renal cell carcinoma primary biopsies may serve as a new predictive factor for immunotherapy.