bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of Performance of Cervical Cytopathology Laboratories and of Screening Programs in Italy
Authors: Branca Margherita , Alieri Silvia , Cialdea Laura , Morosini Pierluigi ,   National Working Group for Quality Assurance in Cytohistopathology, Boccato P. , Branca M. , Cappa A.P.M. , Carretti D. , Coscia-Porazzi H.L. , Cristofori E. , Di Bonito L. , Fabiano A. , Giacomini G. , Minucci D. , Montanari G. , Peroni M. , Perrone-Donnorso R. , Rilke F. , Turolla E. , Vecchione A. , Boccato P. , Giacomini G. , Rilke F. , Turolla E.
Published: April 2018

Structure, performance, management, quality control and participation in screening programs of cervical cytology laboratories have been evaluated through a questionnaire sent to all public Italian hospitals, relevant university departments and senior members of relevant scientific associations. Completed questionnaires were received from 276 centers, which gives a response rate of 73%. In this report we concentrate on the need for improvement, but there are a number of centers who have all or almost all the features traditionally associated with good or excellent practice. The main results of the survey are the following. Most of the centers examine relatively few cervical smears, so their workload could be considered too low for maintaining a good level of practice. Six centers examine 3 specimens per woman, about 25% examine 2 specimens, and the rest only 1 specimen. There is a marked variability in filing and storing practices of positive and negative smears and results. Internal quality control is inadequate in most centers, and external quality control is limited to voluntary exchange of dubious or interesting smears. Only half of the centers are involved in screening programs. In 75% of the programs the suggested screening interval is 1 year or even 6 months; only 7 (4.5%) agree with the UICC/ IARC recommended interval of 3 years. The target population coverage varies from 10% to 85%, and it is less than 50% in 78% of the programs. Only 6 programs have an active women's call system. The survey has confirmed the need for launching a national program of internal and external quality control. Almost all centers have expressed their interest to take part.
Immunohistochemical Expression of c-erbB-2 in Human Breast Cancer by Monoclonal Antibody: Correlation with Lymph Node and Er Status
Authors: Querzoli Patrizia , Marchetti Elisabetta , Fabris Guidalberto , Marzola Andrea , Ferretti Stefano , lacobelli Stefano , Hazan Rebecca , King C. Richter , Nenci Italo
Published: April 2018

c-erbB-2 Protein expression was investigated in a series of fifty primary breast cancers by means of a specific monoclonal antibody and immunocytochemistry. Specific staining was observed at the plasma membrane level of neoplastic cells, according to the reported localization of c-erbB-2 protein. Sixty-four percent of tumors scored positive, with a variable amount of stained cells. The rate of protein expression was found to exceed the reported gene amplification. No relationship was observed between c-erbB-2 protein staining and age, meno pausal status or histologic subtypes. An inverse association was found between c'erbB-2 protein staining and estrogen receptor content of tumors, assayed by immunocytochemistry. A positive relationship was observed between c-erbB-2 protein expression and presence of axillary node metastasis. These findings suggest that c-erbB-2 protein expression is a marker of tumor aggressiveness and that its prognostic power deserves further investigation both in node-positive and node-negative patients.
A Phase II Study of Idarubicin and Prednisone in Multiple Myeloma
Authors: Alberts Albert S. , Falkson Geoffrey , Rapoport Bernardo L. , Uys Almarie
Published: April 2018

Twenty-one patients with multiple myeloma were treated with idarubicin 45 mg/m2 orally day 1 and prednisone 60 mg/m2 day 1-4 every three weeks. Moderate to severe gastrointestinal and hematopoietic toxicity were observed. Twelve of the twenty-one patients had relapsed on prior treatment. Of these, 2 patients responded. Two patients had primary resistant disease, neither responded. Seven patients had no prior treatment, three responded. ldarubicin and prednisone have modest activity in refractory myeloma, with short duration of response and severe toxicity.
Peripheral Blood and Tumor Infiltrating Lymphocytes in Non-Small Cell Lung Cancer: Analysis at the Population and Clonal Level
Authors: Viale Maurizio , Ferrini Silvano , Serrano Salvatore , Serrano Davide , Ardizzoni Andrea , Nicolin Angelo
Published: April 2018

Tumor infiltrating (TIL) and peripheral blood lymphocytes (PBL) were isolated from 18 patients with non-small cell lung cancer undergoing radical surgery. Surface marker analysis revealed that TILs and PBLs mainly consisted of CD3+T cells and that TILs generally displayed a lower CD4/CD8 ratio. Differences were found in the expression of CD25 (IL-2 receptor) and DR (MHC class II) antigens, which were increased in TILs, and in the percentage of CD16+ natural killer (NK) cells, which was reduced in TILs as compared to PBLs. Accordingly, the NK activity of TILs was lower than that of PBLs, whereas neither TILs nor PBLs expressed spontaneous cytolytic activity against fresh autologous tumor cells, melanoma cells and the « NK-resistant » A549 lung carcinoma cell line. After 4 days of culture in medium with recombinant-inter-leukin-2 (rIL-2), TILs and PBLs acquired cytolytic activity against all cell targets, but TILs expressed higher levels of cytotoxicity than autologous PBLs only in 3 patients out of 16 tested. More importantly, both TILs and PBLs displayed similar levels of cytotoxic activity against autologous tumor cells. TILs and PBLs from 8 patients were also analyzed by a limiting dilution microculture system. Cloning efficiency was remarkably lower in TILs, and surface marker analysis of T cell clones confirmed that an accumulation of CD8+ lymphocytes, which displayed cytolytic activity in a lectin-dependent assay, occurred at the tumor site. The non-MHC-restricted cytolytic activity of TIL- and PBL-derived T cell clones against K562, A549, and allogeneic melanoma cells and the cytolytic activity against autologous tumor cells showed no significant differences. Only 53% of TIL clones released IL-2 in response to PHA+TPA stimulation, whereas 68% of PBL-derived clones were IL-2 producers. Moreover, most PBL- and TIL-derived clones released tumor necrosis factor alpha in response to mitogen stimulation.
Ultrasonographic Evaluation of Palpable Breast Masses: Analysis of 134 Cases
Authors: Cosmacini Paola , Veronesi Paolo , Galimberti Viviana , Ferranti Claudio , Viganotti Giovanni , de Yoldi Gianfranco Coopmans
Published: April 2018

Sonography has become a helpful adjunct to mammography mainly for a differential diagnosis between simple cysts and solid masses. The authors examined by ultrasound 134 palpable masses in the breast which had been previously evaluated by clinical examination and mammography and then submitted to biopsy or fine needle aspiration. The exact diagnosis of a simple cyst was made in 94.1% of the cases, whereas the diagnosis of fibroadenoma was made in 80% of the cases. Ultrasound examination proved to be useful in patients with dense breasts: in this group, 82.1% of the patients with a histologic diagnosis of benign status had a correct ultrasound diagnosis. In agreement with other authors, we believe that breast sonography has no part in screening programs.
Diagnostic Delay in Breast Cancer: Correlation with Disease Stage and Prognosis
Authors: Rossi Simonetta , Cinini Claudia , Di Pietro Cinzia , Lombardi Celestino Pio , Crucitti Antonio , Bellantone Rocco , Crucitti Francesco
Published: April 2018

Diagnostic delay in a group of 189 women with breast cancer was studied and correlated with first symptom, stage of disease, histologic grade and prognosis. Diagnostic delay was divided into patient delay (time from the patient's discovery of a symptom to the first medical consultation) and system delay (time from medical diagnosis to treatment). Patients were divided into five groups by patient-delay time: 0 to 30 days; 31 to 90 days; 91 to 180 days; 181 to 365 days; and > 365 days. The median diagnostic delay was 60 days (range, 4-980) and was not influenced by patient age, marital status or nature of first symptom. A consistent and direct relationship was found between delay and tumor size, nodal involvement, presence of metastases, and histologic grade of disease at diagnosis. No correlation was found between diagnostic delay and histologic type distribution. The three-year survival rate after treatment was significantly lower for patients with a longer delay. Our data indicate that diagnostic delay appears to be an important determinant of stage at diagnosis in women with breast cancer and that it has an important influence on survival. In most cases, delay was mainly patient dependent (60 days); the median system-dependent delay was 15 days (range, 4-47). Since early treatment is generally accepted to be one of the most important determinants of prognosis in breast cancer patients, a reduction in diagnostic delay may lengthen survival time.
Pseudocyst of Tumor Involution: A Sign of Nodal Control in Radiation Therapy of Head and Neck Carcinoma
Authors: Dvořák Eduard
Published: April 2018

Regression of large metastatic lymph nodes in head and neck carcinoma following successful radiation therapy is a relatively lengthy process. This is especially true for nodes containing central necrosis. This article on serial CT scans identifies morphologic changes of prognostic significance, demonstrated on the basis of two case reports. Specifically identified are the transitional morphologic state, which is radiographically indistinguishable from an inflammatory condition, and, in addition, a seemingly end-stage of nodal tumor involution, which is represented by a pseudocyst formation, in a patient of long-standing duration.
Malignant Melanoma of the Penis. A Report of Four Cases
Authors: Zurrida Stefano , Bartoli Cesare , Clemente Claudio , De Palo Giuseppe
Published: April 2018

Malignant melanoma (MM) of the penis is a rare neoplasia. We report 4 cases by a retrospective survey of all cases of MM observed at the Istituto Nazionale Tumori of Milano from 1967 to 1988. The problem of the therapeutic approach is still unsolved. Therefore, any case is useful for a better knowledge of the natural history of this disease.
Intramuscular (Subfascial) Vascular Spindle Cell Lipoma. A Case Report
Authors: Jensen Marianne Lidang , Nielsen Vibeke Thue
Published: April 2018

Spindle cell lipoma is a distinct type of lipoma characterized by replacement of mature fat by collagen forming spindle cells. It is a benign lesion occurring chiefly in males older than 45 years and affects the subcutaneous tissues in the regions of the shoulder and posterior neck. Deep-seated (intramuscular) spindle cell lipomas are probably uncommon tumors and to date only two cases have been reported in the literature. A new case of a vascular variant of spindle cell lipoma in an intramuscular (subfascial) location is presented and the differential diagnosis is discussed.
Diagnostic and Prognostic Relevance of the Immunophenotype in Acute Myelocytic Leukemia
Authors: Callea Vincenzo , Morabito Fortunato , Martino Bruno , Stelitano Caterina , Oliva Bianca , Nobile Francesco
Published: April 2018

The immunophenotype of 72 cases with acute myelocytic leukemia was investigated with a panel of monoclonal antibodies. When the morphologic criteria of the FAB classification was compared with the normal myeloid and erythroid pathway of differentiation identified by MoAbs, a relationship was found with FAB M5 and M6. Moreover, a constant negativity to HLA-DR and CD15 antigens in M3 and the contemporaneous expression of HLA-DR and CD11b antigens on the M4 and M5 leukemic cells were observed. We identified phenotypically distinct groups of patients with different responses to therapy. In fact, patients whose leukemic cells did not express the HLA-DR antigen showed, in a univariate analysis, a significantly higher percentage of complete remissions than did HLA-DR-positive patients. Multivariate discriminant analysis, in line with this result, showed that the parameters of discriminant capacity were, in order of statistical significance, young age, low WBC count and the lack of DR expression, respectively. A trend for a better response to therapy, without any statistical relevance, was also observed in CD11b-negative and CD33-positive cases. Similar results were detected In patients who expressed either DR or CD11b, or none of these markers. These findings indicate that immunophenotype may identify some FAB subtypes. Moreover, in some cases the phenotypic profile can provide useful information about the clinical outcome.
Genital Human Papilloma Virus Infection in Males. A Clinico-Pathologic Study
Authors: Koronel Remi , Stefanon Bernardina , Pilotti Silvana , Bandieramonte Gaetano , Rilke Franco , De Palo Giuseppe
Published: April 2018

From March 1987 to December 1988, 402 male sexual partners of 317 women with human papilloma virus (HPV) infection of the lower genital tract and 85 with HPV-associated cervical and/or vulvar intraepithelial neoplasia (CIN and/or VIN) were submitted to clinical examination and peniscopy. The latter was performed at a 6-15 X magnification after a 3 min exposure to 5% acetic acid solution. Visible lesions were biopsied. Thirty-one patients had clinical evidence of HPV infection in the glans, penile shaft or urethra, and 222 had peniscopic evidence of subclinical aceto-white lesions. Of 31 patients with clinical lesions, 11 showed also aceto-white subclinical lesions. Of 253 peniscopically positive males, 237 were biopsied and 191 of these were histologically ascertained. Three patients had penile intraepithelial neoplasia, one with clinical appearance of a Buschke-Löwenstein tumor. The incidence of HPV infection in male sexual partners of women affected by HPV infection of the lower genital tract associated or not with intraepithelial neoplasia is lower than expected. However, clinically negative males should not be considered disease free; in fact, 12 patients, negative at the first examination, showed histological evidence of HPV infection at subsequent controls. Therefore, follow-up of at least 6 months should be allowed to Identify HPV bearing males. The reported low frequency of HPV infection may be due to the fact that the males may harbour the virus in the urethra, prostate or seminal vesicles or penis without any clinical evidence of disease. Although research for HPV-DNA in intraurethral and penile scraping material might be useful for diagnosis, peniscopy with a 5% acetic acid application remains the clinical test for evaluating HPV Infection in males. The importance of peniscopy should be viewed with respect to the prevention of infection or reinfection of the female sexual partners, in addition to the specific diagnostic purpose in male patients.
Malignant Peripheral Nerve Sheath Tumor Arising in a « De Novo » Ganglioneuroma. A Case Report
Authors: Damiani Stefania , Manetto Valeria , Carrillo Giovanna , Di Blasi Arturo , Nappi Oscar , Eusebi Vincenzo
Published: April 2018

A case of a « de novo » ganglioneuroma showing an internal area of malignant nerve sheath tumor is described. The tumor arose in an 18-year-old girl without a history of von Recklinghausen's disease. Immunohistochemically, the ganglioneuromatous component was positive with anti-synaptophysin, anti-S100 protein and anti-vimentin antisera, whereas the malignant part was immunoreactive only with anti-S100 protein and anti-vimentin antisera. The patient is free of disease 4 years after surgery. The clinicopathologlc features of this rare case are discussed.
Some Aspects of Purine Nucleotide Metabolism in Lymphocytes of B-CLL
Authors: Tabucchi Antonella , Leoncini Roberto , Pagani Roberto , Pizzichini Maria , Terzuoli Lucia , Vannoni Daniela , Porcelli Brunetta , Mannello Enrico , Dispensa Egidio
Published: April 2018

The authors studied the behavior of some enzymes involved in purine nucleotide metabolism in human peripheral blood lymphocytes from normal and B-cell chronic lymphocytic leukemia subjects. Determinations were made with radiochemical methods associated with high performance liquid chromatography. Results indicated a marked increase in de novo purine synthesis enzymes, particularly those of the « inosinic branch point ». The latter were absent in normal lymphocytes, whereas they were well evident in leukemic lymphocytes, with the exception of AMP-S synthetase. Whereas the enzymes of the « salvage pathway » were spared in comparison to other proteins, those of the « catabolic pathway » significantly decreased. The authors discuss the possibility that such enzymes may be used as tumor markers.
Trends in European Breast Cancer Incidence and Possible Etiology
Authors: Caygill Christine P.J. , Hill Michael J.
Published: April 2018

In this study the trends in breast cancer incidence in a number of European countries, over the last 20 years, have been evaluated. There is a wide range in incidence; the risk being highest in north and west Europe (and highest in Switzerland) and lower in south and in east Europe. There was little difference, however, between countries in the incidence of the disease occurring before the menopause, and this incidence has shown little temporal change in the time period 1960-1985. Indeed, in many countries there has been little change in incidence in any age band since 1975. The use of oral contraception has been claimed to be a risk factor in premenopausal breast cancer. In two countries, the data on oral contraceptive usage were available; in neither was there any evidence that the introduction and growth in such usage was related to the risk of breast cancer in any age band that might have been exposed to them. The reasons for this are discussed in the light of recent reports to the contrary.
Adenoid Cystic Carcinoma of the Breast.: Value of Immunohistochemical Study in Diagnosis
Authors: Trojani Monique , De Mascarel Isabelle , Coindre Jean-Michel
Published: April 2018

An immunohistochemical study of 5 cases of adenoid cystic carcinoma (ACC) of the breast was performed with antibodies against keratin, EMA, vimentin, S-100 protein, alpha-smooth muscle actin and collagen IV. Results show the following: 1) ACC may be diagnosed and differentiated from ductal carcinoma (invasive or in situ). The key to diagnosis is positivity within tumor masses of alpha-smooth muscle actin, a specific marker for myoepithelial cells. Actin-rich cells are not generally observed in ductal carcinomas, except at the periphery of a few invaded ducts, corresponding to a residual myoepithelial cell layer. Other markers may be positive in both ACC and ductal carcinoma; these are not specific and only the percentage and distribution of positive cells are helpful for diagnosis (small clusters of keratin-positive cells in ACC « versus » most positive cells in ductal carcinoma). 2) The functional pleomorphism of the cell population is underlined with cells differentiating towards epithelium and myoepithelium stained by corresponding markers, and undifferentiated cells unstained by any marker. These results confirm the value of an immunohistochemical study in the diagnosis of ACC of the breast.
CO2 Laser Surgery in Laryngeal Cancers: Three Year Results
Authors: Chiesa Fausto , Tradati Nicoletta , Costa Luigi , Podrecca Stefano , Boracchi Patrizia , Garramone Rocco , Sala Luigi , Bartoli Cesare , Molinari Roberto
Published: April 2018

The purpose of this paper is to evaluate the relapse-free survival and the overall survival at three years of 39 laryngeal cancers (10 T1 and 29 small recurrent carcinomas with mobile vocal cord) operated on by CO2 laser surgery at the Istituto Nazionale Tumori in Milan from 1982 to 1987. The 10 patients with T1 cancers had two local recurrences, whereas the 29 patients with recurrent carcinomas had 14 local recurrences. Local relapses occurred in 2/16 patients with cancer limited to the vocal cord and in 9/17 patients with glottic tumors extended to the anterior commissure or to the ventricular band or to the arytenoid. Supraglottic cancers recurred in 3/4 patients. The authors conclude that transoral laser surgery is an effective modality for treatment of T1 primary and small recurrent carcinomas of the larynx, when limited to the middle third of the vocal cord.
Mitomycin-c, Adriamycin, 5-Fluorouracil and Leucovorin (L-FAM2) in the Treatment of Advanced Gastric Cancer: A Phase II Study
Authors: Zaniboni Alberto , Simoncini Edda , Marpicatl Patrizia , Meriggi Fausto , Arcangeli Giuseppina , Garattini Patrizia , Raffaglio Ernesto , Ferragni Amelio , Marini Giovanni
Published: April 2018

Thirty previously untreated patients with advanced measurable gastric cancer were given a combination chemotherapy consisting of 5-fluorouracil, 400 mg/m2, and leucovorin, 200 mg/m2 iv on days 1 to 3, mitomicyn-C, 10 mg/m2 on day 1 (every other cycle) and adriamycin, 40 mg/m2 on day 2, repeated every 21 days. The overall response rate was 46 % (14/30; 95 % confidence limits: 28 %-64 %) including 4 patients with a complete remission. Eight patients progressed. Median duration of remission (CR+PR) was 10 months, with a median survival of 13, 8 and 4 months for CR + PR, NC and PD, respectively. Main toxicities were leukopenia (WHO grade III-IV in 36 % of the patients) and alopecia. One patient died from myocardial infarction after an adriamycin cumulative dose of 480 mg/m2. No other treatment-related death occurred. L-FAM2 is an effective combination for advanced gastric carcinoma. Further studies based on the association of leucovorin and 5-fluorouracil in combination with other active drugs are warranted.
Leukocyte Alkaline Phosphatase and Carcinoembryonic Antigen in Metastatic Colorectal Cancer Patients
Authors: Walach Natalio , Guterman Amiram , Zaidman Jacob L. , Kaufman Suzana , Weimberger Lola , Scharf Sally
Published: April 2018

Peripheral blood leukocyte alkaline phosphatase scores and plasma carcinoembryonic antigen levels in 26 patients with metastatic colorectal cancer were compared to those in 30 healthy controls. Patients had metastases to the liver and abdomen. The mean leukocyte alkaline phosphatase score in the metastatic colorectal cancer patients was significantly higher than in the control group (246 ± 65 vs, 52 ± 26, p < 0.001); and the mean carcinoembryonic antigen level in the patients was also significantly higher than in the controls (110 ± 100 vs, 4.9 ± 3 ng/ml, p < 0.001). One hundred percent of the metastatic cancer patients had elevated LAP scores and 73% of these patients had elevated CEA levels. There was a difference between the mean CEA levels in the patients with liver metastases and those with abdominal metastases (162 ± 135 vs, 39 ± 53 ng/ml, p < 0.04). The results suggest that although both markers are elevated in metastatic colorectal cancer, the LAP score seems to be more useful in detecting metastatic disease, since we found 11 % false negatives with the CEA level and 0 % false negatives with the LAP score.
Association of Adenocarcinoma and Leiomyosarcoma of the Sigmoid Colon. A Case Report
Authors: Di Palma Silvana , Andreola Salvatore , Bertario Lucio , Rossetti Carlo
Published: April 2018

Malignant tumors of the gastro-intestinal tract showing both carcinomatous and sarcomatous components are rare. Very few cases were described in the stomach and only one case in the colon. We describe a second case of a tumor of the sigmoid colon showing adenorcarcinoma intermigled with leiomyosarcoma elements.
Cancer-associated Hemolytic-uremic Syndrome with Spontaneous Resolution. A Case Report
Authors: Seminare Patrizia , Franchi Fabrizio , Abdolrahimzadeh Solmaz , Gozzer Maria , Barone Carlo
Published: April 2018

A case of cancer-related hemolytic-uremic syndrome is reported. The patient presented a spontaneous recovery, which is unusual in this clinical picture. Mitomycin C is regarded as responsible for this toxic event in most cases. The case history reported here is discussed in relation to dose and scheduling of mitomycin C, and a safe maximum dosage in suggested.
Distant Metastases in Differentiated Thyroid Cancer: Long-term Results of Radioiodine Treatment and Statistical Analysis of Prognostic Factors in 214 Patients
Authors: Casara Dario , Rubello Domenico , Saladini Giorgio , Gallo Vittorio , Masarotto Guido , Busnardo Benedetto
Published: April 2018

Long-term results and statistical analysis of prognostic factors in a series of 214 patients with distant metastases from differentiated thyroid cancer (DTC) are reported here. These 214 were part of a total series of 1457 patients with DTC referred to our center from 1967 to 1987. All patients underwent surgery and 131-I therapy and were treated with TSH suppressive doses of thyroid hormones. After a mean follow-up of 7.3 years including clinical, scintigraphic, radiological and laboratory investigations, 24.4 % of patients were alive without disease, 36.5 % alive with disease, 1.8 % dead without disease and 37.3 % dead with disease. One of the main factors influencing the survival in our series was 131-I uptake (RIU) by metastatic tissue. No case of complete remission of disease was observed among patients with nonfunctioning metastases. Another important factor was the site of metastases, patients with bone metastases having the worst prognosis. The patient's age at diagnosis represented another important factor for survival; patients over 40 years, particularly those over 60 years had a bad prognosis. A clear interrelation was found among the factors advanced age, nonfunctioning metastases and bone metastases. Patients with these last clinical features were considered to be at high risk and generally had a fatal outcome. Another significant prognostic factor revealed by univariate analysis was the histologic type. Patients with follicular tumor showed a poorer prognosis in comparison to papillary tumor. When multivariate analysis was applied, the factors age at diagnosis, site of metastases and RIU proved to have a significant influence on survival, but not the histologic type. Lastly, the relative rate of males was higher in the group of patients with metastases in comparison to the whole series of DTC patients. Despite this, the factor sex did not influence survival.
Is Breast Cancer Ever Cured? Follow-Up Study of 5623 Breast Cancer Patients
Authors: Ciatto Stefano , Bonardi Rita
Published: April 2018

The authors evaluated 5623 cases of primary breast cancer followed for 1 to 21 years. Overall and breast cancer death rates were determined and compared to expected rates. Breast cancer patients showed overall and breast cancer death rates significantly higher than expected and which persisted at long-term follow-up. The observed/expected overall death ratios for follow-up periods of 0–5, 6–10, 11–15 or 16–20 years were 3.61, 2.55, 1.60 and 2.11, respectively. Death rates from breast cancer at 5, 10, 15 and 20 years were 20%, 32%, 40% and 48% respectively. The evidence of a persistent excess mortality even after long-term follow-up suggests the hypothesis that breast cancer is a systemic disease when clinically diagnosed. This study provided no evidence of a « clinical » cure for breast cancer patients. Even for N- patients the 5, 10, 15 and 20 year death rates from breast cancer were 12%, 20%, 28% and 38%, respectively. N- breast cancer, which is currently considered as a localized disease cured by surgery in most cases, would be better regarded to as a slow-growing metastatic disease, although « personal » cure may be achieved in many subjects dying of causes other than breast cancer.
Distal Intramural Spread in Colorectal Cancer: A Reappraisal of the Extent of Distal Clearance in Fifty Cases
Authors: Sidoni Angelo , Bufalari Andrea , Alberti Paolo F.
Published: April 2018

Fifty colorectal carcinomas were Investigated to demonstrate distal intramural spread (DIS). In 17 cases (34 %) a DIS ranging from 0.25 to 3.5 cm was present. DIS was positively correlated with stage C2 (p < 0.01), lymph node metastasis (p < 0.03) and Infiltrative growth of the tumor (p < 0.05). Our results show that DIS is a relatively frequent event but of limited extension. In fact, a distal clearance margin of 2 cm was considered safe for all patients but one C2 mucoid case. No pathologic feature can predict preoperatively the presence and extent of DIS.
Relationship between Nutritional Status and Tumor Growth in Humans
Authors: Bozzetti Federico , Boracchi Patrizia , Costa Aurora , Cozzaglio Luca , Battista Antonello , Giori Alberto , La Monica Gaudenzio , Silvestrini Rosella
Published: April 2018

Aims and background

There is considerable evidence from studies on tumor-bearing animals that nutritional support aimed at maintaining a good nutritional status can indeed promote tumor growth. Experience in humans, however, is scanty and controversial, this issue never having been extensively investigated. The purpose of this study was to analyze whether there exists a relationship between nutritional status and tumor growth in patients with non-Hodgkin's lymphoma. The hypothesis behind it was that if it is true than an abundant availability of substrates promotes tumoral growth, then the better the nutritional status the higher the tumor cell proliferation.

Methods

Two hundred and forty six adult patients with non-Hodgkin's lymphoma were characterized according to nutritional status (percent of weight loss as compared to usual body weight, serum albumin, serum cholinesterase, number of lymphocytes) and rate of incorporation of 3H thymidine labelling index in the tumor tissue. The values of serum albumin, serum cholinesterase and lymphocytes were subdivided into three classes adopting as cut-off points the tertile values of their distribution, while weight loss was scored as a “no” and a “yes”. The association between nutritional parameters and labelling index was evaluated by a univariate analysis (X2 test and Mantel-Haenszel X2 test and the odds ratio) and by a logistic multiple regression model.

Results

Results of the univariate analysis show a statistically significant association between “poor” nutritional status (depressed nutritional indexes) and “high” labelling index (increased tumoural growth), while the multiple regression analysis found that the only significant association was that between low serum cholinesterase and high labelling index.

Conclusions

These data demonstrate for the first time in a large series of patients that maintenance of a good nutritional status does not have any deleterious effect on the tumor growth.
The Role of Intraoperative Therapy by Electron Beam and Combination of Adjuvant Chemotherapy and External Radiotherapy in Carcinoma of the Pancreas
Authors: Fossati Vittorio , Cattaneo Giovanni Mauro , Zerbi Alessandro , Galli Laura , Bordogna Gianni , Reni Michele , Parolini Danilo , Carlucci Michele , Bissi Amleto , Staudacher Carlo , Di Carlo Valerio , Calandrino Riccardo
Published: April 2018

Aims and background

In the treatment of pancreatic carcinomas, one modality is intraoperative radiotherapy (IORT). A study was carried out to assess the feasibility of IORT alone or in a multimodality approach with postoperative adjuvant chemotherapy and external radiotherapy and to compare local control and survival of patients. Another objective of this retrospective study was to verify prognostic factors in resected patients treated with IORT.

Methods

From January 1985 through September 1992, 54 adenocarcinomas of the pancreas (unresectable and resected patients) were treated with IORT by electron beam at the San Raffaele Hospital and then analyzed. Comparison was also carried out between IORT-treated resected patients and a non-randomized control group of resected patients treated without IORT in the same period.

Results

In unresectable patients treated by laparotomy bypass and IORT, overall median survival was 6 months and 8 months in non-metastatic patients. Relief of severe pain present in 14 patients was observed in 85% within 12 days of IORT. As regards resected patients, the most important finding was that significantly better local control resulted from IORT. In fact, overall, local relapses were 25% in the IORT group and 55.8% in the non-IORT group (control group); instead, survival of the IORT group was not significantly longer than that of the control group. From a statistical analysis of resected patients treated with IORT and performed on prognostic factors on the basis of available data, survival was significantly influenced by tumor pathologic grading and diameter; postoperative adjuvant therapy was not a significant prognosis factor.

Conclusions

IORT has a role in local control of unresectable pancreatic carcinomas and in control of resultant severe pain. In resected patients, IORT is effective in decreasing local recurrences but has little impact on survival. To obtain more satisfactory results, new and more effective adjuvant therapies and better abdominal prophylaxis should be tested.
Intensive Weekly Chemotherapy for Elderly Gastric Cancer Patients, Using 5-Fluorouracil, Cisplatin, Epi-Doxorubicin, 6S-Leucovorin and Glutathione with the Support of G-CSF
Authors: Cascinu Stefano , Catalano Giuseppina
Published: April 2018

Aims and background

Elderly patients constitute the largest group of advanced gastric cancer patients. Since there is a widespread misconception that the elderly are poorly tolerant of chemotherapy, most of them are untreated or receive a less aggressive but also less efficacious chemotherapy. However, because tolerance and response to cancer seem to vary more with physiologic age than chronologic age, we evaluated the feasibility and activity of an intensive weekly chemotherapy in elderly gastric cancer patients.

Methods

23 advanced gastric cancer patients (13 males and 10 females), older than 70 years, received weekly: cisplatin, 40 mg/m2 iv; epi-doxorubicin, 35 mg/m2 iv; 6S-leucovorin, 250 mg/m2 iv; 5-fluorouracil, 500 mg/m2 iv; and glutathione, 1.5 g/m2 G-CSF, at the dose of 5 μg/kg, was administered daily from the day after to the day before each chemotherapy administration.

Results

Toxicity was mild. The most common adverse effects were leukopenia (grade 3 in 2 patients); thrombocytopenia (grade 3 in 1 patient) and anemia (grade 3 in 3 patients). Five patients (20%) achieved a complete response and 9 (39%) a partial response, resulting in an overall response rate of 59% (95% CI, 40% to 78%). The median survival time was 13 months for all the patients and 15 months for patients with objective responses.

Conclusions

This regimen appears feasible also in elderly gastric cancer patients and, because of its activity, suitable for further studies.
Carboplatin and Etoposide in Previously Treated Colorectal Cancer Patients
Authors: Colucci Giuseppe , Maiello Evaristo , Giuliani Francesco , Cifarelli Rosaria Alba , Giotta Francesco
Published: April 2018

Aims and background

Salvage treatment of advanced colorectal cancer patients has not been well defined as yet, and new potentially active drugs or combinations should be evaluated for these situations.

Methods

From February 1993 to September 1993, the combination of carboplatin (CBDCA) and etoposide (VP-16), both as 100 mg/m2 for three consecutive days, was administered to 17 colorectal cancer patients who had been previously subjected to FA-FU combination chemotherapy. The CBDCA+VP-16 treatment was repeated every 3 weeks. A total of 58 cycles was administered, and 16 patients were evaluable for response.

Results

There was no objective response, but 2 stable diseases and 14 progressive diseases were observed. Toxicity was mild, with no WHO 3–4 grade toxicity.

Conclusion

this combination chemotherapy was judged ineffective for pretreated colorectal cancer patients.
Sequential Subcutaneous Thymopentin, Interferon Alpha-2A and Interleukin-2 in Metastatic Renal Cell Cancer
Authors: Di Lauro Luigi , Del Medico Pietro , Carpano Silvia , Cancrini Antonio , Gionfra Tommaso , Vici Patrizia , Rosselli Michele , Lopez Massimo
Published: April 2018

To determine the activity of sequential administration of thymopentin (TP-5), interferon alpha-2a (IFN) and interleukin-2 (IL-2) in metastatic renal cell cancer (RCC), 17 patients with RCC were treated with TP-5 50 mg/d on days 1 to 14, IFN 3 MIU/d on days 14, 15, 21, 22 and IL-2 18 MIU/d on days 16 to 20, and 23 to 27. Treatment was given subcutaneously and cycles were repeated every 6 weeks. All patients were assessed for toxicity and response. No objective responses were observed. Two patients had a short-lived disease stabilization. Median survival was 9 months. Toxicity was generally moderate. The most important side-effects were related to IL-2 administration. In view of the lack of antitumor activity, the combination of TP-5 + IFN + IL-2 in the doses and schedule used in this trial cannot be recommended. The investigation of chemotherapeutic and immunological agents that can effectively synergize with IFN or IL-2 is essential.
Lonidamine plus Cyclophosphamide in the Treatment of Adanced Non-Small Cell Lung Cancer in the Elderly: A Phase II Study
Authors: Salvati Franco , Antilli Antonio , Cruciani Anna Rita , Lombardi Alessandra , Mugnaini Luigi , Nunziati Francesco , Perrone Nicola , Portalone Luigi , Signora Mauro
Published: April 2018

Aim and background

The aim of this Phase II trial was to verify the therapeutic activity and tolerability of chemotherapy with lonidamine (LND) plus cyclophosphamide (CTX) in advanced non-small cell lung cancer (NSCLC) in the elderly. The rationale of the combination is reported. CTX showed mild toxicity, with a 12% objective response (OR) in monochemotherapy; LND potentiated the in vitro antiproliferative activity of alkylating agents, mainly CTX, without increasing myelotoxicity, particularly important in the elderly.

Methods

The schedule consisted of CTX, 600 mg/m2/i.v. on day 1 every 21 days for 6 cycles; LND, 450 mg/die/p.o. from day 1 to progression.

Results

Between November 1990 and April 1991, 41 patients with stage III–IV NSCLC were enrolled; 35 were assessable for response. Median age was 73 years (range, 71–79 years); 13 patients (32%) presented stage III A, 20 (49%) stage III b, and 8 (19%) stage IV disease. Cardiovascular conditions and/or chronic respiratory failure contraindicated surgical treatment in stage III A patients. Of enrolled patients, 14.6% experienced PR, 48.8% SD and 14.6% dropped out of the study. Median time to progression was 4 months (range, 2–9 months) and median survival 9 months (range 3–45 months). No patient showed WHO grade IV LND-related toxicity. In 1 patient (2.5%), LND was discontinued after 5 therapy cycles due to WHO grade III myalgia; in 80% of patients, LND oral dosage was reduced to 300 mg/day due to WHO grade II myalgia, and 20% of patients completed treatment with the full dose.

Conclusions

CTX plus LND can be considered a well tolerated therapeutic approach in the elderly with NSCLC with good PS and good liver, renal and cardiac conditions, but 14.6% PR is a slightly better result as compared with 12% PR obtainable with CTX alone as reported in the literature, even though most patients presented with advanced disease and no specific toxic effect was observed. Therefore, a confirmatory randomized trial (CTX vs CTS plus LND) would hardly be useful.
Combined and Sequential Expression of p53, Rb, Ras and Bcl-2 in Bronchial Preneoplastic Lesions
Authors: Ferron Paola Elisabetta , Bagni Maria , Guidoboni Massimo , Beccati Maria Donatella , Nenci Italo
Published: April 2018

Aims and background

Several simple molecular abnormalities have been detected in bronchial preneoplastic lesions, but the simultaneous presence of these alterations has been scarcely investigated.

Methods

We studied, by an immunohistochemical method, the expression of p53, Rb, Ras and Bcl-2 in 65 samples from surgical specimens and diagnostic biopsies selected for the presence of preneoplastic changes in the bronchial epithelium. To perform an analysis of the combined expression of all markers in the same areas, we accurately mapped every consecutive section on which immunohistochemical reactions were performed, subdividing each specimen into 25x microscopic fields, which allowed good topographical mapping.

Results

It was found that the frequency of p53-positive and Rb-negative microscopic fields was directly related to the morphological grading of lesions. On the other hand, Ras expression characterized high-grade lesions not showing squamous differentiation (non-squamous Cis). Regarding Bcl-2 expression, only slight differences in positivity distribution were found between the different lesions. More interesting was the parallel evaluation of all markers in the same areas: one of the main patterns, found to be correlated with the severity of histopathological features, was characterized by combined p53 hyperexpression/Rb hypoexpression; furthermore, when Ras and Bcl-2 hyperexpression were superimposed to the above pattern, the former mainly characterized non-squamous Cis, while the latter was present only in high-grade squamous lesions. However, the most frequently encountered pattern did not show any alteration of the studied markers, suggesting that other mechanisms could be involved in bronchial carcinogenesis.

Conclusions

The detection of combined molecular abnormalities in bronchial preneoplasia could clarify the steps involved in lung carcinogenesis; furthermore, a simple and inexpensive method, such as immunohistochemistry, could be routinely applied also to cytologic specimens in order to detect those lesions, or patients, that are prone to progression towards lung cancer.
Brain Metastases in Well-Differentiated Carcinoma of the Thyroid
Authors: Samuel Aban M. , Shah Damayanti H.
Published: April 2018

Fifteen patients (4 males and 11 females) developed brain metastases from well-differentiated thyroid cancer within 1 month to 14 years of the initial diagnosis. One patient presented with a brain tumor. Except for 3 patients with unique brain metastases, all the others had extensive metastases in nodes, lungs and bones in various combinations. Brain metastases generally appeared after the onset of metastases at other sites. The histology of the brain tumor matched the primary pathology in the 6 operated cases. The treatment was surgery and external radiation in 6 cases, and radioiodine or chemotherapy in the others. Survival in general was less than 6 months after the diagnosis of brain metastases. The prognosis is poor once the onset of brain metastases is evident.
Cancer Mortality in Italy, 1993
Authors: Decarli Adriano , La Vecchia Carlo
Published: April 2018

Background

Data and statistics are presented on cancer death certification for 1993 in Italy, updating previous publications covering the period 1955–1992.

Methods

Data for 1993 subdivided into 30 cancer sites are presented in 8 tables, including age-and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35–64 year age group.

Results

Age-adjusted death certification rates (on the world standard population) for all neoplasms declined from 189.8 in 1992 (and a peak of 199.2 in 1986) to 187.8/100, 000 males in 1993, and remained stable around 100, 000 females. The favorable trends were even larger in middle and younger age males, but not in children below age 15, whose overall age-standardized cancer mortality rates increased for the fourth subsequent year. Lung cancer was the leading site of cancer mortality, with over 30, 900 deaths. For the fifth subsequent year, its rates in males declined, to reach 56.0/100,000. The decline in lung cancer rates is now established in Italian males and is substantial in middle age, whereas the rise in female lung cancer rates seems to have leveled off over the last few years. Rates for other major cancer sites (intestines, stomach, female breast, prostate, pancreas, leukemias and lymphomas) were stable, but some decrease was apparent also in 1993 for Hodgkin's disease.

Conclusions

Italian cancer mortality rates in 1993 were moderately favorable in males, due to the leveling of the tobacco-related epidemic, whereas no appreciable change was registered in females. The persisting unfavorable trends in childhood cancer mortality should be investigated.
Paclitaxel Activity in Anthracycline Refractory Breast Cancer Patients
Authors: Vici Patrizia , Di Lauro Luigi , Conti Francesca , Capomolla Elisabetta , Gionfra Tommaso , Amodio Antonella , Lopez Massimo
Published: April 2018

Aims and background

We investigated the efficacy and tolerability of two doses of paclitaxel, 175 mg/m2 and 135 mg/m2, over a 3-hr infusion, without prophylactic G-CSF, in heavily pretreated patients with anthracycline-resistant breast cancer. Although paclitaxel may share with anthracyclines a common mechanism of drug resistance, there is evidence that the two drugs are not completely cross resistant.

Methods

From July 1994 to January 1996, 42 patients were treated every 3 weeks, for a maximum of 6 cycles; paclitaxel dose was established according to pretreatment extension.

Results

In 41 assessable patients we observed 9 partial responses, for an overall response rate of 22% (95% CI, 10–34%). There was no difference in response rate between the two dose levels. Median duration of response was 9 months, median time to progression 5 months, and median survival 9 months. The dose-limiting toxicity was neutropenia, which was grade 3–4 in 40% (135 mg/m2) and 62% (175 mg/m2) of the patients (P = 0.28); neutropenic fever occurred in 24% of the patients, without significant differences between the two dose levels. Other toxicity was mild to moderate.

Conclusions

Paclitaxel at doses of 175 mg/m2 or 135 mg/m2 is active and well tolerated in advanced breast cancer patients resistant to anthracyclines. The prophylactic use of colony-stimulating factors seems appropriate in heavily pretreated patients given the higher dose level.
Relationship between Cathepsin-D and Other Prognostic Factors in Human Breast Cancer
Authors: Glikman Patricia , Rogozinski Amelia , Mosto Julian , Pollina Angelica , Garbovesky Carlos , Levy Carlos
Published: April 2018

Cathepsin-D (CATH-D) is a lysosomal protease induced by estrogens in estrogen receptor-positive breast cancer cell lines and constitutively produced by estrogen receptor-negative breast cancer cells. The concentration of CATH-D in the cytosol of 97 human breast tumor tissues was correlated with other well-known prognostic factors for human breast cancer. CATH-D was significantly higher in node-positive than in node-negative tumors (P = 0.042, Kruskal-Wallis test). However, no correlation was found between enzyme levels and the number of positive nodes. CATH-D concentration did not correlate with age, menopausal status, clinical stage of the disease, size of the primary tumor, steroid receptors, thymidine labeling index, histological grade, nuclear grade or cellularity. CATH-D did not show any association with the known prognostic factors evaluated in this study and its association with lymph nodes was only weak.