bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Treatment of Neuroendocrine Tumors
Authors: Bajetta Emilio , Di Bartolomeo Maria , Zilembo Nicoletta , Bochicchio Anna Maria
Published: April 2018

Background

Tumors of the neuroendocrine system are characterized by amine precursor uptake and decarboxylation, and they represent a heterogeneous group of carcinomas including carcinoids, islet cell carcinomas of the pancreas, medullary thyroid carcinomas and Merkel cell carcinomas. Their similar cytochemical and ultrastructural properties sustain the hypothesis of a common embryologic origin within the neural crest. Many of these tumors grow slowly, and reducing tumor burden represents the treatment of choice. However, when surgery is not feasible, medical treatment has to be considered. Therapeutic approaches in metastatic disease often do not consider the different biologic behaviors of these neoplasms. Moreover, efficacy of the treatment is associated with lack of a clear definition of the type of response: objective, symptomatic or biochemical.

Methods

In this review we have analyzed the different medical approaches used in the treatment of neuroendocrine tumors in an attempt to define their precise role in the different neoplasms.

Results

In carcinoid tumors, immunotherapy and the somatostatin analogue can be efficaciously used for the control of carcinoid syndrome. For inhibition of tumor growth, chemotherapy should be used only in patients with rapidly progressive disease, and the results are still unsatisfactory.

Conclusions

Although all these tumors appear to have similar cytochemical properties, the responsiveness of the various neoplasms is very different. In the future, a specific treatment modality and a clear definition of the type of response (objective, symptomatic or biochemical) need to be defined for each type of neuroendocrine tumor.
Mitomycin C, 5Fluorouracil and Folinic Acid in Combination with Alpha 2b Interferon for Advanced Colorectal Cancer
Authors: Mattioli Rodolfo , Mezzanti Paola , Silva Rosa Rita , Battelli Nicola , Manocchi Paola , Pilone Alberta , Rossini Simonetta , Delprete Stefano , Bascioni Romeo , Battelli Tullio
Published: April 2018

Aims and Background

This study was conducted to investigate the activity and toxicity of 5fluorouracll + folinic acid + mitomycin C combined with alpha 2b Interferon in advanced colorectal cancer based upon recent studies suggesting a possible biochemical modulation of 5 fluorouracil by interferon.

Patients and methods

Between June 1990 and April 1991 25 previously untreated patients with advanced colorectal carcinoma were treated with mitomycin C 10 mg/m2 iv bolus on day 1, 5fluorouracil 375 mg/m2 on days 1 to 4 and folinic acid 200 mg/m2 on days 1 to 4 every 4 weeks, combined with alpha 2b interferon 3 million U day continuously.

Response

Of the 25 patients entered into the study, 20 were evaluable for response as 5 patients withdrew due to toxicity (grade 3-4 thrombocytopenia in 4 cases and fatigue in 1). No complete response was recorded, 6 patients had partial remission (30 %; 95 % confidence interval, 10 % to 50 %), 4 experienced no change and 10 showed progressive disease. The toxicity of this regimen was significant, particularly myelosuppression.

Conclusions

This combination showed a significant toxicity and low response rate compared with other 5 fluorouracil based regimens in advanced colorectal cancer.
A Randomized Study of Low-Dose Interleukin-2 Subcutaneous Immunotherapy versus Interleukin-2 plus Interferon-Alpha as First Line Therapy for Metastatic Renal Cell Carcinoma
Authors: Lissoni Paolo , Barni Sandro , Ardizzoia Antonio , Andres Marco , Scardino Epifanio , Cardellini Paolo , Bitta Ruggero Della , Tancini Gabriele
Published: April 2018

Aims and Background

IL-2 given subcutaneously in combination with interferon-alpha 2b (IFN) appears to induce a response rate comparable to that obtained with IL-2 intravenous injection in patients with metastatic renal cell carcinoma (RCC) but with lower toxicity. The role of IFN when combined with IL-2 has however still to be defined. The present study was performed to draw some preliminary conclusions about the effect of IFN in combination with IL-2 in metastatic RCC.

Methods

The study included 30 consecutive patients with metastatic RCC who were randomized to treatment with IL-2 subcutaneous therapy (3 million IU twice/daily for 5 days/week for 6 weeks) or with IL-2 plus IFN (5 million U/m2 subcutaneously thrice weekly). In patients without progressive disease, a second cycle was repeated after a 28-day rest period.

Results

No significant difference in partial response rate was found between patients treated with IL-2 alone and those given IL-2 plus IFN (5/15 vs 4/15). Similarly, no difference was seen in the percentage of stable disease (7/15 vs 7/15). Toxicity was higher in patients who received IL-2 plus IFN. Lymphocyte and eosinophil mean increase was higher in patients treated with IL-2 alone than in those treated with IL-2 plus IFN, without however any significant difference.

Conclusions

The present results, which require confirmation in a larger series, indicate that combination with IFN does not increase the efficacy of IL-2 subcutaneous immunotherapy in metastatic RCC but only the toxicity of treatment.
Radio-Hyperthermia in Post-Surgical Recurrence of Melanoma
Authors: Guenzi Marina , Franzone Paola , Muttini Maria Pia , Bacigalupo Almalina , Scolaro Tindaro , Giudici Stefania , Cavagnetto Francesca , Vitale Vito
Published: April 2018

Aims and background

Malignant melanoma is one of the most radioresistant tumors. It can be treated with combinated hyperthermia and radiation therapy.

Methods

From January 1991 through June 1992, 7 patients, 1 male and 6 female, aged 40-88 years (mean 75), with skin and nodal postsurgical recurrences of melanoma, were treated with a combination of radiation therapy and hyperthermia. Two patients presented systemic disease when they reached our observation, but all of them were without symptoms. None of them underwent surgical excision of the recurrence before or during thermoradiotherapy. None received chemotherapy for these recurrences or had received radiotherapy in the past. They were irradiated with electron beams, with electron energies selected according to the depth of the lesions. The total dose was 40 Gy in 10 fractions in 5 weeks. Hyperthermia was administered for 10 minutes to 1 hour after irradiation. An inductive method of radiofrequency heating at 434 of 915 MHz was used depending on the depth of the lesions. In all of these treatments a ionized water bolus was used. The prescribed hyperthermic dose was 42 °C for half a hour. The treatments were carried out twice a week for 5 weeks. A fiberoptic multichannel thermometer was used for thermometry.

Results

Four patients (57 %) achieved a complete response, 2 patients (29 %) a partial response, and 1 patient (14 %) stabilization. We found no correlation between tumor volume and response rate. Site effects and complications of the treatment were minimal (moderate erythema).

Conclusions

Our results are in the wide range of values reported in the literature.
Sphenoid and Cavernous Sinuses Involvement as First Site of Metastasis from a Fallopian Tube Carcinoma. Case Report
Authors: Merimsky Ofer , Inbar Moshe , Groswasser-Relder Irith , Neudorfer Meira , Chaitchik Samario
Published: April 2018

The occurrence of central nervous system metastases in ovarian cancer patients ranges from 0.88 to 4.5 %. Centra nervous system involvement in a fallopian tube carcinoma is extremely rare. A 77-year-old woman with an invasive tubal carcinoma was admitted because of ophthalmoplegia, sparing the lateral rectus muscle of the left eye, a decreased left corneal reflex and hypoesthesia along the distribution of the ophthalmic and maxillary branches of the left trigeminal nerve. CT scan showed a space occupying lesion in the left sphenoid sinus invading the left cavernous sinus and the submucosa of the left lateral wall of the nasopharynx, proven histologically to be a metastasis from her primary cancer. Attention should be paid to the possibility of distant and unusual metastases associated with tubal cancer in order to treat the patients promptly.
Breast Metastasis from Gastric Signet Ring Cell Carcinoma, Mimicking Inflammatory Carcinoma. A Case Report
Authors: Cavazzini Giovanna , Colpani Francesco , Cantore Maurizio , Aitini Enrico , Rabbi Carla , Taffurelli Monica , Pari Franca , Bellomi Alberto , Bertuzzi Alberto , Smerieri Franco
Published: April 2018

We report a case of breast metastasis of signet ring cell gastric cancer clinically presented as a primary inflammatory carcinoma. Metastases to the breast are uncommon; review of the literature demonstrated only 300 cases. The clinical and radiographic features of the metastatic lesion were unlike those reported in the literature. Although a primary signet ring cell breast carcinoma was described, the pathologic patterns of the breast lesion, here reported, lead us to conclude this was a metastasis and not another primary tumor.
What Do Italian Hospital Physicians Know about Quality of Life Assessment in Oncology?
Authors: Belli Gianfranco , Tamburini Marcello , Paci Eugenio
Published: April 2018

Aims

To assess the current level of information and use of quality of life assessment instruments by Italian physicians involved in oncologic patient care.

Methods

Specifically trained scientific representatives of a pharmaceutical company interviewed 2237 hospital physicians all over Italy.

Results

A total of 1390 physicians (62.1%) had some knowledge of quality of life assessment tools in oncology, but 364 of them (26.2%) were unable to recall the name of any instruments. The one that was most frequently recalled by the 1026 physicians who knew of the existence of one or more instruments was the Karnofsky Performance Status (KPS) (91%) followed by the Eastern Cooperative Oncology Group performance scale (ECOG) (35.5%) whereas the Quality of Life Index and Visual Analogue Scale were at the very bottom of the list (5.9% and 3.7%, respectively). Physician age and type of department were found to be strong predictors of knowledge of the instruments, which was greater among young physicians and those working in oncological departments. Of the physicians aware of the KPS, 56.6% used it, whereas the percentage of physicians using ECOG was higher (69.5%).

Conclusions

The collected data indicate a poor knowledge of quality of life assessment instruments in Italian physicians. Most physicians tend to use so-called «objective» instruments where the assessment is made by the physician and not by the patient (KPS, ECOG Quality of Life index), are practically unaware of the new generation of «subjective» self-rating instruments. The use of such instruments in particular might provide greater insights into the impact of the disease and related treatments on the quality of life of cancer patients.
Intra-Arterial Hepatic Carboplatin-Based Chemotherapy for Ocular Melanoma Metastatic to the Liver. Report of a Phase II Study
Authors: Cantore Maurizio , Fiorentini Giammaria , Aitini Enrico , Davitti Bruno , Cavazzini Giovanna , Rabbi Carla , Lusenti Anita , Bertani Mario , Morandi Claudio , Benedini Viviano , Smerieri Franco
Published: April 2018

Aims and Background

ocular melanoma tends to metastasize to the liver, sparing for a long time the rest of the organism. Therefore, a regional treatment is especially indicated.

Methods

eight patients with ocular melanoma metastatic to the liver were treated with intraarterial hepatic carboplatin-based chemotherapy at the dose of 300 mg/m2 once every two weeks at an outpatient clinic. All the patients were submitted to laparotomy with surgical implantation of an arterial port device through the gastroduodenal artery.

Results

the overall response rate was 38% with a median survival time of 15 months. The regimen was well tolerated and the principle toxicity was myelosuppression; any instance of hepatic and/ or cholangitic damage was reported.

Conclusions

Carboplatin seems suitable for intraarterial hepatic chemotherapy and active in ocular melanoma metastic to the liver.
Carcinoma of the External Auditory Meatus and Middle Ear. Results of the Treatment of 28 Cases
Authors: Gabriele Pietro , Magnano Mauro , Albera Roberto , Canale Giovanni , Redda Maria Grazia Ruo , Krengli Marco , Negri Gian Luigi
Published: April 2018

Aims

The authors report their experience on the treatment of 28 cases of middle ear (3) and external auditory meatus (EAM) cancers (25) with surgery and/or radiation therapy. According to histologic type, there were 23 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenocystic carcinoma.

Methods

Surgery alone was performed in 2 cases, surgery combined with radiotherapy in 11 cases, and radiotherapy alone in 15 cases. Postoperative radiation therapy dose ranged between 4500 and 5500 cGy; the definitive dose was 6000-7000 cGy. The median follow-up was 61 months.

Results

Complete respons rate 6 weeks after the end of the treatment, evaluated by CT scan, was 85.7% (24/28). Definitive local control was obtained in 20/28 cases for the primary site and in 26/28 cases for the neck. Nine of the 10 recurrences were retreated with low-dose radiotherapy combined with surgery, chemotherapy or hyperthermia. A new local control was obtained in 2 cases. Four patients were lost during the follw-up at 13, 14, 17 and 23 months after the end of the treatment. The survival rate was 54% (13/24); disease-free survival was 50% (11/22).

Conclusions

Despite a not very aggressive treatment, our results are quite good.
Patterns of Care and Survival in Non Small Cell Lung Cancer: 15 Years’ Experience in a General Hospital
Authors: Clerici Maurizia , Panvini Daniela , Torri Valter , Colombo Fulvia , Luporini Gino , Tinazzi Angelo , Nicolucci Antonio , Marsoni Silvia
Published: April 2018

Background

Transferring results derived from clinical research into practice is particularly difficult in lung cancer where clear indications for treatment are defined only for selected subgroups of patients. Studies on hospital-based lung cancer population could provide data for quantifying this issue.

Patients and methods

This was a follow-up study of consecutive, first-diagnosis cases referred to the in-and outpatient cancer clinics of a large italian general hospital between January 1975 and December 1990. Data were collected from medical records and recorded on ad hoc standardized forms. Analysis focused on changes in distribution over time of patient-related characteristics, prevalence of specific treatment strategies and survival of the study population.

Results

1345 primary non small cell lung cancer cases were reviewed and 1125 were fully evaluable. In early stages (510/1125, 45%) only 237 patients actually underwent surgery. In this group surgery increased from 36 to 69% whereas chemotherapy decreased from 58 to 15%. In the advanced group (615/1125, 55%) chemotherapy was the preferred treatment but combined modalities tripled over time (from 4 to 12%). No significant changes in survival were observed within each group over time.

Conclusion

Despite changes in the therapeutic approaches, mortality from lung cancer does not seem reduced over time. Since the proportion of cases that could potentially benefit from “active” treatments is small, for the large majority of patients a switch in clinical research from a cure to a careoriented strategy should be considered.
Post-Radiation Gliomas
Authors: Salvati Maurizio , Puzzilli Fabrizio , Bristot Roberto , Cervoni Luigi
Published: April 2018

Aims and background

Radiotherapy is important in the treatment of neoplasm of the central nervous system, but various side effects, particularly neoplastic, have been described. Recently, post-radiation gliomas have been reported.

Methods

The authors review 88 cases of cerebral glioma following radiotherapy in patients operated for neoplasms of the nervous system, including 6 personal cases of post-radiation gliomas treated in the Neurosurgical Division of the Department of Neurological Sciences, “La Sapienza” University, Rome. The criteria used to define this unusual pathologic association are discussed.

Results

There was a male predominance. Post-radiation gliomas were particularly malignant, the average dose was 33 Gy, and average free latency was 9.6 years. The first disease was most frequently acute lymphatic leukemia.

Conclusions

Post-radiation gliomas have particular features but do not present a histologic or clinical behavior different from analogous spontaneous gliomas. The fact that 88 cases have been reported in recent years suggests that a thorough biological, clinical studies be carried out on this association.
Daytime Circulating Melatonin Levels in Smokers
Authors: Tarquini Brunetto , Perfetto Federico , Poli Riccardo , Tarquini Roberto
Published: April 2018

Aims and background

Melatonin secretion is required to be a potential inhibitor of the development and growth of tumors, and cigarette smoking is a well established risk factor for cancer at various sites.

Methods

Circulating melatonin levels of 20 smokers and 20 non smokers (controls), sampled at the same hour from awaking in order to obtain a comparable circadian synchronization, were compared.

Results

Our data showed higher melatonin circulating levels in smokers (17.44 ±1.8 pg/ml) than in nonsmokers (9.77 ± 1.4 pg/ml).

Conclusions

The causes, mechanism and meaning of this phenomenon are still unknown. The most actractive hypothesis considers higher melatonin levels in smokers as an attempt to counterbalance cellular growth stimulus, a natural “brake” mechanism to restrain the proliferation of normally differentiated tissues: smoke is a prominent risk factor for several different tumors.
Vinorelbine as Single Agent in Pretreated Patients with Advanced Breast Cancer
Authors: Barni Sandro , Ardizzoia Antonio , Bernardo Gianni , Villa Silvia , Strada Maria Rosa , Cazzaniga Marina , Archili Caterina , Frontini Luciano
Published: April 2018

Vinorelbine is a new semisynthetic vinca alkaloid with high activity against breast cancer. In this multicenter clinical study we evaluated the activity and toxicity of vinorelbine as a single agent in 30 advanced breast cancer patients pretreated with anthracycline and/or mitoxantrone (24 with recurrent tumor, 6 with non operable cancers). Vinorelbine was given at a weekly dose of 20 mg/m2 for a minimum of 3 weeks. Treatment was continued until there was disease progression or evidence of serious toxicity. Predominant sites of metastasis were viscera (14 cases), soft tissue (11 cases) and bone (5 cases). A median number of 12 doses of vinorelbine (range 3-34) were administered to each patient. Objective responses were recorded in 11 of them and 15 had minimal responses or stable disease. Four patients showed progression of disease during vinorelbine chemotherapy. The median duration of response was 5 months (2-14). The median survival time was 7 months (2-20+): 9 months for responders and 5 months for those with stable or progressive disease. The most important and dose-limiting toxicity was represented by leukopenia. The compliance of patients was very good and the treatment was well accepted by them all including those with low performance status. In conclusion, this study provides further evidence that a weekly schedule with vinorelbine as a single agent is effective and well-tolerated also in pretreated advanced breast cancer patients.
Lymphocytosis Decline is not Responsible for Tumor Progression in Cancer Patients Chronically Treated with Interleukin-2
Authors: Lissoni Paolo , Barni Sandro , Andres Marco , Scardino Epifanio , Vigoré Luigi , Vezzo Roberto , Rescaldani Roberto , Tancini Gabriele
Published: April 2018

Aims and background

The antitumor activity of IL-2 is mediated by an increase in lymphocyte number. Moreover, our previous studies have shown that therapy for 1 week/month with low-dose subcutaneous IL-2 is sufficient to maintain high levels of lymphocytes in cancer patient who have had tumor regression or stable disease (SD) in response to IL-2 immunotherapeutic cycles. This study was performed to establish whether tumor progression in cancer patients chronically treated with IL-2 may be associated with lymphocyte number decline.

Methods

The study included 53 metastatic renal cell cancer patients, who were treated with 2 induction cycles of IL-2 subcutaneous immunotherapy (6 million IU/day for 5 days/week for 6 weeks, corresponding to one cycle). Tumor regression occurred in 15/53 patients, 20 patients had a SD, and the remaining 18 cases progressed. Non progressed patients (n = 35) underwent a maintenance therapy consisting of one week of therapy every month. After a median follow-up of 18 months, 26/35 patients with response or SD had progressed. The immune investigation consisted of lymphocyte, T lymphocyte, NK cell number determination and sCD25 level detection.

Results

The mean number of lymphocytes, T lymphocytes and NK cells observed on IL-2 maintenance therapy was significantly higher than that seen before beginning the immunotherapy. Moreover, mean number of lymphocytes and mean levels of sCD25 observed at the time of tumor progression were respectively lower and higher than those seen on maintenance therapy in the same patients, without, however, significant differences.

Conclusion

Despite the importance of lymphocytes in medianting the antitumor activity of IL-2, this study shows that tumor progression in cancer patients chronically treated with low-dose IL-2 after response or SD during IL-2 induction cycles is not associated with a significant decline in lymphocyte, T lymphocyte or NK cell numbers. Further studies, carried out to analyze the functional status of immune cells at the time of tumor progression, will be necessary to define the role of immunity in cancer patients progressing under IL-2 chronic therapy.
The Role of Radiotherapy in the Treatment of Stage III Non-Small Cell Lung Cancer: A Survey of Clinical Practices in Lombardy, Italy, by the Airo-Lombardia Cooperative Group
Authors: Palazzi Mauro , Valdagni Riccardo , Poli Marisa , Buffoli Alberto , Leoni Mario , Vavassori Vittorio , Di Lorenzo Innocenzo , Corbella Franco , Nava Simonetta , Cazzaniga Luigi Franco , d'Affronto Caterina , Di Muzio Nadia , Borsa Giuseppe
Published: April 2018

Aims and background

The role of radiotherapy in the treatment of stage III non-small cell lung cancer is controversial. The aim of this survey was to investigate the use of this modality in current clinical practice in Lombardy, a highly industrialized region of northern Italy.

Methods

A questionnaire was sent to all 13 radiotherapy centers in Lombardy, covering statistical, clinical, technical and strategical aspects, and the responses were analyzed.

Results

A wide range of attitudes was observed among participating radiation oncologists; the percentage of cases treated with curative intent varied largely between centers (4-100%), as did the proportion of patients given to radiation only rather than combined modality treatment (5-100% vs 0-90%).

Conclusions

An urgent need exists for better cooperation between all clinicians involved in lung cancer treatment, pursuing the goals of a more uniform clinical practice and a more aggressive clinical research attitude.
Cytomorphologic Characterization of Cell Subsets Isolated by Density Gradient Centrifugation from Tumor Effusions of Ovarian Endometrioid Carcinoma
Authors: Bar Julia K. , Harłozińska Antonina , Sobańska Ewa , Cislo Mieczysław
Published: April 2018

Aims

Cytomorphologic characterization of tumor cell subsets, according to the stage of pathologic differentiation, and comparison of cellular composition in tumor cyst and ascitic fluids were carried out on individual patients with ovarian endometrioid carcinoma.

Methods

A density gradient centrifugation technique was applied to fractionate the cells from tumor effusions.

Results

The enrichment of cell forms representing individual stages of pathologic differentiation by gradient centrifugation facilitated their cytomorphologic characterization. According to cytomorphologic features, 5 discrete cell subpopulations were identified and catalogued. The cellular composition of tumor cyst and ascitic fluids in individual patients was similar, but the number of fractions and percentage of cell subsets differed.

Conclusions

The estimation of precise cytomorphologic criteria for cell forms in tumor effusions facilitated the cytologic diagnosis of ovarian endometrioid carcinoma. The possibility to concentrate poorly differentiated, frankly malignant cell subsets in low densities could significantly improve the diagnosis of tumor effusions.
The Cost of Hypertermia: Nine Years Experience at the Radiation Therapy Department of the Turin University
Authors: Gabriele Pietro , Orecchia Roberto , Madon Eugenia , Redda Maria Grazia Ruo , Sannazzari Gian Luca
Published: April 2018

Background

In this paper the authors try to quantify the expenditure for the equipment, staff, treatment per patient and research, sustained at the Radiation Therapy Department of the University of Turin for the treatment of cancer with hyperthermia

Methods

Two hyperthermic computerized devices are available: the SAPIC SV03 multifrequencies system (915, 434 and 2-30 MHz) for external hyperthermia, and the SACEM system. working only with the frequency of 915 MHz, for interstitial and intracavitary heating. From September 1983 to December 1991, 408 patients have been treated with hyperthermia, for a total number of treated sites of 483; 2960 heating sessions were performed, with a average of six sessions per patient.

Results

The overall cost of our “hyperthermia project” was about 2,000,000,000 Italian liras; the equipment cost was estimated at 1,258,650,000 Liras (839,100 US$), and the cost per treatment and per heat session at about 3,985,200 (2676 US$) and 664,200 liras (443 US$), respectively. The cost of the research program can be estimated in 175,000,000 liras (116,666 US$). The National Health System provides for a partial reimbursement of 2,000,000 liras (1,333 US$) for each course of hyperthermia. Taking into account the mean expected life expectancy and increasing purchases for replacement of equipment, these costs increase 10% each year. As regards the cost-benefit problem, using the Rees formula it varies from 1112 US$ when hyperthermia is used as elective treatment to 3380 US$ when hyperthermia is used as palliative treatment.

Conclusions

Hyperthermia is, in our experience, an expensive therapy.
Effect of Octreotide on Neuroenolase Levels in Patients with Small Cell Lung Cancer
Authors: Soresi Enzo , Invernizzi Giovanni , Boffi Roberto , Borghini Umberto , Schiraldi Gianfranco , Mantellini Paolo Valerio , Gramegna Giovanni , Liuzzi Antonio
Published: April 2018

Aims and Background

The somatostatin analog octreotide has an antiproliferative effect on small cell lung cancer lines in vitro and in experimental xenograft transplantation systems in vivo. Thus it is worth investigating octreotide activity in the clinical setting.

Methods

We studied the effect of octreotide (200 μg three times a day subcutaneously for seven days) on serum levels of the tumor marker neuroenolase in 13 patients with small cell lung cancer.

Results

A decrease in neuroenolase levels was observed at day 7 during octreotide treatment, with a mean ± SD of 32.6 ± 42.0 ng/ml compared to basal values of 44.4 ± 57.7 ng/ml and to washout values of 50.3 ± 65.7 ng/ml ( P < 0.03).

Conclusions

Our results indicate that octreotide is effective in reducing neuroenolase levels in small cell lung cancer patients. These data suggest a possible role for octreotide in the treatment of this kind of tumor.
Usefulness of the Nd:Yag Laser in Parenchyma-Sparing Resection of Pulmonary Nodular Lesions
Authors: Mineo Tommaso Claudio , Cristino Benedetto , Ambrogi Vincenzo , Natali Gian Luca , Casciani Carlo Umberto
Published: April 2018

Aims and background

The neodymium: yttrium-aluminium-garnet (Nd:YAG) laser has been successfully employed in parenchyma-sparing resection of pulmonary nodular lesions. We report our experience with limited resection using a noncontact Nd: YAG laser applied through a thoracotomic approach.

Methods

During the period March 1987-October 1993, we performed parenchyma-sparing resections of 66 pulmonary nodular lesions with a noncontact Nd:YAG laser in 47 patients. Nodules were approached through postero-lateral thoracotomy (n= 40), median sternotomy (n= 5) or staged bilateral thoracotomy (n= 2). Fifty-two lesions were located in a peripheral position and the others (n= 14) at various depths within the parenchyma.

Results

Fifteen lesions were benign: hamartoma (n= 5), chronic pneumonic infiltrate (n= 3), tuberculoma (n= 3), asbestosis (n= 2), Wegener's granuloma (n= 1). Twelve lesions were attributable to primary lung cancer and 33 were metastatic lesions. Another 6 lesions turned out to be necrotic metastases following chemotherapy. There were no perioperative deaths. Pulmonary re-expansion was shortly obtained: mean drainage time was 4.31 ± 3.9 days. Only one patient presented a prolonged drainage time (11 days); in this case, the air leak was successfully treated by tissue glue sealant trans-drainage infiltration. Follow-up ranged from 2 to 96 months. No case of relapse on the resection site has been observed.

Conclusions

The results suggest that Nd:YAG laser resection is safe and worthwhile in patients with multiple lesions and borderline pulmonary function.
Leiomyosarcoma of the Soft Tissues in a Patient with Nevoid Basal-Cell Carcinoma Syndrome
Authors: Garcia-Prats Maria Dolores , Lopez-Carreira Montserrat , Mayordomo Jose Ignacio , Ballestin Claudio , Rivera Fernando , Diaz-Puente Maria Teresa , Muñoz Manuel , Cortes-Funes Hernan , Martinez-Tello Francisco
Published: April 2018

A 57-year-old man was admitted with complaints of progressive anorexia, weight loss and right flank pain. He had been treated for basal-cell carcinoma of the skin 19 years before. On physical examination, eight moles in the face, back and left thigh were found along with palmar pits. In addition, a painful induration in his right thigh was evident. Biopsy proved that six moles were basal-cell carcinomas and the thigh mass a high-grade leiomyosarcoma. Computed tomographs revealed multiple metastases in the lungs and the liver. The patient was treated with epirubicin, with partial response, and subsequently with ifosfamide. He died 17 months after diagnosis. Whereas the world literature records several cases of soft tissue tumors in patients with nevoid basal-cell carcinoma syndrome, this is the first report of a simultaneous occurrence of leiomyosarcoma and nevoid basal-cell carcinoma syndrome.
Comparison of Immunoassays for Tumor Markers CA 19-9, CA 15-3 and CA 125: Data from an International Quality Assessment Scheme
Authors: Pilo Alessandro , Zucchelli Gian Carlo , Cohen Richard , Bizollon Charles Albert , Cappelli Gino , Cianetti Alberto , Gion Massimo , Piffanelli Adriano , Bombardieri Emilio
Published: April 2018

Data collected in the 1993 and 1994 cycles of an international external quality assessment (EQA) program and in a national multicenter collaborative study were cumulatively analyzed to evaluate the standardization of the methods currently in use for the assay of mucinous tumor markers CA 19-9, CA 15-3 and CA 125. On average the between-laboratory variability was 15.2 and 16.0 CV% for CA 15-3 and CA 125 respectively; the between-laboratory variability found for CA 19-9 was markedly worse (mean 28.3 CV%). The variability component attributable to systematic differences between different methods/kits was relatively small for CA 15-3 and CA 125 (18% and 24% of the total variability) but markedly larger for CA 19-9 (48% of the total variability). The agreement of CA 19-9 results worsened in the last few years when new nonisotopic techniques became available. The precision of the methods/kits most used in the survey ranged from 9.9 to 13.3 CV% for CA 125 and from 11.6 to 13.9 CV% for CA 15-3. For these two tumor markers the precision of the traditional IRMAs does not appear different from that of the new fully automated nonisotopic techniques. The precision of CA 19-9 methods was on average worse (from 11.7 to 19.6 CV%) although two automated systems exhibited a precision better than that of IRMAs. In conclusion, the results of this study indicate that CA 15-3 and CA 125 are satisfactorily assayed whereas CA 19-9 assay appears affected by larger differences between methods and by poorer precision of laboratories and kits.
Differences in Blood Glutathione Levels of Patients with Advanced or Localized Carcinoma
Authors: Engin Atilla
Published: April 2018

Aims and background

The increased level of blood glutathione (GSH) is an important biochemical feature in animal epithelial tumor. The aim of this study was to investigate the blood GSH concentrations in well characterized cancer patients and healthy volunteers.

Methods

Two different groups of carcinoma cases were used. The first group consisted of 15 blood samples drawn from disseminated gastric adenocarcinoma patients, and the second group comprised 15 samples obtained from localized or locally advanced skin carcinoma cases without lymph node metastasis. GSH and hemoglobin concentrations were measured by using the method of Beutler et al.

Results

The mean blood GSH in patients who had advanced malignant disease was 129.13 ± 7.49 mg/dl and in patients who had localized cancer was 96.24 ± 3.90 mg/dl. These results indicate that the blood GSH level is 31% higher in localized carcinoma cases and 78% higher in metastatic disease than those of controls. Blood GSH concentrations were expressed on the basis of blood volume and also on hemoglobin content. Similar results were calculated with either mode of expression.

Conclusion

By comparing the two groups of patients, we found that higher blood GSH concentration was correlated with metastatic growth.
Solitary Brain Metastases from Thyroid Carcinoma: Study of 6 Cases
Authors: Salvati Maurizio , Cervoni Luigi , Celli Paolo
Published: April 2018

Aims and background

Although systemic metastases from thyroid cancer are relatively frequent, they rarely affect the nervous system and only exceptionally originate from well-differentiated carcinoma.

Methods

The authors describe 6 cases of solitary brain metastases from thyroid carcinoma, well-differentiated in 3 cases and anaplastic in the other 3 cases.

Results

Four patients were females and 2 males (M:F ratio, 1:2); average age was 51 yrs (range 48-56). On average, the interval between diagnosis of the thyroid tumor and appearance of the metastasis was 2.8 years (range 1-12 years) and was shorter in the anaplastic forms (1.2 versus 4.4 years). Average survival was 15 months (range 6-48 months); in particular, average survival was longer in patients with well-differentiated carcinoma (9 vs 21 months) as also in those who did not present other metastatic sites (6 vs 24 months). Death was due to systemic progression of the disease in 4 cases and to brain-relapse in the other 2 cases.

Conclusions

Surgery, radioactive iodine (where uptake is demonstrable), and radiotherapy are the main therapies available for metastases from thyroid carcinoma. However, survival of patients appears to be modified by the type of treatment performed.
Neuroendocrine Carcinoma of the Skin: A Case Report of “Multiple Neuroendocrine Carcinoma” Onset and Long-Term Remission after Chemotherapy
Authors: Galante Emanuele , Angelini Elisabetta , Ferroni Claudio , Scavina Paola , Bianchi Sergio , Megale Claudio , Costarelli Leopoldo
Published: April 2018

We herein report a case of “multiple neuroendrocine carcinoma” onset, with a torpid course, metastasis in the left breast, and an initial considerable sensitivity to the chemotherapy. We conclude that a re-evaluation of the studies on this neoplasia carried out to date is needed, in order to identify new regimens, which increase the complete response rates and their duration.
Linkage between Aids Surveillance Systeml and Population-Based Cancer Registry Data in Italy: A Pilot Study in Florence, 1985-90
Authors: Barchielli Alessandro , Buiatti Eva , Galanti Claudio , Lazzeri Vera
Published: April 2018

The role of the Tuscany population-based Cancer Registry (TCR) in the assessment of cancer incidence in AIDS patients, and the completeness of cancer reporting to the Italian AIDS surveillance system (RAIDS) was evaluated through a linkage between the TCR and the RAIDS in the period 1985-90. In the Province of Florence, the incidence of Kaposi's sarcoma in AIDS cases was underestimated by 24% (95% CI; 9.8%-47%; 6/25 cases) by RAIDS in comparison with the TCR. Of kaposi's sarcomas unknown to RAIDS, 2 were incident at the time of AIDS diagnosis (“truly” unreported cases) and 4 were late manifestations of AIDS. Moreover, 1 non-Hodgkin lymphoma unknown to RAIDS and 10 other malignancies (4 lung cancers) were identified through the TCR. In AIDS patients, the incidence of lung cancer was 95-fold (99% CI, 16-310) the expected one on the basis of age-sex-specific incidence rates in the general population of the same area. Altogether, about 25% of AIDS cases developed a cancer during HIV infection. In spite of the small size of the present study, the results confirm the role of population-based cancer registries in the assessment of the occurrence of malignancies in AIDS patients.
Soluble Intercellular Adhesion Molecule-1 and Serum Cytokines in Melanoma Patients Treated with Liposomes Containing Muramyl Tripeptide
Authors: Favaro Daniela , Santarosa Manuela , Quaia Michele , Spada Antonella , Freschi Andrea , Talamini Renato , Galligioni Enzo
Published: April 2018

Aims and Background

A soluble form of intercellular adhesion molecule-1 (sICAM-1) has been recently identified in patients with malignant melanoma. It has been demonstrated that inflammatory cytokines can modulate the cellular expression of ICAM-1 and the shedding of this molecule by cells. To our knowledge, few data exist on serum sICAM-1 levels in cancer patients treated with immunomodulators. Liposomes containing muramyl tripeptide (MLV MTP-PE) can activate monocytes from cancer patients in vitro and in vivo, making them cytotoxic such as tumor necrosis factor- α (TNF-α) and Interleukin-6 (IL-6). The purpose of the present study was to evaluate the levels of sICAM-1 and their possible correlation with serum inflammatory cytokine levels in melanoma patients treated with MLV MTP-PE.

Methods

The sera from 9 patients with metastatic melanoma treated with MLV MTP-PE, 4 mg i.v. twice a week for 12 weeks, were tested in ELISA system to detect sICAM-1, TNF-α, IL-6, Interleukin-1 β (IL- β) and Interferon-γ (IFN-γ) before, and 2 and 24 h after the 1st, 12th and 24th infusion of MLV MTP-PE.

Results

Baseline levels of sICAM-1 were elevated in all patients (median 540 ng/ml: range 400-1030 ng/ml). Twenty-four h after the 1st infusion of MLV MTP-PE, we observed 6 increases in sICAM-1 levels, 1 decrease and 2 stable values (median 720 ng/ml: range 410-1820; P = 0.060). Twenty-four h after the 12th infusion, sICAM-1 increased in 3 patients and did not change in 4 (median 790 ng/ml: range 495-1650 ng/ml; P = 0.069). At the 24th infusion, sICAM-1 increased in 4 of 6 evaluable patients and remained stable in 2 (median 802 ng/ml: range 510-1450 ng/ml; P = 0.045). To better analyze the variations in sICAM-1, the patients were arbitrarily divided into two groups according to their clinical behavior: 4 presented stabilization (all lesions, n = 2; some lesions, n = 2) (Group A); 5 presented progressive disease (Group B). In Group A, sICAM-1 levels remained stable or showed a modest increase during treatment (except in 1 patient, who exhibited a substantial variation after the 12th infusion). In contrast, in Group B very high levels of sICAM-1 were observed at the beginning of the study therapy in 1 patient and after the 1st infusion in 3 patients; these values remained high until the 24th infusion. In most of the patients, TNF-α and IL-6 increased after the 1st infusion, but not thereafter. IFN-γ was never detected; IL-1 β was detectable in a few cases, but only before the infusions.

Conclusions

baseline levels of sICAM-1 were elevated in all patients and further increased during treatment only in patients with more aggressive disease. No correlation was found between sICAM-1 and inflammatory cytokines. It would therefore seem that in patients with advanced disease, higher levels and a progressive increase in sICAM-1 may be unfavorable prognostic factors.
Cardiac and Pulmonary Effects of Alpha Tumor Necrosis Factor Administered by Isolation Perfusion
Authors: Villani Fabrizio , Galimberti Milena , Mazzola Gaetano , Stifani Italo , Santinami Mario , Rizzi Maurilia , Manzi Renato
Published: April 2018

Aims

We studied cardiac and pulmunaty function in 22 patients affected by in transit metastases from cutaneous melanoma and metastases from soft tissue sarcoma of the limbs and treated with isolation perfusion in extracorporeal circulation with rTNF alpha at doses ranging from 0.5 to 4 mg/m2 in mild hyperthermia.

Patients and methods

All patients experienced a septic-like shock syndrome of variable severity: this feature lasted from 24 to 72 h and was controlled by the infusion of dopamine. Seventeen patients suffered from respiratory insufficiency, which required assisted ventilation (7 cases mechanical ventilation for 1 day, 8 cases for 2 days, and 2 cases synchronized intermittent mandatory ventilation).

Results

Spirometrie parameters recorded 7-15 days after treatment did not change from baseline values. In contrast, lung transfer factor for carbon monoxide significantly declined in a dose dependent fashion.

Conclusions

Our data confirm that rTNF alpha administered by isolation perfusion technique induces systemic cardiovascular and pulmonary side effects. Further studies are required to better define time course and reversibility of impaired pulmunary function.
Massively Diffuse Multifocal Granulocytic Sarcoma in a Child with Acute Myeloid Leukemia
Authors: Dufour Carlo , Garaventa Alberto , Brisigotti Massimo , Rosanda Cristina , Mori Pier Giorgio
Published: April 2018

A case of granulocytic sarcoma in an 8-year-old boy with acute myeloid leukemia and t (8; 21) is reported. The case is of interest due to massive extension of the tumor, which may raise different diagnostic difficulties with other solid tumors such as lymphoma, Ewing sarcoma, and soft tissue sarcoma. Furthermore, the tumor was localized in some sites, such as the parotid region and peripheral nerves, which are not usually involved in granulocytic sarcoma. The case points out the diagnostic difficulties with this kind of tumor and appears to contribute to the identification of a subgroup of acute myeloid leukemia with peculiar features, such as M2 morphology with Auer rods, t (8; 21), granulocytic sarcoma and a poor prognosis.
Comparative in Vitro and in Vivo Study of a Nitroxyl Derivative of 5-Fluorouracil (Magnizil) on Human Gastrointestinal Tumors
Authors: Seminare Patrizia , Bogdanov Gennadij , Codacci-Pisanelli Giovanni , Leonetti Carlo , Konovalova Nina , Diatchkovskaya Raya , Gargano Letizia , Aronne Teresa , Franchi Fabrizio
Published: April 2018

Aims and background

There is much interest in nitroxyl derivatives of cytotoxic agents. We evaluated the potential activity of magnizil, a derivative of 5-fluorouracil, on human gastrointestinal tumors in 3 different in vitro and in vivo experimental models.

Methods

The activities of magnizil and 5-fluorouracil were comparatively determined in vitro on the HT29 cell line by a clonogenic assay and on tumor clinical specimens by an antimetabolic assay. The activity of both the drugs against human tumors was also assessed in mice with the subrenal capsule assay.

Results

A similar cytotoxic activity was found for magnizil and 5-fluorouracil on the HT29 cell line. As regards human tumors, a lower activity was observed for the nitroxyl derivative than for 5-fluorouracil, with response rates of 25% and 50%, respectively, at comparable concentrations. Moreover, among the tumors transplanted in the subrenal capsule of mice, two were sensitive to magnizil and 3 to 5-fluorouracil.

Conclusions

Even though experimental results on human tumors indicate a somewhat lower activity for magnizil than the parent compound, its low toxicity and the possibility to clinically use high doses suggest the opportunity to further investigate the potential of this new anticancer agent on larger series of colorectal cancers in experimental systems.
Unusual Ultrastructural Findings in Giant-Cell Fibroblastoma
Authors: Bosman Cesare , Boldrini Renata , Pietro Vincenzo , Corsi Alessandro
Published: April 2018

We report on a 4-year-old boy with recurrent giant-cell fibroblastoma of the right nasal genal region. Histologic examination revealed that both lesions were constituted of spindle and stellate cells and a minor amount of multinucleated giant cells in a myxoid stroma containing cisternal-like spaces. Immunohistochemical examination revealed positivity for vimentin in both cellular components. Ultrastructural examination showed, in some spindle and multinucleated cells, two kinds of intracellular crystalline inclusions, located, respectively, in the cisternae of the rough endoplasmic reticulum and, apparently free, in the cytoplasm. To the best of our knowledge, this case, unusual for its location, is the first example of giant-cell fibroblastoma bearing intracellular crystalline inclusions.
Clinical Development of new Fluoropyrimidines: A Major Improvement in Colorectal Cancer Treatment?
Authors: Colleoni Marco , Nelli Patrizia , Manente Paolo
Published: April 2018

Aims and background

Colorectal cancer represents an increasing problem and is responsible for about 16,000 deaths per year in Italy. Fluorouracil represents the most widely used agent, but therapeutic responses have remained consistently discouraging. The overall response rates for fluorouracil as a single agent range from 5% to 15%, and the addition of biochemical modulators, although able to improve response rate, has not been shown conclusively to prolong survival.

Methods

In recent years, several new compounds characterized by a high therapeutic index, optimal absorption through the gastrointestinal tract when administered orally and selective hepatic metabolization have been synthesised. In this review we analyzed published data on new fluoropyrimidines in an attempt to better define their role and to evaluate any significant improvement over fluorouracil.

Results

Athough no sure advantage over fluorouracil has been detected, interesting results have been reported for fluorouracil analogs with alternative routes of administration such as oral or intra-arterial chemotherapy.

Conclusions

Further studies, possibly randomized, should also measure quality of life and treatment-related costs in order to define their real advantage over fluorouracil in the palliation of advanced colorectal cancer.
Epidemiology of Classic Kaposi's Sarcoma, with Special Reference to Mediterranean Population
Authors: Franceschi Silvia , Geddes Marco
Published: April 2018

An excess of classic Kaposi's sarcoma (KS) in individuals of southern European ancestry has long been suspected and recently quantified in terms of age-standardized rates. In Italy and most notably in southern Italy for the period 1976-84, prior to the AIDS epidemic, KS incidence rates were two-to-three-fold higher than in the United States and Sweden and many ten-fold higher than in England and Wales and Australia. A high frequency of classic KS has also been documented in Israel and, in low-risk countries, in individuals born in southern Europe and the Middle East. Many infections have been suspected to play a role in the etiology of KS, including cytomegalovirus, malaria and, most recently, a new virus of the herpes family, identified in AIDS-associated and classic KS. The present review deals with epidemiologic data concerning KS in the Mediterranean and stresses the opportunity to combine the study of KS in AIDS as well as non-AIDS patients in order to shed light on this no longer rare disease.