bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of Gallium-67 in Determining the Radicality of Lymph Node Dissections of the Neck for Metastatic Lymph Nodes with Extranodal Spread in Patients Affected by Carcinoma of the Head and Neck
Authors: Ricci Sante Basso , Chiti Arturo , Molinari Roberto , Borsa Giuseppe , Ricci Paolo Basso , Villa Sergio
Published: April 2018

Aims and background

Based on the fact that scintigraphy more readily reveals uptake of a radioisotope in a superficial position owing to incomplete surgical radicality, the authors examined by 67Ga scintigraphy a group of patients who had undergone dissection of lymph nodes of the neck from carcinoma with extranodal spread. They then checked the follow-up to ascertain the efficacy of 67Ga scintigraphy in relation to the eventual recurrences in the soft tissues of the neck.

Methods

A group of 136 patients were examined by 67Ga scintigraphy and followed for a minimum of 3 years after complementary radiotherapy. A group of 20 patients with no lymph node metastases was used as control to evaluate eventual false positives or false negatives.

Results

Recurrences in the soft tissues of the neck occurred in 35 (42.7%) of the 82 patients positive at 67Ga scintigraphy and in 6 (11.1%) of the 54 patients negative at the examination (P = 0.0001). All the patients in the control group were negative at 67Ga scintigraphy and without recurrences.

Conclusions

67Ga scintigraphy can give reliable information on the risk of recurrences in the soft tissues of the neck. Since in spite of postoperative radiotherapy the percentage of local recurrences in cases with positive 67Ga scintigraphy was rather high (42.7%), the authors propose a scheme of radiotherapy based on administration of a higher dose per fraction on the scintigraphically positive area.
Sentinel Lymph Node Identification in Breast Cancer: Feasibility Study
Authors: Motta Cinzia , Cartia Gianluca , Muni Alfredo , Giudici Mauro , Falcetto Giorgio , Castaldo Paolo , Galli Tonino
Published: April 2018

The aim of the study was to evaluate in our institute the technique of sentinel node (SN) identification and biopsy in the surgical treatment of early breast cancer. Between June 1998 and November 1999 54 patients (age range, 31–75 years) where studied. Inclusion criteria were age less than 75 years, indication for conservative surgery, absence of palpable axillary nodes, Karnofksy index >70. Lymphoscintigraphy was performed 16–18 hours prior to surgery, following injection of 0.1–0.2 mL of 99mTc-Nanocoll: the administered activity was 3–4 MBq in group A (44 pts) and 7–8 MBq in group B (10 pts). The colloids were administered by transdermal supralesional injection in 49 patients with palpable nodules and by intraparenchymal ultrasound-guided injection in five patients with non-palpable nodules. Planar projections were performed starting from the 5th until the 80th min (or 180th in the event of late migration). In 10 patients further projections were acquired 14–18 h following tracer administration. All nodes identified by gamma probe (MR 100 Pol. Hi. Tech) were histologically evaluated by immunohistochemistry and standard histology. Scintigraphic visualization of the SN was obtained in 49 patients: in 38 of these patients there was only one SN while in 11 patients there were two or three SNs. The delayed scan made in 10 patients did not show any further nodes. In all patients given US-guided perilesional injections migration was late (after at least 60 min). Our study confirms the validity of the scintigraphic procedure, its safety for patients and health care workers, and the feasibility of interdisciplinary collaboration.
Different Sites and Modes of Tracer Injection for Mapping the Sentinel Lymph Node in Patients with Breast Cancer
Authors: Bianchi Pietro , Villa Giuseppe , Buffoni Ferdinando , Agnese Giuseppe , Gipponi Marco , Costa Rosario , Maragliano Cristina , Canavese Giuseppe , Mariani Giuliano
Published: April 2018

Several studies have been published describing the techniques of identification of the “sentinel lymph node'’ (SN). There are marked differences in the techniques used by different investigators. Although agreement exists about the tracer particle size and the volume of injection, it is unknown what is the best site where to inject the tracer or the vital dye. The aim of the present study was to define the influence of different sites of injection on imaging of the lymphatic ducts and their SNs. We performed a pilot study in 30 consecutive patients with breast cancer who underwent SN biopsy by means of radioguided surgery and vital blue dye mapping. The patients were divided into six groups of five patients each; each patient was given a subdermal (ID) or peritumoral (IP) injection of radiotracer (300 μCi in 150 mL of 99mTc-HSA microcolloids; Albures, Amersham Sorin) above the tumor site in order to localize the SN. After the identification of the SN, a second injection of radiotracer was performed, which was different in each patient subset. In some cases more than one lymph node appeared on the lymphoscintigraphic scans after the second injection of radiotracer.

When the peritumoral route was used it took longer to visualize the lymphatic pathways. For the ID route, injection at the exact skin projection over the tumor is optimal. Internal mammary lymph nodes were identified by both IP (2) and ID (1) injection, irrespective of the quadrant in which the tracer was injected.

Our findings support the hypothesis of a precise topographic correspondence between the primary tumor and its specific SN. The subdermal route is more accurate than the intraparenchymal route, as it allows faster identification of the lymphatic vessels and SN. We believe these observations should be taken into account for the proper selection of the injection site of either vital dye or radiopharmaceuticals.
Detection of Sentinel Node in Breast Cancer: Pilot Study with the Imaging Probe
Authors: Scopinaro Francesco , Pani Roberto , Soluri Alessandro , Pellegrini Rosanna , Scafò Raffaele , De Vincentis Giuseppe , Capoccetti Francesca , David Vincenzo , Chiarini Stella , Stella Salvatore
Published: April 2018

The commonly used gamma probes are easy to use but also give rough information when employed in radioisotope-guided surgery. When images are required for exact localization, a gamma camera as well as a probe have to be used. Position-sensitive photomultipliers have contemporaneously allowed high-resolution scintigraphy and miniaturization of gamma cameras. We have assembled a miniature gamma camera with a 1-square-inch field of view and an intrinsic resolution of about 1 mm. When the minicamera is collimated with a large-holed, highly sensitive collimator, it acquires a spatial resolution of 3 mm. This prototype has been tested in the detection of difficult-to-image breast cancer sentinel nodes. Five nodes that had not been found with the usual technique of an Anger camera plus conventional probe were checked with the miniature camera that we named imaging probe: it actually is small enough to be used as a probe and large enough to give an image. One of the five nodes was found and imaged. It was small, disease-free, close to the tumor and probably hidden by the Compton halo around the peritumoral injection site. Our pilot study shows that the imaging probe, although still a prototype, has certain advantages over conventional methods when lymph node localization is required during surgery.
Sentinel Node Biopsy in Patients with Cutaneous Melanoma of the Head and Neck
Authors: Mattioli Lorenzo , Belli Filiberto , Gallino Gianfrancesco , Ditto Antonino , Castellani Maria Rita , Testoni Monica , Sturm Emiel , Bombardieri Emilio , Cascinelli Natale
Published: April 2018

Biopsy of head and neck sentinel nodes (SNs) can be technically problematic due to the unpredictable and variable drainage patterns of this anatomic region. The aim of the present study was to evaluate the feasibility of SN biopsy for cutaneous melanoma of the head and neck. We performed SN biopsy in 17 patients affected by stage I cutaneous melanoma of the head and neck on the basis of lymphoscintigraphy, blue dye and gamma probe. A total of 24 procedures were performed. Drainage to more than one lymphatic basin was observed in five patients (two basins in three cases and three basins in two cases) and in all cases SN biopsy was performed in all basins. The biopsy distribution by site was: six cervical nodes, five parotid nodes, four supraclavicular and submandibular nodes, three auricular and axillary nodes. The SN identification rate was 87.5% (21/24); metastases were discovered in four cases, with a positivity rate of 23.6%. At the time of writing, 1 patient is alive with local disease, 3 patients are dead and 13 are alive and free of disease with a follow-up ranging from 1 to 40 months (median, 21 months) following SN biopsy. In our opinion preoperative lymphoscintigraphy and the intraoperative use of a gamma probe are useful for the identification of lymphatic drainage of cutaneous melanoma of the head and neck.
Soft Tissue Sarcomas in the General Population Living near a Chemical Plant in Northern Italy
Authors: Costani Gloria , Rabitti Paolo , Mambrini Adelmo , Bai Edoardo , Berrino Franco
Published: April 2018

Background and objectives

After the notification by a general practitioner of a high frequency of soft tissue sarcomas among subjects living close to the industrial area of the city of Mantua (northern Italy), the local Medical Association carried out a formal epidemiologic investigation to corroborate or falsify the hypothesized excess. Several industrial activities of the area were hypothesized to be a source of environmental pollution that might cause soft tissue sarcomas.

Methods

All general practitioners working in the area were requested to report the cases of soft tissue sarcoma diagnosed in the study area. Person-years of observation were computed for all subjects who ever resided in the area between 1984 and 1997. Expected incidence was computed from the cancer registry covering a nearby province (Varese) and from the pool of Italian cancer registries. Peripheral soft tissue sarcoma and visceral sarcomas were included in the analysis.

Results and conclusions

Overall, 20 cases were observed in a 13-year period, 8.87 were expected from the Varese province cancer registry and 7.72 from the pool of Italian registries. The corresponding standardized morbidity ratios were 2.25 (95% confidence interval, 1.34–3.47) and 2.6 (95% confidence interval, 1.6–4.0), respectively. A significant excess persisted after excluding 5 cases that had been the object of the original notification. We hypothesize that the soft tissue sarcoma excess may have resulted from environmental pollution by industrial toxic emissions, which likely included 2,3,7,8-tetra-chloro-dibenzo-dioxin.
Quality of Life in Patients with Early Stage Breast Carcinoma Treated with Conservation Surgery and Radiotherapy. An Italian Monoinstitutional Study
Authors: Amichetti Maurizio , Caffo Orazio
Published: April 2018

Aims

To evaluate the quality of life (QOL) in patients with early stage invasive carcinoma of the breast treated with conservative surgery and postoperative irradiation.

Methods

A mailed survey to examine QOL was conducted in 227 subjects with breast cancer treated in 1990 and 1994 with conservation surgery plus definitive irradiation. The self-compiled questionnaire was developed based on a series of 38 items assessing six core areas of QOL. Furthermore, the patients were requested to evaluate the degree of information provided by the medical staff concerning the disease, the treatment and related side effects and to evaluate the effects of the treatment on their social, overall QOL, and health status.

Results

The questionnaire was completed by 156 patients (68.7%) who had a median age of 56 years (range, 28–75 years) at the time of treatment and 59 years (range, 31–82 years) at the time of the study. The physical condition was reported to be good. Data relating to sexual life were provided by more than 90% of the patients. Some limitations in sexuality, some interference with sexual desire, and some modifications during intercourse were reported by 11, 11, and 10 patients, respectively. The subjective evaluations of the cosmetic results of the therapies were judged good-excellent by 56% of the patients, 12 (8%) only had a negative perception of their body image. Twenty-five percent of the sample declared that they felt tense, 19% nervous, 18% lonely, 27% anxious and 16% depressed. Only six patients (4%) declared that the treatment had had a bad on their social life, and 18 (11%) thought that their health status has been affected by the treatment. A worsening of QOL due to the disease or the treatment was reported by 8% of the responders. The amount of information received concerning the treatment and its side effects was considered sufficient by most of the patients.

Conclusions

The results of the study revealed a satisfactory health-related QOL in patients treated with breast conservation and postoperative irradiation. A preserved favorable body image and lack of a negative impact on sexuality was observed, even though about half of the patients reported a negative judgement on esthetic outcome. Some patients had persistent psychosocial concerns. No significant additional problems attributable to radiation therapy capable of affecting QOL outcomes were reported.
Peripheral Primitive Neuroectodermal Tumor (Ppnet) of Pelvic Origin: Report of a Case Arising from an Unusual Location
Authors: Mata Fernando , Losa Fernando , Camacho Luis , Trigo Vicente Fernandez , Barrios Pedro , Mas Jorge
Published: April 2018

A peripheral primitive neuroectodermal tumor arising from the abdominopelvic cavity is reported in a 24-year-old young male without any previous remarkable pathology. He was admitted to our hospital with complaints of urinary symptoms (acute urinary retention) and mild intestinal occlusion that had been present for three months. Physical examination and CT scan revealed a pelvic mass occupying the entire pelvic cavity. The diagnostic workup included a CT-guided biopsy which defined the tumor as a sarcomatous type. Radical surgery was performed including tumor resection, pelvic exenteration (bladder and prostate gland) and urinary and fecal diversion. Adjuvant chemotherapy (VAIA) was delivered once the histology was confirmed. We reviewed the available literature focusing on the varied nomenclature of this tumor (peripheral neuroepithelioma, Askin's tumor, Ewing's extraosseous tumor, peripheral adult neuroblastoma, peripheral primitive extracranial neuroectodermal tumor (PPNET), the clinical features, the role of diagnostic imaging techniques, pathologic assessment and controversial therapeutic management. In addition, the prognosis and survival of this rare condition were analyzed.
Neoadjuvant Moderately High-Dose Chemotherapy with rh-G-CSF in Locally Advanced Breast Carcinoma
Authors: Fornasiero Adriano , Ghiotto Cristina , Daniele Otello , Favaretto Adolfo G , D'Amanzo Paola , Ziade Azzam
Published: April 2018

Aims and Background

The poor results of local treatment for locally advanced breast carcinoma (LABC) justify the use of chemotherapy as primary treatment. Retrospective studies have shown a positive correlation between dose and response rate in advanced breast cancer. G-CSF has shown efficacy in achieving optimal dose intensity and ameliorating chemotherapy-induced myelosuppression. The aim of the present study was to assess the efficacy of a moderately high-dose chemotherapy regimen in terms of response rate, disease-free and overall survival and to assess the role of G-CSF in induced neutropenia.

Methods

Inclusion criteria were the following: age <65 years, WHO performance status <2, histologically proven breast carcinoma, adequate hematologic, renal and hepatic function, stage IIIA or IIIB disease, and no metastatic disease. No prior chemotherapy or radiotherapy was allowed. Three cycles of the following chemotherapy were used preoperatively: epirubicin (100 mg/m2 on day 1), cyclophosphamide (400 mg/m2 for 3 consecutive days) and rh-G-CSF (5 μg/kg/die from day 4 to day 12 every 14 days). After mastectomy or quadrantectomy plus radiotherapy, all patients were treated with 4 courses of adjuvant chemotherapy according to the CMF 1-8 schedule (methotrexate, 40 mg/m2; cyclophosphamide, 600 mg/m2; fluorouracil, 600 mg/m2; all on days 1 and 8, with recycle every 4 weeks).

Results

From May 1992 to June 1996, 57 patients with histologically proven LABC were preoperatively treated. Forty-four patients were premenopausal and 13 postmenopausal; the median age was 45 years (range, 29-64). Thirty-five patients had stage IIIA and 22 patients stage IIIB disease (7 with inflammatory disease). Forty-seven patients underwent radical mastectomy and 10 conservative surgery. A clinical response was noted in 93% (95% confidence interval, 83-98%) of patients (12% complete responses and 81% partial responses); 2 pathological complete remissions (3.5%) were obtained. No toxic deaths were observed. All patients had a follow-up of at least 42 months. The overall 5-year survival rate was 76% (standard error - SE), 6%) and the 5-year disease-free survival rate was 68% (SE, 6.3%).

Conclusions

The 14-day regimen was well tolerated and effective in LABC patients, although not superior to standard-dose chemotherapy. To improve results the use of new drugs in controlled clinical trials seems warranted.
Mammary Fetal Gland: Identification of New Oncofetal Antigens by Monoclonal Antibodies B72.3, MM1.80 and 4.36
Authors: Pistolesi Sabina , Nuti Marianna , Castagna Maura , Pingitore Raffaele
Published: April 2018

Aims and Background

The B72.3, MM1.80 and 4.63 monoclonal antibodies directed against tumor-associated antigens react in human breast also with metaplastic, preneoplastic and metastatic cells, whereas they do not react with normal adult mammary tissue. The aim of our study was to point out the expression of these antigens during mammary gland development, since tumor-associated antigens are known to represent antigens of differentiation.

Study design

Fifty female fetal breasts between 20 and 40 weeks of gestational age were studied.

Results

Mammary tissue was identified only in 15 cases. B72.3, MM1.80 and 4.36 monoclonal antibodies reacted with epithelial antigens and maintained the same location and intensity in the various gestational ages. Immunoreactivity was weak, cytoplasmic and widespread for the 4.36 monoclonal antibody, intense and cytoplasmatic in a large number of cells for the B72.3 monoclonal antibody, and intense and luminal for the MM1.80 monoclonal antibody.

Conclusions

Such data further support the hypothesis that the normal process of development and differentiation can occur during tumor progression processes. Identification of these new oncofetal markers could offer a new perspective able to recognize the different phases of neoplastic progression and could be useful for prevention.
Impaired Perforin-Dependent NK Cell Cytotoxicity and Proliferative Activity of Peripheral Blood T Cells is Associated with Metastatic Melanoma
Authors: Jović Victor , Konjevic Gordana , Radulović Sinisa , Jelić Svetislav , Spuzić Ivan
Published: April 2018

Aims and Background

Patients with metastatic melanoma often have defects in the percentage and function of peripheral blood NK cells, which are involved in the non-specific innate antitumor immune response, and T cells, which participate in the specific acquired antitumor immune response. The aim of this study was to investigate in more detail not only the percentage but also the activation status and function of NK and T cells in patients with metastatic melanoma prior to therapy.

Methods

The percentage of peripheral blood CD56+ NK cells, CD3+ T cells and their CD4+ and CD8+ subsets, as well as the expression of the activation antigens CD69, CD38 and HLA-DR were analyzed by flow cytometry. The functional capacity of NK cells was evaluated by the 51-chromium release cytotoxicity assay, while the proliferative activity of T cells was estimated by the lymphocyte transformation test to mitogen phytohemagglutinin.

Results

The results obtained in this study have revealed a new aspect of NK and T cell dysfunction that is not, as commonly reported, associated with a decrease in their percentage. Moreover, a significant number of the investigated patients had a higher percentage of NK cells that did not lead to improved NK ceil cytotoxicity as a result of the detected defect in the NK cell perforin-mediated cytotoxic mechanism of tumor cell lysis. The impaired proliferative response of T cells was associated with a decreased expression of the activation antigen HLA-DR.

Conclusion

The novel finding in this study of melanoma patients with metastatic disease is the impaired perforin-depen-dent NK cell cytotoxic mechanism, which was recently shown to be primarily responsible for preventing metastasis. Another interesting finding was the generally hyporeactive status of T cells, possibly resulting from persistent antigenic stimulation. The observed dysfunction of NK and T cells in patients with metastatic melanoma prior to therapy point to the need to supplement chemotherapy with appropriate immunotherapeutic agents in order to overcome the immunosuppression associated with advanced malignancy.
Brain Metastases from Colorectal Carcinoma
Authors: Zorrilla Miriam , Alonso Vicente , Herrero Ana , Corral Mónica , Puértolas Teresa , Trufero Javier Martínez , Artal Angel , Antón Antonio
Published: April 2018

Aims and Background

Brain metastases are an unusual finding in patients with colorectal carcinoma. We wished to determine the clinical presentation, the time interval between the diagnosis of colorectal carcinoma and the appearance of brain metastases, and the overall survival.

Patient characteristics

The median age of our patients was 61 years. Brain metastases developed subsequently to the diagnosis of colorectal cancer in nine patients. All patients had neurologic symptoms. All patients had progressing systemic disease at the moment of intracranial presentation. Four patients received whole brain radiation therapy. The median survival was 11 weeks.

Discussion

The development of brain metastasis is a late event in the course of colorectal carcinoma and occurs most often in patients with extensive systemic disease that contraindi-cates surgical resection. Radiotherapy can improve the survival of this group of patients whereas the role of chemotherapy is still unclear due to the low frequency of such cases.
Epithelial Ovarian Cancer in Female Pseudohermaphroditism. A Diagnosis by Computed Tomography and Review of the Literature
Authors: La Fianza Alfredo , Generoso Paola , Valenti Luigi , Vailati Alberto , Soriani Alessandra , Alberici Elisa
Published: April 2018

We describe the case of a patient proven to be a female pseudohermaphrodite with a complete virilization syndrome who developed an epithelial tumor of the ovary of borderline malignancy. The tumor appeared as an abdominal mass with cystic features on ultrasonography. The diagnosis of the intersexual condition and adnexal cancer was made by computed tomography (CT).
Extraordinarily Elevated Ca19-9 in Benign Conditions: A Case Report and Review of the Literature
Authors: Akdoğran Meral , Şaşmaz Nurgül , Kayhan Burçak , Bıyıkoğrlu ibrahim , Dişibeyaz Selçuk , Şahin Burhan
Published: April 2018

Carbohydrate antigen CA19-9 is commonly used in the diagnosis of pancreatic and biliary malignancies. However, increases in its level in benign conditions such as acute cholangitis or pancreatitis have also been reported. A 79-year-old woman presented with cholangitis and a pancreatic pseudocyst while showing elevation of CA19-9 up to 35,500 U/mL. The patient was adequately treated and at two months’ follow-up the CA19-9 level had returned to normal.
Pleuropulmonary Blastoma in a Child Presenting with Pneumothorax
Authors: Güler Elif , Kutluk M Tezer , Yalçin Bilgehan , Cila Ayşenur , Kale Gülsev , Büyükpamukçu Münewer
Published: April 2018

Pleuropulmonary blastoma is an uncommon primary malignant tumor of the lung. Surgery is the most important part of the treatment. Despite the use of chemotherapy with or without radiotherapy, the prognosis is poor. Here we report on the case of a 2.5 year-old boy presenting with pneumothorax who turned out to have a right hemithoracic mass. The patient underwent surgical resection of the mass. Pathologic diagnosis was type II pleuropulmonary blastoma. Postoperative thoracic CT showed nodular residual densities so the patient was given adjuvant combination chemotherapy with cisplatin and etoposide. He has been disease free for 12 months.
Irinotecan Hepatic Arterial Infusion Chemotherapy for Hepatic Metastases from Colorectal Cancer: Results of a Phase I Clinical Study
Authors: Fiorentini Giammaria , Lucchi Silvia Ricci , Giovanis Petros , Cantore Maurizio , Guadagni Stefano , Papiani Giorgio
Published: April 2018

Background

Hepatic arterial infusion chemotherapy is a promising approach in liver metastases from colorectal cancer, but chemical hepatitis, biliary sclerosis, arterial thrombosis and right upper quadrant pain are limiting factors. Irinotecan (CPT-11) is an active drug in colorectal cancer. We planned a short hepatic arterial infusion of CPT-11 to describe the toxicity, to determine the dose-limiting toxicity, and to define the doses of CPT-11 to be recommended for phase II studies.

Patients and Methods

Fourteen patients with a median liver substitution of 30% (10-60%) were enrolled. All patients received hepatic arterial infusion chemotherapy with CPT-11 on an outpatient basis every 3 weeks as a short, 30-min infusion.

Results

At 240 mg/m2, 2 of 4 patients experienced grade 4 diarrhea and neutropenia, and 3 of them also reported grade 4 abdominal pain of the right upper quadrant. The maximum tolerated dose was reached at 240 mg/m2. The recommended doses of CPT-11 for phase II studies is 200 mg/m2, given every 3 weeks.

Conclusions

CPT-11 presents a low hepatic toxic profile and could be considered a new active drug, suitable for hepatic arterial infusion in liver metastases from colorectal cancer.
Acupuncture in the Treatment of Menopause-related Symptoms in Women Taking Tamoxifen
Authors: Porzio Giampiero , Trapasso Tiziana , Martelli Silvia , Sallusti Elisa , Piccone Caterina , Mattei Antonella , Di Stanislao Carlo , Ficorella Corrado , Marchetti Paolo
Published: April 2018

Fifteen patients were enrolled in a pilot study to evaluate the safety and efficacy of acupuncture for the treatment of menopausal symptoms in tamoxifen-treated patients. Patients were evaluated before treatment and after one, three and six months with the Greene Menopause Index and were treated according to the traditional Chinese medicine. Anxiety, depression, somatic and vasomotor symptoms were improved by the treatment; libido was not modified. Acupuncture seems to be safe and effective for the treatment of menopausal symptoms in women with previous breast cancer taking tamoxifen. Confirmatory studies with a larger number of patients and with a placebo-treated group are warranted.
Cd40 Activation as Potential Tool in Malignant Neoplasms
Authors: Ottaiano Alessandro , Pisano Carmela , De Chiara Anna , Ascierto Paolo Antonio , Botti Gerardo , Barletta Emiddio , Apice Gaetano , Gridelli Cesare , Iaffaioli Vincenzo Rosario
Published: April 2018

Background

CD40, a cell surface molecule, is expressed on B-cell malignancies and many different solid tumors. It is capable of mediating diverse biological phenomena such as the induction of apoptosis in tumors and stimulation of the immune response. It has thus been studied as a possible target for antitumor therapy. The general aim of this review is to focus the attention of clinical oncologists on the involvement of CD40 in tumors and the rationale of CD40-activation-based therapies in new, biologically oriented antitumor protocols.

Methods

A Medline review of published papers about the role of CD40 activation in cancer therapy.

Results

Many authors have shown that CD40 activation promotes apoptotic death of tumor cells and that the presence of the molecule on the surface of carcinoma lines is an important factor in the generation of tumor-specific T-cell responses that contribute to tumor cell elimination. The CD40 ligand (CD40L) is the natural ligand for CD40; it is expressed primarily on the surface of activated T lymphocytes. Preclinical studies suggest that CD40-CD40L interaction could be useful for cytotoxicity against CD40-expressing tumors and for immune stimulation. Tumor inhibition was observed when tumor cells were treated with agonistic anti-CD40 monoclonal antibodies or with the soluble form of CD40L. The results of the first phase I clinical trial to treat cancer patients with subcutaneous injection of recombinant human CD40L have been recently reported. Immunohistochemical studies have revealed that detection of CD40 in primary cutaneous malignant melanoma and lung cancer may have a negative prognostic value. Interestingly, up-regulation of CD40 was observed in the tumor vessels of renal carcinomas and Kaposi's sarcoma, suggesting possible involvement of CD40 in tumor angiogenesis. Recently, it has also been shown that CD40 engagement on endothelial cells induces in vitro tubule formation and expression of matrix metalloproteinases, two processes involved in the neovascularization and progression of tumors.

Conclusions

CD40 activation represents an exciting target for hematological malignancies and solid tumors expressing the molecule, but its functional role in cancer development still remains unclear and controversial.
An Estimate of Prostate Cancer Prevalence in Italy
Authors: La Vecchia Carlo , Bruzzi Paolo , Decadi Adriano , Gaboardi Franco , Boyle Peter
Published: April 2018

Estimates of the total number of men with a previous diagnosis of prostate cancer in Italy range from 55,000 to 135,000. This wide range of variation is largely due to uncertainties on the number of protein-specific antigen-detected, asymptomatic cases. The number of clinically detected cases, including cases with advanced disease, is less subject to uncertainty, with reasonable estimates ranging from 45,000 to 60,000.
Comparison of Radiation-Induced Oral Mucositis Scoring Systems
Authors: Etiz Durmuş , Orhan Bülent , Demirüstü Canan , Özdamar Kazim , Çakmak Ahmet
Published: April 2018

Background

A number of oral toxicity scoring systems have been described, but their direct comparison has rarely been undertaken and little data exists. An impediment to mucositis research has been the lack of an accepted, validated scoring system. The objective of this study was to design a test and validation of scoring systems.

Materials and methods

Forty-three patients with head and neck malignancies who had been irradiated were evaluated. Five different mucositis scoring systems (World Health Organization, Radiation Therapy Oncology Group, “Hickey”, “Van der Schueren” and “Makkonen”) were compared with each other.

Results

Daily mucositis scores demonstrated a high correlation among scoring systems (P <0.05 and coefficient of correlation κ and r = 0.5 - 0.95). Objective mucositis scores demonstrated a strong correlation with symptoms.

Conclusions

All scoring systems were equally valid. The exact grading of mucositis is achieved by combining clinical information about pain and nutritional status with oral mucosal reactions.
Radiation Therapy Combined with Photofrin or 5-Ala: Effect on Lewis Sarcoma Tumor Lines Implanted in Mice. Preliminary Results
Authors: Schaffer Moshe , Schaffer Pamela M , Jori Giulio , Corti Luigi , Sotti Guido , Hofstetter Alfons , Dühmke Eckhart
Published: April 2018

Aims and background

Ionizing irradiation is a well-established therapeutic modality for cancer. Photodynamic therapy (PDT), especially with 5-ALA and Photofrin, is highly effective in some tumor types. Chemical modifiers, so-called radiosensitizers, are used in order to increase the efficacy of radiotherapy. Most of the known and routinely used radiosensitizers are not tumor selective, so that the normal tissue reaction toxicity is also increased. In the present study we investigated whether a porphyrin derivative that is currently used as a tumor-photosensitizing agent in photodynamic therapy (PDT) may also act as a tumor-specific radiosensitizer.

Materials and methods

For our investigation we used Balb/c mice implanted with Lewis sarcoma and irradiated with 3 Gy combined with injection of 5-ALA or Photofrin at various concentrations before irradiation.

Results

5-ALA had no effect as a radiosensitizer at any of the concentrations examined. Photofrin at a concentration of 5 mg/kg proved to be a chemical modifier of ionizing radiation, delaying tumor growth and reducing the overall tumor volume by about 50% after six days.

Conclusion

Photofrin has marked efficacy as a radiosensitizer and can be used in the future as a selective tumor radiosensitizer.
Bleomycin-Induced Upper Lobe Fibrosis: A Case Report
Authors: Marruchella Almerico , Franco Cosimo , Garavaldi Giovanna , Uccelli Mario , Bottrighi Pietro
Published: April 2018

We report a case of late-onset pulmonary fibrosis involving the upper lobes that occurred in a young man treated with bleomycin for mediastinal germ-cell carcinoma. The parenchymal lesions became clinically apparent about two years after chemotherapy had been completed, with a slowly progressive course and sparing the lower lung fields during follow-up. Other possible diagnoses could be excluded on the basis of the patient's clinical history, laboratory tests and pathological findings.
Lymph Nodal Merkel Cell Carcinoma; Primary or Metastatic Disease? A Clinical Case
Authors: Fotia Giuseppe , Barni Roberto , Bellan Cristiana , Neri Alessandro
Published: April 2018

We report a case of Merkel cell carcinoma (MCC) presenting in the lymph nodes in the absence of a primary cutaneous site. The MCC was treated by palliative radiotherapy, which controlled the disease locally. Eight months after diagnosis a mass appeared on the ipsilateral knee; histopathological examination of this lesion confirmed the diagnosis of MCC. The patient died two months later due to the development of pulmonary metastases. Interestingly, the neoplastic tissue was confined to the regional lymph nodes for several months before the primary site appeared. Primary lymph nodal MCC is rare and the diagnosis is difficult. In our opinion the only way to make a diagnosis of primary lymph nodal MCC is by appropriate clinical follow-up.
Third-Line Hormonal Treatment with Exemestane in Postmenopausal Patients with Advanced Breast Cancer Progressing on Letrozole or Anastrozole. A Phase II Trial Conducted by the Hellenic Group of Oncology (HELGO)
Authors: Gennatas Constantine , Michalaki Vasiliki , Carvounis Eleni , Psychogios John , Poulakaki Nikiforita , Katsiamis George , Voros Dionysios , Kouloulias Vasilis , Mouratidou Despina , Tsavaris Nikolaos
Published: April 2018

Aims and Background

The understanding of hormonal therapies in postmenopausal women with metastatic breast cancer has advanced greatly in the past several decades. With the introduction of orally active, potent and selective third-generation aromatase inhibitors (anastrozole, letrozole and exemestane), approaches to the treatment of hormone-sensitive advanced breast cancer are undergoing reevaluation. For treatment of advanced or metastatic disease that has progressed on tamoxifen, all three agents are active. The purpose of the study was to assess the antitumor efficacy and tolerance of exemestane administered as third-line hormonal therapy to postmenopausal women with metastatic breast cancer refractory to letrozole and anastrozole.

Study design

Sixty postmenopausal women with stage IV hormone receptor-positive carcinoma of the breast were enrolled in the study. All patients had received two prior hormonal manipulations and had measurable or assessable disease. All adverse events were monitored.

Results

Objective tumor response was achieved in 12 (20%) patients (95% CI, 9.6-30.4). The overall clinical benefit was 38.3% (95% CI, 21.2-49.3), and the median duration of objective tumor response was 20 months (range, 9-26). The median time to death was 17.4 months (95% CI, 16.14-18.66).

Conclusions

Exemestane represents an active and well-tolerated treatment option in pretreated patients with advanced breast cancer who have received standard first- and second-line hormonal therapies. By extending the sequence of hormonal therapy, disease progression and the need for chemotherapy may be significantly delayed.
Long-Term Consequences of Total Gastrectomy: Quality of Life, Nutritional Status, Bacterial Overgrowth and Adaptive Changes in Esophagojejunostomic Mucosa
Authors: Murawa Dawid , Murawa Pawel , Oszkinis Grzegorz , Biczysko Wiesłtawa
Published: April 2018

Objectives

The aim of the study was to evaluate long-term quality of life and adaptive changes in the mucosa of the proximal section of the small intestine used for esophagojejunostomy reconstruction in stomach cancer patients after total gastrectomy.

Material and methods

Thirty-one patients who had undergone stomach cancer-related total gastrectomy were included in the study, which spanned a period of 48 to 127 months (79.6 months on the average) after the surgery. The analysis included: a) evaluation of selected biochemical parameters; b) microbiological evaluation of esophagojejunostomic area; c) evaluation of adaptive changes in esophagojejunostomic mucosa using light and electron microscopy; d) quality of life evaluation with a Troidl questionnaire.

Results

Quality of life was subjectively rated as good or very good by almost all subjects. The analyzed biochemical parameters were within the range of normal values in all the subjects with the exception of mild abnormalities in alkaline phosphatase and vitamin B12 levels in some patients. Microbiological examination of mucosal specimens from below the esophagojejunostomy revealed significant bacterial flora overgrowth in all the patients, with streptococci being the most abundant species. Light and electron microscopy examination of the epithelium confirmed it was normal and characteristic of a healthy small intestine.

Conclusions

Long-term quality of life in patients after complete stomach resection is considered good or very good, irrespective of the reconstruction method used, and the esophagojejunostomic mucosa of the reconstructed area is normal and typical for a healthy small intestine.
Two Exercise Schemes in Postoperative Breast Cancer: Comparison of Effects on Shoulder Movement and Lymphatic Disturbance
Authors: de Rezende Laura Ferreira , Franco Ricardo Laier , de Rezende Mariana Ferreira , Beletti Patrícia Odila , Morais Sirlei Siani , Gurgel Maria Salete Costa
Published: April 2018

Aims and Background

We attempted to determine the best method of performing the exercises in rehabilitation after breast cancer surgery and their influence on postoperative complications. Currently, there are no guidelines for these exercises. The scope of this study was to evaluate the effect of two schemes of physiotherapy exercises (directed or free) on shoulder function and lymphatic disturbance in postoperative rehabilitation.

Subjects

Sixty women who underwent a modified radical mastectomy or quadrantectomy with axillary dissection were randomized into two groups.

Methods

The physiotherapy technique used was kinesiothera-py. The directed group performed physiotherapy following a regimen of 19 exercises. The free group performed the exercises following the biomechanical physiological movements of the shoulder without a previously defined sequence or number of repetitions.

Results

The averages of the flexion, abduction and external rotational movements of the shoulder showed better recovery with statistical significance in the directed group compared to the free group. There was no significant difference between the groups in lymphatic disturbance.

Conclusion

At the end of 42 days of follow-up, the movements of flexion, extension, abduction and external rotation of the shoulder were better rehabilitated in the directed group. The two schemes of exercises were not different with regard to lymphatic disturbance.
Association between Immunohistochemical Expression of Topoisomerase IIα, Her2 and Hormone Receptors and Response to Primary Chemotherapy in Breast Cancer
Authors: Manna Eliza Del Fiol , Teixeira Luiz Carlos , Alvarenga Marcelo
Published: April 2018

The aim of this study was to evaluate the association between immunohistochemical expression of topoisomerase IIα, HER2 and hormone receptors and response to primary anthracycline-based chemotherapy in locally advanced breast cancer. We analyzed 109 medical charts of patients treated with primary anthracycline-based chemotherapy in the Women's Integral Health Care Center from 1996 to 2004. The clinical and pathological response to primary chemotherapy was associated with topoisomerase IIα and HER2 expression and hormone receptor negativity. Statistical analysis was performed using chi-squared, Fisher's exact test and Mann-Whitney test. No statistical association between clinical response and expression of topoisomerase IIa, HER2 and hormone receptor negativity was found. However, there was an association between complete pathological response and hormone receptor negativity (P = 0.0289). The present study suggested that these markers should not be considered predictors of response to primary anthracycline-based chemotherapy, and prospective studies must be designed for this purpose.
Report on a Case of Pure Cribriform Carcinoma of the Breast with Internal Mammary Node Metastasis: Description of the Case and Review of the Literature
Authors: Gatti Giovanna , Pruneri Giancarlo , Gilardi Daniela , Brenelli Fabricio , Bassani Guillermo , Luini Alberto
Published: April 2018

Aims and background

Pure ductal invasive carcinoma of the breast is more frequently associated with lymphatic invasion, lymph node involvement and high malignant histological grade than combined forms of breast carcinoma. Internal mammary node metastases are not frequently detected when the axillary nodes are negative.

Patients and methods

We report our experience of a case of pure cribriform carcinoma, associated with an intraductal cribriform component, in which the sentinel axillary nodes were negative, while nodal and perinodal metastasis was detected in one internal mammary lymph node.

Conclusions

Data from the literature show that positive internal mammary nodes are an unusual finding when the axillary sentinel node is negative, especially in cases of cancer with a relatively good prognosis, such as cribriform cases.
Valore E Limiti Del Circolo Patologico Nella Diagnosi Angiografica Di Natura Dei Tumori Cerebrali
Authors: Porta C. , Gattoni A.
Published: April 2018

180 cases of brain neoplasms were surgically and histologically investigated. Basing on the morphological characteristics of the pathological circulation (observed in 80 cases, or the 44.4 per cent), the possibility of an angiographic diagnosis of benignity, malignancy and histological type is discussed.

It is stated that in glioblastomas, meningiomas and metastases a rather uniform angiographic picture of the pathological circulation exists, on which a radiological diagnosis may be established.

The causes of error and the limitations in the differential diagnosis for the various tumour types are indicated; a thorough analysis of all data derived from angiographic, craniographic and clinical observations is advised.

Following the exposed procedure, a precise diagnosis of the tumour type has been possible in the 50 per cent about of the cases.
Azione Tossica Delle Diverse Frazioni Endocellulari Del Sarcoma Galliera Iniettate Nel Coniglio a Scopo Immunizzante
Authors: Zinnari A.
Published: April 2018

6 groups of rabbits have been submitted to immunizing treatment with mitochondria from rat liver or with horse serum (controls), and with mitochondria, nuclei and supernatant from Galliera sarcoma. The doses of antigen were equivalent as total nitrogen, and the experimental conditions were the same for all animals.

Whereas normal endocellular fractions, horse serum and supernatant from Galliera sarcoma did not give significant results, the tumour mitochondria and nuclei were demonstrated to exert a very high toxic action in the rabbit, causing, in particular, a diminution of total proteins, and especially of globulins.

Following the treatment with the antigens, two different immunitary reactions have been observed, one of which was characterized by an increase in total nitrogen and globulins (especially beta-2 and gamma), and the other by a decrease of the same substances.
Ricerche Sull'Azione Antineoplastica Di Un Nuovo Farmaco Di Origine Vegetale: La « Vincaleukoblastine »
Authors: Soldati M. , Gaetani M.
Published: April 2018

The action of the Vincaleukoblastine sulphate has been studied on some experimental tumours. In the ascites tumour, Ehrlich adenocarcinoma of the mouse and ascites myeloma of the rat, the agent showed a marked antineoplastic activity, with increase of the average survival and reduction of the tumour growth. On the other hand, it proved to be scarcely effective or ineffective on the Oberling-Guérin-Guérin solid tumour.

The cytologic examination showed a blocking in the very early mitotic stages, with very high values of the mitotic index in the first hours after introduction of the substance (up to the 14 per cent about) and very severe morphologic alterations of the neoplastic cells (increased vacuolization, cytoplasmic buddings, breaking up of nuclear chromatin with formation of micronuclei, monster cells).

The most sensitive to the drug action were demonstrated to be the most atypical and indifferentiated tumour elements belonging to the reticuloendothelial system. As a matter of fact, the ascites myeloma underwent a tumour growth inhibition of the 97 per cent following VLB introduction.

VLB, which is promptly and rapidly eliminated, showed rather moderate and reversible toxic effects, which reflect mainly on the bone marrow, with a rapid and transient decrease in number of granuloblasts and erythroblasts.
Ricerche Sull'Azione Della « Vincaleukoblastine Sulphate » in Associazione Ad Altre Sostanze
Authors: Di Marco A. , Soldati M. , Gaetani M.
Published: April 2018

The antitumoral action of Vincaleukoblastine in association with other substances on Ehrlich ascites tumour has been studied by tests of acute cytotoxicity and by therapeutic trials on the animal.

The cytologic analysis of tumour elements, and the values of the calculated mitotic indexes showed that cortisone exerts an antagonistic action on VLB. This finding has been confirmed by therapeutical experiments: in fact, the simultaneous use of the two drugs did not result in a higher antitumoral activity but rather in a shortening of the survival time (probably due to enhancement of toxic effects) in comparison with animals treated with the alkaloid alone.

Aminopterin-Vincaleublastine association also failed to exert a significant antitumoral effect, and the data obtained do not differ essentially from those observed after separate administration of the substances.

Glutammic acid was found to induce a transient inhibition on VLB activity, as earlier reported by Johnson and coworkers. It is, however, stated that other substances, which interfer on cell energetic metabolism, such as glucose and d-ribose in phosphate buffer, seem to cause a delay of VLB antitumoral action.
A Histologic Study of Rhabdomyosarcomas
Authors: Fiocca Silvio
Published: April 2018

Four cases of pleomorphic rhabdomyosarcomas are described. A great variation of cellular size and shape, the presence of giant cells, of small round cells, and of strap-shaped and racquet-shaped cells, the identification of longitudinal striation in tumor cells, the absence of a close connection between the tumor cells and the stroma, are believed to be the most important criteria for the identification of these tumors. Cells with typical cross striations are considered residual muscle cells.