bluuebunny/crossref_metadata_2025 huggingface dataset:
Control of Nausea and Vomiting by Granisetron in Ovarian Cancer Patients Treated with Different Cisplatin-Based Regimens
Authors: Bresciani Gianluigi , Böhm Silvia , Oriana Saro
Published: April 2018

Aims

The study evaluated the safety and efficacy of granisetron as an antiemetic drug in ovarian cancer patients treated with cisplatin-based chemotherapy.

Study design

Two groups of consecutive patients were considered: the first (Group A) with advanced disease, receiving 4-day cisplatin therapy in a 40 mg/m2 daily dose; the second (B), with minimal disease after radical surgery at high risk of recurrence, treated by single-day chemotherapy with a 90 mg/m2 dose. In both groups, 3.0 mg of granisetron was administered as a 10 min. intravenous infusion, 30 min. before cisplatin infusion. The treatment schedule included in all patients the administration of 125 mg i.v. of methylprednisolone 2 h before chemotherapeutic infusion. No further doses of granisetron were allowed within each 24 h study period for breakthrough nausea and vomiting. Assessment for nausea and vomiting was made at 24 h intervals through the 6-day study period for both groups using a diary card.

Results and conclusion

In group A, 25 patients were collected and evaluated; in group B, 25 were recruited and 13 evaluated. In both groups, excellent control of nausea and vomiting was achieved, since in group A we had a global major antiemetic efficacy of granisetron in 69.2% of patients (54.4% complete control and 14.8% major control); in group B, global major efficacy was present in 83.3% of cases (31.6% complete control and 51.7% major control). The antiemetic effect in the days following antiblastic treatment lasted longer in group A.
Role of Postoperative Radiation Therapy in the Management of Early Stage Primary Gastric Non-Hodgkin's Lymphomas: A Retrospective Analysis
Authors: Cerizza Lorenzo , Varinelli Diego , Antognoni Paolo , Vanoli Paolo , Vavassori Vittorio , Tordiglione Michele
Published: April 2018

Background

Clinical approaches to early primary gastric non-Hodgkin's lymphomas have not yet been clearly defined, and the role of postoperative radiotherapy remains a matter of discussion.

Methods

Twenty-seven patients with early primary gastric non-Hodgkin's lymphoma were observed from December 1978 to December 1990 at our Institution. They were staged according to Musshoff and Schmidt-Volmer (19) as I E (n = 16), II E 1 (n = 7) and II E 2 (n = 4). All of them underwent local combined treatment, consisting of surgery and postoperative radiotherapy; chemotherapy was also administered to 10 patients, mainly with the CHOP regimen, for 4-6 cycles before radiotherapy. Irradiation was delivered using 10 MV photons from a linear accelerator. Large abdominal fields were employed in 21 cases with daily fractions of 1.5-2 Gy up to a median total dose of 30 Gy (range: 27-36 Gy). Six patients were irradiated only on the surgical bed up to 40.5 Gy (range: 39-40.5 Gy).

Results

The 5-year overall and disease-free survivals were respectively 92.4% and 89.8%. The main known prognostic indicators, stage of disease, type of surgery as well as age and sex, were not found to be statistically significant in our series. No clear difference emerged between patients sequentially treated with the combination surgery-chemotherapy-radiotherapy and those who did not receive adjuvant chemotherapy. Two patients recurred at distant sites, but no local failure was seen during the follow-up.

Conclusions

Although no firm conclusion can be drawn, our experience, in agreement with recent published reports, points out that the use of postoperative radiotherapy is associated not only to favorable results in terms of local control and survival, but also, and moreover, to a negligible incidence of side effects and sequelae. However, in the absence of multi-institutional prospective randomized studies, whose activation is nowadays strongly warranted, the exact role of adjuvant therapies remains a matter of discussion, and the optimal treatment of early primary gastric non-Hodgkin's lymphoma still depends on individual experience and the physician's philosophy.
Feasibility of Intraportal Chemotherapy with Fluorouracil and Folinic Acid Immediately after Hepatic Resection for Colorectal Metastases
Authors: Bignami Paola , Doci Roberto , Montalto Fabrizio , Fissi Susanna , Di Bartolomeo Maria , Gennari Leandro
Published: April 2018

Background

About 50% of recurrence after resection of hepatic metastases from colorectal cancer remain confined to the liver. Adjuvant locoregional treatments could reduce the failure rate, but these treatments have been scantily investigated. Experimental models have shown that both intra-arterial chemotherapy (IAC) and intraportal chemotherapy (IPC) in adjuvant setting were able to reduce metastatic growth, but IPC should be initiated in the immediate postoperative period.

Aims

To evaluate the feasibility of immediate postoperative IPC of fluorouracil (5-FU) plus folinic acid (FA) in a consecutive series of patients undergoing hepatic resection for metastatic colorectal cancer.

Methods

Forty-three consecutive patients underwent hepatic resection. The first 25 (Control Group = CG) received only surgery; the latter 18 (Treated Group = TG) were candidate to postoperative IPC of 5-FU 750 mg/m2 plus FA 20 mg/m2/day continuous infusion for 8 days. One patient was not treated owing to bleeding, thus only 17 received the treatment.

Results

Postoperative morbidity was 14%, equally distributed in both groups. Biochemical hepatic parameters of TG were not statistically different from those of CG. Five patients (29%) developed systemic toxicity: one hematologic grade 4; 3 mucositis grade 3 and one allergic erythema. Three of these patients had been treated by systemic chemotherapy less than one year before.

Discussion

IPC of 5-FU plus FA in the immediate postoperative period has not yet been tested. The schedule we have investigated neither affected the postoperative outcome, nor influenced hepatic function and regeneration. Systemic toxicity was evident and severe mainly in patients already pretreated by systemic chemotherapy. In these patients, however, toxicity did not affect further outcome. This study confirms the feasibility of immediate intraportal chemotherapy after hepatic resection.
Combination of Epirubicin and Lonidamine for Treatment of Advanced Breast Cancer
Authors: Moraglio Lorenza , Brema Fulvio , Pastorino Gisella , Martini Maria Cristina , Vallauri Matteo
Published: April 2018

Aims and background

In vitro and in vivo studies have shown that lonidamine potentiates the cytotoxic effect of anthracyclines in simultaneous and sequential combination. On the basis of such evidence, we evaluated the activity and toxicity of a combination of epirubicin plus lonidamine in advanced breast cancer.

Methods

Between January 1991 and November 1993, 33 patients with advanced breast cancer, age <75 years and PS <2, were treated with epirubicin (75 mg/m2 i.v. on day 1, every 3 weeks), plus lonidamine (450 mg/day orally from day 1 continuously until disease progression).

Results

Thirty patients were evaluable for response: 4 achieved complete response (13%) and 8 partial response (27%) (total response rate = 40%), 6 (20%) had stabilization of disease, and 12 (40%) progression of disease. The median duration of response was 10 months (range, 4-24+ months). This scheme was tolerated, with a mild additional toxicity related to lonidamine: only WHO grade III myalgia in 1 patient (3%) and epigastralgia in 3 patients (9%).

Conclusions

Although some patients seem to have benefited from the combination at the dose levels of the drug used in the study, the therapeutic advantages of addition of lonidamine remain unclear.
Breast Carcinoma with Osteoclast-Like Giant Cells: Immunohistochemical and Ultrastructural Study of a Case and Review of the Literature
Authors: Viacava Paolo , Naccarato Antonio Giuseppe , Nardini Vincenzo , Bevilacqua Generoso
Published: April 2018

We describe an unusual case of infiltrating ductal carcinoma, not otherwise specified, containing numerous benign stromal osteoclast giant cells (OGCs). Macroscopically, the tumor appeared as a well-outlined dark brown mass and was initially interpreted as a benign lesion on the mammograms. OGCs were uniformly distributed in the tumor and were found in vascularized, hemorrhagic stroma often abutted on the nests of tumor cells. Electron microscopy supported a histiocytic origin of the OGCs, but immunohistochemistry failed to confirm the observation. The patient was alive and well 30 months following the operation. A review of the literature concerning breast carcinoma with OGCs is also presented.
Lymphoepithelioma-Like Carcinoma of the Lung. Two Cases Diagnosed in Caucasian Patients
Authors: Ferrara Gerardo , Nappi Oscar
Published: April 2018

Lymphoepithelioma-like carcinoma is a non-nasopharyngeal undifferentiated carcinoma with prominent lymphoid infiltration. Ten cases arising in the lung have been reported so far; seven cases were diagnosed in Orientals, with the Epstein-Barr virus (EBV) genome demonstrated in neoplastic cells by in situ hybridization; the remaining three cases affected Caucasian patients and showed no evidence of hybridized viral genome. The present study describes two additional cases of lymphoepithelioma-like carcinoma of the lung in Caucasians, with reference to the differential diagnosis versus other thoracomediastinal malignancies. The neoplastic nuclei, blastlike in appearance, together with the immunohistochemical profile of the neoplastic cells (positivity for cytokeratins, and negativity for CD antigens, S100 protein, placental alkaline phosphatase, and neuroendocrine markers) represent the basic pathologic features of a lymphoepithelioma-like carcinoma and allow its recognition even on small bioptic fragments, in which the typical biphasic, Regaud-like morphology might be inapparent. In accordance with the previously reported cases of pulmunary lymphoepithelioma-like carcinoma in Caucasian patients, the present study found no evidence of the Epstein-Barr virus genome in neoplastic cells with in situ hybridization.
Comparing Two Modalities of Screening for Prostate Cancer: Digital Rectal Examination + Transrectal Ultrasonography Vs. Prostate-Specific Antigen
Authors: Ciatto Stefano , Bonardi Rita , Mazzotta Antonia , Lombardi Claudio , Santoni Roberto , Cardini Sergio , Zappa Marco
Published: April 2018

Aims and background

To evaluate the performance and feasibility of screening for prostate cancer by comparing screening modalities.

Methods

Prospective study of two comparable cohorts of healthy resident males aged 60 to 75 years. Screening attenders in the two invited cohorts were screened either by digital rectal examination (DRE) and transrectal ultrasonography (TRUS), or by serum prostate-specific antigen determination (PSA: cutoff 4 ng/ml). Attendance and biopsy rates, predictive values, prevalence of screen-detected cancers, as well as screening costs were determined, and the efficiency of the two screening modalities was compared.

Results

1425 subjects were screened by DRE + TRUS. Attendance rate was 33.7%, the biopsy rate was 2.7%, and the prevalence of detected cancers was 1.82%. A total of 1315 subjects was screened by PSA. Attendance rate was 66.9%, the biopsy rate was 2.8%, and the prevalence of detected cancers was 1.67%. Screen-detected cancer stage was more favorable than observed in clinical practice, and early detection was evident, with the prevalence/incidence ratio higher than 10:1 in both programs. The cost per subject screened was about 34,000 Lire for DRE + TRSU and about 30,000 Lire for PSA program.

Conclusions

The study confirms that early detection of prostate cancer is possible and that screening is practically feasible. Both screening modalities achieved comparable results as regards early detection, but screening by PSA had a higher compliance and lower costs. PSA seems the ideal test to be used in prospective controlled studies aimed at demonstrating screening efficacy.
Combined Carboplatin and Cytosine Arabinoside in Metastatic Melanoma Refractory to Dacarbazine
Authors: Bajetta Emilio , Buzzoni Roberto , Vicario Giovanni
Published: April 2018

This is a preliminary report on the efficacy and toxicity of the combination chemotherapy regimen with carboplatin and cytosine arabinoside in dacarbazine-resistant metastatic melanoma. Patients were considered eligible in the presence of measurable disease sites, an ECOG performance status of 2 or less, a life expectancy of at least 2 months, and prior dacarbazine treatment. The planned schedule consisted of cytosine arabinoside (150 mg/m2 intravenously plus 50 mg subcutaneously), followed by a rapid infusion of carboplatin (350 mg/m2 on day 1). Courses were administred every 3 weeks according to hematologic recovery. Twenty-one consecutive patients were evaluable for activity and toxicity, the response rate was 19% (95% confidence interval, 5-42%). There was no complete remission. Toxicity was tolerable being myelosuppression the main side effect. In conclusion, the combination of carboplatin and cytosine arabinoside has limited activity as a salvage treatment in melanoma patients failing on dacarbazine chemotherapy. Moreover, the regimen is well tolerated and easy to administer in an outpatient setting.
Endometrial Stage I Carcinoma Treated with Surgery and Adjuvant Irradiation: A Retrospective Analysis
Authors: Boz Giovanni , De Paoli Antonino , Innocente Roberto , Del Pup Lino , Talamini Renato , Scarabelli Carlo , Scozzari Giovanni , Roncadin Mario , Franchin Giovanni , Trovò Mauro G.
Published: April 2018

Aims and background

Data from the literature show that the incidence of pelvic recurrences in poor prognosis endometrial carcinoma is significantly reduced by combined surgery and radiotherapy compared to surgery alone.

Methods

In this paper we analyze the results of the combined treatment surgery and adjuvant irradiation in patients with endometrial carcinoma with regard to survival, site of progression, and toxicity. The surgical treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy in 40 patients. Pelvic and para-aortic node dissection was performed in 19 patients and lymph node sampling in 5.

Results

Overall 5-year survival was 85%. One patient had local failure, and 5 patients with local control of disease had distant metastases. Toxicity was mild and transient.

Conclusions

Our experience confirms the data of the literature. Postoperative irradiation is a safe and well-tolerated treatment that can achieve a good local control in high risk, stage I, endometrial carcinoma. The control of distant metastases remains an open question.
Spontaneous Mutation of Cell Oncogenes Plays a Minor Role in Neoplastic Transformation of Virus-Induced Murine T-Cell Lymphomas
Authors: Gasparotto Daniela , Maestro Roberta , Vukosavljevic Tamara , Piccinin Sara , Sandrin Alberto , Rizzo Silvana , Boiocchi Mauro
Published: April 2018

Mink cell focus-forming viruses (MCF) are slow-transforming retroviruses that are able to accelerate the appearance of T-cell lymphomas when injected in newborn AKR mice. Activation of proto-oncogenes by proviral insertion is thought to be the major mechanism by which these viruses exert their oncogenic potential. However, molecular phenomena not strictly virus-determined, such as mutations in cellular oncogenes/tumor suppressor genes or chromosome aberrations, have been hypothesized to contribute to the achievement of the fully neoplastic phenotype in MCF-infected mice. To evaluate the role of spontaneous mutagenesis phenomena in murine virus-induced lymphomagenesis, we analyzed a series of 18 MCF247-induced thymic lymphomas and derived cell lines for the presence of p53 and c-ras gene mutations. Only 1 mutation at the p53 gene and 1 mutation at the ki-ras gene were detected in our study. Our results suggest that spontaneous mutagenesis plays a minor role in virus-induced lymphomagenesis and support the notion that multiple proviral insertions could be the prevalent mechanism of transformation in this experimental system.
Prognostic Factors in Adult Medulloblastoma. A Clinico-Pathologic Study
Authors: Giordana Maria Teresa , Cavalla Paola , Chiò Adriano , Marino Silvia , Soffietti Riccardo , Vigliani Maria Claudia , Schiffer Davide
Published: April 2018

Aims and background.

Medulloblastoma in adults is a rare tumor. The small number of cases in the reported series has not permitted a definite assessment of the prognostic role of clinical, pathologic and cell kinetics factors. The largest series of medulloblastoma in adults treated in a single institution is herein reported.

Methods.

The clinical, therapeutic, pathologic and proliferation features of medulloblastoma in 44 adult patients (> 18 years) were analyzed retrospectively with regard to postoperative survival. The proliferation potential of each tumor was evaluated by the immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA) and Ki-67, clone MIB-1, in paraffin sections.

Results.

The overall 5- and 10-year survival rates were 40% and 35.6%, respectively. Significant factors in predicting a longer postoperative survival were: age < 37 years, decade of management (1977-1990), radiotherapy (50-55 Gy on the posterior fossa and 30-35 Gy on the spinal cord) and nuclear isomorphism. When corrected for adequacy of radiotreatment, desmoplastic type and differentiation were significantly correlated with a shorter survival. The PCNA-labelling index (LI) ranged from 34.5 to 82.2%, the MIB-1-LI ranged from 9.6 to 64.7%. No association was found between PCNA- or MIB-1-LI values and microscopic features, or between LI values and prognosis.

Conclusions.

Contrary to a general assumption, desmoplastic medulloblastoma and differentiated medulloblastoma are negative prognostic factors in adequately radiotreated adult patients. This may possibly be referred to lower radiosensitivity of these tumor variants. The LI with PCNA or Ki-67 is of no help in identifying aggressive tumors.
Effectiveness of Fludarabine in Advanced B-Cell Chronic Lymphocytic Leukemia
Authors: Montillo Marco , Tedeschi Alessandra , Delfini Costante , Olivieri Attilio , D'Adamo Francesca , Leoni Pietro
Published: April 2018

Aims

The study was carried out to investigate the efficacy and toxicity of fludarabine phosphate in the treatment of B-cell chronic lymphocytic leukemia (B-CLL) in previously treated patients.

Methods

Sixteen patients, 11 males and 5 females, 9 in stage B and 7 in stage C, according to the Binet Staging System, were treated with a maximum of 6 cycles of fludarabine (25 mg/m2) for 5 days, every 4 weeks. All patients had been pretreated, 10 were refractory to standard regimens, 5 were in relapse, and 1 patient was in partial remission.

Results

Thirteen patients were judged suitable for evaluation. Overall 9 patients were responsive to treatment; 4 complete and 5 partial responses were observed. Of the 4 patients in complete remission, 3 were alive at 6, 10 and 13 months, respectively, from the beginning of treatment. One patient died after 11 months for acute graft-versus-host disease after allogenic bone marrow transplantation by an HLA sibling donor. Two of the 5 patients in partial remission were alive at 7 and 17 months, respectively, and the other 3 died (2 of disease reexpansion after 14 and 16 months and 1 of septic shock following pneumonia). Four patients were not responsive to treatment: 1 died from disease progression after 8 months from the beginning of therapy, 1 from cardiac failure after 9 months, 1 from septic shock following meningitis, and 1 was alive after 7 months of follow-up. Treatment was well tolerated, with nausea and vomiting in only one patient. We observed two episodes of pneumonitis, without any evidence of the responsible agent, a tumor lysis syndrome with acute renal failure, a recurrence of autoimmune thrombocytopenia, and a Coombs-positive hemolytic anemia.

Conclusions

Fludarabine phosphate is effective in the treatment of patients with advanced B-CLL, even in those refractory to multiple chemotherapy regimens.
Endocrine Effects of Granulocyte Colony-Stimulating Factor in Cancer Patients
Authors: Rovelli Franco , Barni Sandro , Tancini Gabriele , Ardizzoia Antonio , Lissoni Paolo
Published: April 2018

Aims and background

In addition to well-documented endocrine properties of interleukins, hemopoietic growth factors could also exert hormonal activities. In fact, our previous studies have shown that GM-CSF may stimulate cortisol and GH release. In contrast, few data only are available about the possible effects of G-CSF. This study was carried out to investigate endocrine effects of G-CSF in cancer patients.

Methods

The study included 8 cancer patients who were investigated after G-CSF (0.3 mg subcutaneously) or during saline infusion alone as control by collecting venous samples at zero time and after 2, 4, 6 and 8 h. Serum levels of cortisol, GH, PRL, FSH. LH, TSH and melatonin were measured by the RIA method.

Results

The circadian rhythm of cortisol was not influenced by G-CSF. No significant differences in mean levels of GH, PRL, FSH or LH were seen after G-CSF and during saline infusion. Both TSH and melatonin decreased after G-CSF, without, however, significant differences with respect to the values seen on saline alone.

Conclusions

The study showed that G-CSF has no substantial endocrine affects in humans. Therefore, G-CSF would differ from GM-CSF not only for its hemopoietic properties, but also from an endocrine point of view.
Applications of 99mTC-Sestamibi in Oncology
Authors: Maffioli Lorenzo , Steens Jeroen , Pauwels Ernest , Bombardieri Emilio
Published: April 2018

Hexakis (2-methoxyisobutylisonitrile) technetium-99m (99mTc-SestaMIBI) is a radiopharmaceutical used in nuclear medicine for myocardial perfusion imaging. In the literature different non-cardiac applications of 99mTc-SestaMIBI have been reported. Clinical studies have been performed also in non-oncologic diseases (such as thyroid adenoma, diabetic foot, osteomyelitis, pulmonary actinomycosis, aneurysmal bone cyst, Sudeck's atrophy). Several models for the uptake mechanism of this radiopharmaceutical have been proposed such as binding to an 8-10 kDa cytosolic protein, simple lipid partitioning, or a membrane translocation mechanism involving diffusion and passive transmembrane distribution. Most evidence points in the direction of the third hypothesis. Many studies have indicated that uptake of hexakis (alkylisonitrile) technetium complexes is dependent on mitochondrial and plasma membrane potentials like other lipophilic cations. This explains the initial biodistribution of 99mTc-SestaMIBI to tissues with negative plasma membrane potentials and with a relatively high mitochondrial content (like heart, liver, kidney and skeletal muscle tissue). Malignant tumours also possess these properties in order to maintain their increased metabolism. This behaviour encouraged the study of 99mTc-SestaMIBI as an interesting tracer imaging various tumour types: osteosarcoma, brain, lung, breast, nasopharyngeal, parathyroid, and thyroid cancer. Recent research on cell cellular physiology has further revealed an active transport of 99mTc-SestaMIBI out of the tumour cells, against the potential gradient. The same mechanism is also responsible for resistance to a structurally and functionally different group of cytotoxic agents, such as vinca alkaloids, epipodophyllotoxins, anthracyclins and actinomycin D. This peculiar type of resistance is due to amplification of the mammalian MDR1 gene, located on chromosome 7. For this reason the 99mTc- SestaMIBI uptake in vivo could permit the prediction of the response to the chemotherapy, when the decreased accumulation of 99mTc-SestaMlBI implies the presence of P-gp enriched tissues. In the next future a particular attention should be dedicated to this matter since one of the most important goals of the clinical trials is the demonstration of the usefulness of 99mTc-SestaMIBI for in vivo assessment of multidrug resistance.
Steroid Hormone Levels in Patients with Advanced Breast Cancer during Therapy with Droloxifene: A Pilot Study
Authors: Dalski Jacqueline , Görlich Max
Published: April 2018

Antiestrogens, particularly tamoxifen, are effective in the treatment of pre- and postmenopausal women suffering from all stages of breast cancer. Unfortunately, many patients become resistant to tamoxifen during therapy, which allows the tumor to progress. Thus, a preclinical recognition of tumor progression, i.e. by monitoring serum hormone levels, could be worthwhile. The serum levels of dehydroepiandrosterone sulfate and estradiol of postmenopausal women with advanced breast cancer treated by the new antiestrogen droloxifene were therefore checked. However, only non-significant changes in the hormone levels during droloxifene therapy were observed, and no relation was found between hormone levels and the course of the disease, success or exhaustion of droloxifene application, or development of tumor progression. Our data do not confirm earlier findings reported in the literature that measurement of hormones seems to be suitable for an early indication of tumor progression during an antiestrogen therapy before its clinical manifestation.
Personal Freedom and Genetic Overdetermination
Authors: Crotti Nadia , Oppenheim Daniel
Published: April 2018

We do not intend to specify definite proposals as regards the scientific responsibility of genetic practice. This field of predicting the development of a pathology in an individual and family history requires reflection on the perception of personal risk, of the importance and reassurance deriving from a personal history, and of the benefits sharing knowledge and care with the clinical and scientific world. We evaluate the possibility to expand a reflection on sign-possibility and sign-expression of disease that could develop a wider comparison with personal freedom when confronted by genetic, philosophical and historical determinations. A parallel and preliminary consideration is made of guidelines for diagnostic and therapeutic behavior.
Time Trends of Benign/Malignant Breast Biopsy Ratios a Multicenter Italian Study
Authors: Ciatto Stefano , Del Turco Marco Rosselli , Marrazzo Antonio , Mazzoleni Guido , Foglietta Flavia , Cappelli Maria Cristina , Ravaioli Alberto , Bonzanini Mariella , Camaghi Pierluigi , Nava Donatella , Modena Stefano , Zanza Antonella , Benassuti Chiara , Falconieri Giovanni , Zappa Marco
Published: April 2018

Aims and background

Although they have been decreasing over time due to improved specificity of diagnostic assessment, benign biopsies of the breast are still common. Benign biopsies should be regarded as negative events, due to their economical and psychological cost and their possible negative impact on cosmesis and on further diagnostic evaluation.

Methods

Retrospective data on benign/malignant breast biopsies ratio (B/M) were collected in 9 Italian centers for a period of 10-15 years. The time trend of B/M and its association to age or to single centers was evaluated.

Results

Overall 31,001 cases were considered. A strong association of B/M to age was evident (average B/M values were 5.0, 1.3, 0.6, and 0.2 for women aged <40, 40-49, 50-59, and >59 years). A significant trend of decreasing B/M over time was observed only for one center. Age standardized B/M was significantly different (P<0.000001) between centers, ranging between 0.34 and 1.69. Multivariate analysis confirmed an independent significant association of age and center to B/M.

Conclusions

Marked differences in B/M are evident between centers, which cannot be explained by the confounding effect of age or by any apparent difference in the diagnostic protocol. The observed differences are likely ascribed to individual variations in diagnostic aggressivity. A progressive increase of the predictive value of calls for surgical biopsy may be achieved over time and centers with a high B/M should make every effort to optimize their performance. Acceptable (<40=5, 40-49=1.5, 50-59=0.75, >59=0.3) and desirable (2.5, 0.75, 0.35, 0.15) age specific reference standards for B/M are proposed.
Prognostic Factors and Results of Radiation Therapy in Optic Pathway Tumors
Authors: Regueiro Carlos-Alfonso , Ruiz María-Visitación , Millán Isabel , de la Torre Alejandro , Romero Jesús , Aragón Gregorio
Published: April 2018

Aims and Background

The role of radiotherapy in the management of patients with optic pathway tumors remains controversial. This study analyzes the outcome of patients treated with radiotherapy and attempts to identify the groups of patients that may require early therapy.

Methods

We retrospectively reviewed 36 patients with optic pathway tumors treated with radiotherapy alone (26 patients) or with postoperative radiotherapy (10 patients). Seven patients had optic nerve tumors and 29 patients had chiasmal tumors. The actuarial progression free survival and observed survival probabilities were calculated using the Kaplan-Meier method and differences between curves were evaluated by the Mantel-Cox test. The obtained significant variables in the univariate analysis were analyzed using the Cox proportional hazards model.

Results

The 10-year actuarial progression-free survival (10-y PFS) rate was 86% for patients with optic nerve gliomas and 47% for patients with chiasmal tumors. The 10-year actuarial observed survival (10-y OS) rate was 75% for patients with optic nerve gliomas and 53% for patients with chiasmal gliomas. In the group of patients with chiasmal tumors, progression-free survival and observed survival rates were significantly lower in infants (10-y PFS: 30%; 10-y OS: 37%), in patients with neurological deficits (10-y PFS and 10-y OS: 23%), in patients with signs of elevated intracranial pressure (10-y PFS and 10-y OS: 9%), with hydrocephalus (10-y PFS and 10-y OS: 0%), or with impairment of consciousness (10-y PFS and 10-y OS: 17%). Evaluation by computed tomography scanning was associated with a significantly higher probability of PFS. Radiation doses lower than 50 Gy were associated with significantly lower PFS and OS rates. In the Cox multivariate analysis, presence of neurological deficits and radiation dose significantly influenced observed survival. Presence of hydrocephalus significantly influenced progression-free survival.

Conclusions

The prognosis of patients with chiasmal gliomas presenting with neurologic deficits is poor and should be treated at diagnosis. A minimum tumor dose of 50 Gy is recommended.
Phase II Study of Pentosan Polysulfate (PPS) in Patients with AIDS-related Kaposi's Sarcoma
Authors: Schwartsmann Gilberto , Sprinz Eduardo , Kalakun Luciane , Yamagushi Nise , Sander Ernesto , Grivicich Ivana , Koya Richard , Mans Dennis Ricardo August
Published: April 2018

Aims and background

To evaluate the response rate, toxicity and survival of patients with AIDS-related Kaposi's sarcoma (AIDS-KS) treated in a phase II clinical trial of pentosan polysulpate (PPS), an inhibitor of basic-fibroblast growth factor (b-FGF) which blocks the growth of Kaposi's sarcoma cells both in culture and in animal models.

Patients and methods

Between March 1992 and March 1994 16 homosexual males with histopathologically confirmed AIDS-KS were accrued for this phase II clinical trial. PPS was administered at the dose of 25 mg/m2 q6 hrs at day 1, followed by 25 mg/m2 q12 hrs daily by a subcutaneous injection. The number of patients to be included in the trial was calculated according to the two-stage Gehan method. Toxicity was graded according to the NCI Common Toxicity Criteria, while responses were evaluated according to the WHO Criteria adapted for KS lesions. Patients were all homosexual males, median age 35 (27-43) years, performance status (WHO) 1 (0-2), NYU stage II-IV and prior therapy included vincristine and etoposide (3 cases), local irradiation (4 cases) and meges-trol acetate (2 cases). Concomitant AZT (zidovudine) was given to 3 patients, while DDI (dideoxyinosine) was administered in one case.

Results

A median of 5 (3-11) weeks of therapy was administered to the patients. Pain at the injection site and low grade fever were the only toxicities observed. Drug-related effects on coagulation parameters or thrombocytopenia were not observed in the trial. One objective response (6%) was documented, which lasted for 9 weeks, while stable disease was observed in three patients, lasting for 11, 9 and 5 weeks, respectively.

Conclusion

This is the first observation of objective antitumor activity with a b-FGF inhibitor in patients with AIDS-KS. Considering its novelty and the lack of significant toxicity, the authors suggest that this experimental approach deserves further evaluation.
A New Regimen of Cisplatin, Epirubicin and Methotrexate (PEM-3) as Primary Chemothfrapy for Locally Advanced Bladder Cancer
Authors: Cacciari Nicoletta , Martoni Andrea , Rossi Andrea Paolo , Turci Paola , Lelli Giorgio , Martinelli Augusto , Maver Paolo , Corrado Francesco , Mannini Daniele , Reggiani Alberto , Concetti Sergio , Martelli Aldo , Melotti Barbara , Cricca Antonia , Zamagni Claudio , Pannuti Franco
Published: April 2018

In this phase II study, 41 patients with locally advanced urothelial bladder cancer (T2-4, NO, MO) were treated with primary chemotherapy (cisplatin, epirubicin, methotrexate: PEM-3). All the patients were assessable for response and toxicity. Clinical monitoring was performed with computerized tomography and cystoscopy. Nineteen clinical complete remissions (46%) and 10 partial remissions (24.5%) were obtained (CR + PR, 70.5%; 95% confidence interval, 57%-85%). Ten patients were considered to have clinically stable disease (24.5%), and 2 patients progressed (5%). Surgery after chemotherapy was performed in 22 cases: in 6 patients (27%) a pathologic complete response was achieved. The pathologic stage was lower than the initial clinical stage in 13 patients (59%). After a median follow-up of 3 years (range, 1-4), the median time to progression was 104 weeks. At this writing, 20 patients, 12 of which were submitted to surgery and 8 were not operated, are disease-free. The 3-year survival rate is 52%. No one had to interrupt the treatment because of toxicity. In conclusion, the PEM-3 regimen is a very active and well-tolerated regimen in locally advanced bladder cancer.
Weekly Low Dose Epirubicin in Elderly Cancer Patients
Authors: Nicolella Dario , Grimaldi Giuseppe , Colantuoni Giuseppe , Belli Mario , Frasci Giuseppe , Perchard John , Comelia Pasquale
Published: April 2018

Aims and background

The treatment of elderly patients with metastatic solid tumours is still a debated problem. Patients over 75 years are generally excluded from combination chemotherapy trials because of higher toxicity. Several clinical studies have shown that weekly low dose epirubicin is a well tolerated and effective treatment for elderly cancer patients (breast, prostate, lung).

Methods

We report a study of patients aged between 75 and 85 years affected by metastatic anthracyclines-sensible carcinomas, to assess the tolerance of epirubicin given weekly at a dose of 25 mg/m2.

Results

25 patients (13 males, 12 females; ECOG P.S. 0-2) entered the study and were evaluable for side effects. One-hundred and ninety-six cycles of therapy have been administered. Side effects were never severe. Mucositis (9 patients), leucopenia (7 patients), anemia (5 patients) were usually of grade 1 or 2. Grade 1 cardiotoxicity (tachycardia) was observed in only one case. Grade 3 toxicity consisted in anemia (1 patient) and mucositis (1 patient), while grade 4 toxicity never occurred. Nineteen patients were evaluable for response: 0 CR, 4 PR (1 lung, 3 breast), 8 SD (3 lung, 3 breast, 2 prostate) have been observed. Compliance was encouraging and the majority of patients showed a decrease in symptoms and an improvement in performance status.

Conclusions

Weekly low-dose epirubicin is a very well tolerated treatment in elderly cancer patients. In view of the negligible toxicity encountered, it could be of utility to test this regimen in patients aged 75 years or older, affected by anthracyclines-sensible metastatic tumors, also to assess activity.
Long-Term Infusion in Cancer Chemotherapy with the Groshong Catheter via the Inferior Vena Cava
Authors: Tavecchio Luca , Bedini Amedeo V. , Lanocita Rodolfo , Patelli GianLuigi , Donati Ilaria , Ravasi Gianni
Published: April 2018

Aims and background

Vascular access through a vein draining into the superior vena cava is commonly used for long-term infusion of drugs inr cancer chemotherapy; prolonged cannulation of the inferior vena cava is generally considered as having an excessively high complication rate.

Methods

Prolonged cisplatin infusion via the inferior vena cava by means of a Groshong catheter was evaluated in 20 consecutive patients with thoracic malignancies showing evidence of superior vena cava infiltration or obstruction.

Results

We achieved 1,291 catheter days for our survey with a mean duration of vascular access of 64.5 days per patient and a mean duration of infusion time of 40 days. There were 2 complications, a catheter obstruction after a 7-day rest period and an ileo-femoral thrombosis 6 days after catheter placement.

Conclusions

Our experience compared favourably with the results obtained by long-term central venous access via the supraumbilical route, and demonstrated the reliability and safety of this approach in cases where the superior vena cava cannulation is technically difficult or impossible.
First-Line Chemotherapy with Cisplatin, Methotrexate and Vinblastine in Metastatic Bladder Cancer
Authors: Pajk Bojana , Čufer Tanja , Červek Jozica , Zakotnik Branko
Published: April 2018

To determine the effectiveness of combination chemotherapy with cisplatin, methotrexate and vinblastine (CMV), we treated 21 chemotherapy naive patients with metastatic transitional cell carcinoma of the bladder. Chemotherapy consisted of methotrexate (30 mD/m2 i.v. days 1 and 8), vinblastine (3 mg/m2i.v. days 1 and 8) and cisplatin (100 mg/m2 i.v. day 2) every three weeks. Dominant metastatic sites were: soft tissues (7 patients), bone (6 patients), lung and liver (8 patients). A complete remission was achieved in 5/21 patients (24%, 95% CI 8-47%) and partial remission in 9/21 patients (43%, 95% CI 22-66%). The median duration was 6 months (2-11) and 9 months (2-26) for complete and partial remissions, respectively. The median survival for all 21 patients was 10 months. Although overall toxicity was mild, we observed myelosuppression grade IV in 2 patients, stomatitis grade III in 2 patients, cystitis grade III in 1 patient and infection grade III in 6 patients. There were no treatment-related deaths. Our data indicate that treatment with the CMV regimen is effective and that side effects are tolerable.
Occasional Diagnosis of Synchronous Renal Cell Carcinoma during Staging of Other Primary Tumors
Authors: Piccinini Lino , Luppi Gabriele , Zoboli Alessandra , Torricelli Pietro
Published: April 2018

Synchronous renal cell cancer (RCC) associated with primary neoplasms of other organs or tissues represents a rare diagnostic report during life. Recently, the widespread use of new diagnostic techniques (echography, computed tomography and magnetic resonance imaging) has permitted diagnosis of clinically silent RCC. We report 6 RCC cases occasionally diagnosed during initial staging of a primary cancer of other organs: 1 rhinopharyngeal carcinoma, 1 gastric cancer, 1 Waldenstrom's disease, 1 non-Hodgkin's lymphoma, 2 breast cancer. RCC was clinically silent in all patients. The diagnostic problems related to a report of a renal mass in patients with neoplastic disease at other sites and the consequent therapeutic implications are discussed.
Sucralfate Prophylaxis of Fluorouracil-Induced Stomatitis
Authors: Giorgi Francesca , Bascioni Romeo , De Signoribus Giorgio , Di Saverio Franco
Published: April 2018

Aims and Background

Various attempts have been made to prevent 5-fluorouracil-induced stomatitis, with unsatisfactory results. Sucralfate is an aluminum hydroxide, complex of sulfated sucrose commonly used in the treatment of gastroduodenal ulcers. We used the compound in a phase II study to reduce and minimize the stomatotoxicity of 5-fluorouracil chemotherapy administered in a multiple-day schedule.

Methods

Fifty-two patients entered the study, and 129 cycles of chemotherapy were evaluated. Seven patients refused sucralfate rinses for taste intolerance.

Results

A low level of stomatotoxicity was recorded: grade 2 stomatitis was observed after 14 cycles (10.8%) and grade 3 after 3 cycles (2.3%).

Conclusions

Sucralfate administration could have a role in the prevention of 5-fluorouracil-induced stomatitis.
Differential Diagnosis of Axillary Masses
Authors: de Andrade Jurandyr Moreira , Marana Heitor Ricardo Cosiski , Filho Joaquim Moraes Sarmento , Murta Eddie Fernando Candido , Velludo Maria Angeles Sanches Llorach , Bighetti Sergio
Published: April 2018

Axillary masses are uncommon alterations when detected as an isolated finding. We evaluated 31 patients with isolated axillary masses. Patients with alterations of the breasts or the upper limbs or with ipsilateral chest lesions were excluded from the study. Nine patients had occult breast cancer, 5 of them in the contralateral breast. Seven had metastatic lymph nodes of non-ductal origin, and 1 had carcinoma of apocrine cells with metastasis to the axilla. Four patients had benign lymphadenopathy which disappeared spontaneously, and 4 others had ruptured infundibular follicular cyst, nodular fibromatosis, inflammatory tuberculous and inflammatory rheumatoid lymphadenitis. Five had an ectopic breast (2 with a fibroadenoma and 3 with fibrocystic changes). One patient had an axillary lipoma. The mean age of patients with malignant pathology was 55.1 ± 10.9 years, and the mean age of patients with a benign pathology was 43.1 ± 14.7 ( P <0.01). Chest X-ray and bilateral mammography are useful when the cause of the mass cannot be determined by taking a detailed history of neoplastic or infectious antecedents, by careful physical examination of the skin of the arms, trunk and neck, or by palpation of the breasts and thyroid. Fine needle aspiration biopsy distinguishes between benign and malignant pathologies. In cases of indeterminate neoplasia, complete axillary dissection for diagnosis is indicated.
Langerhans Cell Histiocytosis Mimicking Malignancy: A Radiological Appraisal
Authors: Potepan Paolo , Tesoro-Tess John David , Laffranchi Alberto , Danesini Gian Maria , Gianni Cristina , Uslenghi Elisabetta , Spagnoli Ivo
Published: April 2018

Aims

To analyze the radiologic characteristics, clinical course and long-term follow-up of 7 radiologically uncommon pediatric cases of Langerhans cell histiocytosis and to identify prognostic factors related to imaging patterns.

Methods

The clinical records and complete imaging data of 75 patients with LCH diagnosed and treated at the National Cancer Institute of Milan between January 1975 and December 1993 were analyzed, and 43 cases presenting as unifocal bone lesions were identified. The plain film, computed tomography and magnetic resonance characteristics enabled the identification of 7 radiologically aggressive and rapidly progressive cases, which were analyzed at presentation and during follow-up.

Results

Although at disease presentation bone lesions appeared lytic destructive, rapidly progressive and often involved adjacent soft tissues, after adequate therapy the disease course was invariably benign and led to almost complete restoration of normal structure and function. Long-term follow-up confirmed the favorable outcome and lack of disease recurrence in all cases.

Conclusions

There is no correlation between radiologically aggressive characteristics and final outcome in Langerhans cell histiocytosis. Radiologists and pediatric oncologists should be acquainted with less common radiologic forms which, at presentation, can mimic more ominous diseases. If recognized and adequately treated, monostotic forms almost invariably have a benign prognosis.
Chemoprevention Trial of Contralateral Breast Cancer with Fenretinide. Rationale, Design, Methodology, Organization, Data Management, Statistics and Accrual
Authors: De Palo Giuseppe , Camerini Tiziana , Marubini Ettore , Costa Alberto , Formelli Franca , Del Vecchio Marcella , Mariani Luigi , Miceli Rosalba , Mascotti Gustavo , Magni Andrea , Campa Tiziana , Di Mauro Maria Gaetana , Attili Angelo , Maltoni Cesare , Del Turco Marco Rosselli , Decensi Andrea , D'Aiuto Giuseppe , Veronesi Umberto
Published: April 2018

The Fenretinide (4-HPR) Breast Cancer Study is a randomized multicenter clinical trial originally designed and conducted by the investigators of the Istituto Nazionale Tumori of Milan. The study is sponsored by the National Cancer Institute of Bethesda and by the Italian National Research Council. The trial was designed to evaluate the effectiveness of the synthetic retinoid 4-HPR, at a dose of 200 mg per os every day for 5 years, in reducing the incidence of contralateral breast cancer in a population of patients previously operated on for breast cancer. Between 1987 and 1993, the Istituto Nazionale Tumori of Milan and 9 other collaborating Centers enrolled 2,972 women between the ages of 30 and 70 years who had been previously operated on for T1-T2 N- M0 breast cancer. This paper describes the rationale, design, methodology, organization, data management, statistics and accrual of the participating population.
Serum Lipid Profile and Its Relationship with Host Immunity in Carcinomas of the Breast and Uterine Cervix
Authors: Ray Amitabha , Sharma Bhuvnesh Kumar , Bahadur Anil Kumar , Pasha Syeed Tazeen , Bhadola Pushpa , Murthy Nandagudi Srinivas
Published: April 2018

Carcinomas of the uterine cervix and breast, which have a different etiopathogenesis, are the most common malignancies among Indian women. Between these two cancers a comparative study was undertaken in which serum lipids were assessed along with host immunity. Thirty randomly selected cases each of breast and cervical carcinoma, and 20 matched healthy control women were studied by means of standard procedures. Significantly higher (P < 0.001) mean levels of triglycerides (x = 192.1 mg/dl, SD ± 113.5) and total cholesterol (x = 212.9 mg/dl, SD ± 49.78) were observed in breast cancer as compared to controls or cervical cancer patients. Patients with cervical cancer had low mean values of all lipid fractions. Women with the above malignancies also showed a significantly decreased CD3+ and CD4+ population (P < 0.001), while there was a significant increase in CD8+ cells (P < 0.005) compared to normal controls. Interestingly, a significant relationship (P < 0.05) was observed between CD8+cells and LDL-cholesterol among the cancer patients (r = 0.3652 and r = 0.4298 for carcinomas of breast and cervix, respectively).
Follow-Up Protocols in Orthopedic Oncology
Authors: Donati Davide , Bini Stefano A. , Bacci Gaetano , Campanacci Mario
Published: April 2018

Little has been written about the specific timing and elements involved in the follow-up of orthopedic oncology patients1,2,7. The experience with bone tumor treatment at the First Clinic of the Istituto Rizzoli started 30 years ago and more than 15,000 patients have been treated to date. The increment of limb salvage surgery is linked with the improvements in imaging and surgical skills and with the availability of new reconstructive techniques. For this purpose it is mandatory to carry out meticulous monitoring of the patients. A large number of patients are still followed up to evaluate the results in terms of oncological and functional status. Based on this experience we developed a time schedule to better respond to the need for adequate patient evaluation.