bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Update on Palonosetron in the Management of Chemotherapy-Induced Nausea and Vomiting
Authors: Celio Luigi , Denaro Angela , Canova Stefania , Gevorgyan Arpine , Bajetta Emilio
Published: February 2018

The need to control chemotherapy-induced nausea and vomiting is continuously stimulating research to find better options for the optimal antiemetic care. Palonosetron is different from conventional serotonin receptor antagonists not only by the fact of having a longer half-life but also by higher binding affinity for serotonin receptors. It is the first agent in the class which is approved for preventing both delayed and acute emesis induced by moderately emetogenic chemotherapy. Recent studies using palonosetron-based antiemetic regimens, as well as in the clinical setting of multiple-day chemotherapy, have been reported. Palonosetron plus dexamethasone given as a pre-treatment infusion was effective for preventing acute and delayed emesis after moderately emetogenic chemotherapy. Palonosetron in combination with dexamethasone and aprepitant was highly effective in preventing emesis in the days following administration of moderately emetogenic chemotherapy. Treatment was well tolerated, with no unexpected adverse events. Multiple-day dosing of palonosetron plus dexamethasone was safe and effective for prevention of emesis induced by 5-day cisplatin-based chemotherapy. There was no evidence of cumulative toxicity when palonosetron was given three times over 5 days. Further evidence from ongoing clinical trials with palonosetron with or without dexamethasone will be available soon. Palonosetron represents an useful addition to the therapeutic armamentarium for the management of chemotherapy-induced nausea and vomiting. Further studies are needed to assess the effectiveness of palonosetronin combination with dexamethasone compared with that of older serotonin receptor antagonists combined with dexamethasone. However, palonosetron may offer advantages of convenience over the short-acting older antagonists due to its ability to be given as a single intravenous dose prior to chemotherapy.
Trastuzumab and Vinorelbine as Highly Effective and Safe Therapy for HER-2-Overexpressing Metastatic Breast Cancer. A Single Institution Experience
Authors: Di Lauro Vincenzo , Murrone Antonio , Bidoli Ettore , Magri Maria D , Crivellari Diana , Veronesi Andrea
Published: February 2018

Aims and Background

Trastuzumab-based therapy has improved survival of women with human epidermal growth factor receptor 2 (HER2)-overexpressing metastatic breast cancer.

Study Design

From September 2002 to July 2006, 45 women with metastatic breast cancer HER2 3+, or 2+ and positive for HER2 gene amplification, were enrolled in the study and received a combination therapy with vinorelbine, 25 mg/m2 weeks 1 and 2, plus trastuzumab, 4 mg/kg loading dose and then 2 mg/kg weekly, in a three weeks cycle. Eligibility criteria included measurable disease and a baseline ejection fraction ≥50%. Forty-two percent of the patients were not pretreated, whereas 58% had received a previous chemotherapy regimen for metastatic disease, including anthracy-clines and/or taxanes (47%), and trastuzumab plus taxol (11%).

Results

We observed 14 (31%) complete responses and 21 (47%) partial responses, with an overall response rate of 78%. Stable disease >6 months was assessed for 5 (11%) patients with a clinical benefit of 89%. Five (11%) patients progressed. With a median follow-up of 11 months, median time to progression was 9 months and median duration of response was 7.6 months for complete remissions and 4 months for partial remissions. Median survival was 29 months.

Conclusions

In spite of a smaller dose intensity of vinorelbine than previously reported, the regimen evaluated was notably effective in terms of response rate, time to progression and survival, with very mild toxicity.
Cellular Mechanisms of Hepatocyte Growth Factor-Mediated Urokinase Plasminogen Activator Secretion by MAPK Signaling in Hepatocellular Carcinoma
Authors: Lee Kyung Hee , Choi Eun Young , Hyun Myung Soo , Eun Jong Ryul , Jang Byung Ik , Kim Tae Nyeun , Lee Heon Ju , Lee Dong Shik , Yun Sung Su , Kim Hong Jīn , Kim Jung Hye , Kim Jae-Ryong
Published: February 2018

Aims and Background

The hepatocyte growth factor, its receptor c-Met, and urokinase-type plasminogen mediate various cellular responses on activation, including proliferation, survival, invasion, and metastasis. The regulatory mechanisms for the proliferation and the particular invasive phenotypes of hepatocellular carcinoma are not yet fully understood. In order to clarify the intracellular downstream signal for hepatocyte growth factor/c-Met signaling in tumor progression and metastasis in hepatoma, we determined the effects of a specific MEK1 inhibitor (PD 098059) and a p38 kinase inhibitor (SB 203580) on hepatocyte growth factor-mediated cell proliferation and urokinase-type plasminogen expression in hepatoma cell lines (HepG2 and Hep3B).

Results

Hepatocyte growth factor treatment induced the phosphorylation of ERK and p38 kinase in a dose-dependent manner, resulting in an early peak of phosphorylation at 3 to 10 min, which then rapidly decreased to a near basal level. Pretreatment with PD 098059 reduced hepatocyte growth factor-mediated cell proliferation and urokinase-type plasminogen secretion. In contrast, SB 203580 pretreatment enhanced cell proliferation and urokinase-type plasminogen secretion due to induction of ERK phosphorylation. Treatment with PD 098059 and SB 203580 resulted in a decrease in phospho-ERK activity. Stable expression of dominant negative-MEK1 in HepG2 cells showed a decrease in hepatocyte growth factor-mediated urokinase-type plasminogen secretion.

Conclusions

Such results suggest that interaction of an MEK/ERK and a p38 kinase might be critical in intrahepatic invasion and metastasis of human hepatoma cells.
NF2 Expression Levels of Gastrointestinal Stromal Tumors: A Quantitative Real-Time PCR Study
Authors: Taddei Antonio , Castiglione Francesca , Degl'Innocenti Duccio Rossi , Buccoliero Anna Maria , Garbini Francesca , Tommasi Cinzia , Freschi Giancarlo , Bechi Paolo , Messerini Luca , Taddei Gian Luigi
Published: February 2018

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract. Until today, there have been few markers specific for the tumor. This has complicated the differential diagnosis of the neoplasm from tumors of smooth muscle origin. Recently, the proto-oncogene c-kit has been shown to be a very relevant marker as it almost invariably is expressed in gastrointestinal stromal tumors. Radiation exposure, hormonal and genetic factors, particularly neurofibromatosis 2, have been implicated in their development and growth. GIST initiation, either in NF2-associated or in sporadic cases, is linked to inactivation of members of the proteins 4.1 superfamily. The majority of the mutations identified in the NF2 gene result in a truncated protein and are clinically associated with a severe phenotype. Occasionally, missense mutations associated with a mild phenotype may occur. We compared NF2 gene expression in 5 cases with gastrointestinal stromal tumors by quantitative real-time polymerase chain reaction analysis. NF2 gene mRNA expression was assessed in fresh tissue of stomach from 5 consecutive patients. We detected no alterations in NF2 gene expression in the quantitative analyses of the 5 tumors.
Psychological Assessment of Women on an Early Breast Screening Program after Radiotherapy to the Chest Wall for Childhood Cancer
Authors: Clerici Carlo Alfredo , Fossati-Bellani Franca , Lepera Paolo , Gennaro Massimiliano , Bergonzi Silvana , Meazza Cristina , Podda Marta , Gandola Lorenza , Veneroni Laura , Casanova Michela , Cefalo Graziella , Ferrari Andrea , Luksch Roberto , Massimino Maura , Polastri Daniela , Spreafico Filippo , Terenziani Monica
Published: February 2018

Aims and Background

This study investigates the psychological status in a population of female patients who received chest irradiation for a childhood cancer and were screened for second primary breast cancer.

Methods

Sixty-eight consecutive such young women were included. Compilation of the Crown-Crisp Index questionnaire was requested and 49/68 patients accepted to fill it in; 14 women in the sample had children (28%).

Results

Twenty-seven of 49 patients achieved a normal score, whereas in 22 the score was slightly above the normal range in at least one scale. Pathological scores were more frequent among the women without children.

Conclusions

Quality of life in this series of long-term survivors does not seem to be severely affected by previous treatment for cancer nor by the concern for the onset of a second primary malignancy.
Primary Infiltrating Ductal Carcinoma Arising in Aberrant Breast Tissue of the Axilla: A Rare Entity. Report of a Case
Authors: Teke Zafer , Kabay Burhan , Akbulut Metin , Erdem Ergun
Published: February 2018

A 52-year-old woman presented with a palpable nodule in the right axilla. Physical examination revealed a 2.5 × 2.5 cm, nontender, firm, brownish, and peripherally hyperemic mass with overlying skin retraction on the right anterior axillary fold. Bilateral mammogram was negative. Ultrasonography of the right axillary region showed a 1.8 × 1.1 cm, poorly defined hypoechoic mass with irregular margins and posterior acoustic shadowing. Fine-needle aspiration biopsy of the mass revealed malignant epithelial cells. The patient underwent a wide local excision of the right axillary lesion with en bloc axillary lymph node dissection. Histopathological examination revealed an infiltrating ductal carcinoma. Here we report this case of carcinoma originating from aberrant breast tissue in the axilla. It is suggested that subcutaneous lesions of uncertain origin around the periphery of the breast should be suspected for breast carcinoma and treated appropriately.
Multiple Bowel Stenosis and Perforation as Long-Term Complications of Chemoradiotherapy for Advanced Cervical Cancer in a Young Woman: Case Report
Authors: Bifulco Giuseppe , Mandato Vincenzo Dario , Piccoli Roberto , Bucci Luigi , Giampaolino Pierluigi , Nappi Carmine
Published: February 2018

Background

Although combined treatment (chemoradiotherapy) appears to improve the overall and progression-free survival of patients wih locally advanced cervical cancer, some acute toxicity is increased (hematological toxicity, nausea, vomiting) while the long-term side effects are unclear.

Case

A35-year-old Caucasian woman with a diagnosis of advanced cervical cancer (FIGO stage IIIB) was treated with neoadjuvant chemoradiotherapy not followed by radical surgery. She underwent whole pelvic radiation therapy for a total of 40 Gy in fractions of 2.5 Gy given 4 times per week for 4 consecutive weeks followed by 2 sessions of intracavitary brachytherapy starting within 7 days of completion of external beam radiotherapy (3500 mg/h and 2500–3000 mg/h). Cis-DDP IV was administered at a dose of 25 mg/m2 on day 1 and then weekly until completion of the radiotherapeutic protocol. After several months the patient presented persistent gastrointestinal symptoms and an X-ray showed findings consistent with bowel occlusion. The patient underwent emergency surgery and multiple bowel stenosis with perforation was diagnosed.

Discussion

This is the first report in which neoadjuvant chemoradiotherapy is associated with the late complication of multiple stenosis and bowel perforation in a young woman with advanced cervical cancer. Considering that despite the large number of studies about noncisplatin agents there is not enough evidence to justify treatment with alternative agents, this case report might provide new important data regarding the late morbidity of cisplatin-based concurrent chemoradiation.
Congenital Tumors of the Retrorectal Space in the Adult: Report of Two Cases and Review of the Literature
Authors: Coco Claudio , Manno Alberto , Mattana Claudio , Verbo Alessandro , Sermoneta Daniel , Franceschini Gianluca , De Gaetano Annamaria , Larocca Luigi Maria , Petito Luigi , Pedretti Giorgio , Rizzo Gianluca , Lodoli Claudio , D'Ugo Domenico
Published: February 2018

Aims and Background

To describe and discuss, on the basis of the authors’ experience and a review of the literature, the main aspects regarding the etiology, diagnosis, treatment and prognosis of congenital tumors of the retrorectal space.

Methods

We present 2 cases of congenital retrorectal tumors, a sacrococcygeal teratoma and a dermoid cyst, which represent, from the pathogenetic point of view, the most frequent presentation of the rare tumors of the retrorectal space.

Results

The reported cases are typical. The teratoma presented as an encapsulated, mixed mass located in the pelvic cavity behind the rectum and the vaginal canal, without signs of sacral involvement. The dermoid cyst appeared as a unilocular lesion filled with sebum and hair, which extended laterally to the iliopubic branch, medially to the urethra and anal canal, and posteriorly to the adipose tissue of the right buttock. Pelvic MRI produced a precise picture of the extension of the lesion and of the relationship between the mass and the pelvic organs and surrounding bony structures. Both lesions were completely removed via the perineal approach without coccygectomy. No recurrences were observed at 2 years of follow-up.

Conclusions

Congenital retrorectal tumors are rare. MRI is crucial for diagnosis and preoperative planning. Complete surgical removal is the treatment of choice. Resection of the coccyx is necessary only in case of its involvement by the neoplastic mass or suspected malignant transformation.
Paralytic Ileus Associated with Capecitabine
Authors: Laudadio Lucio , Biondi Edoardo , D'Ostilio Nicola , Cesta Alisia , Di Giandomenico Francesca , Forciniti Samantha , Nuzzo Antonio
Published: February 2018

Paralytic ileus is a temporary arrest of intestinal peristalsis. We report on two patients with breast cancer who developed paralytic ileus following treatment with capecitabine. The pathophysiology of this disorder and its possible connection to capecitabine are described with the aim of promoting the early recognition of the clinical picture so that unnecessary surgery can be avoided.
Smoking in Italy 2007, with a Focus on the Young
Authors: Ferketich Amy K , Gallus Silvano , Iacobelli Nicholas , Zuccaro Piergiorgio , Colombo Paolo , La Vecchia Carlo
Published: February 2018

Aims and Background

Although smoking has been on the decline in Italy, its prevalence is still high among younger individuals. We analyzed data from the 2007 tobacco survey and present the findings on smoking prevalence by selected characteristics, with a particular focus on the young.

Methods

The data were collected from 3,057 Italians aged 15 years and older in March and April 2007 who were randomly selected to be representative of the general Italian population. The prevalence of self-reported current smoking was estimated overall and by age group, education, geographic region, and gender. Additionally, intentions to quit and trends in smoking in the total population and among individuals aged 15–24 years were estimated.

Results

The smoking prevalence overall was 23.5% (27.9% among males and 19.3% among females), with higher estimates among adults living in central regions and among men with a lower educational level. Among individuals aged 15–24 years, since 2001 the male prevalence has fluctuated between 30% and 35% and the female prevalence between 20% and 25%. Overall, the prevalence decreased by approximately 40% in this age group. A small percentage (3.3%) reported having intention to quit smoking in the next 6 months.

Conclusions

The smoking prevalence is the lowest estimate reported since 1957, and the gap between men and women has diminished. Compared to earlier birth cohorts, the lower current estimate among younger adults suggests that the rates will decrease in the future.
Serum Cytokine in Response to Chemo-Radiotherapy for Hodgkin's Disease
Authors: Villani Fabrizio , Busia Alessandra , Villani Massimiliano , Vismara Chiara , Viviani Simonetta , Bonfante Valeria
Published: February 2018

Aims and Background

Mediastinal radiotherapy and multiple-drug chemotherapy, including bleomycin employed in the treatment of Hodgkin's disease, can produce lung toxicity leading to fibrosis. There is increasing evidence of the involvement in the fibrosing process of different cytokines and growth factors such as TNF-alfa, IL-1 beta, TGF-beta and PDGF.

Material and Methods

In a pilot study, we evaluated lung function in 20 patients suffering from Hodgkin's disease, mainly in stage II A, submitted to multiple-drug chemotherapy including bleomycin (ABVD) and mediastinal radiotherapy and correlated its modifications with serum concentration of the cytokines determined by immunoenzymatic assay. Spirometry and transfer lung function for carbon monoxide (DLCO) were performed before, at the end of chemotherapy, at the end of radiotherapy and after a follow-up of 6 and 12 months.

Results

DLCO decreased at the end of the combined treatment and then remained constantly decreased. TNF-alfa, TGF-beta and PDGF-alfa concentrations did not change, whereas IL-1 beta significantly increased after the completion of the combined treatment and after a follow-up of 6–months and then declined to normal values after 12 months. The serum concentration of the cytokine was significantly higher in patients who had a DLCO <75% of predicted after 1 year than in patients with a DLCO >75%.

Conclusions

The results indicate a potential role of IL-1 beta in the pathogenesis of chemoradiotherapy-induced lung toxicity, which needs to be confirmed in a larger patient population.
An Evaluation of Half-Body Irradiation in the Treatment of Widespread, Painful Metastatic Bone Disease
Authors: Miszczyk Leszek , Tukiendorf Andrzej , Gaborek Aleksandra , Wydmański Jerzy
Published: February 2018

Aims

Evaluation of analgesic uptake, pain intensity, and quality-of-life changes after half-body irradiation of patients with bone metastases.

Material and Methods

Ninety-five patients (97 irradiations) were treated with single half-body irradiation fraction (3–8 Gy). Thirty-three patients had upper-half-body irradiation, 55 lower-half-body irradiation and 9 middle-half-body irradiation. The patients were examined on the day of irradiation, 2 and 4 weeks later, and then once a month. The intake of analgesics, pain level (from 0 to 10), and the quality of life (EORTC QLQ-C30) were evaluated. The fluctuations of pain levels and the particular scaling values of QLQ-C30 during a one-year period were analyzed (Kendall t correlation).

Results

Over the course of 5 months, the incidence of patients using strong opioids decreased from 43.8% to 33.3%, and the incidence of patients who did not need to resort to analgesics increased from 6.7% to 25%. The mean pain level decreased from 6.1 points (half-body irradiation) to 3.1 points 2 weeks later. An inverse correlation between pain level readings and time was statistically significant. An increase was observed in the values of the five functional scales as reflected on the EORTC QLQ-C30 questionnaire (four of which correlated significantly with the observation time). A similar situation prevailed with respect to global health status. A decrease was observed in most of the values on the symptoms scales; 6 saw a significant decrease, in correlation with the follow-up. Correlations were also found between pain intensity and functionality, and between symptoms scales readings and global health status.

Conclusions

Half-body irradiation of cancer patients suffering from painful multiple bone dissemination is an effective and simple treatment modality that affords significant quality-of-life improvement and pain relief, thus allowing for a reduction in the use of strong analgesics.
Infantile Myofibromatosis in a Three-Year-Old Boy Presented as Subdural Hematoma
Authors: Güngör Sabiha , Çağlar Kudret , Akdur Dilaver , Orhan Diclehan
Published: February 2018

Infantile myofibromatosis, mostly developing at birth or in early infancy, is a rare clinical disorder characterized by myofibroblastic lesions. We report clinical, radiological and pathological features of a three-year-old boy who was diagnosed with infantile myofibromatosis originating from the occipital region contrary to radiological findings in advanced diagnostic studies.
Exposure to Benzene and Risk of Breast Cancer among Shoe Factory Workers in Italy
Authors: Costantini Adele Seniori , Gorini Giuseppe , Consonni Dario , Miligi Lucia , Giovannetti Lucia , Quinn Margaret
Published: February 2018

Aims and background

Evidence of the association between leukemia and benzene exposure has been provided by several epidemiological studies. An increased risk of breast cancer among women exposed to benzene has also been suggested. The aim of this study was to analyze breast cancer risk in a cohort of 1,002 women exposed to benzene in a shoe factory in Florence, Italy, where an excess of leukemia in men was reported.

Methods

The cohort of women at work on January 1st, 1950, was followed from 1950 to 2003 for mortality and from 1985 to 2000 for incidence of breast cancer. For a sub-cohort of 797 women, cumulative exposure to benzene was available.

Results

Standardized mortality ratios were obtained for the 797 women for whom information on cumulative exposure was available. For those with <30 years of latency the standardized mortality ratio was 58.5 (95% CI, 18.9–181.2, based on 3 deaths) and 151.1 (95% CI, 78.6–290.3, based on 9 deaths) for ≥30 years of latency. In the >40 ppm-year and ≥30 year latency period category, the standardized mortality ratio was 166.0 (95% CI, 62.3–442.2, based on 4 deaths). The standardized incidence ratio for women with a latency period <30 years was 140.9 (95% CI, 75.8–261.9, based on 10 cases) and 108.2 (95% CI, 64.1–182.7) for a latency period ≥30 years. For cumulative exposure >40 ppm-years and a latency period <30 years, the standardized incidence ratio was 211.9 (95% CI, 29.9–1504.1, based on 1 case).

Conclusions

The study moderately supports the hypothesis that benzene represents a risk factor for breast cancer.
Smoking Status and Gastric Cancer Risk: An Updated Meta-Analysis of Case-Control Studies Published in the past Ten Years
Authors: La Torre Giuseppe , Chiaradia Giacomina , Gianfagna Francesco , De Lauretis Angelo , Boccia Stefania , Mannocci Alice , Ricciardi Walter
Published: February 2018

Background

A meta-analysis of published studies was performed in order to clarify the risk of gastric cancer associated with cigarette smoking status.

Methods

Eligible studies were all the case-control studies investigating an association between smoking status and gastric cancer published from January 1, 1997, until June 30, 2006. In order to evaluate the quality of the published data, a qualitative scoring of papers was applied. The principal outcome measure was the odds ratio for the risk of gastric cancer associated with the smoking status using a random effects model. Cigarette smoking status was assessed in two ways: ever (current and ex) versus never smokers; current versus never smokers.

Results

We found a statistically significant result for the association between ever smoking status and gastric cancer risk (OR = 1.48; 95% CI, 1.28–1.71), considering 14,442 cases and 73,918 controls. Moreover, we found an odds ratio of 1.69 for current smoker status in comparison to never smokers (95% CI, 1.35–2.11). Considering only high quality studies, the odds ratio increased by 43% for gastric cancer risk in ever smokers (OR = 1.43; 95% CI, 1.24–1.66; Q = 378.60, P <0.00001; I2 = 90%) and by 57% in current smokers (OR = 1.57; 95% CI, 1.24–2.01). We also considered separately Caucasians and Asian studies, finding for ever smokers an odds ratio of 1.46 (95% CI, 1.25–1.70; Q = 125.68, P <0.00001; I2 = 82.5%) and of 1.47 (95% CI, 1.13–1.91; Q = 366.77, P <0.00001; I2 = 94%), respectively.

Conclusions

From the results of this quantitative meta-analysis, it appears that cigarette smoking has to be considered an important risk factor. The use of qualitative scoring decreases the magnitude of the relationship both for ever and current smoker exposure by 5–12%. Future studies on this topic need to clarify the biological interaction between environmental factors (such as cigarette smoking) and different polymorphisms on gastric cancer.
Colorectal Cancer after Breast Cancer: Magnitude of Risk in Clinical Practice and in the Literature
Authors: Khalil Said , Ceccarelli Francesca
Published: February 2018

Aims and background

The aim of our study was to estimate the incidence of second primary tumors among breast cancer patients from the Division of Oncology of Andosilla Hospital (Viterbo, Italy). In particular, we studied the relationship between breast and colorectal cancer.

Methods and Study Design

Eligible women were those with primary invasive breast cancer who had been treated and/or followed up at our division. We compared our data with those reported in the literature.

Results

Of 114 women with breast cancer, 21 (18.5%) developed multiple primary cancers, with colorectal cancer accounting for a quarter. We found a higher incidence of colorectal cancer than reported in the literature (5% vs 0.66–1%). At the moment we are not able to explain this difference.

Conclusions

Quite a few studies reported a link between breast and colorectal cancer, but the magnitude of the risk (standardized incidence ratio 1.3–2) does not justify a screening program for colorectal disease in breast cancer patients. However, considering that the risk is small but not negligible – along with the high incidence of colorectal adenomas described in breast cancer patients and the possible existence of common risk factors – we invite clinicians not to neglect the possibility of a colorectal cancer diagnosis in women who have had breast cancer.
Elderly cancer patients’ preferences regarding the disclosure of cancer diagnosis. Experience of a single institution in Italy
Authors: Cavanna Luigi , Di Nunzio Camilla , Seghini Pietro , Anselmi Elisa , Biasini Claudia , Artioli Fabrizio , Mordenti Patrizia
Published: February 2018

The disclosure of a diagnosis of cancer is complex, particularly in older patients for reasons related to the wishes of the family, fear of discouraging the patient, or the patient's inability to understand the information. So our insight into older people's perspectives regarding the disclosure of their cancer diagnosis is fragmentary and inadequate. To examine the views of older adults regarding this issue, we performed a prospective observational study in an inpatient oncology clinic. From January 2006 to June 2006, a sample of 132 consecutive cancer patients aged over 70 years with a variety of solid tumors, recently diagnosed and mainly at an advanced stage, agreed to take part in a survey about the disclosure of the diagnosis of their disease. Of the 132 patients who verbally agreed to participate and were given questionnaires, 106 returned data. The majority of patients (64.1%) in this study wanted to be informed about the diagnosis of their disease also if it was cancer, and 58.5% were in fact informed about the exact nature of their disease. Male patients were more keen to know the diagnosis than female patients (P = 0.002) and they were in fact more informed about their diagnosis than female patients (P = 0.005). Patients with more formal education were more informed than patients with less formal education (P = 0.035). This study demonstrates that the preferences of older patients regarding cancer diagnosis disclosure are highly similar to those of younger people. Male patients and patients with more formal education were more informed than female patients and patients with less formal education.
Primary Intraosseous Cavernous Hemangioma of the Metacarpal Bone: A Very Rare Entity. Case Report
Authors: Simonetti Sara , Mignogna Chiara , La Mantia Vittorio , Lanza Franco , Insabato Luigi
Published: February 2018

Intraosseous cavernomas are very rare benign lesions representing less than 1% of all skeletal tumors and most frequently observed in vertebrae and head and neck bones. Solitary hemangiomas of the hand bones are exceptionally rare. We report a case of this neoplasm in the distal epiphysis of the third metacarpal bone in a 68-year-old man, along with the clinicopathological findings. The differential diagnosis and a review of the literature are discussed.
Incidence of Invasive Cervical Cancer and Direct Costs Associated with its Management in Italy
Authors: Ricciardi Alessandro , Largeron Nathalie , Rossi Paolo Giorgi , Raffaele Mimma , Cohet Catherine , Federici Antonio , Palazzo Fabio
Published: February 2018

Aim and background

Cervical cancer is the second most common cancer in European women aged 15–44 years. The aim of this study was to estimate the direct cost of managing invasive cervical cancer in Italy.

Methods

Data from the Italian Network of Cancer Registries were used to estimate the annual number of new cervical cancer cases. To assess the management costs, a typical management pathway for each FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) cervical cancer stage was derived from published guidelines. Data from the Modena Cancer Registry were used to estimate the proportion of patients by FIGO stage. This algorithm was combined with tariffs for outpatient and inpatient procedures to obtain a mean cost for each FIGO stage.

Results

An estimated 2,927 new cases of cervical cancer occurred in Italy in 2005 (crude incidence 9.7/100,000; world age-standardized incidence 6.0/100,000). The estimated numbers of new cases by FIGO stage were: FIGO I, 1,927; FIGO II, 556; FIGO III, 259; and FIGO IV, 185. Costs for the most frequent procedures were estimated as: € 6,041 for radical hysterectomy or other surgery; € 4,901 for radio-chemotherapy; € 1,588 for brachytherapy; and € 3,795 for palliative chemotherapy. Mean management costs for incident cases (including 10 years of follow-up) were estimated at: FIGO I, € 6,024; FIGO II, € 10,572; FIGO III, € 11,367; FIGO IV, € 8707; and € 5,854 for the terminal phase (1 month). The total direct management cost was estimated at € 28.3 million per year.

Conclusions

This is one of the first studies to estimate the direct cost of treating patients newly diagnosed with invasive cervical cancer in Italy. Although according to current management pathways real treatment costs are likely to be underestimated, this information is necessary to design evidence-based vaccination policies able to harmonize primary and secondary prevention of cervical cancer.
Is Complete Axillary Dissection Necessary for all Patients with Positive Findings on Sentinel Lymph Node Biopsy? Validation of a Breast Cancer Nomogram for Predicting the Likelihood of a Non-Sentinel Lymph Node
Authors: Amanti Claudio , Lombardi Augusto , Maggi Stefano , Moscaroli Alessandra , Lo Russo Marzia , Maglio Riccardo , Provenza Giuseppe , Romano Camilla , Pezzatini Massimo , Scopinaro Francesco , Di Stefano Domenica
Published: February 2018

Aim and background

Axillary dissection in patients positive for sentinel lymph nodes is currently under discussion in the literature, since approximately only 50% of such patients has metastases in the remaining lymph nodes. To identify patients at risk for non-sentinel lymph nodes metastases, a nomogram was developed by the Breast Service of the Memorial Sloan-Kettering Cancer Center. The aim of this study was to assess the nomogram's predictive accuracy in a population of Italian breast cancer patients in our hospital.

Materials and methods

The system of calculation used as variables prognostic factors of breast cancer: pathologic size, tumor type and nuclear grade, lymphovascular invasion, multifocality, estrogen receptor status, method of detection of the sentinel lymph nodes metastases (frozen section, serial hematoxylin-eosin, routine hematoxylin-eosin, and immunohistochemistry), number of positive and number of negative sentinel lymph nodes.

Results and conclusions

To measure the discrimination of the nomogram, a receiver-operating characteristic curve was construed, and the area under the curve was calculated. However, the area under the curve was 0.72, a very high value considering that the limit of acceptability is 0.70–0.80. The calculation system developed by the Memorial Sloan-Kettering Cancer Center provides a predictive value on the histopathologic state of sentinel lymph nodes.
Spontaneous Rupture of Giant Gastric GIST Presenting as Hemoperitoneum and Mimicking Cavernous Liver Angioma
Authors: Fiscon Valentino , Portale Giuseppe , Isoardi Roberto , Frigo Flavio , Migliorini Giovanni
Published: February 2018

Spontaneous rupture of gastrointestinal stromal tumor (GIST) with hemoperitoneum is an extremely rare clinical presentation of this mesenchymal tumor. We report the unusual case of a 68-year-old man who was admitted to the hospital with abdominal pain. While waiting for the results of his laboratory tests the patient became pale and tachycardic and his abdomen distended with generalized rebound tenderness. A CT scan suggested rupture of a cavernous angioma of the liver and the patient was brought to the operating room for an explorative laparoscopy, which revealed hemoperitoneum from a ruptured giant gastric GIST. After conversion to laparotomy, the tumor was excised: it was 11 × 10 × 5 cm in size, with massive necrosis and clotted blood inside. Immunohistochemical examination revealed reactivity to c-KIT and CD34, consistent with the diagnostic criteria for GIST, with low mitotic activity (<5/50 HPF). The postoperative course was uneventful, and the clinical and radiological follow-up at 6 months is negative for recurrence.
An Unusual Cause of a Parotid Mass in an Immunocompetent Host: Classic Kaposi's Sarcoma
Authors: Pagani Davide , Bellinvia Monica , Capaccio Pasquale , Scoppio Biancamaria , Brambilla Lucia , Pignataro Lorenzo
Published: February 2018

Kaposi's sarcoma (KS) is a virally driven vascular tumor that usually has a multifocal origin, with multiple vascular nodules in the skin and other organs, particularly the gastrointestinal tract. Four variants of KS have been described: HIV-related, African, iatrogenic and classic. Primary classic KS of the head and neck is rare in any case, but KS arising in intraparotid lymph nodes, especially with no cutaneous involvement, is exceptionally rare. We report the case of an immunocompetent 71-year-old man who presented with a three-month history of a slowly progressive swelling in the right parotid region. After parotidectomy and histopathological diagnosis of lymph node localization of KS, a thorough dermatological examination did not reveal any skin lesions, and chest and abdominal computed tomography scans, esophagogastroduodenoscopy, and fecal occult blood test were all negative for visceral and other lymph node localizations. We here discuss the peculiarity of the presentation, the differential diagnosis, and the management strategy of such a rare disease.
Efficacy of Pins and Diplomas as a Reward for Long-Term Smoking Cessation
Authors: Munarini Elena , De Marco Cinzia , Rossetti Edoardo , Invernizzi Giovanni , Ruprecht Ario A , Villani Fabrizio , Mazza Roberto , Boffi Roberto
Published: February 2018

Aims and background

Since 2004, the Antismoking Center of the National Cancer Institute of Milan has rewarded those who have been ex-smokers for longer than a year with a “former smoker” pin and a diploma. We investigated firstly whether these rewards contributed to maintain smoking withdrawal, secondly, which one of these was more appreciated and why, and thirdly, how they may have influenced the ex-smokers' perception of smoking and how this was reflected on those surrounding them (i.e., ex-smokers' personal and/or interpersonal areas).

Methods

A multiple-choice questionnaire was developed to investigate how much the rewards were appreciated and their effectiveness in maintaining smoking cessation. Moreover, smokers and non-smokers were asked about the impact of the pin. The questionnaire was completed on the phone by the last 100 ex-smokers who entered the pin and diploma program.

Results

All subjects appreciated the rewards, but only a few of them considered them as an aid to maintain long-term smoking cessation. Those who preferred the diploma stated that it represented a contribution to their self-esteem, an official recognition of being an ex-smoker, besides being something to show with pride to others. Those who preferred the pin principally stated it allowed them to be an example to other smokers. Most of the subjects reported that they wore the pin in several circumstances, raising interest and admiration.

Conclusions

Rewarding ex-smokers one year after smoking cessation with a small prize may be a useful practice to improve the doctor-patient relationship, which is vital to maintain smoking cessation, and to boost the awareness of the availability of aids to reach this objective.
Long-Term Outcome of Postoperative Irradiation in Patients with Newly Diagnosed WHO Grade III Anaplastic Gliomas
Authors: Nagy Monika , Schulz-Ertner Daniela , Bischof Marc , Welzel Thomas , Hof Holger , Debus Jürgen , Combs Stephanie E
Published: February 2018

Purpose

Patients with anaplastic gliomas have a more favorable overall survival than patients with glioblastomas. In most analyses, WHO grade III and IV tumors are not analyzed separately. The present analysis reports outcome after postoperative radiotherapy in patients with WHO grade III gliomas.

Patients and methods

Between January 1988 and January 2007, 127 patients with WHO grade III tumors were treated with radiotherapy; the histological classification was pure astrocytoma in 104 patients, oligoastrocytoma in 12 and pure oligodendroglioma in 11 patients. Median age was 48 years. After the primary diagnosis, a biopsy had been performed in 72 patients; subtotal and total resections were performed in 37 and 18 patients, respectively. In all patients radiotherapy was applied with a median dose of 60 Gy in conventional fractionation. The median follow-up time was 18 months.

Results

Median overall survival was 17 months. Overall survival was significantly influenced by the extent of surgery. Median overall survival was 32 months after complete resection, 36 months after subtotal resection, and 12 months after biopsy. Median overall survival was 7 months for patients with anaplastic astrocytomas, 44 months for patients with mixed tumors, and 47 months for those with pure oligodendrogliomas. Age significantly influenced overall survival. Median progression-free survival was 9 months; the extent of neurosurgical resection significantly influenced progression-free survival.

Conclusion

Patients with WHO grade III anaplastic astrocytomas, oligodendrogliomas and oligoastrocytomas show favorable overall survival after postoperative radiotherapy compared with glioblastoma patients and should therefore be analyzed separately. Radiochemotherapy might further improve outcome.
Genomic Markers for Ovarian Cancer at Chromosomes 1, 8 and 17 Revealed by Array CGH Analysis
Authors: Dimova Ivanka , Orsetti Beatrice , Negre Vincent , Rouge Carole , Ursule Liza , Lasorsa Laurence , Dimitrov Rumen , Doganov Nikolai , Toncheva Draga , Theillet Charlles
Published: February 2018

Aims and background

The literature data show that the most frequently affected chromosomes in ovarian carcinogenesis are 1, 8 and 17. In the present study we aimed to define more precisely at a high resolution the genomic imbalances of these chromosomes in ovarian cancer and to determine genomic markers separating tumors of different histological types and stages.

Methods

Array comparative genomic hybridization (CGH) with a resolution of ≈0.8 Mb was applied in 28 primary ovarian tumors. We identified regions of highly frequent gains or losses (affecting more than 40% of ovarian cancers) and determined sites showing alterations of elevated amplitude (amplifications or homozygous deletions). Doing this we also identified at least two adjacent changed clones.

Results

We determined anomalies strongly associated with the disease such as deletions at 8p21-23, 17p12-13, 1p35-36 or amplifications at 1q23, 17q12, 17q23.2, 8q13.2, 8q24. We defined more precisely the gains in 17q12–q24, finding as strong candidates for ovarian tumorigenesis the genes LASP1 (17q12), TGF11 (17q21.32), MUL (17q23.2), TBX2 (17q23.2), AXIN2 (17q24.3) and GRB2 (17q25.1). Of particular note was gain of 8q13.2, which occurred at a high frequency in ovarian cancer, especially in serous and late-stage tumors. We found that gains of 1q32-1q43, 8p11-p12, 8q11.23, 8q13.2, and 8q24.21-8q24.22 and losses of 1p36.21, 8p23.1-8p21.1 and 8q21.2 were associated with serous histology, whereas losses of 1q23 and 1q32-43 and gains of 17q11.2-12 and 17q25 were associated with mucinous histology. Gains of 1q23, 8q24, 17q23.2, 17q24.2 and losses of 1p35-36, 8p, 17p, and 17q were specific for late-stage ovarian cancers.

Conclusions

Our study has identified potential genomic markers of interest on chromosomes 1, 8 and 17 in ovarian cancer. Tumors showed a wide variety in the patterns of alteration, suggesting that alternative mechanisms of genomic instability may play a role in this tumor type.
Primary Hepatic Leiomyosarcoma in a Young Man after Hodgkin's Disease: Diagnostic Pitfalls and Therapeutic Challenge
Authors: Giuliante Felice , Sarno Gerardo , Ardito Francesco , Pierconti Francesco
Published: February 2018

Background

Primary leiomyosarcoma of the liver is a rare tumor whose development patterns are unsatisfactorily known.

Patient case

A 26-year-old male patient with a previous history of radiochemotherapy treatment for Hodgkin's lymphoma was referred to our unit with a histological and radiological diagnosis of primary hepatic leiomyosarcoma. Six months before referral, in a workup for hypertension, a CT scan of the abdomen had shown a 2.5-cm lesion in liver segment VII, which was interpreted as an angioma. Shortly before referral the lesion had grown to 7.8 cm, associated with two smaller lesions in segments VIII and III, and a diagnosis of hepatic leiomyosarcoma was made at biopsy. After referral he underwent a right hepatectomy with wedge resection of segment III. This was followed by rapid progression of the disease, in spite of transient stabilization under gemcitabine treatment. Octreotide was also administered after the detection of elevated chromogranin A in serum. The patient died 25 months after liver resection.

Conclusions

The challenges and peculiarities of this case are related to the rarity of the tumor, its accidental discovery without immediate suspicion of its nature, its very aggressive behavior that was only partly controlled by chemotherapy, and the unusual expression of a neuroendocrine phenotypic feature with high serum chromogranin A levels.
Docetaxel and Gemcitabine in the Treatment of Metastatic Breast Carcinoma: A Dose Finding Study
Authors: Leonardi Vita , Palmisano Valentina , Pepe Alessio , Usset Antonella , Manuguerra Giovanna , Savio Giuseppina , Laudani Agata , De Bella Manuela Tamburo , Alù Massimo , Calabria Caterina , Carruba Giuseppe , Agostara Biagio
Published: February 2018

Aims and background

Patients with metastatic breast cancer previously treated with anthracyclines for advanced disease are usually refractory to any further treatment with anthracyclines and have a poor prognosis. Therefore, new drugs or new combinations of drugs are needed. One approach has been to focus on the type of chemotherapy with low toxicity that preserves quality of life during treatment, such as weekly drug administration.

Study design

We designed a dose-finding study to determine the maximum tolerated dose of gemcitabine plus docetaxel, given on a weekly schedule in metastatic breast cancer previously treated with anthracyclines. Three escalating doses of gemcitabine (900, 1000 and 1100 mg/m2) on days 1 and 8 in combination with a fixed dose of docetaxel, 35 mg/m2 on days 1 and 8 were planned. Dose-limiting toxicity included grade >3 hematologic toxicity, grade >2 stomatitis, asthenia, diarrhea or organ-specific toxicity (except alopecia). Dose escalation was stopped if 1 out of 3 patients at any dose level experienced dose-limiting toxicity.

Results

Nine patients received a mean of 5.1 (range, 1–9) cycles. Gastrointestinal and leukopenia were the main dose-limiting toxicity. No patient experienced dose-limiting toxicity at dose level 1; at dose level 2, 2 out of 3 patients had dose-limiting toxicity and 3 additional patients treated at dose level 2 confirmed that the maximum tolerated dose had been reached.

Conclusions

The recommended gemcitabine dose in combination with docetaxel (35 mg/m2 for a phase II study) was established at 900 mg/m2.
Laparotomy with a Curative Intent in Patients with Suspected Locally Recurrent Gastric Cancer
Authors: Ozer Ilter , Bostanci E Birol , Ozogul Yusuf , Ulas Murat , Ercan Metin , Kece Can , Orug Taner , Atalay Fuat , Akoglu Musa
Published: February 2018

Aims and background

Most recurrent gastric tumors are unsuitable for further resection or palliative surgery. The aim of the present study was to evaluate the role of re-resection in patients with local-regional recurrences of gastric cancer.

Methods and study design

Between 1998 and 2007, 26 patients underwent laparotomy for local-regional gastric cancer recurrence. Length of time to recurrence, recurrence patterns, operative procedures, morbidity, mortality and survival after re-resection were evaluated.

Results

Re-resection was possible in 13 patients (50%). Among patients with resectable tumors, survival times were markedly longer, with 2 patients reaching 60 months of survival and 2 other patients reaching 48 and 28 months, respectively. Among patients with early recurrence, peritoneal carcinomatosis was more common. After re-resection, morbidity and mortality were seen, each in one patient.

Conclusions

Most of the re-resected recurrences were intraluminal. In patients with early recurrences of gastric cancer, peritoneal carcinomatosis was encountered most frequently. Re-resection was beneficial and long-term survival was achieved after re-resection.
Postoperative Accelerated Radiotherapy with Cytoprotection Followed by Three-Dimensional Conformal Boost in Patients with Early Endometrial/Cervical Cancer
Authors: Koukourakis Michael I , Tsoutsou Pelagia G , Abatzoglou Ioannis , Soulimioti Georgia , Sismanidou Kyriaki , Liberis Vassilios , Giatromanolaki Alexandra , Sivridis Efthimios , Galazios George
Published: February 2018

Aims and background

Adjuvant external beam radiotherapy is highly recommended for uterine carcinomas invading beyond the inner half of the myometrium or cervical stage IIa carcinomas. The addition of a booster intracavitary dose is widely used.

Methods

We assessed the feasibility and toxicity of a hypofractionated accelerated conformal radiotherapy scheme (2.7 Gy per fraction, for 14 consecutive fractions to the pelvis) supported with the cytoprotective agent amifostine (HypoARC). The amifostine dose was individualized (500–1000 mg daily subcutaneously). A booster dose of radiation was given to the vagina and stump using a 6-field 3D-conformal technique (3 × 4 Gy or 4 × 3 Gy) instead of intracavitary radiotherapy.

Results

Grade 2 diarrhea appeared in 9/25 (36%) and grade 1 cystitis in 7/25 (28%) cases. Analysis according to the amifostine dose level clearly showed reduced toxicity in patients receiving a daily dose of 750–1000 mg (P <0.009). Within a median follow-up of 31 months (range, 11–52), there was only one case with grade 2 colitis (the patient had received no amifostine). None of the patients treated has relapsed locally or to distant organs within a median of 31 months of follow-up.

Conclusions

It is concluded that HypoARC followed by 3D-conformal booster dose to the vagina is feasible and convenient for patients and for busy radiotherapy departments, as it reduces the overall time by 50%. When supported by high-dose daily amifostine, it has an impressively low rate of early and late radiation toxicity.