bluuebunny/crossref_metadata_2025 huggingface dataset:
Altered Fractionation Schedules in Radiotherapy of Head and Neck Cancer. A Review
Authors: Fallai Carlo , Olmi Patrizia
Published: April 2018

The authors review the main contributions of international literature to show the current status in clinical trials on unconventional fractionations of the dose in radiotherapy of head and neck cancers. Several clinical (but only a few randomized) trials have been conducted over the last 15 years using hyperfractionated (HF), accelerated (AF) or mixed (HF-AF) schedules. HF schedules have obtained promising results in terms of local control in comparison with conventional fractionation (CF) of the dose. Improvement in survival was also obtained by the random trials of Pinto and Sanchiz, whereas in EORTC trial no. 22791, the improvement in survival rate was only marginal. A significant increase in local control and, less frequently, in survival has been claimed in several studies using HF-AF. Such data still need to be confirmed by a random study, since EORTC trial 22811 showed superimposable results in comparison with CF. Selection of the most suitable cases for altered fractionation schemes is also being studied in ongoing trials of the EORTC (22851) and RTOG (90-03). As regards acute reactions during and after altered fractionation, they are more severe than after CF. Only pure HF with a dose intensity approximately comparable to CF seems to produce similar acute reactions. Several factors have been found to influence the severity of acute mucosal reactions: interfraction interval, overall treatment time, total dose, and field size. As regards late damage, genuine HF schemes seem to cause roughly equivalent late damage in comparison to CF, whereas high-dose intensity schedules have a higher rate of complications. Interfraction interval, overall treatment time, total dose, fraction size and field size can influence the risk of late sequelae. Before altered fractionations can be considered standard therapy, more data are needed, which should be provided by multicentric randomized trials, some of which are already in progress.
Accelerated Hyperfractionation of Radiotherapy for Rapidly Growing Inoperable Breast Cancer Unresponsive to Chemotherapy
Authors: Giannakakis Dimitrios , Koukourakis Michael , Sotiropoulou Anastasia , Zambatis Haralambos , Scarlatos John
Published: April 2018

Eleven patients with rapidly growing inoperable breast carcinoma were treated with a thrice-a-day fractionation of 1.2 Gy per fraction (5-h intervals, 15 fractions per week). Nine of them had been considered as non-responders to previous aggressive multidrug chemotherapy. A split of 2 weeks was inserted after 54 Gy, and radiation fields were then restricted to the clinical positive area up to a total tumor dose of 90 Gy. Nine of 11 patients completed their treatment, and 7 of them were considered as complete responders. Acute toxicity was surprisingly low (grade I-II). Four patients surviving 12-18 months after radiotherapy did not relapse and did not present any late complications. A favorably improved quality of life was obtained for all 9 patients.
A Case of Malignant Phyllodes Tumor with Muscular and Fatty Differentiations
Authors: Isimbaldi Giuseppe , Sironi Maria , Declich Paolo , Galli Carlo , Assi Agnese
Published: April 2018

A 50-year-old female underwent surgical removal of a mammary phyllodes tumor, whose peculiar histologic feature was the coexistence of areas of liposarcoma and leiomyosarcoma. The morphologic differential diagnosis is briefly discussed.
Biologic Relevance of Elevated Red Cell Adenosine Deaminase Activity in Myelodysplastic Syndromes and Paroxysmal Nocturnal Hemoglobinuria
Authors: Di Marco Pietro , Tinnirello Daniela , Tambone-Reyes Mario , Tedesco Laura , Luna Salvatore , Citarella Pietro
Published: April 2018

Red cell adenosine deaminase (ADA-RBC) activity in patients with myelodysplastic syndromes and paroxysmal nocturnal hemoglobinuria is significantly increased compared to that observed in normal controls. ADA-RBC activity is not related to fetal hemoglobin concentration, but it is significantly correlated with hemoglobin concentration at diagnosis and with the degree of morphologic dysplasia in the erythroid lineage. The results of our study suggest that the observed enzymatic abnormality may constitute a non-specific manifestation of the stem cell alteration that determines these disorders.
Kaposi's Sarcoma on a Lymphedematous Arm following Radical Mastectomy
Authors: Merimsky Ofer , Chaitchik Samario
Published: April 2018

Chronic lymphedema predisposes for local Immune incompetence, manifested by development of Stuart-Treves syndrome, Kaposi's sarcoma and fibroma-like lesions. A 91-year-old female with multiple cancers developed classic Kaposi's sarcoma on a chronically lymphedematous arm 26 years after radical mastectomy and irradiation of the involved axilla. The Kaposi lesion partially responded to electron beam irradiation.
Adrenal Gland Metastasis in Osteogenic Osteosarcoma. A Radiological Case Report
Authors: Potepan Paolo , Danesini Gian Maria , Spagnoli Ivo , Laffranchi Alberto , Giovannardi Giulia , Turrini Elisabeta , Guzzon Adalgiso
Published: April 2018

Adrenal gland metastases from osteogenic sarcoma are rare and an unusual pattern of relapse. The recognition of solitary metastases, particularly when located in uncommon sites is very important for subsequent treatment. The authors describe the radiological features of an adrenal metastases from osteogenic sarcoma.
Medical Oncology and Home Care in Italy
Authors: Terzoli Edmondo , Garufi Carlo , Ranuzzi Mario , Saso Umberto , Nisticò Cecilia
Published: April 2018

Aims and Background

Home care programs are designed to provide care for cancer patients in their homes. Aim of the study is to describe the activities of home care program, to examine the organization and efficiency of this type of care in Italy.

Methods

A questionnaire was sent to the regional representatives of the National Society of Medical Oncology and to the regional health departments.

Results

a) the home care program is uniformly distributed throughout the country; b) the number of personnel in the different centers varies greatly from one area to another; c) approximately 50 % of the centers do not cover emergency situations (at night or on holidays); and d) there is little involvement of the public sector.

Conclusions

In spite of these problems, the home care system is taking on a fundamental role, especially for advanced cancer patients.
A Phase II Study of Combination Chemotherapy in Advanced Ovarian Carcinoma with Cisplatin and Cyclophosphamide plus Reduced Glutathione as Potential Protective Agent against Cisplatin Toxicity
Authors: Locatelli Maria Cristina , D'Antona Adelaide , Labianca Roberto , Vinci Maria , Tedeschi Michele , Carcione Rosario , Corbo Antonello , Venturino Paola , Luporini Gino
Published: April 2018

Aims and Backgroud

The clinical use of cisplatin (CDDP)„ one of the most active agents in advanced ovarian cancer, is limited by nephrotoxicity and cumulative neurotoxicity. In preclinical studies, reduced glutathione (GSH) demonstrated a protective action against CDDP nephrotoxicity. We treated 20 patients with advanced ovarian carcinoma, with polichemotherapy containing CDDP + GSH, to assess the protective action of GSH against CDDP nephrotoxicity.

Methods

Between January 1988 and December 1989, 20 patients, with advanced ovarian carcinoma (St. III-IV-FIGO), not pretreated received CDDP: 45 mg/m2 i.v., on day 1-2, + cyclophosphamide (CPA): 900 mg/m2 i.v. on day 2 + GSH 2500 mg i.v. in normal saline 100 ml (in 15 min), before CDDP, every 21-28 days.

Results

A pathologic complete response rate (PCR) of 55 % (11/20) was observed (7/14 patients with bulky disease). Median survival was 26.5 months and 5 patients were still alive and disease free at 35 months. Toxicity was limited, without any case of nephrotoxicity.

Conclusions

On the basis of our previous experience with the same regimen without GSH, this study suggests that also in the clinical setting, GSH has no negative interference on CDDP activity and that GSH might improve the therapeutic index of CDDP. However, our data need to be confirmed by large randomized clinical studies.
Primary Carcinoma of the Fallopian Tube
Authors: Frigerio Luigi , Pirondini Alfredo , Pileri Massimo , Pifarotti Giorgio , Busci Luisa , Rabaiotti Emanuela , Ferrari Augusto
Published: April 2018

Background

Because of the rarity of fallopian tubecancer, clinical approaches have changed during the last 18 years.

Methods

Twenty-nine patients with fallopian tube cancer were treated at the Gynecologic Oncology Department of Milan University from 1970 to 1988. The mean patient age was 59 years. Parity, symptomatology and histology were considered. Distribution by stage was as follows: I, 11 (37 %); II, 10 (34 %); III, 8 (27%) according to the Dodson classification. Twenty patients (69 %) underwent surgery followed by pelvic irradiation. Adjuvant chemotherapy was performed in the treatment of 5 women with stage I disease, 6 with stage II, and all 8 with stage III.

Results

Five-year overall survival was 41.38 %: 47.6% at stages I and II, 25% at stage III. Radiotherapy has not been replaced by cisplatin-based multiagent chemotherapy. Optimal surgical debulking combined with accurate lymph node sampling are not followed by systematic use of repeat laparotomy.

Conclusions

The procedures described in this work improve the clinical assessment and patient survival, and make different series comparable.
Concurrent Carboplatin (CBDCA), Vindesine (VDS) and Radiotherapy in Stage III Non Small Cell Lung Cancer (NSCLC)
Authors: Tomirotti Maurizio , Gramegna Giovanni , Mantellini Paolo , Fossati Vittorio , Mezzetti Maurizio , Dimaiuta Mariastella , Scanni Alberto
Published: April 2018

Aims

Aim of the study was to test, in a cooperative and prospective trial, the effectiveness and feasibility of a chemo-radio-therapy program in stage III non small cell lung cancer (NSCLC).

Methods

The schedule consisted in carboplatin (CBDCA) 150 mg/m2/iv on days 1, 3, 5 and vindesine VDS 2.5 mg/m2/iv on days 1, 8, 15, 22 every 4 weeks for 2 cycles followed by radiotherapy 60 Gy with CBDCA 50 mg/m2 weekly as radioenhancer. The same schedule was proposed as neoadjuvant treatment in 10/47 patients (stage III A) and as exclusive treatment in 37/47 (stage III B) admitted patients.

Results

In the neoadjuvant subgroup partial remission was obtained in 5/10 patients, and 3 of them underwent surgery with consequent CR. In the stage III B subgroup, 2 complete remissions were obtained (survival 14 and 9+ months). Toxicity was mild.

Conclusions

Our results confirm the feasibility of the schedule in stage III NSCLC.
Polymorphic Epithelial Mucin (PEM) Epitopes in the Estimation of the Sequence of Neoplastic Changes in Colon Adenocarcinoma
Authors: Slesak Barbara , Harlozinska Antonina , Lapinska Jadwiga , Knapik Zbigniew
Published: April 2018

Aims

The relation between the expression of PEM epitopes and the sequence of neoplastic changes in individual patients with colon adenocarcinoma was investigated.

Methode

Immunohistochemical staining was performed using four monoclonal antibodies to PEM epitopes (139H2, 140C1, 115D8, 115F5) on tissue sections from frankly malignant lesions, adjacent mucosa, colonic mucosa taken 1 cm and 5 cm from the lesion and normal control mucosa.

Results

A clear correlation between PEM expression and the site of mucosa sampling was demonstrated. The expression of PEM molecules defined by all studied monoclonal antibodies was highest in colon adenocarcinoma, similar but slightly weaker in adjacent mucosa and colon mucosa taken 1 cm from the frankly malignant lesion, lowest in mucosa 5 cm from the lesion, and virtually absent in control normal colonic mucosa.

Conclusions

The immunological changes could be one of the first signs of a premalignant process and the estimation of PEM epitopes could show some cellular abnormalities not detectable by standard pathomorphological criteria.
Screening for Breast Cancer: Report of a Population-Based Experience in the City of Milan, Italy
Authors: Pravettoni Angelo , Cescon Sandra , Fioretti Cristina , Gandini Daniela , Moro Giacomina , Rizzato Rosanna , Rizzi Anna Maria , Verga Maurizio , Saibene Franco , Uslenghi Carlo Matteo
Published: April 2018

Aims and Background

Mammographic screening is recommended as a current health practice. The aim of the present study is to report the results of a new program which started in the city of Milan in 1989.

Methods

A total of 4882 women aged 50 to 61 years and resident in quarter no. 16 of Milan were invited by mail to attend the screening at the San Paolo Hospital based on two-view mammography and physical examination.

Results

A total of 2953 (603 %) women attended the first screening round, and 18 cancers were detected (1 Tis, 8 T1, 9 T2). The detection rate was 6.9 × 1000, and the prevalence/incidence ratio was around 3.5.

Conclusions

The study confirms the feasibility of breast cancer screening in an urban setting by using the existing general hospital facilities and should be considered as a possible model for other urban experiences.
Secondary Leukemia following Treatment for Hodgkin's Disease
Authors: Salvagno Luigi , Simonato Lorenzo , Sorarù Mariella , Bianco Antonio , Chiarion-Sileni Vanna , Aversa Savina Maria Luciana , Camporese Rina , Garofolin Patrizia , Fiorentino Mario
Published: April 2018

Aims and Background

Patients treated for Hodgkin's disease with chemotherapy or with the association of chemotherapy and radiotherapy have an increased risk of secondary leukemia. The aim of this study was to evaluate the leukemogenic risk due to these treatment modalities.

Methods

We performed a case-control study on a population of 1410 patients treated for Hodgkin's disease from 1970 to 1990 in our Institute. Among these patients, we identified 25 cases of secondary leukemia and 3 cases of myelodysplasia, all occurring more than one year after the diagnosis of Hodgkin's disease. Three cases occurred among the patients treated with radiotherapy alone. When we analyzed the risk in relation to the type of treatment (radiotherapy, chemotherapy, or both), the comparisons were relative to patients treated with radiotherapy alone.

Results

We found that chemotherapy alone is associated with a fivefold increased risk (odds ratio = 5.4) compared with radiotherapy alone. When both treatments are used, the risk is not further increased (odds ratio = 4.4). Patients receiving more than 6 courses of chemotherapy have an excess risk (relative risk = 2.5) compared with those treated with 6 courses or less. No increased risk was observed after splenectomy.

Conclusions

This study confirms an increased incidence of secondary leukemia occurring in patients treated for Hodgkin's disease. The increased risk seems to be correlated with the number of courses of alkylating agent therapy, whereas it is unaffected by the addition of radiotherapy.
Fluorouracil plus Folinic Acid in Metastatic Adenocarcinoma of Unknown Primary Site Suggestive of a Gastrointestinal Primary
Authors: Nolè Franco , Colleoni Marco , Buzzoni Roberto , Bajetta Emilio
Published: April 2018

Aims and Background

The results of treatment strategies for carcinoma of an unknown primary location have been discouraging. Currently, no chemotherapeutic approach can be considered standard.

Methods

We therefore initiated a Phase II study in which fluorouracil (370 mg/m2, day 1 through 5) plus folinic acid (200 mg/m2 day 1 through 5) was administered in a subset of 17 patients (median age, 57 years) affected by histologically diagnosed adenocarcinoma of unknown primary location characterized by liver metastases and elevated CEA of CA 19.9. All of the patients had a performance status of 0-2 (ECOG Scale), and liver involvement was > 30 % in 7 cases.

Results

No objective response was observed (4 cases of stabilization and 13 of disease progression). Median survival was 5 months. Toxicity was mild or moderate, and severe diarrhea was observed in only one case.

Conclusions

The proposed regimen is inactive among this subset of patients and confirms that subdiaphragmatic metastases are related to a poor prognosis. Our results, in agreement with data published in the literature, suggest that patients affected by adenocarcinoma of an unknown primary origin metastatic to the liver and with a good performance status should be treated in an investigative setting.
Antiemetic Activity of Oral Lorazepam in Addition to Methylprednisolone and Metoclopramide in the Prophylactic Treatment of Vomiting Induced by Cisplatin. A Double-Blind, Placebo-Controlled Study with Crossover Design
Authors: Clerico Mario , Bertetto Oscar , Morandini Maria Pia , Cardinali Claudia , Giaccone Giuseppe
Published: April 2018

Aims and Backgorund

It has been suggested that lorazepam has a definite role as an antiemetic drug in antiemetic cocktails. In this study we examined the antiemetic efficacy of metoclopramide (200 mg) and methylprednisolone (1000 mg) with or without lorazepam.

Methods

Sixty patients treated with cisplatin-containing regimens were entered into a randomized, double-blind study with cross-over. Lorazepam 2.5 mg or placebo were administered orally the evening before therapy and just after the beginning of fluid infusion for chemotherapy. Degree of nausea and number of vomiting episodes, together with somnolence, were recorded on a data flow sheet and visual-analogue scales.

Results

100 cycles (50 patients) are evaluable. In 39 cycles there was no nausea and vomiting, in 74 cycles acceptable control of emesis was reached (0-2 episodes of vomiting), without significant differences among the two arms. However, nausea was shorter in lorazepam arm (p < 0.01), and 80 % of the patients preferred treatment with lorazepam (p < 0.003). Anxiety was reduced in the patients treated with lorazepam (p < 0.4).

Conclusions

Lorazepam improves tolerability to cisplatin-containing chemotherapy, mainly by influencing the psychological status of the patient and favoring the amnestic process.
Oat-Cell Carcinoma of Primary Location in the Pericardium. A Case Report
Authors: Cruz Juan J. , Abad Mar , Fonseca Emilio , Gómez Amalia , Sánchez Pedro , Paz José I. , Martín Germán , Martín Cándido
Published: April 2018

A case of oat-cell carcinoma arising in the pericardium of a 51-year-old woman is described. The patient had multiple nodes; the largest was 2 × 1 cm. Two years later the patient presented with a tumor on her lower gum; this measured 2 mm and had similar characteristics to the previous one. The immunohistochemical study showed strong positivity for neuron-specific enolase. From review of the literature, it may be concluded that this is the first report of oat-cell carcinoma occurring in the pericardium.
Epididymal Lymphoma. A Case Report
Authors: Ginaldi Lia , De Pasquale Andrea , De Martinis Massimo , Calvisi Giuseppe , Coletti Gino , Ventura Terenzio , Quaglino Dennis
Published: April 2018

Primary epididymal lymphoma is an unusual observation. Only 2 cases of non-Hodgkin's lymphoma of the epididymis have been previously reported. We describe the clinical and pathologic features and management of a primary high-grade malignant lymphoma of the epididymis in which a tentative diagnosis of lymphoma was made on the basis of cytologic examination and immunochemical staining of the material obtained from an aspiration needle biopsy.
Prevention of Exposure of Young Children to Parental Tobacco Smoke: Effectiveness of an Educational Program
Authors: Vineis Paolo , Ronco Guglielmo , Ciccone Giovannino , Vernero Elena , Troia Bruno , D'Incalci Tina , Gogliani Franco
Published: April 2018

Aims and Background

We conducted a population-based trial to evaluate the efficacy of an intervention aimed at preventing exposure of young children to parental tobacco smoke.

Methods

Of the 1142 eligible couples (parents of newborn babies), 1015 were recruited; the intervention was offered to 402 and not to 613 families.

Results

A strong association was found between social class and smoking behavior, in particular smoking during meals at home. The intervention itself had limited effectiveness In decreasing the number of smokers. The effect was stronger in mothers and in higher social groups. Among the «white-collar» families belonging to the intervention group, the proportion of mothers who stopped smoking was 3 times higher than in the control group (not statistically significant).

Conclusions

Educational interventions against smoking should be planned taking into account the difference in efficacy according to social class.
Subcutaneous Low-Dose Interleukin-2 plus Alpha Interferon in Advanced Malignant Melanoma
Authors: de Braud Filippo , Biganzoli Laura , Bajetta Emilio , Colleoni Marco , Zampino M. Giulia
Published: April 2018

Aims and Background

Interferon (IFN) and interleukin-2 (IL-2) have been proven to be active agents in the treatment of malignant melanoma, but the most effective doses of these cytokines were often associated to important side effects and poor patient compliance. Recently, the subcutaneous administration of low-dose IL-2 was found to be a well-tolerated and effective treatment for renal cancer. Since the combination of low doses of IL-2 and IFN has been hypothesized to have synergistic biologic and cytotoxic effects, we evaluated feasibility and patient compliance of a scheme that combined recombinant IFN-alpha (rIFN-α) (3 million units by intramuscular injection, 3 times a week) plus low-dose IL-2 (9 million IU, 3 to 5 times a week) administered subcutaneously for 2 weeks every 28 days.

Results

Fifteen patients with disseminated malignant melanoma previously treated with chemotherapy entered the study. All but the first 2 self-administered the therapy at home and were followed in an out-patient setting. None of them required in-patient care for toxicity. No WHO grade 4 side effects were detected; the only grade 3 side effects were fever and asthenia in 5 % of the cycles. Mild hematologic toxicity (grade 2) was observed at the highest weekly dose of IL-2. No major responses were observed in this subset of heavily pretreated patients.

Conclusions

We conclude that the regimen studied is feasible and well tolerated in an out-patient setting, but it is unlikely to be effective. The good patient compliance makes this schedule eligible to evaluate whether IL-2 plus rIFN-α can enhance the results of chemotherapy in this disease.
Genetic Events Responsible for Colorectal Tumorigenesis: Achievements and Challenges
Authors: Kopnin Boris
Published: April 2018

Colorectal carcinogenesis is a multistep process that is accompanied by accumulation of changes in proto-oncogenes and tumor-suppressor genes. APC/MCC, RAS, DCC, p53 mutations and/or allelic losses, hyperexpression of c-MYC and RB genes, as well as other genomic alterations appear at characteristic stages of tumor development and are observed in most neoplasms. However, consideration of each of these abnormalities leaves many unanswered questions. The striking data on recurrent amplification of the RB tumor-suppressor gene as well as suppressive activities of protein kinase C and activated RAS genes, at least in some colon carcinoma cell lines, suggest the unusual effects of some signalling pathways in colonic epithelial cells. The results obtained to date indicate that distinct sets of genetic changes may underlie the development of colorectal tumors.
Chemotherapy with Mitomycin C and Vinblastine in Pretreated Metastatic Breast Cancer
Authors: Perrone Francesco , De Placido Sabino , Carlomagno Chiara , Nuzzo Francesco , Ruggiero Angela , De Laurentiis Michelino , Gridelli Cesare , Pagliarulo Clorindo , Bianco Angelo Raffaele
Published: April 2018

Aims

In February 1986 we began a study to test the activity of mitomycin C (12 mg/m2) plus vinblastine (6 mg/m2) on day 1 of a 28-day cycle (MV) as second or third-line chemotherapy for metastatic breast cancer patients.

Methods

As of February 1988 the study was stopped after 26 patients had been enrolled. The median age of the patients was 54 years (range 35-78); all patients were progressive from chemotherapy; 15 (57.7 %) patients were treated as second and 11 (42.3 %) as third line; 19 (73.1 %) patients had received anthracyclines as first (13 patients) or second-line (6 patients) chemotherapy; 18 (69.2 %) patients had visceral Involvement; 7 (26.9 %) had one metastatic site, 11 (42.3 %) two sites, 6 (23.1 %) three sites and 2 (7.7 %) four sites.

Results

Overall, 86 cycles were administered, with a median number of 3 cycles per patient. Toxicity was mild; hematologic side effects required discontinuation of treatment in 3 cases. Vomiting occurred in 3 (11.5 %) patients, nausea in 5 (19.2 %). Moderate neurologic toxicity was recorded in 6 (23 %) patients. No complete and 3 partial responses were observed. The objective response rate was 11.5 % (exact 95 % confidence interval, 2.4-30.1). Responses occurred independently of disease-free interval, dominant metastatic site, response to previous chemotherapy, previous anthracycline and line of treatment; all responses were recorded in patients under 50 years of age. Kaplan-Meier estimated median time to progression and overall survival were 13 and 40 weeks, respectively.

Conclusion

The MV regimen was well tolerated but showed little activity in pretreated metastatic breast cancer.
Evaluation of the Esthetic Results of Conservative Treatment of Breast Cancer
Authors: Moro Gregorio , Ciambellotti Emanuele
Published: April 2018

Aims and backgrounds

This paper describes the evaluation of a personal series of 106 breast cancer patients, aged 28-75 years (average, 54), treated between 1988 and 1971, to determine the success of a conservative protocol proposed as a means of combining radicality with a better cosmetic result, less alteration of the body image and an improved quality of life.

Methods

All the patients were operated with quadrantectomy and excision of axillary lymph nodes, followed by radiotherapy: 50 Gy to the whole breast plus 10 Gy on the tumor bed (boost irradiation). Adjuvant hormone and/or chemotherapy was also administered in 71/106 cases. The mean follow-up was 22.3 months. Cosmetic assessment was subjective and objective (asymmetry, loss of volume, retraction). All patients were photographed.

Results

The subjective judgements were: excellent 79, satisfactory 25, and poor 2, compared with objective assessments of 72, 20 and 14, respectively. Patients with poor esthetic results were almost all either T2 or treated with chemotherapy.

Conclusions

Conservative treatment of breast cancer using integrated irradiation and surgery can therefore attain the required objective of eradication of the cancer while maintaining a satisfactory esthetic and therefore good psychologic outcome.
Hyperthermic Potentiation of Cisplatin Cytotoxicity on Solid Ehrlich Carcinoma
Authors: Osman Abd El-Moneim Mahmoud , Ahmed Mohamed Mohamed Sayed , Khayyal Mohamed Taky El-Din , El-Merzabani Mahmoud Mohamed
Published: April 2018

Background

Hyperthermia produces marked effects on many biochemical parameters of tumor cells and has been reported to potentiate the effect of many drugs. We therefore evaluated the possible synergistic effect between hyperthermia and cisplatin against solid Ehrlich carcinoma. The study was based on the measurement of some biologic characteristics in tumor tissues, namely: DNA, RNA, and protein content and their rate of synthesis as parameters for nuclear damage; total lipids and cholesterol as parameters for membrane damage; acid-phosphatase and acid-ribonuclease as parameters for lysosomal damage; and tumor volume as a direct parameter for tumor growth.

Methods

Treatment of solid Ehrlich carcinoma by hyperthermia at 43 °C for 30 min for 3 successive days produced a 41.5 % decrease in tumor volume, as well as a significant decrease in nucleic acids, protein contents and their rate of synthesis, in total lipids and cholesterol, and in acid-phosphatase and acid-ribonuclease. Chemotherapeutic management of the tumor by 5 mg/kg × 3 of cisplatin alone showed a continuous increase in tumor volume but at a lower rate than that of the untreated control. However, when cisplatin was given 1 h prior to hyperthermia, the tumor volume was significantly decreased by 82.6 %.

Results

The effects observed on all the investigated parameters were intensified when cisplatin was combined with hyperthermia. The results obtained suggest that hyperthermia may enhance the penetration of cisplatin to its target site inside the tumor cells due to a membrane-damaging effect. The enhanced lethality of cisplatin on tumor cells may also be due to the inhibition of DNA repair processes by hyperthermia.
Unusual Breast Edema and Erythema during Radiotherapy in the Conservative Approach of Breast Cancer. A Case Report
Authors: Rovirosa-Casino Angeles , Biete Albert , Velasco Martin , Moreno Fernando
Published: April 2018

The appearance of breast edema in the conservative approach of breast cancer is correlated with axillary dissection, and it is worsened by radiotherapy. In rare cases there are serious edema and erythema of the breast at the beginning of radiotherapy. We present a patient with edema and erythema of the breast with an unusual evolution after conservative surgical treatment of the breast cancer. Possible etiologies and published data are reviewed.
Extraskeletal Myxoid Chondrosarcoma. A Clinicopathologic and Immunohistochemical Study of two Cases
Authors: Elizalde Jesus M. , Ereño Cosme , Florencio Maria R. , Eizaguirre Beatriz , López José I.
Published: April 2018

Two extraskeletal myxoid chondrosarcomas arising on the left lower extremity of two women, aged 48 and 72 years, respectively, are reported. One case mimicked clinically an organized hematoma. By light microscopy, they showed a lobular architecture. Anastomosing cords of cells lying in a myxoid background were the histologic hallmark. Based on conventional criteria, they were classified as neoplasms of low (G1) and intermediate (G2) grade malignancy. Both cases were strongly positive for S-100 protein and vimentin. Follow-up confirmed the low aggressiveness of this entity.
Asbetos Exposure, Physical Activity and Colon Cancer: A Case-Control Study
Authors: Vineis Paolo , Ciccone Giovannino , Magnino Assunta
Published: April 2018

Aims and Background

An association between colon cancer and the occupation of model or pattern maker in the car industry has been repeatedly suggested. The aim of our study was to investigate colon cancer and occupational exposures (in particular in the car industry) in an industrialized area of northern Italy.

Methods

We conducted a hospital-based case-referent study on colon cancer (n = 131; hospital controls, n = 463). All subjects were interviewed, and jobs in the car industry were investigated. Occupational exposure to asbestos and the level of physical activity were blindly assessed. All the jobs were classified according to energy expenditure (less than 8, 8-12 and more than 12 kJ/min).

Results

We found no association between colon cancer and any job in the car industry. No subject had worked as a model or pattern maker. Sedentary work was associated with colon cancer in men but not in women. An excess risk was demonstrated among males for job titles involving putative exposure to asbestos (4 cases and 3 controls; OR = 4.8, 95 % c.i. 1.05-21.5), in particular pipe fitters and boilermakers (3 cases and 1 control; OR = 10.7; 1.07-103).
Cancer Incidence in Turin: The Effect of Migration
Authors: Rosso Stefano , Patriarca Silvia , Vicari Piera , Zanetti Roberto
Published: April 2018

Aims and Background

Studies on migrant populations have been of great value in clarifying the role of environmental factors in cancer occurrence. Most of them consider migrants from other countries or continents. Turin, the target territory of this study, was an important area of Internal migration initially from the East, and more recently from southern Italy.

Methods

The study compared incidence rates (age-standardized) of the native population, of the migrants and incidence rates of the Cancer Registries located in the four main areas of origin.

Results

Overall incidence rates in migrants from southern Italy were intermediate compared with those of the stable populations of the South and the North. The same effect was not true for people from the North-East, who migrated in earlier decades. In this population, migration towards lower-incidence areas did not reduce cancer incidence. Migrants from the South showed a significant increase in intestinal, breast, and tobacco-related tumors compared to the stable southern population. No effect of migration was found for cancer of the mouth, pharynx, esophagus, stomach or corpus uteri. Incidence of liver cancer in migrant southern males was significantly different from the stable and the native north-western population.

Conclusions

The results, based on incidence data, validated previous findings based on mortality data on the effect of Italian Internal migrations and showed that migrants underwent changes in some environmental exposures. In particular, migrants from the South to the North of Italy came into contact with new risk factors, with an increase in occurrence of cancer.
A Pilot Clinical Trial of Postoperative Adjuvant Intraperitoneal Cisplatin, 5-Fluorouracil, 6S-Leucovorin and Interferon Alpha 2b in Patients with Resected Gastric Cancer
Authors: Cascinu Stefano , Valentini Gabriele , Catalano Giuseppina
Published: April 2018

Aims and Background

The study was performed to assess the toxicity and impact on relapse pattern of postoperative intraperitoneal cisplatin, 5-fluorouracil, leucovorin and interferon therapy as adjuvant treatment for gastric cancer patients who are at high risk for recurrence after potentially curative resection (T2 N1-2; T3-4 N any Mo).

Patients and Methods

Starting 14 to 21 days after potentially curative resection of primary gastric cancers, 22 patients were given intraperitoneal cisplatin, 60 mg/m2; 5-fluorouracil, 1000 mg/m2; 6S-leucovorin, 250 mg/m2; interferon alpha 2b, 10 MU/m2; every other week for six times.

Results

After a median follow-up of 24 months, 63 % of patients were alive and free of disease. Eight patients had recurred; five had an intraabdominal component, and 3 had extraabdominal failure. Toxicity was mild: no grade III-IV WHO toxicity was observed.

Conclusions

Intraperitoneal cisplatin, 5-fluorouracil, 6S-leucovorin and interferon is a tolerable therapy in the postoperative setting for patients with resected gastric cancer. These data make this approach interesting for the development of new programs of adjuvant therapy of high-risk gastric cancer.
Plasma D-Dimer Measurement as a Marker of Gynecologic Tumors: Comparison with CA 125
Authors: Relia Carmela , Coviello Maria , De Frenza Nicola , Falco Gaetano , Chiuri Eufemia , Colavito Paolo , Quaranta Michele , De Leonardis Antonio
Published: April 2018

Background

Fibrin is formed and degraded Intra-abdominally in ovarian cancer, and the cross-linked fibrin degradation product, D-dimer (D-D), has been found in increased concentrations In the plasma of these patients.

Methods

D-dimer and Ca 125 levels were determined simultaneously in 110 patients with gynecologic neoplasms. D-dimer and Ca 125 assays were performed using the Dimertest Stripwell EIA Kit (Ortho) and CA 125-11 EIA assay (Roche), respectively.

Results

D-dimer plasma and Ca 125 serum levels were significantly higher in patients with ovarian cancer (mean ± SE = 894.2 ± 173.7 ng/ml and 760.5 ± 292.7 U/ml, respectively) than in those with uterine cancer (mean DD ± SE = 109.7 ± 23.5 ng/ml and mean Ca 125 ± SE = 50.0 ± 23.1 U/ml) or those with benign disease (mean D-D ± SE = 70.5 ± 5.5 ng/ml and mean Ca 125 ± SE = 6.6 ± 2.8 U/ml). The levels of both markers Increased with regard to ovarian cancer disease status. Mean D-D ± SE was 90.0 ± 22.8 ng/ml and mean Ca 125 ± SE was 2.1 ±1.2 U/ml in patients with complete remission; mean D-D ± SE was 143.3 ± 33.5 ng/ml and mean Ca 125 ± SE was 26.2 ± 13.6 U/ml in patients with partial remission. In active disease, both markers had very high levels: D-D mean ± SE = 1021.6 ± 173.0 ng/ml and Ca 125 mean ± SE = 1154.7 ± 458.1 U/ml. In all groups of ovarian cancer patients, D-dimer sensitivity was better than that of Ca 125. In advanced ovarian cancer patients, the D-dimer concentration in ascites was up to 100 fold that in plasma.

Conclusions

Our results suggest that D-dimer can serve as a sensitive indicator to monitor the extent and course of the disease in ovarian cancer patients. The patient follow-up is ongoing to establish the predictive value of D-dimer measurement with respect to prognosis.
Tamoxifen Failure in Medullary Thyroid Carcinoma
Authors: García-Pascual Luis , Millán Montserrat , Anglada Jordi , Garau Javier
Published: April 2018

We report the results of short-term tamoxifen treatment (20 mg two times a day orally) in 2 patients with metastatic medullary thyroid carcinoma. Patient A had a rapid tumor progression with development of Cushing's syndrome before initiation of tamoxifen treatment. Patient B had a slowly progressive course. In both cases, neither clinical nor biochemical improvement were observed, after 1 and 3 months of tamoxifen therapy, respectively.
Subcutaneous Therapy with Low-Dose Interleukin-2 plus the Neurohormone Melatonin in Metastatic Gastric Cancer Patients with Low Performance Status
Authors: Lissoni Paolo , Brivio Fernando , Ardizzoia Antonio , Tancini Gabriele , Barni Sandro
Published: April 2018

Aims and background

Patients with disseminated gastric cancer are generally in very bad clinical conditions, which make them not eligible for potentially active polychemotherapies. This justifies the development of less toxic therapies such as the use of biological response modifiers. Unfortunately, IL-2, one of the most promising cytokines, does not seem to be effective in gastric cancer. Our previous studies have shown that the pineal hormone melatonin (MLT) may amplify IL-2 activity, which becomes biologically effective also at very low doses. Based on these considerations, a pilot study was performed with low-dose subcutaneous IL-2 in combination with MLT in metastatic gastric cancer patients with low performance status.

Methods

The study included 14 patients with metastatic gastric cancer who received IL-2 at a dose of 3 million IU/day at 8.00 p.m. subcutaneously for 6 days/week for 4 weeks. MLT was given orally at a dose of 50 mg/day at 8.00 p.m. every day starting 7 days before IL-2. In patients in whom the disease did not progress, a second cycle was given after a rest period of 21 days.

Results

A tumor regression was obtained in 3/14 (21 %) patients, complete response in 1 and partial in 2, with a median duration of 13+ months. The disease stabilized in 6/14 (43 %) patients and progressed in the remaining 5 (36 %). Survival was significantly longer in patients with response or stable disease than in those with progression. Toxicity was low in all cases.

Conclusions

These preliminary results show that the combination on of low-dose subcutaneous IL-2 and the pineal hormone MLT may represent a new well tolerated biotherapy, capable of inducing objective tumor regression also in patients with metastatic gastric cancer and low performance status.
Ovarian Function Suppression with the Gonadotrophin-Releasing Hormone (GnRH) Analogue Goserelin in Premenopausal Advanced Breast Cancer
Authors: Bajetta Emilio , Celio Luigi , Zilembo Nicoletta , Bono Aldo , Galluzzo Domenico , Zampino Maria Giulia , Longhi Alessandra , Ferrari Leonardo , Buzzoni Roberto
Published: April 2018

Aims and background

Goserelin is a gonadotrophin-releasing hormone (GnRH) analogue that induces the suppression of gonadal steroidogenesis, and it could therefore be a medical alternative to irreversible surgical castration. We report the clinical and endocrine results from 40 goserelin-treated premenopausal patients with advanced breast cancer.

Methods

A depot formulation of the drug (3.6 mg s.c.) was administered fortnightly for the first 4 doses, and monthly thereafter. Gonadotrophins and estradiol (E2) levels were measured before and at specific times during the treatment.

Results

Objective responses were observed in 17 of the 38 evaluable patients (45%), six of whom achieved complete remission. The best responses were observed on soft tissues (65%). Castration E2 levels were achieved in all of the patients.

Conclusions

Our results confirm that goserelin is as effective as surgical oophorectomy in premenopausal advanced breast cancer.
Mitomycin «C» and Vinorelbine as Second Line Chemotherapy for Metastatic Breast Carcinoma
Authors: Agostara Biagio , Gebbia Vittorio , Testa Antonio , Cusimano Maria Pia , Gebbia Nicolò , Callari Angela Maria
Published: April 2018

Aims and background

Patients with metastatic breast carcinoma resistant to first line chemotherapy may require further treatment. Results o second line chemotherapy are still largerly unsatisfactory. For this reason a phase II study on the combination of mitomycin C and vinorelbine was carried out.

Methods

Forty patients with anthracycline pretreated metastatic breast cancer were treated with a combination of mitomycin C 10 mg/m2 i.v. on day 1, and vinorelbine 25 mg/m2 i.v. on days 1 and 8. This cycle was repeated every 28 days. Responses were evaluated according to the WHO criteria.

Results

A major objective response was recorded in 16 cases (40%; 95% confidence limits 32%-48%), with 2 patients (5%) obtaining a complete response with a median duration of 8.0+ months, and 14 (35%) a partial response with a median duration of 7.3+ months. Nine patients (23%) showed no change, and 15 progressed. Patients who did not meet the minimal required criteria to be evaluable were considered as treatment failures. Responses were seen at all sites of disease, but skin, nodal, and soft tissue lesion were more che-mosensitive than liver, lung, and bone ones. The mean survival of patients with complete and partial responses was 8.9+ months, whereas that of patients with no change or progressive disease was 7.8 and 6.0 months respectively. Treatment was very well tolerated by most patients. Gastrointestinal toxicity was mild. Grade 2 leukopenia was recorder in 45% of patients, and grade 3 leukopenia in only 10%. Grade 2 thrombocytopenia was seen in 5%. Reversible mild to moderate constipation occurred in 45%, but no case of severe neurotoxicity was observed.

Conclusions

Our data suggest that the combination of mitomycin C and vinorelbine is active in metastatic breast carcinoma refractory to first line chemotherapy containing anthracyclines, and may be safely administered on an outpatient basis.
High-Dose Interstitial Brachytherapy for Glioblastoma Multiforme
Authors: Micheletti Enrico , Baroncelli Giovanni , La Face Beniamino , Feroldi Piero , Galelli Marco , Giunta Filippo
Published: April 2018

Aims and background

The long-term prognosis for survival of patients with inoperable glioblastoma multiforme (GBL) is very poor. Conventional external radiotherapy gives only transitory result. This severe prognosis led us to elaborate a high-dose rate (HDR), after-remote-loading brachytherapy treatment protocol: our aim was both therapeutic and psychologic

Methods

Five patients with GBL (T1 G4 UICC) were treated with stereotactic biopsy followed by HDR brachytherapy. A unique coaxial after-loading catheter was stereotactically inserted through the center of the target volume. The treatment schedule considered 5 fractions, 5 Gy/fraction at the dose specification surface, 2 fractions per day.

Results

The treatment was well tolerated. Tumor progression started again at the 8th to the 16th week from the end of the treatment. ECOG performance status at the 8th week was better than before the therapy in 2 of 5 patients and was stable in 2 of 5 patients. Order neuroperformance status was stable in 2 patients at 8 weeks. At the 16th week there was neurologic deterioration. The average survival was 21 weeks.

Conclusions

Our approach seems to be of some interest for the pal-lation of GBL, and it offers some advantages, in particular regarding the short treatment period. Our procedure can be improved: a multicatheter implant and a more fractionated schedule could be taken into account.
Epidemiology and Etiopathology of Human T-Lymphotropic Viruses: Diagnostic and Clinical Implications for Non-Endemic Areas
Authors: Del Mistro Annarosa , Calabrò Maria Luisa , Favero Anna , Chieco-Bianchi Luigi
Published: April 2018

Human T-lymphotropic viruses (HTLV) type I and II were first described more than a decade ago. HTLV-I epidemiology and etiopathology are more defined than those of HTLV-II, but conflicting results have been obtained in seroepidemiologic surveys, mainly for difficulties in the discrimination between the two infections. The introduction of advanced serologic and molecular assays has recently provided sensitive and specific tools for diagnosis, and the epidemiologic and etiopathologic patterns linked to these retroviruses are being more precisely defined. Moreover, extensive nucleotide sequence analyses performed so far have mainly focused on HTLV-I isolates. The recent discovery of new HTLV-II endemic areas and the isolation of HTLV-II strains from intravenous drug users have finally provided the material for the molecular characterization of HTLV-II isolates, which is now a rapidly envolving field. We review the diagnostic strategies available and the etiologic associations reported so far for both viruses and also discuss the occurrence and significance of indeterminate serologic reactivities observed in both endemic and non-endemic areas.
Cancer Risk Related to Uncommon Migration within Italy
Authors: Conti Ettore M.S. , Ramazzotti Valerio , Romagnoli Laide , Tonini Giuseppe , Crespi Massimo
Published: April 2018

Aims and background

Given the industrialization in Italy over this past century much migration has occurred within the country especially from southern to northern regions. Following repeated drainings of the pre-existing marsh area (Pontina plain) during the 1930s the Latina province received an unusual north-south immigration from the regions of Veneto, Friuli and Emilia Romagna. This consisted principally of manual workers, farmers and their families. Four new towns developed after a few years (Littoria, later renamed Latina, Sabaudia, Pontinia and Aprilia), and the whole province quickly reached a population of 60,000. The availability of a population-based Cancer Registry in the Latina province allowed us to assess the cancer risk in this migrant population.

Methods

Standardized Incidence Ratios (SIRs) according to cancer site and sex were computed for residents over the age of 55 years, born in northern Italy. Population data, by sex, age and region of birth were based on the 1981 census. The age-sex-site specific incidence rates for the 1983-1987 period for the entire population of the Latina province over 55 years of age were used as standard.

Results

A significant excess of cancer risk for subjects of both sexes born in northern Italy was found. In addition, a statistically significant higher risk was observed for the cancers of the lung, skin (non-melanomas) and prostate in males, and of the mouth-pharynx, lung and skin (non-melanomas) in females.

Conclusions

SIRs for all sites confirm the findings from other studies on migrants in Italy and strongly support the hypothesis that the place of birth has an important influence on the frequency of cancer. Some possible etiological factors are suggested for cancer sites with higher frequencies in northern-born subjects.