bluuebunny/crossref_metadata_2025 huggingface dataset:
Capecitabine in Combination with Oxaliplatin as First-Line Therapy for Advanced Gastric Cancer: A Case Report
Authors: Mazzola Rosario , Alù Massimiliano , Leonardi Vita , Procopio Giuseppe , Agostara Biagio
Published: February 2018

Gastric cancer is one of the most common cancers worldwilde. The five-year survival for stage IV gastric cancer is around 5–10% in Western countries. Advanced gastric cancer is sensitive to numerous agents, but there is no generally accepted standard regimen. Here we report on a case of advanced gastric cancer occurring in a 72-year-old man who underwent treatment with capecitabine plus oxaliplatin, achieving a complete response. Free full text available at www.tumorionline.it
The INTER-ROMA Project - a Survey among Italian Radiation Oncologists on Their Approach to the Treatment of Bone Metastases
Authors:   AIRO (Italian Association of Radiation Oncology) and the AIRO Palliative Care Group, De Bari Berardino , Chiesa Silvia , Filippi Andrea Riccardo , Gambacorta Maria Antonietta , D'Emilio Valentina , Murino Paola , Livi Lorenzo
Published: February 2018

Aims and background

Radiotherapy has an established palliative role for bone metastases but despite the large number of patients treated there is still controversy surrounding the optimal radiotherapy schedule to prescribe. The aim of this survey was to determine the decision patterns of Italian radiation oncologists in four different clinical cases of patients with bone metastases.

Methods and study design

During the latest national meeting of the Italian Association of Radiation Oncology (AIRO), four clinical cases were presented to attending radiation oncologists. The cases were different with respect to the histology of the primary tumor, performance status, pain before and after analgesics, tumor site, and radiological characteristics of the metastatic lesions. For each clinical case the respondents were asked to give an indication for treatment; prescribe doses, volumes and treatment field arrangements; decide whether to prescribe prophylactic supportive therapy or not; and provide information about factors that particularly influenced prescription. Finally, a descriptive statistical analysis was performed.

Results

Three hundred questionnaires were distributed to radiation oncologists attending the congress. One hundred twenty-five questionnaires were returned but only 122 (40.6%) were adequately completed and considered for the analysis. Considerable differences were observed among radiation oncologists in prescribing and delivering radiotherapy for bone metastases. There was also a notable divergence from international guidelines, which will be discussed in this report.

Conclusions

Despite the results of clinical trials, Italian radiation oncologists differ considerably in their decisions on treatment doses and volumes. National guidelines are needed in order that patients can be treated uniformly and better data will become available for evidence-based palliative radiotherapy.
Current Role of 111In-DTPA-Octreotide Scintigraphy in Diagnosis of Thymic Masses
Authors: Guidoccio Federica , Grosso Mariano , Maccauro Marco , Orsini Federica , Perri Marzio , Boni Giuseppe , Banti Elena , Grassetto Gaia , Rubello Domenico , Mariani Giuliano , Volterrani Duccio
Published: February 2018

Aims and background

Thymic tumors (thymomas and thymic carcinomas) represent 50% of all mediastinal tumors. Thymomas usually express high levels of somatostatin receptors, which enable in vivo imaging with 111In-DTPA-octreotide (OctreoScan®). The aim of this study was to further investigate the role of radionuclide techniques in the diagnosis, staging and follow-up of these tumors.

Methods

Eight patients (5 women, 3 men, age range 35–79 years; mean ± SD 56.1 ± 15.8 years) entered the study. In 4 patients, myasthenia gravis was the presenting symptom. 111In-DTPA-octreotide scan was performed within 3 weeks after contrast enhanced CT and/or MRI. Planar and tomographic images were acquired within 24 hours of the injection of 111 MBq OctreoScan. The scintigraphic results were defined in correlation with the histological findings.

Results

Histology revealed thymoma in 3 patients, thymic carcinoma in 1, insular carcinoma of presumably thymic origin in 1, thymic carcinoid in 1, and thymic hyperplasia in 2 patients. Two thymomas were at stage I, 1 thymoma and 1 thymic carcinoma at stage II, 1 insular carcinoma of presumably thymic origin at stage IV, and 1 thymic carcinoid at stage IV. OctreoScan consistently accumulated in primary and/or metastatic sites of thymic tumors while no radiotracer uptake was detected in the 2 patients with benign thymic hyperplasia. In 1 patient with a very large mediastinal mass (13 cm in largest diameter) and multiple metastatic deposits in the lungs, OctreoScan scintigraphy showed a large area of pathological uptake in the anterior mediastinum and a small area of focal uptake in the cervical-dorsal region of the right lung corresponding to a lymph node expressing somatostatin receptors.

Conclusions

OctreoScan is avidly taken up by thymic tumors, enabling the diagnosis of these tumors and a better evaluation of their extension. It does not accumulate in thymic hyperplasia, thus allowing the differential diagnosis between these 2 pathological conditions. In patients affected by myasthenia gravis, OctreoScan scintigraphy can play an important role in characterizing thymic masses.
Primary Breast Lymphoma Clinically Mimicking Acute Mastitis: A Case Report
Authors: Sun Li-Min , Huang Eng-Yen , Meng Fan-Yun , Chang Nai-Jen , Chung Li-Min , Liang Ji-An , Lu Chiao-Yi
Published: February 2018

Extranodal non-Hodgkin lymphoma of the breast is a rare disease. We present a case of primary breast lymphoma with atypical clinical manifestations that looked like acute mastitis. A 46-year-old woman had noted a painful swelling in the right breast for 2 months. The mass had an inflammatory appearance and acute mastitis was the clinical impression. She underwent a core biopsy of the mass, and pathology showed inflammatory changes. The inflammatory mass regressed and recurred during hospitalization, and further incision with debridement was done. The histological findings were consistent with diffuse large B cell lymphoma. Systemic examination found stage IIE disease. She received chemotherapy and local radiation is planned.
Use of socio-economic factors and healthcare resources to estimate cancer survival in European countries with partial national cancer registration
Authors: Lillini Roberto , Vercelli Marina , Quaglia Alberto , Micheli Andrea , Capocaccia Riccardo
Published: February 2018

Background and aims

Cancer is a chronic disease whose clinical history has a strong relationship with socio-economic indicators, and it could be defined as a real “social disease”. For this reason, socio-economic factors can be used to project survival rates by means of ecological models. The present study had two main aims: to generalize to all adult patients study of the association between survival and socio-economic and healthcare technologies and related medical resources factors; to provide insights on the possible bias in giving national meaning to survival rates based on pools of regional cancer registries where national coverage is not available.

Material and methods

The EUROCARE 3 Study provided age-standardized survival rates at 5 years from the diagnosis for 10 major cancer sites collected by 52 cancer registries from 21 European countries for the period 1990–1994. For each area and country, socio-economic and health-related variables were collected for the period 1993–1995. Multiple linear regression models were used to compute predicted survival rates in countries totally covered by registration, starting from the correlation between socio-economic and health-related variables and observed survival rates. For those areas not totally covered by cancer registry activity, a correctional parameter coming from the previous linear regression models was computed in order to estimate survival at a national level also in these countries.

Results

Predicted survival rates were very close to the observed rates for countries totally covered by cancer registries. The estimates were also good for nations with partial national cancer registration, with less convergence in results for countries where socio-economic differences between the whole territory and the covered area were relevant.

Conclusions

In the light of these findings, evaluation of the role of socio-economic and health-related factors and the estimation of survival is of utmost importance in order to evaluate healthcare outcomes and to support planners in allocating resources in a more effective and egalitarian way.
Liver resection for noncolorectal and nonneuroendocrine metastases: Results of a study on 56 patients at a single institution
Authors: Bresadola Vittorio , Rossetto Anna , Adani Gian Luigi , Baccarani Umberto , Lorenzin Dario , Favero Alessandro , Bresadola Fabrizio
Published: February 2018

The usefulness of surgical treatment for hepatic metastases of noncolorectal non-neuroendocrine (NCRNNE) tumors is not yet clear due to the natural history of these tumors, their frequent systemic dissemination and their histological heterogeneity. The aim of this study was to evaluate the long-term outcome of patients who underwent liver resection for NCRNNE metastases. For this purpose we retrospectively analyzed 202 patients who underwent liver resection for metastasis between January 1989 and December 2006 at the Department of Surgery of the University Hospital of Udine. Fifty-six patients underwent liver resection because of NCRNNE metastases. The preoperative assessment was based on hepatic ultrasonography and CT scan; PET was used in a few patients. All patients had intraoperative liver ultrasonography to evaluate the lesions and to define the resection. Gender, age, primary tumor site (gastrointestinal or nongastrointestinal), synchronous or metachronous metastasis, unilobar or bilobar localization, number and diameter of the lesion(s), type of resection, margin status, positive lymph nodes in the hepatoduodenal ligament, and time between surgery and diagnosis of liver metastases were evaluated as possible prognostic factors for survival. Univariate analysis showed that the location of the primary tumor and the disease-free interval since the treatment of the primary tumor were positive predictive factors for longer survival. Multivariate analysis showed that the only independent significant factor was gastrointestinal versus nongastrointestinal origin. Demographic data, the synchronous or metachronous appearance of metastases, their unilobar or bilobar location, number and size, the type of resection, the resection margin status and the involvement of lymph nodes did not prove to be prognostic factors.
Three-dimensional conformal postoperative radiotherapy in patients with parotid tumors: 10 years' experience at the European Institute of Oncology
Authors: Alterio Daniela , Jereczek-Fossa Barbara A , Griseri Mara , D'onofrio Alberto , Giugliano Gioacchino , Fiore Maria R , Vitolo Viviana , Fossati Piero , Piperno Gaia , Calabrese Luca S , Verri Elena , Chiesa Fausto G , Orecchia Roberto
Published: February 2018

Aims and background

Salivary gland malignancies are rare. The aim of our study was to investigate radiotherapy-related toxicity and clinical outcome in patients treated at our division with postoperative radiotherapy (pRT) for parotid tumors.

Methods and study design

Forty-three consecutive patients (32 with primary parotid tumors, 9 with parotid metastases and 2 with recurrent benign diseases) were retrospectively analyzed.

Results

The median follow-up was 28 months. Twenty and 5 patients had a follow-up longer than 2 and 5 years, respectively. Thirty-seven patients were alive and most of them (78%) were free from disease. The local and distant control rates were higher in patients with primary parotid tumors (94% and 87.5%) than in patients with parotid metastases (87.5% and 75%). Grade 3 radiotherapy-related acute toxicity of skin and mucosa was recorded in 20.9% and 28% of patients, respectively. Two patients (4.7%) had grade 4 skin toxicity. Late toxicity data were available for 33 (77%) patients. None of the patients developed severe (grade 3 and 4) late toxicity of soft tissues, skin or temporomandibular joints.

Conclusions

Postoperative radiotherapy is a feasible treatment that was found to be effective mainly in patients with primary parotid tumors. Toxicity was acceptable but could probably be further reduced using more advanced radiotherapy techniques. Longer follow-up is required to achieve definitive results.
A retrospective analysis after low-dose-rate prostate brachytherapy with permanent 125I seed implant: clinical and dosimetric results in 70 patients
Authors: Chiumento Costanza , Montagna Antonietta , Clemente Stefania , Cozzolino Mariella , Fusco Vincenzo
Published: February 2018

Aims and background

To evaluate the biochemical disease-free survival (bDFS) rate after 125I permanent-implant prostate brachytherapy.

Methods

Patients with a diagnosis of prostate adenocarcinoma and adequate PSA follow-up were selected for this retrospective study. Brachytherapy with permanent 125I seeds was performed as monotherapy, with a prescribed dose of 145 Gy to the prostate. Patients were stratified into recurrence risk groups according to the National Comprehensive Cancer Network (NCCN) guidelines. Biochemical failure was defined using the American Society of Therapeutic Radiology and Oncology (ASTRO) guidelines. The post-implant D90 (defined as the minimum dose covering 90% of the prostate) was obtained for each patient. Two cutoff points were used to test the correlation between D90 and bDFS results: 130 Gy and 140 Gy. bDFS was calculated from the implant date to the date of biochemical recurrence. Univariate and multivariate analysis were performed using the SPSS software and included clinical stage, pretreatment PSA, Gleason score (GS), androgen deprivation therapy, D90, and risk groups. In the univariate analysis we used a cutoff point of 5.89 ng/mL for PSA and 5 for GS.

Results

From June 2003 to April 2007, 70 patients were analyzed. The patients' distribution into recurrence risk groups was as follows: 39 patients (56%) in the low-risk group, 23 patients (33%) in the intermediate-risk group, and 8 patients (11%) in the high-risk group. At a median follow-up of 47 months (range, 19–70 months) bDFS was 88.4%, with a global actuarial 5-year bDFS of 86%. Disease-related factors including initial PSA level, GS and risk group were significant predictors of biochemical failure (P = 0.01, P = 0.01, P = 0.006, respectively). In multivariate analysis, risk group (P = 0.005) and GS (P = 0.03) were statistically significant.

Conclusion

Our data are in agreement with those in the literature and, despite the short follow-up, confirm the advantage of brachytherapy for patients at low and intermediate risk of recurrence.
Expectations of survivors, caregivers and healthcare providers for testicular cancer survivorship and quality of life
Authors: De Padova Silvia , Rosti Giovanni , Scarpi Emanuela , Salvioni Roberto , Amadori Dino , De Giorgi Ugo
Published: February 2018

Aims and background

We compared expectations of testicular cancer survivors and their caregivers with those of healthcare providers for testicular cancer survivorship care and quality of life to identify experiences and potential expectations in which there was disagreement.

Methods

In a meeting with testicular cancer survivors, their caregivers, and care providers with an interest in testicular cancer, we distributed a structured questionnaire with 24 questions divided into 3 sections: personal information, information on the quality of life of survivors, information on the role of care providers, general practitioners and health-related internet sources in the expectations of survivors.

Results

The overall response rate was 91% (29 of 32) for patients and 100% (14 of 14) for caregivers with all questionnaires evaluable, while among 60 care providers, 42 (70%) responded with 41 (68%) evaluable. Between patients/caregivers and care providers, expectations were most incongruent for the role of primary care physicians in testicular cancer follow-up: important/fundamental for 58% of patients/caregivers and 88% of care providers (P = 0.010). Comparing patients/caregivers with care providers in their views of the experience of testicular cancer survivorship, we found several discrepancies: the fear of recurrence was high/very high for 18 of 43 (42%) patients/caregivers and in the perception of 40 of 41 (98%) care providers (P <0.001), and psychological distress was considered as highly relevant by 35% of patients/caregivers and 93% of care providers (P <0.001).

Conclusions

Patients/caregivers and care providers have different perceptions of survivors' experiences and discordant expectations with respect to the roles of primary care providers in testicular cancer survivorship care. Uncertainties about the roles and responsibilities of physicians can lead to deficiencies in care, supporting the need to make survivorship care planning a standard component in cancer management.
Do elderly cancer patients have different care needs compared with younger ones?
Authors: Romito Francesca , Corvasce Chiara , Montanaro Rosanna , Mattioli Vittorio
Published: February 2018

Aims and background

The increasingly older population confronts oncologists with an imposing challenge: older cancer patients have specific healthcare needs both independent of and associated with the diagnosis of cancer. The aim of the present study is to examine whether elderly versus younger cancer patients have different needs with respect to attendance, treatment and information.

Methods and study design

This is an observational and cross-sectional study. Cancer patients aged 35 to 82 years were consecutively interviewed. The group was divided into two subgroups aged ≤65 and ≥66 years old. The Needs Evaluation Questionnaire (NEQ) was used to assess patients' needs and demographic variables were collected. Data analysis was carried out by means of cross-tabulation analyses and the chi-square test.

Results

The requests most frequently expressed by the older group concerned financial-insurance information (73.9%), the need to talk to people with the same illness (71.7%), the need to receive more comprehensible information from doctors and nurses (71.7%), and the need for a better dialogue with clinicians (69.6%). Few significant differences between the two age subgroups were found, with the exception of issues such as the need for intimacy and support.

Conclusions

Elderly patients have informational and relational needs similar to those of younger patients. In fact, most of the whole sample flagged up the need for higher levels of satisfaction especially concerning a better dialogue with health staff, along with a new factor: the need to talk to people with the same illness.
Floating cells with stem cell properties in gastric cell line SGC-7901
Authors: Zheng Qiuhong , Gong Fusheng , Xu Yangmei , Zheng Tianrong , Ying Mingang
Published: February 2018

Aims

To obtain floating spheres from the adherent gastric cancer cell line SGC-7901 and to analyze the properties of the spheres.

Methods

Serum-free medium was applied to cultured SGC-7901 cells. Limiting dilution assay, tumor formation assay, microarray analysis, and real-time fluorescent quantitative PCR were used to test the stem cell properties of the spheres.

Results

A subpopulation of SGC-7901 cells formed floating spheres in serum-free medium. These cells showed enhanced tumorigenic ability and also highly expressed certain stem-cell-associated proteins.

Conclusions

We successfully propagated floating spheres with stem cell properties in the SGC-7901 gastric cell line.
Disparity in the “time to patient access” to new anti-cancer drugs in Italian regions. Results of a survey conducted by the Italian Society of Medical Oncology (AIOM)
Authors: Gori Stefania , Di Maio Massimo , Pinto Carmine , Alabiso Oscar , Baldini Editta , Barbato Enrico , Beretta Giordano Domenico , Bravi Stefano , Caffo Orazio , Canobbio Luciano , Carrozza Francesco , Cinieri Saverio , Cruciani Giorgio , Dinota Angelo , Gebbia Vittorio , Giustini Lucio , Graiff Claudio , Molino Annamaria , Muggiano Antonio , Pandoli Giuliano , Puglisi Fabio , Tagliaferri Pierosandro , Tomao Silverio , Venturini Marco
Published: February 2018

Aims and background

In 2009, the Italian Society of Medical Oncology (AIOM) conducted a survey to describe the impact of regional pharmaceutical formularies on the disparity of access to eight new drugs among cancer patients treated in Italian regions. The survey documented some regional restrictions for some anti-cancer drugs. In the study, we analyzed the “time to patient access” to new anti-cancer drugs in Italian regions.

Methods

In March 2010, we analyzed the availability of 17 new anti-cancer drugs at a regional level, specifically the coherence of regional authorizations compared with national authorizations approved by the Italian Medicines Agency (AIFA). In the regions with pharmaceutical formularies, we analyzed the characteristics of technical-scientific committees for the evaluation of inclusion of hospital drugs in these formularies. We also analyzed the time from EMA (CMPH) authorization to AIFA marketing authorization, the time from AIFA marketing authorization to patient availability, and the total time from EMA (CMPH) authorization to patient availability of the drugs in all Italian regions, for 11 of these drugs.

Results

Some drugs were included in all the regional pharmaceutical formularies, without restrictions, whereas other drugs were not included in one and others were not included in more than one formulary. Median time from EMA to AIFA was 11.2 months (range, 2.9–17.1). Median time from AIFA to patient availability was 1.4 months (range, 0.0–50.5) in regions with drug formularies versus 0.0 months in regions without drugs formularies. Median total time from EMA to patient availability was longer in regions with formularies (13.3 months; range, 2.9–65.3) than in regions without formularies (11.2 months; range, 2.9–24.0), where drugs are immediately available after AIFA marketing authorization. Moreover, the interval was very long (range, 2.9–65.3) for some drugs in regions with formularies.

Conclusions

The analysis confirmed that the presence of multiple hierarchical levels of drug evaluation can create disparity in drug availability for Italian citizens.
Helical tomotherapy for meningiomas of the skull base and in paraspinal regions with complex anatomy and/or multiple lesions
Authors: Combs Stephanie E , Sterzing Florian , Uhl Matthias , Habl Gregor , Schubert Kai , Debus Jürgen , Herfarth Klaus
Published: February 2018

Aim

To evaluate helical tomotherapy for the treatment of complex-shaped uni- or multifocal meningiomas.

Methods and materials

Between 2007 and 2009, 12 patients with complex-shaped meningiomas and/or multiple meningioma lesions were treated with helical tomotherapy. Histologic classification according to the most recent WHO classification for brain tumors was WHO grade I meningioma in 5 patients, atypical WHO grade II meningioma in 5 patients, and anaplastic WHO grade III meningioma in 2 patients. Eight patients were treated with primary radiotherapy, and in 4 patients tomotherapy was performed as re-irradiation for recurrent tumors.

Results

All patients were alive at the time of this analysis. Treatment was well tolerated by all patients. No severe side effects were observed. Four of 12 patients developed progression during follow-up at 2, 4, 17 and 29 months after radiotherapy. Of these, 2 patients were diagnosed with anaplastic meningiomas, and 2 patients suffered from atypical meningioma. Tumor progression developed after primary radiotherapy in 2 patients, and 2 recurrences developed after re-irradiation.

Conclusions

Helical tomotherapy can help meet the challenge of treating complex-shaped meningiomas in critical locations with one or multiple lesions due to the excellent dose distributions and the favorable clinical results.
Pastoral care in hospitals: A literature review
Authors: Proserpio Tullio , Piccinelli Claudia , Clerici Carlo Alfredo
Published: February 2018

Aims and background

This literature review investigates the potential contribution of the pastoral care provided in hospitals by hospital chaplains, as part of an integrated view of patient care, particularly in institutions dealing with severe disease.

Methods and study design

A search was conducted in the Medline database covering the last 10 years.

Results

Ninety-eight articles were considered concerning the modern hospital chaplains' relationships and the principal procedures and practices associated with their roles, i.e., their relations with the scientific world, with other religious figures in the community, with other faiths and religious confessions, with other public health professionals and operators, with colleagues in professional associations and training activities, and with the hospital organization as a whole, as well as their patient assessment activities and the spiritual-religious support they provide, also for the patients' families.

Conclusions

Improvements are needed on several fronts to professionalize the pastoral care provided in hospitals and modernize the figure of the hospital chaplain. These improvements include better relations between modern chaplains and the hospital organization and scientific world; more focus on a scientific approach to their activities and on evaluating the efficacy of pastoral care activities; greater clarity in the definition of the goals, methods and procedures; the design of protocols and a stance on important ethical issues; respect for the various faiths, different cultures and both religious and nonreligious or secularized customs; greater involvement in the multidisciplinary patient care teams, of which the hospital chaplains are an integral part; stronger integration with public health operators and cooperation with the psychosocial professions; specific training on pastoral care and professional certification of chaplains; and the development of shared ethical codes for the profession.
Orthotopic ileal neobladder reconstruction in a woman who developed squamous cell carcinoma of the urinary bladder after kidney transplantation
Authors: Moon Kyung Chul , Ahn Hyun Soo , Min Sun Ho , Kim Hyung Suk , Ku Ja Hyeon
Published: February 2018

The case of a 62-year-old woman who developed squamous cell carcinoma of the bladder 16 years after a kidney transplant is reported here. After the transplant, immunosuppressive therapy was maintained with cyclosporin A (200 mg/day) and the patient's serum creatinine level was 0.9 mg/dL. She was diagnosed with squamous cell carcinoma of the bladder 16 years later and underwent radical cystectomy with an orthotopic ileal neobladder. The Studer technique was used and the afferent ileal loop was anastomosed to the graft ureter. The postoperative course was uneventful. At the 6-month follow-up visit, the patient showed no evidence of recurrence. Her serum creatinine level was 1.0 mg/dL. The patient was continent during the day and the night. This case shows that the construction of an orthotopic ileal neobladder after cystectomy is safe and feasible in kidney transplant recipients.
Primary adrenal gland carcinosarcoma associated with metastatic rectal cancer: A hitherto unreported collision tumor
Authors: Bertolini Federica , Rossi Giulio , Fiocchi Federica , Giacometti Marco , Fontana Annalisa , Gibertini Maria Chiara , Roncucci Luca , Luppi Gabriele , Torricelli Pietro , Rossi Aldo , Conte Pier Franco
Published: February 2018

In this report we describe the case of a young woman with familial adenomatous polyposis who developed metastatic rectal cancer during pregnancy. At diagnosis, we decided to perform a transabdominal laparoscopic adrenalectomy, because of the high risk of bowel obstruction, and to define the origin of the adrenal gland lesion, suspected to be primary on the basis of imaging results. The histological specimen showed a collision tumor between an adrenal metastasis of a rectal tumor and a primary adrenal gland carcinosarcoma. The peculiarity of the case is due not only to its clinical presentation during pregnancy, but also to the presence of this uncommon adrenal collision tumor. A particular challenge for the clinician is to define the priority between these two tumors: the presence of two distinct and colliding aggressive neoplasms poses a problem in the choice of the best therapeutic approach, also given the impossibility to biopsy all metastatic sites. However, we decided to treat the patient as having a metastatic rectal cancer, because we had a solid histological confirmation of metastases.
The Effect of Neoadjuvant Chemotherapy on Hormone Receptor Status, HER2/neu and Prolactin in Breast Cancer
Authors: Pedrini José Luiz , Savaris Ricardo Francalacci , Schorr Mario Casales , Cambruzi Eduardo , Grudzinski Melina , Zettler Cláudio Galleano
Published: February 2018

Aims and Background

Histological and immunohistochemical findings may vary in cases of breast cancer. Possible changes in tumor markers between biopsies performed before and after neoadjuvant chemotherapy are controversial and pose a challenge when a clinical decision is needed. The objectives of the present study were: (i) to compare the immunohistochemical expression of estrogen, progesterone and prolactin receptors and HER-2/neu in breast cancer before and after neoadjuvant chemotherapy; and (ii) to correlate the expression of these tumor markers with partial tumor response to neoadjuvant chemotherapy.

Methods and Study Design

Immunohistochemical staining for breast tumor markers was performed in 90 cases of breast cancer. Statistical analysis was carried out using Fisher's exact test, McNemar's test, Spearman's correlation and the Kappa index with linear weighting (κ).

Results

Agreement between markers before and after neoadjuvant chemotherapy was fair to moderate (κ = 0.37–0.51). The immunohistochemical expression of HER-2/neu and prolactin receptors showed a significant, albeit weak correlation before and after neoadjuvant chemotherapy (HER-2/neu, rho = 0.34; P = 0.0009; κ = 0.35 [95% CI, 0.19–0.51]). Prolactin status changed in 28/90 cases (P = 0.001; McNemar's test), whereas no changes were found in estrogen or progesterone receptors. No association was found between tumor marker expression and tumor response.

Conclusions

It seems prudent to reevaluate immunohistochemical markers such as HER-2/neu after neoadjuvant chemotherapy, since the findings will guide the strategy for implementation of adjuvant systemic treatment. No correlation was found between the tumor markers analyzed in the present study and partial tumor response to neoadjuvant chemotherapy.
Predictors of Sensitivity to Preoperative Chemoradiotherapy of Rectal Adenocarcinoma
Authors: Yan Hongjiang , Wang Renben , Zhu Kunli , Zhao Wei , Jiang Shumei , Feng Rui , Xu Xiaoqing , Meng Xiangjiao , Sun Huiying , Zhang Haiqin , Mu Dianbin , Xu Zhongfa
Published: February 2018

Objectives

The purpose of the study was to identify predictive factors of tumor response to preoperative chemoradiotherapy for rectal adenocarcinoma.

Methods

Ninety-eight patients with nonmetastatic rectal adenocarcinoma received preoperative concurrent chemoradiotherapy and underwent mesorectal excision. After treatment, tumor response according to tumor regression grade were evaluated. The correlation of clinicopathologic factors to tumor response was analyzed.

Results

The results from a univariate analysis indicated that pretreatment carcinoembryonic antigen level ≤3.0 ng/ml (P = 0.002), non-fixed tumor (P = 0.001), and tumor circumferential extent ≤50% (P = 0.001) were associated significantly with a good tumor response. They also indicated that pretreatment positive lymph nodes (P = 0.032) were associated significantly with a poor tumor response. In multivariate analysis, the results indicated that pretreatment carcinoembryonic antigen level (hazard ratio, 2.930; P = 0.003), tumor mobility (hazard ratio, 2.651; P = 0.002) and circumferential extent of tumor (hazard ratio, 2.394; P = 0.019) independently predicted a good pathologic response rate. Pretreatment positive lymph nodes were not significantly associated with a good response (hazard ratio, 0.361; P = 0.191).

Conclusions

Pretreatment carcinoembryonic antigen level, tumor mobility and circumferential extent of tumor may be helpful in predicting responsiveness in rectal adenocarcinoma to preoperative chemoradiotherapy, although the results should be confirmed in larger, more homogeneous studies.
Dihydroartemisinin Induces Endoplasmic Reticulum Stress-Mediated Apoptosis in HepG2 Human Hepatoma Cells
Authors: Gao Xiaoling , Luo Ziguo , Xiang Tingxiu , Wang Kejian , Li Jian , Wang Pilong
Published: February 2018

Aims and Background

Previous studies showed that dihydroartemisinin (DHA) possessed antitumor activity in many human tumor cells through the induction of apoptosis. The aim of this study was to investigate the effects of DHA on apoptosis in the human hepatocellular carcinoma cell line HepG2 and the possible molecular mechanisms involved.

Methods

The inhibitory effect of DHA on HepG2 cells was measured by MTT assay. The percentage of apoptotic cells was detected by flow cytometry with double staining of fluorescein isothiocyanate-annexin V/propidium iodide. The intracellular production of reactive oxygen species (ROS) and intracellular Ca2+ concentration ([Ca2+]i) were detected by fluorescence spectrophotometry. Protein expression of GADD153, Bcl-2 and Bax in HepG2 cells was examined by Western blot and immunocytochemistry.

Results

DHA significantly inhibited proliferation of HepG2 cells in a dose- and time-dependent manner. The apoptosis rates in HepG2 cells treated with 0, 50, 100 and 200 mol/L DHA for 24 hours were 2.53 ± 0.88%, 24.85 ± 3.63%, 35.27 ± 5.92% and 48.53 ± 7.76%, respectively. Compared with the control group, DHA significantly increased ROS generation and [Ca2+]i level (P <0.05), with the generation of ROS preceding the increase in [Ca2+]i. An increase in GADD153 and Bax expression and a decrease in Bcl-2 were observed in DHA-treated cells. Pretreatment with the antioxidant N-acetylcysteine could attenuate the effects of DHA in the experiments.

Conclusion

DHA could inhibit proliferation and induce apoptosis in HepG2 cell lines through increasing the intracellular production of ROS and [Ca2+]i. Endoplasmic reticulum stress-induced apoptosis may contribute to this effect by regulating the expression of GADD153, proapoptotic Bax, and antiapoptotic Bcl-2.
Curative Resection of Combined Neuroendocrine Carcinoma and Adenocarcinoma of the Gallbladder
Authors: Il Kim Dong , Il Seo Hyung , Lee Jee Yeon , Kim Hyun Sung , Han Koon Taek
Published: February 2018

Neuroendocrine carcinoma of the gallbladder has very rarely been reported as it accounts for only 0.5% of all neuroendocrine tumors. It has a very aggressive biological behavior. These tumors are usually diagnosed at an advanced stage and surgical management is therefore not an option. We performed a hepatopancreaticoduodenectomy along with adjuvant chemotherapy in a 48-year-old patient with a neuroendocrine carcinoma of the gallbladder. The patient has been followed up at the outpatient clinice for 18 months without there having been any recurrence. Patients with a locally invasive neuroendocrine carcinoma in the gallbladder may benefit from aggressive surgical treatment followed by adjuvant chemotherapy. The primary management in high-grade metastatic tumors is, however, mainly medical.
Hospital Discharge Database as a Tool to Monitor Incidence, Survival and Burden of Cancer in Adolescents and Young Adults
Authors: Scurti Veronica , Di Ienno Sabrina , Fanizza Caterina , Belfiglio Maurizio , D'ettorre Antonio , Romero Marilena , Tognoni Gianni
Published: February 2018

Aims and Background

Cancer in young patients (15–39 years) is unique for the distribution of types, therapeutic options and clinical evolution. Administrative databases represent well-documented tools in epidemiology, and in oncology they are very important in those realities without cancer registries. Our study aimed to analyze the occurrence, outcomes and burden of cancer in young patients through the analysis of hospital discharge records.

Methods

Hospital discharge databases and civil registries were analyzed through record linkage technique. Annual incidence rate (AIR), standardized incidence rate (SR), overall survival, hospitalization rate, and mean number of hospitalizations were evaluated.

Results

Among 2,330,459 young adults, 1846 new cancer patients had been hospitalized in the analyzed period. The SR was 69.3/100,000/year: 1051, 56.9%, were females (AIR 91.0 and SR 76.0) and 795, 43.1%, were males (AIR 67.6 and SR 62.5). Hematological disease was more frequent in males than females (25.5% vs 14.7%, P <0.0001), whereas solid tumors were more frequent among females (85.3% vs 74.5, P <0.0001). The distribution by diagnostic group showed that among females breast cancer was the most frequent (n = 272, SR 17.2), whereas among males genitourinary tract cancer (n = 245, SR 19.2), especially testicular cancer (n = 187, SR 15.1), was the most frequent. Metastatic disease at diagnosis was already present in 198 patients with a solid cancer (13.3%), whereas 213 (11.5%) developed metastasis in the following years. At 12 months from the diagnosis, 87 of 1488 patients with solid cancers and 35 of 358 patients with hematologic disease failed: overall survival was 94% and 90%, respectively. Patients with a new diagnosis of cancer had produced 6663 hospitalizations, 4640 (69.6%) of which were due to solid tumors, 3992 (59.9%) produced by patients over 29 years old, and 3606 (54.1%) by females. The percentage of day hospital admissions increased proportionally with patient age: 25.7% of all hospitalizations among older adolescents (15–20 years) and 32.9% among young adults of 34–39 years.

Conclusions

Administrative data have clear advantages in terms of availability and large numbers. Comparison of our results with the literature showed that a health care delivery database can provide useful information for clinical-epidemiologic evaluations in oncology as well as for the analysis of health services utilization.
HER-3 Status by Immunohistochemistry in HER-2-Positive Metastatic Breast Cancer Patients Treated with Trastuzumab: Correlation with Clinical Outcome
Authors: Gori Stefania , Foglietta Jennifer , Mameli Maria Grazia , Stocchi Lucia , Fenocchio Daniela , Anastasi Paola , Iacono Daniela , Del Sordo Rachele , Basurto Carlo , De Angelis Verena , Sidoni Angelo
Published: February 2018

Aims and Background

HER-3 signaling might contribute to resistance to trastuzumab. To clarify the role of HER-3 in HER-2-positive breast cancer, it is important to evaluate the level of HER-3 and its correlations with clinical outcome in metastatic breast cancer patients treated with trastuzumab.

Methods

HER-3 status by immunohistochemistry was evaluated in HER-2-positive metastatic breast cancer patients treated with trastuzumab-based therapy at our institution. Two scorings were utilized for interpreting staining for HER-3, and the correlation between HER-3 status and clinical outcome was evaluated.

Results

We evaluated HER-3 status in 61 of 76 HER-2-positive metastatic breast cancers treated with trastuzumab-based therapy at our institution from 4/1999 to 3/2006. We observed 55.2% objective responses; median time to progression and overall survival from start of trastuzumab therapy were 9.6 months (0.921–78.87) and 29.1 months (1.4–129.5+), respectively. With a cutoff of 50% staining tumor cells, we found 30 HER-3-negative and 31 HER-3-positive tumors. HER-3 status was not significantly associated with clinical outcome, but a shorter time to progression and overall survival were observed in patients with HER-3-positive tumors.

Conclusions

HER-3 status by immunohistochemistry was not significantly associated with clinical outcome in HER-2-positive metastatic breast cancer patients. Further studies are necessary to evaluate the prognostic and predictive role of HER-3.
Prognostic Effect of Age on Survival of Patients with Stage I Adenocarcinoma of the Lung
Authors: Ryu Jeong-Seon , Choi Chang-Min , Yang Seok-Chul , Song Sang-Yun , Jeon Young-June , Jang Tae-Won , Kim Do-Jin , Jang Seung Hun , Yang Sei-Hoon , Lee Min-Ki , Lee Kwan-Ho , Jo Hyang-Jeong , Jang Se-Jin , Kim Young-Tae , Cho Jae-Hwa , Choi Yoo-Duk , Nam Hae-Seong , Kim Hyun-Jung , Suh Young Ju
Published: February 2018

Aims and Background

It is still unclear whether age is an independent prognostic factor in patients with stage I NSCLC.

Methods

Five hundred and sixty-nine patients with stage I adenocarinoma who underwent surgical resection as first treatment were included. The effect on overall survival of age, gender, smoking habits, Charlson comorbidity index score (CCIS), type of surgery, tumor size and lymphatic or blood vessel invasion was analyzed.

Results

When the patients were divided into four groups according to quartiles of age, distributions of gender, smoking habit, CCIS, histology, blood vessel invasion and adjuvant chemotherapy were significantly different among the four groups. Age, gender, smoking habit, CCIS, tumor size and lymphatic and blood vessel invasion were significantly associated with overall survival of the patients in Kaplan-Meier analysis (logrank, P <0.001, P <0.001, P = 0.029, P <0.001, P = 0.001, P = 0.001 and P = 0.007, respectively). Moreover, the highest quartile of age (over 68 years old) was a prominent determinant for a worse prognosis after adjustment for the confounding variables using a Cox proportional hazard model (adjusted hazard ratio = 2.735, 95% confidence interval = 1.623–4.608, P <0.001).

Conclusions

The findings suggest that age is an important determinant of overall survival in patients with stage I adenocarcinoma. Therefore, age should be considered in classifying the patients into groups of higher or lower risk for death as well as in designing clinical trials.
Analysis of Gene Copy Number Variations using a Method Based on Lab-on-a-Chip Technology
Authors: De Lellis Laura , Mammarella Sandra , Curia Maria Cristina , Veschi Serena , Mokini Zhirajr , Bassi Chiara , Sala Paola , Battista Pasquale , Mariani-Costantini Renato , Radice Paolo , Cama Alessandro
Published: February 2018

Aims and Background

Copy number variations (CNVs) contribute to genome variability and their pathogenic role is becoming evident in an increasing number of human disorders. Commercial assays for routine diagnosis of CNVs are available only for a fraction of known genomic rearrangements. Thus, it is important to develop flexible and cost-effective methods that can be adapted to the detection of CNVs of interest, both in research and clinical settings.

Methods

We describe a new multiplex PCR-based method for CNV analysis that exploits automated microfluidic capillary electrophoresis through lab-on-a-chip technology (LOC-CNV). We tested the reproducibility of the method and compared the results obtained by LOC-CNV with those obtained using previously validated semiquantitative assays such as multiplex ligation-dependent probe amplification (MLPA) and nonfluorescent multiplex PCR coupled to HPLC (NFMP-HPLC).

Results

The results obtained by LOC-CNV in control individuals and carriers of pathogenic MLH1 or BRCA1 genomic rearrangements (losses or gains) were concordant with those obtained by previously validated methods, indicating that LOC-CNV is a reliable method for the detection of genomic rearrangements.

Conclusion

Because of its advantages with respect to time, costs, easy adaptation of previously developed multiplex assays and flexibility in novel assay design, LOC-CNV may represent a practical option to evaluate relative copy number changes in genomic targets of interest, including those identified in genome-wide analyses.
Dichloroacetate Induces Different Rates of Cell Death in Cancer and Noncancer Cell Lines in Vitro
Authors: Washington Jovonia T , Quintyne Nicholas J
Published: February 2018

Aims and Background

The pyruvate mimetic dichloroacetate (DCA) has been shown to induce cell death in cancer cells. A number of studies in vitro and in vivo have suggested this molecule may serve as an anticancer agent, but some cells are resistant. Here we wanted to examine the effects of DCA on cancerous and noncancerous cells grown in culture for a prolonged period of exposure and at increasing concentrations.

Methods

Six cancer cell lines (A549, SK-HEP-1, HCT116, UPCI:SCC070, HeLa and MES-SA) and three noncancerous lines (RPE, GM03349B and HEK293) were exposed to 0.5 mM DCA for seven days and cell counts were taken every day to determine viability and cell cycle progression. The same cell lines were also exposed to higher doses of DCA up to 10 mM and viability was scored.

Results

Five cancer cell lines showed high levels of cell death early in the trial, but three of the lines showed a second delayed increase in cell death at later stages. HCT116 cells were unaffected by 0.5 mM DCA. GM03349B and RPE cells also died when treated with DCA. At high concentrations, all cell lines exhibited high rates of death. No specific cell cycle arrest of the cells was observed.

Conclusion

We found that there is considerable difference in the way cancer cells are affected by DCA. Some have populations that are highly resistant to treatment, while others have stronger rates of death only after prolonged exposure. We also found noncancerous cells are not all resistant to DCA, a significant finding that has not previously been observed in other in vitro DCA trials.
Synchronous Association of Two Neuroendocrine Gastroenteropancreatic Tumors, An Adenocarcinoma of the Cecum, and a Meckel's Diverticulum: A Case Report
Authors: Pozzato Paolo , Casadei Gian Piero , Fornelli Adele , Arigliano Vincenzo , Virzì Salvatore , Bondi Arrigo , Tomassetti Paola , Ventrucci Maurizio
Published: February 2018

Neuroendocrine gastroenteropancreatic tumors constitute a heterogeneous group of neoplasms, with the primary tumors being located in the gastric mucosa, pancreas, and small and large intestine. The development of a second primary malignancy in patients with these tumors is a well-described phenomenon, and the reported incidence ranges from 12% to 46%. The most common site of associated noncarcinoid malignancies is the gastrointestinal tract, which involves from 30% to 60% of the tumors. We report a case of concurrent colon carcinoma and two neuroendocrine tumors of the duodenum.
Rare Lesions and Tumors of the Urinary Bladder. Selected Issues
Authors: Lopez-Beltran Antonio
Published: February 2018

Morphological variants of urothelial cancer have been recently described. The timely identification and recognition of these histological variants should avoid their misinterpretation as benign lesions. We emphasize the peculiar features of these variants because some may require different/specific therapeutic approaches.
Overall and Disease-Free Survival Greater than 12 Years in Metastatic Non-Small Cell Lung Cancer after Linear Accelerator-Based Stereotactic Radiosurgery for Solitary Brain Metastasis
Authors: Scorsetti Marta , Alongi Filippo , Navarria Piera , Cortinovis Diego , Bidoli Paolo
Published: February 2018

The best treatment approach for solitary brain metastasis is not well defined and there is no consensus on this issue. It is still being debated whether patients with isolated brain metastasis should undergo surgical resection or stereotactic radiosurgery, and which patients should receive adjuvant whole brain radiotherapy. The median survival in patients with single or multiple metastatic lesions who underwent only stereotactic radiosurgery improved from two-three months to nine months. To the best of our knowledge this is the first report on patients treated with linear accelerator-based stereotactic radiosurgery alone where an overall survival of more than 12 years was obtained, maintaining good quality of life in three cases of solitary brain metastasis from non-small cell lung cancer. In addition to the case reports, we present a brief literature review on this topic.