bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Locally Advanced Cervical Cancer in Pregnancy: A Case Report
Authors: Rabaiotti Emanuela , Sigismondi Cristina , Montoli Serena , Mangili Giorgia , Candiani Massimo , Viganò Riccardo
Published: February 2018

Background

Carcinoma of the cervix is the most common malignancy associated with pregnancy. In the first and second trimesters patients should receive the same treatment as is used in nonpregnant women and termination is advised. In selected cases neoadjuvant chemotherapy (NACT) could be proposed but only a few cases have been reported.

Case

A 27-year-old woman, gravida 1 para 0, at 15 weeks' gestation, was diagnosed with FIGO stage IB2 squamous cervical cancer. After refusing to terminate pregnancy, she was treated with neoadjuvant chemotherapy (cisplatin) starting at 18 weeks. A cesarean section with radical surgery was performed at 32 weeks and a healthy baby delivered. Four weeks later the patient started chemoradiation therapy. She relapsed 1 year after surgery and died when her child was 2 years old.

Conclusion

NACT followed by radical surgery was an unsuccessful treatment in our patient; platinum-based chemotherapy was harmless to the child up to the last follow-up.
Image-Guided-Radiotherapy Retreatment of Spine Metastasis: A Case Report and Radiobiological Evaluation
Authors: Ingrosso Gianluca , D'Andrea Marco , Miceli Roberto , Benassi Michaela , Giudice Emilia , Di Murro Luana , Nicolais Rebeca , Giubilei Cesare , Di Marzo Alessandro , Fedele Dahlia , Tortorelli Grazia , Santoni Riccardo
Published: February 2018

Aims and background

The present case report describes vertebral metastasis retreatment using kilovoltage cone-beam computed tomography (CBCT) for setup error correction, in order to improve target irradiation and prevent spinal cord toxicity. We evaluated the feasibility of the second radiation therapy course on the overlapping treatment volume.

Methods and study design

A patient with metastatic kidney cancer, previously treated to the tenth dorsal vertebra with conventional radiation planning (21 Gy; 3 × 7 Gy), underwent retreatment. In order to deliver 30 Gy (15 × 2 Gy) to the target volume with the second irradiation, we evaluated the residual dose that could be received by the spinal cord. We calculated the biologically effective dose according to the linear-quadratic model, using an α/β ratio of 2 Gy. A 3-dimensional conformal plan was generated; CBCT imaging was used to ensure accurate repositioning.

Results

A total of 15 CBCT scans were performed; the mean setup corrections in the lateral, longitudinal and vertical directions were 3.38 mm (SD 2.09; range, −0.2 mm ÷ 7.6 mm), 2.13 mm (SD 3.38; range, −5.9 mm ÷ 6 mm), and −1.28 mm (SD 2.02; range, −7.1 mm ÷ 0.3 mm), respectively.

Conclusion

Image-guided radiotherapy is an alternative approach for the retreatment of spine tumors; it ensures accurate patient setup correction and high-precision treatment delivery, which are required for target volumes very close to critical structures. Free full text available at www.tumorionline.it
4. Pathological Diagnosis and Tumor Markers
Authors: Milione Massimo , Seregni Ettore
Published: February 2018

Pulmonary and digestive neuroendocrine tumors (NETs) are a group of neoplasms whose incidence and prevalence has been constantly increasing over the last years thanks to the significant improvements in instrumental diagnostic techniques. Because NETs are extremely heterogeneous a correct histopathological diagnosis is essential for appropriate treatment. More specifically, the histopathological diagnosis of NETs can be regarded as a multistep: identification of the neuroendocrine nature of the neoplasm, determination of tumor grading; identification of unknown primary. Laboratory biomarkers for the study of gastroenteropancreatic neuroendocrine tumors include both specific markers and non-specific or general markers. At the moment, chromogranin A is the best available and most frequently used biomarker for the diagnosis of NETs, offering the highest overall sensitivity. CgA has also demonstrated some utility in the assessment of response to treatment and as indicator of tumor recurrence. Free full text available at www.tumorionline.it
Small Nodular Melanoma: The Beginning of a Life-Threatening Lesion. A Clinical Study on 11 Cases
Authors: Bono Aldo , Tolomio Elena , Carbone Antonino , Moglia Daniele , Crippa Federica , Tomatis Stefano , Santinami Mario
Published: February 2018

Aims and background

Because of its high thickness, nodular melanoma often bears a poor prognosis. Thus, an earlier diagnosis of this type of lesion while it is still thin would be an important step in secondary prevention. The principal aim of the present study was to better define the initial clinical features of nodular melanoma to allow an early diagnosis. A secondary aim was to establish the prognosis of this type of lesion.

Methods

We retrospectively studied and illustrated the clinical features of 11 small (≤6 mm maximum diameter) cutaneous nodular melanomas seen and treated during a 10-year period. Prognostic characteristics of the various lesions were also described.

Results

The results of the study help to describe a small nodular melanoma as a dark and/or pink/red raised lesion, which may be evenly or unevenly colored, with well-defined borders, that often appears de novo. A correct clinical diagnosis was made in 7 of the cases. During a median follow-up of 6 years, none of the patients had local or distant relapses.

Conclusions

Detection of small nodular melanoma is feasible by accurate visual inspection, provided that physicians are aware of this type of lesion and maintain the index of suspicion at a high level to bring about curative surgery. Free full text available at www.tumorionline.it
Alkaline Phosphatase Levels as a Prognostic Factor in Metastatic Colorectal Cancer Treated with the FOLFOX 4 Regimen: A Monoinstitutional Retrospective Study
Authors: Maisano Roberto , Azzarello Domenico , Del Medico Pietro , Maisano Maurizio , Bottari Maria , Egitto Giovanni , Nardi Mario
Published: February 2018

Aims and background

Metastatic colorectal cancer has a heterogeneous behavior, and a set of patients will have minimal response and rapid disease progression. To understand this heterogeneity, studies have evaluated biological and clinical prognostic factors. Alkaline phosphatase seems to be a key prognostic factor, so we have reviewed the outcomes of our patients with respect to alkaline phosphatase levels.

Methods and study design

Between January 2003 and December 2008, we treated with the FOLFOX 4 regimen 103 consecutive patients with metastatic colorectal cancer. Thirty-two patients had alkaline phosphatase ≥300 U/l.

Results

Median time to progression was 4 months for patients with high alkaline phosphatase levels and 8 months for those with low alkaline phosphatase levels. Median overall survival was 8 and 17.5 months, respectively. Only 3 patients in the high alkaline phosphatase group obtained partial response (9.4%) compared to 3 complete responses and 24 partial responses (41.5%) in low alkaline phosphatase group. Toxicity was substantially different, with more grade 3–4 neutropenia, diarrhea and oral mucositis in the high than low alkaline phosphatase group.

Conclusions

Alkaline phosphatase is an uncomplicated and potent prognostic factor. Patients with high alkaline phosphatase levels had a poor prognosis. Free full text available at www.tumorionline.it
Image-Guided Stereotactic Body Radiation Therapy for Localized Prostate Cancer
Authors: Kang Jin-Kyu , Cho Chul Koo , Choi Chul Won , Yoo SeongYul , Kim Mi-Sook , Yang KwangMo , Yoo HyungJun , Kim Jin Ho , Seo Young Seok , Lee Dong Han , Jo MoonKi
Published: February 2018

Purpose

We report the results of a retrospective study of stereotactic body radiation therapy (SBRT) using CyberKnife for localized prostate cancer. The study focused on the safety and feasibility of this treatment modality.

Materials and methods

Between October 2002 and December 2007, 44 patients suffering from localized adenocarcinoma of the prostate were treated with SBRT using CyberKnife at the Korea Cancer Center Hospital. The patients were divided into 3 groups: a low-risk group (5 patients), an intermediate-risk group (10 patients), and a high-risk group (29 patients). Five patients received 32 Gy in 4 fractions, 28 patients received 34 Gy in 4 fractions, and 11 patients received 36 Gy in 4 fractions.

Results

The median age of the patients was 69 years (range, 53–79 years) and the median duration of follow-up 40 months (range, 12–78 months). There were 6 acute and 3 late grade 2 urinary toxicities, and 4 acute and 5 late grade 2 rectal toxicities, but there were no grade 3 or higher treatment-related toxicities. The 5-year cause-specific survival rate and progression-free survival rate were both 100%. At last follow-up, the biochemical failure-free rate of the low-risk, intermediate-risk and high-risk patients was 100%, 100% and 90.8%, respectively.

Conclusion

SBRT using CyberKnife for localized prostate cancer is safe and well tolerated. We obtained promising results with 34 Gy in a 4-fraction regimen especially for the high-risk patients. Free full text available at www.tumorionline.it
Treatment of Recurrent Glioblastoma with Stereotactic Radiotherapy: Long-Term Results of a Mono-Institutional Trial
Authors: Maranzano Ernesto , Anselmo Paola , Casale Michelina , Trippa Fabio , Carletti Sandro , Principi Massimo , Loreti Fabio , Italiani Marco , Caserta Claudia , Giorgi Cesare
Published: February 2018

Aims and background

Few clinical data exist concerning normal brain tissue tolerance to re-irradiation. The present study evaluated long-term outcome of 22 recurrent glioblastoma patients re-irradiated with radiosurgery or fractionated stereotactic radiotherapy.

Methods

Twenty-two patients were treated with radiosurgery (13, 59%) or fractionated stereotactic radiotherapy (9, 41%) for 24 lesions of recurrent glioblastoma. The male/female ratio was 14: 8, median age 55 years (range, 27–81), and median Karnofsky performance status 90 (range, 70–100). The majority of the cases (77%) was in recursive partitioning analysis classes III or IV. Radiosurgery or fractionated stereotactic radiotherapy was chosen according to lesion size and location.

Results

Median time between primary radiotherapy and re-irradiation was 9 months. Median doses were 17 Gy and 30 Gy, whereas median cumulative normalized total dose was 141 Gy and 98 Gy for radiosurgery and fractionated stereotactic radiotherapy, respectively. All patients submitted to radiosurgery had a cumulative normalized total dose of more than 100 Gy, whereas only a few (44%) of fractionated stereotactic radiotherapy patients had a cumulative normalized total dose exceeding 100 Gy. Median follow-up from re-irradiation was 54 months. At the time of analysis, all patients had died. After re-irradiation, 1 (4%) lesion was in partial remission, 16 (67%) lesions were stable, and the remaining 7 (29%) were in progression. Median duration of response was 6 months, and median survival from re-irradiation 11 months. Three of 13 (23%) patients submitted to radiosurgery developed asymptomatic brain radionecrosis. The cumulative normalized total dose for the 3 patients was 122 Gy, 124 Gy, and 141 Gy, respectively. In one case, the volume of the lesion was large (14 cc), and in the other 2 the interval between the first and second cycle of radiotherapy was short (5 months).

Conclusions

Re-irradiation with radiosurgery and fractionated stereotactic radiotherapy is feasible and effective in recurrent glioblastoma patients. Apart from the importance of an accurate patient selection, cumulative radiotherapy dose and a correct indication for radiosurgery or fractionated stereotactic radiotherapy must be taken into account to avoid brain toxicity. Free full text available at www.tumorionline.it
Prognostic Significance of p53 Protein and X-ray Repair Cross-Complementing Protein 1 in Non-Small Cell Lung Cancer
Authors: Rybárová Silvia , Hodorová Ingrid , Muri Jozef , Mihalik Jozef , Adamkov Marian , Svajdler Marián , Piovarci Dalibor , Mirossay Ladislav
Published: February 2018

Objectives

p53 and XRCC1 protein expression were evaluated in 54 samples of non-small cell lung cancer.

Patients and methods

The immunohistochemical method was used for detection of the monitored proteins. Tissue samples were divided according to histopathological tumor type. The results were then compared with basic clinical and histopathological parameters (histopathological type, nuclear grade and TNM tumor stage IA, IB).

Results

Statistically significant correlations were found between histopathological type and p53 expression, since P <0.05 (P = 0.015). Comparing p53 expression with grade resulted in a strong positive correlation (P <0.0396, R2 = 0.9223). The percentage of p53-positive tumors progressively increased from 0% in grade 1 to 75% in grade 4. No correlation was found between p53 expression and tumor stage. In case of XRCC1, the highest level was found in squamous cell lung carcinoma, where 71% of samples was positive. In case of large cell carcinoma samples, it was 67%, and in adenocarcinoma 52% of samples showed XRCC1 immunoreactivity. No statistically significant correlation was found between histopathological type, grade or early stage (IA, IB) of non-small cell lung cancer and expression of XRCC1 protein profile without neoadjuvant therapy.

Conclusions

We found a statistically significant correlation between p53 expression and histopathological tumor type. It is possible that stabilized p53 protein plays an important role in the development of squamous and large cell carcinoma. Our findings also suggest that p53 expression cumulates with the dedifferentiation of cancer cells. It is possible that the expression of XRCC1 is not fixed and could be changed by the status of cancer cells and in relation to therapy. Relevant data about pre- versus post-chemotherapy and XRCC1 expression are needed to evaluate the influence of XRCC1 on drug resistance. Free full text available at www.tumorionline.it
Basic Fibroblast Growth Factor Affects the Expression of Angiogenin and Cell Proliferation in A375 Human Melanoma Cells
Authors: Zhao Jia , Yang Qiong , Yang Jianli , Wang Ji , Fan Lingling , Wang Li
Published: February 2018

Aims and background

Human malignant melanoma is a very aggressive and highly angiogenesis-dependent tumor. Basic fibroblast growth factor and angiogenin are the potentially important angiogenic factors for melanoma progression and metastasis. Many studies have mainly focused on how they induce angiogenesis. In the present study, we investigated the effects of basic fibroblast growth factor on the expression of angiogenin and melanoma cell growth.

Methods and study design

Angiogenin mRNA and protein expression were investigated by means of semi-quantitative reverse transcriptase polymerase chain reaction assay and western blotting. We analyzed cell proliferation using MTT, flow cytometry and soft agar assay. Immunofluorescence staining was applied to investigate co-localization and nuclear translocation.

Results

We found that basic fibroblast growth factor negatively affected the expression of angiogenin in A375 cells. The result showed that down-regulation of basic fibroblast growth factor induced decreased cell proliferation of A375 cells, and in basic fibroblast growth factor up-regulated cells, cell proliferation was increased. We demonstrated that basic fibroblast growth factor protein was co-localized with angiogenin and that it underwent nuclear translocation in A375 cells.

Conclusion

These findings suggest that there is a cooperation mechanism between basic fibroblast growth factor and angiogenin in A375 cells, and the cooperation mechanism affects the progress of tumor cell proliferation and angiogenesis. Free full text available at www.tumorionline.it
Filgrastim Helps to Heal Herpes Zoster Faster: Two Case Reports
Authors: Sayin Meral , Bakkal Bekir H
Published: February 2018

Herpes zoster is an infectious disease caused by varicella-zoster virus that may occur sporadically at any age. We report on two patients with herpes zoster who received chemotherapy for breast cancer. Both patients were immunocompromised and received filgrastim therapy for the management of neutropenia. Zoster occurred during filgrastim therapy but the symptoms were alleviated rapidly in the course of therapy. We conclude that granulocyte colony-stimulating factor therapy helped symptom alleviation and accelerated the recovery from herpes zoster in our chemotherapy-treated patients. Free full text available at www.tumorionline.it
Metastatic Melanoma: An Unusual Presentation
Authors: De Vita Ferdinando , Giordano Guido , Fabozzi Alessio , Guerrera Barbara , Fabozzi Teresa , Fasano Morena , Ferrara Marianna , Fascione Antonio , Di Benedetto Giuseppe
Published: February 2018

In this report we describe a case of a malignant cutaneous melanoma metastasizing to the pleural surface and peritoneal cavity 5 years after surgical resection of the primary lesion. Malignant cutaneous melanoma is a very aggressive cancer able to metastasize anywhere in the body. Pleural secondary lesions represent a rare event described only in a small number of patients and the association with peritoneal localizations may suggestan uncommon pattern of spread that we discuss. Free full text available at www.tumorionline.it
Trends in Prostate Cancer Incidence and Mortality before and after the Introduction of PSA Testing in the Slovak and Czech Republics
Authors: Ondrusova Martina , Ondrus Dalibor , Karabinos Juraj , Muzik Jan , Kliment Jan , Gulis Gabriel
Published: February 2018

Aims and background

As two neighboring countries in central Europe with national cancer registries, the Slovak (SR) and Czech Republics (CR) are countries with a medium global rate in the occurrence of prostate cancer. This paper analyzes the incidence of prostate cancer and mortality before and after the introduction of PSA testing in the two Republics and the possible reasons for any differences discovered and compares the results with selected regions and countries of the world.

Study design and results

In the Slovak Republic, prostate cancer incidence (age-adjusted to the world standard population) has risen from 14.6/100, 000 in 1968 (95% CI, ±1.5772) to 36.2/100, 000 in 2005 (95% CI, ±2.0678). The estimated annual increase in the incidence during the period 1968–1991 (before nationwide PSA testing) was 0.421; from 1991 (when nationwide PSA testing began) to up to 2003 it was 0.941. Mortality rates grew from 7.3/100, 000 in 1968 to 14.9/100, 000 in 2005. In spite of the geographic proximity of the two countries, the increase in incidence occurred faster in the Czech than in the Slovak Republic, from 15.8/100, 000 in 1977 (95% CI, ±0.9748) to 59.5/100, 000 in 2005 (95% CI, ±1.7187). The estimated annual increase in incidence in the Czech Republic for the period of 1977–1991 was 0.581. From 1991 (when national PSA testing began) until 2003, it was 1.981. In the period before 1991, mortality rose more sharply in the Czech than in the Slovak Republic, whereas after the introduction of PSA testing mortality stabilized more quickly in the Czech than in the Slovak Republic. In the Slovak Republic, a significant reduction in mortality was observed after 2002 and has continued to the present and probably is not affected only by the results connected with the increase in PSA testing.

Conclusions

The difference in the incidence and mortality of prostate cancer in the Slovak and the Czech Republics results from a difference in the intensity of PSA testing as well as from the introduction of complex, more effective treatment in advanced clinical stages.
Absence of Paxillin Gene Mutation in Lung Cancer and other Common Solid Cancers
Authors: Kim Min Sung , Yoo Nam Jin , Lee Sug Hyung
Published: February 2018

Aims and background

Mounting evidence indicates that deregulated cell adhesion is involved in the mechanisms of cancer pathogenesis. A recent study showed that the paxillin gene (PXN) encoding a focal adhesion protein was somatically mutated in lung cancers. The aim of this study was to confirm the presence of PXN mutations in lung cancers as well as in other common solid cancers.

Methods

We analyzed somatic PXN mutations in 45 lung, 45 gastric, 45 colorectal, 45 breast, 45 liver and 45 prostate cancers by polymerase chain reaction and single-strand conformation polymorphism assay.

Results

Neither lung nor other cancers were found to be associated with somatic mutations of PXN.

Conclusions

In contrast to the previous report, our study revealed that PXN mutation was absent in lung cancers and other common solid cancers, suggesting that PXN mutation may not play a principal role in solid cancer development.
Hereditary Paraganglioma Syndrome Associated with SDHD Gene Mutations: A Patient with Multicentric Presentation Treated with Radiotherapy. Case Report
Authors: Garibaldi Elisabetta , Bresciani Sara , Panaia Rocco , Delmastro Elena , Malinverni Giuseppe , Gabriele Pietro
Published: February 2018

Introduction

Extra-adrenal paragangliomas are rare tumors arising from neuroendocrine cells. Sporadic and hereditary forms have been recognized. Among the latter, the PGL1 and PGL4 syndromes are associated with a high risk of multiple localizations. The treatment of choice for paragangliomas is surgical resection, but in some cases surgery can be difficult due to particular or multiple tumor sites or may result in severe neurological deficits. In such cases radiotherapy can be an effective alternative. In this paper we describe the case of a patient affected by hereditary paraganglioma syndrome with multicentric presentation who was treated at our center by external radiotherapy.

Case report

A 55-year-old man presented in April 2008 with multiple paragangliomas: one in the left pontocerebellar angle, two in the middle neck, one mediastinal paraaortic mass, and an abdominal paraaortic lesion. The left pontocerebellar and mediastinal tumors were treated with three-dimensional conformal radiotherapy (3D-CRT) at total doses of 50.40 Gy and 55.80 Gy, respectively. The neck lesions were treated with intensity-modulated radiotherapy (IMRT) at a total dose of 55.80 Gy. The abdominal paraaortic lesion was surgically resected.

Results

No severe acute or late toxicity as evaluated with the EORTC-RTOG scale was observed. Fourteen months after the end of radiotherapy a whole body CT scan showed that the tumor lesions were stable in size and in their relations to contiguous structures. The arterial pressure was controlled by medical therapy and urine catecholamine levels were within the normal range.

Conclusions

We believe that in patients affected by unresectable paragangliomas radiotherapy is a safe and effective alternative to surgery. The use of high-dose conformity techniques such as 3D-CRT and IMRT will allow higher local control rates with relatively few side effects thanks to the possibility of dose escalation and reduction of the amount of irradiated healthy tissues.
Matrix metalloproteinase-9 decreased after chemotherapy in patients with non-small cell lung cancer
Authors: Ertan Esra , Soydinc Hilal , Yazar Aziz , Ustuner Zeki , Tas Faruk , Yasasever Vildan
Published: February 2018

Aims and background

The aim of the study was to investigate the alteration in serum matrix metalloproteinase-9 (MMP-9) levels after chemotherapy and the association between the changes in serum levels of MMP-9 and response to chemotherapy in patients with advanced stage non-small cell lung cancer.

Methods and study design

Twenty-eight consecutive patients with advanced non-small cell lung cancer and 24 healthy controls were enrolled in the study. The patients were treated with cisplatin-based combination chemotherapy. After two cycles, the response was evaluated. Before and after two cycles of chemotherapy, serum samples were collected from the patients.

Results

Prechemotherapy MMP-9 (ng/ml) levels were significantly higher in patients with advanced stage non-small cell lung cancer than in controls (7.2 ± 2.8 vs 4.5 ± 2.1, P<0.001). Prechemotherapy MMP-9 levels were elevated compared to postchemotherapy levels as well (7.2 ± 2.8 vs 5.2 ± 3.3, P = 0.005). Prechemotherapy MMP-9 levels were significantly higher than postchemotherapy MMP-9 levels in patients with partial response (7 patients) (8.2 ± 1.8 and 3.2 ± 2.3, respectively; P = 0.018), but the pre- and postchemotherapy MMP-9 levels were no different in patients with stable disease or progressive disease (21 patients) (7 ± 3.1 and 5.9 ± 3.3, respectively; P = 0.08).

Conclusions

The difference between pre- and postchemotherapy MMP-9 levels in responders was more prominent than that in nonresponders. Whether the decline in serum MMP-9 levels might be used as a marker of response to chemotherapy should be investigated in larger studies.
Wall defects after abdominoperineal resection: A modified tension-free technique
Authors: Vannelli Alberto , Battaglia Luigi , Rampa Mario , Boati Paolo , Putortì Antonella , Pelleriti Daniela , Fedele Fabienne , Leo Ermanno
Published: February 2018

Background

The treatment of wall defects after abdominoperineal resection has yet to be defined. In this study we report the outcome of a modified prosthetic technique for the treatment of combined large incisional and parastomal hernia performed after abdominoperineal resection.

Material and methods

Between January 2005 and July 2008, 21 consecutive patients who underwent abdominoperineal resection for low rectal cancer received surgical repair for large incisional hernias with a modified mesh technique consisting of a tension-free attachment of the prosthetic material to the posterior sheath of the rectus abdominis muscle. The surgical outcome was assessed mainly as the recurrence rate of abdominal hernia and postoperative complications.

Results

Among the 21 patients we reported two minor complications: partial necrosis of the skin flap (4.8%) and a seroma (4.8%). One major complication occurred: extensive necrosis of the skin flap (4.8%). We reported one death due to stroke 20 days after surgery. The mean postoperative hospital stay was 6.1 days (SD, 2.3).

Conclusions

This study encourages the use of a tension-free modified prosthetic technique for the repair of combined wall defects after abdominoperineal resection. The technique does not lead to an increase in the incidence of complications, offering a considerable advantage to the patient.
Impact of delayed radiotherapy on local control in node-negative breast cancer patients treated with breast-conserving surgery and adjuvant radiotherapy without chemotherapy
Authors: Kim Kyubo , Chie Eui Kyu , Han Wonshik , Noh Dong-Young , Ha Sung W
Published: February 2018

Aim and background

To evaluate the effect of the surgery-radiotherapy interval (SRI) on local control in node-negative breast cancer patients treated with breast-conserving surgery and adjuvant radiotherapy without chemotherapy.

Methods

From February 1992 to January 2002, 171 patients with node-negative breast cancer underwent breast-conserving surgery and adjuvant radiotherapy without chemotherapy. The whole breast was irradiated up to 50.4 Gy in 28 fractions followed by a 10-Gy boost to the tumor bed. Forty-four patients received tamoxifen in addition to radiotherapy. Patients were divided into 2 groups according to the length of SRI: <6 weeks (128 patients) versus ≥6 weeks (43 patients). The median follow-up period was 87 months (range, 22–167).

Results

The 8-year local control rates of patients with SRI <6 weeks and ≥6 weeks were 94.5% and 92.7%, respectively (P = 0.1140). When age, tumor size, resection margin status, combination with hormonal therapy, and SRI were incorporated into the Cox proportional hazards model, SRI <6 weeks and age at diagnosis ≥40 years were associated with increased local control (P = 0.0343 and 0.0264, respectively). In the subgroup analysis, SRI <6 weeks was correlated with a higher local control rate for patients aged <40 years (P = 0.0142). Among older patients, however, there was no statistical difference in local control according to SRI (P = 0.6655). Treatment interval had no impact on overall and distant metastasis-free survival.

Conclusions

Early radiotherapy within 6 weeks of breast-conserving surgery is associated with increased local control in patients with node-negative breast cancer not undergoing chemotherapy.
Three-dimensional conformal radiation therapy for refractory laryngeal granuloma
Authors: Wang Jianhua , Shi Mei , Xia Yuesheng , Luo Shanquan , Fu Xuehai , Xiao Feng , Li Jianping , Deng Zhihong , Long Xiaoli
Published: February 2018

Aims and background

The etiology of laryngeal granulomas is often multifactorial and the benefit of pharmacological therapy remains unclear. Anti-reflux treatment is only effective in granulomas definitely induced by gastroesophageal reflux. Steroid inhalation has shown favorable results but it is unclear whether it shortens the healing process. Surgical excision is associated with high recurrence rates. The aim of this study was to evaluate the role of 3-dimensional conformal radiation therapy (3DCRT) in the treatment of refractory laryngeal granuloma.

Methods and study design

The study was a retrospective review including all patients presenting to the Department of Radiation Oncology at Xijing Hospital from January 2004 to March 2007. We studied a total of 15 cases of refractory laryngeal granuloma that had recurred ≥2 times. Patients had previously been managed with voice rest, corticosteroids, antibiotics, antacids, surgery and botulinum toxin. All patients accepted surgical excision and immediate adjuvant 3DCRT at a total dose of 15 Gy over 5 days.

Results

All patients were successfully treated with surgery and 3DCRT. There has been no granuloma recurrence in 3 years of follow-up.

Conclusions

3DCRT is a safe and effective therapy for refractory laryngeal granulomas, especially when other methods have failed.
Endometrial metastasis of lung adenocarcinoma: A case report
Authors: Tiseo Marcello , Bersanelli Melissa , Corradi Domenico , Bartolotti Marco , Gelsomino Francesco , Nizzoli Rita , Barili Matteo Pesenti , Ardizzoni Andrea
Published: February 2018

The female genital tract is an infrequent site of metastasis, in particular from extragenital primary tumors such as non-small cell lung cancer. Ovarian metastases have been described as disseminations of lung adenocarcinoma; rare cases of secondary localizations in adnexa, cervix and vagina were also observed in the literature, but none of these had endometrial involvement. We report the first case, to our knowledge, of non-small cell lung cancer with metastatic spread to the endometrium.
Doses of capecitabine and oral vinorelbine are not relevant for efficacy in breast cancer patients: An analysis of dose intensity
Authors: Battelli Nicola , Bittoni Alessandro , Pagliacci Alessandra , Zepponi Laura , Scartozzi Mario , Mariotti Carlo , Cascinu Stefano
Published: February 2018

Background

The combination of capecitabine and vinorelbine is a valuable regimen in metastatic breast cancer treatment, even in pretreated patients.

Patients and methods

Forty-one pretreated consecutive patients were treated with capecitabine, 1000 mg/m2, twice daily, for two of three weeks, and vinorelbine, given orally at a dose of 60 mg/m2, days 1 and 8 in three-week cycles.

Results

A total of 301 courses was given, with a median of 8 courses (range, 3–13). Median dose intensity of capecitabine was 75% of the planned dose and for vinorelbine it was 72%. We observed 18 partial response (43.9%), 15 stable disease (36.6%), and 8 progressive disease (19.5%). Median progression-free survival was 9 months (range, 1–22) and median overall survival was 27.2 months (range, 4–40). Overall response rate (complete + partial response) was not statistically different between patients who received more or less than the median dose intensity of capecitabine and vinorelbine, and there was no difference in overall survival or progression-free survival.

Conclusions

Capecitabine and oral vinorelbine is an effective and well-tolerated “all-oral” regimen for advanced breast cancer patients. The use of lower doses than those currently recommended should be not detrimental in terms of efficacy.
TomoDirect: An efficient means to deliver radiation at static angles with tomotherapy
Authors: Franco Pierfrancesco , Catuzzo Paola , Cante Domenico , La Porta Maria Rosa , Sciacero Piera , Girelli Giuseppe , Borca Valeria Casanova , Pasquino Massimo , Numico Gianmauro , Tofani Santi , Meloni Teodoro , Ricardi Umberto , Ozzello Franca
Published: February 2018

Aims and background

The TomoTherapy Hi-Art II system is able to deliver dynamic intensity-modulated radiation therapy within a helical geometry providing robust conformality and modulation, abrupt dose falloff, and reliable accuracy. A new upgrade named TomoDirect was introduced recently, allowing delivery of radiation at discrete angles with a fixed gantry. We present our preliminary clinical experience with TomoDirect.

Methods

Three specific clinical contexts were chosen for the implementation of TomoDirect, namely palliation of bone metastasis pain (BP), whole brain radiation therapy for intracranial secondary lesions (WBRT), and adjuvant whole breast radiation therapy after conservative surgery for early stage breast cancer (AWBRT). After appropriate positioning, planning CT, contouring, and plan generation, all patients were treated with the TomoDirect upgrade of the TomoTherapy Hi-Art II system with different doses and fractionation according to clinical decision-making.

Results

Between May and December 2010, 41 patients were treated with TomoDirect. Eighteen patients were treated for BP (mainly vertebral metastases) with a predominant posterior field arrangement. Seven patients were treated for WBRT (multiple brain lesions) with a parallel-opposed latero-lateral approach and 16 patients were treated for conventionally fractionated AWBRT mainly with a 2-field tangential approach. Radiation treatments were generally well tolerated and the acute toxicity was mild.

Conclusions

While helical tomotherapy allows the delivery of very sophisticated treatment plans, in certain anatomical sites and clinical contexts where the number of beam directions is constrained and supposed not to affect plan quality, TomoDirect might be an efficient means to deliver radiation at static angles with consistent dosimetric and clinical results.
Mesenchymal chondrosarcoma of the spleen: Report of a case
Authors: Rossetto Anna , Saccomano Enrico , Zompicchiatti Aron , Avellini Claudio , Toffoli Silvia , Miolo GianMaria , Frustaci Sergio , Uzzau Alessandro
Published: February 2018

Background

Chondrosarcoma is a malignant tumor of chondrogenic origin and the mesenchymal type is a very rare finding. Mesenchymal chondrosarcoma tends to develop mostly in the skeleton but may also occur as a primary tumor in periosteal nervous and muscular tissues, the anterior cerebral falx, meninges, brain, maxillary sinus, eyelid, thyroid, pleura and mediastinum, while in the abdomen the most frequent locations are the kidney, retroperitoneum and even the perineum and the anogenital area. Apparently, the only splenic mesenchymal chondrosarcoma in the literature occurred in a dog.

Methods and study design

Our paper reports the case of a patient who had a diagnosis of mesenchymal chondrosarcoma of the spleen.

Results

We adopted surgery as the main therapeutic procedure without achieving complete recovery but preserving a good quality of life for our patient, minimizing the repercussions of the disease on her working and relational life.

Conclusions

The absence of important or invalidating symptoms and the persistence of good general conditions before and after each surgical operation encouraged us to adopt the surgical option as the most rational.
Synchronous primary lung cancers: A multidisciplinary approach in diagnosis
Authors: Kontic Milica , Stevic Ruza , Stojsic Jelena , Jekic Biljana , Bunjevacki Vera
Published: February 2018

Background

For patients with two or more primary cancers a correct diagnosis is critically important because prognosis and treatment vary considerably between multiple primary cancers and metastatic disease.

Case report

Two bilateral synchronous primary lung malignancies of different histological types were diagnosed and immunohistochemically confirmed in a 60-year-old woman. In biopsy specimens of the right lung pure squamous cell carcinoma was detected (stage IIIa). The tumor expressed AE1/AE3, cytokeratin 5 and 34βE12. In biopsy specimens of the left lung small cell carcinoma was detected (stage IIIa). The small cells expressed synaptophysin, chromogranin A and CD56. DNA was extracted from paraffin-embedded tissue of both tumors. Exons 5–9 of the TP53 gene were examined for genetic mutations by polymerase chain reaction and DNA sequencing analysis. Direct sequencing of DNA isolated from the small cell carcinoma revealed a TGC to TTC mutation at codon 404 of TP53 exon 5. In DNA isolated from the squamous cell carcinoma no TP53 mutation was found. The tumors' different response to chemotherapy also suggested that they belonged to different histological types. The patient lived 24 months after the diagnosis, which is more typical for stage III than for stage IV lung carcinoma.

Conclusion

Discrimination of synchronous primary lung cancers from intrapulmonary metastases based only on clinical findings can be very difficult. Multidisciplinary diagnostic evaluation is therefore very helpful in cases like this, because a correct diagnosis will determine the best treatment for the patient and consequently a better prognosis.
Neuroendocrine tumors of unknown primary site: Gold dust or misdiagnosed neoplasms?
Authors: Catena Laura , Bichisao Ettore , Milione Massimo , Valente Monica , Platania Marco , Pusceddu Sara , Ducceschi Monika , Zilembo Nicoletta , Formisano Barbara , Bajetta Emilio
Published: February 2018

Aims and background

Neuroendocrine tumors of an unknown primary site are rarer than other neuroendocrine tumors (0.6–2% of all neuroendocrine tumors) and have a poor prognosis. The aim of the study was to review the cases of unknown primary site neuroendocrine tumors encountered at the Istituto Nazionale Tumori of Milan between 1984 and 2008 in order to verify their incidence and evaluate their characteristics and prognosis.

Methods and study design

During the study period, 750 neuroendocrine tumor patients attended our Institute, 82 of whom (10.9%) were diagnosed as having neuroendocrine tumors of an unknown primary site. The data from their medical records were analyzed descriptively, and survival probabilities were calculated using the Kaplan-Meier method and the logrank test, considering patient, tumor and treatment-related characteristics.

Results

The 82 patients with neuroendocrine tumors of an unknown primary site (34 males) had a median age of 60 years; 57 (69.5%) had histologically well-differentiated tumors, 3 (3.7%) poorly differentiated tumors, and 22 (26.8%) had tumors that could not be classified. Of the 52 patients (62.2%) who underwent Octreoscan(®) (Bykgulden Italia SpA), 40 (78.4%) showed a pathological uptake and 11 (21.6%) were negative. Thirty-one patients (37.8%) underwent metastatic site surgery, which was radical in 11 cases (35.4%). Forty-eight patients (58.5%) received somatostatin analogues, and 41 (50.0%) underwent chemotherapy. At the end of the study period, 59 patients (72.0%) had died, 31 (53.0%) because of disease progression, and 23 (28.0%) were still alive.

Conclusions

Neuroendocrine tumors of an unknown primary site are difficult to identify but their incidence is higher than previously reported, and the prognosis remains unfavorable.
Multi-field-of-view SPECT is superior to whole-body scanning for assessing metastatic bone disease in patients with prostate cancer
Authors: Giovanella Luca , Castellani Massimo , Suriano Sergio , Ruberto Teresa , Ceriani Luca , Tagliabue Luca , Lucignani Giovanni
Published: February 2018

Aim

The aim of this study was to compare the diagnostic performance of whole-body bone scintigraphy (WBS) and multi-field-of-view single photon emission tomography (multi-FOV SPECT) with 99mTc-oxidronate (99mTc-HDP) in patients with prostate cancer (PCa).

Methods

In a prospective study, WBS and SPECT acquisitions were performed in194 patients with histologically confirmed PCa and serum prostate-specific antigen (PSA) levels above 10 ng/mL. Scans obtained using the two modalities were interpreted separately. Clinical and biochemical follow-up, radiological studies and biopsies served as benchmarks for the assessments. The impact of PSA level on WBS and SPECT results was also evaluated.

Results

The patient-based sensitivity, specificity, accuracy, PPV and NPV values of SPECT examinations were higher than those of WBS, especially in patients with serum PSA levels ≶40 ng/mL.

Conclusion

Multi-FOV SPECT proved to be more sensitive and specific than WBS in detecting bone metastases in PCa patients.
Influence of Tumor Cell Culture Supernatants on Macrophage Functional Polarization: In Vitro Models of Macrophage-tumor Environment Interaction
Authors: Caras Iuliana , Tucureanu Catalin , Lerescu Lucian , Pitica Ramona , Melinceanu Laura , Neagu Stefan , Salageanu Aurora
Published: February 2018

Aims and background

Macrophages are heterogeneous cells with extensive functional plasticity; they can change their functional profiles repeatedly in response to environmental changes anywhere between their extreme phenotypical programs (labeled as M1 and M2 polarization, respectively). In terms of antitumoral immune response, M1 macrophages are considered to be beneficial, while M2 macrophages supposedly promote tumor progression. Tumor-associated macrophages (TAMs) represent a major leukocyte population present in many tumors. Although many studies indicate that TAMs elicit several M2-associated protumoral functions, including promotion of angiogenesis, matrix remodeling and suppression of adaptive immunity, their role regarding tumor progression is still controversial. The aim of the present study was to develop an appropriate in vitro model to study the effect of tumor-secreted soluble factors on the functional phenotype of macrophages.

Methods and study design

THP-1 human monocytic line cells and peripheral blood mononuclear cells from healthy volunteers were used for macrophage differentiation; primary tumor cell culture supernatants or tumor cell line supernatants were employed along with various cytokines, growth factors and other stimuli to design different model variants and to better mimic the in vivo tumor microenvironment.

Results

The cytokine secretion patterns of these macrophages suggest that primary tumor cell culture supernatants are able to switch the macrophage phenotype or to induce functional polarization of macrophages toward a mixed M1/M2 phenotype.

Conclusions

These data support the hypothesis that TAM behavior is modulated by the tumor microenvironment itself.
Unusual giant cell tumor of a floating rib: A case report
Authors: Tavecchio Luca , Radaelli Stefano , Pelosi Giuseppe , Leo Francesco , Pastorino Ugo
Published: February 2018

Giant cell tumor is an unusual neoplasm of the ribs. Herein is presented the case of a patient with an abdominal wall mass, which turned out to be a giant cell tumor of the 11th rib. This is a very uncommon site for a giant cell tumor, which also had a peculiar shape. No other similar case has been reported in the medical literature.
A Phase II Trial of 5-Fluorouracil, Leucovorin and Mitomycin C in Patients with Advanced Gastric Cancer
Authors: Kim Sung Rok , Yuh Young Jin , Sohn Byeong Seok , Yang Sung Hyun
Published: February 2018

Aims and Background

Low-dose leucovorin is a well known potentiator of 5-fluorouracil activity in colorectal cancer but not in gastric cancer. To assess their efficacy on response rate and survival, 5-fluorouracil and low-dose leucovorin were combined with mitomycin C.

Methods

Fifty patients with gastric cancer and metastatic disease, unresectable or relapsed disease were treated with the following regimen every 28 days: mitomycin C, 7 mg/m2 IV bolus on day 1, and leucovorin, 20 mg/m2 IV, followed immediately by 5-fluorouracil, 375 mg/m2 on days 1–5. All had measurable disease and were assessable for toxicity. Prognostic factors were analyzed to examine any association with response rate or overall survival.

Results

Nineteen of the 48 assessable patients (39.6%; 95% confidence interval [CI], 25.8–53.4) responded, including 4 complete responses (8.3%). The median progression-free survival was 108 days (range, 18+ - 146), and the median duration of survival was 338 days (11.3 months; range, 18+ - 903 days). Response rate and overall survival were not significantly associated with CEA level, performance status, age, or primary and metastatic tumor sites. Toxicity associated with the chemotherapy was tolerable, and all patients were treated at the outpatient clinic. Leukopenia and thrombocytopenia WHO grade ≥3 occurred in 5% and 1% of the patients, respectively. Nausea and vomiting were the most frequent adverse effects (29%), all grade 1 or 2.

Conclusions

Combination chemotherapy of 5-fluorouracil plus leucovorin with mitomycin C is effective for the treatment of advanced gastric cancer and is well tolerated.
Overexpression of Tyrosine Kinase Receptor B Promotes Metastasis of Ovarian Serous Adenocarcinoma by Lymphangiogenesis
Authors: Zheng Weiping , Dai Qunyun , Tao Pingping , Sun Aijing , Wang Yungen , Bao Lei , Zhang Guorong
Published: February 2018

Aims and Background

The aim of this study was to detect the expression features of tyrosine kinase receptor B (TrkB) and analyze the possible correlation between TrkB expression and lymph vessel density (LVD) in metastasis of ovarian serous adenocarcinoma.

Methods

An immunohistochemical method was used to evaluate TrkB expression in 139 ovarian tumor sections (103 primary ovarian serous adenocarcinomas and 36 serous adenomas) and investigate the correlation between TrkB expression and LVD, which was estimated by means of VEGFR-3 assessment.

Results

TrkB was significantly upregulated in serous adenocarcinomas and absent in serous adenomas. There was no association between TrkB expression and the histological grade of cancer cells. The expression of TrkB was correlated with surgico-pathological stage and metastasis in serous adenocarcinomas. The level of TrkB was higher in advanced-stage than in early-stage disease. TrkB was overexpressed in metastatic lesions compared with the corresponding primary lesions. Furthermore, a positive correlation between TrkB expression and LVD in serous adenocarcinomas was observed.

Conclusions

TrkB was overexpressed in ovarian serous adenocarcinomas and might be involved in cancer metastasis by associated lymphangiogenesis.
Nipple Adenoma Arising in a Supernumerary Mammary Gland: A Case Report
Authors: Shinn Louise , Woodward Claudia , Boddu Samyukta , Jha Pankaj , Fouroutan Hutan , Péley Gábor
Published: February 2018

Nipple adenoma, a benign tumour of the breast, is a relatively rare occurrence. This report describes an even rarer case of nipple adenoma arising within a supernumerary mammary gland. The presenting symptoms were a lump and throbbing pain in the axilla. Ultrasound scan and core biopsy proved inconclusive so surgical excision was undertaken, thus allowing a histological diagnosis. The patient made a full and uneventful recovery. Physicians must be aware that diseases of the breast and nippleareola complex may also arise in accessory mammary tissue and accessory nipples should not be discounted as a common congenital anomaly. Instead they must be regarded, examined and treated as normal breast tissue.