bluuebunny/crossref_metadata_2025 huggingface dataset:
From Clinical Trials to Clinical Practice: Predictors of Response to Erlotinib in Advanced Non-Small Cell Lung Cancer Patients Pretreated with Chemotherapy
Authors: Mazzoni Francesca , Rotella Virginia , Pratesi Nicola , Boni Luca , Simi Lisa , Orlando Claudio , Comin Camilla Eva , Maddau Cristina , Di Costanzo Francesco
Published: February 2018

Background

Inhibition of the epidermal growth factor receptor pathway with tyro-sine kinase inhibitors can improve outcome of patients with advanced non-small cell lung cancer after first-line chemotherapy. The use of clinical characteristics and molecular markers may permit the identification of patients who are more likely to benefit from erlotinib.

Patients and methods

Retrospective analysis of unselected patients with metastatic non-small cell lung cancer who had previously failed on at least one line of chemotherapy and treated at our institution with erlotinib (150 mg/day orally) until disease progression. Mutations of epidermal growth factor receptor (exon 19–21) and KRAS (codon 12–13) genes were screened with high-resolution melting analysis and identified with direct sequencing.

Results

Fifty-three patients were included in the study. The disease control rate was 38%. Median progression-free survival and median overall survival were 4 and 15 months, respectively. Skin rash, diarrhea and mucositis were the most common toxicities of erlotinib. In 19 patients, erlotinib dose was reduced for toxicity. The disease control rate and progression-free survival were significantly better in non-smokers, responders to chemotherapy and patients with epidermal growth factor receptor mutations. Overall survival was longer in patients with skin toxicity and epidermal growth factor receptor mutations.

Conclusions

In our experience, epidermal growth factor receptor mutations, response to previous chemotherapy and non-smoking status were predictors of higher disease control rate and longer progression-free survival. Overall survival was significantly longer in patients with epidermal growth factor receptor mutations and skin toxicity.
AKT Signaling Pathway in Invasive Ductal Carcinoma of the Breast: Correlation with ERα, ERβ and HER-2 Expression
Authors: Wang Xiuling , Yi Lina , Zhu Yan , Zou Jue , Hong Yuelin , Zheng Weiqiang
Published: February 2018

Aims and background

Estradiol exerts most of its effects by direct binding to the estrogen receptor in breast carcinoma, ERβ expression is a useful biomarker for breast cancer in a manner that is independent of ERα expression. However, studies evaluating ERβ expression with certain tumor variables, such as tumor grade and disease-free survival, had produced conflicting results. The Akt signaling pathway currently attracts considerable attention as a new target for effective therapeutic strategies. The current study attempted to compare the relative associations of variables including ERα, ERβ, HER-2/neu and AKT staining with the presence of metastases or survival.

Methods and study design

Immunohistochemical staining was employed to determine the expression of ERα, ERβ, pAkt and HER-2/neu in 110 cases of primary breast carcinoma.

Results

Positive ERα, ERβ, pAkt and HER-2/neu expressions were respectively observed in 46.4% (51/110), 59.1% (65/110), 40.9% (45/110) and 31.8% (35/110) of the tumors. pAkt was significantly associated with HER-2/neu overexpression (P <0.005) and axillary lymph node metastasis (P <0.05). However, there was no significant relationship between pAkt and ERα, ERβ, p53 (P >0.05) expressions. Survival analysis showed that pAkt positivity was associated with poor disease-free survival of the patients.

Conclusions

The current study suggested that activity of the Akt signaling pathway may indicate a poor prognosis in patients with breast carcinoma. The results implied that estrogen can activate the PI3K-Akt pathway through ERα and ERβ-independent mechanisms in breast cancer.
Megavoltage CT Images of Helical Tomotherapy Unit for Radiation Treatment Simulation: Impact on Feasibility of Treatment Planning in a Prostate Cancer Patient with Bilateral Femoral Prostheses
Authors: Alongi Filippo , Fodor Andrei , Maggio Angelo , Cozzarini Cesare , Fiorino Claudio , Broggi Sara , Alongi Pierpaolo , Calandrino Riccardo , Di Muzio Nadia
Published: February 2018

Metal prosthesis artefacts on CT images can be a significant problem in the definition of volumes of interest, dose calculation and patient setup in modern radiotherapy. We experienced considerable difficulties in defining the organs at risk and treatment volumes on kVCT images of standard CT simulation in a prostate cancer patient due to the presence of bilateral femoral prostheses causing artefacts. As shown in the current case, MVCT images of the patient in the treatment position obtained using a helical tomotherapy unit can provide sufficient morphological information to define the pelvic anatomic structures for radical prostate treatment planning. The patient completed the planned treatment and at 90 days after the end of treatment no severe side effects were recorded. Since there have been few reports on the use of MVCT images to overcome the problem of hip prosthesis artefacts, a brief literature review was also carried out.
Squamous Cell Carcinoma of the Umbilicus: Management of an Unusual Localization
Authors: Macripò Giuseppe , Caliendo Virginia , Grassi Marcella , Lista Patrizia , Ribero Simone , Giacone Elena , Milanese Enrica , Ciuffreda Libero
Published: February 2018

We describe the case of a squamous cell carcinoma spreading to the skin and regional lymph nodes from the umbilicus. Bilateral inguinal lymphadenectomy and a session of electrochemotherapy with bleomycin 15 mg/m2 were performed. However, because of the development of new cutaneous nodules in the abdominopelvic region, we performed targeted palliative therapy with erlotinib 150 mg/day. Targeted adjuvant therapy was preferred to the use of a major cytotoxic agent because of the high risk of superinfection and heart failure. Erlotinib produced a partial clinical response with reduction of the number and size of the skin nodules. CT scan performed after 60 days of treatment did not show any new lesions.

To our knowledge, this is the first report of an umbilical metastatic squamous cell carcinoma treated with modern targeted therapy. This therapeutic strategy can be considered a valid palliative option in the management of metastatic cutaneous nodules of this rare primary site.
Single-dose palonosetron and dexamethasone in preventing nausea and vomiting induced by moderately emetogenic chemotherapy in breast and colorectal cancer patients
Authors: Brugnatelli Silvia , Gattoni Elisabetta , Grasso Donatella , Rossetti Franca , Perrone Tania , Danova Marco
Published: February 2018

Aims and background

Palonosetron, a unique second-generation 5-HT3 receptor antagonist, has been demonstrated to control emesis related to chemotherapy-induced nausea and vomiting (CINV). The aim of this study was to evaluate the efficacy and tolerability of palonosetron followed by a single dose of dexamethasone in patients with breast cancer (BC) or colorectal cancer (CRC) receiving moderate emetogenic chemotherapy (MEC).

Methods and study design

Chemotherapy-naive BC and CRC patients were given MEC as adjuvant or first-line treatment. Palonosetron (0.25 mg IV) and dexamethasone (8 mg IV) were administered before chemotherapy on day 1. The primary endpoint was complete response (CR; no vomiting and no use of rescue medication) during the overall study period (days 1–5). The antiemetic response was evaluated during the acute (day 1) and delayed (days 2–5) phases.

Results

Sixty-eight patients were enrolled (median age 61 years, 56 females; BC = 40, CRC = 28). CR was observed in 46 of 68 patients (67.6%), while CR during the acute and delayed phases was 75.0% in each cancer group. The antiemetic regimen was well tolerated.

Conclusions

A single administration of palonosetron and dexamethasone on day 1 in BC and CRC patients adequately controls CINV during the entire period of emetic risk.
TomoTherapy stereotactic body radiation therapy (SBRT) for the salvage treatment of locally recurrent esophageal adenocarcinoma following trimodality therapy: A case report
Authors: Russo James Kyle , Rosen Lane
Published: February 2018

Esophageal cancer patients with local recurrence after chemoradiation and surgery (trimodality therapy) have limited palliative treatment options. We present a case of local recurrence successfully palliated using TomoTherapy stereotactic body radiation therapy (SBRT). The patient was a 58-year-old man with distal esophageal adenocarcinoma initially treated with trimodality therapy. Symptomatic local recurrence developed 4 years later. Using TomoTherapy SBRT successful palliation was achieved with 3500 cGy in 7 fractions given every other weekday. He remained free of local recurrence without requiring further local therapies, eventually succumbing to metastatic disease 11 months after radiation. Presently there are no reported cases of malignant esophageal obstruction treated with SBRT. Radiosurgery is increasingly used in extracranial sites such as the liver, lung and spine. Reirradiation was convenient and well tolerated by our patient and the response durable. Palliation of local recurrence in esophageal cancer initially treated with trimodality therapy can be achieved using SBRT and is a reasonable option in appropriately selected patients. Further studies are needed to clarify its role in this and other body sites.
Smoking in young and adult population, Italy 2009
Authors: Tramacere Irene , Gallus Silvano , Pacifici Roberta , Zuccaro Piergiorgio , Colombo Paolo , La Vecchia Carlo
Published: February 2018

Aims and background

To monitor smoking prevalence and trends of young and adult populations in Italy.

Method and study design

A survey on smoking was conducted during March-April 2009 on a sample of 3213 participants (1546 men and 1667 women), representative of the Italian population aged 15 years or over. Data from a simplified questionnaire were collected in an over-sample of 1010 young individuals, reaching a total of 1390 participants aged 15–24 years (713 males and 677 females).

Results

In 2009, 25.4% of Italians described themselves as current cigarette smokers (28.9% of men and 22.3% of women). Among young people, male smoking prevalence steadily declined from 38% in 2001 to 29% in 2009. Smoking prevalence in young females decreased from 30% in 2001 to 19% in 2008, but increased to 23% in 2009. Among both males and females aged 15–17 years, smoking prevalence was around 10%. This increased in the 18–24 year age group, with 37.6% of current smokers among males and 28.9% among females. Among young current smokers, 45.5% reported that they would reduce the number of cigarettes smoked per day, 11.1% would quit smoking, and 4.3% would switch to hand-rolled cigarettes, assuming that the minimum price of a pack of cigarettes increased to €5.

Conclusions

Our findings indicate that smoking prevalence has decreased over recent years, particularly in the young. Still, over one-fourth of Italian adults are smokers. An increase in cigarette price represents an effective strategy to control tobacco, particularly in the young.
Using administrative data to identify and stage breast cancer cases: Implications for assessing quality of care
Authors: Yuen Elaine , Louis Daniel , Cisbani Luca , Rabinowitz Carol , De Palma Rossana , Maio Vittorio , Leoni Maurizio , Grilli Roberto
Published: February 2018

Aims and background

The study evaluated the use of Italian hospital discharge data (SDO, scheda di dimissione ospedaliera) for identifying women with incident breast cancer, determining stage at diagnosis and assessing quality of care.

Study design

Women aged 20+ years residing in the Regione Emilia-Romagna, Italy, between 2002 and 2005 were studied. Case identification using algorithms based on ICD-9-CM codes on hospital discharge data were compared with AIRTUM-accredited cancer registry data. Sensitivity, specificity and positive predictive value were computed overall, by age and cancer stage. Compliance with guidelines for radiation therapy using registry and hospital data were compared.

Results

A total of 11,615 women was identified by AIRTUM-accredited cancer registries as incident cases, whereas 10,876 women were identified by the SDO algorithm. Sensitivity was 84.8%, specificity was 99.9%, and the positive predictive value was 90.6%. Of the 1,022 who were false positives, 363 (35.5%) were women identified in registry data as having an incident case prior to 2002 and therefore were not included in the analysis. There were 1,761 false negatives; nearly 50% were over 70 years of age or did not undergo a surgical procedure and therefore were not included in our SDO-based case finding. Sensitivity declined as the patient population became older. However, we observed relatively good positive predictive value for all age groups. Algorithms using the SDO data did not clearly identify specific cancer stages. However, the algorithm may have utility where stages are grouped together for use in quality measures.

Conclusions

Cases were identified with good sensitivity, specificity and positive predictive value with SDO data, with better rates than similar previously published algorithms based on Italian data. These hospital claims-based algorithms facilitate quality of care analyses for large populations when registry data are not available by identifying individual women and their subsequent use of health care services.
Phase II trial of oxaliplatin plus oral capecitabine as first-line chemotherapy for patients with advanced gastric cancer
Authors: Yang Tingsong , Shen Xiaojun , Tang Xiaojun , Wei Guo , Zhang Hao , Du Chenghui , Xue Xuchao , Ma Liye , Nie Mingming , Bi Jianwei
Published: February 2018

Aims and background

The efficacy of chemotherapy for advanced gastric cancer is now widely accepted. However, the survival advantage is small, and no internationally accepted standard regimen has emerged. The present study investigated the efficacy and safety of oxaliplatin plus oral capecitabine (XELOX regimen) as first-line chemotherapy in previously untreated patients with advanced gastric cancer.

Methods and study design

Patients received intravenous oxaliplatin (130 mg/m2 over 2 h on day 1) plus oral capecitabine (1,000 mg/m2 twice daily on days 1–14). Treatments were repeated every 3 weeks.

Results

Seventy-four patients were enrolled in the study, median age was 61 years (range, 32–74); median follow-up was 13.2 months (range, 2–24.5). In total, 364 cycles of chemotherapy were delivered. Overall response rate was 62.2% (95% CI, 51.2–73.2), with 3 complete and 43 partial responses; median time to progression and overall survival were 5.9 (95% CI, 4.8–7.0) and 10.8 months (95% CI, 7.9–13.7), respectively. The most common hematological adverse event was anemia (67.6% of patients). Grade 3–4 neutropenia was observed in 5 patients. The most common nonhematological toxicities were neuropathy (64.9%), nausea/vomiting (48.6%), diarrhea (28.4%), and hand-foot syndrome (39.2%). Grade 3–4 toxicities were rare. There were no treatment-related deaths.

Conclusions

The XELOX regimen was active and well-tolerated as first-line chemotherapy in patients with advanced gastric cancer.
Bisphosphonate-induced osteonecrosis of the jaw in patients with bone metastatic, hormone-sensitive prostate cancer. Risk factors and prevention strategies
Authors: Bantis Athanasios , Zissimopoulos Athanasios , Sountoulides Petros , Kalaitzis Christos , Giannakopoulos Stelios , Deftereos Savas , Tsakaldimis Giorgos , Thomaidis Vasilios , Touloupidis Stavros
Published: February 2018

Aims and background

Evidence from the literature suggests that osteonecrosis of the jaw is emerging as a serious complication of treatment with bisphosphonates for patients with advanced prostate cancer.

Methods and study design

This study is a series of 60 patients with osseous metastases from prostate cancer under complete androgen deprivation therapy. All patients also received bisphosphonates intravenously every 3 to 4 weeks. Over a period of 3 and a half years, we recorded the incidence, presenting signs and symptoms of osteonecrosis of the jaw among those patients and the diagnostic workup required.

Results

Nine of the 60 patients with metastatic prostate cancer were found to be affected with osteonecrosis of the jaw secondary to bisphosphonate administration at the Urology Department at the University Hospital of Alexandroupolis between January 2006 and August 2009. For diagnostic reasons, all 9 patients underwent computed tomography scan and magnetic resonance imaging of the maxillary region, as well as a three-phase whole body bone scan.

Conclusions

There is evidence that administration of bisphosphonates in patients with advanced prostate cancer may increase the risk of osteonecrosis of the jaw. Guidelines regarding the diagnosis and management of those patients are needed.
Importance of adherence to guidelines in breast cancer clinical practice. The Italian experience (AIOM)
Authors: Barni Sandro , Venturini Marco , Molino Annamaria , Donadio Michela , Rizzoli Sara , Maiello Evaristo , Gori Stefania
Published: February 2018

Aims and background

Project RIGHT (Research for the Identification of the most effective and hIGHly accepted clinical guidelines for cancer Treatment) is promoted by the Italian Association of Medical Oncology (AIOM) to evaluate the concordance between AIOM breast cancer guidelines and clinical practice in Italy. In RIGHT-1, feasibility and the appropriateness of indicators were assessed in patients with early breast cancer. RIGHT-2 evaluated the compliance with guidelines in a nationwide program.

Methods

Thirty-five Italian centers participated in the RIGHT-2 survey. Ten indicators were evaluated to verify an agreement between 2005 AIOM breast cancer guidelines and practice. Patients with clinical stage I-II invasive breast cancer, age ≤70 years, who had their first visit at the oncology center between October 2005 and November 2006 were included.

Results

In RIGHT-2, ≥90% adherence for the diagnosis indicator and three therapy indicators were observed. The lowest degree of compliance (0%) was observed for the follow-up indicator in asymptomatic patients.

Conclusions

In RIGHT-2, compliance to the 2005 AIOM breast cancer guidelines was 64%. When the follow-up indicator was eliminated, overall adherence to AIOM guidelines was 71%. The results highlight the need to continue improving the already good standards of breast cancer care.
A feasibility study of zoledronic acid combined with carboplatin/nedaplatin plus paclitaxel in patients with non-small cell lung cancer with bone metastases
Authors: Ishiwata Toshiji , Hirose Takashi , Hirama Michihiro , Miura Kayo , Iwakami Shin-ichiro , Tominaga Shigeru , Adachi Mitsuru , Takahashi Kazuhisa
Published: February 2018

Aims and background

Although zoledronic acid (ZOL) has been reported to inhibit bone metastasis from lung cancer, the optimum chemotherapy regimen in combination with ZOL has not yet been determined.

Methods and study design

Eighteen patients having non-small cell lung cancer (NSCLC) with bone metastasis who received carboplatin/nedaplatin plus paclitaxel combined with ZOL (4 mg every 28 days) were enrolled to investigate the feasibility of this treatment. The efficacy was evaluated by the percentage of patients at 9 months who were receiving radiation therapy, the time to first radiation treatment, and quality of life. Adverse effects were also evaluated.

Results

Only 3 among 18 patients received radiation therapy for bone metastases during the 9 months of the study. ZOL seems to prolong the median time to the first radiation treatment and maintain the quality of life regarding pain and activity status. No patients discontinued the treatment, although grade 3 or 4 treatment-related adverse effects occurred in 8 patients.

Conclusions

ZOL combined with carboplatin/nedaplatin plus paclitaxel is an effective and tolerable treatment for NSCLC with bone metastases.
Radiation therapy is a treatment to be considered for recurrent epithelial ovarian cancer after chemotherapy
Authors: Lee Shin-Wha , Park Sang-Min , Kim Yong-Man , Kim Young-Seok , Choi Eun-Kyung , Kim Dae-Yeon , Kim Jong-Hyeok , Nam Joo-Hyun , Kim Young-Tak
Published: February 2018

Aims and background

Radiation therapy provides a safe and effective alternative treatment option for recurrent epithelial ovarian cancer, although it has not been a treatment of choice. We evaluated the efficacy and toxicity of radiation therapy for recurrent epithelial ovarian cancer after chemotherapy according to the disease status.

Methods

This was a retrospective study of 38 patients with recurrent epithelial ovarian cancer treated with radiation therapy at the Asan Medical Center, Seoul, Korea, between January 1997 and December 2007. We analyzed their clinical characteristics and the outcome of radiation therapy.

Results

Thirty-eight patients were treated with radiation therapy. Their median age was 51.5 years. Most patients were FIGO stage III (27/38) with serous adenocarcinoma (26/38). All patients had received at least one regimen of platinum-based chemotherapy; 24 patients were sensitive to the first chemotherapy and the others were resistant. Lymph node and abdominopelvic wall were the most common sites of radiation therapy. The response rate was 65.0% (16 complete remissions and 10 partial remissions), and the median regression rate was 78.8% (range, −66.6 to 100.0). Median progression-free survival was 7.2 months (range, 1.0–66.6). In 28 patients who had a solitary relapsed site from the radiographic finding at the time of radiation therapy, it was 10.7 months (range, 1.8–66.6). Neither hematologic nor intestinal toxicity of grade 3–4 was observed. Prognostic factors were sensitivity to platinum and the site treated with radiation therapy.

Conclusions

Radiation therapy is a treatment that should be considered for recurrent epithelial ovarian cancer, especially in good responders to platinum or patients with solitary relapsed lesions.
Dosimetric and clinical predictors of radiation-induced lung toxicity in esophageal carcinoma
Authors: Zhu Shu-chai , Shen Wen-bin , Liu Zhi-kun , Li Juan , Su Jing-wei , Wang Yu-xiang
Published: February 2018

Aims and background

Radiation-induced lung toxicity occurs frequently in patients with esophageal carcinoma. This study aims to evaluate the clinical and three-dimensional dosimetric parameters associated with lung toxicity after radiotherapy for esophageal carcinoma.

Methods and study design

The records of 56 patients treated for esophageal carcinoma were reviewed. The Radiation Therapy Oncology Group criteria for grading of lung toxicity were followed. Spearman's correlation test, the chi-square test and logistic regression analyses were used for statistical analysis.

Results

Ten of the 56 patients developed acute toxicity. The toxicity grades were grade 2 in 7 patients and grade 3 in 3 patients; none of the patients developed grade 4 or worse toxicity. One case of toxicity occurred during radiotherapy and 9 occurred 2 weeks to 3 months after radiotherapy. The median time was 2.0 months after radiotherapy. Fourteen patients developed late irradiated lung injury, 3 after 3.5 months, 7 after 9 months, and 4 after 14 months. Radiographic imaging demonstrated patchy consolidation (n = 5), atelectasis with parenchymal distortion (n = 6), and solid consolidation (n = 3). For acute toxicity, the irradiated esophageal volume, number of fields, and most dosimetric parameters were predictive. For late toxicity, chemotherapy combined with radiotherapy and other dosimetric parameters were predictive. No obvious association between the occurrence of acute and late injury was observed.

Conclusions

The percent of lung tissue receiving at least 25 Gy (V25), the number of fields, and the irradiated length of the esophagus can be used as predictors of the risk of acute toxicity. Lungs V30, as well as chemotherapy combined with radiotherapy, are predictive of late lung injury.
Treatment of recurrent high-grade gliomas with GliaSite brachytherapy: A prospective mono-institutional Italian experience
Authors: Gobitti Carlo , Borsatti Eugenio , Arcicasa Mauro , Roncadin Mario , Franchin Giovanni , Minatel Emilio , Skrap Miran , Zanotti Bruno , Tuniz Francesco , Cimitan Marino , Capra Elvira , Drigo Annalisa , Trovò Mauro G
Published: February 2018

Aims and background

The present study evaluated toxicity, local control, and survival in patients with relapsed high-grade glioma after surgery and external beam radiation therapy and treated with re-operation and GliaSite brachytherapy.

Methods

Between 2006 and 2008, 15 patients with recurrent high-grade glioma underwent re-operation and GliaSite brachytherapy. Ten patients were males and 5 females. Median age was 40 years (range, 20–71). Karnofsky performance status was ≥70. All patients but one received GliaSite irradiation of the surgical cavity wall at the dose of 4500 cGy at a depth of 1 cm.

Results

No severe acute side effects were observed during GliaSite brachytherapy. Pathologically documented, symptomatic late radiation necrosis was observed in 3 patients (20%); 2 subsequently died of further complications. Two patients were alive at a median follow-up 13 months (range, 1–30). Median overall survival after GliaSite brachytherapy was 13 months.

Conclusions

Patients with recurrent high-grade glioma can be treated with additional surgery and GliaSite brachytherapy, delivering 4500 cGy at 1 cm depth without significant acute side effects but with a significant rate (20%) of late radiation necrosis, resulting in 13% of treatment-related deaths. Compared with the literature, survival results in our study appear to be satisfactory, but they may be related to patient selection criteria. Re-intervention followed by GliaSite brachytherapy should not be offered as a standard treatment for recurrent high-grade glioma, because of the high rate of late complications, treatment-related deaths, and high treatment costs.
Detection of somatostatin receptor subtypes 2 and 5 by somatostatin receptor scintigraphy and immunohistochemistry: Clinical implications in the diagnostic and therapeutic management of gastroenteropancreatic neuroendocrine tumors
Authors: Sclafani Francesco , Carnaghi Carlo , Di Tommaso Luca , Rodari Marcello , Destro Annarita , Rimassa Lorenza , Giordano Laura , Chiti Arturo , Roncalli Massimo , Santoro Armando
Published: February 2018

Aims and background

Somatostatin receptor scintigraphy (SRS) is the standard method for the detection of somatostatin receptors (SSTRs). It is commonly used in gastroenteropancreatic neuroendocrine tumor (GEP-NET) staging, and represents the criterion of choice for treatment with somatostatin (SST) analogs. Immunohistochemistry (IHC) was reported as a reliable method for the detection of SSTRs with theoretically superior sensitivity over SRS.

Methods and study design

We retrospectively analyzed the sensitivity and specificity of IHC in the detection of SSTRs in a cohort of consecutive patients with GEP-NETs attending our Institute from 1997 to 2007. IHC analysis was restricted to SSTR2 and SSTR5, and the results were interpreted according to two different scoring systems. SRS was used as the gold standard.

Results

Forty-four patients were enrolled; 24 (55%) had foregut carcinoids, 9 (20%) midgut carcinoids, 2 (5%) hindgut carcinoids, and 9 (20%) had GEP-NETs of unknown primary sites. A high concordance rate between IHC and SRS was shown, irrespective of the IHC scoring system applied (73% and 70%). The sensitivity of IHC was 89.3% and 78.6% and the specificity 43.8% and 50%, depending on the scoring system used.

Conclusions

Although SSTR2 was shown to be expressed by IHC in up to 50% of tumors not visualized by SRS, SRS still remains the method of choice in the diagnostic and therapeutic management of GEP-NETs. More pathological and clinical data are needed to properly understand the clinical relevance of immunohistochemical detection of SSTR expression in the absence of tumor uptake at SRS.
Preparation of anti-NYD-SP8 rabbit polyclonal antibody and its application in the analysis of NYD-SP8 expression in nasopharyngeal carcinoma cell lines and clinical tissues
Authors: Yang Ling-Lin , Wu Jing-Bo , Liu Zhi-Gang , Liu Li , Zeng Mu-Sheng , Yan Shan-Shan , Chan Hsiao-Chang , Xia Yun-Fei
Published: February 2018

Aims and background

NYD-SP8 is a recently identified protein, the biological characteristics of which are still unclear. The aim of this study was to prepare an anti-NYD-SP8 rabbit polyclonal antibody and investigate the expression of NYD-SP8 in human nasopharyngeal carcinoma cell lines and nasopharyngeal carcinoma tissues.

Methods

The anti-NYD-SP8 rabbit polyclonal antibody was prepared and ELISA was performed to assess the antibody titer. With this antibody, the NYD-SP8 expression in four nasopharyngeal carcinoma cell lines, CNE1, CNE2, 5–8F and 6–10B, was examined by Western blot and its expression in clinical tissues was also assessed by immunohistochemistry.

Results

The anti-NYD-SP8 rabbit polyclonal antibody with a high titer was successfully prepared. Western blot showed higher NYD-SP8 expression in CNE2 and 6–10B cells and lower expression in CNE1 and 5–8F cells. Immunohistochemistry demonstrated overexpression of NYD-SP8 in nasopharyngeal carcinoma tissue while the expression in normal nasopharyngeal tissue was negligible.

Conclusions

Our anti-NYD-SP8 rabbit polyclonal antibody can be used both for Western blot and immunohistochemistry, and can be a valuable tool to investigate the function and distribution of NYD-SP8. The different NYD-SP8 expression in various nasopharyngeal carcinoma cell lines indicated its complicated functions at different biological stages. The overexpression of NYD-SP8 in clinical nasopharyngeal carcinoma tissue indicated that it could play an important role in nasopharyngeal carcinoma carcinogenesis.
MUTYH-associated colon disease: Adenomatous polyposis is only one of the possible phenotypes. A family report and literature review
Authors: Zorcolo Luigi , Fantola Giovanni , Balestrino Luisa , Restivo Angelo , Vivanet Caterina , Spina Francesca , Cabras Francesco , Ambu Rossano , Casula Giuseppe
Published: February 2018

Aims and background

The MutY human homologue gene (MUTYH) is responsible for about a quarter of attenuated familial adenomatous polyposis. Occasionally, it has been associated with hyperplastic polyps and serrated adenoma. We report a family where the same MUTYH mutation determined four different phenotypes, including a case of hyperplastic polyposis syndrome.

Patients and methods

A family with a history of right-sided colon cancer and multiple colonic polyposis was investigated. Genetic tests were correlated with clinical findings to define phenotypic manifestations of MUTYH mutations. The pertinent English-language literature was reviewed to evaluate the risk of malignancy of MUTYH and the role of prophylactic surgery.

Results

Three male siblings carried a biallelic MUTYH mutation (G382D-exon13), while the fourth was heterozygote. One developed an isolated cecal cancer at the age of 48. Another, aged 38, was diagnosed with numerous minute colonic and rectal polyps and underwent a proctocolectomy, with final pathology showing a picture of hyperplastic and lymphoid polyposis. The third biallelic brother, 46 years old, developed four hyperplastic lesions, while the heterozygote brother had a large flat serrated adenoma of the right colon removed at the age of 50.

Conclusion

Many aspects of MUTYH mutation still need to be clarified and one of them regards the different phenotypic expressions. Although the majority of reported cases manifested attenuated adenomatous polyposis, hyperplastic polyps and serrated adenomas appear to be more common than expected. Presenting hyperplastic polyposis syndrome is very unusual and may represent a clinical dilemma for correct management. Current evidence suggests to handle MUTYH-associated polyposis as typical FAP.
Cancer Research Performance in the European Union: A Study of Published Output from 2000 to 2008
Authors: Micheli Andrea , Di Salvo Francesca , Lombardo Claudio , Ugolini Donatella , Baili Paolo , Pierotti Marco A
Published: February 2018

Aims and Background

Although several studies have assessed cancer research performance in individual European countries, comparisons of European Union (EU27) performance with countries of similar population size are not available.

Methods

We compared cancer research performance in 2000–2008 between EU27 and 11 countries with over 100 million inhabitants. Performance should not have been affected by the 2007–2009 recession. We examined 143 journals considered oncology journals by Journal Citation Reports, accessing them via Scopus. Publications were attributed to countries using a published counting procedure.

Results

For number of publications, the USA held a clear lead in 2006–2008 (yearly averages: 10,293 USA vs 9,962 EU27), whereas the EU27 held the lead previously. EU27 was also second to the USA for total impact factor. China markedly improved its cancer publications record over the period. Compared to the USA, EU27 and Japan, the other countries (all developing) had a poor publications record.

Conclusions

Comparative cancer research spending data are not available. However from 2002 to 2007, gross domestic expenditure on research and development (UNESCO data) increased by 34% in North America, 161% in China and only 28% in EU27. Thus the European Union is lagging behind North America and may well be eclipsed by China in research and development spending in the near future. We suggest that these new findings should be considered by policymakers in Europe and other countries when developing policies for cancer control.
Prevention of Cutaneous Damages Induced by Radiotherapy in Breast Cancer: An Institutional Experience
Authors: Ravo Vincenzo , Calvanese Maria Grazia , Di Franco Rossella , Crisci Vincenzina , Murino Paola , Manzo Roberto , Morra Anna , Cammarota Fabrizio , Muto Paolo
Published: February 2018

Background and Aims

A minimal part of patients treated with radiotherapy on the entire breast may present an acute, subacute or chronic cutaneous damage of the healthy tissues involved in the radiation fields. The aim of this retrospective study was to evaluate the most efficient topical hydrating treatment in the prevention of cutaneous radio-induced acute effects in breast cancer.

Material and Methods

From February 2009 to March 2010, 100 patients affected by breast cancer have been recruited, all of the female sex and with an average age of 47 years. The following topical treatments were compared: Pure vitamin E (Vea lipogel®), Omega-3,6,9 (Quinovit®), Betaglucan, sodium hyaluronate (Neoviderm®), Vitis vinifera A.s-I-M.t-O.dij, (Ixoderm®), natural triglycerides-fitosterols (Xderit®). All enrolled patients were subjected to breast conservative treatment (quadrantectomy with or without homolateral axillary dissection) and without prosthesis positioning, in combination or not with hormonal treatment. Evaluation of the cutaneous acute toxicity was defined according to the RTOG scale either during radiotherapy and during follow-up (3 months after radiation treatment).

Results

All patients completed the radiotherapy; 62% of patients presented G0-G1 cutaneous toxicity, 28% have developed G2 cutaneous toxicity, 10% have developed G3 toxicity; no patient presented G4 toxicity. Analysis of the data revealed a correlation between the topical treatment used and the incidence of cutaneous toxicity.

Conclusions

Of the patients who used the cutaneous hydrating creams – betaglucan, sodium hyaluronate (Neoviderm®) and Vitis vinifera A.s-I-M.t-O.dij (Ixoderm®) – during the radiation treatment, 80% developed G0-G1 toxicity and 20% G2 toxicity. The patients who used the other hydrating creams tested in the study manifested not only G1-G2 toxicity but also some G3 toxicity. Chemotherapeutic treatment with taxanes and/or anthracyclines did not result in an increased breast cutaneous toxicity induced by radiotherapy. The hormone therapy given to patients undergoing radiotherapy did not result in increased breast cutaneous toxicity. Further analysis on a larger number of patients is necessary for definitive results.
Non-Sentinel Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node: Validation of Five Nomograms and Development of a New Predictive Model
Authors: Lombardi Augusto , Maggi Stefano , Russo Marzia Lo , Scopinaro Francesco , Di Stefano Domenica , Pittau Maria Grazia , Tiberi Simone , Amanti Claudio
Published: February 2018

Aims and Background

Discordance of intraoperative analysis with definitive histology of the sentinel lymph node in breast cancer leads to completion axillary lymph node dissection, which only in 35–50% shows additional nodal metastases. The aim of the study was to identify individual patient risk for non-sentinel lymph node metastases by validating several statistical methods present in the recent literature and by developing a new tool with the final goal of avoiding unnecessary completion axillary lymph node dissection.

Methods

We retrospectively evaluated 593 primary breast cancer patients. Completion axillary lymph node dissection was performed in 139 with a positive sentinel lymph node. The predictive accuracy of five published nomograms (MSKCC, Tenon, Cambridge, Stanford and Gur) was measured by the area under the receiver operating characteristic curve. We then developed a new logistic regression model to compare performance. Our model was validated by the leave-one-out cross-validation method.

Results

In 53 cases (38%), we found at least one metastatic non-sentinel lymph node. All the selected nomograms showed values greater than the 0.70 threshold, and our model reported a value of 0.77 (confidence interval = 0.69–0.86 and error rate = 0.28) and 0.72 (confidence interval = 0.63–0.81, error rate = 0.28) after the validation. With a 5% cutoff value, sensitivity was 98% and specificity 9%, for a cutoff of 10%, 96% and 2%, respectively.

Conclusions

All the nomograms were good discriminators, but the alternative developed model showed the best predictive accuracy in this Italian breast cancer sample. We still confirm that these models, very accurate in the institution of origin, require a new validation if used on other populations of patients.
Effect of Endostatin on Preventing Postoperative Progression of Distant Metastasis in a Murine Lung Cancer Model
Authors: Wang He-Lan , Ning Tao , Li Mei , Lu Ze-Jun , Yan Xi , Peng Qian , Lei Na , Zhang Hui , Luo Feng
Published: February 2018

Aims and Background

The relapse and metastasis of cancer remain a predominant cause of death after surgical removal of the primary tumor. There is a positive linkage between the postoperative upregulation of systemic angiogenic activity and distant tumor metastasis. In the present study, we established a spontaneous metastasis model and investigated whether antiangiogenic therapy using endostatin could prevent the progression of distant metastasis after removal of the primary tumor.

Methods

Female C57BL/6 mice were implanted subcutaneously with 1 × 106 Lewis lung cancer cells. Twenty days after implantation of the cancer cells, the primary tumor was removed and the mice were randomly divided into three groups. The NS group received normal saline, the L-ES group received 3 mg/kg endostatin, and the H-ES group received 20 mg/kg endostatin intravenously daily for 10 days. The effect of endostatin on lung metastases and the survival time of the mice were observed. Flow cytometry and immunohistochemistry were carried out to assess the angiogenic activity. The serum endostatin levels in peripheral blood were measured using an enzyme-linked immunosorbent assay.

Results

The mean number of metastatic pulmonary nodules and the mean net lung weight in the NS, L-ES and H-ES groups was 10.2, 2.8 and 4.0, and 0.55g, 0.31g and 0.36g, respectively. The difference between the NS group and the endostatin-treated groups was statistically significant (P <0.05). The endostatin-treated mice showed prolonged overall survival (P <0.05). Compared with the NS group, the endostatin-treated groups had lower levels of circulating endothelial cells in peripheral blood and showed a decrease in microvessel density in the metastatic tumors, with a more marked reduction in the L-ES group (P <0.05). The systemic presence of endostatin was gradually increased with the continued administration of endostatin to the mice.

Conclusions

Antiangiogenic therapy with endostatin is effective in inhibiting the postoperative progression of distant metastasis.
Lifestyle and Breast Cancer Recurrences: The DIANA-5 Trial
Authors: Villarini Anna , Pasanisi Patrizia , Traina Adele , Mano Maria Piera , Bonanni Bernardo , Panico Salvatore , Scipioni Corrado , Galasso Rocco , Paduos Adriana , Simeoni Milena , Bellotti Elena , Barbero Maggiorino , Macellari Giorgio , Venturelli Elisabetta , Raimondi Milena , Bruno Eleonora , Gargano Giuliana , Fornaciari Giuseppe , Morelli Daniele , Seregni Ettore , Krogh Vittorio , Berrino Franco
Published: February 2018

Aims and Background

The DIANA (Diet and Androgens)-5 study is a multi-institutional randomized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles, associated with moderate physical activity, in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu. The intervention is expected to reduce serum insulin and sex hormones, which were associated with breast prognosis in previous studies.

Methods

Between 2008 and 2010, the study randomly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group, to be followed-up through 2015. General lifestyle recommendations for the prevention of cancer are given to both groups, and the intervention group is being offered a comprehensive lifestyle intervention, including cooking classes, conferences, common meals and exercise sessions. Adherence assessments occurred at baseline and at 12 months and are planned at 36 and 60 months. They include food frequency diaries, anthropometric measures, body fat distribution assessed with impedance scale, one week registration of physical activity with a multisensor arm-band monitor, metabolic and endocrine blood parameters. Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are validated through medical record verification.

Results

The randomized groups were comparable for age (51.8 years), proportion of ER-negative tumors (22%), axillary node metastasis (42%), reproductive variables, tobacco smoking, blood pressure, anthropometric measurements and hormonal and metabolic parameters.

Conclusions

DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences. We will assess evidence of effectiveness, first by comparing the incidence of additional breast cancer events (local or distant recurrence, second ipsilateral or contralateral cancer) in the intervention and in the control group, by an intention-to-treat analysis, and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score.
Radiotherapy for Inoperable Non-Small Cell Lung Cancer using Helical Tomotherapy
Authors: Monaco Alessia , Caruso Cristina , Giammarino Daniela , Cianciulli Michele , Pressello Maria Cristina , Donato Vittorio
Published: February 2018

Aim

To investigate the impact of tomotherapy on the dose delivered to the lungs and other normal tissues.

Material and Methods

From February 2008 to May 2009, 35 patients with stage IIIA/IIIB non-small cell lung cancer were treated with helical tomotherapy at the S. Camillo-Forlanini Hospital. For our study we selected 20 patients who underwent chemotherapy followed by sequential radiotherapy. The planning target volume was delineated using planning CT scan and FDG-PET. The mean prescribed radiation dose was 67.5 Gy delivered in 30 fractions at a dose of 2.25 Gy per fraction.

Results

Median follow-up was 12.3 months. All patients developed acute esophageal toxicity, 15 of RTOG grade 1 and 5 of RTOG grade 2. At first follow-up 15 patients presented stable disease or partial response, 4 patients presented complete response, and 1 patient presented disease progression.

Conclusions

Helical tomotherapy is useful to achieve dose-per-fraction escalation without increasing the treatment-related morbidity. Our results applying dose escalation were encouraging considering that we delivered doses that may be difficult to achieve with 3-dimensional treatments with no excessive complication rates.
Emotional Distress and Needs in Italian Cancer Patients: Prevalence and Associations with Socio-Demographic and Clinical Factors
Authors: Annunziata Maria Antonietta , Muzzatti Barbara , Bidoli Ettore , Veronesi Andrea
Published: February 2018

Aims and Background

Since emotional distress is a relevant psycho-social component of an oncological disease experience, its study is useful in multidisciplinary patient cancer care. In the present research, emotional distress together with needs during hospitalization were recorded and their associations with several socio-demographic and clinical variables were verified.

Methods and Study Design

Five hundred and forty-four consecutive oncological in-patients completed two self-assessment questionnaires concerning emotional distress and needs (i.e., Hospital Anxiety and Depression Scale, Needs Evaluation Questionnaire).

Results

27.4% and 20.8% of the enrolled patients were probable cases, respectively, for anxiety and depression; when possible cases were included the percentages raised to 52.5% and 39.3%, respectively. Furthermore, 11.9% and 20.2% of participants were simultaneously probable and possible cases for both conditions. Few differences in anxiety and depression according to socio-demographic and clinical variables were demonstrated, whereas needs seemed to be more frequently associated to them. Finally, needs also seemed to be associated with both anxiety and depression, with possible and probable cases for anxiety and depression displaying more needs than non-cases.

Conclusions

The implications for both the quality of care and disease adjustment by cancer patients are discussed together with study limitations.