bluuebunny/crossref_metadata_2025 huggingface dataset:
Her2/neu Expression by Reverse Transcriptase-Polymerase Chain Reaction in the Peripheral Blood of Prostate Cancer Patients
Authors: Fantinato Ana Paula , Tobias-Machado Marcos , Fonseca Fernando , Pinto Jorge Luiz Freire , Wroclawski Marcelo Langer , Wroclawski Eric , Verotti Maurício , Del Giglio Auro
Published: February 2018

Background/Aims

Evaluation of Her2/neu expression in the peripheral blood mononuclear cell fraction of prostate cancer patients by RT-PCR may afford an opportunity for the detection of circulating tumor cells and thus serve as a marker of micrometastatic disease.

Methods

We studied Her2/neu expression by reverse transcriptase-polymerase chain reaction in peripheral blood mononuclear cell fraction samples of 21 controls and serially in 43 patients with prostate cancer.

Results

None of the 21 controls expressed Her2/neu whereas 23.25% (95% CI, 11.75–38.63) of the patients were positive at entry into the study, and 65.11% (95% CI, 49.07–78.99) of them had at least one positive result during the follow-up period. Her2/neu positivity at study entry did not correlate significantly with PSA level, Gleason score, clinical stage or time to PSA progression. When we analyzed only patients with advanced disease, we observed a trend towards a shorter time to PSA progression in patients with at least one positive Her2/neu result during the follow-up (log-rank test, P = 0.08).

Conclusions

We conclude that Her2/neu expression in the peripheral blood mononuclear cell fraction of prostate cancer patients is frequent and therefore this assay may potentially be useful to detect the presence of micrometastatic disease in men with prostate cancer and for monitoring patients enrolled in trastuzumab-based therapeutic protocols.
Low Frequency of p53AND k-ras Codon 12 Mutations in Non-Small Cell Lung Carcinoma(NSCLC) Tumors and Surgical Margins
Authors: Vatan Ozgur , Bilaloglu Rahmi , Tunca Berrin , Cecener Gulsah , Gebitekin Cengiz , Egeli Unal , Yakut Tahsin , Urer Nur
Published: February 2018

Aims and Background

Lung cancer is one of the most common cancers and has became a predominant cause of cancer-related death throughout the world. The k-ras codon 12 mutation, which is the most common lung cancer mutation, is found in 15 to 30% of all lung cancers. Furthermore, the p53 gene has a very important role in the biological properties of tumor cells, and it is mutated in about 50% of non-small cell lung cancers. Residual tumor cells remain in surgical margins diagnosed as tumor free by histopathological techniques, and they can play a role in forming any local recurrence. Molecular methods may be exploited that are sensitive enough to detect small numbers of tumor cells.

Methods

In the present study, we examined p53 gene mutations and k-ras codon 12 mutations from the tumor samples and surgical margins of 34 non-small-cell lung cancer patients. P53 gene mutations were analyzed by single strand conformational polymorphism analysis, heterodublex analysis and DNA sequencing. K-ras codon 12 mutations were analyzed by the mutagenic PCR-restricted fragment length polymorphism method.

Results

A p53 mutation was detected only in primary tumors of 3 out of 34 patients (8.82%). These mutations were clustered in exon 5. Moreover, a k-ras codon 12 mutation was detected in both the primary tumor and the surgical margin tissues of 2 out of 34 patients (5.88%).

Conclusions

The detected mutation rate was low, in the range given in the literature. We think that different mechanisms related to other genes and individual genetic differences might play a role in cancer formation in our study group. We believe that molecular studies are necessary to identify biomarkers and to determine genetic alterations in histopathologically normal surgical margins.
Development and Validation of a Patient-Physician Relationship Index in the Advanced Cancer Setting
Authors: Ostacoli Luca , Costantini Massimo , Beccaro Monica , Dellai Monica , Gorzegno Gabriella , Picci Rocco Luigi , Sguazzotti Erica , Berruti Alfredo , Torta Riccardo , Furlan Pier Maria
Published: February 2018

Background

The quality of the relationship between patient and medical staff is crucial in oncological settings. We have developed and validated a short, self-administered questionnaire to measure patients’ satisfaction with their relationship with the physician: the Patient-Physician Relationship Index (PPRI).

Materials and Methods

Content validity was evaluated by a two-stage (development and judgment) process. One hundred and nine cancer patients with metastatic disease were assessed during the second cycle of chemotherapy and 59 were reassessed eight weeks later. Quality of life and anxiety and depression were also evaluated.

Results

The PPRI is monofactorial. Cronbach's alpha coefficient was 0.81. Sensitivity to change was shown by the correlation with changes in patients’ conditions. The PPRI scores were only weakly correlated with the majority of the EORTC and HAD subscale scores.

Conclusion

The PPRI is an easy-to-use, self-administered questionnaire, developed in a population of patients with advanced cancer. It has good internal consistency and sensitivity to change.
Survival Benefit with GM-CSF Use after High-Dose Chemotherapy in High-Risk Breast Cancer
Authors: Kuzhan Okan , Özet Ahmet , Ulutin Cüneyt , Kömürcü Şeref , Arpaci Fikret , Öztürk Bekir , Öztürk Mustafa
Published: February 2018

Aims and background

The role of high-dose chemotherapy in breast cancer has not been fully defined. It has been concluded that new trials should focus on defining potential subgroups that are more likely to benefit from high-dose chemotherapy. We compared survival differences in patients receiving human granulocyte-colony stimulating factor (G-CSF) or granulocyte-monocyte colony stimulating factor (GM-CSF) after high-dose chemotherapy with stem cell support.

Methods

High-risk non-metastatic breast cancer patients (axillary lymph node involvement more than 8) aged 16 to 65 years and with a performance status ≤1 underwent high-dose chemotherapy with autograft. Written informed consent was obtained from every patient, and the study was approved by the local ethics committee.

Results

For 54 eligible women, the median follow-up was 41.4 months. The five-year disease-free survival was 45.7%. The five-year projected overall survival rate was 53.9%. Among them, patients who received GM-CSF (n = 12) posttransplant lived longer than the patients who received G-CSF (n = 15) (five year survival rates, 46.6% vs 75%, P <0.050). The patients who received GM-CSF posttransplant had fewer relapses (5 vs 9). However, between the two groups there was no statistically significant difference regarding disease-free survival rates calculated with the Kaplan-Meier method (58.8% vs 40%; P = 0.121).

Conclusions

Patients receiving GM-CSF posttransplant lived longer and they had fewer relapses than those who received G-CSF. This result merits consideration. The antitumor activity of GM-CSF should be investigated further in prospective randomized trials.
Neutropenic Enterocolitis: Is There Aright Timing for Surgery? Assessment of a Clinical Case
Authors: Bagnoli Pietro , Castagna Luca , Cozzaglio Luca , Rossetti Carlo , Quagliuolo Vittorio , Zago Mauro , Santoro Armando , Doci Roberto
Published: February 2018

Neutropenic enterocolitis is a severe and potentially life-threatening complication that may affect patients undergoing chemotherapy for acute leukemia or lymphoma. These patients may develop systemic sepsis through bacterial or fungal translocation across the intestinal wall. In many cases neutropenic enterocolitis is confined to the cecum, but the entire colon is sometimes involved. Most patients are treated conservatively because an improvement occurs when the absolute neutrophil count rises. However, a surgical approach consisting of resection of the colon may sometimes be necessary, even in patients with complete aplasia and a high risk of complications. The right time to perform surgery is hard to define.

Intestinal wall thickness, evaluated by ultrasound, is an important prognostic factor which could act as a guide to surgical indication. We analyze a case of neutropenic enterocolitis which occurred in a patient with acute myeloid leukemia during chemotherapy and we suggest that, as well as intestinal wall thickness, hemodynamic worsening should be considered an indication for surgery.
Long-term Outcome after Colorectal Cancer Resection. Patients’ Self-Reported Quality of Life, Sexual Dysfunction and Surgeons’ Awareness of Patients’ needs
Authors: Di Fabio Francesco , Koller Michael , Nascimbeni Riccardo , Talarico Carlo , Salerni Bruno
Published: February 2018

Aims and background

Current follow-up care programs focus mainly on detection of tumor recurrence or metachronous cancer. Other aspects that affect the quality of life (QoL) of long-term survivors, such as sexual dysfunction, psychological distress or depressive symptoms, have been poorly investigated. We studied these issues, and also investigated the surgeons’ awareness of their patients’ needs in order to determine how to improve follow-up care programs.

Methods

QoL of 62 colorectal cancer patients was assessed during follow-up using the European Organization for Research and Treatment of Cancer (EORTC) questionnaire QLQ-C30 and the symptom-specific module (QLQ-CR38). Postoperative sexual problems were evaluated with a 6-item questionnaire. Relevant needs to be examined during follow-up were investigated among patients and surgeons, by filling in the same checklist.

Results

During long-term follow-up (range, 14–74 months), rectal cancer patients reported lower QoL than colon cancer patients regarding defecation-related problems (P = 0.0001). Sixty-one percent of colon cancer patients reported no sexual dysfunction, whereas only 24% of individuals with rectal cancer reported no problems (P = 0.007). Patients reporting no sexual problems had significantly better QoL than the others, particularly with respect to physical functioning (P = 0.001), social functioning (P = 0.05), financial problems (P = 0.01) and body image (P = 0.0001). Addressing emotional problems during follow-up was important for 26% of the patients, while this was neglected by surgeons (P = 0.03).

Conclusions

QoL measurement in a clinical setting may help to detect QoL problems that could otherwise go unnoticed in the routine of follow-up care. Specifically, it was useful to detect defecation-related problems, sexual dysfunction and a mismatch in judging the importance of psychological distress between patients and their doctors. Neglecting these issues may cause long-term postoperative dissatisfaction.
Shoulder Function in Various Types of Neck Dissection. Role of Spinal Accessory Nerve and Cervical Plexus Preservation
Authors: Selcuk Adin , Selcuk Barin , Bahar Secil , Dere Huseyin
Published: February 2018

Aims and background

The aim of this study is to determine the effects of two different types of nerve-sparing neck dissection on shoulder function. Even if the spinal accessory nerve is spared in functional neck dissection, some degree of shoulder syndrome may occur. The role of the cervical plexus in shoulder function and the effects of dissection of level 5 are emphasized.

Methods

Twenty-six patients with laryngeal carcinoma were studied prospectively. Seventeen anterolateral and 15 functional neck dissections were performed. Electromyographic evaluation was carried out in all patients to assess spinal accessory nerve function preoperatively and at the sixth week and sixth month postoperatively. Shoulder disability was evaluated by a questionnaire (shoulder pain disability index) and goniometric measurements were done preoperatively and at the sixth postoperative month.

Results

In patients who underwent anterolateral neck dissection, the goniometric results were better than in the functional neck dissection group. The questionnaire results also showed better quality of life of patients who underwent anterolateral neck dissection. Electrophysiological evaluation of the trapezius muscles of both groups at the sixth week showed significant differences. The distal motor latency values of the anterolateral neck dissection group were shorter than those of the other group. Electrophysiological evaluation at the sixth postoperative month showed shorter distal latency values in the anterolateral dissection group, without statistical significance.

Conclusions

Preservation of the cervical plexus and less disturbance of the spinal accessory nerve are important to diminish postoperative shoulder disability. The type of neck dissection has an important influence on shoulder function.
Oncogene and Tumor Suppressor Gene Expression Changes in the Peripheral Blood Leukocytes of Patients with Colorectal Cancer
Authors: Csontos Zsolt , Nádasi Edit , Csejtey András , Illényi László , Kassai Miklós , Lukács László , Kelemen Dezső , Kvarda Attila , Zólyomi Annamária , Horváth Örs Péter , Ember István
Published: February 2018

Aims and background

The mortality of colorectal cancer continues to stagnate despite the development of new therapeutic approaches. Therefore, identifying high-risk population groups could contribute to the prevention of a considerable part of deaths caused by colorectal tumors.

Methods

Fifty patients with colon cancer and 50 patients with other, nonmalignant diseases were selected for the study. Expression of the c-myc, Ha-ras and p53 genes was determined in the peripheral leukocytes of the participants.

Results

Marked elevations of the expression of all three investigated genes were seen in the colon cancer patients when compared to the controls.

Conclusions

Our investigations showed that increases in the expression of c-myc, Ha-ras and p53 genes can be demonstrated in the peripheral leukocytes of colon cancer patients. By applying our method to clinical investigations, individuals with a high risk of having developed colon cancer may be identified and early diagnosis may be established.
Association of GIST, Breast Cancer and Schwannoma in a 60-Year-Old Woman Affected by Type-1 von Recklinghausen's Neurofibromatosis
Authors: Invernizzi Roberta , Martinelli Barbara , Pinotti Graziella
Published: February 2018

Neurofibromatosis (NF1 or von Recklinghausen's disease) is a common autosomal dominant disease associated with a higher incidence of neoplasms than in the general population. We report the case of a 60-year-old woman affected by NF1 who was coincidentally diagnosed with a gastrointestinal stromal tumor, a breast carcinoma and a peripheral nervous system tumor.
Large Adrenal Metastasis in Non-Small Cell Lung Carcinoma. Case Report and Literature Review
Authors: Charalambous Stavros , Mylonaki Efrosyni , Fotas Asterios , Papatsoris Athanasios G , Papathanasiou Athanasios , Triantafyllidis Argyrios , Rombis Vasilios , Touloupidis Stravros
Published: February 2018

Adrenal metastases are frequent in patients with non-small cell lung carcinoma (NSCLC). We present a case of a large adrenal metastasis from NSCLC and we discuss the relevant literature. In such cases, early surgical intervention is recommended to avoid spontaneous rupture of the tumor and improve patient survival.
Optical Biopsy of Cancer: Nanotechnological Aspects
Authors: Rotomskis Ricardas
Published: February 2018

Naturally occurring differences in the optical properties of normal and cancerous tissue have been exploited frequently in optical detection systems. However, optical biopsy of cancer can be improved by using targeted, optically active and bright contrast agents to enhance the optical signal from disease-specific molecular markers. Nanotechnology has advanced greatly in recent years and can be applied to variety of biomedical research areas, as well as optical biopsy in clinical settings. Quantum dots (QDs) are stable, bright fluorophores that, under ideal conditions, can have high quantum yields, narrow fluorescence emission bands, high absorbency, very large effective Stokes shifts, high resistance to photobleaching, and can provide excitation of several different emission colours using a single wavelength for excitation. Optically efficient, cancer specific QDs provide a new tool to enable non-invasive visualization of disease-specific molecular and tissue changes with subcellular spatial resolution. Nanotechnology is in a unique position to transform cancer diagnostics and to produce a new generation of fluorescent markers and medical imaging techniques with higher sensitivity and precision of recognition.
Nanotechnology Applications in Medicine
Authors: Angeli Elena , Buzio Renato , Firpo Giuseppe , Magrassi Raffaella , Mussi Valentina , Repetto Luca , Valbusa Ugo
Published: February 2018

In recent years there has been a rapid increase in nanotechnology applications to medicine in order to prevent and treat diseases in the human body. The established and future applications have the potential to dramatically change medical science. The present paper will give a few examples that could transform common medical procedures.
Towards Safe Nanoparticle Technologies for Nucleic Acid Therapeutics
Authors: Miller Andrew D
Published: February 2018

Nucleic acid therapeutics (or gene therapy) has to date failed to deliver on promise but rapid improvements in the understanding and use of delivery technologies should reverse this situation. In this review of work performed in and in collaboration with the Imperial College Genetic Therapies Centre, progress towards safe nanoparticles for efficient delivery of functional nucleic acids in vivo is described. The intention is to demonstrate the fruits of a journey from the results of initial studies in animal models of disease that suggested that so much should be possible so quickly, to the realization that new technologies are rarely successful so quickly, through to developments in the present day that appear to be approaching the preclinical/clinical threshold with realism but measured confidence. New chemistry is central to the design and formulation of safe nanotechnologies. Chemistry should have a central role to play in ensuring that nucleic acid therapeutics truly live up to their potential for therapy and cure, none more so than in the derivation of newer and better therapies for cancers.
Therapeutic Reactive Oxygen Generation
Authors: Scharff Peter , Ritter Uwe , Matyshevska Olga P , Prylutska Svitlana V , Grynyuk Iryna I , Golub Alexandr A , Prylutskyy Yuriy I , Burlaka Anatoliy P
Published: February 2018

An increase of the intracellular reactive oxygen species (ROS) concentration leads to the development of oxidative stress and, thus, to the damage of cell components. The cause-and-effect relations between these processes have not been fully established yet.

The ability of photo excited supramolecular composites containing fullerenes C60 immobilized at nanosilica particles to generate reactive oxygen species (ROS) in cells of two types (rat thymocytes, and transformed cells of ascite Erlich carcinoma, EAC, and leucosis L1210) is demonstrated.

The damaging effect of photo excited C60-composites are shown, which appeared to be selective and manifested in transformed cells, but not in thymocytes. It has been shown that after the irradiation of aqueous solutions or cell suspensions in the presence of fullerene C60, the generation of reactive oxygen species is observed.

It has been shown that the influence of photo excited fullerene C60 on metabolic processes depends on the composition of C60-containing complex and on the type of the cells. The damaging effects of photo excited fullerene C60-containing composites were demonstrated to be selective. The data presented suggest that the application of fullerene C60-containing composites for the selective activation of ROS-dependent death program in certain types of tumor cells is very promising.
Rectus Abdominis Muscle Resection for Abdominal Wall Recurrence of Mucinous Adenocarcinoma or Peritoneal Mesothelioma
Authors: Yan Tristan , Sugarbaker Paul
Published: February 2018

Aims and Background

Diagnostic technologies which penetrate the abdominal wall in an attempt to definitively diagnose an intraabdominal malignancy by biopsy can contaminate the abdominal wall by cancerous cells. With follow-up these entrapped cancer cells may progress as an abdominal wall recurrence of the disease process. Frequently, laparoscopy is the definitive diagnostic study which results in the abdominal wall cancer progression.

Methods

We examined recurrences within the abdominal wall and attempted to establish a surgical approach to this problem which would maximize a functional result and minimize the incidence of disease persistence within the abdominal wall.

Results

Eighteen patients with abdominal wall recurrence were studied. Laparoscopy port sites resulted in the abdominal wall disease in eight patients, in four the recurrence was at a previous ostomy site, in three it was in a Pfannenstiel incision and in three it was in a McBurney incision site. All of these patients were treated by total resection of the rectus abdominis muscle. This resulted in a complete removal of visible disease that was dissecting along the fibers of the rectus abdominis muscle.

Conclusions

No patients required reoperation for abdominal wall hernia and mesh repair was not used in any of these patients. Disease control within the abdominal wall has been excellent.
Radiotherapy in Italy after Conservative Treatment of Early Breast Cancer. A Survey by the Italian Society of Radiation Oncology (AIRO)
Authors: Aristei Cynthia , Amichetti Maurizio , Ciocca Mario , Nardone Luigia , Bertoni Filippo , Vidali Cristiana
Published: February 2018

Aims and Background

The aim of surveys on clinical practice is to stimulate discussion and optimize practice. In this paper the current Italian radiotherapy practice after breast-conserving surgery for early breast cancer is described and adherence to national and international guidelines is assessed. Furthermore, results are compared with an earlier survey in northern Italy and international reports.

Study Design

A multiple-choice questionnaire sent to all 138 Italian radiation oncology centers.

Results

48% of centers responded. Most performed breast-conserving surgery when tumor size was ≤3 cm. All centers routinely performed axillary dissection; 45 carried out sentinel node biopsy followed by axillary dissection when the sentinel node was positive. Most centers re-excised when resection margins were positive. The median interval between surgery and radiotherapy, when chemotherapy was not administered, was 60 days. Adjuvant chemotherapy was preferably administered before radiotherapy. Regional lymph nodes were never irradiated in 10 centers; in all others irradiation depended on the number of positive lymph nodes and/or involvement of axillary fat and/or tumor location in medial quadrants. All centers used standard fractionation; hypofractionated schemes were available in 6. Most centers used 4–6 MV photons. In 59 centers the boost dose of 10 Gy could be increased if margins were not negative. All centers ensured patient setup reproducibility. Treatment planning was computerized in 59 centers. The irradiation dose was prescribed at the ICRU point in 56 centers and portal films were made in 54 centers. Intraoperative radiotherapy was used in 4 centers: for partial breast irradiation in 1 and for boost administration in 3 centers.

Conclusions

Although the quality of radiotherapy delivery has improved in Italy in recent years, approaches that do not conform to international standards persist.
Expression of Embryonic Lethal Abnormal Vision (ELAV)-Like Protein HuR and Cyclooxygenase-2 (COX-2) in Ewing Sarcoma
Authors: Do Sung-Im , Araujo Eduard Santini , Kalil Ricardo K , Bacchini Patrizia , Bertoni Franco , Unni K Krishnan , Park Yong-Koo
Published: February 2018

Aims and Background

HuR is a member of the family of ELAV (embryonic lethal abnormal vision)-like proteins that stabilize several cellular mRNAs by binding to AU-rich elements in the 3’ untranslated region of the mRNA. Cyclooxygenase-2 (COX-2) is a well known enzyme that promotes tumor growth and metastasis. Recent studies have shown that HuR can stabilize the mRNA of COX-2, and cytoplasmic expression of HuR is associated with increased COX-2 expression in some cancers. The aim of this study was to investigate the correlation between COX-2 and HuR in Ewing sarcoma.

Methods

The expression patterns for HuR and COX-2 were assessed via immunochemical analysis of 70 Ewing sarcoma samples.

Results

Nuclear HuR expression was observed in 12 of 70 (17.1%) cases, but cytoplasmic expression was not observed. COX-2 expression was seen in 25 of 70 (35.7%) samples. Nuclear HuR and COX-2 were simultaneously expressed in 8 of 70 (11.4%) samples. The expression of nuclear HuR was significantly associated with COX-2 expression (P = 0.014). Neither HuR nor COX-2 expression showed a correlation with age or sex.

Conclusions

COX-2 expression in Ewing sarcoma may not be directly related to mRNA stabilization by HuR. However, a correlation between COX-2 expression and nuclear HuR expression through indirect mRNA stabilization can be suggested.
Biological Markers and DNA Flow Cytometric Analysis in Radically Resected Patients with Non-Small Cell Lung Cancer. A Study of the Perugia Multidisciplinary Team for Thoracic Tumors
Authors: Ludovini Vienna , Pistola Lorenza , Gregorc Vanesa , Floriani Irene , Rulli Eliana , Di Carlo Luciana , Semeraro Antonia , Daddi Giuliano , Darwish Samir , Stocchi Lucia , Tofanetti Francesca Romana , Bellezza Guido , Sidoni Angelo , Tognellini Rita , Crinò Lucio , Tonato Maurizio
Published: February 2018

Aims and Background

The aim of this study was to evaluate the relationship between a panel of biological markers (p53, Bcl-2, HER-2, Ki67, DNA ploidy and S-phase fraction) and clinical-pathological parameters and its impact on outcome in non-small cell lung cancer (NSCLC).

Methods and Study Design

Tumor tissue specimens obtained after surgical resection were collected from consecutive patients with NSCLC. We used an immunocytochemical technique for p53, Bcl-2, HER-2 and Ki67 analysis in fine-needle aspirates obtained from surgical samples that were also evaluated by flow cytometric DNA analysis using a FACScan flow cytometer.

Results

From April 2000 to December 2005, 136 patients with radically resected NSCLC were recruited. Median age was 66 years (range, 31–84 years), male/female ratio 117/19, ECOG performance status 0/1 127/4, stage I/II/III 76/25/35, squamous/adenocarcinoma/large-cell/mixed histology 62/49/17/8, smokers yes/no 121/11. Positivity of p53, Bcl-2, HER-2 and Ki67 was detected in 51.4%, 27.9%, 25.0% and 55.8% of the samples, respectively; 82.9% of the cases revealed aneuploid DNA histograms and 56.7% presented an S-phase fraction of more than 12%. Statistically significant associations between high Ki67 and poorly differentiated tumors (P = 0.016) and a smoking history (P = 0.053); p53 positivity and high Ki67 (P = 0.002); HER-2 positivity and adenocarcinoma subtype (P = 0.015) and presence of lymph node involvement (P = 0.006); and Bcl-2 positivity and squamous cell carcinoma subtype (P = 0.058) were observed. At univariate analysis, high Ki67 proved to be the only marker associated with disease-free survival (P = 0.047). After adjusting for stage, none of the examined immunocytochemical markers emerged as an independent factor for disease-free and overall survival; only pathological stage was identified as an independent prognostic factor for disease-free survival (P = 0.0001) and overall survival (P = 0.0001). In the group of 76 patients classified as TNM stage I, high Ki67 was the only marker associated with recurrence of disease (P = 0.05).

Conclusions

Our data do not support a relevant prognostic role of immunocytochemical markers in NSCLC, even if the Ki67 index might have particular relevance to identify patients with more aggressive tumors who are at high risk for disease relapse.
Adjuvant Chemotherapy and Whole Abdominal Irradiation for Gastric Carcinoma
Authors: Kundel Yulia , Levitt Mark L , Oberman Bernice , Sadezki Siegal , Tichler Thomas , Symon Zvi , Catane Raphael , Pfeffer Raphael , Brenner Baruch
Published: February 2018

Aims and Background

To analyze the efficacy and toxicity of adjuvant chemotherapy followed by whole abdominal irradiation in the treatment of resectable gastric cancer with positive lymph nodes.

Methods and Study Design

Between 1996 and 1999, 10 patients with node-positive gastric cancer underwent complete gross resection and were treated by postoperative chemoradiotherapy. The chemotherapy regimen consisted of 5-fluorouracil, 1000 mg/m2/day as a 96-hr continuous infusion on day 1, and cisplatin, 100 mg/m2 on day 2, every 21 days. Six courses were planned. Radiotherapy was administered 3 weeks after completion of the chemotherapy protocol as a single-fraction dose of 600 cGy in a two-field (anterior and posterior) configuration.

Results

Treatment was generally well tolerated, with no treatment-related deaths. However, 9 of the 10 patients died of recurrent disease, with a median survival of 20 months (range, 7–84).

Conclusions

Adjuvant chemotherapy with whole abdominal irradiation for gastric cancer is safe and tolerable but has no apparent effect on patient outcome. Studies in larger series are needed to evaluate the role of the approach in this disease.
Complete Response of Colorectal Liver Metastases after Intra-Arterial Chemotherapy
Authors: Fiorentini Giammaria , Del Conte Alessandro , De Simone Michele , Guadagni Stefano , Mambrini Andrea , D'Alessandro Michelina , Aliberti Camillo , Rossi Giuseppe , Cantore Maurizio
Published: February 2018

Aims and Background

We demonstrated that colorectal liver metastases considered in complete response after intra-arterial floxuridine-based chemotherapy had recurred in situ.

Methods and Study Design

One hundred and six colorectal liver metastases disappeared after intra-arterial chemotherapy. Persistent macroscopic disease was observed at surgery at the site of 52 of 106 liver metastases, even though computerized tomography scan and ultrasound showed a complete response. The sites of 35 initial liver metastases that were not visible at surgery were resected. Pathologic examination of these sites, considered in complete response, showed viable cancer cells in 22 of 35 cases.

Results

After 1 year of follow-up, 33 of 106 liver metastases considered in complete response had recurred in situ. After 2 years of follow-up, persistent macroscopic or microscopic residual disease or recurrence was observed in 86 (81%) of the 106 liver metastases.

Conclusions

Nevertheless, 19% of the patients had a long-lasting response. This means that floxuridine given as intra-arterial hepatic chemotherapy can still be considered an interesting option of cure in the treatment of colorectal liver metastases. When feasible, the site of the lesion that disappeared after intra-arterial chemotherapy should be resected at surgery. The best palliative cure of liver metastases should be the combination of local-regional strategies like intra-arterial chemotherapy, surgery or radiofrequency ablation with the systemic approach.
Mammographic Microcalcification in an Autogenously Reconstructed Breast Simulating Recurrent Carcinoma
Authors: Hsu Wayne , Sheen-Chen Shyr-Ming , Eng Hock-Liew , Ko Sheung-Fat
Published: February 2018

Breast cancer is a common cancer among women. The transverse rectus abdominis myocutaneous (TRAM) flap is a popular option because not only does it provide a breast with satisfactory bulk composed of autogenous tissue but it also provides an abdominal dermolipectomy to the patient. Fat necrosis remains a common problem following TRAM flap reconstruction, occurring in 10% to 36% of patients undergoing the procedure. A 44-year-old woman underwent a modified radical mastectomy followed by pedicled TRAM flap reconstruction after 5 months. Follow-up mammography 27 months after TRAM flap reconstruction showed a cluster of microcalcifications in the deep retroareolar area and recurrent breast carcinoma was highly suspected. Physical examination did not detect any abnormality of the reconstructed breast. Stereotactic hook localization was performed and an excisional biopsy was successfully done. The histological features of the resected specimens corresponded to fat necrosis change. Only with the awareness of the existence of such entity and careful follow-up can the occurrence of fat necrosis in TRAM flap reconstructed breasts be accurately detected and appropriately treated.
Cholesterol and Cholesterol-Rich Membranes in Prostate Cancer: An Update
Authors: Di Vizio Dolores , Solomon Keith R , Freeman Michael R
Published: February 2018

Cells maintain normal structure and function by responding appropriately to cues from the surrounding milieu. Extracellular stimuli are transduced from the surface through the plasma membrane by a complex series of interactions between ligands, their receptors and intracellular signaling partners (e.g., kinases, G proteins). Cholesterol-enriched membrane microdomains, generally referred to as “lipid rafts”, exist within the lipid bilayer of all mammalian cells and play an important role in signaling from the cell surface to various subcellular compartments. Lipid rafts have also been implicated in tumor growth and aggressiveness. Epidemiological evidence suggests that the modern Western diet, which contains substantial levels of cholesterol and other fatty substances, promotes prostate cancer progression. Consistent with this idea, prolonged inhibition of the cholesterol synthesis pathway by pharmacologic intervention in men has recently been associated with reduction in risk of advanced prostate cancer. In this review, we discuss the possibility that membrane cholesterol promotes prostate cancer progression by a mechanism that involves dysregulation of lipid raft-resident signaling complexes. This hypothesis provides new avenues for mechanistic studies as well as therapeutic intervention.
Life Tables for World-Wide Comparison of Relative Survival for Cancer (CONCORD Study)
Authors: Baili Paolo , Micheli Andrea , De Angelis Roberta , Weir Hannah K , Francisci Silvia , Santaquilani Mariano , Hakulinen Timo , Quaresma Manuela ,   the CONCORD Working Group, Coleman Michel P
Published: February 2018

Background

The CONCORD study compares population-based relative survival from cancer using data from cancer registries in five continents. To estimate relative survival, general mortality life tables are required. Available statistics are incomplete, so various approaches are used to construct complete life tables. This article outlines how the life tables were constructed for CONCORD; it compares life expectancy at birth between 101 populations covered by cancer registries in 31 countries and compares the impact of two approaches to the deployment of life tables in relative survival analysis.

Methods

The CONCORD approach, using specific mathematical methods, produced complete (single-year-of-age) life tables by sex, cancer registry area, calendar year (1990–1999) and race (only in the USA). In order to study the impact of different approaches, we compared relative survival in the USA using the US national life table, centered on the relevant census years, and the CONCORD approach. We estimated relative survival in each American participating cancer registry for patients diagnosed with breast (women), colorectal or prostate cancer during 1990–1994 and followed up to 1999.

Results

Average life expectancy at birth during 1990–1999 varied in CONCORD cancer registry areas from 64 to 78 years in males and from 71 to 84 years in females. It increased during the 1990s more in men than in women. In the USA, it was lower in blacks than in whites. Relative survival in American populations was lower with the CONCORD approach, which incorporates trends and geographic variation in background mortality, than with the USA census life tables.

Conclusions

International variation in background mortality by geographic area, calendar time, race, age and sex is wide. We suggest that in international comparisons of cancer relative survival, complete life tables that are specific for cancer registry area, calendar year and race should be used.
A Retrospective Analysis of the Diameter of Metastatic Lymph Nodes in Apparently Early Stage Endometrial Cancer
Authors: Boran Nurettin , Akdag Derya , Halici Filiz , Tulunay Gokhan , Turan Taner , Bozok Serap , Erdogan Zuhal , Kose M Faruk
Published: February 2018

Aims and background

The objective of this retrospective study was to assess the diameter of metastatic lymph nodes in a population of women with apparently early stage endometrial cancer at laparotomy.

Methods and study design

Among 700 cases with endometrial cancer, 27 cases with disease clinically limited to the uterus in the laparotomy and found to have retroperitoneal node metastasis after pathologic examination were included in this study. Pathologic characteristics of the tumors, pelvic and paraaortic node counts and the largest diameter of each metastatic node were evaluated.

Results

The median number of nodes removed was 38; median number of pelvic and para-aortic nodes was 29 and 8, respectively. A total of 85 metastatic nodes were identified. Mean diameter of the metastatic para-aortic and pelvic nodes was 6.8 mm and 9 mm, respectively. Nine patients had single metastatic nodes, and the diameters of the single metastatic para-aortic lymph node was 1 mm in one case, 2 mm in one case, 3 mm in one case and 4 mm in one, and 5 mm in two patients. Two cases had isolated para-aortic lymph node metastasis without pelvic lymph node metastasis. Diameters of the metastatic para-aortic lymph nodes were 4 and 5 mm in one case and 4 mm in the other case.

Conclusions

The diameters of metastatic nodes may be as small as 1 mm. By sampling or selective para-aortic and/or pelvic lymphadenectomy, some of the nodes might go undiagnosed, and such understaged cases cannot take adjuvant therapy (chemotherapy-radiotherapy). For correct staging of cases with endometrial cancer, complete systematic para-aortic and/or pelvic lymphadenectomy might be appropriate.
Weekly Concomitant Boost in Adjuvant Radiotherapy for Patients with Early Breast Cancer: Preliminary Results on Feasibility
Authors: Corvò Renzo , Giudici Stefania , Maggio Francesca , Bevegni Monica , Sampietro Chiara , Lucido Maria Rosaria , Orsatti Marco
Published: February 2018

Aims and background

Recent advances in the management of patients with breast cancer are focused toward the reduction of overall treatment time of radiotherapy by delivering a dose biologically equivalent to a standard schedule. The aim of the present study was to evaluate the feasibility and preliminary toxicity of a moderately hypofractionated whole breast irradiation schedule with the addition of a concomitant boost delivered to the tumor bed once-a-week in patients with early breast cancer submitted to conservative surgery.

Materials

We selected patients with pT1c and pT2 N0/N+ M0 carcinoma of the breast with negative surgical margins. The basic course consisted of 4600 cGy prescribed to the ICRU 50 reference point dose and delivered in 20 fractions, 4 times a week for 5 weeks. Once a week, immediately after whole breast irradiation, a concomitant photon boost of 120 cGy was delivered to the lumpectomy area. Overall, according to the linear-quadratic model, the schedule provides a biologically equivalent dose of 87 Gy for breast tumor (assuming α/β = 4 Gy), of 66 Gy for acute responding normal tissues (assuming α/β = 10 Gy), and 99 Gy for late responding normal tissues (assuming α/β = 3 Gy). Biologically, the schedule compares favorably with the 6-week conventional regimen consisting of 50 Gy, 2 Gy/fraction, followed by a 10 Gy boost (BEDtumor,90 Gy; BEDacute effects, 72 Gy, and BEDlate effects, 100 Gy).

Results

From November 2004 to April 2007, we tested this radiotherapy schedule in 176 patients. All enrolled patients had achieved a minimum follow-up of 6 months and were considered in detail for the evaluation of feasibility. Three clinical examinations were performed by a group of independent physicians at treatment end, after 1 month and after 6 months. According to the RTOG/EORTC Toxicity Criteria, of the 176 assessable patients at the end of radiotherapy, 58% showed grade 0–1 skin toxicity, 30% grade 2 and 12% grade 3. At one month of follow-up, grade 0 toxicity was observed in 47% of cases, grade 1 in 46% and grade 2 in 7%. At 6 months, late (skin and subcutaneous tissue) toxicity was assessed with the following scores: grade 0 in 68%, grade 1 in 26% and grade 2 in 6% of the patients. At 6 months, cosmesis was excellent, good and fair in 71%, 24% and 5% of patients, respectively.

Conclusions

The explored adjuvant schedule planned to intensify the radiotherapy course for patients with early breast cancer by adding a weekly concomitant boost appears to be feasible and provides low local toxicity and excellent to good short-term cosmetic results.
Management of Mucinous Urachal Neoplasm Presenting as Pseudomyxoma Peritonei
Authors: Sugarbaker Paul H , Verghese Mohan , Yan Tristan D , Brun Erwin
Published: February 2018

Background

Mucinous neoplasms of the urachus are rare malignancies so that the physicians’ index of suspicion for a timely and accurate diagnosis is low. Also, this disease may present with a wide variety of symptoms and signs.

Methods

Two patients with pseudomyxoma peritonei as the initial presentation of urachal mucinous adenocarcinoma were treated successfully. The medical literature regarding treatment options for this manifestation of the disease was searched.

Results

Two patients with large volume of pseudomyxoma peritonei originating in a mucinous urachal neoplasm were treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Our first patient required two reoperations to palliate the accumulation of gross mucinous ascites. She died 11 years after diagnosis with progression of mucinous adenocarcinoma resulting in starvation. The second patient had ostomy closure with second look surgery at one year after definitive treatment; four small tumor nodules were seen and easily resected. The patient is currently without evidence of disease and has a normal quality of life. Seven prior manuscripts that report a single case of pseudomyxoma peritonei were reviewed to explore the full range of treatment options and survival for this rare condition.

Conclusion

Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy may be a new treatment option for mucinous urachal neoplasms presenting with pseudomyxoma peritonei. Other management strategies such as systemic chemotherapy seemed to hold little promise for this group of patients.
Prostate Adenocarcinoma Presenting with Supraclavicular Node Enlargement: Report of a Case
Authors: Platania Marco , Bajetta Emilio , Guadalupi Valentina , Buzzoni Roberto , Colecchia Maurizio
Published: February 2018

This report describes a case of prostate adenocarcinoma presenting with supraclavicular adenopathy and deep venous thrombosis in the ipsilateral arm. Biopsy revealed the enlarged node to be an undifferentiated adenocarcinoma of unknown origin, while CT scan evidenced widespread adenopathies. Because of the increase in serum PSA, the immunohistochemical staining of the biopsy specimen was reviewed and strong positivity for PSA suggested a prostatic origin. We emphasize the importance of PSA immunohistochemistry and serum PSA level monitoring in men presenting with carcinoma of undetermined origin and generalized lymphadenopathies.
An Unconventional Cancer Treatment Lacking Clinical Efficacy Remains Available to Italian Cancer Patients
Authors: Merlo Domenico Franco , Beccaro Monica , Costantini Massimo ,   the Italian Survey of the Dying of Cancer Study Group, Costantini Massimo , Beccaro Monica , Di Leo Silvia , Sormani Maria Pia , Bruzzi Paolo , Merlo Domenico Franco , Morasso Gabriella , Rossi Paolo Giorgi , Borgia Piero , Montella Maurizio , Grimaldi Maria , Paci Eugenio , Susini Nicoletta , Cecioni Riccardo , Miccinesi Guido , Pisanti Renato
Published: February 2018

Aims and Background

An unconventional cancer treatment known as “Di Bella multitherapy” gained popularity among Italian cancer patients during the 90's. In 1999, it was shown to lack any detectable antitumor activity. Access to the multitherapy was investigated three years later within the post-bereavement Italian Survey of the Dying of Cancer (ISDOC), whose broader aim was to investigate the end-of-life care experiences of terminal cancer patients.

Methods

ISDOC was carried out in a two-stage probability sample of 2,000 out of 160,000 Italian cancer patients deceased between March 2002 and June 2003. For each cancer patient, a non-professional caregiver, i.e., the closest and the best-informed person about her/his last three months of life, was identified. A specific question concerning the “Di Bella multitherapy” was included in a semi-structured questionnaire that was administered face-to-face to the caregivers by trained interviewers. Weighted estimates of the frequency of patients receiving the multitherapy in the target population and their 95% confidence intervals were computed by taking into account stratification and clustering of observations.

Results

During their last three months of life, 0.7% (95% CI, 0.3–1.6) of terminal cancer patients, corresponding to some 1,100 subjects (range, 480–2,560), received the multitherapy. No statistically significant difference was observed for age at death, cancer type, gender, education, marital status, or residence.

Conclusions

The finding indicates that an unconventional cancer treatment proven to lack clinical efficacy remained accessible to Italian cancer patients. Ethical, deontologic, and economic implications call for a routine monitoring of provision of and access to unproven cancer treatments.
Factors Related to Complementary/Alternative Medicine use among Cancer Patients in Central Anatolia
Authors: Er Ozlem , Mistik Selcuk , Ozkan Metin , Ozturk Ahmet , Altinbas Mustafa
Published: February 2018

Aims and Background

We aimed to evaluate the prevalence of and factors related to the use of complementary/alternative medicine among cancer patients undergoing or following conventional treatment at the Erciyes University Oncology Hospital in Central Anatolia.

Study Design and Patients

Face-to-face interview and a questionnaire were carried out with cancer patients attending the outpatient clinic of Medical Oncology. Questionnaire items included patients’ demographic data, treatment, use of complementary/alternative medicine and possible related factors. Multivariate analysis was performed to compare the factors related to use of complementary/alternative medicine.

Results

A total of 268 consecutive cancer patients were enrolled in the study. Overall, 43% of the patients were using or had used complementary/alternative medicine. Totally, 90% of the patients using complementary/alternative medicine utilized herbs, and most of the herbs used were stinging nettle. Nearly half of the patients using complementary/alternative medicine (46.1%) were aiming to fight the disease. Among users, nearly half of them regarded the method used as effective and 54 (50.5%) suggested the use of complementary/alternative medicine to other patients. Only 23.1% of the patients discussed the use of complementary/alternative medicine with their physician. In logistic regression analysis, younger age, higher educational status, advanced stage of the disease, longer duration of the disease and current treatment status were significantly associated with the use of complementary/alternative medicine. In our regression model, the predictivity rate of these variables was 72.2% for use of complementary/alternative medicine according to the backward Wald test.

Conclusions

Use of complementary/alternative medicine among cancer patients in our center is modestly high, and the most common method is herbal therapy. Communication between the patient and the physician shouldbe improvedon this subject.