bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Implication of Clinical and Pathologic Features in Patients with Glioblastoma Multiforme Treated with Concomitant Radiation plus Temozolomide
Authors: Donato Vittorio , Papaleo Antonella , Castrichino Annamaria , Banelli Enzo , Giangaspero Felice , Salvati Maurizio , Delfini Roberto
Published: February 2018

Aims and background

Glioblastoma multiforme is the most common and most malignant primary brain tumor in adults. The current standard of care for glioblastoma is surgical resection to the extent feasible, followed by adjuvant radiotherapy plus temozolomide, given concomitantly with and after radiotherapy. This report is a prospective observational study of 43 cases treated in the Department of Radiotherapy, University of Rome La Sapienza, Italy. We examine the relationship between pathologic features and objective response rate in adult patients treated with concomitant radiation plus temozolomide to identify clinical, neuroradiologic, pathologic, and molecular factors with prognostic significance.

Methods

Forty-three consecutive patients (24 males and 19 females), ages 15-77 years (median, 57) with newly diagnosed glioblastoma multiforme, were included in this trial between 2002 and 2004 at our department. All patients were treated with surgery (complete resection in 81%, incomplete in 19%) followed by concurrent temozolomide (75 mg/m2/day) and radiotherapy (median tumor dose, 60 Gy), followed by temozolomide, 200 mg/m2/day for 5 consecutive days every 28 days. Neurologic evaluations were performed monthly and cranial magnetic resonance bimonthly. We analyzed age, clinical manifestations at diagnosis, seizures, Karnofsky performance score, tumor location, extent of resection, proliferation index (Ki-67 expression), p53, platelet-derived growth factor and epidermal growth factor receptor immunohistochemical expression as prognostic factors in the patients. The Kaplan-Meier statistical method and logrank test were used to assess correlation with survival.

Results

Fourteen patients (32%) manifested clinical and neuroradiographic evidence of tumor progression within 6 months of surgery. In contrast, 5 patients (12%) showed no disease progression for 18 months from the beginning of treatment. Median overall survival was 19 months. Multivariate analysis revealed that an age of 60 years or older (P <0.03), a postoperative performance score ≤70 (P = 0.04), the nontotal tumor resection (P = 0.03), tumor size >4 cm (P = 0.01) and proliferation index overexpression (P = 0.001) were associated with the worst prognosis. p53, PDGF and EGFR overexpression were not significant prognostic factors associated with survival.

Conclusions

The results suggest that analysis of prognostic markers in glioblastoma multiforme is complex. In addition to previously recognized prognostic variables such as age and Karnofsky performance score, tumor size, total resection and proliferation index overexpression were identified as predictors of survival in a series of patients with glioblastoma multiforme.
The Technique of Intensity-Modulated Radiotherapy in the Treatment of Cholangiocarcinoma
Authors: Petera Jiří , Papík Zdenek , Zouhar Milan , Jansa Jan , Odrazka Karel , Dvorak Josef
Published: February 2018

Aims and background

Conventional radiotherapy in inoperable cholangiocarcinoma is limited by radiotolerance of the surrounding tissues. The aim of our dosimetric study was an evaluation of intensity-modulated radiotherapy in the treatment of inoperable bile duct carcinoma.

Methods

Four patients with inoperable cholangiocarcinoma treated by self-expandable stent placed to the biliary tree and radiotherapy were studied. The rotational technique, conformal 3D BOX technique and intensity-modulated radiotherapy plan were compared. Dose volume histograms and the normal tissue complication probability concept were used for comparison. The stent was used for target motion verification.

Results

The intensity-modulated radiotherapy plans showed favorable dose distribution in planning target volume and remarkable sparing of organs at risk.

Conclusions

The intensity-modulated radiotherapy technique in bile duct carcinomas deserves further research and clinical evaluation.
Epidermal Growth Factor Receptor Serum Levels and Prognostic Value in Malignant Gliomas
Authors: Quaranta Michele , Divella Rosa , Daniele Antonella , Di Tardo Silvia , Venneri Maria Teresa , Lolli Ivan , Troccoli Giuseppe
Published: February 2018

Aims and background

The epidermal growth factor receptor (EGFR) is a member of a family of cell membrane receptors that use tyrosine kinase activity as the signal transduction mechanism. It is commonly expressed or overexpressed by many solid tumors and correlates with disease progression and a poor clinical prognosis. Increased EGFR expression might therefore be a strong prognostic feature in multiple tumor types, and inhibition of its cellular actions may have substantial therapeutic benefit. The aim of this study was to estimate the EGFR serum concentration for potential use as a biological marker of brain cancer to predict prognosis and follow-up after treatment.

Methods and study design

Serum samples obtained from 50 healthy individuals and 65 brain cancer patients (35 glioblastoma multiforme and 30 anaplastic astrocytomas) were collected before and after treatment and assayed for EGFR extracellular domain serum concentrations by a sandwich ELISA.

Results

EGFR was elevated in 47 of 65 brain cancer patients, with mean serum values of 84 ± 18 ng/ml, compared with that of healthy controls (43.6 ± 11 ng/ml, P = 0.001). There was a significant difference in the mean serum levels of EGFR between glioblastoma multiforme patients (96.2 ± 12 ng/ml) and anaplastic astrocytoma patients (71.6 ± 18 ng/ml, P = 0.04). Sixty brain cancer patients underwent surgery; EGFR serum levels did not show significant differences from those observed before surgery. For all patients, median overall survival was 13 months (anaplastic astrocytoma, 18 months; glioblastoma multiforme, 12.5 months). In 47 patients with high EGFR serum levels, overall survival was reduced (P = 0. 01), with a median survival time corresponding to 11.5 months (anaplastic astrocytoma, 14.5 months; glioblastoma multiforme, 10.5 months).

Conclusions

Although a prospective study with large sample size is warranted, serum EGFR extracellular domain may be potentially useful as a biological marker of gliomas for prediction of prognosis and follow-up after treatment.
β-Catenin and CD44 Expression in Keratoacanthoma and Squamous Cell Carcinoma of the Skin
Authors: Tataroglu Canten , Karabacak Tuba , Apa Duygu Düşmez
Published: February 2018

CD44 and β-catenin are adhesion molecules expressed on a wide variety of cells. Failure of this expression is believed to lead to disruption of cell-cell adhesion and to neoplasia. The aim of this study was to investigate the staining intensity of CD44 and β-catenin in keratoacanthomas and squamous cell carcinomas of the skin. The proliferation index, PCNA staining, was also evaluated in these cases. The abnormal expression of β-catenin significantly predominated in squamous cell carcinomas (n = 20, 76.9%) compared with keratoacanthomas (P = 0.002, χ2 = 7.8). Most keratoacanthomas (n = 11, 61.1%) more frequently showed strong staining intensity with CD44 compared with squamous cell carcinoma (P = 0.001, χ2 = 13.7). The proliferation index was higher in squamous cell carcinoma (P = 0.000, χ2 = 12.8). These findings suggest that CD44 and β-catenin expression may have an important role in the development of malignancy and in the determination of biological features of keratoacanthoma and squamous cell carcinoma of the skin.
Regional Estimates of Stomach Cancer Burden in Italy
Authors: Inghelmann Riccardo , Grande Enrico , Francisci Silvia , Verdecchia Arduino , Micheli Andrea , Baili Paolo , Capocaccia Riccardo , De Angelis Roberta
Published: February 2018

Aims and background

Stomach cancer still remains one of the most frequent tumors in Italy and Europe. The aim of this paper is to present estimates for stomach cancer mortality, incidence and prevalence over the period 1970-2010 for the Italian regions and for Italy as a whole.

Methods

Estimated figures for incidence, prevalence and mortality were obtained by using the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates and projections up to the year 2010 by means of a statistical back-calculation approach. Survival at the regional and national levels was modelled on the basis of published survival data from the Italian cancer registries.

Results

Incidence and mortality trends for both sexes decrease by about 60% during the estimation period 1970-2010. Both indicators show a 2-fold male/female ratio all over the country, and a similar gender time trend. The incidence and mortality in the North and Center of the country are estimated to be higher and to decrease more steeply than those in the South, both for men and women. A total of around 13,000 incident cases, 57,000 prevalent cases, and 8,000 deaths are estimated to have occurred in Italy in 2005.

Conclusions

The incidence and mortality trends are estimated to decline during the entire period 1970-2010, with different slopes between northern-central and southern regions. The incidence and mortality are quite similar among Italian regions, showing that the risk of developing the disease diminishes and is becoming more homogeneous than in the past decades all over the country.
Regional Estimates of Breast Cancer Burden in Italy
Authors: Grande Enrico , Inghelmann Riccardo , Francisci Silvia , Verdecchia Arduino , Micheli Andrea , Baili Paolo , Capocaccia Riccardo , De Angelis Roberta
Published: February 2018

Aims and background

Breast cancer is the most common cancer and the leading cause of cancer death among women. Knowledge of the present and future burden of the disease at a regional and national scale is a major issue in Italy, where the frequency and coverage of screening programs vary considerably across the country. This study presents estimates and projections of the female breast cancer incidence, prevalence and mortality for Italy and all Italian regions in the period 1970-2010.

Methods

The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of breast cancer survival.

Results

Breast cancer mortality has been declining from the late 1980s in the northern-central regions and from the mid 1990s in the southern regions Puglia, Sicilia and Sardegna. Stable mortality rates are estimated for the other southern regions in the 2000's first decade. The incidence rate in Italy is estimated as increasing until the late 1990s, and stable thereafter (93 per 100,000). The incidence curve is also estimated to flatten in many northern-central regions from the late 1990s or later. Rising incidence trends are estimated in all southern regions, with the exception of Puglia. About 8,500 deaths, 37,000 new diagnoses and 416,000 prevalent cases for breast cancer are estimated among Italian women in 2005. In the same year, the proportion of prevalent cases in the northern area (1,221 per 100,000) is about twice that estimated in the South (685 per 100,000).

Discussion

The geographical variation in female breast cancer burden can be explained by the unequal distribution of screening. A more widespread screening activity in the southern regions would help to bridge the gap between northern-central and southern regions. Continuous monitoring of regional epidemiological indicators for breast cancer is crucial to evaluate the effect of different health measures taken to control breast cancer in Italy.
Regional Estimates of Prostate Cancer Burden in Italy
Authors: Inghelmann Riccardo , Grande Enrico , Francisci Silvia , Verdecchia Arduino , Micheli Andrea , Baili Paolo , Gatta Gemma , Capocaccia Riccardo , Valdagni Riccardo , De Angelis Roberta
Published: February 2018

Aims and background

Prostate cancer is one of the most common cancers in developed countries and the most common among men in industrialized countries. The introduction of new diagnostic procedures caused an increase in new diagnoses in Italy starting from the early 1990s, while the prognosis of prostate cancer improved due to the use of hormonal treatments. The aim of this paper is to present estimates of prostate cancer mortality, incidence and prevalence over the period 1970-2005 for the Italian regions and for Italy as a whole, and to assess the changes that opportunistic screening and the diffusion of more effective treatments introduced.

Methods

Estimated figures for incidence, prevalence and mortality were obtained with the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of the relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates up to the year 2005 by means of a statistical back-calculation approach. Survival at regional and national levels was modelled on the basis of published survival data from the Italian cancer registries.

Results

The incidence trend showed a steep increase all over the country during the entire estimation period 1970-2005 with a more pronounced increase in the Center-North then in the South of Italy. Incidence of northern and central regions was about twice as high as that of southern regions. Mortality trends were however constant or declining in the majority of northern-central regions, while they still increased in the South. A total of around 43,000 incident cases, 174,000 prevalent cases and 9,000 deaths were estimated for Italy in 2005.

Discussion

The effects of opportunistic screening are reflected in an earlier diagnosis for many patients. The existing North-South gradient in incidence seems to be associated with the different spread of the PSA test in different parts of the country. Prostate cancer remains a great health problem in terms of both incidence and prevalence.
Estimated and Observed Cancer Incidence in Italy: A Validation Study
Authors: Capocaccia Riccardo , Buzzoni Carlotta , Grande Enrico , Inghelmann Riccardo , Bellù Francesco , Cassetti Tiziana , de Dottori Margherita , Donato Andrea , De Lisi Vincenzo , Falcini Fabio , Federico Massimo , Ferretti Stefano , Fusco Mario , Giacomin Adriano , Guzzinati Stefano , Mangone Lucia , Piffer Silvano , Rosso Stefano , Sechi Ornella , Tagliabue Giovanna , Tumino Rosario , Vercelli Marina , Vitarelli Susanna
Published: February 2018

Aims and background

The study aimed to validate model-based incidence estimates by means of observed incidence rates provided by Italian cancer registries, for five major cancer sites (stomach, colon and rectum, lung, breast and prostate cancers) and for all cancers together.

Methods

Recent incidence rates observed by Italian population-based cancer registries were extracted from the data base of the Italian Association of Cancer Registries. Regional estimates of incidence rates for the same cancers were obtained by the MIAMOD method. Observed and estimated crude incidence rates and incidence trends were compared for the period of diagnosis 1985-2000. Eight Italian cancer registries and seven regions were selected for the analysis since they had incidence data available during the entire selected period.

Results and conclusions

An excellent agreement between estimated and observed crude incidence rates was found for all single cancer sites, regarding absolute incidence levels and time trends. A partial exception was breast, where empirical data showed a sudden increase in the last three years of observation, perhaps due to organized screenings in some Italian regions, and not captured by statistical models. Substantial underestimation of model-based incidence rates was found for all cancers combined, where the difference tended to increase with calendar year, up to a maximum of 20% in recent years. The greatest part of the discrepancy can be attributed to multiple cancers, which were included in cancer registries statistics but were not accounted for in MIAMOD estimates.
Cancer Prevalence Estimates in Italy from 1970 to 2010
Authors: De Angelis Roberta , Grande Enrico , Inghelmann Riccardo , Francisci Silvia , Micheli Andrea , Baili Paolo , Meneghini Elisabetta , Capocaccia Riccardo , Verdecchia Arduino
Published: February 2018

Aims and background

The growing number of cancer survivors in Italy is expected to continue to increase as a consequence of population aging and survival improvements, but few estimates are currently available, particularly on the national and regional scale. The purpose of this work is to present detailed and updated prevalence estimates in Italy over the period 1970-2010 by cancer site (all cancers combined, stomach, colon and rectum, lung, breast and prostate) and gender.

Methods

Prevalence was derived with the MIAMOD statistical method, using cancer-specific mortality and relative survival as input data. Survival data from the Italian cancer registries were modeled to derive a national estimate for each cancer site and sex. To estimate prevalence trends, survival was assumed to improve in the future with the same rate observed in the period 1978-1994. A double scenario for survival - increasing or stationary - was considered to decompose the prevalence growth from 1995 to 2005 by its determinants: demographic changes, incidence and survival dynamics. The prevalence estimates were also decomposed by disease duration (2, 5 and 10 years) and by age (0-44, 45-59, 60-74 and 75-99).

Results

The proportion of cancer survivors in 2010 is expected to be about 4% in women and 3% in men, about twice the values attained in 1990. The highest dynamics was observed for prostate cancer, with a three-fold increase just in the 1995-2005 period (from 212 to 623 per 100,000), whereas in absolute terms breast cancer presented the highest levels (1,700 per 100,000 in 2010). The overall number of cancer prevalent cases is expected to rise by about 48% in the decennium 1995-2005 (from 1,152,000 to 1,709,000), and this growth is mainly attributable to incidence dynamics (+21%), then to survival improvements (+14%) and population aging (13%). In 2005, the 2-year prevalent cases were estimated to be 20% of all cancer survivors, 21% between 2 and 5 years from the diagnosis, 23% between 5 and 10 years, with 36% surviving for more than 10 years. Prevalence proportion was very high in the elderly (12.6% for 75-84 years and 8% for 60-74 years).

Conclusions

Updated prevalence data with appropriate coverage of the national territory are essential to define priorities in health care management and to develop cancer control programs. Prevalence by disease duration and by age should be the basis for planning research on the quality of life of cancer survivors, as long as cancer continues to become an even more chronic disease.
Italian Cancer Burden by Broad Geographical Area
Authors: Baili Paolo , De Angelis Roberta , Casella Ilaria , Grande Enrico , Inghelmann Riccardo , Francisci Silvia , Verdecchia Arduino , Capocaccia Riccardo , Meneghini Elisabetta , Micheli Andrea
Published: February 2018

Aims and background

Cancer burden estimates in Italian regions are available for the period 1970-2010 as a result of the project “I TUMORI IN ITALIA” connected with EUROCHIP, the European project on cancer control. The Italian health-care system is organized at a regional level, so regional estimates of cancer indicators are useful to identify priorities for cancer plans. We compared cancer site-specific epidemiological estimates by 3 macro-areas (obtained by grouping regions) to suggest priorities for Italian cancer control plans, both at national and regional levels.

Methods

Mortality and incidence estimates for all cancers combined and for stomach, colorectal, lung, breast and prostate cancers were downloaded from the website www.tumori.net and aggregated in broad age classes (0-54, 55-74 and 75-84 years) and macro-areas (northern, central and southern Italy).

Results

Historically, Southern Italy had a lower cancer risk than the Center and North. After 2000 this epidemiological picture disappeared and the incidence and mortality rates in the Center are reaching those of the North. Also the weight of various cancer sites on all cancers has changed in Italy in the last decades. Lung cancer is still the most frequent cancer in the male population in the South, while in the Center-North it has been surpassed by prostate cancer and colorectal cancer. The lung cancer weight on all cancer deaths is increasing in women. Prostate cancer has become the most frequent male cancer in the Center-North in the age class 55-84. Breast cancer is the most frequent cancer in the female population and its incidence rates in the North are higher than those in the Center-South for all age classes. Colorectal cancer incidence rates have dramatically increased in men and colorectal cancer is nowadays the second cancer diagnosed in women in all age classes and macro-areas.

Discussion

From the epidemiological data here presented we derived the following suggestions and observations for cancer control plans: a) tobacco prevention should focus on the male population in the South, and on female populations in the country as a whole; b) prevention concerning diet and physical activity (risk factors for colorectal cancer) should be considered mainly for men at a national level; c) the coverage of breast cancer screening programs should be increased in the Center-South; d) colorectal cancer screening should be promoted at a national level; e) PSA testing (that is not actually included among the screening programs recommended) for prostate cancer is probably more widespread in the Center-North, resulting in an increased incidence without any evident decline in mortality as yet.
Mesenchymal Chondrosarcoma. An Analysis of Patients Treated at a Single Institution
Authors: Cesari Marilena , Bertoni Franco , Bacchini Patrizia , Mercuri Mario , Palmerini Emanuela , Ferrari Stefano
Published: February 2018

Background

We analyzed clinical and treatment-related factors influencing the outcome of patients with mesenchymal chondrosarcoma (MC). Twenty-six patients (median age, 31 years) were identified using the Tumor Center and Chemotherapy Department database of the study institute.

Methods

Patients received surgery (24 patients) and/or radiotherapy (5 patients), and chemotherapy (12 patients).

Results

After a median follow-up of 48 months (7-237 months) 10 patients were alive. The 10-year overall survival (OS) was 27% in those who achieved complete surgical remission and 0% in those who did not (P = 0.0007). A worse 10-year probability of OS was observed in patients who were metastatic at presentation (metastatic 0%, localized 31%, P = 0.02), in patients with soft tissue MC (soft tissue MC 0%, bone MC 29%, P = 0.06) and in hemangiopericytoma-like MC (hemangiopericytoma-like MC 0%, Ewing's-like MC 33.5%, P = 0.9). In those patients who achieved complete surgical remission, the 10-year DFS was 76% for those who received chemotherapy and 17% for those who did not (P = 0.008).

Conclusions

Our experience confirmed the importance of complete surgical remission in MC treatment and suggests that the addition of chemotherapy should offer a benefit in terms of DFS. Due to the rarity of MC, multicentrer studies are needed to identify the most active chemotherapy regimen.
Late Relapse in Testicular Germ Cell Tumors
Authors: Detti Beatrice , Livi Lorenzo , Scoccianti Silvia , Meattini Icro , Gacci Mauro , Lapini Alberto , Biti Giampaolo
Published: February 2018

Aims and Background

Analysis of patients with late relapse of testicular germ cell tumors (GCTs) with reports on clinicopathological features and outcomes.

Methods

We identified all patients diagnosed with testicular GCTs at our Institute between 1988 and 2004 who developed relapse ≥24 months after completion of primary therapy. A retrospective case-note review was performed to extract clinical, pathological, treatment and outcome data.

Results

Six patients (1.25%) developed late relapse. All patients presented with stage I disease and were classified as “good risk” according to the International Germ Cell Consensus Classification. Mean time to late relapse was 48 months. Markers at late relapse were normal in all patients. Relapse was confined to retroperitoneal sites in five patients and located in the mediastinum in one patient. Five patients were managed by chemotherapy alone while one underwent combined treatment with surgery followed by chemotherapy. All patients obtained a complete response and all remained free from recurrence with a mean follow-up of 115 months.

Conclusions

The incidence of late relapse in this small series is low. Chemonaive patients with late relapse were successfully salvaged with chemotherapy alone or surgical excision followed by cisplatin-based chemotherapy. The optimal duration of follow-up in patients with testicular GCTs is not known and practice varies widely. At our Institute we advise lifelong follow-up of all patients with malignant GCTs of the testis.
Breast Cancer Diagnostic Methods: Screen-Detected and Clinical Cases. An Italian Survey of Women's Experiences
Authors: Rossi Paolo Giorgi , Camilloni Laura , Mantellini Paola , Barile Vincenzo , Borgia Piero , Federici Antonio , Mangia Marialuisa , Paci Eugenio , Vella Alessandro , Zappa Marco
Published: February 2018

Aims and Background

The real practice of breast cancer diagnosis and treatment is often very different from guideline recommendations. Screening programs should minimize deviations from “best practice”. The aim of the study was to compare cases detected by screening programs with cases that were not part of the public screening program, analyzing the diagnostic pathways from the first suspected breast problem to therapeutic intervention for breast cancer.

Methods

We interviewed a random sample of 268 women aged 49–70 years in three Italian regions (Lazio, Tuscany, Basilicata) who were treated for breast cancer, stratified by screening participation.

Results

In the nonscreened group, 48% of women were symptomatic and 50% were diagnosed by preventive tests. The proportion of women treated within 30 days of diagnosis was significantly lower in the screened group, 21.3% vs 35.8% (P = 0.0003). The mean number of tests (mammography, ultrasonography, cytology and histology) performed in the screened group was significantly higher than in the nonscreened group, 3.7 vs 2.8 (P = 0.001). The percentage of women treated without a preoperative histological or cytological diagnosis was lower in the screened group than in the nonscreened group, 14% vs 25% (P = 0.024).

Conclusion

Participation in screening programs seems to lead to more appropriate disease management even for breast cancer cases treated at the same hospital.
Adenomyoepithelioma of the Breast
Authors: Huang Chun-Ying , Sheen-Chen Shyr-Ming , Eng Hock-Liew , Ko Sheung-Fat
Published: February 2018

Adenomyoepithelioma of the breast is an uncommon tumor characterized by the presence of both epithelial and myoepithelial cells; its first full description was published in 1970 by Hamperl.

A 45-year-old woman presented a left breast lump that had been palpable for 4 weeks. There was no family history of breast cancer. Neither axillary nor supraclavicular lymph nodes were palpable. Craniocaudal mammography showed a 1.6 cm, well-defined nodule with several punctate intranodular calcifications in the subareolar region of the left breast. Color Doppler sonogram showed an ovoid, well-defined, homogeneous hypoechoic subareolar nodule with prominent peripheral vessels in the 6 o'clock position of the left breast. Operation was arranged and intraoperative frozen section examination revealed proliferation of round, oval or tubular glandular elements with intervening islands and bands of polygonal myoepithelial cells. Adenomyoepithelioma of the breast was the impression. Wide excision with adequate removal of the tumor and preservation of the left breast contour was successfully achieved. The diagnosis of adenomyoepithelioma of the breast was confirmed by immunohistochemical studies.
Primary Neuroendocrine Carcinoma of the Breast: A Case Report
Authors: Yaren Arzu , Kelten Canan , Akbulut Metin , Teke Zafer , Duzcan Ender , Erdem Ergun
Published: February 2018

Primary neuroendocrine carcinoma of the breast is an extremely rare tumor. We present our experience of primary neuroendocrine carcinoma of the breast in a 76-year-old woman. Surgical biopsies from breast and axillary lymphadenopathy showed a neuroendocrine carcinoma. Immunohistochemical staining of tumor cells with GCDFP15, NSE and chromogranin were positive. Computed tomography scans of the chest and abdomen showed no lesion for metastasis or another primary origin. Adjuvant hormone therapy was given, since the tumor was immunohistochemically receptor positive.
Negative Impact of Heat Exposure on Cosmesis after Conservative Treatment for Breast Cancer
Authors: Chie Eui Kyu , Kim Kyubo , Noh Dong-Young , Choe Kuk Jin , Kim Tae-You , Im Seok-Ah , Bang Yung-Jue , Ha Sung W
Published: February 2018

Aim and background

To identify the factors influencing cosmesis after conservative treatment in breast cancer.

Methods

Retrospective analysis was done on 424 patients who underwent postoperative radiotherapy after conservative surgery for breast cancer from February 1992 to January 2002. Most of the patients underwent quadrantectomy. Whole breast irradiation up to 50.4 Gy was delivered in 28 fractions followed by a 10 Gy boost in 5 fractions to the tumor bed. Regional lymph node irradiation was administered if indicated. Breast cosmesis was scored in 4 tiers. Breast symmetry was analyzed by the relative distance from the sternal notch to the nipple, using photos taken prior to radiotherapy and 2 years after its completion. Median follow-up was 64 months.

Results

Breast cosmesis was excellent in 15%, good in 63%, fair in 19%, and poor in 3% of the patients. In multivariate analysis, tumors >2 cm ( P = 0.0109), lower quadrant location ( P = 0.0026), lymph node irradiation ( P = 0.0028), and heat exposure ( P = 0.0152) were related to poor cosmesis. The cosmesis score after radiotherapy compared to the pre-radiotherapy score was deteriorated in patients who had undergone lymph node irradiation ( P <0.0001) and heat exposure ( P = 0.0027). Breast symmetry was worse for patients who had tumors >2 cm ( P <0.0001), upper quadrant tumor location ( P <0.0001), chemotherapy in combination with radiotherapy ( P = 0.0136), lymph node irradiation ( P = 0.0006) and heat exposure ( P = 0.0355). Changes in symmetry by radiotherapy were greater for lymph node-irradiated patients ( P <0.0001).

Conclusions

With larger tumor size, lymph node irradiation, and chemotherapy in combination with radiotherapy, heat exposure was found to have a negative impact on cosmesis in patients undergoing conservative treatment for breast cancer. Patients should therefore be advised to avoid heat exposure after breast irradiation.
Intrathoracic Malignant Peripheral Nerve Sheath Tumor with Angiosarcoma in a Child with NF1
Authors: Elli Murat , Can Bilge , Ceyhan Meltem , Pinarli Faruk Güçlü , Daǧdemir Ayhan , Ayyildiz Halil Suat , Gürsel Bilge , Daǧçinar Adnan
Published: February 2018

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon in children and adolescents but occur more frequently in NF1 patients. Angiosarcomatous differentiation in MPNSTs is a rare entity with poor prognosis. We report on a 13-year-old boy with intrathoracic angiosarcoma arising in MPNST associated with NF1.
Metamorphosis of melanoma. Trends in size and thickness of cutaneous melanoma over one decade at the Istituto Nazionale Tumori, Milan
Authors: Bono Aldo , Tolomio Elena , Bartoli Cesare , Carbone Antonino , Tomatis Stefano , Zurrida Stefano , Santinami Mario
Published: February 2018

Aims and background

Messages about the description of the clinical features of cutaneous melanoma (CM) have remained unchanged since 1985, when the ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) rule for melanoma detection was formulated. Given the significant shift to the diagnosis of earlier-stage CMs over the past decades, it is reasonable to think that also the clinical aspects of the disease might have changed. The aim of this study was to examine trends in the presentation of CM over the last decade at our Institution, focusing on two characteristics of the disease: size and thickness.

Methods

A retrospective study was conducted including 1,603 primary invasive CMs seen and treated at the Unit for Melanoma Detection at our Institute between January 1997 and December 2006.

Results

The results showed a trend towards smaller CMs, with a difference of 3 mm in median size from the beginning to the end of the period. Detection of small (≤6 mm) CMs increased at a rate of about 1.5% per year, with a current ratio of 25% with respect to all CMs. Thickness remained substantially unchanged over time.

Conclusions

Physicians must be aware that the characteristics of melanoma have undergone a metamorphosis over the years and the ABCD signs cannot be relied on for adequate sensitivity to further the early detection of CM.
Comorbidity and Prognosis in Advanced Hypopharyngeal-Laryngeal cancer under Combined Therapy
Authors: Montero Elena Hernández , Trufero Javier Martínez , Romeo Javier Azúa , Terré Fernando Clau
Published: February 2018

Aims and background

The success of combined treatment in head and neck cancer resides largely in its completion, which can be compromised when the patient's general health status is precarious. The objective of this investigation was to study the role of comorbidity as a prognostic factor in a large, homogeneous population affected by locally advanced pharyngeal-laryngeal cancer, under a combined protocol treatment. The a priori hypothesis is that comorbidity strongly conditions overall survival and specific overall survival in these patients and can aid in the selection and individualization of treatments.

Methods

After a 24-month follow-up, a univariate and multivariate retrospective analysis of survival and prognostic factors was performed using 14 clinical, pathological and molecular variables including the comorbidity index calculated following the Picarillo method. The settings were the Otolaryngology, Oncology and Pathology Departments of the Miguel Servet University Hospital, Zaragoza, Spain, a referral center of the National Health System. Of the original 114 patients selected, 15 were withdrawn because the tumor spread to maxillofacial areas, or due to the lack of attendance at the clinic, incomplete clinical data or coexistent primary tumors. The group under analysis consisted of the 99 remaining patients affected by stage III and IV laryngeal and/or hypopharyngeal cancers that had not received previous treatments. The main outcomes to analyze were overall survival, specific overall survival and relative risk.

Results

Overall survival at 2.5 years was 68.1% (95% CI, 57.7–78.5). Specific overall survival at 2.5 years was 74.8% (95% CI, 64.9–84.6). In the multivariate analysis, tumor staging, neoadjuvant chemotherapy response and comorbidity (RR = 1.55 and 1.44 for overall and specific overall survival, respectively) present themselves as three prognostic factors independent of overall and specific overall survival.

Conclusions

The role of comorbidity as an independent prognostic factor in patients affected by laryngeal and/or hypopharyngeal cancer treated with chemo-radiotherapy should be taken into account in the tailoring of treatments and the improvement of therapeutic results.
Can Axillary and Supraclavicular Radiotherapy be Avoided after Breast-Conserving Surgery and Axillary Dissection in Women with Multiple Involved Axillary Nodes?: Experience at the European Institute of Oncology
Authors: Galimberti Viviana , Leonardi Maria Cristina , Rotmensz Nicole , Botteri Edoardo , Iodice Simona , Sagona Andrea , Sahium Rafaela Cecilio , Bassani Gulliermo , Berrettini Anastasio , Monti Simonetta , Gentilini Oreste , Sangalli Claudia , Luini Alberto , Orecchia Roberto , Veronesi Umberto
Published: February 2018

Aims and background

Although some guidelines recommend adjuvant radiotherapy (RT) to the axilla and supraclavicular nodes if 4 or more axillary nodes are involved, the current practice at our Institute is not to irradiate the axilla but to perform complete axillary dissection in which all 3 Berg levels are removed. We performed a retrospective analysis of patients with 4 or more axillary nodes involved and sufficient follow-up to provide indications as to whether our current treatment is adequate.

Methods

We retrospectively analyzed 287 T1–T3 patients with a median follow-up of 5 years and 4 or more involved nodes treated by quadrantectomy and breast RT but no axillary RT; supraclavicular RT was given only when prognostic factors were unfavorable.

Results

A total of 170 (59.2%) patients did not receive supraclavicular RT, while 117 (40.8%) patients received supraclavicular irradiation. No patient received axillary RT. After a median follow-up of 5 years (range, 4–105 months), 4.7% had died and 13.5% had developed distant metastases in the no supraclavicular RT group, compared to 12.0% dead (P = 0.028 log rank) and 24.8% (P = 0.201 log rank) in the supraclavicular RT group. No patients with supraclavicular RT developed supraclavicular metastases compared to 4 in the no supraclavicular RT group. There were no axillary recurrences.

Conclusions

Complete axillary dissection appears adequate treatment in patients with 4 or more involved nodes. The low breast recurrence rate also suggests that breast conservation is adequate treatment in such patients. Supraclavicular RT appears to reduce the number of supraclavicular metastases but confers no survival advantage. Although a small number of cases were examined in this retrospective single-center series, all received highly uniform treatment.
The Management of Gastric Adenocarcinoma with Postoperative Chemoirradiation. A non-randomized comparison of oral UFT and 5-FU
Authors: Surenkok Serdar , Beyzadeoglu Murat , Oysul Kaan , Ozyigit Gokhan , Ataergin Selmin , Arpaci Fikret , Ozet Ahmet
Published: February 2018

Aims and background

We assessed the therapeutic results and tolerability of postoperative chemoradiotherapy with either oral UFT or 5-fluorouracil for carcinoma of the stomach.

Methods and study design

Forty-six patients treated with chemoradiotherapy following total or subtotal gastrectomy for gastric carcinoma formed the cohort evaluated. The group included 39 males and 7 females whose ages ranged from 21 to 74 years (median, 53 years). In all patients, surgical therapy was the initial approach with a curative intent. The types of operations performed were total gastrectomy in 11 or subtotal gastrectomy in 35 patients. Radiotherapy began from 14 to 161 days after surgery (median, 55 days). Twenty patients received concomitant oral UFT (200 mg/m2), and 26 patients were given 5-fluorouracil (425 mg/m2, iv bolus) concurrently with irradiation consisting of one or two cycles, usually as a 3-day bolus at the start and last 3 days of irradiation therapy for radiosensitizing purposes. The patients were treated using either cobalt-60 or 6 MV photons, and irradiation doses delivered to the tumor bed and regional lymphatics ranged from 40 to 50 Gy (median, 46 Gy).

Results

Median follow-up for the entire group was 24 months (range, 2–67). The 2-year overall survival of the entire group of patients was 64%. The 2-year overall survival rates for 5-fluorouracil and oral UFT groups were 72% and 66%, respectively (P = 0.3). Treatment-related factors were reviewed to identify any impact on survival. Analyses included type of surgery and dissection, fraction size, the total dose of irradiation and the type of chemotherapy. A significant detrimental effect in survival in the patients treated with D2 dissection compared to the patients treated with D1 dissection was noted (P = 0.01). Overall grade II-III toxicity of oral UFT was significantly lower than 5-FU (4 patients vs 14 patients, P = 0.03).

Conclusions

Concomitant use of oral UFT with radiation seems to be more tolerable and an equally effective regimen in the treatment of locally advanced gastric cancer compared with 5-fluorouracil. D2 dissection was found to have detrimental effects on survival in this cohort.
Upper Urinary Tract Transitional Cell Carcinoma. A 10-year Experience
Authors: Papatsoris Athanasios G , Chrisofos Michael , Skolarikos Andreas , Varkarakis Ioannis , Lekas Alexandros , Dellis Athanasios , Koritsiadis Sotirios , Deliveliotis Charalambos
Published: February 2018

Objective

To present our 10-year experience with patients surgically treated for upper urinary tract transitional cell carcinoma.

Patients and methods

We reviewed the medical records of 264 patients (218 males and 46 females), aged 37–93 years (mean, 69.5), treated surgically for upper tract transitional cell carcinoma during the period January 1996 to December 2005.

Results

During the mean follow-up of 58 months (range, 12–120), local relapse was diagnosed in 14% of the patients. The mean time to recurrence was 13 months (range, 1–102). The overall mortality was 14%, and the mean survival was 109 months. Survival was significantly influenced by the following parameters: male gender (P = 0.0151), age over 80 years (P = 0.0012), location in both the pelviocaliceal system and the ureter (P = 0.051), a two incision operation (P = 0.0075), grade III (P = 0.0314), stage T3 and T4 (P <0.0001).

Conclusions

Tumor stage was identified as the most important determinant in predicting recurrence and survival. Other predictors of survival included male gender, age over 80 years, location in the pelviocaliceal system and the ureter, a two incision operation, and high grade.
Human Papillomavirus Infection in Patients with Residual or Recurrent Cervical Intraepithelial Neoplasia
Authors: Takač Iztok
Published: February 2018

Aims and background

The main purpose of this longitudinal study was to evaluate the frequency of HPV infection in patients with residual or recurrent CIN.

Methods

797 consecutive patients with CIN, treated with conization, were included. In 38 patients with residual or recurrent CIN in whom reconization was performed, infection with high-risk HPV types was analyzed.

Results

Reconization was performed in 4.8% of patients. Before reconization, 21 patients (55.3%) were infected with high-risk HPV and 17 patients (44.7%) were HPV negative. Among the HPV-negative patients, two (11.8%) had CIN 1, five (29.4%) CIN 2, nine (52.9%) CIN 3 and one patient (5.9%) had microinvasive cancer of the uterine cervix. The difference in frequency of infection with high-risk HPV was not significant (chi-square 0.372; p>0.05).

Conclusions

On the basis of the study results it is not possible to recommend the HPV test as the only method of detection of residual or recurrent CIN after conization.
Hamartoma of the Breast: An Underrecognized Disease?
Authors: Lee Wei-Feng , Sheen-Chen Shyr-Ming , Chi Shun-Yu , Huang Hsuan-Ying , Ko Sheung-Fat
Published: February 2018

Hamartomas of the breast are benign tumors composed primarily of dense, fibrous tissue with variable amounts of fat and associated ducts.

A 48-year-old woman had noted a lump in her right breast for a number of years. She came to our clinics because of the recent progressive enlargement of this lump. Physical examination revealed a large, mobile, round, painless mass in the lower inner quadrant of the right breast. There were no palpable axillary lymph nodes. Mammography showed a circumscribed, 4.5 × 2.5 cm mass with a radiolucent periphery and moderately radiopaque center. On the basis of the clinical and mammographic findings, hamartoma of the breast was highly suspected. A lumpectomy was performed and histological examination of the specimen revealed overgrowth of mammary lobules and ductules, forming a well-circumscribed lesion with admixed fat tissue. Hamartoma of the breast was confirmed.

With the awareness of this entity and good correlation of imaging findings, the clinical diagnosis of hamartoma of the breast should not be difficult. If careful attention is paid to the clinical information, histological underdiagnosis of hamartoma of the breast can be avoided.
Adenoid Cystic Carcinoma of Trachea Treated with Adjuvant Hypofractionated Tomotherapy. Case Report and Literature Review
Authors: Alongi Filippo , Di Muzio Nadia , Motta Micaela , Broggi Sara , De Martin Elena , Bolognesi Angelo , Cattaneo Mauro , Calandrino Riccardo , Fazio Ferruccio
Published: February 2018

Adenoid cystic carcinoma, also called cylindroma, is the second most common histological type of tracheal malignancy but represents 1% of all respiratory tract cancers. We report a case of a 59-year-old patient submitted to an incomplete resection of the trachea and subsequently treated with adjuvant tomotherapy. There have been no reports in the literature regarding intensity-modulated radiation therapy with linac or tomotherapy systems in adenoid cystic carcinoma of the trachea.

The present clinical case demonstrates the feasibility of adjuvant intensity-modulated radiation therapy techniques for optimizing the dose coverage of the tumor bed while sparing surrounding normal tissues. A dosimetric comparison between the tomotherapy plan and a 3-dimensional conformal radiotherapy plan is also reported. We demonstrate that tomotherapy permits an increase in the dose per fraction without important acute adverse effects. At 24 months’ follow-up, our patient shows no evidence of disease with negative histological findings.
Myocardial Perfusion Defects after Radiation Therapy and Anthracycline Chemotherapy for Left Breast Cancer: A Possible Marker of Microvascular Damage. Three Cases and Review of the Literature
Authors: Gallucci Giuseppina , Capobianco Alba Maria , Coccaro Mariarosa , Venetucci Angela , Suriano Vincenzo , Fusco Vincenzo
Published: February 2018

Radiation therapy to the thorax may induce early and late cardiac adverse effects if large parts of the heart have been included in the irradiation field and particularly if anthracycline-containing chemotherapy is concomitantly administered. We describe 3 cases of cardiotoxicity in patients with left breast cancer treated with anthracycline-containing chemotherapy and left thoracic radiotherapy. In 2 cases we observed asymptomatic electrocardiographic abnormalities of ventricular repolarization mimicking anterior myocardial ischemia and SPECT reversible myocardial perfusion defects. In 1 case we observed echocardiographic abnormalities of left ventricular wall motion and reversible myocardial perfusion abnormalities. We recommend close cardiac monitoring of patients treated with anthracycline chemotherapy and left thoracic radiotherapy to better understand the clinical impact of these abnormalities.
Improvement of European Translational Cancer Research. Collaboration between Comprehensive Cancer Centers
Authors: Ringborg Ulrik , De Valeriola Dominique , van Harten Wim , Bosch Antonio Llombart , Lombardo Claudio , Nilsson Kenneth , Philip Thierry , Pierotti Marco A , Riegman Peter , Saghatchian Mahasti , Storme Guy , Tursz Thomas , Verellen Dirk
Published: February 2018

Even though the increasing incidence of cancer is mainly a consequence of a population with a longer life span, part of this augmentation is related to the increasing prevalence of patients living with a chronic cancer disease. To fight the problem, improved preventive strategies are mandatory in combination with an innovative health care provision that is driven by research. To overcome the weakness of translational research the OECI is proposing a practical approach as part of a strategy foreseen by the EUROCAN+PLUS feasibility study, which was launched by the EC in order to identify mechanisms for the coordination of cancer research in Europe.