bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Expression of Bile Canalicular CD10 and Sinusoidal CD105 (Endoglin) in Peritumoral Hepatic Tissue
Authors: Nakamura Toshitsugu
Published: February 2018

Aims and background

Hepatic tissues, including bile canaliculi and sinusoids, around primary or metastatic tumors are destructed and regenerate associated with tumor growth, and may show some phenotypic changes. The present study was undertaken to examine the expression of CD10 in bile canaliculi [CD10(BC)] and CD105 (endoglin) along hepatic sinusoids [CD105(HS)] in peritumoral hepatic tissue (PTH).

Methods

Fifty samples of resected liver bearing hepatocellular carcinoma (HCC) or metastatic carcinoma were immunostained for CD10 and CD105. The immunoreactivity for CD10(BC) and CD105(HS) in the background hepatic tissue of tumors and PTH was scored separately.

Results

CD10(BC) was moderately or markedly expressed in the background hepatic tissue without chronic hepatitis or cirrhosis in most of the cases, and was significantly downregulated in chronic hepatitis and cirrhosis. CD105(HS) was negative or minimally positive in most of the cases of hepatic tissue bearing metastatic carcinoma, and showed a significant increase in chronic hepatitis and cirrhosis. Compared with the background, PTH revealed significantly decreased CD10(BC) staining irrespective of HCC or metastatic carcinoma, and showed belt-like CD105(HS) expression in 66.7% of the cases of metastatic carcinoma and in 88.6% of those with HCC.

Conclusions

These data indicate that the expression patterns of CD10(BC) and CD105(HS) in PTH are similar to those in chronic hepatitis and cirrhosis, which may be caused by persistent injury and resultant regeneration of hepatic tissue.
Late Tonsil Metastases from Renal Cell Cancer: A Case Report
Authors: Massaccesi Mariangela , Morganti Alessio G , Serafini Giovanni , Di Lallo Alessandra , Deodato Francesco , Picardi Vincenzo , Scambia Giovanni
Published: February 2018

The occurrence of renal carcinoma metastasis to the head and neck region is extremely rare. Some authors have reported metastasis of renal cell carcinoma to the parotid glands, nose and paranasal sinus, tongue, larynx, thyroid and palatine tonsil. In this report we describe a rare case of renal cell cancer metastasized to the right tonsil in a 76-year-old man with previously diagnosed bone and lung metastases. To the best of our knowledge this is the first documented example of radiotherapy treatment in this type of presentation. Radiotherapy was effective in treating the lesion with satisfactory functional results.
Primary Peritoneal Malignant Mixed Mesodermal (Müllerian) Tumor
Authors: Hussein Mahmoud R , Hussein Saad Rezk Abudlwahed , Abd-Elwahed Ahmad Rezk
Published: February 2018

Aims and background

Malignant mixed mesodermal tumor (MMMT) is a biphasic neoplasm (carcinosarcoma) composed of both epithelial and mesenchymal elements. Extragenital MMMT, including primary peritoneal MMMT, is an extremely rare tumor with features consistent with its origin from the secondary Müllerian system. The neoplastic elements of extragenital MMMT presumably arise directly from the mesothelium or submesothelial stroma and hence parallel the biphasic pattern of the genital (uterine or ovarian) counterpart.

Methods and study design

Here we report on the clinical, pathological, and immunohistochemical features of a case of peritoneal MMMT in a 65-year-old woman. The patient presented with abdominal fullness and pain. Gynecological examination revealed a huge pelvic abdominal mass. On histology, the tumor consisted of poorly differentiated carcinomatous and sarcomatous (rhabdomyosarcoma) components. Further immunohistochemical analysis revealed positive reactivity for both epithelial (cytokeratin and epithelial membrane antigen) and mesenchymal (vimentin, S-100, and desmin) markers. The patient refused treatment and died of the disease three months later.

Results and conclusions

Based on the present case and on previous studies, primary peritoneal MMMT seems to be a rare but highly malignant neoplasm with an aggressive behavior and poor prognosis. Its exact origin, histogenesis and molecular alterations are poorly understood.
Organization of population-based cancer control programs: Europe and the World
Authors: Otter Renée , Qiao You-Lin , Burton Robert , Samiei Massoud , Parkin Max , Trapido Edward , Weller David , Magrath Ian , Sutcliffe Simon ,   ICCC-3 Session E group
Published: February 2018

As cancer is to a large extent avoidable and treatable, a cancer control program should be able to reduce mortality and morbidity and improve the quality of life of cancer patients and their families. However, the extent to which the goals of a cancer control program can be achieved will depend on the resource constraints a country faces. Such population-based cancer control plans should prioritize effective interventions and programs that are beneficial to the largest part of the population, and should include activities devoted to prevention, screening and early detection, treatment, palliation and end-of-life care, and rehabilitation.

In order to develop a successful cancer control program, leadership and the relevant stakeholders, including patient organizations, need to be identified early on in the process so that all partners can take ownership and responsibility for the program. Various tools have been developed to aid them in the planning and implementation process. However, countries developing a national cancer control program would benefit from a discussion of different models for planning and delivery of population-based cancer control in settings with differing levels of resource commitment, in order to determine how best to proceed given their current level of commitment, political engagement and resources. As the priority assigned to different components of cancer control will differ depending on available resources and the burden and pattern of cancer, it is important to consider the relative roles of prevention, early detection, diagnosis, treatment, rehabilitation and palliative care in a cancer control program, as well as how to align available resources to meet prioritized needs.

Experiences from countries with differing levels of resources are presented and serve to illustrate the difficulties in developing and implementing cancer control programs, as well as the innovative strategies that are being used to maximize available resources and enhance the quality of care provided to cancer patients around the world.
Retrospective Long-Term Results and Prognostic Factors of Postoperative Treatment for UICC Stages II and III Rectal Cancer
Authors: Genovesi Domenico , Cèfaro Giampiero Ausili , Vinciguerra Annamaria , Augurio Antonietta , D'alessandro Marco , Borzillo Valentina , Marchese Rita , Di Nicola Marta
Published: February 2018

Aims

To retrospectively evaluate 5-year local control, disease-free survival, cancer-specific survival and overall survival rates in patients with UICC stages II and III rectal cancer treated with adjuvant therapy and especially to analyze the impact of some prognostic factors on clinical outcome at univariate and multivariate analyses.

Methods and Materials

We retrospectively reviewed 306 patients treated with postoperative 5-fluorouracil-based chemoradiation (278 patients) or radiotherapy alone (28 patients) after curative surgery. The following prognostic factors were considered at univariate and multivariate analyses: age, sex, tumor location, surgery procedure, pathological stage, histology, tumor grade, surgical margins and radiotherapy technique.

Results

The 5-year actuarial rates for local control, disease-free survival, cancer-specific survival and overall survival were respectively 89.7%, 59.7%, 68.6% and 61.4% for the 278 patients (91%) treated with postoperative chemoradiation. Univariate analysis showed that abdominal-perineal resection impacted disease-free survival and that the T4 variable had an impact on cancer-specific survival and disease-free survival. Instead, age ≥70, N2, IIIB (p T3 p N1) and IIIC (pT3 p N2) stage impacted cancer-specific survival, disease-free survival and rate of distant metastases. Multivariate analysis showed as significant variables age ≥70 years, pN1 and pN2 and extraperitoneal tumor location.

Conclusions

Our retrospective study showed a good 5-year local control. Factors such as individual pT4, pN1, pN2, age ≥70 years, abdominal-perineal resection, stages IIIB-IIIC versus II-IIIA and extraperitoneal tumor location negatively influenced disease-free survival, distant metastases and cancer-specific survival. Differences exist between stages II and III rectal cancer and treatment modulation and intensification are required in order to offer the most appropriate and effective adjuvant treatment and to improve survival of rectal cancer patients.
Thalidomide Improves Prevention of Chemotherapy-Induced Gastrointestinal Side Effects following a Modified FOLFOX7 Regimen: Results of a Prospective Randomized Crossover Study
Authors: Liu Yunpeng , Zhang Jingdong , Teng Yuee , Zhang Lingyun , Yu Ping , Jin Bo , Zhao Mingfang , Shi Jing , Liu Shizhou , Song Na , Li Zhi
Published: February 2018

Aims and Background

Thalidomide was firstly evaluated for the control of chemotherapy-induced gastrointestinal side effects following a modified FOLFOX7 (mFOLFOX7) regimen.

Methods and Study Design

Chemotherapy-naive patients with malignant tumors were randomized into two groups: A-B group (A, 0.3 mg of ramosetron plus 10 mg of dexamethasone on day 1, was given intravenously in the first cycle, and B, 0.3 mg of ramosetron plus 10 mg of dexamethasone on day 1 intravenously plus 150 mg orally twice daily of thalidomide on days 2 through 5, in the second cycle) and B-A group (those drugs were given in the reverse sequence). The primary end point was the efficacy of thalidomide in controlling delayed (days 2 through 5) chemotherapy-induced nausea and vomiting (CINV). The secondary end point was the safety of thalidomide.

Results

Of 52 patients enrolled, 50 patients (96%) were assessable. Complete response rates of delayed nausea (no nausea) were higher with group B than group A (52% vs 24%, P = 0.004 on day 2; 58% vs 24%, P =0.001 on day 3; and 60% vs 36%, P = 0.016 on day 4). Complete response rates of delayed emesis (no emetic episodes, no rescue therapy) for group B and A also showed significance (86% vs 66%, P = 0.019 on day 2 and 76% vs 56%, P = 0.035 on day 3). Complete response rates on anorexia for group B were higher than those for group A on days 2 through 5. More patients in group B reported sedation or dizziness than in group A (42% vs 9.6%; P = 0.000).

Conclusions

Thalidomide improves prevention of chemotherapy-induced gastrointestinal side effects following the mFOLFOX7 regimen. It is a safe, effective antiemetic.
Brain Metastases Secondary to Breast Cancer: Symptoms, Prognosis and Evolution
Authors: Oltean Daniela , Dicu Tiberius , Eniu Dan
Published: February 2018

Aims and Background

Brain metastases confer a worse prognosis to breast cancer because they determine a severe increase in mortality. The aim of this study was to identify the early symptoms in patients with brain metastases after breast cancer treatment and to evaluate the median survival rate in women with single and operable brain lesions.

Patients and Methods

We examined 43 patients with brain metastases secondary to breast cancer treated in the Oncological Institute Prof I Chiricuţă, Cluj-Napoca, during the period 2000-2006.

Results

The median interval between the breast cancer diagnosis and detection of central nervous metastases was 21 months. The most frequent symptoms were headache, gait disturbance, nausea and vomiting. Patients with a single brain lesion had a median survival of 23 months compared to only 7 months in case of patients with multiple brain metastases.

Conclusions

The prognosis is worse in patients with solitary brain metastases secondary to breast cancer than in patients who present extracranial metastases. Among factors considered favorable in these patients are a single brain lesion, accessibility to surgery, and the absence of associated extracranial metastases.
Role of Glutathione S-Transferase Omega Gene Polymorphisms in Breast-Cancer Risk
Authors: Chariyalertsak Sunanta , Purisa Wichai , Sangrajrang Suleeporn
Published: February 2018

Background/Aims

Genetically influenced variations in the levels of activity and/or expression of some members of the glutathione S-transferase (GST) family have been identified as risk factors for cancer. One, GST omega (GSTO), has been found in a very limited number of studies. The aim of the present study was to investigate the influence of GSTO1 and GSTO2 polymorphisms on breast cancer risk.

Methods

DNA isolated from the blood of 101 patients with breast cancer and 151 healthy controls was investigated for GSTO1 and GSTO2 polymorphisms by polymerase chain reaction-restriction-fragment length polymorphism.

Results

Univariate and multivariate analyses showed no association between GSTO1 and GSTO2 genotypes and the risk of breast cancer. A higher prevalence of wild-type GSTO1 (A140/A140) was significantly correlated with advanced-stage breast cancer (OR = 0.1, 95% CI, 0.01-0.77), but the presence of the genotype did not correlate with patient age at diagnosis, menopausal status, tumor size, lymph node metastasis, or estrogen-receptor status. No association was found between GSTO2 genotype and clinicopathological features.

Conclusions

The results of the study suggest that GSTO1 and GSTO2 variants are not associated with breast cancer risk, but that wild-type GSTO1 (A140/A140) is likely among cases at an advanced stage.
Telomerase RNA Expression and DNA Ploidy as Prognostic Markers of Prostate Carcinomas
Authors: Bantis Athanassios , Patsouris Efstratios , Gonidi Maria , Kavantzas Nikolaos , Tsipis Angelos , Athanassiadou Anna-Maria , Aggelonidou Eleni , Athanassiadou Pauline
Published: February 2018

Aims and Background

The objective of this study was to determine whether there was a correlation between telomerase RNA expression and DNA ploidy status with clinicopathological parameters and biochemical recurrence after radical prostatectomy.

Study Design

Telomerase RNA expression and DNA ploidy were evaluated in imprint smear samples obtained from 112 prostates after radical prostatectomy. The results were correlated with pathological stage, Gleason score and serum PSA.

Results

Positive telomerse RNA expression was detected in 67.8% of prostate carcinomas. The multiple linear regression model showed a statistically significance increase in telomerase RNA expression with increased Gleason score ( P <0.0001) and preoperative serum PSA values ( P = 0.0125). DNA ploidy status also varied significantly with Gleason score ( P <0.0001) and preoperative serum PSA values ( P = 0.0110). Five patients with diploid tumors and negative telomerase RNA expression developed a recurrence. However, recurrence was associated with DNA aneuploidy ( P = 0.001) as well as with high telomerase RNA overexpression ( P = 0.001).

Conclusions

We conclude that telomerase RNA expression and DNA ploidy could be additional markers in the field of prognosis of prostate carcinomas.
Extragonadal Yolk sac Tumor outside of the Midline of the Body: A Case Report of a Child with a Yolk Sac Tumor of the Pontocerebellar Angle
Authors: Lazzareschi Ilaria , Furfaro Ilaria Francesca , Coccia Paola , Puma Nadia , Riccardi Riccardo
Published: February 2018

Yolk sac tumor is a rare germ cell neoplasm occurring mainly in the gonads. Extragonadal yolk sac tumor is a very rare malignancy; its main distribution is along the midline of the body at three principal sites: mediastinum, central nervous system and retroperitoneum. Most yolk sac tumors are diagnosed between seven months and three years of age.

We report a case of primary yolk sac tumor in a 13-month-old child. The tumor was located in the pontocerebellar angle, an atypical location that may not have suggested a yolk sac tumor as first diagnosis. We want to highlight the importance of performing tumor marker measurements during the first year of life, also for tumors located away from the midline.
Metronomic Chemotherapy Against Cancer: From Paradigm to Clinical Practice?
Authors: Calvani Nicola , Orlando Laura , Nacci Angelo , Sponziello Francesco , Cinefra Margherita , Cinieri Saverio
Published: February 2018

We describe two paradigmatic cases where metronomic antitumor chemotherapy was successfully employed in patients not suitable for standard treatments. The first patient was affected by advanced soft tissue sarcoma but she also had ischemic cardiopathy. She received oral cyclophosphamide 50 mg once daily and methotrexate 2.5 mg bid twice weekly, obtaining a significant clinical response with a progression-free survival of 7 months. The second patient was over 70 years of age and suffered from metastatic gastric cancer. Because of his poor performance status he was given capecitabine 1500 mg daily, achieving a complete remission with a current disease-free survival of 13 months. In both cases no significant toxicities were observed.
Alcohol, Tobacco and Genetic Susceptibility in Relation to Cancers of the Upper Aerodigestive Tract in Northern Italy
Authors: Canova Cristina , Richiardi Lorenzo , Merletti Franco , Pentenero Monica , Gervasio Carmine , Tanturri Gabriella , Garzino-Demo Paolo , Pecorari Giancarlo , Talamini Renato , Barzan Luigi , Sulfaro Sandro , Franchini Giovanni , Muzzolini Chiara , Bordin Sandro , Pugliese Gaetano Natale , Macrì Ettore , Simonato Lorenzo
Published: February 2018

Aims and background

Each year in Italy there are approximately 14,000 new cases and 7,000 deaths from cancer of the upper aerodigestive tract, which includes malignant tumors originating from the oral cavity, pharynx, larynx and esophagus. Established etiological factors include tobacco consumption and heavy alcohol drinking. The study of single nucleotide polymorphisms in upper aerodigestive tract cancer etiology may help to identify high-risk subgroups and to better understand the pathways leading to the development of these cancers.

Methods

Italian results on about 500 cases and 500 controls from a large case-control study (ARCAGE) conducted in 10 European countries are presented with the major objectives of updating results on the effects of alcohol and tobacco consumptions in northern Italy, investigating the role of genetic variation with regard to the metabolism of alcohol and carcinogens from tobacco smoke, and evaluating possible interactions of these single nucleotide polymorphisms with these carcinogens.

Results

The present study confirmed the importance of tobacco smoking and alcohol drinking as the main risk factors for upper aerodigestive tract cancers, indicating that about 68% of cancers among populations in northern Italy can be attributed to the combination of these risk factors. Significant associations between metabolizing phase I genes (CYP1A1 and CYP2A6), phase II genes (GSTA2) and upper aerodigestive tract cancers were found. A polymorphism of ADH1C has been associated with an increased risk of upper aerodigestive tract cancers, suggesting that the less rapid alcohol metabolizers are more susceptible to upper aerodigestive tract cancer risk.

Conclusions

Our results suggest that the ADH1C allele modifies the carcinogenic dose response for alcohol in the upper aerodigestive tract, giving rise to a gene-environment interaction. The role of genes as possible modifiers of life-style risks seems the most reliable.
Image-Guided Robotic Radiosurgery as Salvage Therapy for Locally Recurrent Prostate Cancer after External Beam Irradiation: Retrospective Feasibility Study on Six Cases
Authors: Vavassori Andrea , Jereczek-Fossa Barbara Alicja , Beltramo Giancarlo , De Cicco Luigi , Fariselli Laura , Bianchi Livia Corinna , Possanzini Marco , Bergantin Achille , DeCobelli Ottavio , Orecchia Roberto
Published: February 2018

Aims and background

Technological advances in treatment planning and execution are providing new potential opportunities in the treatment of recurrent prostate cancer. This study was conducted to evaluate the feasibility and safety of reirradiation with image-guided radiosurgery using CyberKnife, a robotic arm-driven compact linear accelerator, for intraprostatic recurrence after external beam radiotherapy (EBRT).

Methods

Between September 2007 and May 2008, 6 patients diagnosed with locally recurrent prostate cancer after EBRT were treated using the CyberKnife system. The total reirradiation dose was 30 Gy in five fractions. Prior to radiosurgery four patients were treated with androgen-deprivation therapy. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and the Houston-Phoenix definition (PSA nadir + 2 ng/mL) were used for toxicity and biochemical failure evaluation, respectively.

Results

After a median follow-up of 11.2 months (range, 9.6–18.6 months), all patients are alive with no evidence of severe urinary or rectal acute morbidity. Local control cannot be exactly determined due to the short follow-up and the bias of the use of androgen ablation. Four patients had biochemical failure, three of them with clinical failure evidence (lymph node, bone and lung metastasis, respectively): none of these patients had clinical evidence of tumor persistence in the prostate.

Conclusions

Salvage radiosurgery with CyberKnife after irradiation is feasible with low urinary and rectal morbidity. A longer follow-up and a larger number of patients are necessary to evaluate its effectiveness and optimal patient selection criteria.
Prognostic Factors in Follicular Lymphoma: The Importance of beta-2 Microglobulin
Authors: Cánovas Araceli , Alonso Juan J , Barreiro Guillermo , Aguirre Ciriaco
Published: February 2018

Aims and background

The Follicular Lymphoma International Prognostic Index (FLIPI) is a useful tool for the prognostic assessment of follicular lymphoma but beta-2 microglobulin (B2M) was not incorporated in this index. We aimed to compare the predictive value of B2M, FLIPI and other prognostic factors not included in the FLIPI index for overall survival (OS), complete remission (CR), and time to treatment failure (TTF) in a nonselected follicular lymphoma series.

Methods and study design

Retrospective univariate and multivariate analysis of the prognostic value (for OS, CR, TTF) of B2M, FLIPI and other prognostic variables in follicular lymphoma was conducted in a cohort of follicular lymphoma patients between 1987 and 2007.

Results

One hundred and six patients were studied. In univariate analysis B2M and B symptoms were significantly associated with OS, and FLIPI only detected two risk levels. In multivariate analysis of OS only two significant variables were found: FLIPI and B2M. Multivariate analysis of CR showed that normal B2M, absence of a bulky mass, uninvolved bone marrow, and chemotherapy with rituximab were significant predictors of CR. FLIPI (three levels), B2M, bone marrow infiltration, and chemotherapy with rituximab were significantly associated with TTF.

Conclusions

We found a high predictive value of B2M for OS, CR, and TTF. B2M and FLIPI were the most important variables to predict OS. However, in our series FLIPI differentiated only between two mortality risk levels.
Sacroplasty in a Patient with Bone Metastases from Hepatocellular Carcinoma. A Case Report
Authors: Toro Adriana , Pulvirenti Elia , Manfrè Luigi , Di Carlo Isidoro
Published: February 2018

Bone metastases account for 10% to 30% of secondary tumors in all cancer types. In patients with primary hepatocellular carcinoma (HCC), bone metastases are usually treated by nonoperative procedures including pain medication, radiotherapy, hormone therapy, chemotherapy, and bisphosphonates. Surgical treatments include vertebrectomy, reconstruction with a cage or polymethylmethacrylate bone cement, and stabilization with pedicle screws. Sacroplasty to treat bone metastases from HCC has been rarely reported in the literature. We describe the case of a patient with vertebral metastases of HCC treated by this approach. A65-year-old man had undergone a hepatic segmentectomy in 2004. In May 2008, after several weeks of back pain and bed rest, the patient underwent computed tomography and magnetic resonance imaging of the abdominal and pelvic spine, which revealed metastatic lesions in S1–S5 on the right and S1–S2 on the left. Sacroplasty was performed on all lesions without complications. The patient was discharged from the hospital the same day of the procedure. Two months later, he reported pain relief and improvement in walking. Due to the technical feasibility, low complication rate, and immediate relief of symptoms, sacroplasty for HCC metastases of the sacrum may be considered a valid therapeutic option.
Vincristine, Doxorubicin, Cyclophosfamide, Actinomycin D, Ifosfamide, and Etoposide in Adult and Pediatric Patients with Nonmetastatic Ewing Sarcoma. Final Results of a Monoinstitutional Study
Authors: Ferrari Stefano , Palmerini Emanuela , Alberghini Marco , Staals Eric , Mercuri Mario , Barbieri Enza , Longhi Alessandra , Cantero Laura , Cesari Marilena , Abate Massimo , Balladelli Alba , Picci Piero , Bacci Gaetano
Published: February 2018

Aims and background

To investigate a six-drug combination in patients with non-metastatic Ewing sarcoma, focusing on chemotherapy-induced necrosis and chemotherapy toxicity in adult and pediatric patients.

Methods and study design

Alternating cycles of vincristine (1.5 mg/m2), doxorubicin (80 mg/m2) and cyclophosfamide (1200 mg/m2) (weeks 0, 6, 13, 22a nd 31), ifosfamide (9 g/m2), vincristine (1.5 mg/m2), and actinomycin D (1.5 mg/m2) (weeks 3, 16, 25 and 34), and ifosfamide (9 g/m2) and etoposide (450 mg/m2) (weeks 9, 19, 28 and 37) were administered. Primary chemotherapy-induced necrosis was graded: G3 (complete necrosis), G2 (microfoci of tumor cells) and G1 (macrofoci of tumor cells).

Results

From 1996 to 1999, 50 patients with Ewing sarcoma were enrolled. The median age was 23.5 years (range, 4–56). Chemotherapy-induced necrosis (in 28 patients) was G3 in 36%, G2 in 21% and G1 in 43%. At a median follow-up of 110 months (range, 36–129), 5-year overall survival and event-free survival were 72% and 66%, respectively. According to histologic response, 5-year event-free survival was 90% in G3, 83% in G2, and 42% in G1 (P = 0.02). In adult and pediatric (<18 years) patients, the incidence of G4 leukopenia was 62% and 74%, respectively, with febrile neutropenia in 13% and 21%, respectively. G4 thrombocytopenia occurred in 3% of cycles in adults and in 7% in pediatric patients. Platelet and red blood cell transfusions were required respectively in 1% and 11% of cycles in adults and in 6% and 24% of cycles in pediatric patients.

Conclusions

The six-drug combination can be administered safely in adult and pediatric populations. About 40% of patients have a poor chemotherapy-induced tumor necrosis, leading to poor probability of survival. New strategies are recommended to improve survival of poor responders to the six-drug combination.
Management of Patients with Gastrointestinal Stromal Tumor in Clinical Practice in Italy: A Critical “Event Tree Model” Analysis of Decision-Making Processes and Outcomes
Authors: Pantaleo Maria Abbondanza , Di Battista Monica , La Rovere Stefano , Astorino Maria , Catena Fausto , Lolli Cristian , Saponara Maristella , Maleddu Alessandra , Nannini Margherita , Di Scioscio Valerio , Santini Donatella , Ceccarelli Claudio , Paterini Paola , Castellucci Paolo , Astolfi Annalisa , Mandrioli Anna , Fusaroli Pietro , Tomassetti Paola , Pinna Antonio Daniele , Biasco Guido
Published: February 2018

Aims and background

Even though the standard treatment of patients affected by gastrointestinal stromal tumors has been well defined by clinical trials and clinical guidelines, in practice it may be different from those proposed in the literature. This paper reports and comments on a critical picture of the management of patients with gastrointestinal stromal tumors who received at least one treatment before arriving at our GIST Study Group.

Methods and study design

Attention was focused on 60 patients from various hospitals. Retrospective clinical data were recorded and analyzed with the “event tree” model, which describes the algorithm of all treatment options that each patient received before. Responses from first to fourth line of therapy, time to progression, and survival analysis were also analyzed.

Results

Starting from the diagnosis of disease, seven possible therapeutic event trees were identified: one for 7 unresectable patients and six different trees for 53 recurred patients who initially underwent surgery. The event trees describe the multitude of different treatments that patients with gastrointestinal stromal tumors received during the course of their disease.

Conclusions

In clinical practice, the treatment of patients affected by gastrointestinal stromal tumor is still difficult, and the published recommendations often do not cover all therapeutic decisions for all clinical presentations of disease. Multidisciplinary dedicated teams are needed to offer the possibility to receive appropriate surgery and innovative medical therapies. The formation of formalized GIST Units is in progress in several parts of Italy. The GIST Units can be organized in a network to facilitate discussion and agreement for the wide variety of clinical presentation.
Epirubicin and Docetaxel as Neoadjuvant Treatment of Locally Advanced Breast Cancer: A Phase II Study
Authors: Lombardi Davide , Scalone Simona , Crivellari Diana , Magri Maria Donatella , La Mura Nicoletta , Miolo GianMaria , Murrone Antonio , Perin Tiziana , Coran Francesco , Candiani Ezio , Massarut Samuele , Veronesi Andrea
Published: February 2018

Aims and background

Neoadjuvant chemotherapy is the standard treatment for locally advanced breast cancer. The combination of anthracyclines and taxanes is considered the first choice chemotherapy in advanced breast cancer. We report here the overall results of a phase II study of epirubicin and docetaxel as neoadjuvant chemotherapy in advanced breast cancer.

Patients and methods

Forty-five patients with locally advanced, nonmetastatic breast carcinoma were treated with epirubicin, 90 mg/m2, docetaxel, 75 mg/m2, intravenously, every 3 weeks for 4 cycles before and 4 cycles after surgery, followed by tamoxifen for 5 years if estrogen receptor positive and radiation therapy if indicated. Patient characteristics included a median age of 45 years; pre/postmenopausal, 31/14 patients; T3-T4 in 33, N0/N1 in 12/33; ductal/lobular in 42/3; ER+ in 23; and HER2 overexpression in 23.

Results

Clinical response included complete remission in 7 patients and partial remission in 27 (response rate, 75%). All 45 patients underwent surgery (quadrantectomy in 7). Histological examination of the breast and lymph nodes revealed no signs of disease in 3 patients and ductal carcinoma in situ only in 2. Twenty-five patients completed the chemotherapy program. G3-G4 toxicity included neutropenia in 39 patients. No other G3-4 toxicity nor toxic deaths occurred. Median relapse-free and overall survival were 35 and 56 months, respectively.

Conclusions

The neoadjuvant treatment was active and well tolerated, but the incidence of pathologic complete remissions was relatively low.
Anti-Androgen Therapy Suspension following Prolonged Clinical and Biochemical Response: Outcomes in a Series of Elderly Patients with Advanced Prostate Cancer
Authors: Castagneto Bruno , Stevani Ilaria , Ferraris Valentino , Giorcelli Laura , Perachino Massimo
Published: February 2018

Aims and background

To describe the outcomes following the suspension of androgen-suppression therapy in a series of elderly patients in an advanced stage of prostate cancer and in prolonged clinical and biochemical response.

Material and methods

Of 371 consecutive patients with advanced prostate cancer and treated with androgen-suppression therapy, 44 older patients were defined as in stable response on the basis of the following: absence of noteworthy dysuria, normal prostate findings on digital rectal examination, and prostate-specific antigen values lower than 0.50 ng/ml. After suspending treatment, it was to be re-scheduled in case of onset of dysuria, evidence of a palpable lesion on digital rectal examination, or a rise in prostate-specific antigen above 10 ng/ml. Progression of disease was defined as a prostate-specific antigen level increase at two subsequent measurements, and/or the appearance of new lesions, and/or evidence of progression of disease on digital rectal examination.

Results and conclusions

Median age of patients was 78.5 years at the moment of therapy suspension. After a median follow-up of 93.9 months, fourteen patients (31.8%) showed progression of disease, but only 7 (15.9%) of these died. In 7 (15.9%) patients, serum testosterone levels did not exceed 0.5 ng/ml, indicating an absence of gonadal activity. The median time to progression was 138.2 months, and the median cumulative survival from the start and from the suspension of androgen-suppression therapy was 105.5 months and 64.1 months, respectively. The savings in drug costs amounted to 772,267 Euro. Taking into consideration these outcomes of survival and of savings in drug costs, we can conclude that in these selected elderly patients, this treatment option could be of interest.
A Case of Relapsed Medulloblastoma Treated with Intensity-Modulated Radiotherapy and Temozolomide
Authors: Mascarin Maurizio , Dall'Oglio Stefano , Palazzi Mario , Sartor Giovanna , Marradi Pier Luigi , Romano Mario , Maluta Sergio
Published: February 2018

We report a case of relapsed high-risk non-metastatic medulloblastoma in a 14-year-old boy, which was treated with intensity-modulated radiotherapy (IMRT) and temozolomide (TMZ). At the age of 11, the patient underwent an MRI-confirmed incomplete resection of a fourth-ventricle medulloblastoma, followed by conventional chemotherapy, craniospinal irradiation (55.8 Gy, 1.8 Gy/fraction) and then myeloablative chemotherapy followed by peripheral blood progenitor cell rescue. After 18 months of complete remission following the completion of chemotherapy, MRI showed a 2.5-cm mass in the olfactory notch. The patient underwent IMRT (45 Gy, 1.8 Gy/fraction) with concomitant administration of TMZ (180 mg/m2, 5 days every 21 days), which was well tolerated. After 5 cycles of TMZ, MRI showed complete remission with no evidence of the mass. TMZ was continued for another 5 cycles and then stopped. At 14 months from the completion of IMRT, a new MRI scan showed multiple nodular relapses around the fourth ventricle and the patient is currently treated with oral etoposide.
Malignant Mesenchymoma of the Thyroid: Case Report and Literature Review
Authors: Shi Huaiyin , Wang Chunyan , Wei Lixin , Lu Sun , Cao Dengfeng
Published: February 2018

Malignant mesenchymoma of the thyroid is extremely rare. We report such a tumor involving the bilateral lobes of the thyroid which showed simultaneous chondrosarcomatous, osteosarcomatous, fibrosarcomatous and rhabdomyosarcomatous differentiation. The patient was a 52-year-old woman admitted with a history of facial swelling, neck thickness and swallowing discomfort of one month's duration. Sonographic examination indicated a thyroid mass involving the bilateral lobes. Macroscopically, the tumors of both lobes were well demarcated, solid, greyish-white, and multinodular on the cut surface. Some nodules were translucent in appearance and hard in texture. Microscopically, the tumor was composed of small primitive mesenchymal cells with osteoid formation resembling the small cell variant of osteosarcoma interspersed with multiple cartilaginous nodules that indicated chondrosarcomatous differentiation. Some tumor cells showed prominent rhabdomyoblastic differentiation with eosinophilic cytoplasm and eccentric nuclei. Fibrosarcomatous areas were also observed. Immunohistochemically, the small primitive mesenchymal cells were positive for vimentin and CD99 and negative for CD56, Syn, CgA, CK, TG, TTF-1, calcitonin, and S-100. The tumor cells in the rhabdomyosarcomatous area were MyoD1 and muscle-specific actin positive. Molecular analysis for BRAF and RAS gene alterations showed no point mutation. The tumor recurred four months after surgery and tumor thrombi were suspected in the bilateral internal carotid arteries on ultrasonography. Primary malignant mesenchymoma of the thyroid is a high-grade malignant tumor with a poor prognosis. Its differerential diagnosis includes anaplastic carcinoma and other rare sarcomas with chondroid, osteoid, and other mesenchymal metaplasia.
Cisplatin plus Docetaxel Combination in the First-Line Treatment of Metastatic Non-Small Cell Lung Cancer
Authors:   the Anatolian Society of Medical Oncology (ASMO), Kaya Ali Osman , Buyukberber Suleyman , Dane Faysal , Isikdogan Abdurrahman , Ustaalioglu Basak Oven , Coskun Ugur , Yumuk Perran Fulden , Dogu Gamze Gokoz , Ozdemir Nuriye Yildirim , Sevinc Alper , Gumus Mahmut , Ozkan Metin , Yildiz Ramazan , Ozturk Banu , Yaman Emel , Benekli Mustafa
Published: February 2018

Aims

To evaluate activity and toxicity of cisplatin plus docetaxel combination in the first-line treatment of chemotherapy-naive patients with metastatic non-small cell lung cancer.

Patients and methods

Between October 2004 and July 2008, 186 patients with metastatic non-small cell lung cancer treated with first-line cisplatin plus docetaxel were retrospectively evaluated in 7 centers. The chemotherapy schedule consisted of cisplatin, 75 mg/m2 iv infusion, and docetaxel, 75 mg/m2 iv infusion on day 1, every 3 weeks.

Results

Median age was 56 years (range, 28–75). Eighteen patients (9.7%) were females and 168 (90.3%) were males, with a median ECOG performance status of 1 (range, 0–2). A total of 833 cycles of chemotherapy was administered (median, 4 cycles; range, 1–6). Two patients (1.1%) achieved clinical complete response, 77 patients (41.4%) partial response, and 66 patients (35.5%) stable disease. Median time to disease progression was 6 months (95% CI, 5.54–6.46). Median overall survival was 14.6 months (95% CI, 11.47–17.73). One- and 2-year overall survival was 55.2% and 19.7%, respectively. The most common grade 3–4 hematological toxicities were neutropenia (n = 32, 17.2%) and anemia (n = 4, 2.2%).

Conclusions

The cisplatin plus docetaxel combination was effective and safe in the first-line treatment of patients with metastatic non-small cell lung cancer.
Fixed-Dose-Rate Gemcitabine Infusion in Patients with Advanced Pancreatic or Biliary Tree Adenocarcinoma
Authors: Mané Joan M , Sancho Aintzane , Muñoz Alberto , Rubio Itziar , Fernández Ricardo , Carrera Sergio , Fuente Natalia , Ballesteros David , Casas Raquel , Marrodán Inés , Mielgo Xabier , López-Vivanco Guillermo
Published: February 2018

Aims and background

Gemcitabine is an effective agent in pancreatic adenocarcinoma. Fixed-dose-rate gemcitabine has an interesting biological and clinical rationale, with successful results in previous studies. We conducted a trial to confirm efficacy and toxicity of fixed-dose-rate gemcitabine in patients with pancreatic or biliary tree adenocarcinoma.

Methods

Eligible patients with locally advanced or metastatic pancreatic or biliary tree adenocarcinoma received fixed-dose-rate gemcitabine at a dose of 1500 mg/m2 at a rate of 10 mg/m2/min weekly for 3 weeks every 28 days. Efficacy measures were overall survival, response rate and progression-free survival.

Results

Sixty-two patients were enrolled, and 59 were assessable for response. Seven patients (11.3%) had a partial response, 26 stable disease (41.9%) and 26 progressive disease (41.9%). Median time to progression was 21 weeks and median overall survival, 37.71 weeks. Main toxicities were grade 3–4 neutropenia (45.2%) and grade 2–3 asthenia (54.8%). No toxic deaths were documented.

Conclusions

Fixed-dose-rate gemcitabine has a relevant antitumor activity but with significant toxicity. It represents an interesting schedule and could be combined with other biological or chemotherapeutic agents.
The Effects of Growth Inhibitory Peptide on Follicular Thyroid Cancer Cell Growth, Migration, and Invasion
Authors: Hua Shih-Che , Chen Syue-Yi , Lu Chieh-Hsiang , Kao Yu-Ting , Yu Hui-I , Chen Ping-Tzu , Lee Ying-Ray , Chang Tien-Chun
Published: February 2018

Aims and background

Thyroid cancer is the most common endocrine neoplasm worldwide. Although differentiated thyroid cancers are associated with a favorable survival, the prognosis worsens dramatically for patients with distant metastasis. Metastases from follicular thyroid carcinoma (FTC) occur earlier and are more aggressive than those from papillary thyroid carcinoma. For FTC that is resistant to radioactive iodine, new treatments are urgently needed. Human alpha-fetoprotein (HAFP) is a tumor-associated fetal protein that has been demonstrated to regulate tumorigenesis. Growth inhibitory peptide (GIP), a synthetic 34-mer peptide isolated from the third domain of HAFP, has been shown to have antitumor growth ability in various human cancers. However, the effects of GIP in FTC have not yet been studied. The aim of this study was to investigate the antitumor ability of GIP in FTC.

Methods and study design

Using both PBS and GIP control peptide as a negative control, the antiproliferative activity of GIP in the WRO human FTC cell line was determined using a tetrazolium-based colorimetric assay. In addition, cell migration and invasion assays were used to measure tumor metastasis inhibition effects in vitro.

Results

GIP did not inhibit WRO cell proliferation in a time- or dose-dependent manner. However, in WRO cells treated with GIP for 4 days, migration was significantly inhibited at concentrations of 50 and 100 μM (33.3% and 19.5%, respectively; both P <0.05). Cell invasion was also significantly inhibited at 50 and 100 μM (67.1% and 39.0%, respectively; both P <0.05).

Conclusions

Although GIP failed to suppress FTC cell growth, it effectively interrupted both FTC cell migration and invasion abilities in vitro. Further validation in an animal model and elucidation of the underlying mechanisms will be required. GIP may potentially serve as an anti-FTC metastasis agent aiding current chemotherapy regimens.
Inflammatory Myofibroblastic Tumor of the Stomach in an Adult Woman: A Rare Intermittent Cause of Gastric Outlet Obstruction
Authors: Albayrak Fatih , Dursun Hakan , Albayrak Yavuz , Altas Sare , Uyanik Abdullah , Yildirim Rahsan
Published: February 2018

Background

Inflammatory myofibroblastic tumor is a neoplasm of intermediate biological potential that frequently recurs and rarely metastasizes.

Case report

We report a rare case of intermittent gastric outlet obstruction by an inflammatory myofibroblastic tumor of the cardia.

Results

A 56-year-old woman presented at the gastroenterology department with a two-day history of hematemesis and melena. She had intermittent nausea and vomiting complaints, which had manifested periodically for about five months. Upper gastrointestinal endoscopy demonstrated a mass of 6 cm in diameter, which was resected. Histological examination revealed ulcerated mucosal granulation-like tissue with myofibroblastic spindle cell proliferation in a storiform pattern.

Conclusions

In order to avoid unnecessary aggressive therapy, gastric IMT should be taken into account when a gastric mass accompanied by the various clinical manifestations of IMT is found in an adult.
Cervical Cancer Screening in Bulgaria - past and Present Experience
Authors:   on behalf of the EUROCHIP Working Group, Valerianova Zdravka , Panayotova Yulia , Amati Camilla , Baili Paolo
Published: February 2018

Background

In Bulgaria the previously (1970–1985) existing population based cervical cancer screening was replaced in the early 1990s with an opportunistic model due to political and socioeconomic reasons. As a result, in the last 20 years, cervical cancer incidence and mortality rates steady increased. The objective of the EUROCHIP project in Bulgaria was to evaluate the readiness of the health system as well as health providers' attitudes to implementation in the country of a population based screening program for cervical cancer.

Methods

Using a structured questionnaire, a convenience sample of medical specialists representing different actors involved in cervical cancer prevention, treatment, financing and policy were interviewed.

Results

The majority of interviewed practitioners worried that organization and implementation of an effective population-based cervical cancer screening program is not possible in the current unstable health system. A nostalgic attitude to the cervical cancer screening, performed in the past and pessimistic view on the capability of the current health system to cope are strong. As main barriers to implementation of an effective program were pointed financial and organizational ones. Motivation for gynecologists to perform smear test should include better information, organization and payment.

Discussion

Medical specialists in Bulgaria are aware of the alarming rates of cervical cancer incidence and mortality in the country. However, due to the insufficient communication and interaction between policy makers and front-line health care staff, they do not have enough information on the ongoing programs. Absence of health policy regarding screening is considered as main barrier for implementation of an effective screening program.
Quality of Life and Fatigue in Hodgkin's Lymphoma Patients
Authors: Miltényi Zsófia , Magyari Ferenc , Simon Zsófia , Illés Árpád
Published: February 2018

Aims and background

Quality of life and survival of patients with malignant diseases are improving thanks to the development in diagnostics and therapy.

Methods

We determined the quality of life and frequency and severity of fatigue with an EORTC QLQ-C30 questionnaire in 168 Hodgkin's lymphoma patients (85 women, 83 men). We scored all functional and symptom scales in cured patients (who were in complete remission for at least 10 years; mean period of survival after the treatment(s) was 16.61 years) and in those who suffered from late complications.

Results

The global health status score (QL2) was significantly lower in patients who had late complications (mean QL2, 45.53) than in patients with no complications (mean QL2, 67.57, P <0.001) and in cured patients (mean QL2, 52.5) than in those who were not disease free 10 years after the treatment or who were treated actively (mean QL2, 67.48, P <0.001). We found that fatigue level (FA) was significantly higher in patients who had been treated more than 20 years before (FA score, 53.37) than in those who were undergoing treatment (FA score, 29.35, P = 0.03). A significantly higher FA score (FA, 48.72) was observed in patients who suffered from late complications of the treatment than in those who had no complications (FA, 31.88; P = 0.001). More co-morbidity can cause higher fatigue scores than observed in these groups of Hodgkin's lymphoma patients.

Conclusions

Fatigue is more frequent than we think, and it has a strong effect on quality of life, so its early recognition and treatment is important and needs multidisciplinary cooperation.