bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer Burden Estimates and Forecasts: Uses and Cautions
Authors: Gatta Gemma , Rossi Silvia , Capocaccia Riccardo
Published: February 2018

Incidence, prevalence and mortality indicators, as provided in this monographic issue for each of the Italian regions and for the major cancers (stomach, colorectal, lung, breast, uterine cervix, prostate cancer and skin melanoma), provide necessary information for cancer control activities. In Italy, these activities are mainly organized on a regional level.

Incidence depends on the distribution of risk factors in the population and is monitored to assess the efficacy of primary prevention programs as well as to measure the effect of screening activities. Mortality is a summary indicator incorporating the effects of both occurrence and survival. Finally, the prevalence of people with a diagnosis of cancer within a population is a direct measure of the demand for health care and social services. When taken separately, each of these indicators provides a partial view of the cancer phenomenon and should therefore be interpreted with caution. In this paper we give some examples of the uses of these indicators, and also of the interpretation difficulties by relating the regional cancer incidence to tobacco use, overweight and residence in polluted sites. We comment on the observed mortality trends in terms of their contribution to incidence and survival. We associate the estimated trends in cancer prevalence from 1990 to 2015 with the gross domestic product, an indicator of the resources available in Italy. The simultaneous consideration of all three indicators, as was done throughout this monograph by means of a unique methodology, is suggested for public health use.
A case of long-term survival after repeated response to oxaliplatin-based chemotherapy and repeated thermoablation of liver metastases from colorectal cancer. Should we introduce the concept of oxaliplatin-resistant tumors?
Authors: Ottone Azzurra , Bellini Elisa , Ferrero Anna , Baratelli Chiara , Taberna Eleonora , Bitossi Raffaella , Brizzi Maria Pia , Tampellini Marco
Published: February 2018

Background

The management of advanced colorectal cancer patients differs among cancer centers. International guidelines recommend offering all the recognized active regimens in order to obtain survival advantage, but little information is given about the sequence and combination in which such regimens should be administered.

Case report

We report the case of a man with multiple liver metastasis from colorectal cancer followed for more than 78 months at our Institution. Repeated response to the same oxaliplatin, 5-fluorouracil and folinic acid chemotherapy schedule was achieved, and repeated radiofrequency ablation of liver metastases was performed until progression of lung and brain disease at 50 and 72 months, respectively, after the diagnosis of advanced disease. Although the tumor became oxaliplatin and chemo-resistant after the onset of extra-hepatic disease, a more aggressive chemotherapy regimen, including a doublet with a biological, halted tumor growth.

Conclusions

The patient survived for more than 78 months without experiencing a major impact on his quality of life. This case reflects the importance of following tumor biology in the therapeutic decision-making process, reintroducing oxaliplatin whenever possible, and adopting a more aggressive strategy when the tumor becomes oxaliplatin-resistant.
Chylothorax in a Patient with Hodgkin's Lymphoma: A Case Report and Review of the Literature
Authors: Janjetovic Snjezana , Janning Melanie , Daukeva Liliana , Bokemeyer Carsten , Fiedler Walter
Published: February 2018

Background

Chylothorax is defined as chyle entering the pleural space. The most common causes of chylothorax are lymphoma followed by bronchogenic carcinoma and trauma.

Case report

We report a case of chylothorax in a patient with Hodgkin's lymphoma. A 28-year old man was admitted to the hospital with exertional dyspnea and dry cough. A chest X-ray showed the large opacity on the left side suggesting to the presence of pleural effusion.

Methods

The effusion was drained, and biochemical tests of the pleural fluid revealed high contents of triglycerides and, hence, confirmed the diagnosis of chylothorax. Cytology of the pleural fluid showed no evidence of Hodgkin's cells. Computer tomography scans of the chest and abdomen exhibited the presence of a soft tissue mass located in the left mediastinum. Mediastinal mass biopsy led to diagnosis of Hodgkin's lymphoma of the nodular sclerosis subtype. The patient received the standard treatment with two cycles of chemotherapy with prednisolone, doxorubicin, cyclophosphamide, vincristine, bleomycin, procarbazine, and etoposide (BEACOPP), followed by an additional two cycles of therapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).

Results

After one cycle of chemotherapy, chylothorax initially decreased. Unfortunately, during the following courses of chemotherapy, the pleural effusion reoccurred and repeated pleural taps were necessary. According to the treatment protocol, radiation of the mediastinal bulk was performed after chemotherapy. Now, nearly one year after completion of radiotherapy, the chylothorax has significantly regressed and no further thoracocenteses were necessary.

Conclusion

The case reveals an example of left-sided chylothorax as the first manifestation of Hodgkin's lymphoma in a young patient. In this case, radiotherapy was shown to be an effective treatment option for lymphoma-associated chylothorax unresponsive to chemotherapy.
Fatal hypersensitivity pneumonitis associated with docetaxel
Authors: Gurram Murali Krishna , Pulivarthi Swaroopa , McGary Carl T
Published: February 2018

We present a patient with advanced breast cancer treated with three cycles of docetaxel who developed repeated episodes of hypersensitivity pneumonitis, progressed to respiratory failure and death despite treatment with corticosteroids and supportive care. Docetaxel-induced hypersensitivity pneumonitis was diagnosed by excluding infection and tumor spread with bronchoalveolar lavage and lung biopsy. Physicians should consider such a condition in all patients who present with interstitial pneumonitis and respiratory failure when they are receiving docetaxel and treat them aggressively with steroids and supportive care, as it can be fatal.
Primary Renal Angiosarcoma: Radiologic-Pathologic Correlation and Literature Review
Authors: Detorakis Efstathios E , Chryssou Evangelia , Raissaki Maria , Androulidakis Emmanouil , Heretis Ioannis , Haniotis Vrettos , Karantanas Apostolos
Published: February 2018

We present a case of primary renal angiosarcoma. We focus on the characteristic striated pattern of the tumor on T2-w MR sequence as well as on other radiological features and correlate them with the pathologic findings. A review of the imaging characteristics of cases published in the literature was subsequently performed.
Retreatment with icotinib in a patient with metastatic lung adenocarcinoma
Authors: Sun Xiaoli , Zheng Yulong
Published: February 2018

A patient with advanced non-small cell lung cancer (NSCLC) was successfully treated with icotinib. The tumor relapsed after a partial response and the patient was retreated with icotinib after temporary cessation. Surprisingly we found that the tumor responded to icotinib again. The exact mechanism of this phenomenon is still unclear. A better understanding of the biological basis of involved events will help us to improve treatment of advanced NSCLC.
Palliative Two-Dimensional Radiotherapy of Pancreatic Carcinoma: A Feasibility Study
Authors: Morganti Alessio G , Marinelli Alfonso , Buwenge Milly , Macchia Gabriella , Deodato Francesco , Massaccesi Mariangela , Kigula-Mugambe Joseph , Wondemagegnhu Tigeneh , Dawotola David , Caravatta Luciana , Sallustio Giuseppina , Piermattei Angelo , Valentini Vincenzo , Cilla Savino
Published: February 2018

Aims and background

The aim of the study was to analyze the dose to be administered with two-dimensional involved-field palliative radiotherapy in advanced pancreatic carcinoma with respect to current dose-volume constraints (QUANTEC).

Methods and study design

The following standard regimens were evaluated: 30 Gy at 3 Gy/fraction (regimen A), 36 Gy at 2.4 Gy/fraction (regimen B), 45 Gy at 1.8 Gy/fraction (regimen C), and 50 Gy at 2 Gy/fraction (regimen D). The following constraints were considered: spinal cord Dmax <50 Gy, duodenum Dmax <55 Gy, liver Dmean <30 Gy, kidneys Dmean <15 Gy. For dose/fraction different from 1.8–2 Gy, the correction of constraints using a value of alpha/beta = 3 for late effects was considered. The calculation of dose/volume constraints was repeated for three different radiation beams: cobalt unit, 6 MV photons, and 15 MV photons. Standard field sizes were used and adapted according to the different beam types, using the parameters of our previous study. Respect of dose-volume constraints was assessed for each type of beam and treatment (dose per fractionation) in all patients. Treatments were considered acceptable in case of: 1) respect of the constraints for spinal cord and duodenum in all patients; 2) respect in >10/15 patients of constraints for kidneys and liver. Therefore, minor violations (<10%) of the constraints for these organs were accepted (in less than 5/15 patients), in consideration of the palliative aim of treatment.

Results

In regimen A (30 Gy, 3 Gy/fraction), evaluated constraints were respected in all patients, regardless of the type of energy. In regimen B (36 Gy, 2.4 Gy/fraction), constraints were met in all patients undergoing irradiation with 6 and 15 MV photons. However, using the cobalt unit, kidney constraint was respected only in 5 of 15 patients. In regimens C and D (45 Gy, 1.8 Gy/fraction and 50 Gy, 2 Gy/fraction, respectively), the constraint for the kidney was respected only in 2–5 patients, depending on the energy used. Furthermore, using 50 Gy, the spinal cord constraint was not respected in 2–3 patients, depending on the beam used. Therefore, only the following treatments were considered acceptable: 1) 30 Gy, 3 Gy/fraction, regardless of the energy used; 2) 36 Gy, 2.4 Gy/fraction, only for treatments performed with linear accelerator (6–15 MV).

Conclusions

The clinical benefits of radiotherapy in pancreatic tumors should not be withheld from patients treated in centers only with two-dimensional technology. Prospective trials, particularly in developing countries, would be useful to evaluate the efficacy in this setting of involved-field two-dimensional treatments using the dose and fractionation defined in this analysis.
Girdin correlated with autophagy in invasive ductal breast carcinomas
Authors: Jiang Ping , Cui Su-Ping , Ren Ya-Li , Mao Jing-Zhuo , Liu Hai-Jing , Tian Yuan , Liu Jian-Ying , Du Juan , Hou Lin , Zhang Bo
Published: February 2018

Aims and background

Increasing evidence claims that autophagy is essential for breast cancer progression. Girdin was found highly expressed in breast cancers. It has been reported that Girdin attenuates autophagy in HeLa cells. We explored the relationship between Girdin expression and autophagic patterns in breast cancer.

Methods and study design

In the study, Girdin expression and autophagic activity were investigated in a series of 99 invasive ductal breast carcinomas after immunohistochemical staining for the autophagy-associated proteins LC3-II and Girdin.

Results

The level of Girdin expression negatively correlated with LC3-II level, which represents autophagic activity (r = −0.289), and positively correlated with lymph node metastasis (r = 0.472). Girdin level was found no different in the “diffuse cytoplasmic” and “stone-like” patterns of LC3-II.

Conclusions

Up-regulated autophagy was negatively associated with Girdin level. There was a significant correlation between Girdin expression and lymph nodes metastasis in invasive ductal breast carcinoma.
Assessment of chemokine serum levels in epithelial ovarian cancer patients
Authors: Falcão-Júnior João Oscar Almeida , Teixeira-Carvalho Andréa , Cândido Eduardo Batista , Lages Elisa Lopes , Freitas G Gustavo Ferreira , Lamaita Rívia Mara , Bonfim Lívia Paula Freire , Salera Rafael Borges , Traiman P Paulo , da Silva-Filho Agnaldo Lopes
Published: February 2018

Aims and background

The study was undertaken to investigate CCL2/MCP-1, CCL3/MIP-1α, CCL4/MIP-1β, CCL5/RANTES and CXCL8/IL-8 women with epithelial ovarian cancer.

Methods and study design

Sixteen patients diagnosed with epithelial ovarian cancer and 18 healthy women with no evidence of malign neoplasia (control group) aged from 23 to 89 years (mean ± SEM, 58.7 ± 2.3) were included. The epithelial ovarian cancer patients underwent laparotomy and debulking surgery. Chemokines serum levels were measured by cytometric bead array. Statistical analysis was performed using Mann-Whitney and Kendall's tau. P <0.05 was considered statistically significant for all analyses.

Results

The tumor staging (FIGO) was classified into: I in 4 cases (25%), III in 5 cases (31.3%) and stage IV in 7 cases (43.8%). Sera chemokine dosages of CCL2/MCP-1 and CCL4/MIP-1β were lower in epithelial ovarian cancer patients than in the control group (P = 0.021 and P = 0.030, respectively). No significant difference between groups was observed in the levels of CCL3/MIP-1α, CCL5/RANTES and CXCL8/IL-8. No association between the chemokines analyzed and tumor stage was found. The serum level of CCL4/MIP-1β was correlated with CA-125.

Conclusions

The study of serum levels of CCL2/MCP-1, CCL3/MIP-1α, CCL4/MIP-1β, CCL5/RANTES and CXCL8/IL-8 chemokines in epithelial ovarian cancer patients identified a down-regulation in CCL2/MCP-1 and CCL4/MIP-1β, which suggests that the two chemokines may play an important role in the pathophysiology of ovarian cancer.
Well-differentiated neuroendocrine tumor of tailgut cyst. A rare entity with controversial medical opportunities
Authors: Damato Angela , Pusceddu Sara , Milione Massimo , Mazzaferro Vincenzo , Magli Michelle , Seregni Ettore , De Braud Filippo , Buzzoni Roberto
Published: February 2018

The incidence of neuroendocrine tumors is rising, and this rise is explained by more than just better diagnostic procedures. About 85% of these neoplasms arise in gastrointestinal or pulmonary sites, but cases where the location is more unusual also occur in clinical practice. The tailgut cyst is a rare entity well described in the medical literature, but a neuroendocrine tumor within such a cyst is a very rare event, with about 30 cases described in the literature to date. In this report we present the case of a young woman with this unusual diagnosis. The characteristics of the case differ from most previous case reports in a few respects: the patient was a young rather than middle-aged female; she had a presacral mass with a significant solid component; at diagnosis, there was evidence of a lytic lesion in the coccyx. Despite this particular medical presentation, radical surgery was accomplished. In this disease the greatest risk is local relapse, but adjuvant radiotherapy may compromise the patient's fertility. We therefore opted for strict control only, but this decision might be debatable.
Nocardia yamanashiensis in an immunocompromised patient presenting as an indurated nodule on the dorsal hand
Authors: Anzalone C Lane , Cohen Philip R , Tarrand Jeffrey J , Diwan Abdul H , Prieto Victor G
Published: February 2018

Background

Nocardia are ubiquitous, aerobic, gram-positive actinomycetes. Nocardiosis typically occurs in immunocompromised patients, although immunocompetent individuals can also be affected.

Purpose

The purpose of this case study is to review the clinical characteristics and treatments of a unique form of cutaneous nocardiosis.

Materials and Methods

We retrospectively reviewed the medical literature using PubMed, searching the terms cutaneous, host, immunocompromised, Nocardia, primary, yamanashiensis. Patient reports and previous reviews of the subject were critically assessed and the salient features are presented.

Results

Cutaneous nocardiosis typically presents as pustular nodules and the lesions may progress to become abscesses, cellulitis, granulomas or keloid-like tumors. N. brasiliensis is the predominant species involved in primary cutaneous nocardiosis; other common Nocardia species involved in human disease are N. farcinica, N. abscessus, N. cyriacigeorgica, and N. nova. Only two individuals (including the patient presented here) with primary cutaneous infection by N. yamanashiensis have been described in the literature; a third clinical isolate was recovered from a lung biopsy.

Conclusion

Nocardia yamanashiensis is a rare clinical form of primary cutaneous nocardiosis. 16S ribosomal gene sequencing, as well as Gram stain and modified Fite acid-fast stain, play a vital role in identifying this clinical variant.
Adenocarcinoma of the Lung in down Syndrome: First Clinical Report
Authors: Satgé Daniel , Salmeron Sergio , Homsi Toufik , Réthoré Marie-Odile , Tredaniel Jean
Published: February 2018

Lung cancer is rare in persons with Down syndrome, and the clinical presentation of the disease has not been described in adults with intellectual disability. We report the first detailed clinical observation of a 33-year-old man with Down syndrome who developed an adenocarcinoma of the lung 30 years after an acute lymphoblastic leukemia in infancy. Despite advanced disease at initial presentation and extensive tumor spreading during the course of the disease, he presented with unusually mild symptoms. The scarcity of lung cancer in people with intellectual disability, and particularly those with Down syndrome, is due, in part, to reduced tobacco use. However, cytogenetic and molecular studies suggest that genes mapping to chromosome 21 may protect against lung cancer. Numerous reports also suggest that, in persons with Down syndrome and other intellectual disability, cancers are often discovered late, leading to loss of the chance of cure and recovery.
Chemotherapy with carboplatin and paclitaxel after failure of primary chemotherapy for advanced thymic carcinoma. A report of three cases and review of the literature
Authors: Watanabe Keisuke , Shinkai Masaharu , Goto Hideto , Yoshikawa Sumiko , Yamaguchi Nobuhiro , Hara Yuu , Shinoda Masahiro , Moriyama Yusuke , Rubin Bruce K , Ishigatsubo Yoshiaki , Kaneko Takeshi
Published: February 2018

For patients with inoperable thymic carcinoma, multidrug chemotherapy containing cisplatin and an anthracycline is often used as first-line chemotherapy. A commonly applied regimen is cisplatin + doxorubicin + vincristine + cyclophosphamide (ADOC). There are relatively few reports on the use of carboplatin and paclitaxel as first-line chemotherapy for thymic carcinoma. In addition, little is known about its efficacy as second-line chemotherapy in patients with advanced thymic carcinoma. We here report on three patients with thymic carcinoma who were treated with carboplatin and paclitaxel as second-line chemotherapy after failure of ADOC. According to the Response Evaluation Criteria in Solid Tumors version 1.1, one patient achieved a partial response and two patients achieved stable disease. The median progression-free survival was 6.7 months and the median overall survival exceeded 3 years. Toxicities were well tolerated. Chemotherapy with carboplatin and paclitaxel appears to be effective as second-line chemotherapy for some persons with thymic carcinoma who fail ADOC.
Cost of Illness in Patients with Multiple Myeloma in Italy: The CoMiM Study
Authors: Petrucci Maria Teresa , Calabrese Elisabetta , Levi Anna , Federico Vincenzo , Ceccolini Michela , Rizzi Rita , Gozzetti Alessandro , Falco Patrizia , Lazzaro Carlo , Martelli Elisa , Boccadoro Mario , Lauria Francesco , Liso Vincenzo , Cavo Michele , Foa Robert
Published: February 2018

Aims and background

Multiple myeloma is the second most common hematological cancer. Although it accounts for only a relatively small percentage of all cancer types, the costs associated with managing multiple myeloma are considerable. Available studies are mainly focused on health care costs. The Costo del Mieloma Multiplo (Cost of MM, CoMiM) study investigated the cost of illness of multiple myeloma in Italy during one year of disease management.

Methods

CoMiM is a retrospective, prevalence-based, multi-center, cross-sectional study based on a stratified sample of patients seen during normal clinical practice (asymptomatic; symptomatic on drugs; symptomatic receiving autologous stem cell transplantation; plateau/remission). Demographics, clinical history, health care and non-health care resource consumption data were collected. Costs were evaluated from the societal viewpoint and expressed in Euro 2008.

Results

Data on 236 patients were analyzed (39 asymptomatic, 17%; 29 symptomatic receiving autologous stem-cell transplantation, 12%; 105 symptomatic receiving drugs, 44%; 63 plateau/remission, 27%). The total cost of illness reached € 19,267.1 ± 25,078.6 (asymptomatic, € 959.3 ± 1091.6; symptomatic receiving drugs, € 21,707.8 ± 21,785.3; symptomatic receiving autologous stem-cell transplantation, € 59,243.7 ± 24,214.0; plateau/remission, € 8130.7 ± 15,092.5). The main cost drivers of total cost of illness were drugs and hospital admissions (46.1% and 29.4%, respectively). Antineoplastics and immunomodulators drove the cost of drugs (21.6% and 21.1% of the total cost of illness). Cost of antineoplastics was led by bortezomib (97.4%), whereas the cost driver for immunomodulators was lenalidomide (99.4%). Cost of hospitalization funded by the Italian National Health Service was strongly influenced by transplantation (94.6%), whereas chemotherapy and skeletal fractures did not exceed 1% and 2%, respectively.

Conclusions

Despite some limitations, the CoMiM study provides Italian health care decision-makers with an insight into the stratified cost of illness of multiple myeloma patients.
Perioperative high-dose-rate interstitial brachytherapy boost for patients with early breast cancer
Authors: Sharma Daya Nand , Deo SVS , Rath Goura Kisor , Shukla Nootan Kumar , Thulkar Sanjay , Madan Renu , Julka Pramod Kumar
Published: February 2018

Aims and background

To evaluate the clinical results of perioperative high-dose-rate interstitial brachytherapy boost treatment preceding whole breast external beam radiation therapy in patients with early breast cancer.

Methods and study design

From 2005–2010, 100 patients with early breast cancer who met the eligibility criteria were enrolled in the study. Brachytherapy implant was performed during the breast-conserving surgery procedure. The boost treatment was started on the 3rd postoperative day to deliver a dose of 15 Gy in 6 fractions over 3 days. Three weeks later, external beam radiation therapy to the whole breast was started for a prescription dose of 50 Gy. The study end points were local recurrence, acute toxicity and cosmetic outcome.

Results

Median age of the patients was 46 years, and median follow-up was 52 months. No patient developed a local recurrence but 5 patients developed distant metastases. The 5-year overall survival and disease-free survival were 86% and 77%, respectively. Eleven patients had acute toxicity; 4 wound complications and 7 grade III skin toxicity. Nine of the 11 patients had breast size of more than 1500 cc. Except for the breast volume (>1500 cc), there was no statistically significant correlation between any of the patient or dosimetry-related factors and acute toxicity. Good-excellent cosmesis was observed in 87% of patients.

Conclusions

Perioperative high-dose-rate interstitial brachytherapy boost followed by whole breast external beam radiation therapy provides excellent local control, acceptable acute toxicity and good-excellent breast cosmesis in patients with early breast cancer.
Clinical outcome of stereotactic body radiotherapy for abdominal lymph node metastases
Authors: Bonomo Pierluigi , Cipressi Samantha , Saieva Calogero , Greto Daniela , Masi Laura , Paiar Fabiola , Di Cataldo Vanessa , Meattini Icro , Cecchini Sara , Mangoni Monica , Doro Raffaela , Iermano Carmine , Bonucci Ivano , Livi Lorenzo , Biti Giampaolo
Published: February 2018

Aims and background

To report the clinical outcome of linac-based or robotic, image-guided stereotactic body radiotherapy in patients affected by abdominal lymph node metastases from different primary cancers.

Methods and Methods

Twenty-six patients with 32 abdominal lymph node metastases were consecutively treated at the University of Florence between April 2011 and May 2012. The mean follow-up was 4.6 months (SD, 3.9; range, 0.3–13). The dose prescription ranged between 24 Gy and 36 Gy delivered in 1–5 fractions.

Results

In terms of local control, complete response to stereotactic body radiotherapy was obtained in 18 cases (66.7%), partial response in 7 (25.9%), and stable disease in 2 (7.4%). At the Cox univariate regression analysis, an increased risk of partial response or absence of local response to radiotherapy was found for subjects of the female sex (P = 0.036), age less than 50 years (P = 0.022), primary tumor of the genital tract (P = 0.007), and previous chemotherapy (P = 0.057). An excellent local control rate (90.9%) was obtained in patients affected by abdominal lymph node metastases of prostatic origin.

Conclusions

Stereotactic body radiotherapy for abdominal lymph node metastases is a safe and effective treatment in terms of high rates of local control, especially in a subset of patients affected by prostate cancer.
Single Skull Metastasis 15 Years after Primary Treatment of Prostate Cancer and with Undetectable PSA Levels: A Case Report and Review of the Literature
Authors: Messina Marco , Ricci Francesco , Spina Bruno , Boccardo Francesco
Published: February 2018

Prostate cancer is the first cause of skull metastases in men, accounting for 12–18% of all cases. This condition is generally a late event in the course of the disease, involving patients with disseminated lesions. Quite rarely is skull involvement the first and single site of distant recurrence. We report the case of a patient who developed a single skull lesion 15 years after primary treatment of prostate cancer, in the presence of undetectable PSA levels. Pathological assessment performed after resection of the lesion revealed a metastasis from prostate carcinoma. Basing on this experience the appearance of craniofacial pain or a nerve deficit in patients with a history of prostate cancer should alert the clinician to exclude distant recurrence of disease, even in the presence of undetectable PSA levels and even if many years have elapsed since the treatment of the primary tumor. Knowledge of these manifestations will reduce any diagnostic delay and lead to the effective delivery of appropriate treatment.
Salvage lenalidomide in four rare oncological diseases
Authors: Szturz Petr , Adam Zdenek , Rehak Zdenek , Koukalova Renata , Kren Leos , Moulis Mojmír , Krejcí Marta , Mayer Jiri
Published: February 2018

In rare disorders, there are often no standard therapy recommendations. Patients with refractory disease may require novel experimental approaches. Applied as second- up to fourth-line treatment, lenalidomide (10–25 mg perorally on days 1–21 in a 28-day cycle) was used in our cohort of four adult patients with aggressive, multisystem and relapsing diseases. Complete and long-lasting remissions (more than 1 year, no maintenance therapy) were achieved in patients with Langerhans cell histiocytosis (11 cycles, combination with dexamethasone and etoposide, consolidated by allogeneic blood stem cell transplant) and plasma-cell Castleman disease (15 cycles, monotherapy). Mixed response with complete disappearance of brain infiltrates was reached in Erdheim-Chester disease (6 cycles, monotherapy) and gastrointestinal bleeding was well controlled in multiple angiomatosis (9 cycles, combination with thalidomide). For disease activity evaluation each patient underwent fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography scan imaging, which was complemented by clinical and laboratory investigations.
What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients
Authors: Alterio Daniela , Ansarin Mohssen , Jereczek-Fossa Barbara A , Zorzi Stefano , Santoro Luigi , Zerini Dario , Massaro Mariangela , Rondi Elena , Ferrario Silvia , Piperno Gaia , Rocca Maria Cossu , Griseri Mara , Preda Lorenzo , Chiesa Fausto , Orecchia Roberto
Published: February 2018

Aims and background

To achieve the goal of organ preservation, both a chemoradiotherapy and a conservative surgical approach can be proposed. The aim of the study was to review all patients treated in our Institute with conservative surgery and postoperative radiotherapy for locally advanced supraglottic tumor.

Methods and study design

A retrospective analysis of 32 patients treated between 2000 and 2010 was performed. Overall survival, disease-free survival and late laryngeal toxicity were evaluated. The impact of surgical procedures, radiotherapy characteristics and addition of chemotherapy on late laryngeal toxicity was studied.

Results

The median follow-up was 38 months. Overall survival and disease-free survival at 5 years were 73% and 66%, respectively. Three (9%) patients experienced local recurrence (after 22, 25 and 40 months, respectively) and were treated with total laryngectomy. The larynx preservation rate was 93%. Severe treatment-related late laryngeal toxicity (grade 3 and 4 laryngeal edema, laryngeal stenosis, presence of tracheotomy at last follow-up because of treatment-related toxicity, and the need for enteral nutrition) was experienced by 34% of patients. The functional larynx preservation rate was 81%. The statistically significant risk factors for severe late toxicity were: female gender, extension of the surgical procedure, removal of one arytenoid and association with concomitant chemotherapy.

Conclusions

We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity requires further studies to improve patient selection and to reduce side effects.
Temperament and character and quality of life in lung cancer patients
Authors: Kukulj Suzana , Margetic Branka Aukst , Jakovljevic Miro , Samarzija Miroslav
Published: February 2018

Aim

The aim of this study was to test whether personality variables are independently associated with health-related quality of life (HRQOL) in lung cancer patients.

Methods

In a cross-sectional study, 86 non-small cell lung cancer patients and 73 healthy subjects matched for gender and age were assessed with the Temperament and Character Inventory. In the patient group QOL was assessed with EORTC QLQ-C30. We used multiple linear regressions to determine whether personality dimensions predict HRQOL. Data on tumor stage, patient age, education and marital status were also collected.

Results

Lung cancer patients differed from healthy controls in the temperament dimension of persistence and the character dimension of self-transcendence. The temperament dimension of harm avoidance and the character dimension of cooperativeness were significant predictors of QOL functional scales and global health status.

Conclusions

In lung cancer patients, the personality dimensions of harm avoidance and cooperativeness showed associations with most QOL dimensions. Personality factors are relevant for patients' QOL perception and should be included in cancer patients' QOL assessment.
Insulin-like growth factor I regulates the expression of isoforms of Wilms' tumor 1 gene in breast cancer
Authors: Tuna Musaffe , Itamochi Hiroaki
Published: February 2018

Aim and background

The Wilms' tumor 1 gene (WT1) is overexpressed in many cancers, including breast cancer, and its high expression is an adverse prognostic factor. However, the factors that regulate WT1 expression are poorly understood.

Methods and study design

Expression of genes at the RNA and protein level was detected by reverse transcriptase-polymerase chain reaction, western blotting, and reverse-phase protein array assays in breast cancer cell lines and tumor samples.

Results

In the study, we showed that the treatment of MCF-7 breast cancer cells with insulin-like growth factor I (IGF-I) increases WT1 protein expression by 77%. IGF-I uses Akt to up-regulate WT1 expression. Conversely, inhibition of IGF-I by IGF-binding protein 3 and of IGF-I receptor (IGF-IR) by anti-IGF-IR antibody (α-IR3) uses Akt to decrease WT1 protein levels in MCF-7 cells. We thus newly identified a mechanism by which IGF-I up-regulates WT1, especially the (+exon 5/-KTS) isoform, at the post-transcriptional level in MCF-7 cells and primary breast tumor samples.

Conclusions

The results indicate a novel posttranscriptional regulatory factor of WT1 in MCF-7 breast cancer cells.
Accreditation for Excellence of Cancer Research Institutes: Recommendations from the Italian Network of Comprehensive Cancer Centers
Authors: Deriu Pier Luigi , La Pietra Leonardo , Pierotti Marco , Collazzo Raffaele , Paradiso Angelo
Published: February 2018

A panel of experts from Italian Comprehensive Cancer Centers defines the recommendations for external quality control programs aimed to accreditation to excellence of these institutes. After definition of the process as a systematic, periodic evaluation performed by an external agency to verify whether a health organization possesses certain prerequisites regarding structural, organizational and operational conditions that are thought to affect health care quality, the panel reviews models internationally available and makes final recommendations on aspects considered of main interest.

This position paper has been produced within a special project of the Ministry of Health of the Italian Government aimed to accredit, according to OECI model, 11 Italian cancer centers in the period 2012–2014. The Project represents the effort undertaken by this network of Comprehensive Cancer Centers to find a common denominator for the experience of all Institutes in external quality control programs.

Fourteen shared “statements” are put forth, designed to offer some indications on the main aspects of this subject, based on literature evidence or expert opinions. They deal with the need for “accountability” and involvement of the entire organization, the effectiveness of self-evaluation, the temporal continuity and the educational value of the experience, the use of indicators and measurement tools, additionally for intra- and inter-organization comparison, the system of evaluation models used, the provision for specific requisites for oncology, and the opportunity for mutual exchange of evaluation experiences.
Serum ALDH1A1 is a Tumor Marker for the Diagnosis of Non-Small Cell Lung Cancer
Authors: Cao Yong-Tong , Li Jing-Hua , Wang Yuan-Tao , Fu Yao-Wen , Xu Jing
Published: February 2018

Background

ALDH1A1 (aldehyde dehydrogenase 1 family, member A1) is highly expressed in non-small-cell lung cancer (NSCLC). We assessed the potential clinical value of serum ALDH1A1 in the diagnosis and prognosis of non-small-cell lung cancer.

Method

Between 2010 and 2011, serum samples from 100 non-small-cell lung cancer patients before tumor resection, 60 patients with benign lung disease, and 60 healthy volunteers were collected and analyzed retrospectively for ALDH1A1, using sandwich ELISA. We further evaluated the serum and tumor ALDH1A1 levels of non-small-cell lung cancer patients before and after surgery. We compared the diagnostic and prognostic values of serum ALDH1A1 with that of carcinoembryonic antigen.

Results

Elevated serum ALDH1A1 levels were observed in 55 of the 100 (55%) non-small-cell lung cancer patients. The ALDH1A1 levels were much higher in patients with advanced stages than in those with early stage tumors. Of the 30 non-small-cell lung cancer patients who underwent surgery, 19 had elevated serum ALDH1A1 levels before surgery, but the serum ALDH1A1 level was undetectable by postoperative day 7. Analysis of receiver operating characteristic curves showed that ALDH1A1 might be better than carcinoembryonic antigen in distinguishing non-small-cell lung cancer from benign disease or the healthy control. Combined application of ALDH1A1 and carcinoembryonic antigen significantly increased the sensitivity of carcinoembryonic antigen alone, with an accuracy of 83%.

Conclusions

Our results showed that serum levels of ALDH1A1 were correlated with carcinogenesis and progression of non-small-cell lung cancer. Detection of serum ALDH1A1 can be helpful in the diagnosis and prognosis of non-small-cell lung cancer. The diagnosis rate of non-small-cell lung cancer could be significantly improved when carcinoembryonic antigen is combined with ALDH1A1.
The Increasing Incidence of Remote Metastasis: A Case Report of Metastatic Hepatocellular Carcinoma to the Rectosigmoid
Authors: Nielsen Jennifer A , Putcha Rajesh V , Roberts Cory A
Published: February 2018

As the fifth most common malignancy worldwide, survival rates of hepatocellular carcinoma (HCC) have only slightly improved over the years due to early-stage detection. HCC is well known to metastasize to the lung, lymph nodes, and musculoskeletal regions; however, only 0.5% to 6% of HCCs metastasize to the gastrointestinal tract. In the case described here, a CT scan and subsequent colonoscopy of a 51-year-old Asian male with a history of hepatitis B and HCC revealed a mass lesion of metastatic HCC 12 cm from the anal verge. Because metastatic HCC to the lower gastrointestinal tract has only recently been reported, it is speculated that the prolonged survival of patients is also increasing the incidence of extrahepatic metastasis, giving the disease greater opportunity to spread to more distant regions of the body. This case may be the farthest metastasis within the gastrointestinal tract to date.
Surgical Treatment of an Isolated Omental Cervical Cancer Recurrence: Report of a Case and Review of the Literature
Authors: Gasparri Maria Luisa , Bellati Filippo , Pernice Milena , Di Donato Violante , Morano Giuseppina , Marchetti Claudia , Donfrancesco Cristina , Antonilli Morena , Panici Pierluigi Benedetti
Published: February 2018

Aims and Background

Recurrent cervical cancer has traditionally been associated with a dismal prognosis. Historically, patients who developed distant metastases from cervical cancer were not considered eligible for surgical resection; only palliative treatment options are available, generally consisting of chemo- and/or radiotherapy. Metastases usually appear in the liver, lung or lymph nodes. The abdominal cavity is a quite unusual site of recurrence and the disease usually has multiple foci. For this reason, peritoneal involvement by cervical cancer is considered a contraindication to local treatment.

Methods and Study Design

We report the first case of a 30-year-old woman with isolated intra-abdominal cervical cancer recurrence diagnosed with 18F-FDG PET/CT, successfully surgically treated.

Results

Histopathological analysis confirmed the tumor to be an omental relapse of squamous cervical cancer previously treated with anterior pelvic exenteration and platinum based chemotherapy. The patient underwent adjuvant treatment with 3 cycles of topotecan and has remained free of disease during the 4 years of follow-up.

Conclusions

In selected cases with isolated recurrences, a surgical resection may provide a long term complete remission in recurrent cervical cancer patients.
Mediating Role of Entrepreneurship in Explaining the Association Between Income Inequality and Regional Economic Performance
Authors: Jung Hyejin , Seo Inseok , Jung Kyujin
Published: February 2018

This research aims to examine whether income inequality affects economic performance at the regional level, which is mediated by entrepreneurship. By considering hierarchical preferences in consumption, it assumes that income inequality has a negative influence on regional economic growth because it lowers the incentive to innovate. Using a structural equation model, the effect of income inequality on regional economic performance, as well as the mediating effect of entrepreneurship, is tested. The results show that income inequality negatively affects both entrepreneurship and economic growth. This result suggests that insufficient demand for new products/services hampers entrepreneurial activities as well as regional economic performance. The findings contribute to the field, highlighting that entrepreneurship mediates between income inequality and economic performance based on demands.
Innovating for Transformation in First Nations Health Using Community-Based Participatory Research
Authors: Kyoon-Achan Grace , Lavoie Josée , Avery Kinew Kathi , Phillips-Beck Wanda , Ibrahim Naser , Sinclair Stephanie , Katz Alan
Published: February 2018

Community-based participatory research (CBPR) provides the opportunity to engage communities for sustainable change. We share a journey to transformation in our work with eight Manitoba First Nations seeking to improve the health of their communities and discuss lessons learned. The study used community-based participatory research approach for the conceptualization of the study, data collection, analysis, and knowledge translation. It was accomplished through a variety of methods, including qualitative interviews, administrative health data analyses, surveys, and case studies. Research relationships built on strong ethics and protocols to enhance mutual commitment to support community-driven transformation. Collaborative and respectful relationships are platforms for defining and strengthening community health care priorities. We further discuss how partnerships were forged to own and sustain innovations. This article contributes a blueprint for respectful CBPR. The outcome is a community-owned, widely recognized process that is sustainable while fulfilling researcher and funding obligations.
Real-time classifier based on adaptive competitive self-organizing algorithm
Authors: Sarafraz Zahra , Sarafraz Hossein , Sayeh Mohammad R
Published: February 2018

This article introduces a novel adaptive competitive self-organizing (ACS) model, with applicability for real-time clustering and vector quantization. An important feature of this model is its dynamic structure and self-adjusting parameters that also offers a solution to the problem of parasitic limit points and consequently in more accurate label assignments. This unsupervised classifier is free of any external control mechanism. Its self-organizing (SO) dynamic is governed by the gradient descent (GD) theory in cooperation with a competition mechanism based on Lotka–Volterra competitive exclusion. The core algorithm of this classifier is based on developing an energy function, where its minima or equilibrium points correspond to the centroid of similar input patterns. Since this energy function is a form of Lyapunov function, it guarantees stabilization of the dynamical trajectories of labels in finite numbers of isolated equilibrium points. This energy function along with other control parameter functions, then, will be the base for the set of ordinary differential equations (ODEs) describing the overall dynamic of our system. Finally, the effectiveness of the proposed ACS model is demonstrated by implementing it on both real and artificial data sets as well as comparing with other well-known clustering methods. ACS method showed a better clustering performance in some categories and an overall comparable rendition.
Lesinurad: A Novel Agent for Management of Chronic Gout
Authors: Haber Stacy L. , Fente Gelila , Fenton Skylar N. , Walker Elise P. , Weaver Brianne M. , Cano Alexander J. , Vu Katherine
Published: February 2018

Objective: To review the pharmacology, efficacy, and safety of lesinurad and determine its role relative to other agents in the management of chronic gout. Data Sources: A PubMed search (1946 to February 2018) using the terms lesinurad and RDEA594 was conducted to identify relevant articles. Study Selection and Data Extraction: In vitro or in vivo evaluations of lesinurad published in the English language were eligible for inclusion. Phase II and III trials were selected for review of efficacy and safety. Data Synthesis: Five clinical trials were evaluated. In 4 trials in which lesinurad was used in combination with a xanthine oxidase inhibitor (XOI), a greater percentage of patients receiving lesinurad 200 mg (54.0%-63.0%) compared with placebo (23.3%-46.8%) achieved a serum uric acid (sUA) level of <6 mg/dL at 1 to 6 months. In one trial involving lesinurad used as monotherapy, a sUA level of <6 mg/dL was achieved by a significantly greater percentage of patients receiving lesinurad 400 mg (29.9%) compared with placebo (1.9%) at 6 months. When used as combination therapy, the drug had an acceptable safety profile, with upper-respiratory-tract infection, nasopharyngitis, and hypertension occurring most commonly and transient renal-related events detected less frequently. Conclusions: Lesinurad has a novel mechanism of action and is safe and effective for the treatment of chronic gout. At this time, lesinurad may be considered as an add-on therapy for patients who have an inadequate response to maximum tolerated doses of a XOI.
Blaming Women or Blaming the System? Public Perceptions of Women’s Underrepresentation in Elected Office
Authors: Dolan Kathleen , Hansen Michael
Published: February 2018

While scholars understand some of the reasons for the underrepresentation of women in elected office in the United States, we know almost nothing about what the public sees as the explanation for this reality. We also know relatively little about the degree to which people see women’s underrepresentation as a problem. Drawing on blame attribution theories, we examine whether people believe that there are systematic or individual explanations for the number of women in elected office. As blame explanations often influence positions on outcomes, we also test whether these explanations are related to people’s attitudes toward women in office and their vote choice behaviors in U.S. House races with women candidates present. Using data from a 2014 Cooperative Congressional Election Study (CCES) survey, we find differences among people in the blame explanations they make. These explanations are significantly related to attitudes about women in office but do not influence vote choice decisions when women run for office.