bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective Analysis on the Management of Metastatic Gastric Cancer Patients. A Mono-institutional Experience. What happens in Clinical Practice?
Authors: Monti Manlio , Foca Flavia , Gardini Andrea Casadei , Valgiusti Martina , Frassineti Giovanni Luca , Amadori Dino 
Published: February 2018

Aims and background Few studies show what happens outside of randomized clinical trials. The purpose of the study was to describe the clinical management of metastatic gastric cancer patients resident in the Forlì area from 2000 to 2009. Methods and study design A total of 270 metastatic gastric cancer patients at diagnosis or relapse were considered. Data from medical records were analysed, and survival probabilities were calculated using the Kaplan-Meier method. Results A total of 115 patients received best supportive care, 155 at least one line of chemotherapy, 71 (45.8%) underwent second-line therapy, and 49 (31.6%) required a drug dose reduction during the first cycle of first-line therapy. Twelve (7.7%) patients died within 15 days of finishing the last chemotherapy. Median overall survival with best supportive care or chemotherapy was 3 months (95% CI, 2–4) and 11 months (95% CI, 9–12) (P <0.0001), respectively. Conclusions Drug dose reductions and delivery of second-line therapy were common. Chemotherapy given towards the end of life was similar to other experiences. Median overall survival was similar to randomized clinical trials.
Pilot study of adjuvant hyperthermic intraperitoneal chemotherapy in patients with colorectal cancer at high risk for the development of peritoneal metastases
Authors: Virzì Salvatore , Iusco Domenico , Baratti Dario , Bonomi Serena , Grassi Antonio , Kusamura Shigeki , Deraco Marcello 
Published: February 2018

Aims and background The prognosis of peritoneal metastases from colorectal cancer has recently improved with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Although outcomes are further improved when early stage peritoneal metastases are treated, adjuvant hyperthermic intraperitoneal chemotherapy has never been thoroughly addressed. This prospective pilot study assessed feasibility, safety and efficacy of hyperthermic intraperitoneal chemotherapy combined with primary curative surgery in colorectal cancer at high risk for peritoneal metastases. Methods Twelve patients were prospectively selected according to predetermined risk factors for the development of peritoneal metastases. Patients underwent conventional colon surgery, closed-abdomen mitomycin-C plus cisplatin-based hyperthermic intraperitoneal chemotherapy, and cytoreductive surgical procedures, as needed. Results Preoperative tumor-related risk factors were confirmed by intraoperative findings and pathological examination in all patients: minimal synchronous peritoneal metastases (n = 2), synchronous ovarian metastases (n = 1), positive peritoneal washing cytology (n = 2), primary tumor directly invading other organs (n = 6), or penetrating visceral peritoneum (n = 1). Major morbidity occurred in 2 patients and operative death in none. Median follow-up was 49 months (range, 22–72). Peritoneal metastases occurred in 1 patient and distant metastases in 2. Five-year overall survival was 83.3%. Conclusions Preoperative/early intraoperative assessment can reliably identify colorectal cancer patients at high risk for peritoneal metastases. Adjuvant hyperthermic intraperitoneal chemotherapy is well tolerated and safe. These preliminary results would support the design of future phase-III trials of adjuvant hyperthermic intraperitoneal chemotherapy.
Management of Vestibular Schwannomas with Linear Accelerator-Based Stereotactic Radiosurgery: A Single Center Experience
Authors: Sager Omer , Beyzadeoglu Murat , Dincoglan Ferrat , Demiral Selcuk , Uysal Bora , Gamsiz Hakan , Oysul Kaan , Dirican Bahar , Sirin Sait 
Published: February 2018

Aims and background The primary goal of treatment for vestibular schwannoma is to achieve local control without comprimising regional cranial nerve function. Stereotactic radiosurgery has emerged as a viable therapeutic option for vestibular schwannoma. The aim of the study is to report our 15-year single center experience using linear accelerator-based stereotactic radiosurgery in the management of patients with vestibular schwannoma. Methods and study design Between July 1998 and January 2013, 68 patients with unilateral vestibular schwannoma were treated using stereotactic radiosurgery at the Department of Radiation Oncology, Gulhane Military Medical Academy. All patients underwent high-precision stereotactic radiosurgery using a linear accelerator with 6-MV photons. Results Median follow-up time was 51 months (range, 9–107). Median age was 45 years (range, 20–77). Median dose was 12 Gy (range, 10–13) prescribed to the 85%-95% isodose line encompassing the target volume. Local tumor control in patients with periodic follow-up imaging was 96.1%. Overall hearing preservation rate was 76.5%. Conclusions Linear accelerator-based stereotactic radiosurgery offers a safe and effective treatment for patients with vestibular schwannoma by providing high local control rates along with improved quality of life through well-preserved hearing function.
Treatment of Depression in Patients with Breast Cancer: A Critical Review
Authors: Callari Antonio , Mauri Mauro , Miniati Mario , Mancino Maricia , Bracci Giulia , Dell'Osso Liliana , Greco Carlo 
Published: February 2018

Aims and background To summarize current knowledge on psychopharmacological and psychotherapeutic options for patients with breast cancer and comorbid depression, starting from the psychiatric viewpoint. Issues on diagnostic boundaries of depression and outcome measures are raised. Methods We completed a literature review from the last 30 years (until March 2012) using PubMed by pairing the key words: ‘breast cancer and depression treatment’ (about 1431 works, including 207 reviews), ‘breast cancer and antidepressants’ (about 305 works, including 66 reviews), and in particular ‘selective serotonin reuptake inhibitors and breast cancer’ (38 works, including 10 reviews) and ‘breast cancer and psychotherapy’ (603 works, including 84 reviews). Papers in the English language were selected, including recent reviews. Results There is little evidence for the superiority of any one specific intervention with pharmacological options or psychotherapy. The heterogeneity of assessment criteria, the small number of subjects collected in systematic studies, the difficulty in adopting standardized outcome measures, and the limited numbers of available drugs with a favorable side effect profile are the main limitations that emerge from the literature. No conclusive findings are available on mid-term/long-term treatment strategies, or when depression is part of a bipolar disorder. Conclusions Further research is necessary to define the most appropriate approach to depression when it occurs in comorbidity with breast cancer. A more accurate definition of the clinical phenotypes of depression in the special population of patients with breast cancer is suggested as a key issue.
Fishing for ALK with immunohistochemistry may predict response to crizotinib
Authors: Bavieri Mario , Tiseo Marcello , Lantuejoul Sylvie , McLeer-Florin Anne , Lasagni Anna , Fantini Riccardo , Rossi Giulio 
Published: February 2018

Background ALK (anaplastic lymphoma kinase) gene rearrangement is a novel oncogenic driver in non-small cell lung cancer (NSCLC) against which a selective inhibitor, namely crizotinib, is effective. Fluorescence in situ hybridization (FISH) is considered the reference method in selecting patients with ALK-positive tumors for treatment with crizotinib. Case report We report the case of a 42-year-old non-smoking woman with an advanced pulmonary ALK FISH-negative adenocarcinoma characterized by strong immunohistochemical expression of ALK fusion protein. The patient received targeted therapy with crizotinib in compassionate use and experienced a long-lasting clinical response. Conclusion FISH testing should not be considered the only method to select patients for therapy with ALK inhibitors and the use of multiple ALK-detecting techniques could be helpful in screening ALK-positive patients more appropriately.
Prostate cancer as a paradigm of multidisciplinary approach? Highlights from the Italian young radiation oncologist meeting
Authors: De Bari Berardino , Fiorentino Alba , Greto Daniela , Ciammella Patrizia , Arcangeli Stefano , Avuzzi Barbara , D'Angelillo Rolando Maria , Desideri Isacco , Kirienko Margarita , Marchiori Debora , Massari Francesco , Fundoni Carla , Franco Pierfrancesco , Filippi Andrea R , Alongi Filippo 
Published: February 2018

Aims and background The diagnostic and therapeutic approach to prostate cancer has evolved rapidly in last decades. Young professionals need an update about these recent developments in order to improve the care of patients treated in their daily clinical practice. Methods On May 18, 2013, AIRO Giovani (the young section of the Italian Association of Radiation Oncology) organized a multidisciplinary meeting involving, as speakers, several young physicians from many parts of Italy actively involved in the diagnostic and therapeutic approach to prostate cancer. The meeting was specifically addressed to young physicians (radio-oncologists, urologists, medical oncologists) and presented the state-of-the-art of the diagnostic/therapeutic approach based on the latest evidence on the issue. Highlights of the congress are summarized and presented in this report. Results The large participation in the meeting (more than 120 participants were present) confirmed the interest of young radiation oncologists in improving their skills in prostate cancer management. The contributions of the speakers confirmed the need for regular updates, considering the promising results of recently published studies and the many new ongoing trials, on the diagnostic and therapeutic approaches to prostate cancer. Conclusions Multidisciplinary meetings are helpful to improve the skills of young professionals.
Frequent Losses of Heterozygosity in the Mitofusin 2 Gene in Hepatocellular Carcinoma: Their Relationship to Clinicopathological Features
Authors: Qu Li , Chen Hui , Wang Guoliang , Wei Jianfeng 
Published: February 2018

Background The aim of the study was to determine the features of loss of heterozygosity in the mitofusin 2 gene and their association with clinicopathological characteristics of hepatocellular carcinoma. Methodology Loss of heterozygosity of four microsatellite loci were detected in tumors and their adjacent normal tissues of 29 surgically resected hepatocellular carcinomas using an ABI3130xl automated sequencer. Results The results showed the incidences of loss of heterozygosity on microsatellite loci D1S2667, D1S2740, D1S434, and D1S228 were 21%, 23%, 21%, and 22%, respectively. Loss of heterozygosity in the mitofusin 2 gene was closely correlated with age, degree of differentiation, capsule integrity, and tumor size (P <0.05) but was not correlated with gender, thrombosis, liver cirrhosis, or alpha-fetoprotein levels (P >0.05). Conclusions Frequent loss of heterozygosity in the mitofusin 2 gene exists in hepatocellular carcinoma. Loss of heterozygosity, which represents a tumor suppressor gene pathway, may play a critical role in the occurrence and development of hepatocellular carcinoma.
Case Report: Long-Lasting Response in a Patient with Metastatic Renal Cell Cancer Receiving Antitumor Cytotoxic T Lymphocytes
Authors: Secondino Simona , Turin Ilaria , Montini Enrica , Porta Camillo , Maccario Rita , Pedrazzoli Paolo , Montagna Daniela 
Published: February 2018

Aims and background Adoptive immunotherapy can be a therapeutic option to treat cancer patients with advanced-stage disease refractory to conventional therapies. Methods and study design We used T-cell therapy with autologous antitumor cytotoxic T lymphocytes (CTLs) in a patient with metastatic renal cell carcinoma. Autologous antitumor CTLs obtained by stimulating CD8-enriched cells with dendritic cells pulsed with irradiated apoptotic tumor cells and expanded in vitro were transfused on days +14 and +28 following chemotherapy and every 2 to 4 months thereafter. Results and Conclusions Treatment with high doses of antitumor CTLs proved to be safe and induced immunological responses and long-lasting clinical benefit in our patient.
KRAS Mutations and M2PK Upregulation in Stool Samples from Individuals with Positive Fecal Occult Blood Tests Screened for Colorectal Cancer
Authors: Battaglia Paolo , Baritono Elisabetta , Remo Andrea , Vendraminelli Roberto , Conti Antonio 
Published: February 2018

Background Screening for colorectal cancer (CRC) requires non-invasive methods of high diagnostic sensitivity and specificity. We evaluated the measurement of genetic and protein biomarkers of CRC in stool samples with the aim of testing their clinical utility in a CRC screening program. Patients and Methods Individuals aged 53–75 years who were at risk of CRC and immunochemical fecal occult blood test (iFOBT) positive were invited to submit stool samples for molecular testing prior to colonoscopy. KRAS codon 12 Gly→Asp, Gly, Val, and codon 13 Gly→Cys gene mutations were tested using an in-house real-time ARMS PCR method. M2PK levels in stool samples were measured utilizing a commercial ELISA kit. Results At colonoscopy, 7.6% of patients were found to have CRC, 50% had adenomas, 10.6% had hyperplastic polyps, 20.2% had diverticulosis and hemorrhoids, and 11.6% had normal mucosa. The best sensitivity for CRC (50%) was found in those cases where M2PK and KRAS abnormalities coexisted. M2PK showed a detection rate of 40.3% for adenomas but the combination of M2PK and KRAS abnormalities was found in only 5.7% of adenomas (P <0.01). iFOBT was false positive in 31.8% of cases in which colonoscopy excluded neoplastic lesions, while the coexistence of molecular and enzymatic abnormalities was more specific with false positive rates between 8.3% and 9.0% (P <0.05). Conclusion Our molecular screening approach demonstrates that detection of cancer-associated biomarkers measured in iFOBT-positive stool samples could help separate true from false positives in a FOBT-based screening process. M2PK showed particular promise for the detection of CRC and adenomas.
Reproducible Deep-inspiration Breath-hold Irradiation with Forward Intensity-modulated Radiotherapy for Left-sided Breast Cancer Significantly Reduces Cardiac Radiation Exposure Compared to Inverse Intensity-modulated Radiotherapy
Authors: Bolukbasi Yasemin , Saglam Yucel , Selek Ugur , Topkan Erkan , Kataria Anglina , Unal Zeynep , Alpan Vildan 
Published: February 2018

Aims and Background To investigate the objective utility of our clinical routine of reproducible deep-inspiration breath-hold irradiation for left-sided breast cancer patients on reducing cardiac exposure. Methods and Study Design Free-breathing and reproducible deep-inspiration breath-hold scans were evaluated for our 10 consecutive left-sided breast cancer patients treated with reproducible deep-inspiration breath-hold. The study was based on the adjuvant dose of 50 Gy in 25 fractions of 2 Gy/fraction. Both inverse and forward intensity-modulated radiotherapy plans were generated for each computed tomography dataset. Results Reproducible deep-inspiration breath-hold plans with forward intensity-modulated radiotherapy significantly spared the heart and left anterior descending artery compared to generated free-breathing plans based on mean doses – free-breathing vs reproducible deep-inspiration breath-hold, left ventricle (296.1 vs 94.5 cGy, P = 0.005), right ventricle (158.3 vs 59.2 cGy, P = 0.005), left anterior descending artery (171.1 vs 78.1 cGy, P = 0.005), and whole heart (173.9 vs 66 cGy, P = 0.005), heart V20 (2.2% vs 0%, P = 0.007) and heart V10 (4.2% vs 0.3%, P = 0.007) – whereas they revealed no additional burden on the ipsilateral lung. Reproducible deep-inspiration breath-hold and free-breathing plans with inverse intensity-modulated radiotherapy provided similar organ at risk sparing by reducing the mean doses to the left ventricle, left anterior descending artery, heart, V10-V20 of the heart and right ventricle. However, forward intensity-modulated radiotherapy showed significant reduction in doses to the left ventricle, left anterior descending artery, heart, right ventricle, and contralateral breast (mean dose, 248.9 to 12.3 cGy, P = 0.005). The mean doses for free-breathing vs reproducible deep-inspiration breath-hold of the proximal left anterior descending artery were 1.78 vs 1.08 Gy and of the distal left anterior descending artery were 8.11 vs 3.89 Gy, whereas mean distances to the 50 Gy isodose line of the proximal left anterior descending artery were 6.6 vs 3.3 cm and of the distal left anterior descending artery were 7.4 vs 4.1 cm, with forward intensity-modulated radiotherapy. Overall reduction in mean doses to proximal and distal left anterior descending artery with deep-inspiration breath-hold irradiation was 39% (P = 0.02) and 52% (P = 0.002), respectively. Conclusions We found a significant reduction of radiation exposure to the contralateral breast, left and right ventricles, as well as of proximal and especially distal left anterior descending artery with the deep-inspiration breath-hold technique with forward intensity-modulated radiotherapy planning.
Management of Pulmonary Oligometastases by Stereotactic Body Radiotherapy
Authors: Gamsiz Hakan , Beyzadeoglu Murat , Sager Omer , Dincoglan Ferrat , Demiral Selcuk , Uysal Bora , Surenkok Serdar , Oysul Kaan , Dirican Bahar 
Published: February 2018

Aims and Background The aim of the study was to evaluate the feasibility, toxicity and effectiveness of active breathing control-guided stereotactic body radiotherapy in the management of pulmonary oligometastases. Methods and Study Design Between June 2010 and June 2012, 20 patients (13 males, 7 females) with 31 pulmonary metastases referred to the Department of Radiation Oncology, Gulhane Military Medical Academy were treated using active breathing control-guided stereotactic body radiotherapy. Response Evaluation Criteria in Solid Tumors and Common Terminology Criteria for Adverse Events were used in the assessment of treatment response and toxicity, respectively. Results Assessment of treatment response revealed complete response, partial response, stable disease, and progressive disease in 30%, 25%, 30%, and 15% of the patients, respectively. At a median follow-up of 14 months, local control was 85% and overall survival was 70%, with negligible treatment-related toxicity. Conclusions Stereotactic body radiotherapy is safe and effective in the management of pulmonary oligometastases. It offers favorable treatment outcomes as a viable non-invasive therapeutic modality.
Incidence and Dose-volume Analysis of Acute Bladder Toxicity following Pelvic Radiotherapy
Authors: Park Jin-hong , Kim Young Seok , Park Jongmoo , Ahn Hanjong , Kim Choung-Soo , Kim Minju , Kim Jong Hoon , Ahn Seung Do 
Published: February 2018

Aims and Background The authors performed this prospective study to evaluate the incidence of acute bladder toxicity following pelvic radiation therapy and to determine any dosimetric predictors for the toxicity. Methods and Study Design Acute bladder toxicity was evaluated weekly by physicians using the Common Terminology Criteria for Adverse Events (CTCAE version 4.0). At the same time, the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) were also assessed by each patient during radiation therapy. We contoured the bladder wall, solid bladder and trigone on the planning computed tomography and analyzed dose-volume histograms to determine which of these could be the most suitable dosimetric predictor. Results Of 92 eligible patients, 27 (29%) demonstrated CTCAE grade 2 acute bladder toxicity, with nocturia as the most frequently observed symptom. IPSS demonstrated better agreement with CTCAE than OABSS. In receiver-operating characteristic curve analysis, the largest area under the curve was observed for V20 of both the bladder wall and the bladder. Conclusions Acute bladder toxicity during pelvic radiation therapy is not a trivial complication and should be actively investigated. Dose-volume relationships demonstrate that both bladder wall V20 and bladder solid V20 are useful surrogates for identifying patients at high risk of toxicity. The roles of IPSS and OABSS need to be validated in a larger study.
An Institution-Wide Algorithm for Treatment of Type II Endoleak Following Endovascular Aneurysm Repair (EVAR)
Authors: Rahimi Saum , Nassiri Naiem , Huntress Lauren , Crystal Dustin , Thomas Jones , Shafritz Randy 
Published: February 2018

Objectives: Multiple endovascular techniques have been described for the treatment of persistent type II endoleaks (pT2ELs) causing aneurysm sac growth following endovascular aneurysm repair (EVAR). In the event of a failed endovascular procedure and a pT2EL, a consensus regarding further treatment is lacking, and the literature suggests repeated endovascular attempts are rarely successful. Herein, we propose an algorithm for definitive management of pT2ELs with persistent sac growth following EVAR. Methods: A retrospective review of 29 patients who underwent treatment of persistent sac growth in the setting of pT2ELs was performed. Intervention methods were determined at the discretion of the operating surgeon. Aneurysmal sac enlargement was defined as a diameter increase > 5 mm, and persistent endoleak was defined as lasting greater than 6 months. Results: From 2000 to 2015, 917 EVAR procedures were performed at our institution. Isolated pT2ELs with sac enlargement were identified in 29 patients. Twenty-five patients underwent direct translumbar sac puncture and coiling and/or Onyx (Onyx, Plymouth, Minnesota) embolization of the culprit vessels. Thirteen (52%) of 25 patients had pT2EL after first endovascular intervention, and 10 (40%) of 25 patients failed 2 endovascular treatments. Of those 10, 7 displayed persistent aneurysmal sac growth and underwent a third embolization procedure. Type II endoleaks persisted in 6 patients; 3 patients were subsequently treated with laparotomy, ligation of lumbar vessels, sac exploration, and sac plication around the endograft. Technical success for this technique was 100%. During a mean follow-up of 38.4 months, no recurrent T2ELs, stent graft migration, and/or disjunction were observed. Conclusions: We propose a new algorithm for the management of pT2ELs. If 2 endovascular procedures fail to control of the endoleak, repeat endovascular attempts are not recommended. Endovascular failure should be followed by laparotomy with surgical ligation of culprit feeding vessels followed by sac exploration and plication of the sac, and endoaneurysmorrhaphy.