bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiotherapy in Italy after Conservative Treatment of Early Breast Cancer. A Survey by the Italian Society of Radiation Oncology (AIRO)
Authors: Aristei Cynthia , Amichetti Maurizio , Ciocca Mario , Nardone Luigia , Bertoni Filippo , Vidali Cristiana 
Published: February 2018

Aims and Background The aim of surveys on clinical practice is to stimulate discussion and optimize practice. In this paper the current Italian radiotherapy practice after breast-conserving surgery for early breast cancer is described and adherence to national and international guidelines is assessed. Furthermore, results are compared with an earlier survey in northern Italy and international reports. Study Design A multiple-choice questionnaire sent to all 138 Italian radiation oncology centers. Results 48% of centers responded. Most performed breast-conserving surgery when tumor size was ≤3 cm. All centers routinely performed axillary dissection; 45 carried out sentinel node biopsy followed by axillary dissection when the sentinel node was positive. Most centers re-excised when resection margins were positive. The median interval between surgery and radiotherapy, when chemotherapy was not administered, was 60 days. Adjuvant chemotherapy was preferably administered before radiotherapy. Regional lymph nodes were never irradiated in 10 centers; in all others irradiation depended on the number of positive lymph nodes and/or involvement of axillary fat and/or tumor location in medial quadrants. All centers used standard fractionation; hypofractionated schemes were available in 6. Most centers used 4–6 MV photons. In 59 centers the boost dose of 10 Gy could be increased if margins were not negative. All centers ensured patient setup reproducibility. Treatment planning was computerized in 59 centers. The irradiation dose was prescribed at the ICRU point in 56 centers and portal films were made in 54 centers. Intraoperative radiotherapy was used in 4 centers: for partial breast irradiation in 1 and for boost administration in 3 centers. Conclusions Although the quality of radiotherapy delivery has improved in Italy in recent years, approaches that do not conform to international standards persist.
Expression of Embryonic Lethal Abnormal Vision (ELAV)-Like Protein HuR and Cyclooxygenase-2 (COX-2) in Ewing Sarcoma
Authors: Do Sung-Im , Araujo Eduard Santini , Kalil Ricardo K , Bacchini Patrizia , Bertoni Franco , Unni K Krishnan , Park Yong-Koo 
Published: February 2018

Aims and Background HuR is a member of the family of ELAV (embryonic lethal abnormal vision)-like proteins that stabilize several cellular mRNAs by binding to AU-rich elements in the 3’ untranslated region of the mRNA. Cyclooxygenase-2 (COX-2) is a well known enzyme that promotes tumor growth and metastasis. Recent studies have shown that HuR can stabilize the mRNA of COX-2, and cytoplasmic expression of HuR is associated with increased COX-2 expression in some cancers. The aim of this study was to investigate the correlation between COX-2 and HuR in Ewing sarcoma. Methods The expression patterns for HuR and COX-2 were assessed via immunochemical analysis of 70 Ewing sarcoma samples. Results Nuclear HuR expression was observed in 12 of 70 (17.1%) cases, but cytoplasmic expression was not observed. COX-2 expression was seen in 25 of 70 (35.7%) samples. Nuclear HuR and COX-2 were simultaneously expressed in 8 of 70 (11.4%) samples. The expression of nuclear HuR was significantly associated with COX-2 expression (P = 0.014). Neither HuR nor COX-2 expression showed a correlation with age or sex. Conclusions COX-2 expression in Ewing sarcoma may not be directly related to mRNA stabilization by HuR. However, a correlation between COX-2 expression and nuclear HuR expression through indirect mRNA stabilization can be suggested.
Biological Markers and DNA Flow Cytometric Analysis in Radically Resected Patients with Non-Small Cell Lung Cancer. A Study of the Perugia Multidisciplinary Team for Thoracic Tumors
Authors: Ludovini Vienna , Pistola Lorenza , Gregorc Vanesa , Floriani Irene , Rulli Eliana , Di Carlo Luciana , Semeraro Antonia , Daddi Giuliano , Darwish Samir , Stocchi Lucia , Tofanetti Francesca Romana , Bellezza Guido , Sidoni Angelo , Tognellini Rita , Crinò Lucio , Tonato Maurizio 
Published: February 2018

Aims and Background The aim of this study was to evaluate the relationship between a panel of biological markers (p53, Bcl-2, HER-2, Ki67, DNA ploidy and S-phase fraction) and clinical-pathological parameters and its impact on outcome in non-small cell lung cancer (NSCLC). Methods and Study Design Tumor tissue specimens obtained after surgical resection were collected from consecutive patients with NSCLC. We used an immunocytochemical technique for p53, Bcl-2, HER-2 and Ki67 analysis in fine-needle aspirates obtained from surgical samples that were also evaluated by flow cytometric DNA analysis using a FACScan flow cytometer. Results From April 2000 to December 2005, 136 patients with radically resected NSCLC were recruited. Median age was 66 years (range, 31–84 years), male/female ratio 117/19, ECOG performance status 0/1 127/4, stage I/II/III 76/25/35, squamous/adenocarcinoma/large-cell/mixed histology 62/49/17/8, smokers yes/no 121/11. Positivity of p53, Bcl-2, HER-2 and Ki67 was detected in 51.4%, 27.9%, 25.0% and 55.8% of the samples, respectively; 82.9% of the cases revealed aneuploid DNA histograms and 56.7% presented an S-phase fraction of more than 12%. Statistically significant associations between high Ki67 and poorly differentiated tumors (P = 0.016) and a smoking history (P = 0.053); p53 positivity and high Ki67 (P = 0.002); HER-2 positivity and adenocarcinoma subtype (P = 0.015) and presence of lymph node involvement (P = 0.006); and Bcl-2 positivity and squamous cell carcinoma subtype (P = 0.058) were observed. At univariate analysis, high Ki67 proved to be the only marker associated with disease-free survival (P = 0.047). After adjusting for stage, none of the examined immunocytochemical markers emerged as an independent factor for disease-free and overall survival; only pathological stage was identified as an independent prognostic factor for disease-free survival (P = 0.0001) and overall survival (P = 0.0001). In the group of 76 patients classified as TNM stage I, high Ki67 was the only marker associated with recurrence of disease (P = 0.05). Conclusions Our data do not support a relevant prognostic role of immunocytochemical markers in NSCLC, even if the Ki67 index might have particular relevance to identify patients with more aggressive tumors who are at high risk for disease relapse.
Adjuvant Chemotherapy and Whole Abdominal Irradiation for Gastric Carcinoma
Authors: Kundel Yulia , Levitt Mark L , Oberman Bernice , Sadezki Siegal , Tichler Thomas , Symon Zvi , Catane Raphael , Pfeffer Raphael , Brenner Baruch 
Published: February 2018

Aims and Background To analyze the efficacy and toxicity of adjuvant chemotherapy followed by whole abdominal irradiation in the treatment of resectable gastric cancer with positive lymph nodes. Methods and Study Design Between 1996 and 1999, 10 patients with node-positive gastric cancer underwent complete gross resection and were treated by postoperative chemoradiotherapy. The chemotherapy regimen consisted of 5-fluorouracil, 1000 mg/m2/day as a 96-hr continuous infusion on day 1, and cisplatin, 100 mg/m2 on day 2, every 21 days. Six courses were planned. Radiotherapy was administered 3 weeks after completion of the chemotherapy protocol as a single-fraction dose of 600 cGy in a two-field (anterior and posterior) configuration. Results Treatment was generally well tolerated, with no treatment-related deaths. However, 9 of the 10 patients died of recurrent disease, with a median survival of 20 months (range, 7–84). Conclusions Adjuvant chemotherapy with whole abdominal irradiation for gastric cancer is safe and tolerable but has no apparent effect on patient outcome. Studies in larger series are needed to evaluate the role of the approach in this disease.
Complete Response of Colorectal Liver Metastases after Intra-Arterial Chemotherapy
Authors: Fiorentini Giammaria , Del Conte Alessandro , De Simone Michele , Guadagni Stefano , Mambrini Andrea , D'Alessandro Michelina , Aliberti Camillo , Rossi Giuseppe , Cantore Maurizio 
Published: February 2018

Aims and Background We demonstrated that colorectal liver metastases considered in complete response after intra-arterial floxuridine-based chemotherapy had recurred in situ. Methods and Study Design One hundred and six colorectal liver metastases disappeared after intra-arterial chemotherapy. Persistent macroscopic disease was observed at surgery at the site of 52 of 106 liver metastases, even though computerized tomography scan and ultrasound showed a complete response. The sites of 35 initial liver metastases that were not visible at surgery were resected. Pathologic examination of these sites, considered in complete response, showed viable cancer cells in 22 of 35 cases. Results After 1 year of follow-up, 33 of 106 liver metastases considered in complete response had recurred in situ. After 2 years of follow-up, persistent macroscopic or microscopic residual disease or recurrence was observed in 86 (81%) of the 106 liver metastases. Conclusions Nevertheless, 19% of the patients had a long-lasting response. This means that floxuridine given as intra-arterial hepatic chemotherapy can still be considered an interesting option of cure in the treatment of colorectal liver metastases. When feasible, the site of the lesion that disappeared after intra-arterial chemotherapy should be resected at surgery. The best palliative cure of liver metastases should be the combination of local-regional strategies like intra-arterial chemotherapy, surgery or radiofrequency ablation with the systemic approach.
Life Tables for World-Wide Comparison of Relative Survival for Cancer (CONCORD Study)
Authors: Baili Paolo , Micheli Andrea , De Angelis Roberta , Weir Hannah K , Francisci Silvia , Santaquilani Mariano , Hakulinen Timo , Quaresma Manuela ,   the CONCORD Working Group, Coleman Michel P 
Published: February 2018

Background The CONCORD study compares population-based relative survival from cancer using data from cancer registries in five continents. To estimate relative survival, general mortality life tables are required. Available statistics are incomplete, so various approaches are used to construct complete life tables. This article outlines how the life tables were constructed for CONCORD; it compares life expectancy at birth between 101 populations covered by cancer registries in 31 countries and compares the impact of two approaches to the deployment of life tables in relative survival analysis. Methods The CONCORD approach, using specific mathematical methods, produced complete (single-year-of-age) life tables by sex, cancer registry area, calendar year (1990–1999) and race (only in the USA). In order to study the impact of different approaches, we compared relative survival in the USA using the US national life table, centered on the relevant census years, and the CONCORD approach. We estimated relative survival in each American participating cancer registry for patients diagnosed with breast (women), colorectal or prostate cancer during 1990–1994 and followed up to 1999. Results Average life expectancy at birth during 1990–1999 varied in CONCORD cancer registry areas from 64 to 78 years in males and from 71 to 84 years in females. It increased during the 1990s more in men than in women. In the USA, it was lower in blacks than in whites. Relative survival in American populations was lower with the CONCORD approach, which incorporates trends and geographic variation in background mortality, than with the USA census life tables. Conclusions International variation in background mortality by geographic area, calendar time, race, age and sex is wide. We suggest that in international comparisons of cancer relative survival, complete life tables that are specific for cancer registry area, calendar year and race should be used.
A Retrospective Analysis of the Diameter of Metastatic Lymph Nodes in Apparently Early Stage Endometrial Cancer
Authors: Boran Nurettin , Akdag Derya , Halici Filiz , Tulunay Gokhan , Turan Taner , Bozok Serap , Erdogan Zuhal , Kose M Faruk 
Published: February 2018

Aims and background The objective of this retrospective study was to assess the diameter of metastatic lymph nodes in a population of women with apparently early stage endometrial cancer at laparotomy. Methods and study design Among 700 cases with endometrial cancer, 27 cases with disease clinically limited to the uterus in the laparotomy and found to have retroperitoneal node metastasis after pathologic examination were included in this study. Pathologic characteristics of the tumors, pelvic and paraaortic node counts and the largest diameter of each metastatic node were evaluated. Results The median number of nodes removed was 38; median number of pelvic and para-aortic nodes was 29 and 8, respectively. A total of 85 metastatic nodes were identified. Mean diameter of the metastatic para-aortic and pelvic nodes was 6.8 mm and 9 mm, respectively. Nine patients had single metastatic nodes, and the diameters of the single metastatic para-aortic lymph node was 1 mm in one case, 2 mm in one case, 3 mm in one case and 4 mm in one, and 5 mm in two patients. Two cases had isolated para-aortic lymph node metastasis without pelvic lymph node metastasis. Diameters of the metastatic para-aortic lymph nodes were 4 and 5 mm in one case and 4 mm in the other case. Conclusions The diameters of metastatic nodes may be as small as 1 mm. By sampling or selective para-aortic and/or pelvic lymphadenectomy, some of the nodes might go undiagnosed, and such understaged cases cannot take adjuvant therapy (chemotherapy-radiotherapy). For correct staging of cases with endometrial cancer, complete systematic para-aortic and/or pelvic lymphadenectomy might be appropriate.
Weekly Concomitant Boost in Adjuvant Radiotherapy for Patients with Early Breast Cancer: Preliminary Results on Feasibility
Authors: Corvò Renzo , Giudici Stefania , Maggio Francesca , Bevegni Monica , Sampietro Chiara , Lucido Maria Rosaria , Orsatti Marco 
Published: February 2018

Aims and background Recent advances in the management of patients with breast cancer are focused toward the reduction of overall treatment time of radiotherapy by delivering a dose biologically equivalent to a standard schedule. The aim of the present study was to evaluate the feasibility and preliminary toxicity of a moderately hypofractionated whole breast irradiation schedule with the addition of a concomitant boost delivered to the tumor bed once-a-week in patients with early breast cancer submitted to conservative surgery. Materials We selected patients with pT1c and pT2 N0/N+ M0 carcinoma of the breast with negative surgical margins. The basic course consisted of 4600 cGy prescribed to the ICRU 50 reference point dose and delivered in 20 fractions, 4 times a week for 5 weeks. Once a week, immediately after whole breast irradiation, a concomitant photon boost of 120 cGy was delivered to the lumpectomy area. Overall, according to the linear-quadratic model, the schedule provides a biologically equivalent dose of 87 Gy for breast tumor (assuming α/β = 4 Gy), of 66 Gy for acute responding normal tissues (assuming α/β = 10 Gy), and 99 Gy for late responding normal tissues (assuming α/β = 3 Gy). Biologically, the schedule compares favorably with the 6-week conventional regimen consisting of 50 Gy, 2 Gy/fraction, followed by a 10 Gy boost (BEDtumor,90 Gy; BEDacute effects, 72 Gy, and BEDlate effects, 100 Gy). Results From November 2004 to April 2007, we tested this radiotherapy schedule in 176 patients. All enrolled patients had achieved a minimum follow-up of 6 months and were considered in detail for the evaluation of feasibility. Three clinical examinations were performed by a group of independent physicians at treatment end, after 1 month and after 6 months. According to the RTOG/EORTC Toxicity Criteria, of the 176 assessable patients at the end of radiotherapy, 58% showed grade 0–1 skin toxicity, 30% grade 2 and 12% grade 3. At one month of follow-up, grade 0 toxicity was observed in 47% of cases, grade 1 in 46% and grade 2 in 7%. At 6 months, late (skin and subcutaneous tissue) toxicity was assessed with the following scores: grade 0 in 68%, grade 1 in 26% and grade 2 in 6% of the patients. At 6 months, cosmesis was excellent, good and fair in 71%, 24% and 5% of patients, respectively. Conclusions The explored adjuvant schedule planned to intensify the radiotherapy course for patients with early breast cancer by adding a weekly concomitant boost appears to be feasible and provides low local toxicity and excellent to good short-term cosmetic results.
Management of Mucinous Urachal Neoplasm Presenting as Pseudomyxoma Peritonei
Authors: Sugarbaker Paul H , Verghese Mohan , Yan Tristan D , Brun Erwin 
Published: February 2018

Background Mucinous neoplasms of the urachus are rare malignancies so that the physicians’ index of suspicion for a timely and accurate diagnosis is low. Also, this disease may present with a wide variety of symptoms and signs. Methods Two patients with pseudomyxoma peritonei as the initial presentation of urachal mucinous adenocarcinoma were treated successfully. The medical literature regarding treatment options for this manifestation of the disease was searched. Results Two patients with large volume of pseudomyxoma peritonei originating in a mucinous urachal neoplasm were treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Our first patient required two reoperations to palliate the accumulation of gross mucinous ascites. She died 11 years after diagnosis with progression of mucinous adenocarcinoma resulting in starvation. The second patient had ostomy closure with second look surgery at one year after definitive treatment; four small tumor nodules were seen and easily resected. The patient is currently without evidence of disease and has a normal quality of life. Seven prior manuscripts that report a single case of pseudomyxoma peritonei were reviewed to explore the full range of treatment options and survival for this rare condition. Conclusion Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy may be a new treatment option for mucinous urachal neoplasms presenting with pseudomyxoma peritonei. Other management strategies such as systemic chemotherapy seemed to hold little promise for this group of patients.
An Unconventional Cancer Treatment Lacking Clinical Efficacy Remains Available to Italian Cancer Patients
Authors: Merlo Domenico Franco , Beccaro Monica , Costantini Massimo ,   the Italian Survey of the Dying of Cancer Study Group, Costantini Massimo , Beccaro Monica , Di Leo Silvia , Sormani Maria Pia , Bruzzi Paolo , Merlo Domenico Franco , Morasso Gabriella , Rossi Paolo Giorgi , Borgia Piero , Montella Maurizio , Grimaldi Maria , Paci Eugenio , Susini Nicoletta , Cecioni Riccardo , Miccinesi Guido , Pisanti Renato 
Published: February 2018

Aims and Background An unconventional cancer treatment known as “Di Bella multitherapy” gained popularity among Italian cancer patients during the 90's. In 1999, it was shown to lack any detectable antitumor activity. Access to the multitherapy was investigated three years later within the post-bereavement Italian Survey of the Dying of Cancer (ISDOC), whose broader aim was to investigate the end-of-life care experiences of terminal cancer patients. Methods ISDOC was carried out in a two-stage probability sample of 2,000 out of 160,000 Italian cancer patients deceased between March 2002 and June 2003. For each cancer patient, a non-professional caregiver, i.e., the closest and the best-informed person about her/his last three months of life, was identified. A specific question concerning the “Di Bella multitherapy” was included in a semi-structured questionnaire that was administered face-to-face to the caregivers by trained interviewers. Weighted estimates of the frequency of patients receiving the multitherapy in the target population and their 95% confidence intervals were computed by taking into account stratification and clustering of observations. Results During their last three months of life, 0.7% (95% CI, 0.3–1.6) of terminal cancer patients, corresponding to some 1,100 subjects (range, 480–2,560), received the multitherapy. No statistically significant difference was observed for age at death, cancer type, gender, education, marital status, or residence. Conclusions The finding indicates that an unconventional cancer treatment proven to lack clinical efficacy remained accessible to Italian cancer patients. Ethical, deontologic, and economic implications call for a routine monitoring of provision of and access to unproven cancer treatments.
Factors Related to Complementary/Alternative Medicine use among Cancer Patients in Central Anatolia
Authors: Er Ozlem , Mistik Selcuk , Ozkan Metin , Ozturk Ahmet , Altinbas Mustafa 
Published: February 2018

Aims and Background We aimed to evaluate the prevalence of and factors related to the use of complementary/alternative medicine among cancer patients undergoing or following conventional treatment at the Erciyes University Oncology Hospital in Central Anatolia. Study Design and Patients Face-to-face interview and a questionnaire were carried out with cancer patients attending the outpatient clinic of Medical Oncology. Questionnaire items included patients’ demographic data, treatment, use of complementary/alternative medicine and possible related factors. Multivariate analysis was performed to compare the factors related to use of complementary/alternative medicine. Results A total of 268 consecutive cancer patients were enrolled in the study. Overall, 43% of the patients were using or had used complementary/alternative medicine. Totally, 90% of the patients using complementary/alternative medicine utilized herbs, and most of the herbs used were stinging nettle. Nearly half of the patients using complementary/alternative medicine (46.1%) were aiming to fight the disease. Among users, nearly half of them regarded the method used as effective and 54 (50.5%) suggested the use of complementary/alternative medicine to other patients. Only 23.1% of the patients discussed the use of complementary/alternative medicine with their physician. In logistic regression analysis, younger age, higher educational status, advanced stage of the disease, longer duration of the disease and current treatment status were significantly associated with the use of complementary/alternative medicine. In our regression model, the predictivity rate of these variables was 72.2% for use of complementary/alternative medicine according to the backward Wald test. Conclusions Use of complementary/alternative medicine among cancer patients in our center is modestly high, and the most common method is herbal therapy. Communication between the patient and the physician shouldbe improvedon this subject.