C. Yavas

Acute effect of palonosetron on electrocardiographic parameters in cancer patients: a prospective study

ObjectivesPalonosetron is a novel 5-hydroxytryptamine3 (5 HT3) receptor antagonist, which has been shown to be superior to first generation 5 HT3 receptor antagonists regarding the prevention of acute, delayed and overall chemotherapy-induced nausea and vomiting. First generation 5 HT3 receptor antagonists may induce electrocardiographic changes of heart rate and repolarization. The acute cardiac effect of palonosteron is unknown. The purpose of this study is to determine acute effects of palonosetron on electrocardiographic (ECG) parameters in cancer patients.Materials and methodsThe study had a prospective design. Seventy-six cancer patients with normal cardiac function who received palonosetron for prevention of chemotherapy-induced nausea and vomiting were enrolled. Standard 12-lead ECG recordings were performed at baseline and 30xa0min after palonosetron administration. P wave durations and corrected QT intervals were measured; P wave dispersion (Pd) and QTc dispersion were calculated.ResultsMedian heart rate did not differ among 76 patients enrolled before and after palonosetron administration (p: 0.6). Systolic and diastolic blood pressures were not significantly different before and after palonosteron (p values 0.9 and 0.3, respectively). Although median QT min value was higher after palonosetron administration than before palonosetron administration, the difference was not statistically significant (p: 0.6).ConclusionPalonosetron seems to have no acute arrhythmogenic potential.

Spironolactone ameliorates the cardiovascular toxicity induced by concomitant trastuzumab and thoracic radiotherapy

AIMnWe aimed to evaluate impact of spironolactone (S) on cardiovascular toxicity of concomitant use of radiotherapy (RT) and trastuzumab (T).nnnBACKGROUNDnS, an aldosterone receptor antagonist, is known to ameliorate the cardiac damage. S ameliorates anthracycline -induced cardiotoxicity, there is no data regarding to effect of S on both T and radiation-induced cardiotoxicity.nnnMATERIALS/METHODSnEighty rats were divided into eight groups: group (G) 1 was defined as control group. G2, G3 and G4 were RT, S and T groups respectively. G5, G6, G7 and G8 were RTxa0+xa0T, Txa0+xa0S, RTxa0+xa0S and RTxa0+xa0Txa0+xa0S groups respectively. Rats were sacrificed at 6th hour; 21st and 100th days after RT. Heart and thoracic aorta samples were taken for microscopical examination.nnnRESULTSnCardiac inflammation and fibrosis scores and; TGF-β expression were not significantly different within study groups at 6th hour and 21st days of RT. By 100th days of RT fibrosis scores and TGF-β expression in cardiac samples were significantly different between study groups (p values were 0.004 and 0.002 respectively). Pair-wise comparisons revealed that both cardiac fibrosis scores and TGF-β expression levels were higher in G5 when compared to G8 (p values were 0.046 and 0.028 respectively). Moreover the TGF-β expression was higher in G5 when compared to G2 (pxa0=xa00.046). We could not demonstrate any significant differences with respect to inflammation, fibrosis and TGF-β expression in thoracic aorta samples between study groups.nnnCONCLUSIONSnAlthough S had a protective effect on cardiac tissue it had no protective effect on thoracic aorta when administered with RTxa0+xa0T.

Amelioration of radiation-induced lung injury by halofuginone: An experimental study in Wistar–Albino rats:

To evaluate effects of halofuginone (H) on radiation-induced lung injury (RILI), 60 rats were divided into six groups: Group (G) 1 control, G2 radiotherapy (RT) only, G3 and G4 2. 5 and 5 μg H and G5 and G6 RT + 2.5 and 5 μg H groups, respectively. A single dose of 12 Gy RT was given to both lungs. H was applied intraperitoneally with daily doses, until animals were killed at 6 and 16 weeks after RT. At 6th and 16th weeks of RT, five rats from each group were killed. Lung tissues were dissected for light and electron microscopy. Chronic inflammation, fibrosis and transforming growth factor-beta (TGF)-β scores of all study groups were significantly different at 6th and 16th week (p < 0.001). Chronic inflammation, fibrosis and TGF-β scores of G2 were higher than G5 and G6 at 6th and 16th weeks of RT. At 16th week, fibrosis and TGF-β scores of G5 were higher than G6 (p = 0.040 and 0.028, respectively). Electron microscopical findings also supported these results. Therefore, H may ameliorate RILI. The effect of the H was more prominent at higher dose and after long-term follow-up. These findings should be clarified with further studies.

The use of concurrent hormonotherapy and radiotherapy does not deteriorate radiation-induced cardiac toxicity:

Postmenopausal patients with breast cancer have two options for adjuvant endocrine therapy, tamoxifen and aromatase inhibitors (AIs) as well as radiotherapy (RT) and chemotherapy. However, there is limited data regarding the optimal sequencing of RT and tamoxifen/AIs. Thus, we aimed to evaluate the effects of tamoxifen and AIs on radiation-induced cardiotoxicity. Eighty ovariectomized rats were divided into eight groups (G). G1 was defined as a control group; G2, G3, G4, and G5 were RT, tamoxifen, anastrozle, and letrozole groups, respectively; G6, G7, and G8 were RT plus tamoxifen, anastrozle, and letrozole groups, respectively. Drugs were started 1 week before RT and continued until the animals were killed 16 weeks after RT. The heart tissues were then dissected and examined with light microscopy to determine endocardial thickness and cardiac fibrosis. The endocardial thickness scores of both RT alone and the tamoxifen groups as well as the cardiac fibrosis score of RT alone were higher than that the control group (p < 0.05 for all). There was no difference in the endocardial thickness and cardiac fibrosis scores of the RT-only group and the RT plus hormonotherapy groups (p > 0.05 for all). Concurrent administration of RT and hormonal therapy with either tamoxifen or AIs did not further amplify radiation-induced cardiac toxicity. This issue warrants further study.

Beta-Hydroxy-Beta-Methyl-Butyrate, L-glutamine, and L-arginine Supplementation Improves Radiation-Induce Acute Intestinal Toxicity

ABSTRACT We aimed to evaluate effects of β-hydroxy-β-methylbutyrate, L-glutamine, and L-arginine (HMB/GLN/ARG) on radiation-induced acute intestinal toxicity. Forty rats were divided into four groups: group (G) 1 was defined as control group, and G2 was radiation therapy (RT) control group. G3 and G4 were HMB/GLN/ARG control and RT plus HMB/GLN/ARG groups, respectively. HMB/GLN/ARG started from day of RT and continued until the animals were sacrificed 10 days after RT. The extent of surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis, crypt distortion, regenerative atypia, vascular dilatation and congestion, and fibrosis were quantified on histological sections of intestinal mucosa. Statistical analyses were performed using the analysis of variance (ANOVA) test. There were significant differences between study groups regarding extent of surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis and crypt distortion, regenerative atypia, vascular dilatation and congestion, and fibrosis (p values were 0.019 for fibrosis, <.001 for the others). Pair-wise comparisons revealed significant differences regarding surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis, vascular dilatation, and congestion between G2 and G4 (p values were <.001, .033, <.001, .007, and <.001, respectively). Fibrosis score was significantly different only between G1 and G2 (p = .015). Immunohistochemical TGF-β score of G2 was significantly higher than G1 and G3 (p values were .006 and .017, respectively). There was no difference between TGF-β staining scores of G2 and G4. Concomitant use of HMB/GLN/ARG appears to ameliorate radiation-induced acute intestinal toxicity; however, this finding should be clarified with further studies.

Comment on “Serum human epididymis protein 4 is associated with the treatment response of concurrent chemo-radiotherapy and prognosis in patients with locally advanced non-small cell lung cancer” by Lan WG et al.

We read the above interesting article by Dr. Lan et al. [1]. The authors assessed the role of human epididymis protein 4 (HE4) in the diagnosis and prognosis of patients with locally advanced non-small cell lung cancer (LA-NSCLC) who underwent concurrent chemo-radiotherapy. HE4 serum levels were obtained from 218 patients with the diagnosis of LA-NSCLC and control group before the treatment. HE4 was measured by enzyme-linked immunosorbent assay (ELISA) with immunoassay kit. Their results suggested that the serum patients with high HE4 serum levels had shorter relapse-free survival (RFS) and overall survival (OS) and HE4 level can discriminate the responders. They concluded that serum HE4 levels may be a useful prognostic biomarker for LA-NSCLC patient receiving concurrent chemo-radiotherapy. After the approval as a novel serum biomarker for early diagnosis and monitoring of ovarian cancer by Food and Drug Administration (FDA), the HE4 is thought as one of the most promising new biomarker [2]. HE4 which is a WAP 4-disulphide core domain 2 (WFDC2) gene products is a family of protease inhibitors and probably has a role in innate immunity and is over-expressed in both serum and tumoral tissues of many patients with the diagnosis of cancer [2, 3]. There are growing data about the both diagnostic and prognostic value of HE4 in different cancer subtypes. Therefore, the authors touched on a current topic. We have couple of concerns regarding this article. First, some reports suggested that HE4 concentrations increased with the age and smoking index [4]. In addition, the concentration of HE4 was changed when there is an alteration in renal function particularly in premenopausal women [5]. Therefore, we wonder if the authors performed a subgroup analysis with respect to the age, smoking status, and renal function of the patients. In addition, the authors evaluated the serum HE4 levels only at enrollment, why did not they reevaluate the serum HE4 levels after treatment? The serum level of HE4 after the chemo-radiotherapy might have given an additional idea about the prognosis. Moreover, the authors could compare the pre-treatment and post-treatment values of HE4. Finally, the higher levels of serum HE4 levels associated with shorter RFS and OS according to the relevant data as well as the result of this valuable study; however, the authors concluded as ‘‘our data show that the patients’ with higher HE4 level tend to have a higher response rate to chemo-radiotherapy and had a better prognosis indicated by RFS and OS’’ at the end of the introduction part. We wonder how the authors interpret this relation. We consider that the authors’ response to the above comments would clarify their interesting and valuable work.

Pelvic radiotherapy does not deteriorate the quality of life of women with gynecologic cancers in long-term follow-up: A 2 years prospective single-center study

Purpose: To evaluate the emotional, sexual and health-related quality of life (HRQoL) concerns of the women with gynecologic malignancy treated with curative radiotherapy (RT). Patients and Methods: A 100 women with diagnosis of gynecologic malignancy were prospectively enrolled. HRQoL at baseline, at the end of RT and during follow-up was assessed using European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 (EORTC QLQ-C30), EORTC QLQ-cervical cancer module 24, and Hospital Anxiety and Depression Scale. Results: The appetite loss, diarrhea, fatigue, dyspnea, insomnia, nausea and vomiting, pain scores, and sexual activity and sexual enjoyment scores were deteriorated after RT (P = 0.02 for pain scores and P < 0.001 for all other). Body image scores were higher in patients with endometrial cancer (P < 0.01). The emotional function, nausea and vomiting, body image and symptom experience scores were higher in patients who underwent chemotherapy (P = 0.04 and P = 0.01). All the complaints of patients improved during follow-up period. The global health status scores and the level of depression deteriorated in patients with locoregional recurrent disease and distant metastasis. The anxiety (P = 0.001) and depression (P = 0.007) levels were higher in basal and after-RT visits but then decreased through the subsequent follow-up visits. Conclusion: Although pelvic RT deteriorated HRQoL in patients with gynecologic malignancy, HRQoL improved during the follow-up period. The progressive disease had a negative impact on HRQoL.

An aggressive parameningeal rhabdomyosarcoma with multiple spinal cord metastases: a case report and review of the literature

PurposeSpinal cord metastasis from rhabdomyosarcoma (RMS) is extremely rare, with three cases reported to date. Herein, we report an aggressive case of RMS of the infratemporal fossa who which developed spinal cord metastases during treatment.Case presentationA 6-year-old girl presented with an enlarging painless mass around her right ear for 3 months. An enhanced magnetic resonance imaging (MRI) revealed a 5 × x4 × x4.5 5 cm mass on her right infratemporal fossa. A tru-cut biopsy was performed, and histopathologic examination revealed the diagnosis of rhabdomyosarcoma. At the time of the diagnosis, cerebrospinal fluid cytology was negative for malignant cells. The patient underwent induction chemotherapy. There was minimal response to chemotherapy, and the patient underwent curative radiotherapy. However, by 12th fraction of RT, the patient developed a progressive weakness on her lower extremity. Spinal MRI revealed multiple gross masses in different parts of the spinal cord. The local radiotherapy was changed toas craniospinal radiotherapy. However, two 2 weeks after the completion of the RT, the patient developed sepsis and expired because of septic shock.ConclusionParameningeal RMS is a peculiar subgroup of RMS, which needs an aggressive approach. Despite aggressive approach, meningeal spread is the most important cause of the treatment failure. We should keept in mind that during the treatment, there can be meningeal spread towards to either the brain or spinal cord; therefore, we should follow -up the patients closely from this aspect.

Giant papillary carcinoma arising in the ectopic buccal thyroid tissue

Ectopic thyroid tissue very rarely occurs in the buccal region. Even more rarely encountered is the papillary carcinoma arising in the ectopic tissue.