Diclehan Unsal

Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study.

Objectives:The purpose of the present study was to evaluate the nutritional status of cancer patients receiving radiotherapy (RT) and to assess the possible contributions of nutritional support to patients with malnutrition. Methods:Prospectively, 207 patients referred to our outpatient radiotherapy department were included. The patients were classified according to tumor site (head/neck, breast, lung, stomach, or colorectal). Nutritional status at the onset, at the end of RT, and 3 and 6 months after irradiation was evaluated with the subjective global assessment (SGA). All of the patients were supported with additional portions of meal or standard enteral feeding formula during and after the irradiation period as long as they were in the moderately or severely malnourished groups, respectively. Results:At the onset, malnutrition was present in 31% of all patients, and it increased to 43% at the end of RT. This difference predominated in head/neck cancer patients. Malnutrition ratios in head/neck cancer patients at the onset and after RT were 24% and 88%, respectively. By a 6-month follow-up, the ratio of patients with malnutrition decreased to 8%. Nutritional status of all groups was found to improve during the 6-month follow-up period, except for the breast cancer group, which included no patients with severe malnutrition at any time. Conclusion:The results of the present study may be helpful in planning an appropriate nutritional support for cancer patients undergoing radiotherapy according to the irradiation site.

Gelatinase B expression as a prognostic factor in patients with stage II/III rectal carcinoma treated by postoperative adjuvant therapy.

Objective:The matrix-metalloproteinases (MMPs) are thought to be critically involved in tumor invasion and metastasis. This retrospective study was aimed both to examine the gelatinase expression status in patients with rectal cancer and to investigate their prognostic value on survival. Methods:Sixty patients who underwent postoperative adjuvant chemoradiotherapy for Stage II and III rectal carcinoma were included. Expressions of MMP-2, MMP-9, and tissue inhibitors of MMP (TIMP-1 and TIMP-2) were analyzed by immunohistochemistry in paraffin-embedded primary rectal cancers and graded for the intensity and the percentage of cells stained. The relation between the expression of the markers studied and clinicopathologic features were evaluated for the primary study endpoint. The data were also analyzed using a multivariate Cox proportional hazards model for prognosis as a secondary endpoint. Results:Positive MMP-9 expression was observed in 70% of the tumors. The ratio of tumors with positive MMP-9 expression was increased according to N stage (P = 0.005), AJCC stage (P = 0.005), and tumor differentiation (P = 0.017). Overall survival was reduced in poorly differentiated tumors and tumors with positive MMP-9 expression (P = 0.002). Disease-free survival was lower in patients with positive MMP-9 expression (P = 0.007). Multivariate analysis indicated that positive MMP-9 expression was an independent predictor of reduced overall survival (P = 0.0103) and reduced disease-free survival (P = 0.0360). The other markers studied were associated with neither any clinicopathologic feature nor any survival parameter. Conclusion:MMP-9 expression was observed in the tumors of patients with Stage II and III rectal carcinoma in comparable values and was characterized by poor overall survival and disease-free survival.

Efficacy and Safety of Concomitant Chemoradiotherapy with Cisplatin and Docetaxel in Patients with Locally Advanced Squamous Cell Head and Neck Cancers

BACKGROUND Chemoradiation (CRT) using cisplatin-based regimens has become the standard of care in the treatment of squamous cell head and neck cancers (SCHNC). The impact of taxanes as radiosensitizing agents with concurrent CRT regimens is unknown. We therefore retrospectively evaluated the efficacy and tolerability of a weekly cisplatin+docetaxel combination with CRT in locally advanced SCHNC. METHODS Sixty-six patients with locally advanced SCHNC (39.4% stage IV, 53% stage III, and 7.6% stage II) were assessed retrospectively. Total radiation dose to the PTV of gross disease (primary and/or node) was 70 Gy/ 35 fractions, 5 fractions per week. Minimum doses of 60 Gy and 50 Gy were administered to PTVs of elective high risk and low risk disease, respectively. Chemotherapy (CT) consisted of weekly cisplatin (20 mg/m2) +docetaxel (20 mg/m2) concurrently with RT. RESULTS The median age of the patients was 58 years (range, 32-77). Objective response rate was 83.3%. The 2-year progression-free survival (PFS) and overall survival (OS) were 75.7% and 78.3%, respectively. The most common grade 3 and 4 toxicities were mucositis (36.4%), nausea and vomiting (12.1%), neutropenia (4.5%). CONCLUSION Weekly cisplatin and docetaxel concurrent with RT for locally advanced SCHNC was found tolerable with high efficacy.

Results of chemoirradiation after curative resection of locally advanced gastric cancer

To evaluate the results of post‐operative chemoirradiation for gastric carcinoma. The records of 58 patients who underwent resection for gastric carcinoma were retrospectively reviewed. Forty‐six patients had complete resection without any residual disease but with high‐risk factors of relapse. Twelve patients had microscopic residual disease. Doses of irradiation ranged from 45 to 54 Gy with a median dose of 49 Gy in 1.8 Gy fractions. Fifty‐three of the patients received 5‐fluorouracil‐based concomitant chemoradiotherapy, and all of them received chemotherapy after the completion of radiotherapy. The median survival of the entire group of patients was 21 months. The 30th month disease‐free and overall survival after surgery was 32 and 45%, respectively. The median survival time and 30th month survival rate was 23 months and 54% in patients with no residual disease, and 15 months and 18% for those with residual disease, respectively (p = 0.049). A statistically significant correlation was detected between residual disease and survival and between high‐grade tumour and survival (p < 0.05 for each). Patients with both nodal involvement and direct tumour extension beyond the gastric wall have a high risk of locoregional failure, and adjuvant chemoradiotherapy reduces local failure and improves survival.

Effect of Sedation with Midazolam or Propofol on Patient's Comfort During Cancer Chemotherapy Infusion: A Prospective, Randomized, Double-Blind Study in Breast Cancer Patients

Abstract Nausea, vomiting and anxiety related to administration of cancer chemotherapy remain significant problems. This randomized, clinical trial was undertaken to evaluate the effect of sedation on the patients comfort during chemotherapy infusion in patients with breast cancer. Forty-five breast cancer patients were randomized into three groups: Group I - chemotherapy, control, Group II - midazolam+chemotherapy, and Group III -propofol+chemotherapy. Nausea occured in 87% and vomiting in 13% of the patients in the control group, while none of the sedated subjects had these side-effects, although 76% of them had experienced then during previous cycles of chemotherapy. Compared with the control group, post-chemotherapy anxiety scores also improved with the addition of midazolam or propofol. Eighty percent of the subjects declared that they would prefer the sedative-containing regimen for their further cycles. Sedation with midazolam or propofol may improve the patients comfort, and provide better control of chemotherapy-related side effects during chemotherapy infusion in breast cancer patients.

Epidemiology of colorectal cancer in Turkey: A cross-sectional disease registry study (A Turkish Oncology Group trial).

BACKGROUND/AIMS This study aimed to determine the epidemiological characteristics of colorectal cancer in Turkey. MATERIALS AND METHODS In this multicenter, prospective, and cross-sectional registry study, data for 968 patients with colorectal cancer from 21 centers in 7 geographic regions were analyzed. RESULTS Diagnosis was colon cancer in 662 (68.4%) and rectum cancer in 306 (31.6%) patients. In total, 60.9% of patients was male; mean age was 58.9±12.6 years. Among patients, 15.0% was drinking alcohol, 17.5% was smoking, 1.5% had familial history of polyposis, 15.0% had diabetes mellitus, 1.0% had inflammatory bowel disease. Fruit and vegetable consumption was low (<3 times/week) in 35.5% and red meat consumption was high (≥3 times/week) in 47.4% of the patients. Median time-to diagnosis was 3.0 months and 4.0 months for patients with colon and rectum cancer, respectively. Mean body mass index was >25 in all group of patients. Distal rectum (61.3%) and sigmoid colon (36.8%) were the most common locations of cancer, for rectum and colon respectively. In total, 85.6% of patients were operated; 25.8% had emergency surgery. Low anterior resection rate was 64.2% in rectum cancer. In majority (89.8%) of the patients with rectum cancer who received preoperative treatment, conventional chemo-radiotherapy regimen was given. pTNM staging at diagnosis showed that stage III and IV patients were in majority (35.9% and 29.7%, respectively). CONCLUSION Colon cancer is more frequent than rectum cancer in Turkey. Colorectal cancer patients are diagnosed at later stages. Most of the cases were operated. Interregional differences for risk factors are worthwhile for evaluation in future trials.

Synchronize primary breast osteosarcoma and contralateral benign cystosarcoma phylloides: radiologic and pathologic imaging.

Alarge irregular lobulated mass with heterogeneous density in the right breast and a smooth dense mass in the left breast were detected on computerized tomography of the chest of a 44-year-old Caucasian woman with history of palpable masses in bilateral breast (Fig. 1). A tru-cut biopsy revealed undifferentiated malignant tumor. Staging studies failed to show any distant metastases. With a presumed diagnosis of breast cancer, she underwent lumpectomy of the left breast and MRM of the right one. Right-sided mastectomy material contained a 15 · 10 · 8 cm tumor. Hypercellular tumor with osteoid deposits is seen in the lower half of the field. Normal breast ductal elements compressed by the tumor bulk are noted above (H&E, 100·) (Fig. 2a). Osteosarcomatous component with atypical osteoblastic proliferation, nuclear pleomorphism, and osteoid deposits (arrows) separated from compressed mammary parenchyma and ductal structures (H&E, 400·) (Fig. 2b). Epithelial ductal cells or remnants of epithelial elements were not identified on multiple sectioning. Malignant glandular and solid areas were not determined. Histopathologic examination revealed morphologic features of typical osteosarcoma. Left-sided lumpectomy material showed a 45 · 35 · 28 mm yellowish white solid lesion. Ductal elements with narrow lumens compressed in hypocellular uniform stroma are seen (H&E, 100·) (Fig. 3a). Breast ductules are seen in fibroblastic stroma consisting of fusiform cells with no cellular atypia and no mitoses (H&E, 200·) (Fig. 3b). Histologic diagnosis of benign cystosarcoma phylloides was made. After the diagnosis, she received adjuvant chemotherapy and radiation therapy. She is alive and being followed up without any evidence of recurrence for 28 months. The prevalence of primary breast sarcoma is less than 1% of women with breast malignancies. Breast osteosarcomas can arise from normal breast tissue or occur as a metaplastic differentiation of primary benign or malignant breast lesion. Also benign and malignant lesions like fibroadenomas, carcinomas may contain bone and osteoid cells. Metastatic bone formation may occur in fibroadenomas and phylloid tumors. After extensive sampling, neoplastic epithelial component can be found in these lesions. We presented our case as a primary breast osteosarcoma Address correspondence and reprint requests to: Ugur Coskun, MD, 40. Cadde. 444. Sokak, 5 ⁄ 5 Ebru Apt., Cukurambar Ankara, Turkey, or e-mail: ugurcos@hotmail.com.

Colonic metastasis from squamous carcinoma of the lung: report of a case and review of the literature

We describe a rare case with metastatic involvement of the gastrointestinal tract (colonic metastasis) secondary to lung cancer. After diagnostic work‐up, a left hemicolectomy was performed. Patient has been alive and healthy 9 months after operation. We report the first case with the longest survival period after the diagnosis of metastasis, although the symptomatic gastrointestinal metastases from lung cancer generally follow a poor prognosis because of their advanced state and multiplicity.

Long-term clinical outcome after accidental overdose of multiple chemotherapeutic agents.

Treatment of non‐Hodgkins lymphoma with the CHOP regimen consists of intravenous cyclophosphamide 750 mg/m2 (day 1), intravenous doxorubicin 50 mg/m2 (day 1), intravenous vincristine 1.4 mg/m2 (day 1), and oral prednisone 100 mg (days 1–5). This regimen is administered in cycles of approximately 3 weeks; a total course of treatment consists of six cycles. We report the case of a 23‐year‐old woman with diffuse large‐cell lymphoma who received an accidental overdose of this chemotherapeutic regimen. The first cycle of her CHOP regimen was initiated (day 1) in our outpatient unit; she was then discharged home. Unfortunately the patient went to another hospital located in the small city where she lived, and all remaining doses of the total course of treatment were administered over the next 5 consecutive days, with no interruption in therapy. She had received cumulative doses of cyclophosphamide 6000 mg, doxorubicin 420 mg, and vincristine 12 mg. She was transferred to our hospital after she developed pancytopenia, fever, and ileus. With the help of intensive supportive care and symptomatic treatment, the patient recovered and was discharged home after a hospital stay of 25 days. After 56 months, she was free of disease and treatment‐related toxicities. Only experienced clinicians should administer chemotherapy, and thorough records must be kept to document the chemotherapy administered, dosages, dates of administration, the procedure used, and the schedule of cycles administered.

Efficacy and safety of concurrent chemoradiotherapy with cisplatin and docetaxel in patients with locally advanced nasopharyngeal cancers.

AIMS AND BACKGROUND Chemoradiation using cisplatin-based regimens has become the standard care in the treatment of nasopharyngeal cancers. The impact of taxanes as radiosensitizing agents with concurrent chemoradiation regimens is unknown. We retrospectively evaluated the efficacy and tolerability of weekly cisplatin + docetaxel combination with chemoradiation in locally advanced nasopharyngeal cancers. METHODS Forty-two patients with locally advanced nasopharyngeal cancers (59.5% stage IV, 23.3% stage III, and 16.7% stage II) were assessed retrospectively. Total radiation dose to the planning target volume of gross disease (primary and/or node) was 70 Gy/35 fractions, 5 fractions per week. Minimum doses of 60 Gy and 50 Gy were administered to planning target volume of elective high-risk and low-risk disease, respectively. Chemotherapy consisted of weekly cisplatin (20 mg/m(2)) + docetaxel (20 mg/m(2)) concurrently with radiotherapy. RESULTS The median age of the patients was 46.5 years (range, 17-79). Objective response rate was 86%. The 4-year progression-free survival and overall survival were 65.4% and 91.3%, respectively. The most common grade 3 and 4 toxicities were mucositis (48%), nausea (22%), neutropenia (12%), dermatitis (5%), fatigue (5%) and weight loss (5%). CONCLUSIONS Weekly cisplatin and docetaxel concurrent with radiotherapy for locally advanced nasopharyngeal cancers was found tolerable with a high efficacy.