Makbule Tambas

Metaplastic Breast Carcinoma Versus Triple-Negative Breast Cancer: Survival and Response to Treatment.

AbstractMetaplastic breast carcinoma (MBC) differs from classic invasive ductal carcinomas regarding incidence, pathogenesis, and prognosis. The purpose of this study was to compare patients with MBC with clinicopathologic and treatment-matched patients with triple-negative breast carcinoma (TNBC) in terms of response to treatment, progression, and survival.Fifty-four patients with MBC and 51 with TNBC, who were treated at Istanbul University, Institute of Oncology, between 1993 and 2014, were included in the study. After correctly matching the patients with 1 of the 2 groups, they were compared to determine differences in response to treatment, disease progression, clinical course, and survival.At a median follow-up of 28 months, 18 patients (17.1%) died and 27 (25.5%) had disease progression. Metaplastic histology was significantly correlated with worse 3-year progression-free survival (PFS) (51 ± 9% vs. 82 ± 6%, P = 0.013) and overall survival (OS) (68 ± 8% vs. 94 ± 4%, P = 0.009) compared with TNBC histology. Patients who received taxane-based chemotherapy (CT) regimens or adjuvant radiotherapy had significantly better PFS (P = 0.002 and P < 0.001) and OS (P < 0.001 and P < 0.001) compared with others. In the multivariate analysis, MBC (hazard ratio [HR]: 0.09, P < 0.001), presence of neoadjuvant chemotherapy (NACT) (HR: 12.8, P = 0.05), and metastasis development at any time during the clinical course (HR: 38.7, P < 0.001) were significant factors that decreased PFS, whereas metastasis development was the only independent prognostic factor of OS (HR: 23.8, P = 0.009).MBC is significantly correlated with worse PFS and OS compared with TNBC. Patients with MBC are resistant to conventional CT agents, and more efficient treatment regimens are required.

Concomitant etoposide and cisplatin provided improved survival compared with docetaxel and cisplatin in patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy.

AbstractPresently, there is no consensus regarding which chemotherapy regimen is best to administer with radiotherapy in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). Herein, our aim was to compare the outcome of patients treated with either etoposide–cisplatin (EP) or docetaxel–cisplatin (DP) in this curative setting.Patients treated with either EP or DP and concurrent radiotherapy from 2004 to2012 were identified and their detailed medical records and follow-up information were obtained for analysis in this retrospective study. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding parameters provided by propensity score methods.A total of 105 patients were treated with concurrent chemoradiotherapy for LA-NSCLC (stage IIB-IIIA-IIIB). The median ages were 54 years (range, 32–70 years) and 55 years (range, 37–73 years) in the EP (n = 50) and DP (n = 55) groups, respectively. The median follow-up time was 27 months (range, 1–132 months) in the EP group and 19 months (range, 1–96 months) in DP group. There was no significant difference in baseline clinicopathologic features including age, sex, performance status, histologic subtype, and clinical TNM stages between groups. In the univariate analysis, the median overall survival of patients treated with EP was higher than that of patients treated with DP (41 vs. 20 months, P = 0.003). Multivariate analysis further revealed a survival advantage with EP compared with DP (hazard ratio [HR], 0.46; 95% confidence interval: 0.25–0.83; P = 0.009). The toxicity profile of the 2treatment groups was similar except that pulmonary toxicity was higher in the DP group (grade 3–4: 0% vs. 6%, P = 0.024).Concurrent chemoradiotherapy with EP may provide more favorable outcomes than DP and with an acceptable safety profile.

Olfactory bulb volume and olfactory function after radiotherapy in patients with nasopharyngeal cancer

OBJECTIVE Radiotherapy is the primary method of treatment for nasopharyngeal cancer (NPC) and many side effects were reported in patients receiving radiation to this area. This study was conducted to evaluate the long-term effects of radiotherapy following NPC on olfactory bulb (OB) volume and olfactory function. METHODS Twenty-four patients with NPC who received radiotherapy at least 12 months ago were recruited. Fourteen healthy subjects with similar demographical characteristics were recruited as the healthy control group. All volunteers were subjected to a nasoendoscopical examination, and abnormalities that could potentially cause olfactory dysfunction were the exclusion criteria from the study. An experienced radiologist segmented the MRI coronal, axial and sagittal slices manually for three-dimensional OB volume measurement in a blinded manner. Olfactory function was assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) test, and average score (0: worst, 7: best) was calculated as the total CCCRC olfactory score. RESULTS The mean CCCRC score was 5.5 ± 1.1 for the nasopharyngeal cancer patients, whereas the mean score of healthy control group was 6.4 ± 0.4. There was a significant difference in the olfactory scores (p=0.003). The mean OB volume in the NPC group was 46.7 ± 12.1mm(3). Among the patients with NPC, the cisplatin receiving group had a mean OB volume of 47.2mm(3), whereas the cisplatin+docetaxel receiving group had a mean OB volume of 46.5mm(3), and they were similar. The MRI measurement of the healthy control group was 58.6 ± 13.8mm(3). The OB volumes of the healthy control group were significantly higher (p<0.05). CONCLUSION Radiotherapy following nasopharyngeal cancer results in a diminished OB volume and deteriorated olfactory function. Chemosensory olfactory dysfunction might be a contributing factor to lack of appetite, cancer cachexia and consequent lowered quality of life in NPC patients.

Conventionally Fractionationed Volumetric Arc Therapy versus Hypofractionated Stereotactic Body Radiotherapy: Quality of Life, Side Effects, and Prostate-Specific Antigen Kinetics in Localized Prostate Cancer

OBJECTIVES To compare conventionally fractionationed volumetric arc therapy (VMAT) and hypofractionated stereotactic body radiotherapy (SBRT) modalities in terms of prostate-specific antigen (PSA) kinetics, toxicity, and quality of life (QOL) in patients with localized prostate cancer. METHODS Patients received radical radiotherapy as either 33.5 Gy/5 fr for SBRT or 75.6 Gy/35 fr for VMAT. International Prostate Symptom Score (IPSS) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Prostate Cancer Module (QLQ-PR25) forms were used to assess QOL. RESULTS Of the 48 patients (28 in SBRT and 20 in VMAT) included in the study, 40 (20 in SBRT and 20 in VMAT) were evaluated for QOL status. PSA control rate was 100% and PSA nadir value was 0.5 ng/dl in both arms during the median follow-up period of 23 months. The magnitude of PSA bounce was higher in the SBRT arm than in the VMAT arm (P = 0.01). The PSA decline rate in the VMAT arm was higher than in the SBRT arm (P = 0.028). Three (10.7%) patients treated with SBRT who had a history of transurethral resection of the prostate (TURP) experienced grade 3 urinary toxicity. No significant difference was observed concerning sexual activity and sexual functioning scores, whereas scores at 10.5 and 13.5 months were decreased in both arms. The SBRT and VMAT arms had similar urinary incontinence, bowel symptoms, and IPSS obstruction scores. The magnitude of increase in IPSS scores at treatment completion was higher in the VMAT arm than in the SBRT arm (P = 0.046). The decrease in hormonal symptom scores at 4.5, 10.5, and 13.5 months was higher in the VMAT arm than in the SBRT arm (P = 0.007, 0.027, and 0.021, respectively). CONCLUSIONS Both treatment modalities had similar effectiveness and provided acceptable outcomes in terms of toxicity and QOL. Grade 3 urinary toxicities might be eliminated with careful patient selection for SBRT.

Effect of the childhood trauma on the adjustment to cancer in the patients with breast cancer

BackgroundEarly identification of patients coping poorly is important for compliance with treatment and control of distress. This study aims to investigate the effect of the childhood trauma experience on the type of reaction and adjustment that the person exhibits to the cancer among the patients with breast cancer.MethodsThis cross-sectional study enrolled 310 patients with breast cancer. The effect of the childhood trauma and the psychological condition on the adjustment to cancer was investigated by assessing the adjustment to cancer, the experiences of childhood trauma and psychological status of the subjects using mental adjustment to cancer scale (MAC), childhood trauma questionnaire (CTQ28), Beck Depression Inventory (BDI) and Beck anxiety inventory (BAI).ResultsMajority of the subjects (77.4%) showed positive adjustment to cancer. Fighting spirit (63.9%) was the most commonly seen mechanism of adjustment to cancer. Of the subjects, 54.5% suffered at least one of the childhood trauma types. Among the patients, 47.1% had depression and 58.4% had anxiety. In the multivariate logistic regression analysis, emotional neglect and depression, respectively, have an effect on both positive and negative adjustment to cancer.ConclusionsOur study demonstrated that childhood trauma, especially emotional neglect, affects coping and adjustment among the patients with breast cancer. It is necessary to determine the childhood experiences to ensure the development of psychosocial interventions that will increase the adjustment and quality of life after the diagnosis of the cancer.

Factors affecting progression-free survival in non-HIV-related Kaposi sarcoma

Abstract Background: Non-HIV related Kaposi sarcoma (NHKS) is a rare indolent neoplasm which is more common around Mediterranean origin. Data concerning factors that influence progression-free survival (PFS) for NHKS are insufficient. The purpose of present retrospective analysis was to distinguish the factors affecting PFS in patients with NHKS. Methods: A hundred and twenty-eight consecutive patients with NHKS who were treated or observed between 1997 and 2014 at Istanbul University Institute of Oncology were included into the study. Treatment response and progression definitions were determined according to different treatment modalities administered at first line. Results: Majority of patients were male (n = 97, 75.8%). Median age of the whole group was 66 years (28–85). Of the patients, 15 patients were immunosuppressant, whereas 113 patients had no disease that caused immunosuppression. Patients were treated with local excision (n = 57, 44.5%), chemotherapy (n = 32, 25.0%) and/or radiotherapy (n = 13, 10.2%) or observed without treatment (n = 26, 20.3%). At a median follow-up of 28 months, 71 (55.5%) patients had progression, while 3 patients (2.3%) died of NHKS. On univariate analysis, patients who had hypertension (HT) had poorer PFS compared with others (19 ± 12 versus 41 ± 22 months; p = 0.03), whereas plaque formation was associated with better outcome (25 ± 9 versus 54 ± 12 months; p = 0.03). In addition, heavy smoking (≥40 pack-years) had a borderline significance regarding better PFS time (23 ± 24 versus 45 ± 38 months, p = 0.06). On multivariate analysis, none of factors evaluated had any impact on PFS. Conclusions: HT was correlated with poorer outcome among NHKS patients. Patients with plaque formation and ≥40 pack-years of smoking had better PFS than others.

Human Papillomavirus in Head and Neck Cancer

Throughout the last three decades, there has been a notable shift in the epidemiology of head and neck cancer (HNC) worldwide. A rapidly spreading subtype of HNCs is caused by human papillomavirus (HPV) infection. HPV-related cancers are now considered to constitute 30–65% of all HNC cases and 50–80% of oropharyngeal cancers. HPVpositive oropharyngeal cancers have a unique demographic profile and tumor biology characteristics. HPV-associated patients predominantly consist of younger men with better performance status and fewer comorbid diseases. They have better dentition, higher numbers of oral sex partners, and use less amount of tobacco or alcohol, higher amount of marijuana compared with HPV-negative patients. In addition, patients with HPVpositive tumors have a 60–80% reduced mortality rates, a finding that was confirmed by multiple trials and led to several ongoing deintensification studies. This chapter describes epidemiologic features of HPV-positive HNC, risk factors for HPV infection and HPVassociated oropharyngeal cancer, HPV detection methods, mechanisms of carcinogene‐ sis and improved treatment response, and the impact of HPV status on clinical outcome as well as deintensification approaches and potential of vaccination.

Is serum tenascin-C level potential biomarker in pancreatic adenocarcinoma? -

Objective: Tenascin-C (TNC) is an extracellular matrix protein involved in the tissue construction. Its expression levels have been detected low levels in normal tissues, but high in many tumors. In this study, we aimed to determine the clinical significance of serum TNC levels in patients with pancreatic adenocarcinoma (PA). Materials and Methods: Thirty-three patients with histopathologically confirmed PA diagnosis and sex- and age-matched 30 healthy controls were included into the current study. Serum TNC levels were measured using Enzyme-Linked Immuno Sorbent Assay (ELISA) method. Results: Median age was 59 (range, 32-84). Of the patients, 61% were male, 70% had good performance status, and 68% had tumors localized at pancreas head. Pancreaticoduodenectomy and palliative surgery were performed in 5 (15%) and 4 (12%) of the 9 (27%) patients who underwent surgical procedure. Serum TNC levels were found to be significantly higher in patients compared with control group (p0.05). Similarly, it was shown that serum TNC levels had no effect on overall survival (p=0.31). Conclusions: Serum TNC level is a diagnostic biomarker for patients with PA. However, it has neither predictive nor prognostic value in this group of patients.

Is sentinel lymph node biopsy enough for axillary macrometastasis

includes patients with both micro and macrometastasis in sentinel lymph node(s). Early stage breast cancer patients with clinical N0 disease and one or two positive sentinel lymph node(s) are randomized to axillary lymph node dissection (ALND) vs. sentinel lymph node dissection (SLND) alone. At a median follow-up of 6.3 years, both 5-year overall survival (91.8% vs. 92.5%; ALND vs. SLND) and 5-year diseasefree survival (82.2% vs. 83.9%; ALND vs. SLND) are not significantly different between the arms (1, 2). Arguably, Z0011 study is one of the most important practice changing or at least practice questioning randomized study in recent years. The second trial is the International Breast Cancer Study Group (IBCSG) 23-01 study, which has the same patient population of Z0011 but with only one or 2 sentinel micrometastatic lymph node(s) and also the same randomization. In IBCSG 23-01 trial, the 5-year disease-free survival is also not significantly different between the groups (84.4% vs. 87.8%; ALND vs. SLND) (3). IBCSG 23-01 trial not only further strengthens the results of the Z0011 for the omittance of axillary dissection in patients with sentinel micrometastatic lymph node breast cancer but also shows that the quality of life (QOL) of patients could be improved with sentinel biopsy alone in terms of sensory motor neuropathy and lymphedema (3, 4). In the consensus report of Saint Gallen 2013, the policy of avoiding full axillary clearance after one or two positive sentinel nodes is endorsed in situations of conservative surgery and radiotherapy (73%, YES; 21%, NO), including several opinions that the inclusion criteria of the available trial results should be considered (5). Although the Z0011 trial provokes us to omit axillary dissection in patients with cT1-2cN0 disease finally staged at pT1-2pN1(sn), it creates more problems than it solves in terms of radiotherapy fields (1). The radiotherapy directed to axillary basins (i.e., third field nodal radiotherapy) is not allowed in the protocol of the Z0011 trial. However, the details of radiotherapy fields could not be clearly understood from the original report (1). Many radiation oncologists try to irradiate at least some part of the axillary level 1-2 (i.e., high-tangential fields) and even think of using third field (i.e., supraclavicular level 3), particularly for patients with no reasonable systemic treatment option (i.e., triple negative case). Recently, the detail of radiotherapy fields at least for some part of the patients in the Z0011 trial is presented at the San Antonio Breast Cancer Symposium 2013 (6). Detailed radiotherapy records were received for 228 patients only: 104/389 (26.7%) ALND vs. 124/404 (30.7%) SLND. Sixty-one of 104 (59%) patients in ALND arm also received some form of lymphatic radiotherapy [supraclavicular, n=22 (21%), posterior axillary boost n=6 (6%), and high tangents n=33 (32%)]. In the SLND arm, some form of lymphatic radiotherapy was also used for 73 of 124 (59%) patients [supraclavicular n=21 (17%), posterior axillary boost n=12 (10%), and high tangents n=40 (32%)] (6). Although the data of the central radiotherapy review of the entire Z0011 population could not be available currently, approximately 60% of the patients have received some form of lymphatic radiotherapy and 18.9% of them have major protocol violation (i.e., third field nodal radiotherapy is not allowed in the protocol). Thus, regional radiotherapy may contribute to the results that have been obtained from both arms of the Z0011 trial.