Nuriye Yildirim

Comparison of ICE (Ifosfamide-Carboplatin-Etoposide) Versus DHAP (Cytosine Arabinoside-Cisplatin-Dexamethasone) as Salvage Chemotherapy in Patients with Relapsed or Refractory Lymphoma

Background: High dose chemotherapy with autologous stem cell transplantation is currently the treatment of choice for relapsed or refractory lymphoma patients. However, its applicability is mostly restricted to patients responding to salvage chemotherapy. Optimal salvage regimen for these patients is unclear. In this study, our aim was to compare the efficacy and toxicity profiles of DHAP (cytosine arabinoside, cisplatin and dexamethasone) and ICE (ifosfamide, carboplatin and etoposide) regimens in the salvage treatment of relapsed and refractory lymphoma. Patients and Methods: In this retrospective analysis, 53 patients with primary refractory or relapsed Hodgkins disease (HD) (n = 13) or non-Hodgkin lymphoma (NHL) (n = 40) who received ICE or DHAP salvage regimen were included. Results: Of 53 patients, 21 (39,6%) were female and the median age was 43 years. A total of 73 courses of ICE and 59 courses of DHAP were administered. Response could be evaluated in 49 patients (36 NHL and 13 HD). Of 49 patients, 11 (22.5%) achieved complete remission (CR) and 17 (35%) achieved partial remission (PR), leading to an overall response rate (ORR: CR + PR) of 57.5%. In the evaluable ICE group (n = 22) rates of CR, PR, and ORR were 27%, 41% and 68% and in the DHAP group (n = 27) rates of CR, PR, and ORR were 18%, 30% and 48% (p = 0.24, for ORR). Toxicity with both regimens was within acceptable limits. The major grade III–IV toxicities for both groups were hematological (neutopenia and thrombocytopenia). The main non-hematological toxicity was renal and observed in 8 patients. Conclusion: Although the toxicity profiles of both ICE and DHAP regimens were similar in the treatment of patients with relapsed or refractory HD or NHL, ICE seems to have higher rates of response than DHAP regimen does.

Capecitabine and Cisplatin Combination Is an Active and Well-Tolerated Doublet in the Treatment of Metastatic Breast Carcinoma Patients Pretreated with Anthracycline and Taxanes

Our aim was to evaluate the activity and toxicity of capecitabine and cisplatin (CapCisp) combination in anthracycline- and taxane-pretreated metastatic breast cancer patients. Thirty-three patients, 20–61 years of age (median 41), were included. They received Cap 2,000 mg/m2 on days 1–14 and Cisp 60 mg/m2 on day 1, repeated every 3 weeks. Twelve nonprogressive patients continued single-agent Cap therapy until progression or until intolerable toxicity after Cisp cessation. The disease control rate in 154 cycles was 81.8%: complete response 3.0% (n = 1), partial response 48.5% (n = 16) and stable disease 30.3% (n = 10). The median time to disease progression was 6.3 months (95% CI 3.8–8.8). The median overall survival was 11.5 months (95% CI 6.9–16.1). The only grade 3 toxicity was neutropenia, observed in 4 patients (12.1%). CapCisp has an encouraging anti-tumor activity with a low toxicity rate in anthracycline- and taxane-pretreated metastatic breast cancer patients.

Prognostic role of pretreatment platelet/lymphocyte ratio in patients with non-small cell lung cancer

SummaryBackgroundIt was reported that hematological markers of systemic inflammatory response might be prognostic in various cancer types. We aimed to evaluate the platelet/lymphocyte ratio (PLR) as a prognostic factor and its effect on overall survival in non-small cell lung cancer (NSCLC).MethodsClinicopathological characteristics and basal (pretreatment) PLR of 145 patients with NSCLC were evaluated retrospectively. The preoperative or pretreatment blood count data were obtained from the recorded computerized database. PLR was defined as the absolute platelet count divided by the absolute lymphocyte count.ResultsA total of 145 patients were enrolled. Median age was 57 years(range 26–83). Receiver operating characteristic curves for overall survival prediction were plotted to verify the optimum cut-off point for PLR. The recommended cut-off values for PLR was 198.2 with a sensitivity of 65.0 % and a specificity of 71.4 %. Median overall survival was 34.0 (95 % confidence interval (CI) 14.7–53.3) months in the group with low PLR (< 198.2), while it was 11.0 (95 % CI 5.6–16.3) months in the group with high PLR (≥ 198.2). The difference between the groups was statistically significant (p < 0.0001).ConclusionsOur study supports the view that a high basal PLR is a poor prognostic factor in NSCLC. However, the validity of the cut-off values for PLR identified in our study needs further prospective trials.

Predictors of outcome in patients with advanced nonseminomatous germ cell testicular tumors.

Background: Predictor factors determining complete response to treatment are still not clearly defined. We aimed to evaluate clinicopathological features, risk factors, treatment responses, and survival analysis of patient with advanced nonseminomatous GCTs (NSGCTs). Materials and Methods: Between November 1999 and September 2011, 140 patients with stage II and III NSGCTs were referred to our institutions and 125 patients with complete clinical data were included in this retrospective study. Four cycles of BEP regimen were applied as a first-line treatment. Salvage chemotherapy and/or high-dose chemotherapy (HDCT) with autologous stem cell transplantation were given in patients who progressed after BEP chemotherapy. Post-chemotherapy surgery was performed in selected patients with incomplete radiographic response and normal tumor markers. Results: The median age was 28 years. For the good, intermediate and poor risk groups, compete response rates (CRR) were, 84.6%, 67.9% and 59.4%, respectively. Extragonadal tumors, stage 3 disease, intermediate and poor risk factors, rete testis invasion were associated with worse outcomes. There were 32 patients (25.6%) with non-CR who were treated with salvage treatment. Thirty-one patients died from GCTs and 94% of them had stage III disease. Conclusions: Even though response rates are high, some patients with GCTs still need salvage treatment and cure cannot be achieved. Non-complete response to platinium-based first-line treatment is a negative prognostic factor. Our study confirmed the need for a prognostic and predictive model and more effective salvage approaches.

Primary duodenal diffuse large cell non-hodgkin lymphoma with involvement of ampulla of Vater: Report of 3 cases

Abstract Primary gastrointestinal system lymphomas constitute about one third of all extranodal lymphomas. Duodenal involvement of the lymphoma is a rare condition. Periampullary lymphoma or lymphomatous involvement of ampulla of Vater is even rarer. Since, periampullary lymphoma is not easy to differentiate from epithelial carcinoma of these sites clinically and radiologically, accurate histopathological diagnosis is essential to plan optimal treatment strategy. Obstructive jaundice and the need for some form of drainage procedure and dose modification of the chemotherapy are additional challenges. In this report, we present three cases of duodenal diffuse large cell lymphoma with involvement of ampulla of Vater, two of whom presented with the initial signs of obstructive jaundice. One of the icteric patients was only diagnosed histopathologically following an explorative laparotomy with the initial diagnosis of carcinoma.

Case report: cavernous sinus metastasis of the parotid carcinoma: a very unusual case

Cavernous sinus is an uncommon site of metastasis for the head and neck tumors, and especially for the tumors of parotid gland. The case reported here is the second reported case of parotid carcinoma metastatic to the cavernous sinus, proven by histopathology. Also it is the first reported parotid gland acinic cell carcinoma metastasis to the cavernous sinus.

Blood flow indices by Doppler ultrasonography vary with neoadjuvant chemotherapy but are not related to plasma VEGF levels in locally advanced breast cancer.

Objective: The aim of our study was to assess the quantity of blood flow to malignant tissue by color Doppler ultrasonography, its correlation with plasma vascular endothelial growth factor (VEGF) levels and response to neoadjuvant chemotherapy of patients with locally advanced and inflammatory breast carcinoma. Methods: We measured blood velocity at peak systole (PSV), end-diastolic velocity and resistivity index [RI = (PSV – end-diastolic velocity)/PSV] by Doppler ultrasonography in primary tumors and/or axillary lymph nodes of patients before and after 2–4 cycles of anthracycline-containing neoadjuvant chemotherapy and basal plasma VEGF levels. Results: Of 21 patients with a median age of 42 years (range 26–68), 16 (76.2%) were premenopausal. Median basal RI was 0.70 (interquartile range 0.68–0.78) and PSV was 24.2 cm/s (interquartile range 18.7–56.6). The median measured VEGF level was 231.5 pg/ml (interquartile range 187.5–345.5). After 2–4 cycles of chemotherapy, 13 patients (61.9%) had partial remission and 8 (38.1%) were stable. Median basal RI (0.70, interquartile range 0.68–0.78) significantly decreased to 0.66 (interquartile range 0.59–073) after chemotherapy (p = 0.043). There was a trend that the greater the shrinkage of the tumor with chemotherapy, the lower the RI (r = 0.70, p = 0.078). Conclusion: The decrease in RI with chemotherapy, which means increased blood flow at diastole of the cardiac cycle into the tumoral tissue, may be related to decreased intratumoral pressure secondary to tumor shrinkage and may reflect a new type of response, that is vascular response.

Predictive Factors Of Liver Metastasis After Curative Treatment For Colorectal Cancer

Introductıon: Colorectal cancer (CRC) is one of the most commonly detected cancers worldwide. Liver metastasis might develop shortly after the diagnosis of colorectal cancer. Liver metastasectomy might improve the five year survival rate to 20-40% in patient with previously treated CRC. We aimed in this study to evaluate the predictive factors to liver metastases in patients with newly diagnosed non metastatic CRC. Methods: Five hundred and seventeen non-metastatic colorectal patients followed at Medical Oncology Department of Ankara Numune Training and Research Hospital between January 2009 and August 2014 were evaluated retrospectively. Patients were divided in to the two subgroups. Group 1 consisted of non-metastatic and metastatic patients except liver metastases. Group 2 consisted of patients with liver metastases. Laboratuary results at the time of diagnosis were evaluated with receiver operating characteristic (ROC) Curve analysis and cut-off values were determined for lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA) and gama glutamil transferase (GGT) with (400 U/L, 50 ng/ml and 90 U/L, respectively). Results: There were 7 cases (%35) with high CEA levels in Group 2 and 28 (%8,7) cases in Group 1. There was a significant difference between this subgroups in univariate analysis (p<0,001). According to LDH levels, there were 5 (%33,3) liver metastases in high LDH group and 17 (%9) liver metastases in low LDH group (p=0,003). There were 5 cases (%33,3) of liver metastases in patients with high GGT and 24 cases(%9,8) in patients with low GGT (p=0,005). LDH was remained only significant factor after multiple logistic regression analysis (OR 7,8: 1,02-59,3). Discussion and Conclusıon: Hepatic metastases from colorectal cancer were an important predictive factor of overall survival. In our study we showed that high LDH levels at the time of diagnosis might be useful predictive factor of liver metastases. We need prospective randomized studies to determine effect of high LDH levels in colorectal cancer.