Sezer Saglam

The clinical and pathological features of 133 colorectal cancer patients with brain metastasis: a multicenter retrospective analysis of the Gastrointestinal Tumors Working Committee of the Turkish Oncology Group (TOG)

Brain metastasis in colorectal cancer is highly rare. In the present study, we aimed to determine the frequency of brain metastasis in colorectal cancer patients and to establish prognostic characteristics of colorectal cancer patients with brain metastasis. In this cross-sectional study, the medical files of colorectal cancer patients with brain metastases who were definitely diagnosed by histopathologically were retrospectively reviewed. Brain metastasis was detected in 2.7xa0% (nxa0=xa0133) of 4,864 colorectal cancer patients. The majority of cases were male (53xa0%), older than 65xa0years (59xa0%), with rectum cancer (56xa0%), a poorly differentiated tumor (70xa0%); had adenocarcinoma histology (97xa0%), and metachronous metastasis (86xa0%); received chemotherapy at least once for metastatic disease before brain metastasis developed (72xa0%), had progression with lung metastasis before (51xa0%), and 26xa0% (nxa0=xa031) of patients with extracranial disease at time the diagnosis of brain metastasis had both lung and bone metastases. The mean follow-up duration was 51xa0months (range 5–92), and the mean survival was 25.8xa0months (95xa0% CI 20.4–29.3). Overall survival rates were 81xa0% in the first year, 42.3xa0% in the third year, and 15.7xa0% in the fifth year. In multiple variable analysis, the most important independent risk factor for overall survival was determined as the presence of lung metastasis (HR 1.43, 95xa0% CI 1.27–4.14; Pxa0=xa00.012). Brain metastasis develops late in the period of colorectal cancer and prognosis in these patients is poor. However, early screening of brain metastases in patients with lung metastasis may improve survival outcomes with new treatment modalities.

Vitamin D Levels in Patients with Breast Cancer: Importance of Dressing Style

BACKGROUNDnVitamin D deficiency is a potentially modifiable risk factor that may be targeted for breast cancer (BC) prevention. It may also be related to prognosis after diagnosis and treatment. The aim of our study was to determine the prevalence of vitamin D deficiency as measured by serum 25-hydroxy vitamin D (25-OHD) levels in patients with BC and to evaluate its correlations with life-style and treatments.nnnMATERIALS AND METHODSnThis study included 186 patients with stage 0-III BC treated in our breast center between 2010-2013. The correlation between serum baseline 25-OHD levels and supplement usage, age, menopausal status, diabetes mellitus, usage of bisphosphonates, body-mass index (BMI), season, dressing style, administration of systemic treatments and radiotherapy were investigated. The distribution of serum 25-OHD levels was categorized as deficient (<10ng/ ml), insufficient (10-24 ng/ml), and sufficient (25-80 ng/ml).nnnRESULTSnThe median age of the patients was 51 years (range: 27-79 years) and 70% of them had deficient/insufficient 25-OHD levels. On univariate analysis, vitamin D deficiency/insufficiency was more common in patients with none or low dose vitamin D supplementation at the baseline, high BMI (≥25), no bisphosphonate usage, and a conservative dressing style. On multivariate analysis, none or low dose vitamin D supplementation, and decreased sun-exposure due to a conservative dressing style were found as independent factors increasing risk of vitamin D deficiency/insufficiency 28.7 (p=0.002) and 13.4 (p=0.003) fold, respectively.nnnCONCLUSIONSnThe prevalence of serum 25-OHD deficiency/insufficiency is high in our BC survivors. Vitamin D status should be routinely evaluated for all women, especially those with a conservative dressing style, as part of regular preventive care, and they should take supplemental vitamin D.

Neoadjuvant chronomodulated capecitabine with radiotherapy in rectal cancer: a phase II brunch regimen study

PurposeThe aim of this study was to evaluate efficacy and safety of chronomodulated capecitabine administered according to a specific time schedule (Brunch Regimen: Breakfast and Lunch) as a part of neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer.MethodsEighty-five patients with stage II and III rectal cancer were included. Patients received capecitabine (1,650xa0mg/m2 per day; 60xa0% dose at 8:00 AM and 40xa0% dose at 12:00 noon) administered during pelvic radiation (total 50.4xa0Gy in 28 fractions, 1.8xa0Gy daily dose between 2:00 p.m. and 4:00 p.m.). After chemoradiotherapy, patients underwent surgery. The primary endpoints were pathological complete response (pCR) rate and toxicity.ResultsIn 17 patients (20xa0%), total tumor regression was achieved according to Dworak pathological grading system. Grade III diarrhea occurred in nine patients (10.5xa0%), while only one patient had grade 3 thrombocytopenia. Grade II or III proctitis were seen in nine (10.5xa0%) subjects, and grade I or II cystitis in six (6.9xa0%). Only three patients (3.3xa0%) developed hand and foot syndrome (both grade I–II). There were no grade IV toxicities.ConclusionsBrunch Regimen for locally advanced rectal cancer consisting of neoadjuvant chronomodulated capecitabine and concurrent radiation therapy is effective and well tolerated with good safety profile, particularly with regard to the occurrence of hand and foot syndrome, in patients with locally advanced rectal cancer.

Chronomodulated oxaliplatin plus Capecitabine (XELOX) as a first line chemotherapy in metastatic colorectal cancer: A Phase II Brunch regimen study.

PurposeThe aim of this study was to evaluate safety and toxicity of chronomodulated capecitabine administered in the morning and at noon according to a specific time schedule (Brunch Regimen: Breakfast and Lunch) as a part of first-line XELOX chemotherapy in patients with metastatic colorectal cancer.MethodsA total of 30 treatment-naïve colorectal cancer patients with metastatic disease were included. Oxaliplatin 130xa0mg/m2 on day 1 plus chronomodulated oral capecitabine 2000xa0mg/m2 per day were administered (50xa0% dose at 8:00 a.m. and 50xa0% dose at 12:00 noon on days 1–14, every 21xa0days). All adverse events, treatment responses and survival were evaluated. In addition, pharmacokinetic profile of capecitabine was examined in a subset of 5 patients.ResultsMedian age was 57.1xa0years (range 32–77xa0years). Median follow-up was 19xa0months (range 3–36xa0months). Three patients (10xa0%) had complete response, 13 patients (43.3xa0%) had partial response and 4 patients (13.3xa0%) had stabile disease. Ten patients had progressive disease at their first evaluation (33.3xa0%). The median progression-free survival (PFS) was 10xa0months (range 2–36xa0months). There were no grade 4 toxicities. One patient (3.3xa0%) had grade 3 neutropenia. Hand-foot syndrome developed in three patients (10xa0%): 6.6xa0%, grade 1 and 3.3xa0%, grade 2.ConclusionsChronomodulated XELOX seems to represent a promising therapeutic option in the first-line treatment of metastatic colorectal carcinoma due to good tumor control and favorable toxicity profile. Phase III randomized trials are required to assess the actual clinical efficacy and side effect profile of this regimen.

Dramatic Response to Catumaxomab Treatment for Malign Ascites Related to Renal Cell Carcinoma With Sarcomotoid Differentiation.

Refractory malignant ascites (MA) is a common complication in cancer patients. Renal cell carcinoma (RCC) is rarely present with peritoneal ascites, which is commonly associated with carcinomas of the gastrointestinal and female reproductive tracts; including especially ovarian high-grade serous carcinoma. Currently, chemotherapy and paracentesis represent the most widely used methods to relieve the symptoms. Recently, intraperitoneal therapy with catumaxomab-a trifunctional hybrid antibody-has been introduced for the treatment of MA. The benefit of this treatment has been demonstrated in patients with distinct abdominal malignancies. In this case report, we present the first case of successful catumaxomab treatment against MA in a patient with advanced RCC with sarcomatoid differentiation. After the second administration of catumaxomab, paracentesis became no longer necessary. Catumaxomab might represent a safe treatment option for MA in the course of metastatic RCC with sarcomatoid differentiation.

Primary renal angiosarcoma with progressive clinical course despite surgical and adjuvant treatment: A case report

Angiosarcoma is an extremely rare, high-grade malignancy, which accounts for <2% of all soft-tissue sarcomas. Cases of primary renal angiosarcoma represent 1% of these. Angiosarcomas involving the kidney usually originate from metastatic skin lesions or primary visceral lesions and most often occur in the sixth and seventh decades of life. The present study describes a case of primary renal angiosarcoma that presented as a large right-sided renal mass with symptoms of flank pain. Despite surgical removal of the tumor, recurrent disease with associated lung metastases was identified at the surgical site following adjuvant chemotherapy. The patient succumbed to the disease 13 months after the diagnosis.

Adjuvant chemoradiotherapy after D2 resection in gastric cancer: a single-center observational study

PurposePrevious studies demonstrated survival benefits in association with the addition of chemoradiotherapy after surgery in gastric cancer. This study aimed to examine the efficacy in terms of loco-regional control and survival and safety of 5-FU-based adjuvant chemoradiotherapy after D2 curative surgery.MethodsThis study included 228 patients (81 female, 147 male) treated for gastric cancer with curative surgery plus adjuvant chemoradiotherapy. Majority of the patients underwent at least D2 lymph node resection. Median three cycles of fluorouracil chemotherapy were administered, and 45-Gy radiotherapy was delivered at 1.8xa0Gy/fraction concomitantly during the second cycle of chemotherapy. Local control, regional control, distant metastasis and overall survival rates were estimated.ResultsThe median age of the patients was 54xa0years (range 25–74xa0years). The most common grade III toxicities were nausea (10xa0%) and neutropenia (9xa0%). During radiotherapy, grade IV local skin reaction occurred in one patient. Median duration of follow-up was 47xa0months. Local, regional and distant recurrence developed in 9 (4xa0%), 41 (18xa0%) and 45 (20xa0%) patients, respectively. Overall 5-year survival rate was 57.2xa0%, and disease-free 5-year survival rate was 53.8xa0%. Multivariate analysis identified less than 15 lymph node involvement as an independent predictor of better survival (pxa0<xa00.001).ConclusionsConcomitant 5-FU-based chemoradiotherapy seems to be an effective and tolerable adjuvant regimen on local control and survival in curatively resected node-positive stomach cancer, particularly when combined with D2 resection.

Trichomegaly Induced by Cetuximab: Case Series and Review the Literature.

Trichomegaly is a rare side effect of epidermal growth factor receptor inhibitors. We present here 4 patients who treated with cetuximab (an epidermal growth factor receptor inhibitor) for metastatic colorectal cancer. All of the cases were treated with cetuximab 500 mg/m biweekly in combination protocol. The mean period from the start of the treatment until the development the trichomegaly was 4.75 (3-6) months. In all of the patients after the end of the cetuximab therapy, trichomegaly was regressed. Only 1 case resolved with topical treatment that conjunctivitis with trichomegaly. Trichomegaly is an important ocular toxicity of cetuximab that can cause visual discomfort and corneal damages. However, these side effects usually do not require discontinuation of treatment.

Can Megestrol Acetate Induce Thrombosis in Advanced Oncology Patients Receiving Chemotherapy

BACKGROUNDnMegestrol acetate (MA) is a steroid origin medicine often used for control of cachexia in oncologic palliative care. Thrombosis is a common problem in oncology patients. One question is whether MA can cause thrombosis. This retrospective, registry-based analysis was therefore conducted to assess thrombotic processes in oncology patients using MA concurrent with chemotherapy.nnnMATERIALS AND METHODSnData on oncology patients at the metastatic stage using MA were obtained from the archives of our center. Outcomes of patients were evaluated for thromboembolic events (VTEs) during treatment.nnnRESULTSnNinety-seven oncology patients with a median age of 62 (33-84) years were included. During the median follow-up of 17 months, 58 (59.8%) died leaving 39 (31.2%) still alive. Median overall survival (OS) was 19 months (6-180). Mean time of MA use was 8.69 months(±3.53), with a median dose of 160mg (range 160-480mg). Eleven VTEs were detected after MA use, 4 of these in pancreatic cancer cases. The patients with thrombosis non-significantly had worse OS, than those without thrombosis (p=0.106).nnnCONCLUSIONSnThis trial revealed that the 11.3% of all patients developed thrombosis,who had been treated with MA and chemotherapy concomittantly. There was no statistically significant difference regarding to occurrence of thrombotic process, among the patients receiving different chemotherapy regimens with MA concomittantly. Pancreatic cancer seemed to be related to thrombosis rather than MA use.

Prognostic significance of carbonic anhydrase IX overexpression in stage III non-small cell lung cancer patients after neoadjuvant treatment

BACKGROUNDnTo assess the prognostic importance of carbonic anhydrase IX (CA IX), a hypoxic biomarker, after neoadjuvant treatment in Stage III non-small cell lung cancer (NSCLC) patients.nnnMETHODSnTissue CA IX expression was examined after surgical resection in 77 patients who had undergone neoadjuvant treatment. The effects of CA IX overexpression and other clinical factors on disease-free survival and overall survival were investigated.nnnRESULTSnIn multivariate analysis, number of neoadjuvant chemotherapy (CT) courses and gender emerged as significant independent predictors for disease-free survival, where administration of 2-3 courses of neoadjuvant chemotherapy (CT) (HR, 3.2 [95% CI 1.3-7.6], pu202f=u202f0.009) and female gender were associated with poor survival (HR, 3.2 [95% CI 1.3-7.7], pu202f=u202f0.009). The only significant independent predictor for overall survival was recurrence (HR, 5.6 [95% CI 2.4-12.8], pu202f<u202f0.001). On the other hand, CA IX overexpression was not associated with disease free survival (pu202f=u202f0.560) or overall survival (pu202f=u202f0.799).nnnDISCUSSIONnOur results do not suggest a prognostic role for CA IX overexpression in stage III NSCLC patients who received neoadjuvant treatment.