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Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Κυριακή 13 Νοεμβρίου 2016
Metastasectomy in Cutaneous Melanoma
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Konstantinos Lasithiotakis, Odysseas Zoras
Metastectomy remains the only treatment in malignant melanoma to offer complete pathologic response within a few days of in-hospital stay. It has been historically associated with the highest survival rates in the literature reported for patients of this stage. However, only a minority of patients are amenable to curative resection of distant metastatic disease. This patient group exhibit slow growing oligometastases as indicated by: a. Long disease free interval after treatment of their primary tumours and b. An exhaustive preoperative work up with the use of PET/CT and MRI scans (im not sure what this sentence means). Only complete resection of all metastases is associated with long term survival and debulking should not be attempted. Metastasectomy has also been shown to offer significant palliation in cases of gastrointestinal bleeding or obstruction. The timing and the sequencing of surgery in the modern multimodal targeted treatment of melanoma is still unclear and warrants further investigation.
http://ift.tt/2fpWXk7
Hyperglycemia, tumorigenesis, and chronic inflammation
Source:Critical Reviews in Oncology/Hematology
Author(s): Shu-Chun Chang, Wei-Chung Vivian Yang
Hyperglycemia is the most prominent sign that characterizes diabetes. Hyperglycemia favors malignant cell growth by providing energy to cancer cells. Clinical studies also showed an increased risk of diabetes being associated with different types of cancers. In addition, poorly regulated glucose metabolism in diabetic patients is often found with increased levels of chronic inflammatory markers, e.g., interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, and emerging evidence has highlighted activation of the immune response in the progression and development of cancer cells. Therefore, uncontrolled proinflammatory responses could conceivably create a chronic inflammatory state, promoting a tumor-favorable microenvironment and potentially triggering immune overactivation and cancer growth. To further understand how hyperglycemia contributes to immune overactivation, the tumor microenvironment and the development of chronic inflammation-associated tumors may provide insights into tumor biology and immunology. This paper provides a brief introduction to hyperglycemia-associated diseases, followed by a comprehensive overview of the current findings of regulatory molecular mechanisms of glycosylation on proteoglycans in the extracellular matrix under hyperglycemic conditions. Then, the authors discuss the role of hyperglycemia in tumorigenesis (particularly in prostate, liver, colorectal, and pancreatic cancers), as well as the contribution of hyperglycemia to chronic inflammation. The authors end with a brief discussion on the future perspectives of hyperglycemia/tumorigenesis and potential applications of alternative/effective therapeutic strategies for hyperglycemia-associated cancers.
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Hyperglycemia, tumorigenesis, and chronic inflammation
Publication date: Available online 13 November 2016
Source:Critical Reviews in Oncology/Hematology
Author(s): Shu-Chun Chang, Wei-Chung Vivian Yang
Hyperglycemia is the most prominent sign that characterizes diabetes. Hyperglycemia favors malignant cell growth by providing energy to cancer cells. Clinical studies also showed an increased risk of diabetes being associated with different types of cancers. In addition, poorly regulated glucose metabolism in diabetic patients is often found with increased levels of chronic inflammatory markers, e.g., interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, and emerging evidence has highlighted activation of the immune response in the progression and development of cancer cells. Therefore, uncontrolled proinflammatory responses could conceivably create a chronic inflammatory state, promoting a tumor-favorable microenvironment and potentially triggering immune overactivation and cancer growth. To further understand how hyperglycemia contributes to immune overactivation, the tumor microenvironment and the development of chronic inflammation-associated tumors may provide insights into tumor biology and immunology. This paper provides a brief introduction to hyperglycemia-associated diseases, followed by a comprehensive overview of the current findings of regulatory molecular mechanisms of glycosylation on proteoglycans in the extracellular matrix under hyperglycemic conditions. Then, the authors discuss the role of hyperglycemia in tumorigenesis (particularly in prostate, liver, colorectal, and pancreatic cancers), as well as the contribution of hyperglycemia to chronic inflammation. The authors end with a brief discussion on the future perspectives of hyperglycemia/tumorigenesis and potential applications of alternative/effective therapeutic strategies for hyperglycemia-associated cancers.
http://ift.tt/2ewjNah
Recurrent squamous cell carcinoma involving cranial nerves in a patient with left glottic carcinoma treated with definitive radiation therapy: a case report
Publication date: Available online 13 November 2016
Source:Practical Radiation Oncology
Author(s): Kunal Sindhu, William Armstrong, Anton Hasso, Ted Farzaneh, Parima Daroui
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State of Dose Prescription and Compliance to International Standard (ICRU-83) in Intensity Modulated Radiation Therapy among Academic Institutions
Publication date: Available online 13 November 2016
Source:Practical Radiation Oncology
Author(s): Indra J Das, Aaron Andersen, Zhe (Jay) Chen, Andrea Dimofte, Eli Glatstein, Jeremy Hoisak, Long Huang, Mark P. Langer, Choonik Lee, Matthew Pacella, Richard A. Popple, Roger Rice, Jennifer Smilowitz, Patricia Sponseller, Timothy Zhu
Purpose/Objective(s)To evaluate dose prescription and recording compliance to international standard (ICRU-83) in IMRT treated patients among academic institutions.Materials/MethodsTen institutions participated in this study to collect IMRT data to evaluate compliance to ICRU-83. Under institutional review board (IRB) clearance, 5094 patient data including treatment site, technique, planner, physician, prescribed dose, target volume, monitor units, planning system and dose calculation algorithm were collected anonymously. The dose-volume histogram (DVH) of each patient, as well as dose points, D100, D98, D95, D50, D2 were collected and sent to a central location for analysis. Homogeneity index (HI) as a measure of the steepness of target which is a measure of the shape of the DVH was calculated for every patient and analyzed.ResultsIn general, ICRU recommendations for naming the target, reporting dose prescription, and achieving desired levels of dose to target were relatively poor. The nomenclature for the target in the dose prescription had large variations, having every permutation of name and number contrary to ICRU recommendations. There was statistically significant variability in D95, D50 and HI among institutions, tumor site and technique with p values <0.01. Nearly 95% of patients had D50 higher than 100% (103.5±6.9) of prescribed dose and varied among institutions. On the other hand, D95 was close to 100% (97.1±9.4) of prescribed dose. Liver and lung sites had a higher D50 compared to other sites. Pelvic sites had a lower variability indicated by HI (0.13±1.21). Variability in D50 is 101.2±8.5, 103.4±6.8, 103.4±8.2 and 109.5±11.5 for IMRT, Tomotherapy, VMAT and SBRT with IMRT, respectively.ConclusionNearly 95% of patient treatments deviated from the ICRU-83 recommended D50 prescription dose delivery. This variability is significant (p<0.01) in terms of treatment site, technique and institution. To reduce dosimetric and associated radiation outcome variability, dose prescription in every clinical trial should be unified with international guidelines.
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Recurrent squamous cell carcinoma involving cranial nerves in a patient with left glottic carcinoma treated with definitive radiation therapy: a case report
Publication date: Available online 13 November 2016
Source:Practical Radiation Oncology
Author(s): Kunal Sindhu, William Armstrong, Anton Hasso, Ted Farzaneh, Parima Daroui
http://ift.tt/2g8yOzy
State of Dose Prescription and Compliance to International Standard (ICRU-83) in Intensity Modulated Radiation Therapy among Academic Institutions
Publication date: Available online 13 November 2016
Source:Practical Radiation Oncology
Author(s): Indra J Das, Aaron Andersen, Zhe (Jay) Chen, Andrea Dimofte, Eli Glatstein, Jeremy Hoisak, Long Huang, Mark P. Langer, Choonik Lee, Matthew Pacella, Richard A. Popple, Roger Rice, Jennifer Smilowitz, Patricia Sponseller, Timothy Zhu
Purpose/Objective(s)To evaluate dose prescription and recording compliance to international standard (ICRU-83) in IMRT treated patients among academic institutions.Materials/MethodsTen institutions participated in this study to collect IMRT data to evaluate compliance to ICRU-83. Under institutional review board (IRB) clearance, 5094 patient data including treatment site, technique, planner, physician, prescribed dose, target volume, monitor units, planning system and dose calculation algorithm were collected anonymously. The dose-volume histogram (DVH) of each patient, as well as dose points, D100, D98, D95, D50, D2 were collected and sent to a central location for analysis. Homogeneity index (HI) as a measure of the steepness of target which is a measure of the shape of the DVH was calculated for every patient and analyzed.ResultsIn general, ICRU recommendations for naming the target, reporting dose prescription, and achieving desired levels of dose to target were relatively poor. The nomenclature for the target in the dose prescription had large variations, having every permutation of name and number contrary to ICRU recommendations. There was statistically significant variability in D95, D50 and HI among institutions, tumor site and technique with p values <0.01. Nearly 95% of patients had D50 higher than 100% (103.5±6.9) of prescribed dose and varied among institutions. On the other hand, D95 was close to 100% (97.1±9.4) of prescribed dose. Liver and lung sites had a higher D50 compared to other sites. Pelvic sites had a lower variability indicated by HI (0.13±1.21). Variability in D50 is 101.2±8.5, 103.4±6.8, 103.4±8.2 and 109.5±11.5 for IMRT, Tomotherapy, VMAT and SBRT with IMRT, respectively.ConclusionNearly 95% of patient treatments deviated from the ICRU-83 recommended D50 prescription dose delivery. This variability is significant (p<0.01) in terms of treatment site, technique and institution. To reduce dosimetric and associated radiation outcome variability, dose prescription in every clinical trial should be unified with international guidelines.
http://ift.tt/2eRgWnI
The inhibiting activity of meadowsweet extract on neurocarcinogenesis induced transplacentally in rats by ethylnitrosourea
Abstract
Inhibitory activity of a decoction of meadowsweet, given postnatally, was studied in rats at risk for neurogenic and renal tumors initiated by transplacental exposure to ethylnitrosourea (ENU). Chemical analysis of ethanol and aqueous extracts of meadowsweet has shown high content of biologically active flavonoids and tannins. Pregnant rats of LIO strain were given a single i.v. injection of ENU, 75 mg/kg, оn the 21st day of gestation. After weaning at 3 weeks after birth, the offspring were divided into two groups: the first was a positive control (ENU), while rats in the second group (ENU + meadowsweet) were given daily a decoction of meadowsweet as drinking water throughout their lifetime. All rats of the first group (ENU) developed multiple malignant tumors, which occurred in brain (86%), spinal cord (43%), peripheral and cranial nerves (29%) and in kidney (31%). More than one-third of CNS tumors were oligodendrogliomas. Mixed gliomas (oligoastrocytomas) occurred less frequently. All other types including astrocytomas, glioblastomas, and ependymomas were rare. All PNS tumors were neurinomas (schwannomas). The spectrum of tumors was similar in rats of the second group. Postnatal consumption of meadowsweet significantly reduced number of tumor-bearing rats (by 1.2 times), the incidence and multiplicity of CNS tumors (brain—by 2.0 and 2.1 times, respectively; spinal cord—by 3.1 and 3.0 times, respectively) and significantly increased latency period, compared to rats of the first group. No significant reduction in PNS or renal tumors was seen in rats given meadowsweet. Meadowsweet extract can be considered an effective cancer preventive agent especially as a neurocarcinogenesis inhibitor.
http://ift.tt/2fJPw5t
The inhibiting activity of meadowsweet extract on neurocarcinogenesis induced transplacentally in rats by ethylnitrosourea
Abstract
Inhibitory activity of a decoction of meadowsweet, given postnatally, was studied in rats at risk for neurogenic and renal tumors initiated by transplacental exposure to ethylnitrosourea (ENU). Chemical analysis of ethanol and aqueous extracts of meadowsweet has shown high content of biologically active flavonoids and tannins. Pregnant rats of LIO strain were given a single i.v. injection of ENU, 75 mg/kg, оn the 21st day of gestation. After weaning at 3 weeks after birth, the offspring were divided into two groups: the first was a positive control (ENU), while rats in the second group (ENU + meadowsweet) were given daily a decoction of meadowsweet as drinking water throughout their lifetime. All rats of the first group (ENU) developed multiple malignant tumors, which occurred in brain (86%), spinal cord (43%), peripheral and cranial nerves (29%) and in kidney (31%). More than one-third of CNS tumors were oligodendrogliomas. Mixed gliomas (oligoastrocytomas) occurred less frequently. All other types including astrocytomas, glioblastomas, and ependymomas were rare. All PNS tumors were neurinomas (schwannomas). The spectrum of tumors was similar in rats of the second group. Postnatal consumption of meadowsweet significantly reduced number of tumor-bearing rats (by 1.2 times), the incidence and multiplicity of CNS tumors (brain—by 2.0 and 2.1 times, respectively; spinal cord—by 3.1 and 3.0 times, respectively) and significantly increased latency period, compared to rats of the first group. No significant reduction in PNS or renal tumors was seen in rats given meadowsweet. Meadowsweet extract can be considered an effective cancer preventive agent especially as a neurocarcinogenesis inhibitor.
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Use of maintenance endocrine therapy after chemotherapy in metastatic breast cancer
Source:European Journal of Cancer
Author(s): S. Sutherland, D. Miles, A. Makris
BackgroundFor women with oestrogen receptor+ metastatic breast cancer (MBC), the options for systemic treatment include endocrine therapy (ET) and chemotherapy. For women whose disease is also HER2+, anti-HER2 therapies are also routinely used either with chemotherapy or less commonly with ET. Where chemotherapy is used as initial therapy, treatment is often discontinued due to cumulative toxicity in the absence of disease progression. In this setting, there is the option of introducing ET with the aim of prolonging response and delaying relapse.MethodsLiterature review revealed four trials addressing the question of whether there is a benefit from introducing ET following chemotherapy for MBC. We also sought evidence for alternative approaches, including concurrent chemotherapy and ET and continuing chemotherapy until disease progression.ResultsThe evidence for the use of ET after chemotherapy in MBC is limited, and the trials done were small. Furthermore, they were performed at a time when both the chemotherapy regimens and ET were different from those used currently. Despite these limitations, there is probably a modest improvement in time to progression for the sequential use of ET after chemotherapy but with no overall survival benefit. An alternative approach, particularly considering agents with relatively low toxicity, such as orally bioavailable fluoropyrimidines, is to continue chemotherapy until disease progression.ConclusionWhere chemotherapy for MBC is discontinued due to toxicity, in the absence of progression, the use of ET, with its relatively low toxicity, is a reasonable approach with the aim of delaying relapse.
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HR+/Her2- breast cancer in pre-menopausal women: The impact of younger age on clinical characteristics at diagnosis, disease management and survival
Source:Cancer Epidemiology, Volume 45
Author(s): Marianna De Camargo Cancela, Harry Comber, Linda Sharp
Young women (20–39 years-old) with breast cancer are diagnosed with more aggressive tumours and consequently have poorer survival. However, there is an evidence gap as to whether age has an independent effect on survival of pre-menopausal women diagnosed with HR+/Her2- tumours. The aim of this population-based study was to compare characteristics at diagnosis, determinants of treatment and survival in women aged 20–39 and 40–49 years diagnosed with HR+/Her2- tumours. From the National Cancer Registry Ireland, we identified women aged 20–49 diagnosed with a first invasive HR+/Her2- breast cancer during 2002–2008. Women aged 20–39 were compared to those aged 40–49 years. Poisson regression with robust error variance was used to explore the impact of age on treatment receipt. Associations between age and survival from all causes was investigated using Cox models. In multivariate models, women aged 20–39 significantly more often having no cancer-directed surgery (IRR=1.49, 95%CI 1.07, 2.08). In those having surgery, younger age was associated with significantly higher likelihood of receiving chemotherapy; age was not associated with receipt of adjuvant radiotherapy or endocrine therapy. Women aged 20–39 undergoing surgery were significantly more likely to die than women aged 40–49 (HR=1.84, 95%CI: 1.31, 2.59). Age is an independent prognostic factor in younger women diagnosed with HR+/Her2- breast cancer, supporting the hypothesis that breast cancer in women under 40 has more aggressive behaviour, even within HR+/Her2- tumours. Future research should explore the reasons for poorer survival in order to inform strategies to improve outcomes in this age group.
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Enrolment of young women attending cervical cancer screening to survey effectiveness of HPV vaccination
Source:Cancer Epidemiology
Author(s): Marc Arbyn, Davy Vanden Broeck, Johannes Bogers, Pierre Van Damme, Marleen Temmerman, Steven Weyers
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HR+/Her2- breast cancer in pre-menopausal women: The impact of younger age on clinical characteristics at diagnosis, disease management and survival
Source:Cancer Epidemiology, Volume 45
Author(s): Marianna De Camargo Cancela, Harry Comber, Linda Sharp
Young women (20–39 years-old) with breast cancer are diagnosed with more aggressive tumours and consequently have poorer survival. However, there is an evidence gap as to whether age has an independent effect on survival of pre-menopausal women diagnosed with HR+/Her2- tumours. The aim of this population-based study was to compare characteristics at diagnosis, determinants of treatment and survival in women aged 20–39 and 40–49 years diagnosed with HR+/Her2- tumours. From the National Cancer Registry Ireland, we identified women aged 20–49 diagnosed with a first invasive HR+/Her2- breast cancer during 2002–2008. Women aged 20–39 were compared to those aged 40–49 years. Poisson regression with robust error variance was used to explore the impact of age on treatment receipt. Associations between age and survival from all causes was investigated using Cox models. In multivariate models, women aged 20–39 significantly more often having no cancer-directed surgery (IRR=1.49, 95%CI 1.07, 2.08). In those having surgery, younger age was associated with significantly higher likelihood of receiving chemotherapy; age was not associated with receipt of adjuvant radiotherapy or endocrine therapy. Women aged 20–39 undergoing surgery were significantly more likely to die than women aged 40–49 (HR=1.84, 95%CI: 1.31, 2.59). Age is an independent prognostic factor in younger women diagnosed with HR+/Her2- breast cancer, supporting the hypothesis that breast cancer in women under 40 has more aggressive behaviour, even within HR+/Her2- tumours. Future research should explore the reasons for poorer survival in order to inform strategies to improve outcomes in this age group.
http://ift.tt/2etEzrl
Enrolment of young women attending cervical cancer screening to survey effectiveness of HPV vaccination
Source:Cancer Epidemiology
Author(s): Marc Arbyn, Davy Vanden Broeck, Johannes Bogers, Pierre Van Damme, Marleen Temmerman, Steven Weyers
http://ift.tt/2etKBbx
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