Prevalence of Helicobacter pylori Infection in Patients with Squamous Cell Carcinoma of the Oesophagus. A Descriptive Case Series Study

Abstract

Introduction

Helicobacter pylori is an important causative factor in gastric carcinogenesis; its role in extra-gastric gastrointestinal malignancies such as oesophageal cancer is controversial. H. pylori is thought to cause extensive gastric atrophy associated with squamous cell carcinoma of the oesophagus. We conducted a study to determine the prevalence of H. pylori infection in patients with squamous cell carcinoma of the oesophagus.

Method

We collected biopsies from the antrum and corpus of 59 patients with confirmed squamous cell carcinoma of the oesophagus, two from each area. These were then examined by an experienced histopathologist using methylene blue staining for the presence of H. pylori.

Results

H. pylori was found in 30 (51 %) of the patients, a prevalence similar to that of the general population in South Africa. Five patients were found to have associated intestinal metaplasia, and all but two had chronic inflammation.

Conclusion

The prevalence of H. pylori in our patients with squamous cell carcinoma of the oesophagus is 51 %, similar to that previously reported in the general population.

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Defining the optimal timing of adjuvant therapy for resected pancreatic adenocarcinoma: A statewide cancer registry analysis

Background

Long-term results of the ESPAC-3 trial suggest that while completing adjuvant therapy (AT) is necessary after resection of pancreatic ductal adenocarcinoma (PDAC), early initiation (within 8 weeks) may not be associated with improved overall survival (OS). The primary aim of this study was to evaluate the OS impact of early versus late AT in a statewide analysis.

Methods

Patients with stages I–III PDAC in the Kentucky Cancer Registry (KCR) from 2004 to 2013, were evaluated. Those undergoing pancreatectomy were stratified into two groups ("early," <8 weeks, vs. "late," 8–16 weeks).

Results

Of 2,221 diagnosed patients with stages I–III, 831 (37.4%) underwent pancreatectomy upfront. Of these, only 420 (50.5%) received AT. Initiation date of AT was not associated with OS (median OS: early, 20.2 vs. late, 19.0 months, P = 0.97). On multivariate analysis, factors that affected OS included stage (II, HR-1.82, P = 0.017; III, HR-3.77, P < 0.001), node positivity (HR-1.51, P = 0.004), poorly/undifferentiated grade (HR-1.34; P = 0.011), but not AT initiation date.

Conclusions

In this statewide analysis, there was no difference in OS between early and late AT initiation for resected PDAC. The ideal window for AT initiation remains unknown as tumor biology continues to trump regimens from the past decade. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

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Intralesional PV-10 for in-transit melanoma—A single-center experience

Background and Objectives

Patients with in-transit melanoma metastasis have longer median survival than patients with distant metastatic disease. Furthermore, local disease control is an important endpoint for symptom management. The treatment of unresectable loco-regional recurrence or in-transit disease has been historically managed with a combination of treatments including surgery, radiotherapy, isolated limb infusion or perfusion as well as systemic therapies. Intralesional PV-10 has been used at Peter MacCallum Cancer Centre since 2010, and the current report presents a retrospective analysis of patient outcomes, reporting the response rates, durability of responses, and observed toxicities.

Methods

Records were analyzed retrieving details of 19 patients treated with PV-10 over a 4-year period from 2010 to 2014. Medical records were reviewed for these patients and data extracted.

Results

Nineteen patients with in-transit melanoma were treated with intralesional PV-10 between 2010 and 2014. Disease control (complete or partial response or disease stability) was achieved in 68% of patients with 26% having a complete response. This was achieved with minimal associated toxicity.

Conclusions

PV-10 is an effective, durable, well-tolerated treatment tool with an acceptable side effect profile for the management of unresectable in-transit melanoma. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

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Patterns of major wound complications following multidisciplinary therapy for lower extremity soft tissue sarcoma

Background and Objectives

The purpose of this study was to determine the pattern and timing of major wound complications (MWCs) in patients at our institution who received multimodality treatment for lower extremity soft tissue sarcoma (LE-STS) and to evaluate the impact of MWCs on tumor control and patient outcomes.

Methods

The medical records of 102 LE-STS patients treated with limb-sparing surgery and radiation therapy were reviewed. MWCs were defined as secondary operations with anesthesia, seroma/hematoma aspiration, admission for IV antibiotics, or persistent deep packing.

Results

MWCs occurred in 22% of patients, with 45% of events occurring >120 days after resection. On multivariate analysis, preoperative external beam radiation therapy (EBRT) (OR 4.29, 95% CI 1.06–17.40, P = 0.042) and skin graft placement (OR 6.39, 95% CI 1.37–29.84, P = 0.018) were found to be independent predictors of MWCs. MWC occurrence did not predict for chronic toxicity and did not impact tumor control or survival.

Conclusions

A considerable proportion of MWCs occur >120 days from surgical resection with preoperative EBRT and skin graft placement independent predictors for MWCs. While an additional source of morbidity, MWC occurrence did not impact tumor control, nor did it predict for chronic toxicity. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

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Re-irradiation of prostate cancer local failures after previous curative radiotherapy: long-term outcome and tolerance

Publication date: Available online 28 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Thomas Zilli, Eileen Benz, Giovanna Dipasquale, Michel Rouzaud, Raymond Miralbell
Purpose/ObjectiveTo evaluate safety, feasibility, side-effect profile, and proof of concept of external beam radiotherapy (EBRT) with or without a brachytherapy (BT) boost for salvage of exclusive local failure after primary EBRT for prostate cancer.Materials and MethodsFourteen patients with presumed exclusive local recurrence after primary EBRT with or without BT were considered eligible for re-irradiation. The median normalized total dose in 2 Gy-fractions (NTD2Gy, α/β ratio=1.5 Gy) was 74 Gy (66-98.4) at 1^st irradiation. Median time between the 1^st RT and the re-irradiation was 6.1 years (range, 4.7-10.2).ResultsBetween 2003 and 2008 salvage treatment was delivered with a median NTD2Gy of 85.1 Gy (70-93.4) to the prostate with EBRT with (n=10) or without (n=4) BT. Androgen deprivation was given to 12 patients (median time of 12 months). No Grade ≥ 3 toxicity was observed during and within 6 weeks after RT. After a median follow-up of 94 months (range, 48-172) post-salvage RT, 5-year Grade ≥3 GU and GI toxicity-free survival figures were 77.9±11.3% and 57.1±13.2%, respectively. Four patients presented with combined Grade 4 GU/GI toxicity. The 5-year biochemical relapse-free, local relapse-free, distant metastasis-free and cancer-specific survivals were 35.7±12.8%, 50.0±13.4%, 85.7±9.4%, and 100%, respectively.ConclusionSalvage whole gland re-irradiation for patients with a suspicious of exclusive local recurrence after initial RT may be associated with a high rate of severe radiation-induced side-effects and a poor long-term biochemical and local control.

Teaser

In this retrospective study we evaluated the long-term results of fourteen prostate cancer patients treated with salvage external beam radiotherapy (EBRT) for exclusive local failure after primary EBRT. Whole gland re-irradiation resulted in a high rate of severe radiation-induced side-effects and a poor long-term biochemical and local control. Alternative salvage re-irradiation modalities should be explored for selected cases of local relapse in accurately designed prospective trials.


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Prognostic value of p16 status on the development of a complete response in involved oropharynx cancer neck nodes after cisplatin based chemoradiation – a secondary analysis of NRG Oncology RTOG 0129

Publication date: Available online 28 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Thomas J. Galloway, Qiang (Ed) Zhang, Phuc Felix Nguyen-Tan, David I. Rosenthal, Denis Soulieres, André Fortin, Craig L. Silverman, Megan E. Daly, John A. Ridge, J Alexander Hammond, Quynh-Thu Le
PurposeTo determine the relationship between p16 status and the regional response of patients with node positive oropharynx cancer treated on Study XXXX.Materials and MethodsPatients with N1-N3 oropharynx cancer and known p16 status who underwent treatment on Study XXXX were analyzed. Pathologic complete response rates in patients treated with a post-chemoradiation neck dissection (with p16-positive or p16-negative cancer) were compared by Fisher's exact test. Patients managed expectantly were compared to those treated with a neck dissection.ResultsNinety-nine of 292 (34%) of patients with node positive oropharynx cancer and known p16 status underwent a post-treatment neck dissection (p16-positive: n=69 and p16-negative: n=30). The remaining 193 patients with malignant lymphadenopathy at diagnosis were observed. Neck dissection was performed a median of 70 (range 17 - 169) days after completion of chemoradiation. Neither the pre-treatment nodal stage (p=0.71) nor the post-radiation, pre-neck dissection clinical/radiographic neck assessment (p=0.42) differed by p16 status.A pathologic complete response (pCR) was more common among p16-positive patients (78%) than p16-negative patients (53%, p=0.02) and was associated with a reduced incidence of local-regional failure (HR 0.33, p = 0.003). On multivariate analysis (MVA) of local-regional failure a test for interaction between pCR and p16 status was not significant (p = 0.37).One-hundred-ninety-three of 292 (66%) of initially node positive patients were managed without a post-treatment neck dissection. Development of a clinical CR was not significantly influenced by p16-status (p = 0.42). Observed patients with a clinical nodal CR had disease control outcomes similar to patients with a pCR neck dissection.ConclusionsPatients with p16-positive tumors had significantly higher complete pathologic response and locoregional control rates than those with p16-negative tumors.

Teaser

This second analysis of XXXX investigates the role of post-treatment neck dissection in the management of node positive oropharynx cancer managed with primary chemoradiation. Patients treated on protocol were imaged 6-8 weeks after the completion of chemoradiation and post-treatment neck dissection was recommended for those with advanced stage (N2-N3) at diagnosis. p16-positive tumors are significantly more likely to develop a complete pathologic response. Many patients were ultimately observed, without increased regional failure.


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Prognostic value of preoperative von Willebrand factor plasma levels in patients with Glioblastoma

Abstract

Circulating biomarker for malignant gliomas could improve both differential diagnosis and clinical management of brain tumor patients. Among all gliomas, glioblastoma (GBM) is considered the most hypervascularized tumor with activation of multiple proangiogenic signaling pathways that enhance tumor growth. To investigate whether preoperative antigen plasma level of von Willebrand Factor (VWF:Ag) might be possible marker for GBM onset, progression, and prognosis, we retrospectively examined 57 patients with histological diagnosis for GBM and 23 meningiomas (MNGs), benign intracranial expansive lesions, enrolled as controls. Blood samples were collected from all the patients before tumor resection. Plasma von Willebrand Factor (VWF):Ag levels were determined by using a latex particle-enhanced immunoturbidimetric assay. The median levels of vWF:Ag were significantly higher in GBMs than in meningiomas (MNGs) (183 vs. 133 IU/dL, P = 0.01). The cumulative 1-year survival was significantly shorter in patients with VWF:Ag levels >200 IU/dL than in those with levels <200 IU/dL and increased VWF levels were associated with a threefold higher risk of death in GBM patients. Our data suggest that VWF:Ag could be a circulating biomarker of disease malignancy, that could be considered, in association with other genetic and epigenetic factors, currently available in the GBM management. Future studies should investigate whether plasma VWF:Ag levels could also be used to monitor therapeutic effects and whether it may have a prognostic value.

Circulating biomarker for malignant glioblastoma could improve both differential diagnosis and clinical management of brain tumor patients. Plasma von Willebrand Factor (VWF):Ag levels were determined in 80 patients (57 glioblastoma and 23 meningiomas). The median levels of vWF:Ag were significantly higher in glioblastoma (GBMs) than in meningiomas (MNGs) and the cumulative 1-year survival was significantly shorter in patients with VWF:Ag levels >200 IU/dL than in those with levels <200 IU/dL and increased VWF levels were associated with a threefold higher risk of death in GBM patients. Our data suggest that VWF:Ag could be a circulating biomarker of disease malignancy, that could be considered, in association with other genetic and epigenetic factors, currently available in the GBM management.

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