Cone-beam-computed tomography evaluation of mandibular nutrient canals in patients with periodontal diseases.

Background and Aim: The aim of this study was to evaluate radiographically the prevalence of mandibular nutrient canals (NCs) in patients with/without periodontal bone loss with aging and to correlate the number of NCs with the severity of bone loss using cone-beam-computed tomography (CBCT). Patients and Methods: CBCT examinations of 208 patients were evaluated retrospectively of all patients, 114 had periodontal bone loss, whereas 94 patients were control subjects. Alveolar bone loss investigations were performed according to the Progressive Rate Index. Results: NCs were observed in 55% of the control group and 86% of the periodontitis patients. NCs were more prevalent in the elderly age group with periodontal bone loss. In the study group, the NCs were statistically more frequent than in the control subjects (P > 0.05). Conclusion: Statistical analysis showed a significant difference between the age groups and the prevalence of NCs increased in patients with periodontal alveolar bone loss with aging (P < 0.05).

Case of metastatic kaposi sarcoma successfully treated with anti-PD-1 immunotherapy.

INTRODUCTION: Kaposi sarcoma (KS) is an angioproliferative malignancy associated with HHV-8. It is mostly observed in patients affected by HIV and/or chronic immunosuppression, while classic KS without underlying immunosuppression are relatively rare. Systemic chemotherapy is used for advanced diseases, although there is no consensus in treatment algorithms. With the demonstration of PD-1 expression in KS, immune-checkpoint-inhibitors (ICI) emerged as possible treatment options. Notwithstanding, the data of ICIs is limited to case reports/series. Herein, we present a case of advanced classic KS, which has been treated successfully with nivolumab. CASE REPORT: 82-year-old male patient was investigated for erythematous lesions on thigh. Punch biopsy lead to KS diagnosis. Abdominal CT showed lymphadenopathies in the inguinal region. After radiotherapy follow-up, patient had shown vertebral & gastric metastases. Because of the PSA elevation patient was diagnosed with prostatic adenocarcinoma. Metastases were investigated for origin. The lesions showed no uptake in Ga-68 PET-CT, therefore accepted as KS metastases. Patient rejected chemotherapy options and consented to immunotherapy trial.Management and outcome: Nivolumab was initiated 3 mg/kg bi-weekly with 12-dose protocol. After nivolumab patient wellbeing is improved and control endoscopy shown no metastases. With these findings patient has been assessed as complete response. DISCUSSION: ICI on KS is still a blurred option to be included in standard regimens; but progressive understanding of PD-1 expression and its role in disease progression may be a milestone for further treatment algorithms on KS. Besides good efficacy, tolerability of ICIs could be helpful patients with comorbidities precluding the use of chemotherapy.

Nivolumab for the salvage treatment of desperate germ cell tumor: A case report.

INTRODUCTION: Testicular germ cell tumors (GCT) are the most common tumor in young men. Their distinctive feature is the exceptional response to platin based combination chemotherapy.Since the prognosis is poor in relapsed and refractory patients, the immune checkpoint inhibitors are candidate agents in these patients although clinical trials are mostly lacking. Herein, we describe a patient with a refractory nonseminomatous GCT using nivolumab as a last resort therapy and provided long term response without any significant toxicity. CASE REPORT: A 41-year-old male presented with the complaint of flank pain eleven years ago. The patient underwent a retroperitoneal lymph node excision and pathology reported as the mixed germ cell tumor. There were no mass in the testicles and the patient was diagnosed with a primary retroperitoneal GCT. Since the disease has progressed under multiple lines of chemotherapy and autologous stem cell transplantation, treatment was started with nivolumab. MANAGEMENT AND OUTCOME: The patient started to treatment with nivolumab 3 mg/kg two weekly as a last resort treatment. The nivolumab was continued and the patient's response to this treatment is ongoing and has been stable for 13 months. DISCUSSION: There are limited treatment options in platinum-refractory germ cell tumors. Recently, immune checkpoint inhibitors tried in this setting with some success in especially non-seminomatous GCTs. We see a good response and prolonged benefit with the use of nivolumab in our patient. Further research including prospective studies on the use of immune checkpoint inhibitors in platinum-resistant testicular cancer can further delineate the role of immunotherapy.

The effects of Desflurane and Sevoflurane on Nesfatin-1 levels in laparoscopic Cholecystectomy: a randomized controlled trial.

BACKGROUND: Nesfatin-1 is involved in cardiovascular regulation, stress-related responses. The objective of this study is to investigate the impact of volatile anesthetics on Nesfatin-1 levels. METHOD: Fourty-two patients aged 30-65 years with the American Society Anesthesiology (ASA) Class I-II who were scheduled for laparoscopic cholecystectomy were included in the study Patients were randomized into two group; desflurane administered group (Group I, n = 21) and sevoflurane administered group (Group II, n = 21). For anesthesia maintenance, the patients received 6% desflurane or 2% sevoflurane in 40% O2 and 60% air. The patient's heart rate (HR), mean, systolic and diastolic arterial pressures (MAP, SAP, DAP), peripheral O2 saturation (SpO2) were monitored and recorded before induction, after induction, after intubation, and during extubation. Blood samples were collected before induction (T1), and after extubation when aldrete score was 10 (T2). RESULTS: Demographic data were similar between the groups. The preoperative levels of nesfatin were similar in the two groups (p = 0.715). In desflurane group, post-operative nesfatin levels were similar compared to preoperative levels (p = 0.073). In sevoflurane group, post-operative nesfatin levels were similar (p = 0.131). The nesfatin levels (postoperative vs preoperative) were similar between the groups (p = 0.900). CONCLUSION: In conclusion, this study results suggest that nesfatin-1 levels are not affected by the use of sevoflurane or desflurane in patients undergoing laparoscopic cholecystectomy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617001023347 , retrospectively registered on 17 July 2017.

Apical extrusion of debris in primary molar root canals using mechanical and manual systems.

AIM: Apical extrusion of debris in primary root canal treatment has not been well elucidated. The purpose of this study is to compare the amount of apically extruded debris during the preparation of primary molar root canals using ProTaper, ProTaper Next, Self-adjusting File (SAF) and hand files. MATERIALS AND METHODS: One hundred sixty extracted primary mandibular molar teeth were assigned to 2 groups: Group 1: Resorbed (n=80) and Group 2: Non-resorbed (n=80) and randomly to four subgroups (n=20 teeth for each subgroup) according to the instruments used, ProTaper, ProTaper Next, SAF, and hand file. The apically extruded debris was collected and dried in preweighed Eppendof tubes. The dry weight was calculated by subtracting the preoperative weight from the postoperative weight. STATISTICS: Data were analysed statistically using the ANOVA and the Bonferroni post hoc t-test. RESULTS: The amount of apically extruded debris was significantly less for the non-resorbed group compared to the resorbed group (P<0.05). Regardless of the resorption groups, ProTaper Next and SAF extruded significantly less debris than did the ProTaper and hand files (P<0.05), while no statistically significant difference was found between ProTaper Next and SAF (P>0.05). CONCLUSION: All instruments caused apically extruded debris in primary teeth.

The Role of Diffusion-Weighted Magnetic Resonance Imaging in the Differential Diagnosis of Simple and Hydatid Cysts of the Liver.

INTRODUCTION: The present study indicates that simple and hydatid cysts in liver are a common health problem in Turkey. The aim of the study is to differentiate different types of hydatid cysts from simple cysts by using diffusion-weighted images. MATERIALS AND METHODS: In total, 37 hydatid cysts and 36 simple cysts in the liver were diagnosed. We retrospectively reviewed the medical records of the patients who had both ultrasonography and magnetic resonance imaging. We measured apparent diffusion coefficient (ADC) values of all the cysts and then compared the findings. RESULTS: There was no statistically meaningful difference between the ADC values of simple cysts and type 1 hydatid cysts. However, for the other types of hydatid cysts, it is possible to differentiate hydatid cysts from simple cysts using the ADC values. CONCLUSION: Although in our study we cannot differentiate between type I hydatid cysts and simple cysts in the liver, diffusion-weighted images are very useful to differentiate different types of hydatid cysts from simple cysts using the ADC values.

Comparison of elasticity values of the right lobe of the liver of normal weight and morbidly obese Turkish patients.

INTRODUCTION: Shear wave elastography is a method for the measurement of tissue stiffness. The advantage of this method is that its outcome is not operator dependent. Our aim was to compare the elastiscity values of the right lobe of the liver of normal weighted and morbidly obese patients. MATERIALS AND METHODS: The mean elastiscity values of the right lobe of the liver were calculated for 38 normal weighted and 37 morbidly obese patients. All the patients had no history of liver disease. RESULTS: The mean elastiscity value was significantly higher in morbidly obese patients than (25,7 +3,30 kPascal) in normal weighted patients for the right lobe of liver (10,55 +2,20 kPascal). CONCLUSION: Morbidly obese patients have a potential risk for liver fibrosis even in the absence of hepatosteatosis.

The evaluation of the angles of Eustachian tubes in the patients with chronic otitis media on the temporal computerized tomography.

INTRODUCTION: Chronic otitis media (COM), affecting all over the world and in a wide range of age groups in Turkey, is an important cause of ear discharge and hearing loss. The main clinical manifestations are tympanic membrane perforation, ear, nose and throat problems. On the tympanic membrane perforation becomes persistent and cholesteatoma development, there are a lot of opinions today. Especially in the pathology associated with otitis media with effusion eustachian tube, it is known that COM and cholesteatoma develop. MATERIALS AND METHODS: In our study, we interpreted 210 patients' temporal computed tomography (CT). Seventy of these 210 patients had otitis media with cholesteatoma, 70 patients had only otitis media without cholesteatoma, and 70 patients had no otitis media. The eustachian tubes were evaluated using temporal CT multiplanar reconstruction method. Angles with the horizontal plane of the eustachian tube and Reid and tubotympanic angles were measured. RESULTS: The angles between eustachian tube and horizontally oriented Reid plane of the patients with cholesteatoma were found to be significantly lower than the patients with otitis media without cholesteatoma and the patients with no history of otitis media. For the tubotympanic angle, no statistically significant differences were observed between the groups. CONCLUSION: These results suggest that the decrease in the angle with the horizontal plane of Reid in the eustachian tube in adults may play a significant role in the etiology of cholesteatoma.

Renal papillary attenuation differences between primary and recurrent idiopathic calcium stone disease patients.

AIM: The aim of this paper was to investigate whether renal papillae of patients with nephrolithiasis are more radiodense than that of control patients and to evaluate the predictability of urolithiasis using papillary density differences between stone and non-stone formers. METHODS: Renal papillary Hounsfield Unit (HU) measurements were conducted at the level of upper pole, middle region and lower pole of both kidneys in a total of 126 primary (group 1), 133 recurrent (group 2) stone disease patients and 108 controls (group 3). RESULT: Mean patient age did not differ significantly between groups (P>0.05). Mean stone diameters (±SD) were 5.0±3.1 mm (3-9 mm) and 6.1±3.3 mm (3-15 mm) for primary and recurrent groups, respectively and group distributions and variances were similar (P>0.05). Mean papillary attenuation values (±SD) were 27.26±9.30 (4.00-56.00) in group 1, 30.42±9.88 (12.00-64.00) in group 2 and 25.83±2.72 (20.30-32.56) in the control group. The difference between the mean papillary attenuation value of the primary stone disease group and the control group was statistically insignificant (P=0.104). When the control group and the recurrent stone group was compared without variances, in terms of the mean renal papillary attenuation value, a statistical significance was achieved (P=0.000). CONCLUSION: With increasing renal papillary HU values, the risk of recurrent calcium stone disease is increased.

Traumatic dental injuries in children. Experience of a hospital in the central Anatolia region of Turkey.

AIM: The purpose of this retrospective study was to identify traumatic dental injuries by using the documentations of children (range 0-14 years, average age: 10.79±2.06) with dental trauma who referred to Cumhuriyet University, Faculty of Dentistry, Department of Pedodontics, in Sivas, Turkey, between January 2007 and June 2012. MATERIALS AND METHODS: A total of 591 children (356 boys and 235 girls) with 1,287 injured teeth (394 primary and 893 permanent teeth) were included in the study. The children were evaluated in terms of gender, age, number of injured teeth, type of trauma, the interval between the traumatic event and time of seeking, and treatment procedures. RESULTS: The highest frequency of trauma occurred in the 12-14 year age group (14%). The most common type of injury was enamel-dentin fractures (58%) in primary teeth and complicated crown fractures (39%) in permanent teeth. Falls (30%) were the major cause of dental injury. Direct restoration (27%) without any endodontic treatment was the most common treatment procedure for permanent teeth. The most frequent treatment for primary teeth was examination and follow-up (42%). The upper central incisors (71%) were the mostly affected teeth in both primary and permanent teeth. Most dental trauma occurred in June and July (12%-8%). Only 63 children (11%) were referred to the clinic less than 30 minutes after trauma. CONCLUSION: Traumatic dental injury is considered a serious public health problems especially in children; parents and teachers should be informed on prevention and emergency management of traumatic dental injuries. In addition, the findings showed that initial treatment after dental trauma should be as quick as possible.

Case report: multiple keratocystic odontogenic tumour in a non-syndromal pediatric patient.

BACKGROUND: Keratocystic odontogenic tumour (KCOT) is an odontogenic tumour which stems from the odontogenic organs mostly localised in the lower jaw, particularly posterior body and ascending ramus of the mandible. The majority of these tumours are single lesions. When detected in the jaw in multiple forms, these cysts are seen in association with Gorlin Goltz/Basal cell naevus syndrome. However a few cases of non-syndromal multiple keratocystic odontogenic tumour have been reported in the literature. CASE REPORT: We report a case of multiple keratocystic odontogenic tumour in a 13-year-old girl demonstrated by panoramic radiography and cone beam computed tomography (CBCT). The differential diagnosis, treatment and imaging modalities are also discussed.

In vitro antifungal susceptibility of the dermatophytes: a single center study from Eastern Black Sea Region of Turkey.

OBJECTIVE: A large number of patients applying to the dermatology clinics are affected by fungal diseases, and a significant portion of which are superficial fungal infections. Dermatophyte infections are a notable public health concern and frequently encountered in clinical practice. Dermatophytosis not only compromises the quality of life but also predisposes individuals to various comorbidities due to its role as a gateway for secondary bacterial agents. This study aims to determine the species distribution of dermatophytes prevalent and assess their susceptibility to antifungal drugs. PATIENTS AND METHODS: Skin, nail, and hair samples were obtained from patients with a clinical diagnosis of dermatophytosis. Samples were all cultured to isolate and identify the species. In vitro liquid microdilution tests were conducted to assess the susceptibility of the isolated strains against terbinafine, fluconazole, griseofulvin, and butenafine. RESULTS: A total of 353 samples were obtained from the hair, skin, and nail lesions of 326 patients. Dermatophyte was isolated in 71 of the samples (20.1%). The cultured dermatophyte subtypes included Trichophyton rubrum (13.8% in 49 samples), Microsporum audouini (5.7% in 20 samples), and Trichophyton mentagrophytes (0.6% in 2 samples). Antifungal susceptibility testing revealed that terbinafine was the most effective antifungal drug against all dermatophyte species, while fluconazole exhibited the highest resistance. CONCLUSIONS: The most common dermatophytosis agent in our region is T. rubrum. The least antifungal resistance was found against terbinafine. Conducting antifungal susceptibility tests is crucial for selecting effective treatment regimens and early detection of resistance development.

Prognostic analysis of patients with operable gastric cancer and tolerability to adjuvant radio-chemo-therapy.

The aim of this study is to evaluate the tolerability and toxicity of adjuvant chemoradiotherapy (CRT) and to analyze the prognosis in patients with operable gastric cancer. The retrospective analysis included 723 patients with operable gastric cancer; stage IB-IV (M0), received adjuvant CRT from 8 Medical Centers in Turkey between 2003 and 2010. The patients' age, sex, tumor localization, Lauren classification, grade and stage of the disease, type of dissection, the toxicity and tolerability status and survival rate were analyzed. All patients were divided into two groups as tolerable group to adjuvant CRT and intolerable group to adjuvant CRT .Among the patient, 73.9% had stage III-IVM0 disease; 61.0% had the intestinal type of gastric cancer, 51.1% had the distal type, and 61.4% had undergone D2 dissections. The number of patients who completed the entire course of the adjuvant CRT was 545 (75.4%).The median follow-up period was 20.8 months (range: 1.5-107 months). Overall Survival (OS) rates were 80% and 52%, while the relapse free survival (RFS) rates were 75% and 48% at 1 and 3 years, respectively.In the univariate analysis of the groups based on the the age defined as <65 or ≥ 65 (p=0.16 / p=0.003), Lauren classification (p=0.004 / p<0.001), localization of tumor (p=0.02 / p=0.04), tumor grade (p=0.06 / p=0.003), disease stage (p<0.001 / p<0.001), type of dissection (p=0.445 / p=0.043), presence or absence of toxicity (p=0.062 / p=0.077) and tolerability of the therapy (p=0.002 / p=0.001). In the cox regression analysis, tumor stage (Hazard Ratio (HR): 0.332; 95% confidence interval (CI): 0.195-0.566; p<0.001), and tolerability (HR: 0.516; 95% CI: 0.305-0.872; p=0.014), were found to be related with the OS. Tumor stage (HR: 0.318; 95% CI: 0.190-0.533; p=<0.001) and tolerability (HR: 0.604; 95% CI: 0.367-0.995; p=0.048) were observed to be statistically significant in terms of the RFS.We have observed that whether a patient can or cannot tolerate adjuvant CRT due to its toxicity is an independent prognostic factor besides the known prognostic factors like tumor stage and Lauren classification. We are of the opinion that the treatment of patients who cannot tolerate adjuvant CRT should be replaced with less toxic adjuvant therapies.

Evaluation of the renal function using cystatin C level in the patients receiving cisplatin-based chemotherapy.

OBJECTIVE: There are some data regarding the role of cystatin C, a cysteine proteinase inhibitor, in determining the glomerular filtration rate (GFR) more accurately. We aimed to evaluate the correlation of serum cystatin C levels with the serum creatinine levels and GFR calculated by Cockcroft-Gault and modification of diet in renal disease (MDRD) formulations in the patients who received cisplatin-based chemotherapy. We also intended to demonstrate its potential use in the early prediction of the renal function changes in these patients. MATERIALS AND METHODS: In the study, 34 patients receiving cisplatin-based chemotherapy with various malignancies were included. The levels of cisplatin were determined prior to the chemotherapy and at the end of cisplatin infusion during the therapy. GFR was calculated by Cockcroft-Gault and MDRD formulations prior to the therapy and at the end of the third course. RESULTS: A statistically significant linear correlation was found between the serum levels of cystatin C and creatinine prior to the chemotherapy (r = 0.42, p = 0.013). However, there was no correlation among the level of cystatin C subsequent to the cisplatin infusion and serum creatinine level following the third course and MDRD and creatinine clearance-Cockcroft-Gault formulations. CONCLUSION: Even though the serum cystatin C levels were correlated with the serum creatinine levels in our study, it was concluded that it was not an appropriate parameter to predict the potential impairments in the renal function during the chemotherapy.

Evaluation of articular eminence pneumatization using cone beam computed tomography.

AIM: Knowledge about the anatomy of the temporomandibular joint (TMJ) and its surrounding structures is mandatory for success in surgical interventions and for understanding the pathway of spread of infections in this region. This study aims to investigate the anatomy and morphology of pneumatized articular eminence (PAT) using cone beam computed tomography (CBCT) imaging in a group of patients. METHODS: A retrospective study on 825 patients (377 males, 448 females) aged between 18 and 91 years was performed using sagittal and coronal CBCT images. PAT was defined as non-expansile, nondestructive cyst-like radiolucency in the zygomatic process of the temporal bone, which appears similar to the mastoid air cells. It was classified in two groups as unilocular and multilocular. Statistical comparison of gender, age and localization was performed using chi-square test and correspondence analysis. P<0.05 was considered as significant. RESULTS: Twenty-eight pneumatized articular eminence were found in 21 patients, representing a prevalence of 2.54%. Patients with PAT had a mean age of 28.9 years with a range of 21-78 years. Ten cases (47.6%) occurred in females and 11 cases (52.4%) occurred in males. The results of statistical tests showed no significant differences among the groups with respect to gender, age, and localization (P>0.05). CONCLUSION: Pneumatization of the articular eminence is a challenging entity for TMJ surgery and spread of infections in this region. Practitioners who are dealing with TMJ surgery and pathology should have detailed information about this anatomical variation since it may cause serious complications.

Comparative efficacy study of 5-year letrozole or anastrozole in postmenopausal hormone receptor-positive early breast cancer.

PURPOSE: To compare the efficacy of adjuvant anastrozole and letrozole in hormone receptor-positive postmenopausal patients with early breast cancer. METHODS: A total of 569 hormone receptor-positive postmenopausal early breast cancer patients were included and analyzed in this study. Of them 238 were taking adjuvant anastrozole and 331 adjuvant letrozole. Demographic and medical data including age, menopausal status, weight, height, treatment history and comorbid diseases were collected from their medical charts. RESULTS: In both anastrozole and letrozole users, the baseline clinicopathologic characteristics and the treatment history with radiotherapy and chemotherapy were similar. The median patient follow-up was 26.4 months. In the anastrozole arm disease free survival (DFS) was 94.9, 81.3 and 66.0%, whereas in the letrozole arm DFS was 90.6, 78.7 and 68.5% in the first, third and fifth years, respectively (p=0.25). Median overall survival (OS) could not be reached due to the low number of events in both arms. Three-year survival rate in the anastrozole arm was 98.8%, whereas in the letrozole arm it was 96.7% (p = 0.20). CONCLUSION: This study showed that both letrozole and anastrozole have similar effects on DFS and OS in the adjuvant hormonal treatment of postmenopausal hormone receptor-positive breast cancer. We believe that this retrospective study is the first to directly compare the efficacy of letrozole and anastrozole.

Impact of the obesity on lymph node status in operable breast cancer patients.

PURPOSE: Although many studies have shown association of obesity and tumor size, the association with the lymph node status is not clear. We examined the relationship of the lymph node status and obesity and other possible factors in early breast cancer patients. METHODS: In this retrospective cohort study, 1295 breast cancer patients who had axillary dissection were included. Patients were grouped according to their body mass index (BMI) values at the time of diagnosis. We analyzed the relationship between BMI and patient and tumor characteristics, especially lymph node status. RESULTS: The median patient age was 48 years (range 20- 84). Of the patients 69.6% had modified radical mastectomy and the remaining 30.4% had breast-conserving surgery and axillary dissection. Median BMI of the patients was 27.2 kg/m(2) and 33.1% (N-429) of them had normal BMI, 36% (N-471) were overweight and 30.5% (N=395) were obese at the time of the diagnosis. Of the patients, 44.2% had N0 disease, and 55.8% had lymph node metastasis. N1 disease had 28.3% (N=367), 13.8% (N=179) had N2 and 13.7% (N=177) had N3 disease. When patients were classified as normal (≤24.9 kg/m(2)) and obese (>24.9 kg/m(2)) group, the total number of lymph nodes removed was higher in the obese group and this difference was statistically significant (18.12±10.48 and 20.36±11.37, respectively, p= 0.001). There was strong correlation between the number of the dissected lymph nodes and BMI (r=0.11; p<0.001). However, there was no statistically significant correlation between the number of metastatic lymph nodes and BMI. The mean number of the dissected and involved lymph nodes was higher in the HER2 positive group compared to the negative ones (21 vs 19, p=0.008; 6 vs 3, p<0.001; respectively) CONCLUSION: The number of the dissected lymph nodes was slightly higher in obese patients but there was no correlation between metastatic lymph node number and BMI. The number of the dissected and involved lymph nodes was higher in the HER2 positive group.

Capecitabine/cisplatin doublet in anthracycline and taxane pretreated and HER-2 negative metastatic breast carcinoma patients.

PURPOSE: To evaluate the activity and toxicity of the combination of capecitabine and cisplatin (CapCisp) in anthracycline- and taxane-pretreated HER-2 negative metastatic breast carcinoma (MBC) female patients. METHODS: Patients with HER-2 negative MBC pretreated with anthracycline and taxane and who were then treated with CapCisp combination were retrospectively evaluated. All patients received Cap 1000 mg/m(2) on days 1-14, and Cisp 60 mg/m(2) on day 1, repeated every 3 weeks. In case of disease control without severe toxicity, single agent Cap was continued until progression or unacceptable toxicities after Cisp cessation. RESULTS: Sixty-four MBC patients with median age 43 years (range 20-66) were included the study. Infiltrative ductal carcinoma prevailed (85.9%). Ten percent of the patients had grade I, 42% grade II, and 48.0% grade III tumors. Estrogen receptor (ER) and progesterone receptor (PR) were positive in 48.4 and 51.6% of the patients, respectively. Twenty-eight percent of the patients had triple negative tumors. Almost the entire patient group had this regimen as a third-line treatment. The median combination chemotherapy cycles were 6 (range 2-8). Twenty-seven non-progressive patients continued treatment with single-agent Cap. Median single-agent Cap cycles after the combination chemotherapy were 4 (range 1-38). Disease control rate was 81.3% (complete response 6.3%; partial response 48.4%, stable disease 26.6%, progressive disease 18.8%). Median follow-up time was 10.6 months. Median time to disease progression was 7 months, median overall survival (OS) was 17 months (95% CI, 6.9-16.1) measured from the start of CapCisp chemotherapy. There were no treatment-related deaths. The most frequent grade 3-4 toxicities were neutropenia (8.1%), nausea - vomiting (7.8%) and thrombocytopenia (6.3%). CONCLUSION: CapCisp doublet has an encouraging antitumor activity with acceptable and manageable toxicity in anthracycline- and taxane-pretreated HER-2 negative metastatic breast carcinoma patients.

Duration of anti-HER2 blockage therapy may improve survival in HER2 positive metastatic breast carcinoma patients.

PURPOSE: The duration of anti-HER2 blockage therapy in metastatic breast cancer patients is still unclear. We aimed to evaluate the effect of the anti-HER2 blockage therapy duration and other factors on survival in HER2 positive metastatic breast carcinoma (MBC) patients. METHODS: The medical records of 193 HER2 positive MBC patients, who did not have the opportunity to receive adjuvant trastuzumab therapy but had received trastuzumab in the metastatic setting were retrospectively evaluated. RESULTS: The median age at diagnosis was 45.0 years (range 21-83). Ninety-two (47.7%) patients received palliative trastuzumab < 6 months median, whereas 101 patients received trastuzumab ≥ 6 months median. The median number of trastuzumab cycles was 8 (range 1-51). Median survival after breast cancer recurrence was 31.0 months (range 24.3-37.7). The duration of trastuzumab therapy had a significant impact on the prognosis of recurrent breast cancer (22.0 vs 49.0 months, for ≤ 6 months of treatment duration, respectively; p<0.0001). Survival after breast cancer recurrence for the patients who received lapatinib plus capecitabine vs those who did not was significantly different (59 patients, p=0.005). Moreover, there was a statistically significant relationship between prolonged lapatinib plus capecitabine combination therapy and improved survival after disease recurrence (p=0.022). In the multivariate Cox regression analysis, treatment with trastuzumab > 6 months (p=0.003) was the only independent prognostic factor for survival after breast cancer recurrence. CONCLUSION: The duration of anti-HER2 blockage therapies, especially with trastuzumab, seems to improve survival of HER2-positive metastatic breast cancer patients who were not previously treated with adjuvant trastuzumab, regardless of other therapies.

Variations in tumor marker levels in metastatic breast cancer patients according to tumor subtypes.

PURPOSE: To investigate whether serum CA 15-3 and CEA levels show differences among subgroups of breast cancer patients at the time of diagnosis of early-stage disease and at disease relapse. METHODS: Patients with metastatic breast cancer diagnosed from 2000 to 2010 were retrospectively analyzed. Data were obtained from medical charts. CA 15-3 and CEA levels of patients with metastatic disease at the time of diagnosis or who relapsed during follow-up were evaluated. Four different breast cancer subtypes were defined: estrogen receptor (ER) and/or progesterone receptor (PR) positive and HER-2 negative (luminal A), ER and/or PR positive and HER-2 positive (luminal B), ER and PR negative and HER-2 positive (HER-2 overexpressing) and triple negative (ER, PR and HER-2 negative). Fifty-eight (13.7%) of the patients were metastatic at the time of diagnosis. RESULTS: 423 metastatic breast cancer patients were included. Of the patients, 232 (54.8%) had luminal A disease, 70 (16.5%) luminal B, 53 (12.5%) HER-2 overexpressing, and 68 (16.1%) triple negative disease. Preoperative CA 15-3 levels were raised in 48.1% of the luminal A group, in 42.8% of the luminal B group, in 26.0% of the HER-2 overexpressing group, and in 33.3% of the triple negative group. CA 15-3 levels after relapse were raised in 44.5% of the luminal A group, in 33.3% of the luminal B, in 28.9% of the HER-2 overexpressing, and in 38.8% of the triple negative group. Preoperative CEA levels were elevated in 44.3% of the luminal A group, in 28.5% of the luminal B, in 43.4% of the HER-2 overexpressing, and in 14.3% of the triple negative group. CEA levels after relapse were raised in 60.8%, 54.7%, 51.1%, and 36.0% of the patients in the 4 subgroups, respectively. CONCLUSION: This study showed that there are differences between the breast cancer subgroups in terms of tumor marker levels in metastatic breast cancer patients. Tumor marker elevation was lower in the triple negative group as compared to the luminal groups. Monitoring CEA levels in luminal A group may be beneficial in determining early relapses. However, this retrospective study requires further prospective confirmative cohort studies.