Phase II clinical trial of sorafenib in metastatic medullary thyroid cancer.

PURPOSE: Mutations in the RET proto-oncogene and vascular endothelial growth factor receptor (VEGFR) activity are critical in the pathogenesis of medullary thyroid cancer (MTC). Sorafenib, a multikinase inhibitor targeting Ret and VEGFR, showed antitumor activity in preclinical studies of MTC. PATIENTS AND METHODS: In this phase II trial of sorafenib in patients with advanced MTC, the primary end point was objective response. Secondary end points included toxicity assessment and response correlation with tumor markers, functional imaging, and RET mutations. Using a two-stage design, 16 or 25 patients were to be enrolled onto arms A (hereditary) and B (sporadic). Patients received sorafenib 400 mg orally twice daily. RESULTS: Of 16 patients treated in arm B, one achieved partial response (PR; 6.3%; 95% CI, 0.2% to 30.2%), 14 had stable disease (SD; 87.5%; 95% CI, 61.7% to 99.5%), and one was nonevaluable. In a post hoc analysis of 10 arm B patients with progressive disease (PD) before study, one patient had PR of 21+ months, four patients had SD >or= 15 months, four patients had SD

[A case of recurrent breast cancer with carcinomatous pleurisy successfully treated with combined chemoendocrine-therapy of CTF (CPA, THP and 5-FU) and anastrozole following instillation therapy 12 years after radical mastectomy].

A 52-year-old female underwent radical mastectomy at the age of 41 for left breast cancer (n0, positive for ER). After a few years of adjuvant TAM therapy, follow-up was stopped at the age of 50 with no recurrence. She had suffered from symptoms of cold since January 2001 and came to our hospital complaining dyspnea on February 11. CXP showed pleural effusion of the entire thoracic cavity and she was admitted to the hospital immediately. Pleural exudate cytodiagnosis showed carcinomatous pleurisy; however, dyspnea and thoracic effusion were improved by continuous thoracic drainage and instillation therapy. Various examinations demonstrated that the carcinomatous pleurisy was due to recurrent breast cancer. They also showed local recurrence, left supraclavicular lymph node metastasis and multiple bone metastasis. Thus, combined chemoendocrine-therapy of CTF (CPA, THP and 5-FU) and anastrozole was administered. After 6 cycles of CTF, the carcinomatous pleurisy, local recurrence and left supraclavicular lymph node metastasis were diagnosed as CR by CXP, chest CT and US and multiple bone metastasis were diagnosed as PR by bone scintigram. The patient continues to be treated on an outpatient basis with no recurrence about one year after the beginning of the treatment (6 months after CTF 6 cycles) and she is taking anastrozole continuously.

Pegylated liposomal doxorubicin in combination with hyperthermia for treatment of skin metastases of breast carcinoma: a case report.

BACKGROUND: Incorporation of doxorubicin hydrochloride into pegylated liposomes (PLD) may decrease chemotherapy side effects and increase the activity. Hyperthermia could further potentiate its effectiveness. CASE REPORT: A patient with skin metastases of breast carcinoma was treated with intravenous infusion of PLD (Caelyx) in combination with ultrasound hyperthermia. Each cycle consisted of infusion of 40 mg PLD absolute dose, followed by 2 fractions of hyperthermia 41-43 degrees C for 45 min 1 and 48 h after infusion. A complete remission was observed after the combination treatment with no significant toxicity. CONCLUSION: Present observations suggest that the combination of PLD with hyperthermia of skin metastases of breast carcinoma may be an active and well tolerated treatment.

[Treatment of a thyroid neoplasm infiltrating the respiratory-digestive tracts]. / Leczenie raka tarczycy naciekajacego droge oddechowo-pokarmowa.

From 1992 to 1999, 58 thyroid gland operations (41 female and 17 male) were performed in ENT Department of the District Hospital in Rzeszów. In 14 (21.4%) cases (9 female and 5 male) thyroid surgery was done for malignant disorders: papillary carcinoma in 11 (79%) patients, follicular carcinoma in 2 patients and medullary carcinoma in 1 patient. There were neck metastases in 9/14 (64.4%) patients. In 3 cases with papillary carcinoma (all with neck metastases) aerodigestive tract was invaded. One patient had neoplasmatic invasion of the larynx and trachea, one patient had invasion of larynx et pharynx and in one patient tumour invaded the esophageal wall. In those patients radical surgery was done: total thyroidectomy with total laryngectomy and radical neck dissection (2 patients) and subtotal thyroidectomy with conservative neck dissection (1 patient). External beam irradiation and radioactive iodine 131 treatment followed surgery. Two patients are still alive 6 years after the treatment free of disease, and 1 patient died of unrelated causes 3 months after the surgery. Symptoms, diagnostic evaluation and treatment of thyroid papillary carcinoma invading the aerodigestive tract are detailed in paper.

[Early evaluation of results after total thyroidectomy in patients with thyroid cancer]. / Wczesna ocena wyników pierwotnego calkowitego wyciecia gruczolu tarczowego u chorych na raka tarczycy.

UNLABELLED: 219 patients (159 females, 60 males) operated in Clinic of Oncological Surgery in Gliwice between 1995 and 1999 were analyzed in this study. In 89% of cases differentiated thyroid carcinoma (DTC) was diagnosed. In other patients medullary cancer (8%) and anaplastic one (3%) were diagnosed. Total thyroidectomy with removal of the central cervical lymph nodes compartment was performed in all cases. In 86% of operations bilateral nodal biopsy was done. In 27% of cases modified cervical lymph node dissection was performed. 44 patients were in T4 stage. In 51% of cases cervical nodal metastases were observed. The operation was estimated as radical in 195 patients. Distant metastases occurred in 15 patients. Bilateral paresis of recurrent laryngeal nerve was not observed, unilateral was noticed in 8.7% of cases, permanent hypoparathyroidism appeared in 15% of patients. In postoperative scintigraphy radioiodine uptake was in the range of 0-10% in 206 cases and in the range of 0-3% in 2/3 of operated patients. 125 patients with DTC were treated with 131I. All patients with DTC were administered L-thyroxine to suppress TSH. In other types of cancer substitutive hormone therapy was introduced. In the entire group 8 deaths occurred and 13 cases of local recurrences were observed during the observation. CONCLUSION: The results prove the high effectiveness of the radical thyroidectomy performed in thyroid cancer.

Percutaneous dilatational tracheostomy in a patient with thyroid cancer and severe airway obstruction.

A patient with extensive metastatic thyroid cancer scheduled for palliative tracheostomy is presented. He had laryngeal dislocation with severe airway obstruction and few anatomical landmarks due to tumour infiltration and radiation. Successful percutaneous dilatational tracheostomy was performed under local anaesthesia.

Management of the neck in thyroid cancer.

The incidence of nodal metastasis in differentiated thyroid cancer ranges between 40% to 75%. Elective neck dissection is generally not advised in patients with differentiated thyroid cancer; however, if clinically apparent nodal disease is noted in the tracheoesophageal groove during surgery, central compartment clearance is advised. If clinically apparent nodal disease is present in the lateral compartment of the neck, modified neck dissection preserving the sternomastoid, accessory nerve, and jugular vein is advised. The "berry picking procedure" is generally not recommended because of the higher incidence of regional recurrence. Due consideration should be given for parathyroidal transplantation if the blood supply to the parathyroids is damaged during central compartment clearance. The incidence of lymph node metastasis is highest in young patients, however, lymph node metastasis has no bearing on long-term survival. There seems to be a higher incidence of regional recurrence in elderly individuals. If patients present with bulky nodal disease, consideration may be given for postoperative radioactive iodine dosimetry and ablation if necessary. Differentiated thyroid cancer represents a unique disease in the human body, where lymph node metastasis has no prognostic implication. Aggressive surgical clearance is advised in patients with medullary thyroid cancer in the central compartment and the jugular chain lymph nodes.

[A clinical report of high-dose epirubicin combined with cyclophosphamide and fluorouracil for advanced breast cancer].

OBJECTIVE: To evaluate safety and efficacy of high-dose epirubicin combined with cyclophosphamide and fluorouracil for advanced breast cancer. METHODS: Thirty two cases with stage III and IV breast cancer were treated with epirubicin (EPI) 90-110 mg/m2, cyclophosphamide (CTX) 600 mg/m2 and 5-fluorouracil (5-Fu) 900 mg/m2 every 21 days. The therapeutic effect was compared with that in patients treated with low-dose EPI(50 mg/m2). RESULTS: The response rate (RR) in patients treated with high-dose EPI was 71.9% (CR = 4, PR = 19) which was significantly better than that in the low-dose EPI-treated patients (CR = 2, PR = 5). The therapeutic effect was slightly better in patients initially diagnosed than in patients in recurrence (RR: 80% vs 68.2%) the median remission and surriving peroid was 7.4 months and 12.5 months, respectively. The major side effect was leukopenia. Mild to moderate GI tract side effects were obsevved. There was no significant cardiotoxicity. CONCLUSION: High-dose EPI combined with CTX, 5-Fu is a safe and effective regimen for patients with advanced breast cancer worthy of further clinical trial.