Brain metastasis of hepatocellular carcinoma- single center experience.

BACKGROUND: Although the most common intracranial neoplasm in the adult population is metastatic tumors, brain metastasis from hepatocellular carcnoma (HCC) are very rare. The aim of this study is to analyze patients with advanced HCC, in order to determine the incidence of brain metastasis and evaluate the clinicopathologic properties. METHODS: The records of HCC patients treated in our university between 2011 and 2019 were reviewed retrospectively. Patient characteristics, symptoms, laboratory data, treatment modalities, and survival after both the diagnosis of HCC and detection of brain metastasis were recorded. RESULTS: Of the 119 hepatocellular carcinoma patients, 34 had metastasis, 8 of which were to the brain. The median time elapsed between the diagnosis of HCC and brain metastasis was 14.6 months and the median overall survival after the detection of brain metastasis was 1.6 months. In 34 patients with metastasis, median survival was 26.2 months for those without brain metastasis, whereas it was 15.8 months for those with brain metastasis (P = 0.460). The survival times after brain metastasis were 11.6 and 3.9 months for the two patients treated with regorafenib and sorafenib after the detection of brain metastasis, respectively. CONCLUSION: In this study, it was found that patients who were clinically eligible to receive tyrosine kinase inhibitors survived longer after the detection of brain metastasis. Our study shows that multidisciplinary evaluation of these patients is vital for treatment guidance, and survival outcomes can be improved with the advancements in surgical and radiotherapy techniques even in patients with poor prognosis.

Survival in recurrent ovarian cancer patients before and after the bevacizumab era: an observational single-centre study.

A retrospective observational study was carried out in Baskent University School of Medicine, Ankara, Turkey. Recurrent ovarian cancer patients treated between 2007 and 2017 were divided into two groups according to their bevacizumab status. The primary endpoints were overall survival (OS) and safety. Three hundred and ninety-six patients enrolled in this study, 200 (50.5%) received bevacizumab while 196 (49.5%) patients never received bevacizumab. The median follow-up time was 48.2 and 47.6 months, respectively. The 5-year OS was 61% and 46%, respectively (p=.007). In multivariate analysis, only platinum-sensitivity (HR: 3.75, 95% CI: 3.0-5.32; p<.001) was identified as independent prognostic factors. In subgroup analyses according to platinum status, bevacizumab did not affect the 5 year OS in platinum sensitive patients (64% versus 68% p=.28) but increased survival in platinum resistant patients (36% versus 44%, p=.00). The rate of grade III-IV haematologic toxicities was 13.7% in the bevacizumab group and 11% in the other group (p=.6).Impact StatementWhat is already known on this subject? Bevacizumab increases the progression-free survival in platinum-sensitive and resistant recurrent ovarian cancer patients without changing overall survival.What do the results of this study add? Bevacizumab did not affect OS in platinum sensitive recurrent ovarian cancer patients however improved OS in platinum resistant patients with mild toxicity.What are the implications of these findings for clinical practice and/or further research? This study emphasised the crucial role of bevacizumab in the treatment of recurrent ovarian cancer patients.

Vismodegib Experience in a Renal Transplant Patient With Basal Cell Carcinoma.

The hedgehog inhibitor vismodegib has been tested and suggested as an effective treatment option for cases of locally advanced or metastatic basal cell carcinoma. A 58-year-old female renal transplant patient with recurrent, inoperable basal-cell carcinoma that originated from nasal skin was evaluated by the transplantation counsel. After a multidisciplinary evaluation of the patient, vismodegib at a dose of 150 mg/day was started in February 2018. Her immunosuppressive regimen consisted of mycophenolate mofetil, tacrolimus, and prednisolone. At her last follow-up in July 2019, she remained disease free with no adverse effects that lowered the quality of life. Although experiences on the use of vismodegib's efficacy and safety have been so far limited and consist of case reports in transplant patients, we experienced an excellent cosmetic result with minimal side effects in a renal transplant patient.

Single-Center Experience of Recurrence Patterns and Survival Analyses of Patients With Hepatocellular Carcinoma and Liver Transplant.

OBJECTIVES: Hepatocellular carcinoma remains a major health problem with increased rates of mortality. The curative treatment options are resection or liver transplant. Because the Milan criteria are restrictive for candidates, they have been expanded into alternative sets of criteria. We aimed to evaluate our indications for liver transplant and their results for hepatocellular carcinoma. MATERIALS AND METHODS: Between December 1988 and January 2020, we performed 652 liver transplant procedures (443 living donors, 209 deceased donors) at Baskent University (Ankara, Turkey). At Baskent University, we developed liver transplant criteria for patients with hepatocellular carcinoma. For our criteria, liver transplant for hepatocellular carcinoma was performed in patients without major vascular invasion and distant metastasis. Clinical data on cancer demographics, recurrence patterns, and survival outcomes were evaluated retrospectively. RESULTS: Of 652 total patients, 49 adult patients (8%) with diagnosis of hepatocellular carcinoma were included in this study. Median age was 55 years. Hepatocellular carcinoma recurrence after liver transplant was detected in 13 patients. Median overall survival was 64.3 months for all study patients; however, median survival was significantly lower in patients who had recurrence (126.3 vs 43.4 mo for nonrecurrent vs recurrent groups; P = .024). In the expanded criteria group (n = 25), 7 patients (28%) had hepatocellular carcinoma recurrence during follow-up, whereas this ratio was 25% (6/24 patients) in the Milan criteria group, with median time to recurrence of 12.6 versus 11.7 months, respectively (not significantly different). CONCLUSIONS: Multidisciplinary treatment modalities, including surgery, interventional radiology techniques, and medical treatments, will probably lead to prolonged survival in patients with hepatocellular carcinoma. According to our center's expanded criteria, recurrence rates and time to recurrence were similar to those shown with the Milan group. We showed that Milan criteria can be safely expanded with promising results even in patients beyond Milan criteria.

Posttransplant Malignancies in Adult Renal and Hepatic Transplant Patients.

OBJECTIVES: The risk of some cancer types increases after organ transplant compared with that shown in the general population; this has been well documented in clinical studies. With patients having longer survival and with the higher number of transplant procedures, cancer is an increasing health concern at high-volume transplant centers. Malignancy has an important effect on short- and long-term graft and patient survival. In this study, we evaluated cancer frequency during transplant patient follow-up. MATERIALS AND METHODS: This single-center retrospective study included patients who underwent solid-organ transplant at the Baskent University Medical Faculty Hospital from 1997 to 2017. Renal and hepatic transplant patients older than 16 years at the time of transplant and diagnosed with cancer after transplant were included the study. In total, 1176 of 2018 renal transplant recipients and 274 of 548 hepatic transplant recipients met the inclusion criteria. RESULTS: We determined that 52 of 1176 renal transplant (4.5%) and 9 of 274 hepatic transplant patients (3.3%) developed posttransplant cancer during follow-up. Of 61 total patients with cancer posttransplant, 44 were males (72.1%) and 17 were females (27.9%), with median age at transplant of 39.2 years. Overall, the incidence of cancer in transplant recipients was 4.2%. The most frequent cancers were basal and squamous skin cancers, which were seen in 18 patients (29%), and Kaposi sarcoma, which was seen in 11 patients (18%). Of the 61 patients who developed cancer, 43 (70%) were still alive at the time of this study. CONCLUSIONS: Despite recent positive developments in the use of immunosuppressive drugs, posttransplant malignancy is still a health problem. Fortunately, most cancers in this patient group have good prognosis and can be cured by surgical resection. Transplant physicians should aim for early detection of these diseases.

Effect of increased number of neoadjuvant chemotherapy cycles on tumor resectability and pathologic response in advanced stage epithelial ovarian cancer.

PURPOSE: To identify the significance of the number of neoadjuvant chemotherapy (NACT) cycles on pathologic response and to define relationship between multiple cycles of NACT and the timing of interval debulking surgery (IDS) in epithelial ovarian cancer (EOC) patients. METHODS: This retrospective case-control study was carried out at the Baskent University in Ankara between 2007 and 2017. We reviewed 62 patients with advanced stage (IIIC-IV) EOC who received NACT in other institutes and operated in our clinic. On the basis of the number of NACT cycles, patients were divided into 2 groups: group 1 received 3 cycles and group 2 received 4 to 6 cycles.The influence of the number of NACT cycles on complete pathologic response, lymph node involvement, overall survival (OS), progression free survival (PFS), platinum resistance and residual tumor were evaluated. RESULTS: The median OS was 44.4 ±4.8 months and 48.8±4.49 months for group 1 and group 2 respectively (p=0.122). PFS was 19.3±3.75 months in group 1 and 24.3±4.67 months in group 2 (p=0.84). Tumor morphology according to lymph node involvement, no visible tumor and complete pathologic response were similar for both groups (p=0.49, p=0.79 and p=0.6 respectively). Pathological absence of residual disease were 13.6% vs 7.5% for group 1 and group 2 respectively (p=0.6) and total response rate was 6/62 (9.67%). Platinum resistance developed in 4 (18.2%) patients and 18(45%) patients in group1 and 2 respectively (p=0.031). Complete resection rates were similar for both groups (p=0.9). After multivariate survival analyses, complete resection remained significant (p=0.000, odds ratio/OR 2.28 [1.41-3.70]), and was independent of age, platinum resistance and number of NACT cycles. Complete resection rates were almost equal in each groups, (68.2% [15/22] and 67.5% [27/40] for group 1 and group 2 respectively (p=0.9)). CONCLUSIONS: Our data suggests that giving more than 3 cycles of NACT is unnecessary because increased number of cycles did not change the resectability and complete pathologic response, while it increased platinum resistance. Moreover OS and PFS remained similar.

Response rates of taxane rechallenge in metastatic breast cancer patients previously treated with adjuvant taxanes.

PURPOSE: This study was conducted to determine the efficacy of taxane-based regimens in patients with metastatic breast cancer pre-treated with taxanes in adjuvant treatment and also to assess the response rates of taxanes in each treatment line. METHODS: The data of 939 breast cancer patients, who had received adjuvant taxane-based chemotherapy, were reviewed retrospectively. In 191 of them local/distant recurrences were detected. The treatments that were given when metastases occurred and the responses were recorded. Response rates (RRs), clinical benefit rates/CBR (complete response/CR + partial response/ PR + stable disease/SD) and progression-free (PFS) and overall survival (OS) values were determined. RRs to the most frequently used protocols in our institutes (capecitabine- based and taxane-based regimens) were compared. RESULTS: Of 191 patients, 11 didn't receive treatment and for the remaining 180 patients 45 (24%) received taxane-based therapies, 89 (49.4%) received capecitabine-based therapies, 28 (15.6%) received hormonotherapy and 18 (10%) received other chemotherapeutics. The RR for first-line taxane regimen was 58.5%, consisting of 5 CRs (12%) and 19 PRs (46%). Menopausal status, histological grade, estrogen/ progesterone receptors, cerbB2 status, having PFS > or ? 2 years and the site of metastases did not predict response to first-line taxane treatment. For the 2nd and 3rd or later line therapies, RRs of taxane rechallenge were above 40%. CONCLUSION: Rechallenging with taxanes after (neo)adjuvant taxane exposure seems to be a reasonable option even in 3rd or further line treatments with high response rates.

Primary yolk sac tumor of endometrium: report of two cases and review of literature.

Primary YST of the endometrium is very rare, therefore there is no guideline for treatment. We report two cases of endometrial YSTs presenting different symptoms and showing different prognoses and discuss the clinical management of these tumors. The present report shows first time that bone and lung metastasis in primary YSTs of endometrium. As the number of reported cases with endometrial YSTs, more information about the prognosis of the disease may be obtained.

Alzheimer disease, inflammation, and novel inflammatory marker: resistin.

BACKGROUND/AIM: Inflammation may play an important role in Alzheimer disease (AD) pathogenesis. A growing amount of evidence indicates that resistin has hallmark regulatory functions such as inflammatory states. The aim of this study was to determine whether plasma resistin levels would be useful in the diagnosis of patients with AD and to investigate the relationships between resistin and other inflammatory markers such as hs-CRP and TNF-α. Materials and methods: In this cross-sectional study, 38 AD patients and 32 control subjects with normal cognitive function aged 65 years and over were included. The diagnosis of AD was made according to DSM-IV and NINCDS-ADRDA criteria. Serum levels of resistin were measured with an enzyme-linked immunosorbent assay method using the human resistin E50 kit. Results: The median resistin level of AD patients was significantly higher than in the control group (86.3 vs. 70.8 pg/mL, P = 0.002). Overall accuracy of resistin in determining AD was 70.66%, with sensitivity, specificity, PPV, and NPV of 75.0%, 65.5%, 73.0%, and 67.9%, respectively. There was no statistically significant difference between AD patients and control subjects with respect to hs-CRP and TNF-α levels. Conclusion: Resistin levels may be considered as a predictor of AD and it may predict activation of the immune system in AD pathophysiology.

Good outcomes of patients with stage IB endometrial cancer with surgery alone.

BACKGROUND: Most patients with endometrial cancer have stage I disease. Adjuvant therapy in stage IB (formerly IC) endometrial cancer is controversial, treatment options including observation or brachytherapy/ radiotherapy in grade 1-3 patients with or without chemotherapy. The purpose of this study was to assess the outcomes of our patients with stage IB endometrioid endometrial cancer. MATERIALS AND METHODS: Sixty two patients with stage IB endometrial cancer and endometrioid histology were retrospectively evaluated. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Adjuvant radiotherapy was discussed with patients and utilized by those who accepted. Adjuvant chemotherapy was not given to any of the patients. RESULTS: Median age was 62 (range, 42-95). Ninety percent of the patients had grade 1-2 disease. Thirteen patients (21%) received intra vaginal brachytherapy (IVBT) and one received whole pelvic radiotherapy (WPRT). Median follow-up time was 46 months (range, 9-77 months). Three patients experienced recurrence (4.8%), two of them died on follow-up and one was still alive at last visit. Two patients with recurrence had FIGO grade 2 tumors and one had a grade 3 tumor. Two patients (3.2%) died without evidence of recurrent disease. Relapse free survival at 5 years was 94.4% and overall survival was 93.1%. CONCLUSIONS: Patients with stage IB disease in our study demonstrated relatively low recurrence rates although the majority of them received no adjuvant treatment. Surgery alone may be sufficient for most patients with this stage of endometrial cancer.

Influence of febrile neutropenia period on plasma viscosity at malignancy.

Cancer, chemotherapy, and infections all together make changes in blood rheology and may affect the defense mechanisms by changing the thrombocyte function and endothelial cell. We have examined changes of blood rheology on plasma viscosity to put on probable following criteria for starting the treatment of febrile neutropenia immediately. A total of 27 postchemotherapy patients (16 males and 11 females) with febrile neutropenia diagnosed according to international guidelines have been included into the study. The plasma viscosity of the patients whose febrile neutropenia has been successfully treated was also measured to assess the impact of the duration of neutropenia on viscosity. The plasma viscosities of the patients were significantly higher during neutropenic episode than in nonneutropenic state (P = 0.006) except for alkaline phosphatase. All study parameters, particularly acute phase reactants, were statistically similar during both states. In the correlation of analysis with study parameters and stages, significant correlation was not observed between plasma viscosity alteration and leukocyte-neutrophil alteration, also other study parameters. We have demonstrated significantly elevated plasma viscosity in our patients during febrile neutropenic episode. Despite normal values of various parameters known to trigger plasma viscosity, particularly fibrinogen, it can be easily argued that the main mechanism may be the endothelial injury during infectious process and immune response mediated microcirculatory blood flow alterations.

Impact of treatment strategies on local control and survival in uterine carcinosarcomas in Turkey.

BACKGROUND: The purpose of this study was to determine the clinical characteristics, patterns of recurrence and survival outcomes in patients with uterine carcinosarcomas treated in our institution. MATERIALS AND METHODS: Records of 26 patients diagnosed between 2007 and 2011 with uterine carcinosarcoma were retrospectively evaluated for demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of DFS and OS RESULTS: Median age was 61 (range 43-78). 10 patients (38%) had stage I disease at diagnosis, 3 (12%) had stage II, 4 (15%) had stage III and 9 (35%) had stage IV. Sixteen patients (62%) received chemotherapy with paclitaxel and carboplatin for 6 cycles. One patient underwent radiotherapy. Median follow up was 17 months. Sixteen patients relapsed and 13 died during follow up. Considering recurrence, 5 out of 16 patients had lung metastases, one had brain metastases and 9 had only intraabdominal recurrence. The 3 year DFS was 37% and the 3 year OS was 30%. CONCLUSIONS: Our data show that uterine carcinosarcomas tend to be at advanced stage at diagnosis and despite the use of chemotherapy, overall prognosis is poor. Surgery remains the mainstay of treatment. More effective adjuvant strategies are needed to reduce relapse and death rates.