Endocrine therapy alone vs. chemotherapy plus endocrine therapies for the treatment of elderly patients with endocrine-responsive and node positive breast cancer: a retrospective analysis of a multicenter study (Anatolian Society of Medical Oncology).

PURPOSE: The extra benefit of adding chemotherapy to effective endocrine therapy (ET) has not been clearly or consistently identified in patients older than 70 years with estrogen receptor (ER) positive and node positive breast cancer. The aim of this study was to evaluate the efficacy of adjuvant ET vs. chemotherapy plus endocrine therapies (Chemo/ET) in such patients. METHODS: In this retrospective multicenter study 191 patients ≥ 70 years with operated hormone receptor breast cancer, who were administered adjuvant ET or Chemo/ET were assessed. RESULTS: The median patient follow-up time was 29.0 months (range 1-252). Therefore disease free survival (DFS) and overall survival (OS) analysis was limited, due to the rather short median follow-up, and only 30-month cumulative percentages are reported herein. The 30-month DFS rates were 50.0% in the ET arm and 49.0% in the Chemo/ET arm (p=0.79). The 30-month OS rates were 86% in the ET arm and 96.0% in the Chemo/ET arm (p=0.08). Cox proportional hazard model showed that only surgery was independent prognostic factor for survival (p=0.047), while tumor size showed a strong trend for statistical significance (p=0.051). CONCLUSION: The addition of chemotherapy to endocrine therapy in older patients has no significant impact on DFS and OS.

Prenatal exposure to diclofenac sodium changes the morphology of the male rat cervical spinal cord: a stereological and histopathological study.

Diclofenac sodium is one of the most commonly used non-steroidal anti-inflammatory drugs. It may cause alteration in the nervous system during neuronal development. However, there is no investigation concerning its role in the cervical spinal cord. Pregnant rats were divided into two groups, namely drug-treated and control (saline-injected) groups. To obtain the offspring of the drug-treated group, a dose of 1mg/kg daily diclofenac sodium (Voltaren, 75 mg/3 ml ampoule, Novartis) was injected into the pregnant rats beginning from the 5th day after mating to the 20th day of the pregnancy. To obtain the control group of offspring, serum physiological at a 1 ml/kg daily dose was injected into the pregnant control rats during the same period. Male offspring were obtained after delivery and each group was divided into two subgroups: 4-week-old and 20-week-old. The total neuron number in diclofenac sodium-treated rats was significantly lower than in the control group animals. The total volume of the cervical spinal cord segments (C1-C4) was also estimated. There was a significant difference between the volumes of the two groups, especially in the 20-week-old subgroup. This may suggest that development of neurons and volume of cervical spinal cord are affected in prenatal animals after administration of diclofenac sodium.

Serum levels of leptin and proinflammatory cytokines in patients with gastrointestinal cancer.

The aim was to investigate the serum levels of leptin, TNF-alpha, IL-1 beta, IL-6, insulin, and growth hormone in patients with upper gastrointestinal cancer and cachexia. A total of 39 patients with various advanced stage (stage IV) gastrointestinal malignancies were enrolled. These cancer patients were divided into two groups according to the presence or absence of cachexia. Fifteen healthy adults were recruited as the control group. Body mass index (BMI; kg/m2) was calculated. Serum leptin, tumour necrosis factor (TNF)-alpha interleukin (IL)-1 beta, interleukin (IL)-6, growth hormone, insulin, glucose, triglyceride, total protein, albumin, erythrocyte sedimentation rate, and CRP were measured. In both cancer groups (cachectic and non-cachectic) body mass index and serum leptin levels were lower than controls (p < 0.001). Serum IL-1 beta, IL-6, and growth hormone levels were higher in both cachectic and non-cachectic groups than those of controls (p < 0.05). Serum TNF-alpha level in non-cachectic group was also significantly higher than in control group (p < 0.01). There is no significant difference between three groups in terms of insulin resistance as assessed by HOMA index. Our results showed that some proinflammatory cytokine levels were increased and leptin level was decreased due to upper gastrointestinal cancers. Increased cytokine levels may lead to decreased food intake and caused a weight loss.

Survival outcomes in aggressive non-Hodgkin's lymphoma according to the International Prognostic Index.

PURPOSE: To retrospectively analyse the disease-free survival (DFS) and overall survival (OS) according to the International Prognostic Index (IPI) risk groups in patients with aggressive non-Hodgkin's lymphoma (A-NHL) treated at the Institute of Oncology, Istanbul University between 1989-1998. PATIENTS AND METHODS: The records of 201 patients with A-NHL and aged 15 years and over were retrospectively analysed. Features evaluated for potential prognostic importance for DFS and OS included sex, age, tumor stage, performance status (PS), "B" symptoms, bone marrow infiltration, number of extranodal disease sites, size of the largest tumor, histologic grade, erythrocyte sedimentation rate (ESR), and serum levels of lactate dehydrogenase (LDH), albumin and beta2-microglobulin. The International Working Formulation system and the Ann Arbor staging system were used for histologic and staging classifications, respectively. Kaplan-Meier, log-rank and Cox's methods were used for statistical analyses. RESULTS: Sixty-six percent of the patients were classified in the low risk group; 23% in the low-intermediate risk group; 9% in the intermediate-high risk group; and 2% in the high risk group. The median follow-up was 25.9 months (range 1-150 months). Five-year DFS and OS were 41% and 47%, respectively, in all patients. According to IPI, based on the age, tumor stage, LDH level, PS, and extranodal involvement in the identified 4 risk groups of all patients and all ages, the 5-year DFS and OS rates were 66-51%, 49- 43%, 40-34%, and 0%, respectively. Patients in the lowintermediate and intermediate-high risk groups had a worse survival outcome than low risk patients (p=0.001). CONCLUSION: The IPI can be used in the selection of appropriate therapeutic strategy for individual patients. IPI is the most acceptable prognostic system, but being not the ideal one, is still being under critical discussion.

Small cell carcinoma of the esophagus: report of a case with review of the literature.

Primary small-cell carcinoma of the esophagus is a rare tumor that disseminates early and has a uniformly poor prognosis if untreated. We report on a patient with esophageal small-cell carcinoma treated with combination chemotherapy following surgical resection. A 48-year-old female had an ulcerated tumor in the distal part of the esophagus, which was microscopically diagnosed as esophageal small-cell carcinoma. Computed tomography (CT) of the chest and abdomen showed no lymphadenopathy or distant metastatic disease. Chemotherapy plus radiation therapy was planned but the patient refused the proposed treatment due to socieconomic reasons. Subsequently, subtotal esophagectomy with lymphadenectomy (3 periesophageal nodes) was performed in another hospital. The histopathologic diagnosis of the primary tumor was small-cell carcinoma and the resected lymph nodes also contained metastatic deposits. On the second postoperative month she was admitted with hepatic metastases. Combination chemotherapy with etoposide 120 mg/m(2)/day on days 1 to 3, and cisplatin 75mg/ m(2)/day on day 1, given intravenously (i.v.) every 3 weeks was started. After 3 courses, the patient achieved complete remission. Esophageal small-cell carcinoma is an aggressive tumor. Patients with disseminated disease should receive combination chemotherapy along with symptomatic treatment.

Unusual metastases from rectal adenocarcinoma; report of two cases with literature review.

Two case reports of patients with skin and orbital metastasis from rectal carcinoma are described. The reasons for the rarity of this kind of metastases are considered. The survival of these cases was very short.

An atypical presentation of metastatic gestational choriocarcinoma with maxillary sinus and subcutaneous involvement; report of a case with literature review.

Extragonadal germ cell tumors are rare neoplasms with histologic features comparable to those of gonadal origin. In this case report we present a 21-year-old female patient with an atypical localization of metastatic gestational choriocarcinoma. She was admitted to our hospital with recurrent epistaxis, abnormal vaginal bleeding, rectal bleeding, subcutaneous nodules on both thighs and forearms and left maxillary mass with intranasal cavity invasion. Laboratory analysis revealed significant elevation in serum beta-human chorionic gonodotropin (beta-HCG) level. Abdominal computerized tomography (CT) revealed left renal and retroperitoneal masses and thoracic CT displayed multiple bilateral lung metastases. Histopathological evaluation of the biopsy specimen obtained from the maxillary sinus showed choriocarcinoma. Based on WHO criteria she was classified as high-risk metastatic choriocarcinoma and treated with combination chemotherapy. We believe that in young women with recurrent epistaxis, gross abnormal vaginal and rectal bleeding and atypical maxillary sinus tumor with multiple lung metastases, choriocarcinoma should be included in the differential diagnosis and previous history of pregnancy or abortion should be obtained.

Prognostic factors in pancreatic carcinoma: serum LDH levels predict survival in metastatic disease.

In this study, our aim was to investigate the impact of various prognostic factors on survival in patients with pancreatic carcinoma. The group consisted of 127 cases with adenocarcinoma histologically. The patients had a median age of 58 years, and 81 (64%) were male. The median survival time of the whole group was 7 months, and the 4-year survival rate was 18%. The median survival duration of the patients without metastases was 8 months, and the survival rate at 1 year was 37.5% and 7.2% at 5 years. It was associated with improved survival compared with the cases with metastatic disease (p < 0.0001). In univariate analysis, decreased performance status (p = 0.0009) and unresectability of tumor (p < 0.0001) were associated with poor outcome. However, only surgery was found to be a statistically significant parameter in multivariate analysis (p = 0.002). The median survival duration of patients with metastases was 5 months, and the 1-year survival rate was 10%. Age younger than 60 years (p = 0.04), decreased serum hemoglobin levels (p = 0.04), and elevated lactic dehydrogenase (LDH) levels (p = 0.0001) were associated with a significantly shorter survival rate. In the Cox model, a high serum LDH level was the only independent unfavorable prognostic factor (p = 0.001). In conclusion, surgical intervention in the group without metastases and serum LDH levels in the group with metastases were the most important prognostic factors influencing survival. Pretreatment serum LDH determinations may provide a useful means of stratifying patient populations when comparing treatment programs for advanced pancreatic cancer.

Treatment of aggressive non-Hodgkin's lymphoma with dose-intensified epirubicin in combination of cyclophosphamide, vincristine, and prednisone (CEOP-100): a phase II study.

Epirubicin is an agent with a lower incidence of cardiotoxicity and myelotoxicity compared with doxorubicin; and it is active in patients with non-Hodgkin's lymphoma (NHL). Our aim was to define the therapeutic efficacy and toxicity of dose-intensified epirubicin in combination with cyclophosphamide, vincristine, and prednisone (CEOP) in patients with diffuse large-cell NHL. Previously untreated patients aged between 15 and 75 years, with at least one measurable lesion, adequate liver, renal, cardiac functions, and no central nervous system involvement were included in the study. The planned chemotherapy regimen CEOP consisted of cyclophosphamide 750 mg/m2, epirubicin 100 mg/m2, and vincristine 1.4 mg/m2 intravenously on day 1 and 100 mg prednisone taken orally on days 1 to 5. Courses were repeated every 21 days. Patients with stage I and II received four cycles of chemotherapy followed by involved-field radiotherapy, and patients with stage III and IV received six cycles of chemotherapy followed by radiotherapy to bulky lymph node sites. Seventy-five patients were enrolled in the study. The complete response rate was 83.8%, and 72 patients were assessable for toxicity. The most common toxicity was myelosuppression; 13.9% of the patients had grade III-IV neutropenia. Severe mucositis, diarrhea, and emesis were uncommon (<10%). At a median follow-up period of 41 months, the 5-year progression-free survival and overall survival rates were 63.5% and 65.3%, respectively. Increasing the dose intensity of epirubicin can yield a similar complete response rate compared with the regimens used in NHL without significantly increasing the toxicity rate associated with chemotherapy. The role of dose-intensive epirubicin should be investigated further in future randomized trials.