A review for solitary plasmacytoma of bone and extramedullary plasmacytoma.

Solitary plasmacytoma (SP) is characterized by a mass of neoplastic monoclonal plasma cells in either bone (SBP) or soft tissue without evidence of systemic disease attributing to myeloma. Biopsy confirmation of a monoclonal plasma cell infiltration from a single site is required for diagnosis. The common presentation of SBP is in the axial skeleton, whereas the extramedullary plasmacytoma (EMP) is usually seen in the head and neck. The ratio of SP seen at males to females is 2 : 1 and the median age of patients is 55 years. The incidence rate of SP in black race is approximately 30% higher than the white race. Incidence rate increases exponentially by advancing age. SBP has a significant higher risk for progression to myeloma, and the choice of treatment is radiotherapy (RT) that is applied with curative intent at min. 4000 cGy. By only RT application, long-term disease-free survival (DFS) is possible for approximately 30% of patients with SBP and 65% of patients with EMP.

Effect of N-acetylcysteine on radiation-induced genotoxicity and cytotoxicity in rat bone marrow.

The aim of this study is to evaluate the potential radioprotective effects of N-acetylcysteine (NAC) against genotoxicity and cytotoxicity. The effect of WR-2721, as a representative of clinically used radioprotector, was compared with that of NAC, using the chromosomal aberration (CA) and micronucleus (MN) test systems in the irradiated rat's femoral bone marrow cells. We also investigated the mitotic index (MI), and the ratio of polychromatic erythrocytes (PCEs) to normochromatic erythrocytes (NCEs). The rats (n = 16) were divided randomly and equally into four groups: Control (C), Radiation (R), R+NAC (received irradiation and 1000 mg/kg NAC) and R+WR-2721 (received irradiation and 200 mg/kg WR-2721) rats. All the irradiated groups received whole-body gamma irradiation as a single dose of 6 Gy. Group R showed higher CA and MN formation when compared to C. Group R showed higher frequency of MN formation when compared to both R+NAC and R+WR-2721. The mean MI and PCE/NCE ratios were lower in Group R when compared to those of Group C. The mean MI and PCE/NCE ratios of both R+NAC and R+WR-2721 groups were lower when compared to those of Group C. The MI in Group R was lower when compared to that of both R+NAC and R+WR-2721 groups. In this study, the results give clues about the beneficial effects of NAC against radiation-induced genotoxicity and cytotoxicity in rat bone marrow and its effect may be comparable to that observed for WR-2721.

Clinical and prognostic features of plasmacytomas: a multicenter study of Turkish Oncology Group-Sarcoma Working Party.

To identify the outcomes of prognostic factors of solitary plasmacytoma mainly treated with local radiotherapy (RT). The data were collected from 80 patients with solitary plasmacytoma (SP). Forty patients (50.0%) received radiotherapy (RT) alone while 38 of them (47.5%) were treated with surgery (S) and RT. The median radiation dose was 46 Gy (range 30-64). The median follow up was 2.41 years (range 0.33-12.33). Ten-year overall survival (OS) and local relapse-free survival (LRFS) were 73% and 94%, respectively. The median progression-free survival (PFS) and multiple myeloma-free survival (MMFS) were 3.5 years and 4.8 years, respectively. On multivariate analyses, the favorable factors were radiotherapy dose of > or =50 Gy and RT + S for PFS and younger age for MMFS. For the patients with medullary plasmacytoma, the favorable factor was younger age for MMFS. RT at > or =50 Gy and RT + S may be favorable prognostic factors on PFS. Younger patients, especially with head-neck lesion and without pre-RT macroscopic tumor, seem to have the best outcome when treated with RT +/- S. Progression to MM remains as the main problem especially for older patients.

The effect of N-acetylcysteine on biomarkers for radiation-induced oxidative damage in a rat model.

Our study aimed to investigate the potential radioprotective effects of N-acetylcysteine (NAC) by comparing its biochemical effects with those of WR-2721, as a representative of clinically used radioprotectors, in preventing oxidative damage caused by gamma irradiation (single dose, 6Gy) in normal rat tissue. The rats (n=40) were divided randomly and equally into 4 groups:Control (C), Radiation (R), R+NAC (received irradiation and 1,000 mg/kg NAC) and R+WR-2721 (received irradiation and 200 mg/kg WR-2721) rats. Liver tissues and blood samples were harvested and utilized for reduced glutathione (GSH), malondialdehyde (MDA) and myeloperoxidase (MPO) detection. Serum and tissue GSH levels of R rats decreased compared to those of other groups (p<0.01). Tissue MDA levels of R+NAC and R+WR-2721 rats decreased compared to R rats (p<0.01; p<0.05, respectively). Tissue MPO activities of R+NAC and R+WR-2721 rats were higher than those of R rats (p<0.001). Serum MPO levels of R+WR-2721 rats were lower than those of C rats and R rats (p<0.01, p<0.001, respectively). In conclusion, the study suggests that the radioprotective effect against radiation-induced oxidative damage of NAC may be similar to that of WR-2721.

Characteristics of synchronous- and metachronous-type multiple primary neoplasms: a study of hospital-based cancer registry in Turkey.

PURPOSE: The aim of this study was to evaluate the demographic, histologic, and topographic characteristics, and the association of synchronous and metachronous multiple primary neoplasms. PATIENTS AND METHODS: Five hundred seventy-two multiple primary tumors (n = 286) of 20,895 tumors recorded from 1993 to 2005 by the office of Izmir Cancer Registry at the Izmir Ataturk Training and Research Hospital were analyzed. chi(2) and Student t test were performed. RESULTS: One hundred fifty-eight patients had synchronous tumors whereas 128 had metachronous tumors. Both groups were more frequent among men and among patients aged > 50 years. The distribution of synchronous and metachronous tumors between sex and age groups was similar (P = .462 and P = .479, respectively). Carcinomas were more frequent and histologic compositions of both of the groups were significantly different (P = .009). Pairs of the same topographic origin were significantly more frequent in synchronous tumors (P = .019). The urogenital system was the most frequent location in all groups. The leading tumoral association was between urogenital-urogenital tumors, also. Detailed evaluation of the metachronous group revealed that the most frequent organ associations were of breast-ovary (n = 7) and bladder-larynx (n = 5). CONCLUSION: Field cancerization in the epithelium, theory of a common clonal origin, or the screening effect might account for the relatively frequent association of urogenital tumors. The association of the tumors of breast-ovary might be related to the endocrine effect. Further studies complying with international rules and using data from different population-based tumor registries are necessary to elucidate site correlation.

Treatment outcome and prognostic factors in non-metastatic esophageal carcinoma.

OBJECTIVE: To investigate the therapeutic outcome and prognostic factors in patients with non-metastatic esophageal carcinoma. METHODS: Between January 1989 and December 2003, 171 patients with non-metastatic esophageal carcinoma patients were retrospectively assessed in the Department of Radiation and Oncology, Institute of Oncology, Turkey. RESULTS: The distribution of the stage at presentation designated 39 stage II patients (23%) and 132 stage III patients (77%). The primary tumors were treated with surgery and postoperative radiotherapy (RT) in 29 patients (17%), with surgery, postoperative RT and chemotherapy (CT) in 17 patients (10%), with radical RT in 40 patients (23%), and with RT and CT in 47 patients (27%). Fourteen patients (8%) did not receive any postoperative adjuvant treatment. Two and three-year survival rates of the whole group were 27.0% and 14.8%, respectively. Clinical staging was the only statistically significant prognostic factor by multivariate analyses (p=0.04). Median survivals by the treatment groups were 12.5 months for surgery alone, 16 months for surgery plus postoperative RT, 15 months in surgery plus postoperative chemoradiotherapy, 9 months in radical RT alone and 17 months in chemoradiotherapy group. Survival advantage was not demonstrated for postoperative RT or RT plus CT. Outcomes were similar between the patients treated with surgery and with chemoradiotherapy (p=0.54). Patients treated with chemoradiotherapy had a longer survival than patients treated with only RT (p=0.05). CONCLUSION: The most important prognostic factor was the stage of the disease. Survival advantage was not demonstrated for postoperative RT or RT plus CT. Outcomes were similar between patients treated by surgery and by chemoradiotherapy.

Evaluation of curative and palliative radiotherapy efficacy in extensive stage small cell lung cancer.

OBJECTIVE: To evaluate the efficacy of curative and palliative radiotherapy in the treatment of extensive stage small cell lung cancer (E-SCLC), and compare therapy effect on survival with or without metastatic disease. METHODS: From January 1998 through December 2004, 128 patients with E-SCLC were treated with radiotherapy and concomitants combined chemotherapy. Radical radiotherapy, consisting of approximately 60 Gy given in up to 30 fractions was performed in 53 (41.4%) of these patients. Others (58.6%) were treated with palliative dose radiotherapy. In all patients, chemotherapy was planned with cisplatin (80 mg/m2) intravenously (i.v.) on day 1, and etoposide (120 mg/m2) i.v. on days 1, 2 and 3, every 3 weeks for 3-6 cycles. Conventional follow-up of patients was conducted at Izmir Oncology Center, Izmir, Turkey. All results were evaluated statistically. RESULTS: One hundred and twenty-four patients (96.9%) were males. The mean age was 58.49 (+/- 9.01), ranging from 37-78 years. Metastases were initially determined in 64 patients (50%). The median follow up of patients was 287.41 days and median survival was 354.87 days. One year survival rate was 35.8%, and 2-year survival rates was 16.9% in the radical radiotherapy group, while these rates were 26.6% and 8% in the others. According to the statistical findings; the gains in duration of median survival with the curative thoracic irradiation are 151.97 days in all 128 patients. CONCLUSION: This study shows that curative radiotherapy at the primary tumor provides an additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This finding raises the question of whether treatment with radical thoracic radiotherapy with concomitant chemotherapy, consisting of first-line drugs, might be more beneficial and cost-effective as well as a less toxic treatment of E-SCLC.

Melatonin can Ameliorate Radiation-Induced Oxidative Stress and Inflammation-Related Deterioration of Bone Quality in Rat Femur.

The aim of the present study was to evaluate the radioprotective effects of melatonin on the biomechanical properties of bone in comparison to amifostine (WR-2721). Forty Sprague Dawley rats were divided equally into 5 groups namely; control (C), irradiation (R; single dose of 50 Gy), irradiation + WR-2721 (R + WR-2721; irradiation + 200 mg/kg WR-2721) radiation + melatonin 25 mg/kg (R + M25; irradiation + 25 mg/kg melatonin), and radiation + melatonin 50 mg/kg (R + M50; irradiation + 50 mg/kg melatonin). In order to measure extrinsic (organ-level mechanical properties of bone; the ultimate strength, deformation, stiffness, energy absorption capacity) and intrinsic (tissue-level mechanical properties of bone; ultimate stress, ultimate strain, elastic modulus, toughness) features of the bone, a three-point bending (TPB) test was performed for biomechanical evaluation. In addition, a bone mineral density (BMD) test was carried out. The BMD and extrinsic properties of the diaphyseal femur were found to be significantly higher in the R + M25 group than in group R (p < 0.05). A significant increase was observed in R + M50 (p < 0.05) in comparison to group R in the cross-sectional area of the femoral shaft and elastic modulus parameter. The protective effect of melatonin was similar to that of WR-2721. Thus, biomechanical quality of irradiated bone can be ameliorated by free radical scavenger melatonin.

Inhibition of Radiation-Induced Oxidative Damage in the Lung Tissue: May Acetylsalicylic Acid Have a Positive Role?

The lung is relatively sensitive to irradiation. It is shown that acetylsalicylic acid (ASA) might reduce oxidative injury and that it has a place in protection from cancer. The aim of this study is to evaluate the potential radioprotective effects of ASA. Whole-body irradiation (6 Gy, single dose) was applied to the rats. Glutathione (GSH), malondialdehyde (MDA), myeloperoxidase (MPO), and nitric oxide (NO) levels in the lung tissue were measured. Control (C), Radiation (R), Radiation + ASA (R + ASA; received irradiation and 25 mg/kg of ASA intraperitoneally (i.p.)), and Radiation + Amifostine (R + WR-2721; received irradiation and 200 mg/kg of WR-2721 i.p.) groups were used. The MPO levels decreased statistically significantly in the group administered ASA. Histopathologically, a radioprotective effect of ASA was more evident in the R + ASA group. ASA is an agent which has not been used as a radioprotector in the clinic yet, and it is worth supporting with more advanced studies.

Soft tissue giant cell tumor of low malignant potential of the neck: a case report and review of the literature.

Giant cell tumor of soft parts is a rare tumor that is clinically and histologically similar to giant cell tumor of the bone. We present a 53-year-old female with a giant cell tumor of low malignant potential arising from the neck. The clinicopathological features and the importance of immunohistochemistry in the differential diagnosis with other giant cell rich tumors was discussed.

Modified IDARAM chemotherapy regimen for primary central nervous system lymphoma: experience of three cases.

The use of radiotherapy (RT) with chemotherapy has improved disease free survival and control in primary central nervous system lymphoma (PCNSL). We have encountered three patients with histologically documented central nervous system lymphoma. In all patients pathological diagnosis was B-cell lymphoma. We modified IDARAM regimen to R-IDARAM to enhance and optimize chemotherapeutic components for the treatment of PCNSL. We made three changes: (i) we added rituximab 375 mg/m(2) day 1; (ii) increased dose of MTX from 2 to 3 g/m(2); and (iii) administered two additional courses of R-IDARAM after cranial RT. Following complete staging after course 2, radiotherapy was applied at a dosage of 3600-4140 cGy in conventional schedule (180 or 200 cGy per day) to whole brain (with 3600 cGy to eyes in one case because of eye involvement) and then 2 additional courses of R-IDARAM (totally four courses) chemotherapy regimen were applied. Complete remission (CR) was achieved after first two cycles of R-IDARAM in patient 1 and 3 and after four cycles in patient 2. Currently, three patients have been alive for 29, 10, 15 months respectively. Currently there is no standard treatment modality for PCNSL. Increased dosage of MTX, adding rituximab and consolidation of the IDARAM to R-IDARAM regimen may improve disease control and outcome in PCNSL patients.

Patterns of care for lung cancer in radiation oncology departments of Turkey.

PURPOSE: To determine the patterns of care for lung cancer in Turkish radiation oncology centers. METHODS AND MATERIALS: Questionnaire forms from 21 of 24 (87.5%) centers that responded were evaluated. RESULTS: The most frequent histology was non-small cell lung cancer (NSCLC) (81%). The most common postoperative radiotherapy (RT) indications were close/(+) surgical margins (95%) and presence of pN2 disease (91%). The most common indications for postoperative chemotherapy (CHT) were ">/= IB" disease (19%) and the presence of pN2 disease (19%). In Stage IIIA potentially resectable NSCLC, the most frequent treatment approach was neoadjuvant concomitant chemoradiotherapy (CHRT) (57%). In Stage IIIA unresectable and Stage IIIB disease, the most frequent approach was definitive concomitant CHRT (91%). In limited SCLC, the most common treatment approach was concomitant CHRT with cisplatin+etoposide for cycles 1-3, completion of CHT to cycles 4-6, and finally prophylactic cranial irradiation in patients with complete response (71%). Six cycles of cisplatin + etoposide CHT and palliative thoracic RT, when required, was the most commonly used treatment (81%) in extensive SCLC. Sixty-two percent of centers did not have endobronchial brachytherapy (EBB) facilities. CONCLUSION: There is great variation in diagnostic testing, treatment strategies, indications for postoperative RT and CHT, RT features, and EBB availability for LC cases. To establish standards, national guidelines should be prepared using a multidisciplinary approach.