Concomitant temozolomide and radiotherapy versus radiotherapy alone for treatment of newly diagnosed glioblastoma multiforme

PURPOSE

To study the efficacy and safety of radiotherapy (RT) with concomitant and subsequent temozolomide in comparison to RT alone in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM) after brain surgical intervention.

METHODS

Twenty patients received cranial fractionated RT (60 Gy total dose: 2 Gy/day, 5 days/week, for 6 weeks) with concomitant oral temozolomide (75 mg/m(2)/day x 7 days/ week, for 6 weeks) followed by temozolomide monotherapy (200 mg/m(2)/day × 5 days every 28 days for 6 cycles). Another 20 patients received only cranial RT (Co-60 teletherapy, 60 Gy in 30 fractions).

RESULTS

At the end of the study the median time to progression free survival (PFS) was 13 months in the temozolomide plus RT treatment group and 5 months in the RT-alone group (p=0.0001). Median overall survival (OS) in the temozolomide plus RT and the RT-alone group was 19 and 11.5 months, respectively (p=0.0264). The main side effect in the temozolomide plus RT group was myelosuppression. Concomitant treatment resulted in grade 3 hematologic toxicity in 6 patients.

CONCLUSION

These data show that the combination of temozolomide, concomitant and subsequent to RT seems more effective than RT alone in patients with newly diagnosed GBM and that multimodality treatment is safe and well tolerated.

Two cases with atypical metastasis in colorectal cancer: splenic and renal metastasis

Atypical metastasis, such as splenic and renal metastasis is rare in colorectal cancer. There have been case reports of colorectal cancer patients with isolated splenic metastasis, even after years of surgery in the literature.

AIM

To report two colorectal cancer cases with atypical metastasis.

RESULTS

The first patient was a 58-year old man who had isolated splenic metastasis after 20 months of surgery. The other one was a 51-year old male patient with both lung and renal metastasis at rectal cancer diagnosis. Splenic and renal metastases have been histopathologically documented in both of them. The first patient was given chemotherapy after splenectomy. The other one had also multiple lung metastases besides renal metastasis. He received palliative chemotherapy.

Education, economic status and other risk factors in gastric cancer: "a case-control study of Turkish Oncology Group"

Diet and lifestyle related to socioeconomic status emerged as risk factors for gastric cancer in several studies. However, the results were not always consistent with the socioeconomic status. The aim of this study was to evaluate the risk factors independent from education as a measure of socioeconomic status. Two hundred and fifty-three patients with gastric cancer diagnosed in 2005 and equal number of control subjects were interviewed for several characteristics and diet. Matching was done for age, gender, city of residence and also for the level of education. Despite these matching preferences, patients had significantly lower income when compared to the control subjects (P = 0.0001). Higher rate of patients were smoking more than 2 packs/day of cigarettes (P = 0.018). Also significantly higher rate of control subjects were using antibiotics (P = 0.002). Coffee (P < 0.0001), salad (P = 0.006), bread (P = 0.005), vegetable-derived cooking oil (P = 0.003) consumptions appeared as highly protective factors against gastric cancer in univariate analysis in the present trial. In multivariate analysis, significant risk reducing factors were bread (P = 0.005) and coffee consumption (P = 0.0001) other than the level income (P = 0.002). In conclusion, the goal of obtaining comparable socioeconomic status by including the level of education in the matching criteria was not met in our study because of the difference in income level. The only risk reducing factor that was not in accordance with income level was the unexpectedly higher rate of bread consumption in control group.

Capecitabine and oxaliplatin (XELOX) as first-line treatment for patients with metastatic colorectal cancer

PURPOSE

For almost 40 years, 5-fluorouracil (5-FU) had been the only drug with demonstrated activity against (CRC), commonly used in combination with leucovorin (LV). Oxaliplatin and capecitabine are two relatively novel drugs used in the treatment of CRC. These drugs have been found to act synergistically, both in vivo and in vitro and their combination (XELOX) is highly active in metastatic colorectal cancer (mCRC). The aim of this study was to determine the safety and efficacy of XELOX in patients with mCRC.

METHODS

The study endpoints were response rates, toxicity, progression free (PFS) and overall survival (OS). XELOX was administered as first line treatment to patients with mCRC. Patient selection criteria included histological confirmation of mCRC, ECOG performance status (PS) <or=2, and adequate bone marrow, renal and hepatic function. Patients received oxaliplatin 130 mg/m(2) i.v., day 1, and oral capecitabine 1000 mg/m(2) twice daily, days 1-14, every 3 weeks.

RESULTS

34 patients were treated with XELOX; males/ females 23/11, median age 53.5 years (range 42-65), ECOG PS 0/1 52%/48%. Metastatic sites were the liver (23/34; 67%), lung (7/34; 20%), and bone (4/34; 11%). No patient achieved complete response (CR), 14 patients showed partial response (PR), 8 stable disease (SD) and 11 progressed (PD). Median PFS was 5.5 months, median OS 12.9 months and 1-year survival 52%.

CONCLUSION

The combination of oral capecitabine with i.v. oxaliplatin appears to be effective and well tolerated in patients with mCRC.

Larynx osteosarcoma: case report

We present the case of a laryngeal osteosarcoma in a 69-year-old man, which generated many diagnostic and treatment difficulties. The patient was admitted to the hospital because of persisting hoarseness and a laryngeal tumor was seen on laryngoscopy. Total laryngectomy was performed and the pathological examination of the resected material showed osteosarcoma of the larynx. Postoperative radiotherapy was planned but the patient declined any treatment. He was readmitted to the hospital 5 months later with a neck tumor and enlarged lymph nodes on the right side of the neck. Chemotherapy started and during treatment metastatic lymph nodes on the left side of the neck and pulmonary metastases were detected.

The symptomatic benefit (the clinical benefit response) from the second-line chemotherapy in patients with advanced gastric adenocarcinoma

There are few reports on use of symptomatic benefits as an alternative or adjunctive for the assessment of objective response in chemotherapy of the advanced cancer. This study is performed to assess the symptomatic benefits (the clinical benefit response), in addition to the efficacy and toxicity of cisplatin plus infusional 5-fluorouracil (5-FU) combination as second-line therapy in patients with advanced gastric cancer. Fifty-eight advanced gastric cancer patients with previous chemotherapy were enrolled into the study. Cisplatin 20 mg/m(2) was given for 5 days, and 5-FU was given 1000 mg/m(2) as 20 h continuous infusion for 5 days, repeated every 28 days. The overall objective response rate was 11.3%, and overall tumour control rate was 33.9%. The clinical benefit response, in terms of weight gain, reduction in analgesic consumption and the improvement in performance status observed in 12 patients [six patients with partial response (PR) and six patients with stable disease (SD)] (22.6%), while the rates of the clinical benefit response in patients with PR and with SD were 100% and 50% respectively. Cisplatin plus infusional 5-FU combination seems to improve disease-related symptoms (clinical benefit response) of patients with advanced gastric cancer, even in patients without objective response.

Efficacy of erythromycin for psoriasis vulgaris

Psoriasis is characterised by the presence of neutrophil overactivation and overproduction of interleukin (IL)-6 and IL-8 from keratinocytes. It is now clear that macrolide antibiotics have anti-inflammatory effects, such as inhibition of IL-6, IL-8 and tumour necrosis factor-alpha, perhaps by suppressing the transcription factor nuclear factor-kappaB or activator protein-1, and reduction of neutrophil activity. It is thus possible that macrolides might be a candidate for adjunctive treatment of psoriasis. In this study, we investigated the effectiveness of treatment with the macrolide antibiotic, erythromycin, for skin lesions and pruritus of patients with psoriasis. In total, 60 patients with psoriasis, especially pruritic psoriasis, were included. This was an open-label study and the analysis was on an intention-to-treat basis. Oral macrolide antibiotics and topical corticosteroids were given to the study group of 36 patients. The control group (24 patients) were treated only with topical corticosteroids. After a 4-week treatment period, scores on the Psoriasis Area and Severity Index (PASI) at baseline and at the end of the treatment, and the effectiveness in reducing itching were compared within and between both groups. Although there was no statistically significant difference between the baseline mean PASI of the two groups (P=0.81), there was a statistically significant difference between the mean PASI of the two groups at the end of the treatment (P=0.023, 95% confidence interval: - 3.45 to - 0.27). The comparison of the mean difference in PASI yielded a statistically significant difference (P=0.03, 95% confidence interval 0.73-3.55). Our study suggests that macrolides could be used as one of the adjunctive therapies for psoriasis vulgaris.

Opinions of the Turkish population on cancer and being informed for the diagnosis of cancer: An opinion survey

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Background: Opinions of the Turkish population on cancer, and their probable attitudes if one of their relative or themselves would have cancer diagnosis are investigated. Methods: The age, gender, profession, education levels of the subjects, their overall opinions on cancer are recorded by an opinion survey. Questions regarding if one of their first degree relatives had cancer, would they like the diagnosis being told to the patient and if they were to be the patient with cancer, would they prefer to be informed about the diagnosis are also asked. Results: 6566 subjects from various geographical regions of Turkey are participated in this survey. Participants’ median age were 33 years (range: 18–100), 53.3% were male. 57.7% of the participants would prefer to hide the cancer diagnosis from their first degree relatives. 54.8% of the participants had relatives with cancer and 69.9% of them said that the diagnosis had been told to the patient. The timing of the disclosure of the diagnosis were immediately in 71.5%, months after the diagnosis in 16.9% and in terminal stage in 9% of the patients. 62.8% of these patients are told to be died from cancer. When their overall opinion on cancer is asked, 76.5% were optimistic, 16.3% were pessimistic and did not believe the medicine, and 2.9% had both positive and negative opinions. Logistic regression analyses showed that 1) younger subjects; female subjects; subjects with lower education levels; subjects having a relative with cancer diagnosis which had not been revealed to the patient or revealed late in the course of the disease, or the patient had been died; subjects with pessimistic opinions about the treatment of the cancer were likely to hide the cancer diagnosis form their first degree relatives. 2) Elder subjects; subjects with lower education levels; subjects having a relative with cancer diagnosis which had been revealed to the patient; subjects having a relative with cancer diagnosis who died from cancer, subjects optimistic about cancer treatment; subjects preferring the diagnosis be hidden from patients were preferring not to be informed about the diagnosis if they were to have cancer. Conclusions: These results are comperable with reports form Eastern Europe and Asian countries.

No significant financial relationships to disclose.

Symptoms or signs due to different chemotherapeutics and their relationship with serum cytokines/VEGF levels in patients with cancer

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Background: Several problems such as myalgia, arthralgia, fever, dyspnea, generalised edema and pleural effusion and rarely “systemic capillary leak syndrome” may appear following the chemotherapy in cancer patients. Although it is supposed that some cytokines are associated with the development of these problems, there is no clear evidence for the relation between the cause and the effect. In this study, the relation between some symptoms following the first chemotherapy in cancer patients and the serum levels of interleukin-2 (IL- 2), interleukin-11 (IL-11), tumor necrosis factor alpha (TNF-a) and vascular endothelial growth factor (VEGF) which are supposed to cause these symptoms was investigated. Methods: Forty-four (28 male and 18 female) patients with cancer who had no heart, lung or renal diseases were consecutively enrolled to this study. Twenty-nine patients (27 with lung cancer, 1 with locally advanced gastric and 1 with pancreatic carcinoma) had active tumors. Fifteen patients (11 with breast cancer, 2 with gastric carcinoma, 1 with colon carcinoma, 1 with ovarian cancer) had no tumor because they were just curatively operated. Patients’ symptoms and findings due to chemotherapy were noted just before the chemotherapy and 24 hours later following chemotherapy. Patients’ serum samples were taken for the measurement of VEGF, TNF, IL-2 and IL-11 levels. Results: Any relation between the chemotherapeutic drugs and the symptoms or findings such as edema, dyspnea, cough and flu-like syndrome in patients were not observed. Otherwise, there were no relation with response to the chemotherapy and serum levels of VEGF, TNF, IL-2 and IL-11. But, patients who were not treated with paclitaxel, docetaxel, gemcitabine and vinorelbine showed a significant decrease in their IL-11 levels (p: 0.006). Conclusions: There was no statistically important difference between chemotherapeutics in terms of cytokine related effects. Although, there was no relation with response to the chemotherapy and serum cytokine levels, serum IL-11 levels were stable in patients administered with paclitaxel, docetaxel, gemcitabine and vinorelbine when compared with other drugs.

No significant financial relationships to disclose.

The effect of venous thromboembolism on survival of cancer patients and its relationship with serum levels of factor VIII and vascular endothelial growth factor: a prospective matched-paired study

BACKGROUND

Venous thromboembolism (VT) increases mortality and morbidity in cancer patients. The primary aim of this study was to evaluate the effect of VT on the survival of cancer patients and its relationship with serum vascular endothelial growth factor (VEGF) and plasma factor VIII levels.

PATIENTS AND METHODS

Eighty-two patients with locally advanced or metastatic cancer were included in this study between September 2001 and March 2004, and 31 of them had VT. Fifty-one matched-paired cancer patients without VT were prospectively selected as a control group in the same period. Criteria for the selection of control group patients were having the same malignancy, stage, metastatic site, performance status and age (+/-5 years) as patients in the VT group.

RESULTS

Plasma factor VIII and serum D-dimer levels in the VT group were significantly higher than those in the control group (p=0.030 and p=0.016, respectively). However, mean serum VEGF levels were similar in both groups (p=0.199). In the VT group, the median survival of patients who had higher serum VEGF levels (>150 pg/mL) was significantly shorter than that of patients in the same group with lower serum VEGF levels (p=0.005). The median survival of the VT group was 14 months, whereas it was 25 months in the control group (p=0.199).

CONCLUSION

There was a worse prognostic trend for cancer patients with VT. Nevertheless, the difference in survival was not statistically significant between the groups. Plasma factor VIII and serum D-dimer levels might have prognostic value in cancer patients with VT. Cancer patients with VT and higher serum VEGF levels had a significantly poorer prognosis.

Double superior vena cava

Duplication of superior vena cava (SVC) is a rare anomaly. The incidence of double SVC in general population is 0.3% whereas in patients with congenital heart disease it varies between 10-11%. Double SVC cases have clinical importance if especially the one on the left side drains into the left atrium. Moreover, double SVC is surgically important in the presence of congenital heart disease. In this article, we presented adult patients who incidentally diagnosed with double SVC, one drained into the right atrium while the other into the left atrium and discussed the embryologic basis of these patent vessels.