Orthopedic surgery relieves breast cancer metastases

Results of a review demonstrate the key role orthopedic surgery can play in the care of breast cancer patients with bone metastases.

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Infrared therapy could help prevent anal cancer in HIV-positive population

Infrared coagulopathy treatment of a potential precursor of anal cancer is effective and warrants further study as a way to reduce anal cancer incidence and mortality among HIV-infected people, report researchers.

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Regorafenib phase III results strongly support use in GIST

Regorafenib is effective for patients with gastrointestinal stromal tumors who have failed to respond to treatment with imatinib and sunitinib, trial results show.

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A case of parosteal osteosarcoma with a rare complication of myositis ossificans

We report the case of a parosteal osteosarcoma of the distal ulna, treated with wide resection without reconstruction. The patient developed lung metastasis and a mass in the interosseus membrane of the forearm proximally to the osteotomy. The lung mass was found to be a metastasis from parosteal osteosarcoma and the biopsy of the forearm mass revealed a myositis ossificans. The suspicion of a recurrence of parosteal osteosarcoma, already metastatic, led to a second wide resection with no reconstruction. A slice of the radial cortex was taken during this second procedure. From a histological point of view, good margins were achieved and diagnosis of myositis ossificans was confirmed. Two months later, a radius fracture occurred and a synthesis, with plate and screws, as added with poly(methyl methacrylate) (PMMA) to reconstruct the bone loss, was performed. Indication of the reconstructive technique and the complication after distal ulna resection in oncologic surgery are discussed in this paper.

via World Journal of Surgical Oncology

Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes

Background: Skin-sparing mastectomy (SSM) and latissimus dorsi (LD) flap immediate breast reconstruction (IBR) is a tailored surgical procedure. The surgical and patient-reported outcome (PRO) of SSM and LD IBR were assessed. Methods: Retrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent) as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group), and analysis was done to identify factors affecting the highest patient satisfaction. Results: The mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%), ductal carcinoma in situ (n = 15, 23.1%), and others (n = 2, 3.1%). One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%), scarring (n = 8, 12.3%), and back pain (n = 6, 9.2%). Fifty patients (76.9%) were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P <0.001), nipple cosmesis (P <0.001), visual difference of bilateral breasts (P = 0.021), and panel assessment score (P <0.001) were factors that affected the highest patient satisfaction. Conclusions: Our SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient's expectation.

via World Journal of Surgical Oncology

A randomized, double-blind, placebo-controlled phase 2 study evaluating the efficacy and safety of romiplostim treatment of patients with low or intermediate-1 risk myelodysplastic syndrome receiving lenalidomide

Background: Lenalidomide treatment in myelodysplastic syndrome (MDS) may lead to thrombocytopenia and dose reductions/delays. This study evaluated the safety and tolerability of the thrombopoietin mimetic romiplostim and its effects on the incidence of clinically significant thrombocytopenic events (CSTEs) in lower risk MDS patients receiving lenalidomide. Methods: Patients were assigned to weekly placebo (n = 12) or romiplostim 500 mug (n = 14) or 750 mug (n = 13) for four 28-day lenalidomide cycles. Results: The treatment groups were generally similar with respect to baseline disease characteristics. Del(5q) abnormalities were noted in 1 (8%) patient in the placebo group, 3 (21%) in the romiplostim 500 mug group, and two (15%) in the 750 mug group. CSTEs were noted in 8 (67%) patients in the placebo group, 4 (29%) in the romiplostim 500 mug group, and 8 (62%) in the romiplostim 750 mug group. Throughout the study, median platelet counts trended lower in placebo-treated than in romiplostim-treated patients. Thrombocytopenia-related adjustments in lenalidomide occurred in 6 (50%) patients in the placebo group, 5 (36%) in the romiplostim 500 mug group, and 2 (15%) in the 750 mug group. Although the percentages of patients who received platelet transfusions were similar across treatment groups, there was a trend toward lower numbers of transfusions in both romiplostim groups during each treatment cycle. There were two serious treatment-related adverse events during the treatment period (cerebrovascular accident, placebo; worsening thrombocytopenia, romiplostim 500 mug). Two patients (romiplostim 500 and 750 mug, respectively) had an increase in bone marrow blasts to >20% during treatment, but had no post-treatment biopsy to confirm or exclude the diagnosis of progression to AML. Conclusions: These data suggest that romiplostim administered to MDS patients during lenalidomide treatment may decrease the frequency of dose reductions/delays due to thrombocytopenia. Additional study is needed to confirm the results of this preliminary trial.Trial registrationClinicalTrials.gov NCT00418665.

via Journal of Hematology & Oncology

Pulmonary influences on early post-operative recovery in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment: a retrospective study

Background: The combination of cytoreductive surgery (CRS) and hyperthermic intraperitonealchemotherapy (HIPEC) is a curative treatment option for peritoneal carcinomatosis (PC).There have been few studies on the pulmonary adverse events (AEs) affecting patientrecovery after this treatment, thus this study investigated these factors. Methods: Between January 2005 and December 2006, clinical data on all pulmonary AEs and therecovery progress were reviewed for 76 patients with after CRS and HIPEC. Patients withpulmonary interventions (thoracocenthesis and chest tubes) were compared with the noninterventionpatients. Two senior radiologists, blinded to the post-operative clinical course,separately graded the occurrence of pulmonary AEs. Results: Of the 76 patients, 6 had needed thoracocentesis and another 6 needed chest tubes. Therewere no differences in post-operative recovery between the intervention and non-interventiongroups. The total number of days on mechanical ventilation, the length of stay in theintensive care unit, total length of hospital stay, tumor burden, and an American Society ofAnesthesiologists (ASA) grade of greater than 2 were correlated with the occurrence ofatelectasis and pleural effusion. Extensive atelectasis (grade 3 or higher) was seen in sixpatients, major pleural effusion (grade 3) in seven patients, and signs of heart failure (grade1-2) in nine patients. Conclusions: Clinical and radiological post-operative pulmonary AEs are common after CRS and HIPEC.However, most of the pulmonary AEs did not affect post-operative recovery.

via World Journal of Surgical Oncology

Gastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases

Background: Despite marked decreases in its incidence, particularly in developed countries, gastric cancer is still the second most common tumor worldwide. There is a paucity of information regarding gastric cancer in northwestern Tanzania. This study was undertaken to describe our experience, in our local setting, on the management of gastric cancer, outlining the clinicopathological and treatment outcome of these patients and suggesting ways to improve the treatment outcome. Methods: This was a retrospective study of histologically confirmed cases of gastric cancer seen at Bugando Medical Centre between January 2007 and December 2011. Data were retrieved from patients' files and analyzed using SPSS computer software version 17.0. Results: A total of 232 gastric cancer patients were enrolled in the study, representing 4.5% of all malignancies. The male to female ratio was 2.9:1. The median age of patients was 52 years. The majority of the patients (92.1%) presented late with advanced gastric cancer (Stages III and IV). Lymph node and distant metastasis at the time of diagnosis was recorded in 31.9% and 29.3% of cases, respectively. The antrum was the most frequent anatomical site (56.5%) involved and gastric adenocarcinoma (95.1%) was the most common histopathological type. Out of 232 patients, 223 (96.1%) patients underwent surgical procedures for gastric cancer of which gastro-jejunostomy was the most frequent performed surgical procedure, accounting for 53.8% of cases. The use of chemotherapy and radiotherapy was documented in 56 (24.1%) and 12 (5.1%) patients, respectively. Postoperative complication and mortality rates were 37.1% and 18.1%, respectively. According to multivariate logistic regression analysis, preoperative co-morbidity, histological grade and stage of the tumor, presence of metastases at the time of diagnosis was the main predictors of death (P <0.001). At the end of five years, only 76 (32.8%) patients were available for follow-up and the overall five-year survival rate was 6.9%. Evidence of cancer recurrence was reported in 45 (19.4%) patients. Positive resection margins, stage of the tumor and presence of metastasis at the time of diagnosis were the main predictors of local recurrence (P <0.001). Conclusions: Gastric cancer in this region shows a trend towards relative young age at diagnosis and the majority of patients present late with an advanced stage. Lack of awareness of the disease, poor accessibility to health care facilities and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment and proper follow-up to improve treatment outcome.

via World Journal of Surgical Oncology

Tivantinib holds personalized therapy promise in HCC

Tivantinib is an effective second-line therapy for hepatocellular carcinoma patients whose tumors exhibit high MET receptor tyrosine kinase expression, indicate phase II study results.

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Breast cancer overdiagnosis concerns for USA

Around a third of screening-detected breast cancers in US women in 2008 may have been overdiagnosed, suggests research published in The New England Journal of Medicine.

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Tomosynthesis plus digital mammography improves cancer detection, reduces recall rates

Tomosynthesis imaging may improve breast cancer detection while reducing recall rates at mammographic screening, say researchers.

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Nonfunctional MED12 gene linked to chemotherapy resistance

Research published in Cell shows that people with tumors that have a nonfunctional version of the mediator 12 gene are resistant to drugs used to treat lung and colon cancer such as gefitinib.

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Invasive ductal breast cancer metastatic to the sigmoid colon

The most common sites of breast cancer metastasis are the bone, lung, liver and brain.However, colonic metastases from breast cancer are very rare in the clinic. We describe anunusual case of sigmoid colonic metastasis from invasive ductal breast cancer. With thisreport, we should increase the clinical awareness that any patient with a colorectal lesion anda history of malignancy should be considered to have a metastasis until proven otherwise.Early diagnosis is very important, which enables prompt initiation of systemic treatment,such as chemotherapy, endocrine therapy or both, thus avoiding unnecessary radical surgicalresection and improving the prognosis.

via World Journal of Surgical Oncology

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Background: Transanal endoscopic microsurgery as a local therapy option for rectal neoplasms is a tissuesparingtechnique that protects the anal sphincter. The present retrospective analysis reportsthe course of observation after local excision of adenomas and T1 low-risk carcinomas usingtransanal endoscopic microsurgery. Methods: In a retrospective analysis we examined data on 279 patients for local recurrence. A total of144 patients had a rectal adenoma (n = 103) or a R0 resection of low-risk T1 carcinomas (n =41). In this collective, we also examined parameters concerning perioperative management,complications, intraoperative blood loss and duration of hospital stay. Results: Patients with adenoma were on average 64.9 (range 37 to 90) years old; 83.5% of theadenomas were located 3 to 11 cm from the anocutaneous line. In adenoma patients therecurrence rate was 2.9% for an observation period of 21.8 months. The postoperative coursewas without any complications in 98.1% of patients.Patients with T1 low-risk carcinoma were 64.6 (range 30 to 89) years old. In all cases, an R0resection could be performed. The recurrence rate was 9.8% for an observation period of 34.4months. In this group the postoperative course was free of complications in 97.6% ofpatients. Conclusions: The high efficacy of transanal endoscopic microsurgery ensures minimally invasive treatmentof adenomas and low-risk T1 carcinomas with low complication rates and a low rate oftherapeutic failure.

via World Journal of Surgical Oncology

Undifferentiated-type gastric adenocarcinoma: prognostic impact of three histological types

Background: The prognostic value of the three constituents of undifferentiated-type gastric adenocarcinoma remains unclear. The present study assessed the clinicopathological characteristics and prognosis of undifferentiated-type mucinous adenocarcinoma (uMAC) and signet ring cell carcinoma (SRC) compared with those of poorly differentiated adenocarcinoma (PDAC). Methods: In total, 1,376 patients with undifferentiated-type gastric adenocarcinoma were included, consisting of 1,002 patients diagnosed with PDAC, 54 with uMAC and 320 with SRC. Clinicopathological factors and survival rates were compared among the three histological types. Results: Significant differences in the distribution of pathological stages were observed among the groups. Patients with SRC had a significantly better survival rate than those with PDAC or uMAC, in both the all patients including non-curative resected patients and curative-resected groups. In addition, there was significant difference in survival between the PDAC and uMAC groups. Multivariate analysis suggested that age, gender, tumor depth, lymph node metastasis and curability significantly affected survival. Histological type was not an independent prognostic factor. There was no significant difference in the pattern of recurrence among the three groups. Conclusions: The uMAC and SRC had worse and favorable prognosis compared with PDCA, respectively. However, there were no differences in survival by pathological stage, thus histological type was not an independent predictor of prognosis.

via World Journal of Surgical Oncology

Algae extracts and methyl jasmonate anti-cancer activities in prostate cancer: choreographers of 'the dance macabre'

There is an overwhelmingly increasing trend of analysis of naturally occurring ingredients in treatment of prostate cancer. Substantial fraction of information has been added that highlights activity at various levels and steps of deregulated cellular proliferation, metastasis and apoptosis. Among such ingredients, algae extracts and jasmonates are documented to have anti-cancer activity in vitro and in vivo and induce growth inhibition in cancer cells, while leaving the non-transformed cells intact. In this short review we outline systematically, how these ingredients predispose prostate cancer cells to undergo apoptosis.

via Cancer Cell International

Lycorine induces cell-cycle arrest in the G0/G1 phase in K562 cells via HDAC inhibition

Background: Lycorine, a natural alkaloid extracted from Amaryllidaceae, has shown various pharmacological effects. Recent studies have focused on the potential antitumor activity of lycorine. In our previous study, we found that lycorine decrease the cell viability of leukemia HL-60 cells and multiple myeloma KM3 cells and induces cell apoptosis. However, the effect and molecular mechanism of lycorine on human chronic myelocytic leukemia cells has yet to be determined. Methods: Human chronic myelocytic leukemia cells K562 were treated with lycorine. Cell viability was monitored using the method of CCK-8. The HDAC enzymatic activity was detected by HDAC colorimetric assay, and the cell cycle was analyzed by flow cytometry. The expression of cell-cycle related proteins were identified using Western blot. Results: In the present study, we further revealed that lycorine can inhibit the proliferation of K562 cells. Analysis of histone deacetylase (HDAC) activity showed that lycroine decreases HDAC enzymatic activities in K562 cells in a dose-dependent manner. Inhibition of HDAC activity has been associated with cell-cycle arrest and growth inhibition. We evaluated the cell cycle distribution after lycorine treatment and found that lycorine causes cell-cycle arrest in the G0/G1 phase. To investigate the mechanism behind this cell cycle arrest, G1-related proteins were assayed by Western blot. After lycorine treatment, cyclin D1 and cyclin-dependent kinase 4 expressions were inhibited and retinoblastoma protein phosphorylation was reduced. Lycorine treatment also significantly upregulated the expression of p53 and its target gene product, p21. Conclusions: These results suggest that inhibition of HDAC activity is responsible for at least part of the induction of cell-cycle arrest in the G0/G1 phase by lycorine and provide a mechanistic framework for further exploring the use of lycorine as a novel antitumor agent.

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Inhibition of breast cancer cell proliferation in repeated and non-repeated treatment with zoledronic acid

Background: Zoledronic acid is used to treat bone metastases and has been shown to reduce skeletal-related events and exert antitumor activity. The present in vitro study investigates the mechanism of action of Zoledronic Acid on breast cancer cell lines with different hormonal and HER2 patterns. Furthermore, we investigated the efficacy of repeated versus non-repeated treatments. Methods: The study was performed on 4 breast cancer cell lines (BRC-230, SkBr3, MCF-7 and MDA-MB-231). Non-repeated treatment (single exposure of 168 hrs' duration) with zoledronic acid was compared with repeated treatment (separate exposures, each of 48 hrs' duration, for a total of 168 hrs) at different dosages. A dose--response profile was generated using sulforhodamine B assay. Apoptosis was evaluated by TUNEL assay and biomolecular characteristics were analyzed by western blot. Results: Zoledronic acid produced a dose-dependent inhibition of proliferation in all cell lines. Anti-proliferative activity was enhanced with the repeated treatment, proving to be statistically significant in the triple-negative lines. In these lines repeated treatment showed a cytocidal effect, with apoptotic cell death caused by caspase 3, 8 and 9 activation and decreased RAS and pMAPK expression. Apoptosis was not observed in estrogen receptor-positive line: p21 overexpression suggested a slowing down of cell cycle. A decrease in RAS and pMAPK expression was seen in HER2-overexpressing line after treatment. Conclusions: The study suggests that zoledronic acid has an antitumor activity in breast cancer cell lines. Its mechanism of action involves the decrease of RAS and RHO, as in osteoclasts. Repeated treatment enhances antitumor activity compared to non-repeated treatment. Repeated treatment has a killing effect on triple-negative lines due to apoptosis activation. Further research is warranted especially in the treatment of triple-negative breast cancer.

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Temsirolimus effective for mRCC patients on hemodialysis

Research findings published in the International Journal of Clinical Oncology suggest that temsirolimus effectively stabilizes disease progression in patients with metastatic renal cell carcinoma undergoing hemodialysis.

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Tumour burden predicts prognosis in mRCC

Tumor burden plays an independent prognostic and predictive role in metastatic renal cell carcinoma, a clinical trial shows.

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Tumors 'not always greatest mortality risk in RCC patients'

Patients with localized solid kidney tumors may be at greater risk for death from non-cancer-related causes before that from disease progression and cancer-related mortality, say US researchers who developed a comorbidity-based risk prediction model.

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Perfusion of renal masses on MR corresponds to histopathologic diagnosis

A magnetic resonance imaging technique that uses blood as a contrast medium is able to distinguish between different histopathologic diagnoses of solid renal masses based on their perfusion level, claims a team of scientists.

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Factors influencing pain in head and neck cancer patients clarified

Individuals with head and neck cancer frequently report pain 1 year after diagnosis, despite being treated with analgesics, show US study results.

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Colorectal cancer patient siblings ‘deserve screening’

Colorectal cancer screening should be offered to the siblings of affected patients, recommends a team of researchers from Hong Kong.

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Assessment of cervical lymph node metastasis for therapeutic decision-making in squamous cell carcinoma of buccal mucosa: a prospective clinical analysis

Background: Cervical metastasis has a tremendous impact on the prognosis in patients with carcinomas of the head and neck and the frequency of such spread is greater than 20% for most squamous cell carcinomas. With emerging evidence, focus is shifting to conservative neck procedures aimed at achieving good shoulder function without compromising oncologic safety. The purpose of this study was to analyze the pattern of nodal metastasis in patients presenting with squamous cell carcinoma of buccal mucosa.Materials and MethodsThis was a prospective clinical analysis of patients who were histologically diagnosed with squamous cell carcinoma of the buccal cavity and clinically N1 and had not received treatment anywhere else. Patients were analyzed for age and sex distribution, tumor staging, location, and metastasis. Results: The incidence of metastatic lymph node in T4 (n=44) was the highest, that is, level I was 100% (44/44), level II was 43.18% (19/44), level III was 15.90% (7/44), and level IV was 4.5% (2/44). Level V was free of metastasis. Among T3 (n=10) lesions, incidence of metastasis in level I was 100% (10/10), level II was 20% (2/10), and level III, IV, and V were free of metastasis. Among T2 (n=6) lesions, incidence of lymph node metastasis in level I was 100% (6/6) and all other levels of lymph nodes were found free of metastasis. Conclusion: Lymphatic spread from carcinoma of the buccal mucosa is low. Involvement of level IV is seen in only 3% of patients. A more conservative approach to the neck in patients with carcinoma of the buccal mucosa is recommended.

via World Journal of Surgical Oncology

Exercise relieves cancer fatigue

A review of studies spanning 45 years shows that exercise, particularly aerobic rather than strength- or flexibility-based training, improves fatigue in cancer patients.

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Watch-and-wait approach feasible following adjuvant therapy for rectal cancer

Patients with rectal cancer managed conservatively following a complete response to chemoradiotherapy achieve similar rates of disease control as those who undergo rectal resection, research shows.

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Novel cancerization marker, TP53, and its role in distinguishing normal tissue adjacent to cancerous tissue from normal tissue adjacent to benign tissue

Background: The histopathological and molecular heterogeneity of normal tissue adjacent to cancerous tissue (NTAC) and normal tissue adjacent to benign tissue (NTAB), and the availability of limited specimens make deciphering the mechanisms of carcinogenesis challenging. Our goal was to identify histogenetic biomarkers that could be reliably used to define a transforming fingerprint using RNA in situ hybridization. Methods: We evaluated 15 tumor-related RNA in situ hybridization biomarkers using tumor microarray and samples of seven tumor-adjacent normal tissues from 314 patients. Biomarkers were determined using comprehensive statistical methods (significance of support vector machine-based artificial intelligence and area under curve scoring of classification distribution). Results: TP53 was found to be a most reliable index (P <10-7; area under curve >87%) for distinguishing NTAC from NTAB, according to the results of a significance panel (BCL10, BECN1, BRCA2, FITH, PTCH11 and TP53). Conclusions: The genetic alterations in TP53 between NTAC and NTAB may provide new insight into the field of cancerization and tumor transformation.

via World Journal of Surgical Oncology

A pure invasive cribriform carcinoma of the breast with bone metastasis if untreated for thirteen years: a case report and literature review

We report a case of pure invasive cribriform carcinoma of the breast, which had been untreated for thirteen years, being found with bone metastasis at initial presentation, because distant metastasis is rarely found in this tumor. A fifty-nine-year-old postmenopausal woman presented with a large left breast mass. Although she had noticed a lump in a left breast thirteen years ago, she had not sought treatment. The tumor had enlarged gradually since from one year before and become ulcerated. The two enlarged axillary lymph nodes were also palpable. After two cycles of neoadjuvant chemotherapy, she underwent left radial mastectomy with a free skin graft. Emission computed tomography result has confirmed bone metastasis. The histological diagnosis of the tumor revealed the pure invasive cribriform carcinoma, since over than ninety percent of invasive tumor components showed a characteristic cribriform growth, and the remainder was tubular carcinoma. She has been well without evidence of tumor recurrence for seven years after surgery and several routine postoperative therapies. Although with favorable prognosis, pure invasive cribriform carcinoma is still possible to develop into the advanced (Stage four) breast cancer if untreated for a long time. However, the survival of this patient for free disease after several locoregional and systemic therapies maybe provide a supplement for invasive cribriform carcinoma's excellent prognosis.

via World Journal of Surgical Oncology

Study of treatment using percutaneous acetabuloplasty and interstitial implantation of 125I seeds for patients with metastatic periacetabular tumors

Background: The periacetabular area is one of the primary sites of metastatic tumors, which often present as osteolytic bone destruction. Bone destruction in the acetabulum caused by metastatic tumors will cause hip pain and joint dysfunction. It results in decreased quality of life for patients. The aim of our study was to explore the clinical effect of metastatic periacetabular tumors treated with percutaneous cementoplasty and interstitial implantation of 125I seeds. Methods: A retrospective analysis was performed on 24 patients with metastatic periacetabular tumors who underwent combined therapy of percutaneous acetabuloplasty and interstitial implantation of 125I seeds between February 2003 and June 2011. There were 13 males and 11 females aged 19--80 years with a mean age of 57.3. The primary tumor site was the lung in eight cases, the breast in six, the prostate cancer in eight, and the liver in two. The amount of implanted 125I seeds was 12--20 seeds/person, with a mean of 16.5 seeds/person, and the matching peripheral dosage (MPD) was 80~100Gy. Routine postoperative chemotherapy and other combined treatments were applied to patients after the surgical operation. Changes in the Karnofsky Score(KPS), Harris Hip Score(Harris), and Visual Analog Scale(VAS) were observed during the follow-up period. Results: The 24 patients' operations were all successful. No major complications occurred. Complete pain relief was achieved in 58% (14 of 24) of patients, and pain reduction was achieved in the 42% remaining (10) patients. The mean duration of pain relief was 8.3 months. Pain recurred in one patient 3 months after surgery. Six patients had died and 18 patients were alive at the time of the 1-year follow-up. Comparing the KPS, Harris and VAS scores pre- and postoperativelyat 1, 6, and 12 months, the combined therapy method was significantly effective in metastatic periacetabular tumor patients (P<0.05). Conclusions: Percutaneous cementoplasty with interstitial implantation of 125I seeds is an effective treatment method for metastatic periacetabular tumor patients,providing tumor resistance, pain relief, increased bone stability, and improved quality of life for patients.

via World Journal of Surgical Oncology

Bevacizumab ruled out for stage III colorectal cancer

Findings from the AVANT trial do not support the use of bevacizumab in patients receiving oxaliplatin-based chemotherapy for resected stage III or high-risk stage II colon carcinoma.

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Improvement of the surgical curability of locally confined prostate cancer including non-organ-confined high-risk disease through retropubic radical prostatectomy with intentional wide resection

Background: Retropubic radical prostatectomy with intentional wide resection (RRP-WR), which enables clear location of the prostate apex and the performance of posterolateral wider resection to remove extraprostatic extension, was introduced to our institutions. The aim of this study is to assess the feasibility and the efficacy of RRP-WR as a surgical intervention for locally confined prostate cancer. Methods: A total of 90 Japanese patients with pathologically proven and clinically locally confined hormone-naive prostate cancer were treated through RRP-WR, and the surgical morbidity was assessed. The patients were observed without immediate treatment until biochemical recurrence (BCR). Results: The surgical morbidities were comparable to conventional procedures. No positive surgical margin (pSM) was pathologically identified in pT2 cases from prostatectomy specimens. It was identified in only 14.3% of pT3a cases, 36.4% of pT3b cases and 100% of pT4 cases. No apical pSM was found except for one of the pT4 cases in the levator ani muscle. PSA was at an undetectable level in 80.0% of all cases, 90.0% of pT2 cases, and 67.5% of pT3 and pT4 cases after surgery. The BCR-free survival rate in all cases was 82.4% and that of high-risk cases without pSM was 76.9% at a median follow-up of 19.3 months (3.3 to 59.2). Conclusions: RRP-WR is feasible and effective in removing organ-confined prostate cancer as well as extraprostatic extension without pSM. Thus, it is worthwhile to evaluate if this procedure improves the clinical outcome of locally confined prostate cancer including high-risk conditions treated by surgical intervention.

via World Journal of Surgical Oncology

Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study

Background: The application of laparoscopic surgery for advanced gastric cancer (AGC) remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer without serosal invasion. Methods: From January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG) performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results. Results: There are not significant differences in clinicopathological characteristics between the two groups (P > 0.05). The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859). The mean number of resected lymph nodes (LNS) between the LAG group and OG group was similar (30.6 +/- 10.1 vs. 30.3 +/- 8.6, P = 0.786). Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05). No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05) and the survival curve after surgery between the LAG group and OG group. Conclusion: Laparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with open gastrectomy for advanced gastric cancer without serosal invasion.

via World Journal of Surgical Oncology

Vitiligo patients have low risk for skin cancer

Evidence suggests that patients with vitiligo have a reduced risk for both melanoma and nonmelanoma skin cancer.

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Fibulin-3 effective biomarker for pleural mesothelioma

Research suggests that levels of fibulin-3 in plasma and effusions may aid in determining the diagnosis and prognosis of pleural mesothelioma.

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Transcription factor expression aids stage I lung cancer prognosis

Expression of thyroid transcription factor-1 is an independent predictor for recurrence of stage I lung adenocarcinoma and allows intermediate-grade tumors to be split into two prognostic subsets, scientists have found.

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3p21.3 tumor suppressor gene RBM5 inhibits growth of human prostate cancer PC-3 cells through apoptosis

Background: Recent studies have indicated that the nuclear RNA-binding protein RBM5 has the ability to modulate apoptosis and suppress tumor growth. The aim of this study is to investigate the expression of RBM5 in human prostate cancer and its mechanism of tumor suppression. Methods: The expression of RBM5 protein in cancerous prostatic tissues and normal tissues was examined by IHC. PC-3 cell line was used to determine the apoptotic function of RBM5 in vitro. PC-3 cells were transiently transfected with pcDNA3.1-RBM5. Cell viability was determined by MTT assay. Rhodamine 123 staining and Annexin V analysis were performed to observe the apoptotic activity of PC-3 cells overexpressing RBM5. Expression of apoptosis-related genes was assessed by western blot. Results: The expression of RBM5 protein was significantly decreased in cancerous prostatic tissues compared to the normal tissues. PC-3 cells overexpressing RBM5 showed not only significant growth inhibition compared with the vector controls, but also dysfunction of mitochondrial membrane potential and increased apoptotic activity. To further define RBM5 function in apoptotic pathways, we investigated differential expression profiles of various BH3-only proteins including Bid, Bad, and Bim, and apoptosis regulatory proteins include P53, cleaved caspase9, and cleaved caspase3. We found that the expression of both BH3-only proteins and apoptosis regulatory proteins was increased in RBM5 transfected cells. Conclusion: The expression of RBM5 protein was significantly decreased in cancerous prostatic tissues, which suggests that RBM5 plays an important role in the pathogenesis of prostate cancer. RBM5 may induce the apoptosis of prostate cancer PC-3 cells by modulating the mitochondrial apoptotic pathway, and thus RBM5 might be a promising target for gene therapy on prostate cancer.

via World Journal of Surgical Oncology

Modulation of doxorubicin cytotoxicity by resveratrol in a human breast cancer cell line

Background: Breast cancer is the most common cancer in the Arab world and it ranked first among Saudi females. Doxorubicin (DOX), an anthracycline antibiotic is one of the most effective anticancer agents used to treat breast cancer. chronic cardiotoxicity is a major limiting factor of the use of doxorubicin. Therefore, our study was designed to assess the role of a natural product resveratrol (RSVL) on sensitization of human breast cancer cells (MCF-7) to the action of DOX in an attempt to minimize doxorubicin effective dose and thereby its side effects Methods: Human breast cancer cell line MCF-7, was used in this study. Cytotoxic activity of DOX was determined using (sulforhodamine) SRB method. Apoptotic cells were quantified after treatment by annexin V-FITC- propidium iodide (PI) double staining using flow-cytometer. Cell cycle disturbance and doxorubicin uptake were determined after RSVL or DOX treatment. Results: Treatment of MCF-7 cells with 15 mug/ml RSVL either simultaneously or 24 h before DOX increased the cytotoxicity of DOX, with IC50 were 0.056 and 0.035 mug/ml, respectively compared to DOX alone IC50 (0.417 mug/ml). Moreover, flow cytometric analysis of the MCF-7 cells treated simultaneously with DOX (0.5 mug/ml) and RSVL showed enhanced arrest of the cells in G0 (80%). On the other hand, when RSVL is given 24 h before DOX although there was more increased in the cytotoxic effect of DOX against the growth of the cells, however, there was decreased in percentage arrest of cells in G0, less inhibition of DOX-induced apoptosis and reduced DOX cellular uptake into the cells. Conclusion: RSVL treatment increased the cytotoxic activity of DOX against the growth of human breast cancer cells when given either simultaneously or 24 h before DOX.

via Cancer Cell International

Colon cancer risk: Supplements no substitute for dietary fiber

Dietary supplementation with resistant starch does not reduce long-term colorectal cancer risk in patients with Lynch syndrome, shows the CAPP2 study.

via Med Wire News

Gene therapy shows promise against dry mouth in cancer patients

Injecting an adenoviral vector encoding human aquaporin-1 into the parotid glands of head and neck cancer survivors improves their symptoms of dry mouth induced by radiation therapy, show study results.

via Med Wire News

Clinical Practice Guidelines for Patients with Gastrointestinal Stromal Tumor in Taiwan

.For many years, the understanding of gastrointestinal stromal tumors (GISTs), which are the most common mesenchymal tumors of the gastrointestinal tract, had been very limited. However, we are now able to provide a more precise definition through the use of pathology classification and molecular techniques. Coupled with the advancement of clinical practice, especially the development of targeted therapy, insight into GIST treatment has improved substantially. At present, organizations such as the National Comprehensive Cancer Network (NCCN) in the USA and the European Society for Medical Oncology (ESMO) have established consensus and drawn up guidelines for the diagnosis, treatment, and follow-up of GISTs.The Taiwan Surgical Society of Gastroenterology convened a group of multidisciplinary experts from across the country and drafted the first national GIST management guidelines in 2007 after a consensus meeting. Following subsequent treatment advances and the growing knowledge in tumor biology, the Taiwan Surgical Society of Gastroenterology experts have conducted a series of meetings to review newer evidence and made modifications to the original guidelines. We herein present the updated recommendations of the Taiwan Surgical Society of Gastroenterology for the diagnosis and treatment of GIST patients. We hope the guidelines can help enhance the quality of diagnosis, treatment and care of GIST patients in Taiwan.

via World Journal of Surgical Oncology

Myxofibrosarcoma of the sinus piriformis: case report and literature review

Myxofibrosarcoma is a common sarcoma in the extremities of older people, but is rare in thehead and neck region. Here, we report the case of a 42-year-old male patient in whommyxofibrosarcoma generated from the sinus piriformis. Histopathologically, the tumor wascharacterized by spindle cellular proliferation with moderate cellular density in fibromyxoidstroma. Immunohistochemically, the tumor cells showed positive reactivity for vimentin, Ki-67, smooth muscle actin, and CD34, but negative staining for S-100. Based on these results,the tumor was diagnosed as a low-grade myxofibrosarcoma. Resection of the tumor wasperformed via a transcervical approach. The patient's postoperative clinical course wasuneventful and no local recurrence or distant metastasis has been found so far. The pathology,clinical characteristics, and treatment of myxofibrosarcoma are also reviewed.

via World Journal of Surgical Oncology

Lgr5 is a potential marker of colorectal carcinoma stem cells that correlates with patient survival

Background: Lgr5 (leucine-rich-repeat-containing G-protein-coupled receptor 5) has recently beenidentified as an intestinal stem cell marker. In order to determine whether Lgr5 is a potentialmarker of cancer stem cells, we investigated whether Lgr5 expression correlated with Ki-67expression and prognosis in colorectal carcinoma. Methods: Lgr5 and Ki-67 expression were evaluated by immunohistochemistry in 192 colorectalcarcinoma specimens. Selection of side population (SP) cells was performed by staining withHoechest 33342, and Lgr5 expression in Colo205 SP cells was then detected byimmunofluorescence. Results: Lgr5 expression was significantly higher in carcinoma than in normal mucosa (P=0.001).Lgr5 was positively correlated with histological grade (P=0.001), depth of invasion(P=0.001), lymph node metastasis (P=0.001), distant metastasis (P=0.004), pTNM stage(P=0.001), and Ki-67 (r=0.446, P=0.001). Multivariate analysis showed that the effect ofLgr5 on survival was independent of Ki-67 (P=0.037). In the in vitro study, Hoechst lowstainingcells were counted in 7% of the Colo205 colon cancer cell line population, and Lgr5expression was strikingly stronger in Hoechst low-staining cells than in high-staining cells(P=0.001). Conclusions: These findings suggest that Lgr5 may play an important role in the progression and prognosisof colorectal carcinoma, and may be a potential new therapeutic target for the treatment ofcolorectal cancer patients. It may also be considered as a potential marker for colorectalcancer stem cells (CSCs).

via World Journal of Surgical Oncology

Cycloartane-3,24,25-triol inhibits MRCKalpha kinase and demonstrates promising anti prostate cancer activity in vitro

Background: Given the high occurrence of prostate cancer worldwide and one of the major sources of the discovery of new lead molecules being medicinal plants, this research undertook to investigate the possible anti-cancer activity of two natural cycloartanes; cycloartane-3,24,25-diol (extracted in our lab from Tillandsia recurvata) and cycloartane-3,24,25-triol (purchased). The inhibition of MRCKalpha kinase has emerged as a potential solution to restoring the tight regulation of normal cellular growth, the loss of which leads to cancer cell formation. Methods: Kinase inhibition was investigated using competition binding (to the ATP sites) assays which have been previously established and authenticated and cell proliferation was measured using the WST-1 assay. Results: Cycloartane-3,24,25-triol demonstrated strong selectivity towards the MRCKalpha kinase with a Kd50 of 0.26 muM from a total of 451 kinases investigated. Cycloartane-3,24,25-triol reduced the viability of PC-3 and DU145 cell lines with IC50 values of 2.226 +/- 0.28 muM and 1.67 +/- 0.18 muM respectively. Conclusions: These results will prove useful in drug discovery as Cycloartane-3,24,25-triol has shown potential for development as an anti-cancer agent against prostate cancer.

via Cancer Cell International

Adding bortezomib ‘boosts acute myeloid leukemia chemotherapy response’

Older patients with untreated acute myeloid leukemia may benefit from having bortezomib added to daunorubicin and cytarabine during induction therapy and to consolidation intermediate-dose cytarabine, the results of a US study indicate.

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Unique functions of CHK1 and WEE1 underlie synergistic anti-tumor activity upon pharmacologic inhibition

Background: Inhibition of kinases involved in the DNA damage response sensitizes cells to genotoxic agents by abrogating checkpoint-induced cell cycle arrest. CHK1 and WEE1 act in a pathway upstream of CDK1 to inhibit cell cycle progression in response to damaged DNA. Therapeutic targeting of either CHK1 or WEE1, in combination with chemotherapy, is under clinical evaluation. These studies examine the overlap and potential for synergy when CHK1 and WEE1 are inhibited in cancer cell models. Methods: Small molecules MK-8776 and MK-1775 were used to selectively and potently inhibit CHK1 and WEE1, respectively. Results: In vitro, the combination of MK-8776 and MK-1775 induces up to 50-fold more DNA damage than either MK-8776 or MK-1775 alone at a fixed concentration. This requires aberrant cyclin-dependent kinase activity but does not appear to be dependent on p53 status alone. Furthermore, DNA damage takes place primarily in S-phase cells, implying disrupted DNA replication. When dosed together, the combination of MK-8776 and MK-1775 induced more intense and more durable DNA damage as well as anti-tumor efficacy than either MK-8776 or MK-1775 dosed alone. DNA damage induced by the combination was detected in up to 40% of cells in a treated xenograft tumor model. Conclusions: These results highlight the roles of WEE1 and CHK1 in maintaining genomic integrity. Importantly, the strong synergy observed upon inhibition of both kinases suggests unique yet complimentary anti-tumor effects of WEE1 and CHK1 inhibition. This demonstration of DNA double strand breaks in the absence of a DNA damaging chemotherapeutic provides preclinical rationale for combining WEE1 and CHK1 inhibitors as a cancer treatment regimen.

via Cancer Cell International

Intraoperative portable ultrasonography localization of clinically impalpable soft-tissue tumors

Background: Most soft-tissue tumors are clinically palpable; however, some can be impalpable to clinical examination making it difficult to plan surgical management. Methods: We present a simple method of perioperative tumor localization using a portable ultrasonography machine. Results: We used the technique for seven cases, on each occasion identifying the tumor and facilitating the optimal surgical approach. Conclusion: The technique is reproducible and readily available, and we recommend its use.

via World Journal of Surgical Oncology

Expression of AQP5 and AQP8 in human colorectal carcinoma and their clinical significance

Background: The aquaporins (AQPs) are a family of small membrane transport proteins whose overexpression has been implicated in tumorigenesis. However, the expression of AQP5 and AQP8 in colorectal cancer and the clinical significance remain unexplored. This study aimed to detect the expression of AQP5 and AQP8 in clinical samples of colorectal cancer and analyze the correlations of their expression with the clinicopathological features of colorectal cancer. Methods: Forty pairs of colorectal cancer tissue and paraneoplastic normal tissue were obtained at the time of surgery from patients with colorectal cancer. The expression of AQP5 and AQP8 was detected by immunohistochemical staining and reverse transcriptase polymerase chain reaction. Results: AQP5 was mainly expressed in colorectal carcinoma cells and barely expressed in paraneoplastic normal tissues. By contrast, AQP8 was mainly expressed in paraneoplastic normal tissues and barely expressed in colorectal carcinoma cells. AQP5 expression was not significantly associated with the sex or age of the patient with colorectal cancer (P>0.05), but was closely associated with the differentiation, tumor-nodes-metastasis stage and distant lymph node metastasis of colorectal carcinoma (P<0.05). Conclusions: AQP5 might be a novel prognostic biomarker for patients with colorectal cancer.

via World Journal of Surgical Oncology

Mastoscopic axillary lymph node dissection ‘preferred choice’

Long-term study findings support the use of mastoscopic axillary lymph node dissection for women with operable breast cancer.

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Ultrasound-guided transbronchial needle aspiration complication rate ‘reassuring’

Multisite findings support the use of endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph node sampling.

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Laparoscopic spleen-preserving No.10 lymph node dissection for advanced proximal gastric cancer in left approach: a new operation procedure

Background: To explore the feasibility of laparoscopic spleen-preserving No.10 lymph node dissection in aleft-sided approach for advanced proximal gastric cancer. Methods: The clinical data of 32 patients with advanced proximal gastric cancer who underwentlaparoscopic spleen-preserving No.10 lymph node dissection from June 2010 to December2011 were analyzed. Results: Laparoscopic spleen-preserving No.10 lymph node dissection using a left-sided approach wassuccessfully performed for all patients without open conversion. The mean operation timewas 206.4+/-54.3 minutes, mean intraoperative blood loss was 68.2+/-34.1 ml, mean number ofNo.10 lymph nodes dissected was 2.8+/-2.1, mean number of positive No.10 lymph nodes was0.6+/-1.2, and the incidence of No.10 lymph node metastasis was 11.6 %. The meanpostoperative hospital stay was 11.3+/-1.5 days. The postoperative morbidity rate was 9.4 %,and there was no postoperative death. Splenic lobar vessels of all 32 patients wereanatomically classified and divided into three types: 4 patients had a single lobar vessel, 22had two lobar vessels and 6 had three lobar vessels. . Conclusions: Laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastriccancer using a left-sided approach is technically feasible. It simplifies the complicatedsurgical procedure of No. 10 lymph node dissection and leads to the popularization andpromotion of this technique.

via World Journal of Surgical Oncology

Osteosarcoma of the jaws: a review of literature and a case report on synchronous multicentric osteosarcomas

Background: In the head and neck region, osteosarcoma is the most common primary malignant bone tumor, representing 23% of total head and neck malignancies. Osteosarcomas of the jaws are nevertheless rare lesions, representing only 2 to 10% of all osteosarcomas. This report reviews a single-center histopathology experience with craniofacial osteosarcomas, and reports the management of unusually large synchronous mandibular and maxillary osteosarcomas in a patient.Patients and methodsA search of the hospital pathology database for specimens with a histological diagnosis of osteosarcomas submitted between July 1992 and May 2011 was made. A chart review of a patient with large synchronous maxillary and mandibular osteosarcomas was performed, and is reported.Case presentationA 21-year-old African man with large maxillary and mandibular tumors under palliative care presented with increasing difficulties with eating, speech, and breathing. Surgical debulking was performed, with histology confirming synchronous osteosarcomas of the mandible and maxilla. The patient is well after one year, with no evidence of recurrence, having undergone no further treatment. Conclusion: Osteosarcomas of the jaw remain enigmatic, and a number of difficulties related to their diagnosis and treatment are yet to be resolved. True synchronous multicentric osteosarcomas of the jaws are extremely rare but, like other osteosarcomas of the jaws, have a favorable outcome, and palliative resection of such lesions, though challenging, can therefore lead to an enormously improved quality of life and self-image, and may even offer the opportunity for cure.

via World Journal of Surgical Oncology

Robotic thyroidectomy versus endoscopic thyroidectomy: a meta-analysis

Background: To conduct a meta-analysis to determine the relative merits of robotic thyroidectomy (RT) and endoscopic thyroidectomy (ET). Methods: A literature search was performed to identify comparative studies reporting peri-operative outcomes for RT and ET. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence interval (95% CI) were calculated using either a fixed-effects or a random-effects model. Results: Six studies matched the selection criteria, which reported on 2048 subjects, of whom 978 underwent RT and 1070 underwent ET. Comparing the outcomes of RT with ET, this meta-analysis indicated that RT was associated with more complications (WMD = 1.51, 95% CI 1.18 to 1.94) and greater amount of drainage fluid (WMD = 17.10, 95% CI 5.69 to 28.51). Meanwhile, operating time (WMD = 1.50, 95% CI -39.59 to 42.58), conversion (WMD = 0.63, 95% CI 0.07 to 6.17), post-operative hospital stay (WMD = -0.05; 95% CI -0.18 to 0.08), and the number of lymph nodes harvested (WMD = 0.62, 95% CI -0.29 to 1.53) were similar for both procedures. Conclusion: The results of this meta-analysis indicated that RT is associated with an increased risk of complications and a greater amount of drainage fluid. Therefore, RT does not appear to have any advantage over ET. Further studies are required to confirm these results.

via World Journal of Surgical Oncology

Malignant mesothelioma of the tunica vaginalis testis: a malignancy associated with recurrent epididymitis?

A 53-year-old Taiwanese male had several episodes of left epididymitis with hydrocele refractory to antibiotic treatment. Partial epididymectomy plus preventive vasectomy were planned, and, incidentally, an ill-defined nodule was found lying on the tunica vaginalis near the epididymal head. The pathological diagnosis was malignant mesothelioma of the tunica vaginalis testis. Radical orchiectomy with wide excision of the hemi-scrotal wall was performed. So far, there is no evidence of recurrence after more than 3 years of follow-up. Malignant tumor should be considered in the case of recurrent epididymitis refractory to empirically effective antibiotic treatment. Although the nature of this tumor is highly fatal, the malignancy can possibly be cured by early and aggressive surgical treatment.

via World Journal of Surgical Oncology

Targeted drug delivery for cancer therapy: the other side of antibodies

Therapeutic monoclonal antibody (TMA) based therapies for cancer have advanced significantly over the past two decades both in their molecular sophistication and clinical efficacy. Initial development efforts focused mainly on humanizing the antibody protein to overcome problems of immunogenicity and on expanding of the target antigen repertoire. In parallel to naked TMAs, antibody-drug conjugates (ADCs) have been developed for targeted delivery of potent anti-cancer drugs with the aim of bypassing the morbidity common to conventional chemotherapy. This paper first presents a review of TMAs and ADCs approved for clinical use by the FDA and those in development, focusing on hematological malignancies. Despite advances in these areas, both TMAs and ADCs still carry limitations and we highlight the more important ones including cancer cell specificity, conjugation chemistry, tumor penetration, product heterogeneity and manufacturing issues. In view of the recognized importance of targeted drug delivery strategies for cancer therapy, we discuss the advantages of alternative drug carriers and where these should be applied, focusing on peptide-drug conjugates (PDCs), particularly those discovered through combinatorial peptide libraries. By defining the advantages and disadvantages of naked TMAs, ADCs and PDCs it should be possible to develop a more rational approach to the application of targeted drug delivery strategies in different situations and ultimately, to a broader basket of more effective therapies for cancer patients.

via Journal of Hematology & Oncology

Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T

Background: Preoperative characterization of complex solid and cystic adnexal masses is crucial for informing patients about possible surgical strategies. Our study aims to determine the usefulness of apparent diffusion coefficients (ADC) for characterizing complex solid and cystic adnexal masses. Methods: One-hundred and 91 patients underwent diffusion-weighted (DW) magnetic resonance (MR) imaging of 202 ovarian masses. The mean ADC value of the solid components was measured and assessed for each ovarian mass. Differences in ADC between ovarian masses were tested using the Student's t-test. The receiver operating characteristic (ROC) was used to assess the ability of ADC to differentiate between benign and malignant complex adnexal masses. Results: Eighty-five patients were premenopausal, and 106 were postmenopausal. Seventy-four of the 202 ovarian masses were benign and 128 were malignant. There was a significant difference between the mean ADC values of benign and malignant ovarian masses (p < 0.05). However, there were no significant differences in ADC values between fibrothecomas, Brenner tumors and malignant ovarian masses. The ROC analysis indicated that a cutoff ADC value of 1.20 x10-3 mm2/s may be the optimal one for differentiating between benign and malignant tumors. Conclusions: A high signal intensity within the solid component on T2WI was less frequently in benign than in malignant adnexal masses. The combination of DW imaging with ADC value measurements and T2-weighted signal characteristics of solid components is useful for differentiating between benign and malignant ovarian masses.

via World Journal of Surgical Oncology

Tanshinone IIA inhibits metastasis after palliative resection of hepatocellular carcinoma and prolongs survival in part via vascular normalization

Background: Promotion of endothelial normalization restores tumor oxygenation and obstructs tumor cells invasion, intravasation, and metastasis. We therefore investigated whether a vasoactive drug, tanshinone IIA, could inhibit metastasis by inducing vascular normalization after palliative resection (PR) of hepatocellular carcinoma (HCC). Methods: A liver orthotopic double-tumor xenograft model in nude mouse was established by implantation of HCCLM3 (high metastatic potential) and HepG2 tumor cells. After removal of one tumor by PR, the effects of tanshinone IIA administration on metastasis, tumor vascularization, and survival were evaluated. Tube formation was examined in mouse tumor-derived endothelial cells (TECs) treated with tanshinone IIA. Results: PR significantly accelerated residual hepatoma metastases. Tanshinone IIA did not inhibit growth of single-xenotransplanted tumors, but it did reduce the occurrence of metastases. Moreover, it inhibited PR-enhanced metastases and, more importantly, prolonged host survival. Tanshinone IIA alleviated residual tumor hypoxia and suppressed epithelial-mesenchymal transition (EMT) in vivo; however, it did not downregulate hypoxia-inducible factor 1alpha (HIF-1alpha) or reverse EMT of tumor cells under hypoxic conditions in vitro. Tanshinone IIA directly strengthened tube formation of TECs, associated with vascular endothelial cell growth factor receptor 1/platelet derived growth factor receptor (VEGFR1/PDGFR) upregulation. Although the microvessel density (MVD) of residual tumor tissue increased after PR, the microvessel integrity (MVI) was still low. While tanshinone IIA did not inhibit MVD, it did dramatically increase MVI, leading to vascular normalization. Conclusions: Our results demonstrate that tanshinone IIA can inhibit the enhanced HCC metastasis associated with PR. Inhibition results from promoting VEGFR1/PDGFR-related vascular normalization. This application demonstrates the potential clinical benefit of preventing postsurgical recurrence.

via Journal of Hematology & Oncology

Many patients over-optimistic about palliative chemotherapy

A majority of advanced colorectal and lung cancer patients in the USA may not understand that chemotherapy is unlikely to cure them, according to the results of a study published in The New England Journal of Medicine.

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Oral verrucous lesions need special diagnostic attention

Care should be taken to diagnose oral verrucous lesions accurately according to their nature, behavior, and malignant potential, and should be differentiated from grade I squamous cell carcinoma, suggest Indian researchers.

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Glycemic load raises colon cancer recurrence risk

Increased glycemic loads and high carbohydrate consumption may increase the risk for colon cancer recurrence, show the results of a US study.

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Association of carcinoid tumor and low grade glioma

Background: Lung carcinoid tumor and low grade glioma are two uncommon malignancies.Patients and methodsWe report the case of 24-year-old man who presented with respiratory disease. Imaging investigations showed a right lung tumor and histological analysis confirmed a typical carcinoid tumor. As part of initial staging, brain MRI revealed an asymptomatic right frontal lesion. First, a right pulmonary lobectomy was performed without adjuvant treatment. In second time, brain tumorectomy was performed. Histological examination confirmed the diagnosis of low grade glioma (LGG). The patient remained in complete remission 2.5 years after the initial diagnosis. Results: This is the first case reporting the association between LGG and lung carcinoid tumor, while no association between LGG and a systemic tumor have been published to date. Association of lung carcinoid tumor with other malignant diseases has been reported but remained uncommon. Only minimal data support a potential molecular common origin. Conclusion: This exceptional association may be fortuitous. However, their concomitant diagnoses suggest a potential association between both rare diseases. A genetic susceptibility remains possible.

via World Journal of Surgical Oncology

The role of A20 in the pathogenesis of lymphocytic malignancy

Autoimmune phenomena were identified in many different cases of hematological diseases and solid tumors, which may be due to alterations in the expression and function of the NF-kappaB signaling pathway. Recently, a number of studies have shown that the deletion or mutation of A20, a negative regulator of NF-kappaB, is frequently found in lymphomas, suggesting that it may be a linker between the altered immune response and leukemogenesis. The aim of this review is to summarize current findings of the A20 biological functions and its molecular mechanism as a tumor suppressor and immune regulator. The identification of A20 mutations and deletions in lymphocytic malignancy and the predictive significance of these aberrations are also reviewed.

via Cancer Cell International

Activity of pemetrexed and high-dose gefitinib in an EGFR-mutated lung adenocarcinoma with brain and leptomeningeal metastasis after response to gefitinib

About 20% to 40% of patients with non-small cell lung cancer (NSCLC) will develop brain metastases during the natural course of their disease. The prognosis for such patients is very poor with limited survival. In addition to the standard whole brain radiation therapy (WBRT), some studies have shown that chemotherapy drugs and/or epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) can improve the outcome of these patients. Here, we report a stage IIIA patient who developed multiple brain metastases one year after operation. Oral gefitinib with concurrent WBRT were given as first-line therapy. Complete response and a 50-month progression-free survival (PFS) were obtained. Double dosage of gefitinib (500 mg per day) together with pemetrexed were given as the second-line therapy after the patient developed new brain lesions and leptomeningeal metastasis during the maintenance therapy of gefitinib. The PFS for the second-line therapy was six months. In total, the patient obtained an overall survival of 59 months since the first diagnosis of brain metastases. Mutational analysis showed a 15-nucleotide deletion and a missense mutation in exon 19 of the EGFR gene, and a missense mutation at codon 12 of the K-ras gene. These underlying genetic changes might partially explain the long-term survival of this patient after brain metastases when treated with concurrent or sequential therapies of EGFR-TKI, radiotherapy and chemotherapy.

via World Journal of Surgical Oncology

Two-drug combo relieves agitation first time

The majority of advanced cancer patients who experience agitation achieve control after the first dose of an antipsychotic–antiseizure combination is administered, show study results.

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Ocular sebaceous carcinoma rare, but often misdiagnosed in UK

Ocular sebaceous carcinoma is rare in the UK, say researchers in the British Journal of Ophthalmology.

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Sapacitabine tolerated, efficacious in elderly leukemia patients

The nucleoside analog sapacitabine appears to be “active and tolerable” in elderly patients with acute myeloid leukemia, say authors of a phase II study reported in the Lancet Oncology.

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Cervical cancer risk remains high after CIN treatment

Women who undergo treatment for screening-detected cervical intraepithelial neoplasia are more than four times more likely to develop cervical cancer than women with normal smear tests, research suggests.

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The unfolded von Willebrand factor response in bloodstream: the self-association perspective

von Willebrand factor (vWF) is a multimeric glycoprotein essential for hemostasis after vascular injury, which modulates platelet-surface and platelet–platelet interactions by linking platelet receptors to the extracellular matrix and to each other. The crucial role of vWF in platelet function is particularly apparent when hemodynamic conditions create blood flow with high shear stress. Through multiple functional domains, vWF mediates the attachment of platelets to exposed tissues, where immobilized vWF is able to support a homotypic and/or heterotypic self-association. The self-association of vWF is also supported by a rapidly expanding reservoir of novel evidences that the thiol/disulfide exchange regulates vWF multimer size in the blood circulation. Moreover, in addition to proteolysis and reduction of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13), the regulation of vWF multimer size and self-association may depend on a disulfide bond reductase activity ascribed to thrombospondin-1 (TSP-1). Along with the classical signaling pathways in activated platelets, evidence is emerging that lipid rafts also play important roles in various phases of hemostasis and thrombosis and facilitate the interaction between the key signaling molecules. Developments in these areas will refine our understanding of the role played by vWF self-association in physiological hemostasis and pathological thrombosis.

via Journal of Hematology & Oncology

Radiosurgery alone can achieve local control of brain metastases

Radiosurgery to the surgical cavity without whole-brain radiotherapy achieves good rates of local control in patients with brain cancer metastases, a study has shown.

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A comparison of patient characteristics, prognosis, treatment modalities, and survival according to age group in gastric cancer patients

Background: The aim of this study was to investigate age-specific incidence rates and to compare diseasestage, treatment, and survival according to age group in patients with gastric adenocarcinoma. Methods: Gastric cancer patients treated at our hospital between 1999 and 2010 were retrospectivelyevaluated. We divided the cases into two subgroups: group 1 consisted of patients older than70 years at the time of treatment, and group 2 included patients aged 70 years or younger. Inall, 151 patients over 70 years of age and 715 patients age 70 years or younger wereanalyzed. Categorical and continuous variables were summarized using descriptive statisticsand compared using statistical software. Overall survival rates were estimated via the Kaplan-Meier method. Results: Median age at diagnosis was 58 years (range: 22 to 90 years). Between 1999 and 2002 theannual median age for patients aged older than70 years was 9.8%, which increased to 20%between 2007 and 2010. The one-year survival rate for patients with metastatic disease (stageIV) was 10.9% (95% CI: 8.9% to 12.9%) and 27.8% (95% CI: 17.3% to 38.2%) in groups 1and 2, respectively (P = 0.015). The five-year survival rate for patients with non-metastaticdisease (in whom curative surgery was performed) was 15.5% (95% CI = 12% to 19%) and26.9% (95% CI = 25.9% to 27.9%) in groups 1 and 2, respectively (P = 0.03). There were nosignificant differences in gender, tumor localization in the stomach, tumor histology,perineural invasion (PNI), lymphovascular invasion (LVI), tumor stage, or type of surgerybetween the two groups. However, fewer of the patients in group 1 underwent adjuvanttreatment (P = 0.02) and palliative chemotherapy (P = 0.007) than group 2 patients that werenon-metastatic and metastatic at presentation, respectively. Conclusions: Groups 1 and 2 were similar in terms of histopathological features and surgical modality;however, the survival rate was lower in group 1 than in group 2. The incidence of gastriccancer was higher in the patients older than 70 years of age. Additional randomized studiesare needed to further assess the safety and clinical benefit of chemotherapy in gastric cancerpatients older than70 years of age.

via World Journal of Surgical Oncology

Acupuncture shows promise in head and neck patients with xerostomia

Acupuncture significantly relieves the symptoms of xerostomia, or dry mouth, compared with oral care education in patients who have undergone radical or adjuvant radiotherapy for head and neck cancer, indicate the results of a randomized crossover trial.

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FoXTROT results: preoperative chemo could become new standard

Preoperative chemotherapy is a feasible option for resectable advanced colon cancer, show results of the FoXTROT trial.

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Evaluation of the metastatic status of lymph nodes identified using axillary reverse mapping in breast cancer patients

Background: Axillary reverse mapping (ARM) is a new technique to preserve upper extremity lymphaticpathways during axillary lymph node dissection (ALND), thereby preventing lymphedemapatients with breast cancer. However, the oncologic safety of sparing the nodes identified byARM (ARM nodes), some of which are positive, has not been verified. We evaluated themetastatic status of ARM nodes and the efficacy of fine needle aspiration cytology (FNAC)in assessing ARM node metastasis. Methods: Sixty patients with breast cancer who underwent ARM during ALND between January 2010and July 2012 were included in this study. Twenty-five patients were clinically node-positiveand underwent ALND without sentinel lymph node biopsy (SLNB). Thirty-five patients wereclinically node-negative but sentinel node-positive on the SLND. The lymphatic pathway wasvisualized using fluorescence imaging with indocyanine green. ARM nodes in ALND field,whose status was diagnosed using FNAC, were removed and processed for histology. Weevaluated the correlation between the cytological findings of FNAC and the histologicalanalysis of excised ARM nodes. Results: The mean number of ARM nodes identified per patient was 1.6 +/-0.9 in both groups. In mostpatients without (88%) and with (79%) SLNB, the ARM nodes were located between theaxillary vein and the second intercostobrachial nerve. FNAC was performed for 45 ARMnodes, 10 of which could not be diagnosed. Six of the patients without SLNB (24%) andonewith SLNB (3%) had positive ARM nodes. Of these sevenpatients, four had >3 positiveARM nodes. There was no discordance between the cytological and histological diagnosis ofARM nodes status. Conclusions: Positive ARM nodes were observed in the patients not only with extensive nodal metastasisbut also in those with a few positive nodes. FNAC for ARM nodes was helpful in assessingARM nodes metastasis, which can be beneficial in sparing nodes essential for lymphaticdrainage, thereby potentially reducing the incidence of lymphedema. However, the success ofsampling rates needs to be improved.

via World Journal of Surgical Oncology