Onkologie最新文献

Background: Conflicting evidence has been published concerning survival disadvantages in the outcome of breast cancer patients in relationship to their residency in urban or rural communities.

Methods: The primary aim of this study was to evaluate differences in patients and treatment characteristics between an urban and a rural breast cancer unit. Therefore, all early breast cancer patients treated consecutively between 1999 and 2007 in a rural and an urban breast cancer unit were included. Patient and tumor characteristics, treatment strategies, and guideline adherence were included to evaluate the prognoses of both populations.

Results: Overall, data from 2,566 patients were included in this analysis. The 610 patients treated in the rural unit showed significantly more negative prognostic criteria than the 1,956 patients treated in the urban center. No differences were observed with respect to surgical and systemic treatment after adjustment for prognostic parameters. Adherence to national guidelines did not differ significantly between both settings and ranged between 78.0 and 95.6%. Furthermore, no differences regarding recurrence-free and overall survival were observed.

Conclusions: The stage-adjusted pattern of care was similar in 2 German breast care units in a rural region and an urban area. Nevertheless, an earlier diagnosis of breast cancer should be enforced in rural areas to avoid extended treatment burden.

Background: The aim of this study was to compare intensity-modulated radiation therapy (IMRT) vs. 2D and 3D radiotherapy (RT) in the treatment of T1 glottic squamous cell carcinoma in an effort to highlight the advantages of IMRT in this particular clinical situation.

Case report: We present the case of an 82-year-old female patient with T1 left true vocal cord squamous cell carcinoma and complete occlusion of the left carotid artery resulting in multiple strokes. The patient underwent definitive RT with 63 Gy (28 × 2.25 Gy). 3 plans were generated: 2D RT, 3D RT, and IMRT. The right carotid artery (Rt.CA) mean dose was 865, 2,065, and 4,268 cGy for IMRT, 3D RT, and 2D RT, respectively. The inferior pharyngeal constrictor (IPC) mean dose was 5,341, 6,456, and 6,451 cGy for IMRT, 3D RT, and 2D RT, respectively. IMRT provided the best homogeneity but at a higher cost and with prolonged treatment time.

Conclusion: IMRT provided the finest planning target volume coverage with minimal Rt.CA and IPC doses. IMRT is recommended in certain clinical scenarios which are not manageable with other techniques.

Background: Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) is an immunoregulatory molecule expressed by activated T cells. In patients with metastatic melanoma, anti-CTLA-4 antibody therapy with ipilimumab achieves durable cancer regression in approximately 10-15% of patients. In the face of complex and sometimes delayed tumor response patterns, prognostic and predictive biomarkers are needed to monitor therapy outcomes and to identify early potential long-term survivors who might also benefit from therapy re-induction.

Case report: The clinical case of a 49-year-old male patient with metastatic melanoma and unfavorable prognostic factors is presented. The time course of the serum biomarker S100B during initial anti-CTLA-4 therapy correlated very well with the clinical situation and, in the present case, proved its potential value as an early biomarker of a subsequently observed radiological response in this stage IV melanoma patient. The observed clinical response lasted for more than 24 months.

Conclusions: Further efforts are required to better understand the patterns of response and the immunological tumor response in patients undergoing CTLA-4 blockade. A validation of S100B as a marker to identify early long-term responders among patients treated with ipilimumab is warranted.

Prostate cancer is one of the most common cancers in men. Various signaling pathways and proteins are involved in prostate carcinogenesis. Ubiquitination and deubiquitination of the related proteins contribute to the development of prostate cancer in various ways. The ubiquitin-proteasome (UPS) system is a common cellular process for protein degradation in eukaryotes. In this article we review recent advances related to the involvement of the UPS pathway in prostate cancer. The UPS pathway plays an important role in the regulation of cellular proteins with respect to cell cycle control, transcription, apoptosis, cell adhesion, angiogenesis, and tumor growth. It is involved in prostate cancer in various ways by modulating prostate cancer-related genes/proteins such as androgen receptor, cyclin-dependent kinase inhibitor P27, cyclin D1, and PTEN. Some ubiquitin-like modifier proteins have also been found to be associated with prostate cancer. The UPS pathway represents a potential therapeutic target for prostate cancer, and proteasome inhibitors represent a class of chemotherapeutic agents that inhibit tumor growth. The UPS pathway is related to prostate cancer in different ways. More research on that link is needed, as targeting the UPS pathway has led to some success in prostate cancer treatment.

Background/aims: To accurately evaluate the impact of the C/T polymorphism in microRNA (miRNA)-196a2 on the colorectal cancer (CRC) risk, by meta-analysis.

Methods: An electronic search for articles was conducted in PubMed, EMBASE, ISI Web of Science, and the Cochrane Library. The pooled odds ratio (OR) and its 95% confidence interval (CI) were used to assess the association through meta-analysis.

Results: 5 studies were used for analysis. The results showed a significant association between the miRNA-196a2 C/T polymorphism and CRC risk in the genetic models (C vs. T: OR = 1.168, 95% CI = 1.106-1.282, p = 0.001; CC vs. TT: OR = 1.368, 95% CI = 1.132-1.654, p = 0.001; TC/CC vs. TT: OR = 1.206, 95% = CI 1.035-1.405, p = 0.016; CC vs.

Tc/tt: OR = 1.254, 95% CI = 1.077-1.461, p = 0.004), with the exception of the TC-versus-TT model (TC vs. TT: OR = 1.130, 95% CI = 0.961-1.329, p = 0.138). In a subgroup analysis based on ethnicity, we identified a significant overrepresentation of the polymorphism in individuals of Asian ethnicity.

Conclusion: This meta-analysis indicates a significant association between the miRNA-196a2 polymorphism and CRC risk.

Background: The aim of this study was to examine the cardiac effects of anthracycline therapy based on speckle-tracking echocardiography (STE) and to identify patients at risk for cardiotoxicity.

Patients and methods: The study included 35 breast cancer (BC) and 15 lymphoma patients who were treated with anthracycline-based chemotherapy. Conventional echocardiography and STE were performed 1 month prior to and 1 month after chemotherapy. Longitudinal strain analysis was performed via STE using automated functional imaging.

Results: The ejection fraction (EF) and the fractional shortening values were significantly lower in the lymphoma group. There was a positive correlation between anthracycline dose and subclinical heart failure (p = 0.024). There was an increase in the myocardial performance index in both groups. After therapy, STE showed regional decreases in the longitudinal strain values in the BC group, but the global strain values did not differ. In the lymphoma group, the apical long-axis, the 4-chamber, and the global longitudinal strain values were significantly lower after therapy (p = 0.002, 0.041, and 0.004, respectively). The long-axis and global longitudinal strain values were significantly lower in the lymphoma patients with normal EF values (p = 0.01 and 0.05, respectively).

Conclusion: Cardiotoxicity during the early phase of anthracycline treatment can be detected via STE prior to the observation of systolic function deterioration.

Background: Patients with mucin-producing adenocarcinoma have an increased risk for venous and arterial thrombosis. When these patients present with thrombocytopenia, disseminated intravascular coagulopathy (DIC) is often the underlying cause.

Case report: We report 2 patients who were admitted due to bleeding symptoms of unknown cause, in whom further workup revealed adenocarcinoma-induced DIC.

Conclusion: In elderly patients presenting with signs of DIC, such as reduced fibrinogen levels, elevated prothrombin time, elevated D-dimer, and thrombocytopenia, without any obvious reason (e.g., sepsis), adenocarcinoma-associated coagulopathy should be considered as the underlying cause. Paradoxically, in these patients bleeding symptoms improve when the patient is sufficiently anti-coagulated with low molecular weight heparin. Treatment of the underlying disease is of central importance in controlling acute or chronic DIC associated with malignant diseases and chemotherapy should be started as soon as possible.

Background: The purpose of this study was to compare the incidence of thyroid cancer among patients with primary non-thyroid cancer, who showed focal thyroid uptake in (18)F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT).

Material and methods: We reviewed a total of 22,674 FDG PET/CTs performed at our institution between March 2005 and June 2011. A retrospective review was conducted on 433 non-thyroid cancer patients (male: n = 90, female: n = 343) who had thyroid incidentaloma on FDG PET/CT. In 286 patients, diagnostic confirmation was done by ultrasound-guided fine needle aspiration biopsy (FNAB).

Results: Among 22,674 FDG PET/CT scans, 483 subjects (2.1%) showed focal thyroid uptake. Among the 286 patients who underwent FNAB, 280 were included in the study. Of those, 68 patients (24.3%) demonstrated papillary thyroid carcinoma on the final pathologic findings. We divided patients into 7 groups depending on the primary cancer.

Conclusion: In patients with cancer of non-thyroid origin, incidental FDG uptake in the thyroid gland was observed in 2.1% and associated with a 24.3% risk for well-differentiated thyroid carcinoma. However, there was no statistically significant difference in the malignant risk of focal FDG uptake of the thyroid gland according to the underlying primary non-thyroid cancer type.

Background: The broad spectrum of antitumor activity of the oral platinum satraplatin (S) and vinorelbine (V) were the rationale for performing a phase I trial to define the maximum tolerated (MTD) and the recommended (RD) dose in adult patients with advanced solid tumors.

Patients and methods: 4 dose levels (DLs) of S (mg/m(2)/day, days 1-5) and V (mg/m(2)/day, days 1, 8, 15, and 22) every 28 days were explored: S60/V60 on days 1, 8 and 15 only; S60/V60; S70/V60; and S80/V60. Subsequently, 3 further DLs were evaluated with V omitted on day 22: S70/V60, S80/V60, and S80/V80.

Results: Treating 27 patients, the MTD was S80/V80 on days 1, 8, and 15, with 2 dose-limiting toxicities in 2 patients (nausea and vomiting grade (G) 3 with skipping of V on day 15, and neutropenia G4 with infection). The RD was S80/V60 on days 1, 8, and 15. The most frequent toxicities (any G) were nausea (70%), diarrhea (59%), anorexia (37%), vomiting (33%), asthenia (26%), constipation (26%), and paresthesia (18%). Partial responses were observed in 2 platinum-sensitive ovarian cancer patients and in 1 prostate cancer patient.

Conclusion: The combination of S and V is tolerable at a DL of S80/V60 on days 1, 8, and 15; further evaluations in platinum- and V-sensitive tumor types would be of interest.

Background: Quality of life (QoL) is frequently investigated as a secondary endpoint in clinical trials but is rarely evaluated in clinical practice. The present survey sought to assess the QoL of patients with advanced gastrointestinal tumours receiving palliative chemotherapy. Furthermore, we wanted to compare the results of subscales of the generic EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, version 3.0) using assessment tools with an emphasis on pain and depression.

Patients and methods: 150 patients with gastrointestinal tumours undergoing palliative chemotherapy completed 3 questionnaires. QoL was assessed using the EORTC QLQ-C30, Beck depression inventory (BDI) was utilised to measure the severity of patients' depression and a visual analogue scale (VAS) was applied to measure patient's pain intensity. Correlations between these assessments were calculated.

Results: The survey revealed that treatment of pain and depression appeared to be inadequate in the present cohort of patients with metastatic gastrointestinal cancer. Good correlations between EORTC QLQ-C30 subscales and the VAS (r = 0.86), as well as the BDI (r = 0.63) were found.

Conclusion: The present analysis indicates the need for better symptom control regarding the examples 'pain' and 'depression'. In view of the good correlation between the EORTC QLQ-C30 and the BDI and VAS, further studies on the implementation of the EORTC QLQ-C30 as a screening tool, or for follow-up measurements in daily practice are warranted.