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Background: Myxofibrosarcoma (MFS) is among the most highly complex sarcoma types. Molecular cytogenetic studies have identified a high level of genomic complexity. Summary: This review provides an update of the current research related to MFS, with particular emphasis on emerging mechanisms of tumorigenesis and their potential therapeutic impact. Many novel possible molecular markers have been identified, not only for prognostication in MFS, but also to serve as possible therapeutic targets, and thereby improve clinical outcomes. However, the molecular pathogenesis of MFS remains incompletely understood. Key Messages: Patients suffering from advanced MFS might benefit from expanded molecular evaluation in order to detect specific expression profiles and identify drug-able targets. Moreover, immunotherapy represents an intriguingly perspective due to the presence of "T-cell inflamed" tumor microenvironment. [ABSTRACT FROM AUTHOR]

Aims: Non-small cell lung cancer (NSCLC) patients with EGFR mutations do not respond well to checkpoint inhibitors. However, little is known about the activity of immunotherapy in NSCLC with other driver mutations. The increasing use of next-generation sequencing (NGS) leads to molecular findings that face the clinician with problems while choosing the best treatment. This study aims at analyzing response of NSCLC with driver mutations to immunotherapy. Patients and Methods: We retrospectively included 84 NSCLC patients diagnosed and treated at 2 German tertiary-care lung cancer centers using NGS and treatment with immunotherapy. Response to immunotherapy was analyzed in correlation to molecular findings. Results: 51 patients harbored at least 1 driver mutation. PIK3CA, EGFR, and STK11 mutations did not respond to immunotherapy. KRAS, TP53, and MET exon 14 skipping mutations responded well. One patient with NF-1 mutation showed durable response. Conclusions: Molecular testing may be of use in guiding treatment decision making in NSCLC. [ABSTRACT FROM AUTHOR]

Background: The role of surgery for small cell lung cancer (SCLC) is not clear. We aimed to evaluate this issue using a population-based database. Methods: Patients diagnosed between 2004 and 2014 with SCLC staged T1–4 N0–2 M0 disease were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching (PSM) was used to reduce bias between the surgical and nonsurgical patient groups. The Kaplan-Meier method and Cox regression analysis were used to compare overall survival (OS) for the matched patients. Results: A total of 8,811 patients were retrieved, including 863 patients who underwent surgical resection. After 1:1 PSM, a matched cohort with 1,562 patients was generated. In the matched cohort, surgery was associated with 5-year OS improvement (from 16.8 to 36.7%, p < 0.001) and lung cancer-specific survival improvement (from 21.6 to 43.2%, p < 0.001). Survival benefits of surgery were significant in all subgroups, including N1–2 disease, except for patients with a tumor size >5.0 cm or T3 disease. Conclusions: Patients with SCLC of limited stage can benefit from surgery, including N1–2 disease. However, patients with a tumor size >5.0 cm or advanced T stage may be unable to benefit from surgery. [ABSTRACT FROM AUTHOR]

Background: Recent years have witnessed a huge shift in the management and prognosis of metastatic prostate cancer with the advent of new-generation anti-hormonal treatments. Docetaxel, which was initially approved in the castrate-resistant prostate cancer setting, has been approved in the earlier course of the disease as it is still castrate sensitive. Summary: Apart from cabazitaxel and in the absence of other effective chemotherapies, docetaxel rechallenge (DR) in patients with proved sensitivity to docetaxel in the earlier stage of the disease remains a possible option. Unfortunately, the pivotal trials rarely reported on the outcomes of docetaxel retreatment which seems a plausible option in patients initially responding to docetaxel and maintaining a minimum progression-free interval of 3–6 months. In this review, a summary of the clinical evidence and potential concerns for the use of DR in patients with metastatic prostate cancer will be presented. Key Messages: Pivotal trials of docetaxel in metastatic castrate-sensitive prostate cancer as well as metastatic castrate-resistant prostate cancer have not reported on the outcomes of DR except in the GETUG-AFU 15 trial where the outcomes were disappointing. Based on the published retrospective data, DR may be effective in patients who initially responded to docetaxel and maintained a progression-free interval exceeding 6 months. [ABSTRACT FROM AUTHOR]

Background: The aim of this retrospective analysis is to understand the natural history of myxofibrosarcoma (MFS), in particular whether the prognosis can be influenced by histologic grade. Methods: We reviewed 229 adult patients with primary MFS of the limbs. We analyzed disease-specific survival (overall survival [OS]) and local recurrence (LR). Results: Median age was 70 years (range, 19–92). Sixteen (7.0%) were grade 1, 38 (16.6%) grade 2, and 175 (76.4%) grade 3. A worse OS was found in grade 3 MFS (73.1%) than in grade 2 and 1 MFS (91.9 and 100%, respectively) at 5 years (p = 0.031). Locally recurred MFS had a worse OS (p = 0.018). A better LR-free rate (100% at 5 years) was observed in grade 1 MFS; however, a similar rate was observed between grade 2 and 3 tumors (77.1 and 80.0% at 5 years, respectively, p = 0.412). Conclusions: Grade 3 MFS has the worst prognosis. Grade 1 MFS have the lowest risk of LR. These data could help identify a high-risk patient group, thus selecting a more careful follow-up for higher-risk patients. Since MFS mostly affects the elderly population, it might be useful to reserve adjuvant treatments (radiotherapy and chemotherapy) to higher-risk patients. [ABSTRACT FROM AUTHOR]

Background: Metastatic colorectal carcinoma (mCRC) is one of the most prevalent types of cancer worldwide. After tumor progression with first- and second-line treatment, trifluridine (FTD) and tipiracil (TPI) has been shown to be a treatment option. Summary: Data from a pivotal phase 3 trial (RECOURSE) and an ongoing phase 3b trial (PRECONNECT) have shown that, in mCRC patients who experienced disease progression after 2 lines of standard therapy, treatment with FTD/TPI is safe and efficacious. Other third-line options include regorafenib, rechallenge with previous treatment lines or personalized approaches based on comprehensive molecular profiling. Randomized trials or sequential studies aiming for the right treatment sequence or predefined subtypes for FTD/TPI or regorafenib as well for rechallenge are missing. However, FTD/TPI as well as regorafenib are recommended by the current ESMO, German S3, and National Comprehensive Cancer Network (NCCN) guidelines in the same situation, thus offering physicians a number of alternatives for the treatment of mCRC patients after the second progression. Key Message: This narrative review summarizes published data and their impact for FTD/TPI as well for regorafenib and rechallenge chemotherapy in clinical practice settings of refractory situations of colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemoradiotherapy (CRT) is a standard treatment for locally advanced rectal cancer. CRT leads to a better local control; however, this does not translate into a survival benefit. Long-term survival is mostly affected by the development of distant metastases after surgery. This study aimed to evaluate predictive clinical factors for the development of early metastatic disease after CRT. Methods: Clinical data of patients with stage II/III rectal cancer submitted to CRT between January 2000 and October 2014 were collected from prospectively maintained electronic databases of three Italian institutes. Patients were divided into two groups: those who developed metastasis within 12 months from surgical resection (Group A) and patients without or with late distant relapse (Group B). Results: Among 635 patients, 86 (13.5%) had early distant relapse within 1 year from surgery (Group A), and 549 (86.5%) did not (Group B). A higher rate of early distant relapse was associated with CEA levels above 3 ng/dL (20% vs. 10%; p <0.001), tumor lying under 5 cm from anal verge (20% vs. 9%; p <0.001), and age under 63 years (17% vs. 11%; p = 0.036). Multivariate analysis confirmed these factors to be independently correlated with a higher risk of early metastasis. Conclusions: Younger age, low tumors, and high serum CEA may be associated with unfavorable early oncological outcomes after CRT and surgery for rectal cancer. These clinical factors could be useful to select patients for more aggressive therapeutic strategies. [ABSTRACT FROM AUTHOR]

Introduction: Hepatoid adenocarcinoma (AC) of the stomach (HAS) represents a rare variant of conventional gastric AC characterised by poor prognosis. They are usually managed with surgery (localised disease) and chemotherapy. Case Report: We present the first case report of a patient with HAS who presented with weight loss, poor appetite, general clinical deterioration (performance status [PS] = 3), and active gastrointestinal bleeding who was treated with fractionated palliative radiotherapy (RT) using 30 Gy in 10 fractions. The use of RT was associated with excellent symptomatic and radiological response and facilitated surgery secondary to significant improvement in general fitness and PS. Conclusion: RT may have a role in the multimodality management of hepatoid AC of the stomach. [ABSTRACT FROM AUTHOR]

Aims: The aim of this retrospective study is to evaluate the role of pulmonary metastasectomy (PM) in patients affected by lung metastasis (LM) of grade 2 and 3 chondrosarcoma (CS). Patients and Methods: The study included 61 patients affected by LM. Patients unfit for PM were treated with chemotherapy and radiotherapy. Results: The patients' mean age was 51 years, ranging from 17 to 84 years; 44 (66.7%) patients had grade 2 CS, while 17 (25.8%) patients had grade 3 CS. Fifty-one patients presented multiple nodules: 44 of those cases were bilateral LM (72.1%). Twenty-nine (47.5%) patients underwent PM, whereas 32 (52.5%) patients underwent chemotherapy and stereotactic radiotherapy alone. At the final follow-up (average of 83 months, range 13–298), 47 (77.0%) patients had died of the disease. A better post-relapse survival rate was observed in patients who underwent PM (55.1 vs. 13.1% at 5-year follow-up, p < 0.001) and in patients with unilateral LM (60.4 vs. 25.6% at 5-year follow-up, p = 0.016). The number of LM also played a prognostic role. Conclusions: Until significant improvements in chemotherapy can be made, PM can be a valid option in the attempt to improve post-metastatic survival. [ABSTRACT FROM AUTHOR]

Background: Many childhood cancer survivors develop treatment-associated late effects emerging years or even decades after the end of treatment. Evidence-based guidelines recommend risk-adapted screening, facilitating early diagnosis and management of these sequelae. Long-term follow-up (LTFU) in specialized late effects clinics is devised to implement screening recommendations in the care of childhood cancer survivors. Objectives: To create a practical LTFU tool for the daily practice. Methods: Current guidelines and screening recommendations concerning LTFU in adult survivors of childhood cancer were reviewed and a comprehensive LTFU approach was developed. Results: A risk stratification model assigning patients to three risk groups with different screening recommendations and frequencies is presented based on current LTFU guidelines. Furthermore, a model of LTFU in a clinical multidisciplinary team is proposed. Conclusions: Although late morbidity and mortality in childhood cancer survivors have been attenuated in the last decade by reducing treatment toxicities, a high proportion of long-term survivors already is or will still be affected by treatment-associated chronic health conditions. With the knowledge of late effects and their occurrence as a consequence of specific treatment modalities, practical LTFU recommendations are essential to achieve standardized and structured LTFU care. [ABSTRACT FROM AUTHOR]

The article discusses the effectiveness of advanced technology for management of mycosis fungoides and sezary syndrome. Information about the several treatments including high-dose total skin electron beam therapy (TSEBT), topical mechlorethamine and systemic chemotherapy, is provided. Also emphasized is the impact of radiotherapy to minimize the burden of cancer patients.

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors most often caused by activating mutations of the KIT gene. KIT tyrosine kinase inhibitors provide targeted therapy for the underlying genetic mutation, and adjuvant therapy is indicated for patients who are at significant risk of relapse following GIST resection. This is a report of the safety of imatinib in patients with GIST in the adjuvant setting in an expanded access program. Methods: In this multicenter, open-label, single-arm trial, safety was assessed based on the frequency of adverse events (AEs). Results: Three hundred patients were treated and analyzed; 40 patients discontinued treatment. Median overall exposure during the program was 181 days (range 9–420); most patients (260/300 treated) completed the study. Six patients had disease recurrence, 4 of whom discontinued. In line with previously published reports, the most frequent AEs were nausea, diarrhea, and periorbital edema. The AEs were mild to moderate in most cases (76%). Conclusions: These findings are in agreement with the known safety profile of imatinib and confirm the safety of imatinib at 400 mg/day in the adjuvant setting. The incidence of severe AEs was low. [ABSTRACT FROM AUTHOR]

The aim of this systematic review and meta-analysis was to investigate the prognostic utility of the platelet-to-lymphocyte ratio (PLR) in head and neck cancer. Medline (via PubMed), EMBASE, Scopus, and the Cochrane Library databases were searched from their inception to May 2017 for relevant literature. A systematic review and meta-analysis were performed to generate the pooled hazard ratios (HR) for overall survival (OS) and disease-specific survival (DSS). The study was conducted in accordance with the Cochrane Handbook and PRISMA guidelines. Risk of bias was assessed using the QUIPS tool. The logarithm of the HR with standard error was used as the primary summary statistic. Heterogeneity was assessed using Cochran's Q and Higgins' I2. A total of 13 studies were included in the final analysis, combining data from 4,541 patients. The results demonstrated that an elevated PLR was significantly associated with poorer OS [HR 1.85, 95% CI 1.35–2.52, p < 0.00001] and DSS [HR 1.57, 95% CI 1.25–1.97, p < 0.0001]. Significant heterogeneity was detected for the pooled end points. Subgroup analysis demonstrated reduction of heterogeneity by controlling for sample size and cutoff value. 95% prediction intervals showed wide ranges crossing the null threshold. [ABSTRACT FROM AUTHOR]

Background: Sarcoma treatment is a complex and multidisciplinary process. Little is known about the actual status of sarcoma care in Germany. Objectives: We evaluated: (1) on an institutional level, which physician diagnosed and treated sarcomas; (2) whether guidelines and tumor board recommendations were routinely implemented; and (c) access to which diagnosis and treatment options was regarded as problematic. We also examined factors that were associated with access problems. Methods: A cross-sectional online survey was employed among German sarcoma physicians between June 2017 and February 2018 with convenience sampling. Results: Two hundred fourteen physicians participated; 46% were oncologists and 27% surgeons, 38% worked in hospitals of maximum care, 34% were office based and 27% worked in other hospitals, 68% of all of the physicians consulted established guidelines, and 93% presented their patients in multidisciplinary tumor boards. The most common access problems were: isolated limb perfusion (39%), deep-wave hyperthermia (33%), and FDG-PET (27%), and 42% reported no access problems at all. Those physicians who treat more than 100 patients per year reported "no access problems" more frequently compared to centers with lower patient numbers (vs. 0–10 patients, OR 0.14; 95% CI 0.03–0.61; vs. 11–100 patients, OR 0.21; 95% CI 0.06–0.73). Conclusions: Access to multidisciplinary tumor boards seems to be largely guaranteed in the participants of our survey. The use of guidelines could be further implemented and expanded. The number of treated patients appears to be a significant factor to avoid access problems to treatment options. [ABSTRACT FROM AUTHOR]

Background: Histologic transformation (HT) of indolent B-cell lymphomas into an aggressive form can occur simultaneously (primary HT, pHT) or sequentially after a preceding diagnosis of indolent lymphoma (secondary HT, sHT). The clinical course after diagnosis of HT is variable. Objectives: To describe the outcome of treatment in pHT and sHT patients. Methods: We retrospectively analyzed HT cases with an underlying follicular lymphoma, nodal marginal zone lymphoma, extranodal marginal zone lymphoma, lymphoplasmacytic lymphoma, or small lymphocytic lymphoma at our institution. Kaplan-Meier estimates were used to calculate progression-free survival (PFS) and overall survival (OS). Results: Ninety-two HT patients were identified, 38 with pHT and 54 with sHT. In sHT, time-to-transformation was not influenced by the preceding treatment strategy of the indolent lymphoma component. In pHT, median PFS was 61 months (95% CI 27–61), and OS was not reached. In sHT, median PFS and OS was 14 months (95% CI 9–32) and 42 months (95% CI 16–90), respectively. Significant differences between pHT and sHT in PFS (p = 0.002; Hazard ratio [HR] 2.30, 95% CI 1.36–3.91) and OS (p = 0.0001; HR 3.30, 95% CI 1.81–6.03) were observed. Response to treatment for transformation was highly prognostic of PFS and OS (p < 0.0001). Conclusions: The outcome in pHT cases is favorable and signifi-cantly better than in sHT cases. Failure to achieve a remission after treatment for transformation confers a dismal pro-gnosis. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the prognostic role of obesity on oncological outcomes, surgical complications, and postoperative morbidity of patients with early-stage cervical cancer. Methods: Between 2000 and 2016, we enrolled 500 patients with early-stage cervical cancer who underwent radical hysterectomy with pelvic node dissection (RHND) at Songklanagarind Hospital. For analysis, patients were divided based on their body mass index (BMI) into under-normal weight (<25 kg/m2), overweight (25–29.99 kg/m2), and obese (≥30 kg/m2) groups. Results: The median age was 47 years, and the median BMI was 24.3 kg/m2 (25% quartile, 22.0 kg/m2; 75% quartile, 27.4 kg/m2). Patients in the obese and overweight groups were more likely to have comorbidities and adenocarcinoma than patients in the under-normal weight group. The median operative time (OT) was significantly longer in the obese and overweight groups than in the under-normal weight group. The 5-year recurrence-free survival (RFS) of the under-normal weight, overweight, and obese groups was 87.5, 86.2, and 97.6%, respectively, and the 5-year overall survival (OS) times were 95.8, 97.8, and 100%, respectively. There were no significant differences in RFS or OS among the 3 weight groups. Multivariate analysis did not identify BMI as a prognostic factor for RFS and OS. Conclusions: A high BMI was not associated with increased surgical complications or postoperative morbidity; furthermore, it was not associated with the prognosis of patients with early-stage cervical cancer after RHND. However, it was associated with adenocarcinoma and longer OT. [ABSTRACT FROM AUTHOR]

Past evidence has shown that lymphocyte-to-monocyte ratio (LMR) could be considered as a potential prognostic factor in non-small cell lung cancer (NSCLC). We conducted the current meta-analysis based on published studies to elucidate the prognostic value of pretreatment LMR on survival outcomes in NSCLC. Comprehensive searches of available electronic databases were implemented to identify potentially related studies that focused on the role of pretreatment LMR in predicting the prognosis of NSCLC patients. The hazard ratios (HRs) with 95% confidence intervals (CIs) were combined to assess the association of pretreatment LMR with overall survival (OS) and progression-free survival (PFS). A total of 20 articles including 8,304 patients were analyzed. Compared with patients with higher LMR, patients with lower LMR had poorer OS (HR = 1.63, 95% CI: 1.44–1.85, p < 0.001) and PFS (HR = 1.49, 95% CI: 1.25–1.77, p < 0.001). The subgroup analysis outcomes were similar to the overall analysis. Pretreatment LMR may be a useful prognostic marker in patients with NSCLC. However, more well-designed studies are warranted to confirm our findings. [ABSTRACT FROM AUTHOR]

Definitive radiotherapy has an affirmative role in treating non-operable esophageal cancer; however, the controversy between elective lymph node irradiation (ENI) and involved-field irradiation (IFI) still remains. To ascertain the benefits and disadvantages of the two radiation target volumes, we performed a meta-analysis with 7 related publications. According to our findings, patients treated with ENI and IFI had nearly identical 1, 2, and 3-year survival rates (pooled odds ratio [OR] = 1.004, p = 0.980, and pooled OR = 1.15, p = 0.594, and pooled OR = 0.918, p = 0.679, respectively). Likewise, no significant differences were detected in local recurrence rates (pooled OR = 1.04, p = 0.883), regional recurrence rates (pooled OR = 0.65, p = 0.555), and distant metastasis rates (pooled OR = 1.29, p = 0.309) between the two treatment groups. However, IFI could significantly decrease the incidences of acute radiation esophagitis (pooled OR = 2.30, p = 0.001) and late pneumonia (pooled OR = 2.52, p = 0.04) compared with ENI. This meta-analysis provides evidence that IFI is more feasible for non-operable esophageal cancer than ENI. [ABSTRACT FROM AUTHOR]

Background: It is known that chemotherapeutic agents cause myocardial cell damage leading to left ventricular dysfunction and heart failure. Fragmented QRS is an indication of fibrosis developing as a result of myocardial cell damage. The aim of this study is to assess whether there is a relationship between the chemotherapeutic treatment and the development of the fragmented QRS complex in electrocardiography (ECG). Patients and Methods: Among 130 patients who were diagnosed with non-Hodgkin lymphoma and received an R-CHOP treatment regimen, the potential emergence of fragmented QRS on ECG as well as the changes in the left ventricular ejection fraction (LVEF) (on transthoracic echocardiography) in response to various chemotherapeutic regimens were sought. Results: New development of a fragmented QRS pattern was observed in 53 of the 130 patients (40.8%). These patients were found to have lower LVEF values along with higher numbers of chemotherapy courses and cumulative doses. In the logistic regression analysis, age (OR = 1.042; 95% CI 1.009–1.076; p = 0.012) and number of courses (OR = 1.848; 95% CI 1.409–2.423; p < 0.001) were found to be the most important predictors of fragmented QRS development. In subjects with a fragmented QRS pattern, there was a significant difference between the initial and repeat LVEF values (p < 0.001). Importantly the emergence of a fragmentation pattern occurred much earlier compared to the drop in LVEF values (10.62 ± 4.04 vs. 15.24 ± 7.49 months). Conclusion: Development of a fragmented QRS pattern in response to cancer therapy emerges as a new parameter potentially predictive of chemotherapy-induced cardiotoxicity. [ABSTRACT FROM AUTHOR]

The effects of anthracycline-based chemical therapies on breast cancer are controversial and inconclusive. We undertook a network meta-analysis to assess the cardiotoxicity and effects of anthracycline therapies in breast cancer. The PubMed, Embase, and Cochrane databases up to August 2018 were reviewed. We identified 19 randomized clinical trials including 3,484 patients with breast cancer which assessed both cardiotoxicity and the effects of anthracycline-based therapies. Eligible studies included the following five treatment strategies: doxorubicin, epirubicin, liposomal doxorubicin (LD), doxorubicin + dexrazoxane (DD), and epirubicin + dexrazoxane (ED). In a direct meta-analysis, epirubicin, LD, DD, and ED had significantly superior cardioprotective effects compared with doxorubicin with odds ratios and 95% CIs of 1.64 (1.04, 2.57), 3.75 (2.46, 5.70), 2.88 (1.93, 4.29), and 3.66 (1.09, 12.33), respectively. Doxorubicin showed no significant difference of response rate compared with epirubicin or LD or DD, respectively. In a network meta-analysis, the ranking order of cardiotoxicity was doxorubicin (worst), epirubicin, DD, LD, and ED (best). The ranking order of the response rate was LD (best), doxorubicin, epirubicin, ED, and DD (worst). The most favorable balance between benefit and risk was shown for ED (best) followed by LD, DD, epirubicin, and doxorubicin. In conclusion, LD or ED is the suitable anthracycline treatment for breast cancer in consideration of both cardiotoxicity and efficacy. [ABSTRACT FROM AUTHOR]

Background: Posttherapeutic mucositis is a common secondary effect of oral cancer treatment. Mucositis affects the oral mucosa, which leads to specific physical impairments in oral function and a negative impact on quality of life. Objective: To evaluate the impairments associated with oral mucositis and their impact on posttherapeutic quality of life. Methods: A retrospective analysis was conducted on 1,652 patients treated for oral cancer during the multicenter rehabilitation study of the German-Austrian-Swiss Cooperative Group on Tumors of the Maxillofacial Region (DÖSAK), which included 43 clinics from Germany, Austria, and Switzerland. The analysis was based on questionnaires filled out by patients following treatment. Results: Approximately 10% of 1,652 patients included in our study had physical or psychological impairments due to increased posttreatment oral mucositis; this was mainly due to adjuvant radiotherapy or radiochemotherapy administered. Oral mucositis was significantly associated with specific physical impairments, especially xerostomia and pain (p = 0.000), which required supportive care and analgesia (p = 0.000). Additionally, impaired ingestion and speech significantly led to psychological disorders such as public avoidance behavior and social isolation (p = 0.001). Depressive coping of disease (p = 0.001) and concomitant depressive tendencies (p = 0.004) were highly associated with mucositis, which was accompanied by diminished general condition (p = 0.001), bleak future prospects (p = 0.006), and a reduction in quality of life (p = 0.002). Conclusion: Minimizing mucositis-related impairments should be a main effort in oral cancer treatment to optimize patient outcome and improve quality of life after therapy. [ABSTRACT FROM AUTHOR]

Background: Videodermatoscopy (VD) is a useful device for supporting dermatologists in the distinction between benign and malignant lesions. However, only few patients have access to VD in daily practice. Objectives: To investigate patient attitudes towards VD. Method: A cross-sectional study was conducted between May and June 2018. Patients were asked to complete a self-administered questionnaire on the popularity of VD. Descriptive analysis was performed including contingency tables and χ2 tests to investigate associations between sociodemographic data and the popularity of VD. Results: A total of 61.2% (123/201) of the patients had not heard of VD at the time of assessment or were unsure. Of the 38.8% of patients (78/201) who already knew of VD, 64.1% (50/78) reported that they had already been investigated by VD; 57.5% (111/193) were willing to pay an extra fee for VD. A high level of education and private insurance status had a statistically significant association with the popularity of VD (p = 0.036 and p = 0.026, respectively). Conclusions: There was a strong information deficit, especially in patients with lower education and statutory health insurance. Nevertheless, the willingness to pay an extra fee for a VD-assisted skin examination was high. Dermatologists should actively offer and inform their patients about VD when performing skin cancer screening. [ABSTRACT FROM AUTHOR]

Dear Editor, We have read the article by Mancuso et al. [[1]] evaluating the impact of cardiovascular (CV) risk factors on overall survival (OS) in polycythemia vera (PV) patients with great interest. Interestingly, even though CV risk factors were recognized as risk factors for thrombosis in PV, with different CV factors differently affecting the type of thrombosis (arterial vs. venous) [[2] [4]], their presence was not included in the European Leukemia Net (ELN) risk assessment [[5]]. The authors have presented univariate survival analysis on a cohort of 165 PV patients demonstrating inferior OS in PV patients with 1 or more CV risk factors. [Extracted from the article]

For almost a decade, 'early integration' has become a buzzword in the palliative care community. Can this still be an issue of controversy? The goals of care in palliative medicine are beyond any criticism and in fact should be, at least in theory, goals of good oncological care. However, the reality presents a different picture. The care of cancer patients requires improvement, and the studies on the early integration of palliative care (EIPC) reveal deficits in the oncological practice. However, the limitations and methodological weaknesses of these EIPC studies are insufficiently analyzed and discussed. The main criticisms relate to the incomplete definition of primary endpoints, published analyses deviating from the study protocols and insufficient consideration for multiple testing. If this criticism is justified, a possible consequence would be to overrate the achievable effects of EIPC and to limit the use of these studies in guiding policies. Improving the care of cancer patients by fostering their primary care by oncologists could provide one of the alternative approaches, but needs to be evaluated in future studies. Unmet needs in physical, psychic, spiritual or social care need to be addressed. Whether this requires a multiprofessional team in all cases is another issue of discussion. [ABSTRACT FROM AUTHOR]

Background: Requesting a second opinion (SO) is common in oncology. The reasons and barriers for patients not seeking an SO have yet been to be investigated. Why do patients have difficulties evaluating their need for an SO and what could be done to minimize these barriers? Patients and Methods: A 2-stage qualitative study was conducted. 1) Participants were studied in 3 focus groups (FGs). The participants themselves analyzed and then grouped their statements into defined categories. 2) Results of the FGs were discussed with 7 experts from different professional backgrounds. The interviews were unstructured and detailed in the protocol. The statements underwent thematic analysis. Results: The following 4 main barriers were identified: 1) state of shock, 2) pressure of time, 3) sense of excessive demands and uncertainty triggered by information overload, 4) fear of jeopardizing the patient-physician relationship. The following 4 main suggestions for minimizing the barriers were identified: 1) written patient information, 2) improvement of communication, 3) patient empowerment (PE), 4) holistic approach. Conclusion: These barriers incapacitate the patients from evaluating the need for an SO. To minimize the barriers, PE, self-management support and shared decision making is recommended. While the implementation of these concepts advances, patients can be empowered by psycho-oncological assistance. [ABSTRACT FROM AUTHOR]

Background: A high neutrophil to lymphocyte ratio (NLR) has been associated with adverse outcomes in non-small cell lung cancer (NSCLC). However, information on epidermal growth factor receptor (EGFR)-mutant advanced NSCLC is scarce, and most of the studies published have been conducted in Asian populations. We aimed to assess the influence of pretreatment NLR on progression-free survival (PFS) and overall survival (OS) in Western European patients treated with EGFR tyrosine kinase inhibitors (TKIs). Methods: A retrospective evaluation of 41 patients with EGFR-mutant advanced NSCLC treated with EGFR TKIs between June 2010 and May 2016 was carried out. The association between several prognostic factors including pretreatment NLR and survival was analyzed. Results: Median PFS and OS were 10.58 and 20.84 months, respectively. OS for patients with a high NLR was 7.4 months, compared to 24.6 months for patients with a low NLR (p = 0.0122). In multivariate analysis, poor performance status (ECOG PS ≥ 2) and presence of ≥ 3 metastatic locations were identified as significant independent prognostic factors for worse PFS. For OS, unfavorable prognostic factors were a high NLR and central nervous system metastasis at diagnosis. Conclusion: Pretreatment NLR is an independent prognostic factor for OS in Western European patients with EGFR-mutant NSCLC treated with EGFR TKIs. [ABSTRACT FROM AUTHOR]

Background: The role of microRNA-133a (miR-133a) in non-small cell lung cancers (NSCLCs) is controversial. Thus, we conducted a comprehensive study based on meta-analysis and The Cancer Genome Atlas (TCGA) database. Methods: Publications were searched in both English and Chinese databases, and meta-analysis was performed using Stata 12.0. The clinical value of miR-133a in NSCLC was investigated by collecting and calculating data from the TCGA database, and the statistical analysis was performed in R 3.5.0. Results: 5 studies with 364 cases were included in this meta-analysis. The combined pooled result showed that high expression of miR-133a was associated with a favorable survival outcome in NSCLC patients (hazard ratio 0.561, 95% confidence interval 0.396-0.794, p = 0.001). Meanwhile, a total of 984 NSCLC patients were extracted from the TCGA database. Results showed an area under the ROC curve value for miR-133a-3p of 0.902, and the expression of miR-133a-3p was linked with clinicopathologic parameters of NSCLC (p < 0.05), including sex, age, social status, and lymph node metastasis. Conclusion: Our study indicated that miR-133a might act as a tumor suppressor and be a valuable independent prognostic and diagnostic biomarker for NSCLC, and NSCLC patients with high expression of miR-133 might have a better prognosis. [ABSTRACT FROM AUTHOR]

Background: Triple-negative breast cancer (TNBC) is a breast cancer subgroup that lacks the expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Certain magnetic resonance imaging (MRI) features of TNBC might reflect the poor prognosis of TNBC. Standardized uptake value (SUV) of [18F]fluorodeoxyglucose positron emission tomography/computed tomography is 1 of predictive prognostic factors for breast cancer. The purpose of this study was to correlate MRI features of TNBC with SUVmax to determine whether MRI findings in TNBC could be helpful for predicting prognosis. Methods: We analyzed MRI findings of TNBC according to breast imaging reporting and data system (BI-RADS) MRI lexicon. We also assessed intratumoral high signal intensity on T2-weighted MRI, time-intensity curve analysis and peritumoral edema. The relationship between MRI features of TNBC and SUVmax was then statistically analyzed. Results: Significant correlations of SUVmax with the internal enhancement pattern, intratumoral high signal intensity on T2-weighted images, and peritumoral edema were noted. There was no significant correlation of SUVmax with mass shape, margin, or kinetics. Conclusion: Certain MRI features of TNBC such as heterogeneous or rim enhancement, intratumoral very high signal intensity on T2 images, and peritumoral edema might be useful in predicting the prognosis of patients with TNBC. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC, pancreatic cancer) carries one of the poorest overall prognoses of all human malignancies known to date. Despite the introduction of novel therapeutic regimens, the outcome has not markedly improved over the past decades, the incidence rates are almost identical to the mortality rates, and PDAC is projected to soon become the second most common cause of cancer-related mortality in Western countries. Despite this clear medical need to develop novel therapeutic strategies against this dire malady, this need has so far not been addressed with sufficient institutional attention and support in terms of research funding and strategical programs. Given the still growing life expectancy and projected demographic changes with a growing proportion of senior citizens in many European societies, this discrepancy is likely to become even more pressing in the future. This article provides a brief overview of ongoing preclinical efforts to identify novel targets and, based on this, to develop novel strategies to treat advanced pancreatic cancer and improve survival and the quality of life of patients suffering from this malignancy. [ABSTRACT FROM AUTHOR]

Background: The treatment of metachronous Krukenberg tumor (mKT) from gastric cancer remains unexplored. We performed a literature review to evaluate whether or not surgical treatment improves survival. Methods: A systematic review according to PRISMA guidelines was performed. Studies reporting on patients who underwent surgical treatment for mKT from gastric cancer were selected. Metachronous disease was divided as follows: confined to the ovaries, confined to the pelvis, or beyond the pelvis. Outcomes evaluated included overall survival (OS), progression-free survival (PFS), resection rate (R0), and factors predicting survival. Results: 13 retrospective reports fulfilled the selection criteria (512 patients). Most of the patients presented at a premenopausal age. The median presentation interval from gastrectomy ranged from 16 to 21.4 months. Median OS ranged between 9 and 36 months. 1-year OS ranged between 52.5 and 59%, and 3-years OS between 9.8 and 36.5%. Resection margin, peritoneal seeding, and chemotherapy regimen and cycles influenced survival. Conclusion: Surgical treatment and adjuvant chemotherapy in patients with mKT from gastric cancer seems to be associated with improved survival and is justified especially in young patients. Disease location and R0 resection should be considered when selecting patients. [ABSTRACT FROM AUTHOR]

For patients aged 60 years or older, the treatment of relapsed aggressive B-cell lymphomas remains challenging. The purpose of this retrospective analysis was to evaluate the results of the R-ICE (rituximab, ifosfamide, carboplatin, etoposide) protocol alone as compared to R-ICE followed by high-dose chemotherapy with autologous transplantation. The 3-year progression-free survival (PFS) and overall survival (OS) rates in 17 patients receiving R-ICE without transplantation were 32% (95% confidence interval (CI): 8.48-55.52) and 35% (95% CI: 11.48-58.52), respectively. Median PFS and OS times were 9 months (95% CI: 2-22) and 12 months (95% CI: 5-19), respectively. In 17 age-matched transplanted patients the respective survival rates were 18% (95% CI: 0.36-35.64) and 24% (95% CI: 4.4-43.6). Median PFS and OS times were 11 months (95% CI: 6-16) and 16 months (95% CI: 13-19), respectively. Thus, R-ICE alone is a reasonable treatment option for elderly patients with relapsed or refractory aggressive B-cell lymphomas. [ABSTRACT FROM AUTHOR]

Background: Despite initial response to chemotherapy, the prognosis of small cell lung cancer (SCLC) patients is limited. Following first-line therapy, the strongest predictor of durable progression-free survival (PFS) is remission quality. Febrile neutropenia (FN) is a frequent complication after chemotherapy, and its prevention could improve treatment density and degree of remission. Patients and Methods: We retrospectively analyzed 39 SCLC patients treated at a German tertiary care lung cancer center between 2013 and 2016. We extracted data sets from electronic records and analyzed anthropometric data, pretherapeutic blood values, and prognostic scores. Discriminant analysis was performed to predict FN. Results: PFS after first-line chemotherapy was significantly shorter in patients with FN (p = 0.003). Pretherapeutic albumin (p = 0.019), C-reactive protein (CRP; p < 0.001), lactate dehydrogenase (p = 0.041), neutrophil-to-lymphocyte ratio (p = 0.009), prognostic nutritional index (p = 0.018), and Glasgow prognostic score (p < 0.001) were significantly associated with FN. CRP in combination with absolute neutrophil count is a strong predictor of FN (positive predictive value 79.8%). Conclusion: SCLC patients with FN after chemotherapy showed significantly reduced PFS. Prevention of FN may improve treatment results. We identified pretherapeutic markers which can predict FN risk. This simple and cost-effective method could serve to identify the need for preventive measures against FN (e.g., prophylactic antibiotic treatment or granulocyte colony stimulating factor administration). [ABSTRACT FROM AUTHOR]

Background: Childhood cancer survivors are at risk for therapy-related sequelae and, therefore, require long-term follow-up. At 2 university hospitals in Germany collaborative multidisciplinary late effects clinics were installed to provide specialized care and to evaluate the current health status of these patients in a clinical setting. Patients andMethods: Every patient who visited the late effects clinics at the university hospital in Lübeck and Erlangen over a period of 3 years and met the inclusion criteria was included in the study. Patients' characteristics as well as cancer diagnosis, treatment related factors and the prevalence of chronic health conditions were assessed. Results: 220 patients attended the late effects clinics during the observation period. The median follow-up period was 16 years (range 5-45 years). In total over 64% of the patients were affected by at least 1 chronic health condition, including endocrine disruptions in 19.1% of the patients. Moreover, secondary neoplasms occurred in 9.1% of the study participants. Conclusion: German childhood cancer survivors are affected by multiple therapy-related sequelae. A comprehensive network of late effects clinics should be established to ensure specialized and risk-adapted care for every childhood cancer survivor in Germany. [ABSTRACT FROM AUTHOR]

Background: Dedifferentiated chondrosarcoma (DDC) accounts for a small proportion of chondrosarcomas. They demonstrate aggressive behaviour with a high rate of local recurrence and systemic progression resulting in poor long-term survival rates. Due to its relatively low incidence, previous studies have grouped different histiotypes together to achieve adequate study numbers for analysis. Methods: This retrospective study examines the clinical course and the role of chemotherapy in the subgroup of patients with DDC where osteosarcoma is the predominant dedifferentiated component. Between 2000-2010, 21 patients were identified. Results: The mean age at presentation was 64 years (range 35-80 years). 12 patients were considered unfit for chemotherapy, whilst 2 patients declined chemotherapy. 5 patients received neoadjuvant chemotherapy, with less than 90% necrosis demonstrated in all these cases. 3 patients received post-operative chemotherapy. The median survival for the entire group was 9.5 months. In the 7 patients who received chemotherapy, the median survival was 17 months, and those who had chemotherapy had a greater median time to local recurrence. Conclusion: This study demonstrates that cytotoxic chemotherapy may be offered to appropriately selected patients. [ABSTRACT FROM AUTHOR]

Germ cell tumors (GCT) are a unique tumor entity with excellent cure rates if guideline-endorsed treatment is thoroughly applied. Even patients with widespread metastatic disease can often be cured with cisplatin-based combination chemotherapy as part of a multimodal treatment approach. However, about 30% of patients with metastatic disease at initial presentation, corresponding to about 5-10% of all GCT patients, relapse or progress despite first-line treatment and therefore require salvage chemotherapy. Salvage systemic treatment either consists of conventional-dose cisplatin-based combination chemotherapy or sequential high-dose treatment with carboplatin and etoposide plus subsequent autologous stem cell support. This review is based on a comprehensive literature search of MEDLINE and conference proceedings of ESMO, ASCO, and EAU meetings until 2018 and provides an overview of current treatment options for germ cell cancer patients relapsing after or progressing during first-line cisplatin-based combination chemotherapy. [ABSTRACT FROM AUTHOR]

Long-acting granulocyte colony-stimulating factor (G-CSF) preparations are increasingly used in the management of chemotherapy-associated neutropenia. Due to the fact that they only need to be administered once following chemotherapy, they are more convenient for patients and easier to use in the clinical routine for physicians than short-term G-CSF preparations. Although the efficacy of these growth factors is generally accepted, there remains some concern regarding their safety. In this article we address safety concerns for long-acting growth factors by providing basic information and available data around important clinical issues that may be helpful for the decision to use or not to use these factors in individual clinical situations. After a critical review of the literature, regarding theoretical considerations based on the physiology of hematopoiesis, data from clinical studies show that long-acting G-CSF preparations can be applied safely in approved indications and are broadly beneficial for patients at risk undergoing chemotherapy. [ABSTRACT FROM AUTHOR]

Background: As there are few data worldwide concerning the frequency and relevance of interactions of prescribed drugs in hemato-oncology, we analyzed the medication prescribed to patients at a clinic within a comprehensive cancer center. Methods: Details of the medication prescribed for all patients in 2011 were extracted from their discharge letters. All potential medication combinations were assess with respect to the risk of interaction using 3 specialized websites. Results: The files of 202 patients receiving 275 drugs were extracted; 4,303 drug combinations were created. Overall, 88% of these combinations were found to be harmless with an interaction value (IV) of 1. However 10% showed potential risk of probable interaction (IV 2 + 3). 47% of the patients had at least 1 drug combination with a risk of interaction. A maximum of 29 drugs with 15 probable and possible interactions were found. Conclusion: Awareness for this topic should be raised in physicians and patients. An important step for avoiding risks of interactions is a systematic check of all drugs prescribed. There is urgent need for reliable data on clinically relevant interactions and for a better network in which physicians and pharmacists can exchange data about relevant interactions. [ABSTRACT FROM AUTHOR]

Background: Pelvic lymphadenectomy, which is the routine surgical treatment for early-stage cervical cancer, causes serious morbidity. The goal of the current retrospective study was to identify predictive factors of lymph node metastasis (LNM) in patients with early-stage cervical cancer. Patients and Methods: The study included 496 patients diagnosed with stages IA2-IB1cervical cancer who underwent a radical hysterectomy with pelvic lymphadenectomy. The predictive factors of LNM were evaluated. Results: The incidence of LNM in this study was 4.6%. LNM was more common in patients with deep stromal invasion (DSI), tumor size > 2 cm, lymph vascular invasion and parametrial involvement (PI). Multivariate analysis showed DSI (p = 0.010) and PI (p = 0.005) were independently associated with LNM. The median follow-up time was 56.9 months. The patients with LNM had poorer 5-year overall survival (77.8%; 95% confidence interval (CI) 44.2-92.6) than the patients without LNM (98.2%; 95% CI 95.6-99.2; p = 0.002) and also poorer 5-year recurrence-free survival (65.5%; 95% CI 38.6-82.8) than the patients without LNM (90.2%; 95% CI 86.5-92.9; p < 0.001). Conclusion: The predictive factors of pelvic lymph node metastasis in stage IA2-IB1 cervical cancer patients were DSI and PI. LNM was associated with poorer oncological outcomes. [ABSTRACT FROM AUTHOR]

Magnetic and superparamagnetic iron oxide nanoparticles are emerging as promising candidates for various applications in biology and medicine, and especially in oncology. These applications, however, require that a specific set of physical, chemical, and biological properties be combined in a given sample of nanoparticles for them to act as intended. Some of these properties are fundamental: They strictly determine the nanoparticles' behavior both in vitro and in vivo. These properties are the charge, the solution stability and zeta potential, and the coating of the nanoparticles. A certain combination of these properties may satisfy a researcher in an in vitro study, but other properties should also be considered when in vivo applications are planned. For in vivo experiments, additional determinants of the quality of nanoparticles are their size, shape, modifications with targeting moieties, and degradation/excretion pathways. All these properties are in the focus of the present review. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the treatment benefit and patterns of recurrence for patients with high-risk vulvar squamous cell carcinoma treated with surgery followed by adjuvant radiotherapy (RT). Patients and Methods: From January 1999 to June 2016, 51 patients underwent total or partial deep vulvectomy with inguinofemoral lymphadenectomy followed by adjuvant RT with 45-50 Gy in 25 fractions +/- a 4-10 Gy boost. 17 (33.3%) women received concomitant chemotherapy. Results: Median overall survival was 81 months. The 5-year disease-free survival and overall survival rates were 52 and 63%, respectively. In univariate and multivariate analysis, patients aged ≤ 76 years and those receiving an RT total dose of > 54 Gy had a significantly lower risk of progression (p = 0.044 and 0.045; p = 0.012 and 0.018, respectively) and death (p = 0.015 and 0.011; p = 0.015 and 0.026, respectively). There was a trend towards a lower risk of progression for patients with tumor size ≤ 4 (p = 0.098) and negative lymphovascular space involvement (p = 0.080). Also, there was a trend towards a higher risk of death (p = 0.075) for grade 3 tumors. Concomitant chemotherapy provided no significant benefit. Conclusion: Only age and RT total dose are significant prognostic variables for squamous cell carcinoma of the vulva treated with primary surgery and adjuvant RT to improve local and locoregional control. [ABSTRACT FROM AUTHOR]

Introduction: We assessed the clinical outcome and survival of 70 patients with primary vaginal squamous cell carcinoma undergoing radiotherapy (RT) at the Divisions of Radiotherapy, University of Pisa and ASST Cremona between January 1995 and June 2016. Methods: 58 patients received external beam RT (EBRT) to the entire vagina, para-vaginal area and pelvic nodes (total dose: 45-50.4 Gy). 29 patients (41.4%) received concomitant weekly cisplatin 40 mg/m2. 35 patients received an additional (15-36 Gy) high-dose-rate (HDR) brachytherapy (BT) boost and 13 received an additional (9-25 Gy) EBRT boost to the primary tumor site. 12 women exclusively received HDR-BT up to a total dose of (30-58 Gy). Results: Median overall survival (OS) was 85 months. A total RT dose of > 60 Gy was significantly associated with a better OS (p = 0.015). There was a trend for a better OS for patients aged < 70 years and for those undergoing EBRT to the entire vagina and pelvis plus BT boost. The most common grade 1-2 acute toxicities were diarrhea (24.1%) and cystitis (20.7%); grade 3 cystitis only occurred in 2 patients (3.4%). Conclusions: EBRT followed by BT boost seems to be the best treatment for vaginal carcinoma. The total dose of RT should be > 60 Gy. [ABSTRACT FROM AUTHOR]

Introduction: We compared the disease free-survival (DFS) and overall survival (OS) rates of patients with high-grade serous primary fallopian tube cancer (HGsPFTC) and high-grade serous epithelial ovarian cancer (HG-sEOC). Methods: 22 early-stage cancer patients (International Federation of Gynecology and Obstetrics (FIGO) stages I-II) with HG-sPFTC were retrospectively evaluated. In addition, 44 control patients diagnosed with HG-sEOC were matched to these patients with respect to tumor stage at diagnosis. All patients underwent complete surgical staging, followed by adjuvant chemotherapy. Kaplan-Meier curves were used to generate survival data. Results: The mean age of HG-sPFTC patients was 59.4 ± 6.2 years, and that of HG-sEOC patients 55.2 ± 11.0 years (p = 0.002). All patients underwent 6 cycles of platinum-based adjuvant chemotherapy. All operations were optimal. The 5-year DFSs were 77.3% for HG-sPFTC patients and 75% for HG-sEOC patients (p = 1.00).The 5-year OS rates were 81.8% in women with HG-sPFTC and 77.3% in those with HG-sEOC (p = 0.75). Conclusion: The DFS and OS rates of patients with early-stage (FIGO stages I and II) HG-sPFTC and HGsEOC were similar. The surgical and adjuvant therapy management of these malignancies should be similar. [ABSTRACT FROM AUTHOR]

The article offers information on an uro-oncology multidisciplinary team discussion (MTD) is to provide the optimal therapy to an individual patient, which derives from an evidence-based discussion of scientific and clinical data. It mentions the potential benefit of MTDs in the management of patients with advanced neoplasms of the upper and lower urogenital tract; and also mentions positive consequences for patient management in multiple dimensions.

Nevertheless it is equally important for the process of decision making on further tumorspecific therapy to clearly address the limitations of antitumor therapy at end-stage cancer in time, to evaluate and be responsive to the patients wishes and to openly discuss end-of-life issues with the patient. CMV IgG pairing between donor/ patient was negative/ negative in 17 patients (32%), positive/ positive in 26 patients (49%), positive/ negative in 4 patients (8%), and negative/ positive in 6 patients (11%). A matched related donor was present for 7 patients (13%), matched unrelated for 27 patients (51%), 18 patients (34%) received their transplant from a mismatched unrelated donor, 1 patient from a haploidentical donor. We here evaluated CLL-IPI in a large sample of elderly patients with comorbidities who represent the majority of patients with CLL outside of clinical trials. [Extracted from the article]