Search

Purpose: We aim to review the available literature on surgical management of oligometastatic pancreatic ductal adenocarcinoma (PDAC), in order to assess the clinical outcomes and intraoperative parameters of the different strategies., Methods: A systematic literature search was performed in PubMed database, in accordance with the PRISMA guidelines. Nine studies met the inclusion criteria incorporating 401 patients., Results: Perioperative mortality was as low as 0%, regarding resection of pancreatic cancer combined with synchronous metastasectomy., Conclusions: Currently, postoperative overall survival and progression-free survival have increased compared to previous trials. Nevertheless, the lack of precise operative indications delays the enhancement of survival rates. Well-designed, randomized controlled studies, assessing pancreatic surgery combined with metastasectomy, are necessary to further assess their clinical outcomes.

Purpose: Glucose-6 phosphate dehydrogenase (G6PD) deficiency has an estimated prevalence of 5 -7.5% of the global population. Administration of some drugs in G6PD deficient patients may result in clinical conditions of varying severity, including potentially fatal sequels. For these reasons, in case of G6PD deficiency, the use of high dose toxic chemotherapy regimens in potentially curable malignancies with associated risk of tumor lysis syndrome, such as in advanced germ cell tumors, raises both physicians' preoccupations and issues for safeguard patients' health. Nonetheless no systematic information is actually available for safety in premedication to be administered, chemotherapy regimens adopted, and supportive care drugs needed to be provided in some particular situations., Methods: We present a case of a patient with metastatic testicular cancer and known g6pd deficiency, admitted in our department. We also performed a literature review in tree medical libraries searching for articles addressing the overmentioned security issues., Results: Available literature is particularly scant. nonetheless, there is no evidence contradicting the administration of cytotoxic chemotherapy to G6PD deficient individuals. Our patient was able to complete the preplaned chemotherapy cycles, without any complications., Conclusion: Given the absence of data supporting the limitation of chemotherapy to G6PD deficient patients, the latter should not be deprived of the indicated antineoplastic treatment. However, certain premedication agents must be avoided. Continuous patient monitoring during treatment may alleviate physicians' and patients' anxiety and preoccupations.

To protect cancer patients from COVID-19 exposure, prioritization strategies are being implemented at global level. Measures include use of tele-health services, deferring elective surgeries, delaying non life-saving therapies, interrupting maintenance and supportive care regimens and suspending screening and regular follow-up visits. Nonetheless, the risk of infection may not always outweigh oncology treatment benefit. Lives of most oncology patients depend on their ability to receive medical, surgical and radiotherapy care. Postponing screening, follow-up and radical surgeries increase patients' risk of developing metastatic disease. A viral pandemic lasts long time and exhibits seasonal and geographical variations. Though vaccines will be available only in the 2021, a global, aggressive, all-embracing and protracted slowdown of oncologic activities will severely jeopardize patients' outcomes. A present international oncologists' panel, ECPC and FAVO, strongly suggest that Hospital measures in a specific geographical area/Nation should be in line with the local epidemic, and restrictions adopted should be adapted and stratified over time.

Purpose: To assess the quality of life (QoL) following palliative radiotherapy (RT) in patients with painful bone metastases., Methods: A literature search limited to English-written publications was carried out, through the Cochrane Central Register of Controlled Trials (November 2018), OvidSP and PubMedCentral (1940-November 2018) databases. Subject headings and keywords included "quality of life"(QoL), "bone metastases", "palliative therapy", "pain" and "radiotherapy". Original articles, literature reviews, trials and meta-analyses revealing alterations in QoL post-RT using ratified measuring tools were examined. Studies referring to other types of metastases (e.g. brain metastases), or to other types of palliative therapy (e.g. the use of bisphosphonates alone), or focusing only on pain, or even reporting QoL only before or only after the use of RT were excluded., Results: Twenty four articles were selected from a total of 1360 articles. Seven trials proceeded to patients' randomization. The most commonly used tool to evaluate QoL was EORTC, followed by Brief Pain Inventory (BPI) and Edmonton Symptom Assessment System (ESAS) questionnaires. All studies showed improvement in symptoms and functional interference scores after RT. The QoL between responders (Rs) and non-responders (NRs) has been juxtaposed in 10 studies. Rs had a significant benefit in QoL in comparison with the NRs., Discussion: Palliative radiotherapy in painful bone metastases improves Rs' QoL.

The integration of immunotherapeutic agents in the treatment of non-small cell lung cancer (NSCLC) has revolutionized the approach of the prevalent type of lung cancer. Although PD-1 and its ligands (PD-L1 and PD-L2) are stimulating molecules of the immune-checkpoint pathway, with primary function to limit inflammatory response and autoimmunity, tumor cells have found a way to exploit these molecules by obtaining the opportunity to respond with PD-L1 expression in cytokine signals and thus to evade immune surveillance. Several immunotherapeutic agents targeting these molecules have already been tested and show quick and remarkable responses and survival prolongation in about 14-20% of chemo-resistant patients in NSCLC, resulting to FDA approval of some PD-1 inhibitors (pebrolizumab, nivolumab), even for first-line treatment of patients with metastatic NSCLC whose tumors have high PD-L1 expression (pebrolizumab). Regarding to the prognostic value of PD-L1 and PD-1 expression as biomarkers in NSCLC, the results still remain contradictory. However, the elevated expression of PD-L1 has been correlated with higher efficacy of the various immunotherapeutic agents, implying a high predictive value of this biomarker, even if the truth about specificity and sensitivity of the aforementioned molecules is generally more complicated.

Purpose: The standard treatment of rectal cancer is surgery along with preoperative radiotherapy, administered alone or in combination with chemotherapy. Preoperative chemoradiotherapy (preCRT) is widely used as it allows better local control and the use of sphincter-saving surgery. Pathological response after preCRT has been shown to be a significant prognostic factor of rectal cancer recurrence and survival. In this review we will assess the value of Hypoxia Induced Factor 1α (HIF-1α), Carbonic Anhydrase IX (CA-9) and Glucose Transporter 1 (GLUT-1) genes as predictive markers of the course of local advanced rectal cancer in patients who underwent pre-CRT., Methods: We searched studies, from Pubmed and in English language, obtained the information by using "HIF-1 alpha", "Carbonic Anhydrase IX (CA-9)", "Glucose Transporter 1 (GLUT-1)" and "rectal cancer" as key words., Results: 27 relevant articles were retrieved in initial stage. After full-text review, 13 articles were selected for the final analysis., Conclusions: HIF-1α, GLUT-1 and CA-IX may be connected with tumor response to preCRT, however, there is still skepticism towards their clinical use as predictors of outcome. Therefore, there is a need to conduct larger and more extensive cohort studies in order to find whether these predictors can be used in practice.

Purpose: To evaluate the use of percutaneous computed tomography (CT)-guided localization of suspicious intrapulmonary nodules with hook wire prior to video-assisted thoracoscopic surgery (VATS)., Methods: From April 2010 to February 2011, 15 patients with suspicious subpleural pulmonary nodules underwent preoperative CT-guided hook wire localization of the lesions, prior to VATS., Results: Histological analysis of the resected suspicious pulmonary nodules revealed malignancy in 12 cases, 2 cases with granulomas and 1 case with bronchiolitis obliterans organizing pneumonia (BOOP). Better results were achieved with the double-thorn hook wire. Conversion to thoracotomy was necessary in the patient with BOOP, due to limited hemorrhage at the site of the lesion., Conclusion: Preoperative CT-guided nodule localization using hook wire fixation is a useful and safe technique that helps in the precise localization of suspicious lesions, reduces the operation time, the postoperative complications, and the hospitalization.

Purpose: Several adjuvant approaches are regarded as available options in the management of localized, resectable gastric cancer .The objective of our study was to evaluate multiple field and anteroposterior conformal technique., Methods: Ninety-seven patients received three dimensional conformal (3DCRT) postoperative adjuvant radiation therapy for gastric carcinoma. Thirty-five patients received anteroposterior (AP/PA) fields (Group B), while 62 patients were irradiated with multifield technique (Group A). Their ages ranged between 29-85 years. The objective of the study was to evaluate the quality of life (QoL) for all patients after the completion of radiotherapy using the QLQ-C30 of the EORTC questionnaire (European Organization for Research and Treatment of Cancer) and to investigate any measurable differences between those two radiation techniques according to QUANTEC criteria and the radiotoxicity., Results: In terms of QUANTEC criteria, the multifield technique was superior concerning the left kidney (p=0.025), right kidney (p<0.001), spinal cord (p<0.001) and planning target volume (PTV) coverage (p<0.001). According to EORTC/ RTOG toxicity criteria, the rate of diarrhea was higher in AP/ PA technique (p=0.028). In terms of QLQ-C30, the multifield technique was superior concerning appetite loss (p=0.022), diarrhea (p=0.046) and global QoL (p<0.001)., Conclusion: On the basis of QLQ-C30 questionnaire, EORTC/ RTOG toxicity and dosimetric parameters, the present report has shown that the three dimensional multifield conformal radiotherapy is superior compared to AP-PA techniques.

Purpose: The purpose of the present article was to investigate the health related quality of life (QoL) of young women with breast cancer., Methods: For the purposes of this article, we reviewed the literature via the electronic databases Pubmed, Scopus and Google Scholar. Key words used were breast cancer, young women, health related quality of life, and quality of life., Results: Young women reported fatigue, pain in the breast and hand problems with lymphedema as the most frequent physical effects of treatment. Other physical problems were the not periodic and painful menses, vaginal dryness and loss of libido. Many young women had depressive symptoms such as depressed mood, helplessness, hopelessness, sleep loss, psychomotor retardation and disorders of appetite. There were often concerns about the health monitoring and self-image, while they were anxious if they will have a baby in the future or if they can nurture the existing ones. Many problems arose in the career of young women. They faced discrimination in the labor supply and/or layoff because they were considered unable to do their job effectively. In addition, they reported isolation problems and feeling different from other women of similar age., Conclusions: Young women consider that their healthrelated QoL is worse compared with older women. Young women worry about their future, with particular reference to their role as mothers and especially to children-bearing. The free screening and non-exclusion of young women is particularly important for breast cancer prevention and women's well-being.

Purpose: The purpose of this study was to present the controversial role of adjuvant radiotherapy to a 72-year-old male patient with Masaoka stage II thymoma and coronary artery bypass and to review the relevant literature., Methods: The data were collected by relevant studies on PubMed and EMBASE. Articles up to March 2017 were included., Results: Although the radiation-induced vascular injury to the internal thoracic artery and its suitability for grafting in a patient who is candidate for coronary artery bypass is documented, the possible catastrophic effect of adjuvant radiotherapy to existing grafts in a patient with prior bypass surgery has not been fully investigated., Conclusion: The application of radiotherapy in a patient with R0 stage II thymoma is currently considered of 2B level of evidence but its potential occlusive effect to an underlying coronary graft may dramatically affect the survival of the patient and accordingly drop the level of evidence of its use.

Purpose: Τo investigate the potential diagnostic and prognostic role of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) serum levels in non-small cell lung cancer (NSCLC)., Methods: One hundred consecutive patients with newly diagnosed primary NSCLC were included in this study (88 men and 12 women). Blood was drawn before any kind of treatment and the collected serum was processed using chemiluminescence in order CEA and CA 19-9 levels to be measured., Results: No significant associations between CEA or CA 19-9 levels and any tested clinical and pathological parameter were detected. Moreover, CEA levels did not seem to affect survival. On the other hand, patients with high CA 19-9 values (≥37 IU/ml) (median survival: 8 months) had a shorter overall survival than patients with low CA 19-9 values (<37 IU/ml) (median survival: 13 months) (p=0.026). However, CA 19-9 levels did not remain an independent prognostic factor in the multivariate survival analysis (p=0.114)., Conclusion: CEA and CA 19-9 serum levels do not seem to have any diagnostic role in NSCLC. With regard to their prognostic role, CEA values do not seem to affect the prognosis in NSCLC. However, high CA 19-9 values are associated with worse prognosis.

Purpose: Hypothalamic-pituitary axis is susceptible to radiotherapy, causing endocrine disorders to childhood cancer survivors. We conducted a systematic review in order to assess the radiation-induced toxicity that leads to hormone secretion abnormalities and their severity in children with brain tumors., Methods: The data were collected by relevant studies on PubMed and EMBASE. Articles up to December 2016 were included. We selected studies which focused on children patients (<18 yr old) with brain tumors treated with radiotherapy and the consequences for their endocrine system., Results: Growth hormone (GH) deficiency was the most common post-irradiation abnormality among children cancer survivors, followed by gonadotrophin (GT), thyroid stimulating hormone (TSH), corticotropin (ACTH) and prolactin (PRL) disorders., Conclusions: The age of the patient, total radiotherapy dose, number of fractions, fraction size and the duration of treatment seem to determine the severity of these disturbances.

Purpose: Dermatomyositis (DM) represents an auto-immune inflammatory myopathy. In this review, we analyzed the incidence of DM as a clinical manifestation highlighting the peculiar clinical and treatment characteristics of this disease when occurring in the context of different malignancies., Methods: A systematic literature review was performed based on database search in PubMed/Medline and included English articles until December 2016., Results: In up to 20% of cases DM appears as a paraneoplastic syndrome associated with multiple malignancies such as ovarian, breast, prostate, lung, nasopharyngeal and colorectal cancer, and non-Hodgkin lymphomas. It can be presented either before, in the time, or after cancer diagnosis. Systemic sclerosis and mixed connective-tissue disease represent common coinciding disorders. Particular caution should be given in the radiotherapy because the microvascular endothelial radiation damage and autoimmune inflammatory collagen vascular disease caused by DM may be additive. There is a higher risk of late toxicity in the presence of other concurrent vascular diseases, including diabetes, hypertension or administration of chemotherapy. Prednisone represents the first-line treatment option but immunosuppressive drugs such as azathioprine and methotrexate may also be incorporated in the therapeutic armamentarium especially when DM is associated with malignancy. Intravenous immunoglobulin could be a promising alternative in prednisone-resistant cases. The effectiveness of therapies with antigen-specific agents such as monoclonal antibodies is currently under investigation., Conclusions: Timely diagnosis coupled with a treatment plan focused on muscular endurance and improvement of skin lesions and other symptoms offer a favorable response to therapy along with the achievement of a higher quality of life for these patients.

Purpose: Intensity Modulated Radiation Therapy (IMRT) is nowadays the treatment of choice, in terms of technique, for either head & neck or prostate cancer. With this paper, we are sharing our experience for the first inplementation of IMRT planning in the public sector in Greece, and especially in the Aretaieion University Hospital of Athens., Methods: From May 2013 until January 2014 four prostate and four head & neck cancer patients were evaluated in the present study. We used the ONCENTRA IMRT treatment planning with a step and shoot technique in a SIEMENS ONCORE Linac. The dose verification method used was based on the delta4(PT) Pre-Treatment volumetric quality assurance system, by Scadidos., Results: In all cases, the Relative Standard Deviation between the prescribed and the calculated average dose received by the target volume was less than 5%, while the γ-index was more than 90%. The acute toxicity was low and equivalent to published data with IMRT technique., Conclusion: In conclusion, the first implementation of IMRT technique in the Medical School of Athens was feasible and safe as well as in terms of dose verification. The IMRT technique is already in clinical use and further results with long term radiation induced toxicity will be reported.

Purpose: To prospectively assess the efficacy of the selective serotonin inhibitor escitalopram on painful bone metastases, in combination with external beam irradiation., Methods: Forty-three patients with cancer metastatic to bone and suffering from depression were treated with 3 Dimensional Conformal Radiotherapy (3DCRT) (30 Gy; 3 Gy/fraction, 5 days/week) combined with escitalopram (20 mg/day). Pain relief was evaluated with Wong/Baker Faces Pain Scale. The patients reported outcome using a RTOG-EORTC quality-of-life self-questionnaire (QLQ-C30 v3.0) and the status of depression according to Hamilton Scale (HAM-17). The assessment was performed at baseline and 6-8 weeks after radiotherapy., Results: Patients treated with radiotherapy and escitalopram tended to show a good response to pain and improvement of their quality of life., Conclusions: Though our data concerned a rather small number of patients, addition of escitalopram to 3DCRT accomplished a high clinical benefit rate on neuropathic pain from bone metastasis.

Purpose: The primary endpoint was to assess the late toxicity of a hypofractionated radiotherapy schedule in relation to radiation parameters concerning the rectum and bladder. The second endpoint was to assess a composite of biochemical and clinical failure., Methods: Sixty-four prospectively selected patients diagnosed with localized low risk prostate cancer, Gleason score (GS) <7, PSA <10, and T1-2N0, were treated with external 3- dimensional conformal radiotherapy (3D-CRT). Patients received 57.75 Gy in 21 daily fractions of 2.75 Gy/fraction., Results: Late gastrointestinal (GI) toxicity was as follows: grade 0: 47 (73.4 %) patients, grade 1: 12 (19.2 %), grade 2: 4 (6.3%), and grade 3: 1 (1.6%). There was a significant correlation between D50, V70 and EORTC/RTOG late rectal toxicity score (p<0.001 and p=0.006, respectively). Grade 1 and 2 late bladder toxicity was seen in 4.7 and 1.6% of the patients, respectively. With a median follow up of 18 months no biochemical relapse was observed., Conclusion: The present study supports the use of hypofractionated radiation therapy which showed a high therapeutic ratio with acceptable toxicity and no biochemical relapse during follow-up.

Introduction: In radiotherapy, a team of highly specialised professionals co-operate in planning and delivery of treatment and are responsible for the effectiveness and safety of the service. The aim of this article was to present the necessity and features of a quality assurance (QA) program in radiotherapy through literature review., Methods: A search was carried out in Scirus, Medline/ PubMed databases using the keywords "clinical oncology", "radiation oncology", "radiotherapy", "oncology practice", "quality assurance" and "quality of care". Twenty-nine articles were chosen covering the period 1995-2007. Further information was obtained from the Royal College of Radiologists' UK website., Results: QA was relevant to three aspects of radiotherapy: 1) clinical, involving resources (staffing and equipment), procedures (treatment planning, follow up) and results (tumor control, toxicity); 2) medical physics, involving the measurements necessary for the safety and precision of equipment; and 3) technical, involving the accurate plan implementation and the smooth function of treatment machines. International guidelines defined best practice in diagnosis and treatment of cancer patients. Moreover, the principles of quality management provided the tools not only for a reasonable use of limited resources but also for continuous improvement of organisations towards patient- centred services., Conclusion: Quality in radiotherapy is a dynamic concept that needs to be measured and re-evaluated using scientific methods and feedback by the users. Successful implementation of a QA program in radiotherapy requires expertise, training and co-ordination in an environment of teamwork.

Purpose: To evaluate the efficacy as well as acute and late toxicity of two different accelerated hypofractionated 3D-conformal radiotherapy (Hypo-3DCRT) schedules in patients with bladder cancer., Methods: Between February 2006 and June 2011, 50 elderly patients with cT1-2N0 bladder carcinoma were treated with Hypo-3DCRT. Mean age was 75 years. All patients were medically inoperable, with poor performance status, who couldn't tolerate either cystectomy or radical external beam irradiation on a daily basis. A dose of 36 Gy in 6 weekly fractions (arm A, N=39) or 39.96 Gy of 3.33 Gy twice daily, once a week, for 6 weeks (arm B, N=11) were prescribed. The primary study endpoints were the evaluation of acute/late gastrointestinal (GI) toxicity according to the EORTC/RTOG scale together with the visual analogue bladder-related pain score (VAS)., Results: The GI acute toxicities were: grade 1: arm A 24/39 (61.5%), arm B 9/11 (81.8%); grade 2: arm A 14/39 (35.9%), arm B 1/11 (9.1%); grade 3: arm A 1/39 (9.1%) (x(2), p=0.29). Only grade 1 late GI toxicity was seen and was significantly higher in arm A: arm A 17/39 (43.6%) and arm B 1/11 (9.1%) (x(2), p=0.037). The reduction of VAS score was similar in both arms (p=0.065). The median relapse free survival (RFS) was 15 and 16 months for arm A and B, respectively (log rank, p=0.71)., Conclusions: Beyond the non-randomized design of the trial, the Hypo-3DCRT schedules used appear to be an acceptable alternative to the traditional longer radiotherapy (RT) schedules for elderly patients unfit for daily irradiation.

The treatment of Hodgkin's lymphoma (HL) is associated with significant toxicity. The objective of high quality management is to keep the concept of combined modality, while trying to decrease the radiation dose, to diminish to a great extent the irradiated volume and at the same time to reduce the number of chemotherapy courses, introducing the so-called optimisation. New directives should be followed to obtain more effective treatments of HL. Shorter cycles of chemotherapy and the utilization of modern techniques in radiotherapy (RT) constitute fundamental steps to achieve this objective. Analysis of randomized studies supports the inclusion of reduced-field and dose of RT in the radiotherapeutic treatment options for HL. RT is an integral part of the combined-modality therapy (CMT) of HL.

Purpose: The monoclonal antibody cetuximab that targets epidermal growth factor receptor (EGFR) has been found effective in the treatment of colorectal cancer. However, mutations in exons 12 and 13 of KRAS oncogene have been reported as negative predictive factors for the treatment response using cetuximab. The purpose of this study was to conduct a meta-analysis of the published studies investigating the predictive value of KRAS mutations in the efficacy of cetuximab in patients suffering from colorectal cancer., Methods: A systematic search of the literature was performed in PubMed, Medline, and Cochrane databases. Sensitivities, specificities and predictive values (negative and positive) of KRAS mutations as regards treatment response were calculated., Results: Twenty-six studies were initially found during the literature search. After thorough evaluation, 13 papers were excluded for various reasons. Therefore, 13 studies were included in the present meta-analysis. In these studies, specificities were found much higher than sensitivities. Combining the data from the 13 studies, it was found that KRAS mutations comprise a negative predictive biomarker for response to cetuximab with very high specificity (0.96; 95% CI 0.84-0.99), and low sensitivity (0.47; 95% CI 0.43-0.50). Finally, the publication bias was found statistically significant., Conclusion: The results of the present meta-analysis suggest that cetuximab should be administered only to patients with colorectal cancer who have the wild type (KRASw) oncogene. Mutations in the KRAS gene are a negative predictive factor for response to cetuximab with very high specificity and low sensitivity. The latter may very well be attributed to additional mechanisms of resistance to anti-EGFR therapies such as mutations in BRAF.