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We aimed to compare the protective effect of L-carnitine (CAR) and amifostine (AMF) against cisplatin (CDDP)-induced nephrotoxicity through biochemical markers and histopathological evaluation. Fifty-seven Wistar albino male rats were randomly classified into six groups, which were AMF+CDDP (n = 11; 200 mg/kg AMF 30 min prior to 7 mg/kg CDDP), CAR+CDDP (n = 11; 300 mg/kg CAR 30 min prior to 7 mg/kg CDDP), CDDP (n = 11; 1 mL/kg isotonic saline 30 min prior to 7 mg/kg CDDP), AMF (n = 8; 200 mg/kg AMF alone), CAR (n = 8; 300 mg/kg CAR alone), and control (n = 8; 1 mL/kg isotonic saline alone). All drugs were given intraperitoneally. Five days after medication, animals were killed, and samples of blood and kidney tissues were collected for biochemical and histopathological evaluation. The serum urea level was highest in AMF+CDDP group among CDDP-applied groups without statistical significance (median, range: 88, 56-21 mg/dL; P > 0.05). There was no statistical significance among CDDP-applied groups in terms of creatinine level (P > 0.05). In the AMF+CDDP group, the median glomerular, tubular, and tubulointerstitial inflammatory damage scores were significantly higher than the other CDDP-applied groups (P < 0.001). The difference between CAR+CDDP and CDDP groups was not statistically significant in terms of renal damage scores. AMF+CDDP group had significantly higher median total nephrotoxicity score than all the other groups (P < 0.001). To conclude, AMF or CAR has no protective effect on CDDP-induced nephrotoxicity. Furthermore, our findings suggest that application of AMF before CDDP may enhance CDDP-induced nephrotoxicity histopathologically.

YURUT-CALOGLU V., CALOGLU M., KAPLAN M., OZ-PUYAN F., KARAGOL H., IBIS K., COSAR-ALAS R, KOCAK Z. & INCI O. (2010) European Journal of Cancer Care19, 656–663 Prognostic factors for renal cell carcinoma: Trakya University experience from Turkey The purpose of the present study is to evaluate the prognostic factors of patients with renal cell carcinoma. The treatment results such as distant metastasis-free survival and overall survival of 59 previously untreated patients were retrospectively analysed. Median follow-up was 17.5 months (3.8–88.5 months). Overall survival was 22.4 months (3–87 months). Distant metastasis developed in 35 (59%) patients. The Eastern Cooperative Oncology Group (ECOG) performance status (P= 0.022), tumour size (P= 0.025) and lymphatic invasion (P < 0.0001) were significantly effective prognostic factors for distant metastasis-free survival on multivariate analysis. Related to overall survival, gender (P= 0.025), ECOG performance status (P= 0.027), nuclear grade (P= 0.002), tumour size (P= 0.029), T stage (P= 0.044), nodal involvement (P= 0.003), surgical margin (P= 0.046), renal sinus invasion (P < 0.0001), perineural growth (P= 0.001) and lymphatic invasion (P < 0.0001) were significant prognostic factors on univariate analysis. Gender (P= 0.008), ECOG performance status (P= 0.027), tumour size (P= 0.025) and lymphatic invasion (P < 0.0001) retained their significance on multivariate analysis. We concluded that the most important prognostic factors for patients with renal cell carcinomas are ECOG performance status, tumour size and lymphatic invasion.

Background To identify the candidates for prophylactic cranial radiotherapy (PCI) among the patients with early and advanced-stage breast cancer. Methods The demographic, pathologic and clinical features and survival results of 182 brain metastatic breast cancer patients treated with cranial radiotherapy were examined. Results Early stage patients who progressed with isolated brain metastasis had longer survival (13 months vs. 4 months P = 0.006). Lobular/mixed type histology (P = 0.033), high nuclear (P = 0.046) and high histological grade (P = 0.034) were the prognostic factors for isolated brain metastases. The most significant factor for the time to brain metastasis was the number of involved of lymph nodes (P = 0.004). In 60% of 148 patients with metastatic breast cancer, a progression with isolated brain metastasis was developed while the systemic disease was under control. Isolated brain metastasis progression was related to the presence of the hepatic metastasis at the first relapse (P = 0.001) and with ErbB-2 overexpression (P = 0.034). The time to the brain metastasis from the first extracerabral metastasis was associated with the high nuclear grade (P = 0.040) and with chemoresistance (P = 0.037). The median survival time after the brain metastases in chemosensitive patients was longer than in chemoresistant patients (8 months vs. 3 months P = 0.044). In chemoresistant patients (P = 0.0028) and/or in triple negative patients (P = 0.05) the development of the brain metastasis was early and the survival after brain metastasis was short. Discussions Since there is a tendency to early brain metastasis in early stage patients with high-grade, lobular/mixed type histology tumors and with a high number of involved lymph nodes, the value of PCI can be explored in these patients by a well designed prospective trial. Advanced stage chemosensitive patients with ErbB-2 over-expression and/or with hepatic metastasis at their first relapse may be candidates for PCI. There is no place for PCI in chemoresistant and triple-negative breast cancer patients.

The aim of this study is to reveal likely demographic, clinical, and pathological differences among hormone receptor negative breast cancer patients according to their HER-2 status. The medical records of hormone receptor negative breast cancer patients with known HER-2 status between January 1999 and December 2006 were reviewed, retrospectively. A total of 91 cases were included in the study (68 HER-2 negative cases and 23 HER-2 positive cases). The results obtained showed that median age, menarche age, childbearing age, number of children, menopause age, and body-mass indexes were similar in both groups. The HER-2 negative patients had more family history of breast cancer than HER-2 positive patients (13.2% and 0%, respectively, P = 0.091). Eighty-three patients received neoadjuvant/adjuvant chemotherapy. Recurrence occurred in 41 (46.6%) patients. Neither recurrence nor disease-free survival of those patients was associated with HER-2 status. Tumor size (P = 0.042) and number of involved lymph nodes (P = 0.001) were found to be independent prognostic factors for disease-free survival. A tendency for more frequent cerebral metastasis was found in HER-2 positive advanced stage patients (P = 0.052). HER-2 positive patients were less responsive to taxanes (P = 0.071). The number of involved lymph nodes (P = 0.004) and HER-2 status (P = 0.043) were found to be prognostic factors for overall survival. HER-2 positive and negative patients should be followed and treated with different strategies. HER-2 positive patients are at least as resistant to systemic therapies as the HER-2 negative patients. Genetic counseling should be routinely provided to triple negative patients and their families. HER-2 positive patients may be candidates for prophylactic treatment strategies concerning cerebral metastasis.

The aim of this retrospective analysis was to investigate the factors affecting the prognosis of brain metastases in breast cancer patients to identify subgroups which might benefit from prophylactic treatments in future. Seventy-three early and 13 advanced stage patients with known Erb-2 status were included. In 14% of the early stage patients, the first recurrence site was isolated brain metastasis. None of the anthracycline resistant patients had brain metastases as their first recurrence site. The median interval between diagnosis and brain metastasis was 41.5 months (95% CI, 35.79–47.20) in early stage patients. The median interval between the first extracerebral metastases to the brain metastases was 15.5 months (95% CI, 12.24–18.76) in all patients. High histologic and nuclear grade, large tumor, anthracycline resistance were the factors which significantly affected the early appearance of brain metastases but only advanced age (≥55 years, P = .035) correlated with isolated brain metastasis. Progression with isolated brain metastases was significantly higher in responsive ErbB-2 positive population (P = .036) and none of other pathological factors was associated with isolated brain metastasis in advanced stage. The median survival after brain metastasis in patients with brain metastasis as first recurrence was longer than the patients with brain metastasis after other organ metastasis (13 months vs 2 months P = .003). The median survival following brain metastases in complete responsive patients was higher than the others (24 months vs 6 months, P = .002). Therefore, response to systemic treatment was more determinative in the development of isolated brain metastases than clinical and pathologic features. ErbB-2 should be emphasized in prophylactic treatment strategies. Prophylactic cranial radiotherapy may be an effective treatment option for metastatic patients with complete responsive disease and with controlled ErbB-2 positive disease.

Background To evaluate the efficiency of docetaxel as second line chemotherapy in patients with platinum-refractory non-small cell lung carcinoma (NSCLC). Patients and methods Fifty-two patients with locally advanced or metastatic NSCLC who had platinum-refractory disease (progressed through or within 3 months of completion of first line therapy) and an Eastern Cooperative Oncology Group performance (ECOG) status 0–2 were treated with second-line chemotherapy consisting of single agent docetaxel (100 mg/m2, intravenously, on day 1 of a 21-day cycle). The median number of treatment cycles was 4 (2–6). Disease-free (DFS) and overall survival (OS), response rates and toxicity were evaluated. Results The median progression-free survival of patients was 3 months (95% CI: 0.01–5.99) and overall survival was 7.2 months (95% CI: 2.2–9.5). One-year overall survival rate was 29%. Disease control (complete response, partial response, or stable disease) was achieved in 25 patients (48%) and overall response rate was 13% (7 patients). There were no complete responses. Seventeen patients (33%) had stable disease and twenty-seven patients (52%) had progressive disease. Age, gender, stage at diagnosis (IIIB vs. IV), performance status at initiation of second-line therapy (0–1 vs. 2) histopathological type (epidermoid vs. others), grade, LDH, albumin, weight loss were evaluated as prognostic factors; however, none of these had a significant affect on survivals. The protocol was well tolerated and there were no toxic deaths. Grade III–IV anemia was present in 8 patients (15%) and thrombopenia in 12 (23%) patients. The most frequent grade 3–4 toxicities were leucopenia (52%) and neutropenia (48%). Febril neutropenia occurred in 14 patients (26%). No patients experienced grade III–IV mucositis and diarrhea. Totally, the need of a dose reduction was about 25% and treatment delay (4–9 days) occurred in 5 patients (10%) and 7 patients (13%), respectively, because of toxicity. Conclusions Second-line chemotherapy with single-agent docetaxel offers a small but significant survival advantage with acceptable toxicity for patients with advanced NSCLC who have platinum-refractory disease.

Activity of tamoxifen as a salvage therapy in patients with advanced epithelial ovarian cancer was evaluated by a number of studies. In this study, we evaluated efficacy of tamoxifen in our patients with platinum-resistant epithelial ovarian carcinoma.A retrospective analysis was conducted of patients who received tamoxifen at a dose 20 mg twice daily for the treatment of advanced epithelial ovarian cancer.Twenty-nine eligible patients were included to the study. There were 1 (3%) complete response, 2 (7%) partial response, 6 (21%) stable disease, and 20 (69%) progressive disease. All patients were progressed after initiation of tamoxifen. Median progression-free survival was 4 mo (95% CI: 2.98-5.02). Disease progression of 19 (65%) patients were shown within the first 6 mo after initiation of tamoxifen. Progression-free survival was between 6 and 12 mo for 7 (24%) patients andor =12 mo for 3 (10%) patients. The median survival after initiation of tamoxifen was 15 mo (95% CI: 7.2-22.8). No toxicity attributable to tamoxifen was seen in any of the patients. The only independent prognostic factor that had a significant predictive value for progression- free survival was the response to tamoxifen treatment (p = 0.043, hazard ratio: 0.12, 95% CI: 0.01-0.94).Considering minimal side effects and ability to cause objective responses, there is a place for tamoxifen in treatment of patients with platinum-resistant ovarian cancer. A phase III trial is required to con- firm the value of the drug in patients presenting these clinical settings.

The term 'radiation recall' describes an acute inflammatory reaction in previously irradiated areas after the administration of certain inciting systemic agents. It was first described in 1959 by D'Angio that dermatitis is related to the application of actinomycin D on the skin. Though this reaction occurs frequently on the skin, it may also be seen in the oral mucosa, the larynx, esophagus, small intestine, lungs, muscle tissue, and brain. Most drugs associated with recall reactions are cytotoxics, however, several other drugs may also elicit the phenomenon. Although this phenomenon is well known, its etiology is not understood. Radiation recall reactions are generally associated with megavoltage radiotherapy. The time interval between the completion of radiotherapy and the recall reaction ranges from days to years. The recall reaction occurs on average 8 days (3 days to 2 months) after the application of the promoting agent. Although no standard treatment exists, some authors suggest discontinuation of the inciting drug and the use of corticosteroids or nonsteroidal anti-inflammatory agents.

BACKGROUND. The study was conducted with the aim of reviewing the clinical features, therapy, and natural course of patients with extrapulmonary small-cell carcinoma (EPSCC) and small-cell lung carcinoma (SCLC) to better define current concepts regarding EPSCCs. METHODS. The medical records of patients with proven diagnosis of small-cell carcinoma (SmCC) between January 1999 and May 2006 were retrospectively reviewed. A total of 65 SmCC cases were included in the study (11 [17%] cases of EPSCC and 54 [83%] cases of SCLC). RESULTS. Progression-free survival of all patients with EPSCC and patients with extensive EPSCC disease was 7 months (95% confidence interval [CI], 0.58–13.42) and 7 months (95% CI, 4.71–13.29), respectively. Overall survival of all patients with EPSCC and patients with extensive EPSSC disease was 32 months (95% CI, 18.74–45.26) and 28 months (95% CI, 12.24–43.76), respectively. Progression-free survival and overall survival for all patients with SCLC were 5 months (95% CI, 2.26–7.74) and 10 months (95% CI, 5.95–14.05), respectively. Progression-free survival and overall survival for patients with extensive disease were 3 months (95% CI, 4.71–13.29) and 5 months (95% CI, 3.33–6.67), respectively. Overall survival was significantly better in all patients with EPSCC and in patients with extensive EPSCC disease compared with all patients with SCLC and patients with extensive SCLC disease (P = .014, P = .004, respectively). Early death and brain metastasis were observed in a higher number of patients with SCLC compared with EPSCC; however, these results were not statistically significant (P = .33 and P = .076, respectively). Smoking history was significantly less in the EPSCC group (P < .0001). CONCLUSIONS. EPSCC is usually treated similarly to SCLC. However, this study suggests some differences such as etiology, clinic course, survival, frequency of brain metastases, and early death between these entities. These possible differences may influence the choice of therapeutic approach. Cancer 2007. © 2007 American Cancer Society.

Paranasal sinuses represent an unusual site for non-Hodgkin's lymphoma (NHL). Failure after treatment for paranasal sinus lymphomas is usually in non-irradiated sites and marginal sites. With this case report, we present a paranasal sinus lymphoma in complete remission with an isolated recurrence in skeletal muscle of the right lower limb for the first time in the literature.

Primary hepatocellular carcinoma (HCC) is common in Turkey and its prognosis is poor. In the current study the authors analyzed the prognostic factors and survival in Turkish patients with inoperable HCC with cirrhosis.Clinical and demographic data of 91 patients consecutively admitted to the authors' institute from 1988 to 2000 were reviewed. A univariate analysis was performed using the Kaplan-Meier method to identify predictors of survival and were compared using the Mantel log-rank test. Independent factors correlated with survival were determined using the Cox regression analysis.Cirrhosis was diagnosed in all patients. Coinfections with HCV and HBV were not observed. Overall median survival was 16.9 months. On univariate analysis, poor performance status (Eastern Cooperative Group); high alpha-fetoprotein (AFP); low albumin; high bilirubin; high alkaline phosphatase; high lactic dehydrogenase; high alanine and aspartate aminotransferase; high gamma-glutamyl transpeptidase; high platelet count; low prothrombin activity; hepatitis B surface antigen positivity; the presence of ascites, encephalopathy, and portal vein thrombosis; poor differentiation and diffuse type of tumor; and no treatment were associated with shorter survival. Multivariate analysis showed that only independent risk factors were related to performance status (Eastern Cooperative Group) at initial presentation and with pathologic characteristic of the tumor: abnormal AFP level.HCC occurred only in patients with liver cirrhosis. Survival time can be predicted from information collected by the physician at the initial assessment.

In Western literature, there are few studies investigating the predictors of early versus late recurrence after curative gastrectomy for gastric cancer. The current study analyzed (1) patients who died of recurrent gastric cancer and (2) prognostic factors, which can be applied to timing of death from tumor recurrence. Of 492 patients who underwent curative resection (R0) for gastric cancer in the Department of Surgery, Medical Faculty of Istanbul between 1994 and 2000, 142 patients who died of recurrence were included into study. None of the patients had received postoperative adjuvant treatment. The patients were divided into 2 groups: an early recurrence group that included 102 patients who recurred and died within 2 years after surgery, and a late recurrence group, which included 40 patients who died of recurrence more than 2 years after surgery. Clinicopathologic findings were compared between the early and late recurrence groups. Multivariate analysis was performed to investigate the independent factors, which are predictive for early versus late recurrence, and prognostic factors independently associated with the survival period. In multivariate analysis, the early recurrence group, when compared with the late recurrence group, was characterized by lymph node metastasis (N1-3 versus N0; P = 0.002). Overall survival was influenced by nodal status (N1-3 versus N0; P = 0.003), type of operation performed (radical total versus radical subtotal gastrectomy; P = 0.003), Eastern Cooperative Oncology Group performance status (PS 3-4 versus PS 1-2; P = 0.004), and tumor localization (cardia versus corpus and antrum; P = 0.046). In contrast, T stage of the disease was not prognostic for survival, although it was close to statistical significance (P = 0.066). Multivariate analysis showed that poorer performance status at initial presentation (P = 0.001) and lymph node metastasis (P = 0.032) independently correlated with overall survival (P = 0.002). Lymph node status was the most important factor predictive for early versus late recurrence and patients with lymph node metastases were at more risk of death within 2 years after curative operation for gastric cancer. Postoperative chemoradiotherapy should be especially recommended for patients at high risk of recurrence of adenocarcinoma of the stomach or who have undergone curative resection.

Spontaneous intracranial hypotension (SICH) is an entity, which is secondary to iatrogenic manipulation and breaching of dura. Postural headache in patients should be suspected, cranial magnetic resonance imaging (MRI) is essential for precise diagnosis. Hallmark of MRI is regular shape of pachymeningeal gadolinium enhancement and subdural effusion. It may mimic central nervous system (CNS) metastasis. Prevention of such cases from receiving cranial radiotherapy by misinterpretation of the gadolinium enhancement as CNS metastasis is an important issue. Capecitabine is an antineoplastic agent, of which metabolites can cross blood-brain barrier in CNS via epithelial tissue. It may cause decrease in CSF production. SICH might be the clinical reflection of this decrease in CSF production. Review of the English literature revealed limited data because of the very little experience with oncologic patients suffering from intracranial hypotension. We report a case of spontaneous intracranial hypotension during capecitabine treatment. Patient was completely well following drug discontinuation and supportive treatment.

Malignant melanoma is a highly unpredictable tumor that has capacity to metastasize to any organ. A better understanding is needed of the clinicopathologic features of metastatic melanoma and, in particular, of its rare manifestations.A 33-year-old woman with a past medical history of malignant melanoma presented with symptoms of throat discomfort and bleeding. On physical examination, a dark pigmented lesion was observed on the right tonsil. Tonsillectomy was performed, and melanoma was diagnosed. Computed tomography of the thorax and abdomen revealed a filling defect in the right atrium and a 4-cm gallbladder mass. Echocardiography revealed a right atrial mass. No further metastasis was detected by whole body (18)F-fluorodeoxyglucose positron emission tomography. Each metastasis was completely resected with clear margins. The pathologic diagnosis of the resected masses was malignant melanoma. 3 weeks after the final surgery, temozolomide was started. The patient has been followed up for 9 months after diagnosis of the first recurrence, and no new metastases have been detected.We report a case with synchronous tonsil, gallbladder, and heart metastases without any other common sites of metastasis of melanoma. The patient was successfully treated with aggressive surgery followed by temozolomide.

Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy.A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months.For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.

Analyses of gene expression status and genetic polymorphisms are methods to identify novel histopathological prognostic factors. In patients with gastric cancer, some cell cycle regulators p53, p21, p27 and Her-2 oncogene have been proposed as prognostic factors. We aimed to investigate the expression and mutation/polymorphism of p21 and Her-2 and also relationship between that genes status and histopathological factors and prognosis in patients with gastric cancer. Forty-four patients with locally advanced gastric cancer were analyzed in this study from January 2000 to December 2008. Clinicopathological parameters, expression and mutation/polymorphism of p21 and Her-2 results were used to predict disease-free survival and overall survival. The positive expression of p21 and Her-2 was observed in 61.4 % (n = 27) and 9.1 % (n = 4) of all 44 tumors, respectively. p21 gene mutation and Her-2 gene polymorphism were detected in 20 % (n = 11) and 2.3 % (n = 1, II phenotype) of cases, respectively. The negative expression of p21 was correlated significantly with diffuse and undifferential type histologies, whole gastric involvement and positive vascular/neural invasion. The median survival rate of patients with negative expression was significantly poorer than that of patients with positive expression of p21 (17 vs. 27 months, p = 0.01, cox regression). p21 mutation was significantly higher in patients with diffuse (p = 0.03) and undifferential (p = 0.02) type histologies. There was no statistically significant association between histopathological parameters and Her-2 gene polymorphism/expression. The negative expression of p21 correlates with disease survival and may be a poor prognostic factor in patients with resected gastric cancer treated with adjuvant chemotherapy.

Aims and background It has been appreciated for some time that the lack of detection of ovarian cancer at clinical and pathological (second-look laparotomy) evaluation is not synonymous with cure. The goal of this study was to define clinical risk factors for recurrence after complete pathological response to postoperative chemotherapy in patients with epithelial ovarian cancer. Methods Fifty-seven patients who met the inclusion criteria of our study were evaluated. The characteristics (age, menopausal status, histological subtype, tumor grade, presence of ascites at diagnosis, type of omentectomy, FIGO stage, and residual tumor volume after primary surgery) of patients with and those without tumor recurrence were compared. Results The median follow-up was 52 months (range, 15–142 months). The overall survival rates of the patients were 100%, 96%, and 87% at 1, 3 and 5 years, respectively. At the time of the study analysis, 21 of 57 (37%) patients had recurrent disease. The median time to recurrence was 16 months. Recurrences were most frequent in the pelvis and abdominal cavity (38%). Age, menopausal status, stage at diagnosis, and residual tumor volume after initial surgery were significantly related to the risk of recurrence in univariate analysis (P = 0.039, 0.038, 0.004, and 0.000, respectively). Residual tumor volume after initial surgery was found to be the only significant independent prognostic factor (P = 0.049, HR: 0.16, 95% CI: 0.02–0.99). Conclusion We believe it is necessary to conduct randomized studies on this issue because insight into predictors of recurrence after pathological complete response to postoperative chemotherapy could be used to select patients for trials of consolidation therapy.

The adverse effects of regimes in cancer treatment have forced us to change to new targeted therapy options. Understanding these side effects, which can lead to discontinuation of the new therapy strategies, will allow the clinical management of these side effects and result in continuing therapies with effective medications. Bevacizumab, which is an IgG1 antibody against vascular endothelial growth factor, has side effects such as proteinuria, hypertension, venous and arterial thromboembolic events, and hemorrhage. This is the first reported case of dural sinus vein thrombosis, during the treatment with bevacizumab.

To evaluate the prognostic factors affecting locoregional control (LRC) and overall survival (OS) of patients with laryngeal carcinoma who were not candidates for surgical treatment due to tumour or host factors but were treated with definitive radiotherapy (RT).Sixty-three consecutive patients, treated with definitive RT between 1999 and 2005, were retrospectively analyzed. All patients had histologically proven squamous cell carcinomas of the larynx. The median age was 62 years (range 43-83 years). Follow-up ranged from 22 days to 68 months (median 32 months).The LRC rates at 2 and 5 years were 70% and 48%. The 2- and 5-year OS rates were 65% and 40%. No statistically significant relationship was found between World Health Organization performance status score (WHO PS) and age (p=.21), tumour site (p=.42), overall stage (p=.11), T stage (p=.19), and N stage (p=.69). Multivariate analyses showed that a WHO PS scoreor=2 (p.0001) and RT treatment timeor=50 days (p=.0172) significantly decreased LRC. Moreover, a WHO PS scoreor=2 (p.0001), RT treatment timeor=50 days (p=.0138), and RT dose66 Gy (p=.04) were significantly negative prognostic factors on OS.Definitive RT, in patients with early- and more advanced-stage squamous cell carcinoma of the larynx, is an important treatment option. It is clear that patients with good pretreatment PS would get better results from definitive RT.

Extrapulmonary small cell carcinomas (EPSCC) can clinically progress differently depending on the primary site of disease involvement. This review is focused on patients with small cell carcinoma (SmCC) exclusively localized in a lymph node or in multiple lymph nodes without any evidence of a primary tumor in any other organ.We searched the period 1980 to 2007 in the PubMed database and identified 11 publications in the English language presenting at least one case of SmCC. In total 28 individual patients were included in the present study. They were scrutinized in terms of epidemiology, clinical presentation, staging, pathology, etiology, treatment and prognosis.Characteristics such as age, gender and smoking were similar to those seen in other EPSCCs. Median survival was not reached (42+, range, 9.1 to 100 months). The survival rate was found to be 79% at 3 years. Seventy-seven percent of the patients had limited stage disease. These patients completely responded to surgical therapy, chemotherapy, radiotherapy or to a combination of these treatments. Seventy-one percent of the patients with limited stage SmCC localized in lymph nodes were recurrence-free during the study periods.Our review patient group with SmCC localized in lymph nodes exhibited an excellent clinical behavior and survival results when compared to other patients with pulmonary and non-pulmonary SmCCs. SmCCs localized in lymph nodes may be a separate clinical entity.

Several studies have shown that the concurrent administration of chemotherapy (CHT) and radiotherapy (RT) is superior to RT alone in patients with inoperable non-metastatic squamous cell carcinoma of the head and neck (InSCCHN). We compared the efficacy and safety profile of RT and concurrent cisplatin CHT given in two different schedules to patients with previously untreated InSCCHN.Fifty patients with previously untreated InSCCHN admitted to our oncology department were included in the study. Thirty of 50 (60%) patients with a younger age or good performance status (PS) (ECOG 0-1) received cisplatin 100 mg/m(2) on a 21-day schedule (group A). Other 20 (40%) patients with older age or poor PS (ECOG 2) received cisplatin 40 mg/m(2) on a 7-day schedule (group B). Each of the 50 patients received concurrent conventional dose RT according to primer tumor location.The median follow-up is 12 months for group A and 12.5 months for group B. Twenty-eight (93.3%) patients in group A and 18 (90%) in group B were evaluable for response. The complete response rate was 50% in group A and 40% in group B (P0.05). The objective response rate was 92% in group A and 90% in group B (P0.05). All grade 3-4 toxic events were seen in 16 (53.3%) of group A patients and 8 (40%) of group B patients (P0.05).Comparison between two treatment modalities appears to result in statistically similar response rates and adverse event profile. A randomized phase III trial is required to confirm the safety and efficacy of weekly cisplatin therapy in patients with poor PS and/or older age at diagnosis.

Ektopik adrenokortikotop (ACTH) salinmasina bagli Cushing sendromu, kucuk hucreli akciger kanserli hastalarda diger bircok paraneoplastik sendromlara gore daha sik gorulur. Bu hastalarda hucresel bagisiklik sisteminin baskilanmasi hem hekimler hem de hastalar icin onemli bir sorundur. Ek olarak kemoterapi, bu hastalarda siddetli ve daha yuksek oranda hematolojik toksisiteye neden olmaktadir. Biz ektopik ACTH salinmasi ile iliskili Cushing sendromuna bagli humoral ve hucresel bagisiklik sistemi baskilanmis cok kotu seyirli bir kucuk hucreli akciger vakasi sunduk. Ayrica, bu ozel vaka ve literatur isiginda Cushing sendrom olan kucuk hucreli akcigerli hastalar icin tedavi stratejileri onerdik.

The incidence of skeletal muscle metastases is reported to be less than 1% of metastases of haematogenous origin. Distant skeletal muscle metastases from head and neck squamous cell carcinomas are exceedingly rare. Only a case with tongue carcinoma metastasized to paravertebral muscles, has been reported so far. The reasons for the rarity of metastatic involvement of skeletal muscle are still unclear. The presence of skeletal muscle metastases in the setting of disseminated disease offers no hope for curative treatment. We report an unusual case of a 63-year-old patient with tongue carcinoma metastasizing to the left shoulder muscles. To our knowledge, this is the first such case to be reported in the English medical literature.

Adenoid cystic carcinoma is the second most common malignancy of the major and minor salivary glands after mucoepidemoid carcinoma. The risk of distant metastases is approximately 20–50%. Although bone, the central nervous system and the other organs may become involved, the lungs are favored sites for metastases. Skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the parotid gland are extremely rare. In this case, a 40-year-old man with lung and bone metastases followed by skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the right parotid gland is presented.

Various remote effects of cancer or paraneoplastic syndromes (PNS) are common in lung cancer, and may be the manifestation of the disease or its recurrence. The symptoms may be endocrine, neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, gastrointestinal, renal, or miscellaneous in nature. Since the symptoms of paraneoplastic syndromes may occur before the local symptoms of the primary tumor, it might be helpful in the early diagnosis of malignancy. We present a 65-year-old man with multiple paraneoplastic syndrome forms consisting of pancytopenia leukocytoclastic vasculitis and hypertrophic pulmonary osteoarthropathy, associated with non-small cell lung carcinoma.

Background: In testicular germ cell tumors (GCT), bone metastases are usually seen late in the disease progress and are almost always associated with involvement of other sites. However, isolated bone metastasis is an extremely rare finding in these patients. Case Report: A 43- year-old man was admitted to the neurosurgery department of our hospital suffering from dysarthria, ataxia, headaches and a progressive swelling above the parietooccipital region of the skull. Radiological, biochemical and pathologic tests showed that the lesion of the skull was an isolated skull metastasis as an initial manifestation of nonseminomatous GCT of the testis. Discussion: When a young patient presents with bone pain or painless swelling, even if it is an unusual site and isolated, testicular GCT should be considered as a differential diagnosis, as these lesions could be the first evidence of metastatic GCT.

Prognostic factors related to survival in patients with inoperable metastatic or recurrent endometrial carcinoma (MREC) have remained unclear due to lack of clinical trials. The management of these patients is also controversial. This study was performed to compare the efficacy and toxicity profiles of two different systemic therapies (chemotherapy vs hormonal therapy) given for the treatment of patients with MREC and to identify the impact of various prognostic factors on the survival.Between 1992 and 2004, 44 patients with MREC were admitted to our oncology department. Four cases were excluded from this retrospective study because of lack of data in their charts. Age, presence of other systemic diseases (such as diabetes mellitus, hypertension), histological type, tumor grade, stage, disease-free interval, site of recurrence or metastasis, systemic treatment modality, overall response to treatment, and duration of time to progression were evaluated as prognostic factors. Cox regression analysis was performed for identification of independent prognostic factors and differences between patients characteristics of two treatment groups were calculated by the chi-square or t test.The median follow-up was 18 mo (range 3-113). The overall response rates for chemotherapy and hormonal therapy group were 42% and 41%, respectively (p0.05). The median time to progression was 4 mo for the chemotherapy group and 5 mo for the hormonal therapy group (p0.05). The median survival after metastasis or recurrence was 11 mo for the chemotherapy group and 16 mo for the hormonal therapy group (p0.05). In the group of chemotherapy, grade 3-4 hematologic and nonhematologic toxicities were seen in eight and two, patients, respectively. No grade 3-4 toxicities were noted in patients treated with hormonal therapy. In multivariate analysis, only time to progression (p=0.001) and grade (p=0.04) were the independent prognostic factors on survival after metastasis or recurrence.Histological differentiation and duration of time to progression are predictive factors for survival after metastasis or recurrence in the whole group. The efficacy of two different groups of treatment in these patients appears to be similar. But the chemotherapy may have some disadvantageous in terms of toxicity. This study supports a future randomized prospective trial of hormonal therapy vs chemotherapy in patients with MREC.

A study was undertaken to analyze the extent of using complementary alternative medicine (CAM) and to compare sociodemographic and medical characteristics of users and non-users of CAM in Turkish oncology patients. A total of 615 patients with cancer who attended ambulatory patient care units answered the questionnaires. Medical information was reviewed from chart data. Some 291 patients (47.3%) had used at least one type of CAM since the time of initial diagnosis. CAMs almost always consisted of herbal agents (95%). Nettle (Urticae herba) used in conjunction with (88%) or without (56%) various herbal agents were the most popular and prominent CAMs used by patients. Univariate and multivariate comparisons of users and non-users of CAM were performed. In multivariate analysis, female sex (p=0.0006), high income (p=0.0008), advanced stage at diagnosis (p=0.02), and usage of multiple chemotherapy applications (p=0.03) were determined as independent factors for CAM use.

Although testicular germ cell tumors have become curable neoplasms, a better understanding of the clinicopathologic features is needed for the rare manifestations associated with treatment failure. We report a rare case of metastatic pure choriocarcinoma involving the small intestine arising from a testicular mixed germ cell tumor. In a patient who developed massive upper gastrointestinal hemorrhage during treatment, the intestinal metastases and focus of bleeding could only be determined by laparotomy. We propose an approach for the determination of subclinical intestinal metastases of testicular germ cell tumor; the case is discussed in light of similar reports in literature.

874 Background: It has been shown that the occurrence of brain metatases in patients with breast cancer decreases survival and alters the quality of life. In the present study, we have searched for...