Search

Background: Recent studies have shown a lower likelihood of locoregional recurrences in patients with low 21-gene recurrence score (RS). In this single institutional study, we investigated any associations between different cut-off values of 21-gene RS and histopathological factors and outcome in patients with long-term follow-up. Methods: Between February 2010 to February 2013, 61 patients with early stage clinically node-negative hormone receptor-positive and HER2-negative breast cancer tested for the 21-gene RS assay, were included into the study. The clinicopathological, treatment and outcome characteristics were analyzed. Results: Median age was 48 (range, 29-72). Of those, 53 patients were diagnosed with Stage 1 (86.9%) and 8 patients were Stage 2 (13.1%) following surgery. Patients with high histologic grade (HG), or with Ki-67>=25% were significantly more likely to have intermediate/high RS based on RS >11 and >18 (Table 1). Based on the 21-gene RS assay, only 19 patients (31%) received adjuvant chemotherapy. At a median follow-up of 112 months, 3 patients developed local recurrences (4.9%) treated with endocrine therapy alone. Among patients treated with endocrine treatment alone (n=42), the clinicopathological characteristics including age < 40, age < 50, high histologic or nuclear grade, high Ki67-scores (>=20%, >=25%, >=30%), presence of lymphovascular invasion, luminal-A type tumor, multifocality, lymph node positivity, tumor size more than 2 cm, RS>=18 or RS>11 were not significantly found to be associated with 10-year locoregional recurrence free survival (LRRFS). However, patients with a RS >=16 have significantly shown a poorer 10-year LRRFS cpmpared to those with RS < 16 (RS < 16; 100% vs RS>=16; 75%, p=0.039, Table 2). Conclusions: These results suggest that Oncotype DX assay may be of little value in patients with high histologic grade or high Ki67 scores (>= 25%) as treatment decision criteria to determine any benefit from chemotherapy. Furthermore, patients with a RS >=16 are more likely to benefit from adjuvant chemotherapies, whereas those with a RS < 16 have an excellent outcome and local control on long term follow-up with endocrine treatment alone. Further prospective studies should be performed to validate these findings in future. Table 1. Correlation of 21-gene Recurrence Score (RS) including different cut-off values with Ki-67 scores and histopathological factors Table 2. Clinicopathologic factors and 21-gene Recurrence Score (=RS) associated with disease free survival (DFS) and locoregional recurrence free survival free survival (=LRRFS). (DFS is equal to LRRFS since none of the patients developed distant metastases) Citation Format: Cihan Uras, Neslihan Cabıoğlu, Fatma Tokat, Halil Kara, Ozlem ER, Taner Korkmaz, Nuran Bese, Umit Ince. FAVORABLE LOCOREGIONAL CONTROL IN CLINICALLY NODE-NEGATIVE HORMONE-RECEPTOR POSITIVE BREAST CANCER WITH LOW 21-GENE RECURRENCE SCORES: A SINGLE INSTITUTIONAL STUDY WITH 10-YEAR FOLLOW-UP [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-11-31.

Background: Most of the studies on salivary gland cancers are limited for various reasons such as being single-center, small number of patients, including only major or minor SGCs, or only including epidemiological data. Methods: A total of 37 medical oncology clinics from different regions of Turkey participated in this retrospective-multicenter study. The analyzed data included clinical and demographical features, primary treatment, metastasis localizations, and treatments and includes certain pathologic features. Results: The study included data from a total of 443 SGCs. 56.7% was in major salivary glands and 43.3% was in minor salivary glands. Distant metastasis in the major SGCs was statistically significantly more common than in the minor SGCs, locoregional recurrence was statistically significantly more common in the minor SGCs than in the major SGCs (p = 0.003). Conclusions: Epidemiological information, metastasis and recurrence patterns, treatment modalities, and survival analysis of the patients over 20 years of follow-up are presented.

Despite most of the prolactinomas can be treated with endocrine therapy and/or surgery, a significant percentage of these tumors can be resistant to endocrine treatments and/or recur with prominent invasion into the surrounding anatomical structures. Hence, clinical, pathological, and molecular definitions of aggressive prolactinomas are important to guide for classical and novel treatment modalities. In this review, we aimed to define molecular endocrinological features of dopamine agonist-resistant and aggressive prolactinomas for designing future multimodality treatments. Besides surgery, temozolomide chemotherapy and radiotherapy, peptide receptor radionuclide therapy, estrogen pathway modulators, progesterone antagonists or agonists, mTOR/akt inhibitors, pasireotide, gefitinib/lapatinib, everolimus, and metformin are tested in preclinical models, anecdotal cases, and in small case series. Moreover, chorionic gonadotropin, gonadotropin releasing hormone, TGFβ and PRDM2 may seem like possible future targets for managing aggressive prolactinomas. Lastly, we discussed our management of a unique prolactinoma case by asking which tumors’ proliferative index (Ki67) increased from 5–6% to 26% in two subsequent surgeries performed in a 2-year period, exerted massive invasive growth, and secreted huge levels of prolactin leading up to levels of 1 605 671 ng/dl in blood.

Many investigations exist regarding the effect of the DNA repair enzyme MGMT (O 6 -methylguanine- DNA-methyltransferase)-encoding gene methylation on the antineoplasticity of temozolomide in glioblastoma patients. However, there exist surprisingly lesser studies regarding the associations between MGMT enzyme biochemistry with glial carcinogenesis. MGMT involves in risk of malignancies associated with ionizing radiation, smoking, exposure to polycyclic aromatic hydrocarbons, chlorinated solvents, vinylchloride and hairdyes. All these factors are also proposed to link with gliomagenesis, yet MGMT interactions with these carcinogens in gliomagenesis are not studied yet. In future, MGMT sequencing may be employed in vulnerable populations working in industries associated with exposure to these carcinogens to develop preventive strategies. Given that MGMT is involved in DNA repair, a polymorphism may simultaneously modify the risk of gliomas while enhancing temozolomide cytotoxicity in both marrow and tumor cells.

WOS:000518031100008 PMID: 31970972 Background: The synthesis of CDK4/6 inhibitors with endocrine treatment in two series of treatment has been widely accepted as the standard for patients with estrogen receptor-positive metastatic breast cancer. In spite of this, the activity of CDK4/6 inhibitors in patients with metastatic breast cancer who have progressed despite receiving multiple lines of treatment is not well understood. Aims: To report the activity and safety of a CDK4/6 inhibitor (palbociclib) in patients in whom at least three lines of treatment for ER+ metastatic breast cancer had failed. Study Design: Multicenter retrospective observational cohort study. Methods: In this retrospective observational cohort study, we included 43 patients who received palbociclib after at least three lines of systemic treatment for ER+/HER2- metastatic breast cancer. Results: The median progression-free survival in our population was 7 months (25th-75th percentile, 4-10), and the median overall survival was 11 months (25th-75th percentile, 6-19). Although there were some adverse events, palbociclib was generally well tolerated, so dose reduction was needed for only six patients (14%). Conclusion: The efficacy of palbociclib among heavily treated hormone receptor-positive/HER2- patients with advanced breast cancer was acceptable in terms of clinical benefit, and it was generally well tolerated among this population.

PurposeNeoadjuvant chemotherapy(NACT) in gastroesophageal junction(GEJ) and gastric cancer(GC) was shown to improve survival in recent studies. We aimed to share our real-life experience of patients who received NACT in order to compare the efficacy and toxicity profile of different chemotherapy regimens in our country.Methods This retrospective multicenter study included locally advanced GC and GEJ cancer patients who received NACT, and had pathological response evaluation between 2007 and 2021. Relation between CT regimens and pathological evaluation were analyzed. Results A total of 728 patients from 45 oncology centers in Turkey were included. Median age at the time of diagnosis was 60 (range: 18-68). Most frequent NACT regimens used were FLOT (65%), DCF (18%) and ECF (8.1%), respectively. In the total study group pCR rate was 8.2%, R0 resection rate 88.5%, and D2 dissection rate was 66.8%. Rate of pCR and near-CR (26.4%), and R0 resection (92.6%) were higher in FLOT arm (p= 0.005 and ConclusionIn our real-life study, FLOT regimen has superior survival outcome despite worse toxicity profile. Clinicians should tailor treatment regimens according to patients’ multifactorial status and comorbidities for to obtain best outcomes.

It is not always possible to find enough data in Deep Learning applications, where huge amounts of data is needed. One may face difficulties while trying to perform qualified works, where data cannot be collected in rare occuring events and situations involving privacy concerns. To overcome this issue, we create a military vehicle dataset in which great amounts of Synthetic Dataset can be found. Thus, with this dataset, we bring a solution to the problem of detecting military vehicles, which is an area where collecting sufficient data is a problem. In a training with 5, 10 and 50 epochs we raise the mAP score by 0.09, 0.03, and 0.02, respectively.

In this study, a new approach is taken to calculate ship transit time, which is an important factor in regulating maritime traffic flow. In order to predict the transit times of ships passing through a water channel, the collected Automatic Identification System signal was processed and an approach to create a dataset was demonstrated and the transition time estimation was made with the regression-based machine learning method Gradient Boosting algorithm. Resampling procedures were applied on the data set in order to balance the data based on the ship types. Ship transit time estimation mean absolute error for cargo and tanker ships was reduced from 12.84 minutes to 8.19 minutes.

"Benign" metastatic leiomyomas (BML) are indolently growing metastatic tumors which mostly associate with uterine leiomyomas in women in reproductive ages. The reason to define these lesions as "benign" despite metastasis is their pathological features with low mitotic counts, lack of or minimal nuclear atypia, pseudocyst formation, and coagulative necrosis unlike leiomyosarcomas. Despite lack of pathological malignant features, they may cause significant morbidity and even mortality. Here, we describe a BML case with metastases to vertebrae and skull bones. Vertebral and skull metastases of BMLs were very rarely reported. In treatment of these tumors, hysterectomy and GnRH modifier treatments are widely employed. GnRH agonists act by desensitization and downregulation of the GnRH receptors, while GnRH antagonists act via the canonical competitive blockage. These treatments reduce FSH and LH levels, thereby reducing the systemic levels of sex steroids which stimulate leiomyoma growth. However, leiomyomas inherently harbor aromatase activity and synthesize their own estrogen; hence, treatment with systemic estrogen antagonists may provide better tumor control. Another important factor in BML pathogenesis is progesterone, and both progesterone receptor antagonists and high-dose progesterone receptor agonists may reduce BML growth. Following surgical treatment of the calvarial mass and radiotherapy of the vertebral metastatic foci, our BML case was successfully managed with hysterectomy and anastrozole treatment. Higher awareness of BML cases and their molecular endocrinological features in the neurosurgical community may pave to develop better strategies for treatment of these tumors causing high morbidity.

In this work, a system has been designed and implemented to classify the sports types found in sports news videos with Long-Short Term Memory Network (LSTM) method and to automatically segment the sport news program. Sports news we encounter in daily life contains anchor part who present news. There is no need to classify these parts. Thus, anchor faces was detected with using Local Binary Pattern Histogram method and removed from sport news in preprocessing step. In order to increase the processing speed instead of performing face recognition to the entire video, scene transitions were determined by using 64-bin histogram method and k-means algorithm and face recognition was performed only at this scene transitions. After the anchors are removed from videos, CNNs were used for feature extraction and LSTM was used for classification of videos by sport. In order to train and test the system, UCF-101 sport dataset, Unsegmented Sport News data set and YouTube sport videos dataset which is created from sport videos from Youtube by us were used. Classification was performed for 9 sport types including swimming, American football, football, tennis, basketball, wrestling, baseball, volleyball, and golf.

BACKGROUND Degludec is an ultralong-Acting, once-daily basal insulin that is approved for use in adults, adolescents, and children with diabetes. Previous open-label studies have shown lower day-To-day variability in the glucose-lowering effect and lower rates of hypoglycemia among patients who received degludec than among those who received basal insulin glargine. However, data are lacking on the cardiovascular safety of degludec. METHODS We randomly assigned 7637 patients with type 2 diabetes to receive either insulin degludec (3818 patients) or insulin glargine U100 (3819 patients) once daily between dinner and bedtime in a double-blind, treat-To-Target, event-driven cardiovascular outcomes trial. The primary composite outcome in the time-To-event analysis was the first occurrence of an adjudicated major cardiovascular event (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) with a prespecified noninferiority margin of 1.3. Adjudicated severe hypoglycemia, as defined by the American Diabetes Association, was the prespecified, multiplicity-Adjusted secondary outcome. RESULTS Of the patients who underwent randomization, 6509 (85.2%) had established cardiovascular disease, chronic kidney disease, or both. At baseline, the mean age was 65.0 years, the mean duration of diabetes was 16.4 years, and the mean (±SD) glycated hemoglobin level was 8.4±1.7%; 83.9% of the patients were receiving insulin. The primary outcome occurred in 325 patients (8.5%) in the degludec group and in 356 (9.3%) in the glargine group (hazard ratio, 0.91; 95% confidence interval, 0.78 to 1.06; P

Each year, 12.7 million people learn that they have cancer and 8.2 million people die of cancer worldwide. Cancer is a major public health issue which causes fundamental changes in the lives of patients and their families. The purpose of this study was to evaluate the lives of patients after diagnosis and determine the changes in their lifestyles.Between September 2013 to December 2013, a questionnaire consisting of 22 questions was administered during a face to face interview to patients at 13 different Oncology Units in Turkey. Each patient was queried during the administration of his/her chemotherapy. Eight of the questions featured independent choices, and 14 had dependent (multiple) choices.A total of 1300 patients were included in the study. Of patients 9.5% were 71 years of age and older which was the oldest age group. The mean patient age was 54.6±13.8 years. Of the whole group of patients 58.5% were female and 41.5% male. After diagnosis, 64% of the patients reported that they were complying with guidelines for a healthy lifestyle and 80% said that they were eating healthier food. At the time they filled in the questionnaire, more than half of the patients (57.3%) felt optimistic about their disease.Diagnosis of cancer may change the patients' dietary and reading habits, social relationships, activities and more importantly, their point of life view.

Bone is the most common site of distant metastases in breast cancer that can cause severe and debilitating skeletal related events (SRE) including hypercalcemia of malignancy, pathologic fracture, spinal cord compression and the need for palliative radiation therapy or surgery to the bone. SRE are associated with substantial pain and morbidity leading to frequent hospitalization, impaired quality of life and poor prognosis. The past 25 years of research on the pathophysiology of bone metastases led to the development of highly effective treatment options to delay or prevent osseous metastases and SRE. Management of bone metastases has become an integral part of cancer treatment requiring expertise of multidisciplinary teams of medical and radiation oncologists, surgeons and radiologists in order to find an optimal treatment for each individual patient. A group of international breast cancer experts attended a Skeletal Care Academy Meeting in November 2012 in Istanbul and discussed current preventive measures and treatment options of SRE, which are summarized in this evidence-based consensus for qualified decision-making in clinical practice. (C) 2014 Elsevier Ltd. All rights reserved.

e15538 Background: The aim of this study was to evaluate the prognostic role of microsatellite instability (MSI) status and PD-L1 expression in surgically resected gastric cancer and the relationship of these parameters with clinicopathological features. Methods: Eighty six gastric cancer patients which had curative surgical resection at Acibadem Atakent and Maslak Hospitals between 2010 and 2017 were analysed. Tumor samples were evaluated with MSI and PD-L1 antibodies by immunohistochemical (IHC) methods. PD-L1 IHC scoring was performed using the combined positive score (CPS). Survival analysis was accomplished using the Kaplan-Meier method. Cox proportional hazard regression model was used to identify independent risk factors that affect patients' overall survival. Results: The rate of PD-L1 expression in tumor cells was 34.9% (n = 30) and the frequency of PD-L1 expression in immune cells with CPS (≥1%) was 57% (n = 49). MSI-H was detected in 11.6%(n = 10), and more observed in PD-L1 positive cases (p = 0.021). MSI-H status was significantly correlated with older age, increased tumor size, presence of PD-L1 expression, and adenocarcinoma subtype. PD-L1 expression was associated with lymph node metastasis, adenocarcinoma subtype, microsatellite instability, presence of preoperative treatment and improved response to preoperative chemotherapy. In our study, the impact of MSI status on survival was not demonstrated, but PD-L1 expression positivity(≥1%) in both tumor cells (15.7 vs 53.4 months, p = 0.008)and in immune cells (20.4 vs NR; p = 0.027) was associated with short overall survival. PD -L1 expression in tumor cells was an independent prognostic factor for overall survival in multivariate analysis (HR: 2.28, p = 0.047). Conclusions: PD-L1 expression was related to a poor prognosis in patients with gastric cancer and can represent a rational approach for PD-1/PD-L pathway-targeted immunotherapy.

Lower extremity trauma is an uncommon cause of reactive thrombocytosis. A 17-year-old male patient with an extreme increase in platelet count caused by penetrating femoral venous injury is presented. During his stay in hospital, two thrombotic attacks were observed. Such events should be considered as high risk for thrombosis and anticoagulant therapy administered.

Aim: Thromboembolism is common in patients with cancer and may be considered a major cause of morbidity and mortality. We studied the most common genetic polymorphism characteristics that may have roles in the development of thrombosis in patients with cancer. Methods: A total of 158 patients with cancer who had had any thrombotic event were included, together with a control group of 134 patients with cancer without a thromboembolic event. The presence of mutations (Factor V Leiden G1691A, prothrombin G20210A) and polymorphisms (methylenetetrahydrofolate reductase [MTHFR] C677T and plasminogen activator inhibitor (PAI-1) 4G/5G) were analysed. Results: A heterozygous polymorphism for Factor V Leiden G1691A was found in 48 patients (30.3%) and a homozygous polymorphism in only one (0.63%), compared to 32 heterozygous (23.8%) and one homozygous (0.74%) polymorphism in the control group (P = 0.462). Prothrombin G20210A heterozygous polymorphism was observed in 11(6.9%) and four (2.5%) in the patients and controls, respectively. The MTHFR C677T heterozygous polymorphism was found in 48 (30.3%) and 24 (15.1%) and the homozygous polymorphism was observed in 15 (9.4%) and 12 (7.5%) in the study and control group, respectively (P = 0.04). Conclusion: Although we found a statistically significant difference between patients with and without thrombosis in respect to MTHFR C677T gene mutation, our data suggest that we do not have enough evidence yet to recommend performing genetic analysis.

Tumor growth and angiogenic factors are usually overexpressed in colorectal carcinomas. We aimed to assess the prognostic role of VEGF, bFGF, PDGF-AA, EGF, HGF, and E-selectin in patients with metastatic colorectal cancer treated with capecitabine and oxaliplatin (XELOX) chemotherapy protocol. Thirty-eight colorectal cancer patients who had evidence of distant metastasis were enrolled in the study. Angiogenic factors were measured before and after third cycle of chemotherapy. Patients were randomized into three groups, partial response (PR), stable disease (SD), and progressive disease (PD) groups, according to their clinical and radiologic evaluation after three cycles of XELOX chemotherapy. Eighteen patients (47.3 %) achieved partial response, 10 (26.3 %) stable disease, and 10 (26.3 %) progressive disease. VEGF (63.20 Pg/ml vs. 19,79 Pg/ml; p < 0.001), EGF (7.29 +/- A 3.08 Pg/ml vs. 4.79 +/- A 2.05 Pg/ml; p < 0.011), HGF (618.16 +/- A 340.39 Pg/ml vs. 452.02 +/- A 217.18 Pg/ml; p < 0.049), and PDGF-AA (691.68 +/- A 187.10 Pg/ml vs. 404.89 +/- A 168.47 Pg/ml; p < 0.001) were significantly decreased in PR group. PDGF-AA levels were also decreased in SD group (706.66 +/- A 206.66 Pg/ml vs. 389.79 +/- A 143.16 Pg/ml; p < 0,001). HGF levels were significantly increased in PD disease group (449.99 Pg/ml vs. 682.22 Pg/ml; p < 0.046). The baseline E-selectin levels were inversely proportional with overall survival that could be an important prognostic factor at the time of diagnosis. This study demonstrated that tumor growth factors can be helpful to determine colorectal cancer prognosis and overall survival in patients with metastatic disease. VEGF, HGF, EGF, and PDGF-AA levels were decreased in PR group. However, meaningful increment was seen HGF levels in PD group. Angiogenic factors and E-selectin provided unique prognostic information in advanced colorectal carcinoma patients.

The aim of the study was to evaluate the efficacy and tolerability of gemcitabine and uracil-tegafur (LIFT) combination in patients with advanced pancreatic carcinoma, retrospectively. Thirty-one patients, including 27 with metastatic disease, were treated with gemcitabine at a dose of 1000 Mg/m(2) in 30 minutes on days 1 and 8, and oral UFT 300 mg/m(2) on days 1-14, as the first-line regimen in advanced stage. The cycle was repeated every 21 days. A total of 116 cycles of chemotherapy were administered, with a median of 3 cycles per patient (range 1-13). The objective response rate was observed in 6 (19.3%) patients with 1 (3.2%) complete response, and 5 (16.1%) partial responses. The median response duration was 4 (range, 3-14) months. Eight (25.8%) patients had a standard deviation of more than 3 months. Median overall survival was 8 months (95% Cl, 6-10 months) and median time to progression was 4.2 months (95% Cl, 1-6 months). This combination was generally well tolerated. There were no life-threatening side effects. Most common toxicities were of hematologic and gastrointestinal nature. In conclusion, this regimen was well tolerated and seemed to have a moderate activity in the palliative treatment of advanced pancreatic carcinoma.

Purpose: The purpose of this retrospective analysis was to describe the clinical course of patients with breast cancer with liver metastases alone who were treated on doxorubicin/cyclophosphamide or taxane-containing chemotherapy protocols at the M. D. Anderson Cancer Center. Patients and Methods: A total of 2,193 patients with metastatic breast cancer were treated on prospective clinical protocols at the University of Texas M. D. Anderson Cancer between 1973 and 2003. Among those, 132 were identified as having the liver as the first site of metastatic disease. The following information was obtained from the medical records: gender, age, race, performance status, menopausal status, hormonal receptor status, laboratory data, primary treatment, prior systemic treatment, disease-free interval, extent of metastatic disease, response to chemotherapy, site of progression, time to tumor progression, overall survival, and cause of death. Results: Of the patients 62% received anthracycline-based regimens and 38% received anthracycline- and taxane-based regimens on various clinical protocols as the initial therapy for metastatic disease. The median follow-up of the patients was 52 months. The overall objective response rate was 66.4%; 16.4% of the patients achieved complete responses. The median time to progression was 14 months. Progression-free survival rates were 56% and 30% at 12 and 24 months, respectively. The median overall survival was 25 months. Sixteen patients (12.1%) survived longer than 60 months. There was a statistically inverse relation between a high lactate dehydrogenase level and achieving a complete response (P < 0.05). Age≥50 years, extent of liver metastases, performance status, and lactate dehydrogenase and albumin levels are significantly related to progression-free survival (P < 0.05). Year of liver metastases diagnosis, extent of liver metastases, performance status, and albumin level are significantly related to overall survival (P < 0.05). Conclusions: This retrospective analysis demonstrated that patients with liver metastases only had high objective response rates and encouraging results for median survival obtained with currently available cytotoxic agents.

Ozlem Er1, Leo Zacharski21Department of Medical Oncology, Erciyes University Medical Faculty, Kayseri, Turkey; 2Department of Medicine, Dartmouth Medical School, Lebanon, New Hampshire, USAAbstract: The association between malignancy and venous thromboembolic disease has been recognized for over a century and a half. During this time, a substantial body of literature has developed showing that malignancy is not only a hypercoagulable state characterized by an increased risk of thrombosis but also that components of blood coagulation reactions are capable of supporting tumor growth and dissemination. In recent years a succession of meticulously performed clinical trials has clarified optimal therapy intended to both prevent and treat thromboembolism that occurs in the setting of cancer. However, much remains to be accomplished in terms of practitioner education on the merits of optimal therapy. Of perhaps greater interest is the possibility that drugs capable of controlling cancer-associated hypercoagulability may provide a means for improving cancer survival while avoiding the toxicities characteristic of conventional anti-tumor therapy. Clearly, ample incentive exists for collaboration between basic and clinical scientists interested in improving the management of malignancy and its thromboembolic complications. Keywords: cancer, dalteparin, low molecular weight heparin, venous thrombosis

The more metastatic sites and bone marrow metastasis in small cell lung cancer (SCLC), the worse the prognosis. Diagnosing the bone marrow invasion at the beginning of the therapy is important for determining of the prognosis and planning the treatment. Abnormalities of some blood parameters may help to estimate the extent of bone marrow invasion by cancer cells. In this retrospective review, the changes in routine laboratory tests that may indicate bone marrow invasion, the predictive values of these tests, and the prognostic importance of bone marrow invasion were evaluated in SCLC patients who were being followed up according to a protocol. One hundred and forty-four patients with SCLC were enrolled in this study. Retrospectively, it was evaluated that 25 (17.4%) of the patients had bone marrow metastasis. According to univariate analysis, there was a significant difference between hemoglobin, white blood cell count, platelet count, lactate dehydrogenase, alkaline phosphatase and uric acid of the patients with and without bone marrow involvement. Among the biochemical parameters, the elevated LDH and AP had the highest sensitivity and specificity as indicators of bone marrow invasion (0.80–0.82 and 0.84–0.78, respectively). The median overall survival of extensive-stage disease with and without bone marrow metastasis were 4.0 ± 1.0 months (95% CI 2.2–5.7) and 7.0 ± 1.2 months (95% CI 4.7–9.3), respectively (P = 0.03). Bone marrow metastasis was found to be an indicator of a bad prognosis. Bone marrow biopsy, that is an invasive procedure, can be performed on selected patients who have changes of routine laboratory tests suggesting bone marrow invasion.

Background: Renal cell carcinoma is the most common malignancy of the kidney in adults. The treatment of metastatic disease remains a particularly difficult problem given the resistance of this disease to most treatment options and usually requires hospitalization. This prospective study aimed to determine the efficacy and systemic toxicity of outpatient Chemoimmunotherapy (CIT) in metastatic renal cell cancer (MRCC) patients. Methods: The patients with MRCC received a combination of 5-fluorouracil 400 mg/m2 intravenously on day 1 once a week, interferon-α 10 MU on days 1,3,5 during weeks 1 and 3, interleukin-2 18 MU on days 1,3,5 during weeks 2 and 4 subcutaneously. Results: Twenty-three MRCC patients were enrolled into the study. The performance status was ECOG 0–2. The median age was 60 years. Twenty patients were evaluable. Chemoimmunotherapy was administered for a median of 10 weeks (range 2–32). Partial remission was obtained in two patients, stable disease in five and no complete response was detected. Median overall survival (OAS) was 10.0 months (95% CI 5.5–14.5 months), progression-free survival (PFS) 7.0 months (95% CI 5.1–8.9 months). The 1-year OAS and PFS rate was 27% and 7%, respectively. Median OAS for patients with and without nephrectomy was 10.0 months (95%CI 7.2–12.8 months) and 6.0 months (95%CI 1.4–10.5 months), median PFS 7.0 months (95% CI 4.1–9.9 months) and 5.0 months (95% CI 3.7–6.2 months), respectively, and there was no statistical significant difference (P = 0.27 and P = 0.20). Most common complaints were fatigue, fever and nausea. Grade 3–4 side-effects were not observed. Conclusion: This CIT scheme showed a low objective response rate, but when combined with stable disease, clinical benefit is favorable. Outpatient administration with mild toxicity is advantageous.

The present study aimed to determine the effect of oral beta-glucan on mucositis and leukopenia in 62 consecutive patients with colorectal cancer treated with an adjuvant FOLFOX-4 regimen. The patients were retrospectively evaluated in 2 groups: one group received beta-glucan and the other did not (control group). Leucocytes, neutrophils, and platelets were evaluated before and 1 week after chemotherapy and oral mucositis and diarrhea were noted. Leucocyte and neutrophil counts after chemotherapy in the beta-glucan group were 7,300/mm(3) and 3,800/mm(3), respectively, and the reductions, as compared to baseline, were not significant (p=0.673 and 0.784). The median platelet count was 264,000/mm(3) after chemotherapy in the beta-glucan group and the reduction, as compared to baseline, was borderline significant (p=0.048). In the control group, reduction in leucocyte, neutrophil, and platelet counts was statistically significant. Oral mucositis and diarrhea were less common in the beta-glucan group. We conclude that beta-glucan can be used to reduce the adverse effects of chemotherapy.

The effect of medroxyprogesterone acetate (MPA) on the mitotic activity of bone marrow and testis during chemotherapy was investigated experimentally in an animal study. A total of 120 male Swiss albino mice were included in this study. Six groups were formed, each consisting of 20 mice. Low-dose MPA (LD-MPA) (15 mg/kg), high-dose MPA (HD-MPA) (100 mg/kg), LD-MPA plus cyclophosphamide (CP) (65 mg/kg), HD-MPA plus CP (65 mg/kg), and CP (65 mg/kg) were administered to the test groups and no drug was administered to the control group. Bone marrow samples and testis were examined for mitotic activity rate (MAR) on days 0, 18, 22, 26, and 30. In groups with regimens containing CP, MAR of hematopoietic cells in bone marrow was suppressed significantly (p 0.05). Mitotic activity rate of the testis cells was significantly suppressed in groups with regimens containing MPA (p

AIMS AND BACKGROUND: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor and associated with alterations in the coagulation system. Addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) had resulted in increase in survival. The present retrospective trial was designed to determine whether the duration of dalteparin usage has an effect on progression and survival. MATERIALS AND METHODS: The medical records of 67 patients with SCLC who were given cisplatin-etoposide and concomitant LMWH (dalteparin) was evaluated retrospectively. RESULTS: Median follow-up of patients was 11.3 months. Outcome: 10.6% complete response, 3.0% good partial response, 36.4% partial response, 10.6% stable disease, and 39.4% progressive disease. Side-effects were seen in 40.3% of the patients. Median dalteparin duration was 6,1 months. According the duration of dalteparin patients were grouped in three: who took dalteparin less than 4 months (Group A), 4-6 months (Group B) and more than 6 months (Group C). Mean overall survival (OS) in Group A was 6.5 months, in Group B 11.8 months, and Group C 14.6 months. Mean OS in Group B and C were statistically significantly (P < 0.001) longer than Group A, between Group B and C there was not any significant difference (P = 0.037). Mean progression free survival (PFS) was 9 months. CONCLUSIONS: The CT plus LMWH minimum 4 months long is well-tolerable, and may improve PFS and OS in patients with SCLC. For treatment of patients with SCLC CT plus LMWH may be considered as effective future-therapy, and further multi-centre randomised prospective clinical trials must be done to determine the new standard treatment approach for SCLC.

Gastric cancer is still an important health issue in Eastern Europe and Middle East, including Turkey, although its prevalence is decreasing in the western world.In order to define the profiles of the patients operated with a diagnosis of gastric cancer in Turkey, a multicenter retrospective study was conducted.Six hundred and forty-eight of the 840 patients with complete data in all parameters were included in the analysis. The median follow-up time was 17.16 months (range, 6-143.63 months). Mean age was 57±11.7 (19-85). There was a recurrent disease in 42% of the tumors located at cardia, corpus or antrum, and 86% of diffuse tumors (p0.0001). The ratio of patients with recurrent disease was greater in stage III and IV tumors (52%) than stage II (29%) and stage I (17%) tumors. There were also greater recurrence ratios in patients with node positive (pN1-3) patients than pN0 tumors, and pT3-4 tumors than pT1 or pT2 tumors. Any recurrence was found in 48% of the tumors with lymphovascular invasion, while in 39% without lymphovascular invasion (p=0.026). A statistically significant difference was found in the recurrence status of patients with positive / dissected node ratio of10% and ≥10% (p0.0001).Gastric cancer cases in Turkey are seen at a younger age, and at a higher stage. Proximal gastric cancer is seen much less than the western series. Prognostic significance of lymphovascular invasion in both univariate, and multivariate analyses is noteworthy.

Primary or secondary involvement of the breast is a rare form of extranodal lymphoma. In this paper, we present a 36-year-old female patient admitted to the hospital with bilateral breast masses. Histological examination confirmed high-grade malignant lymphoma involving both breasts.

Association of excision repair cross-complementing gene 1 (ERCC1) expression and treatment response and survival was evaluated in advanced stages of gastric cancer patients who were given different platinum-based chemotherapy.Forty-one patients with advanced gastric cancer were enrolled into the study from January 2000 to December 2009. ERCC1 expression was evaluated by immunohistochemistry (IHC).Thirteen of the 41 patients (31%) were shown to have ERCC1 positive lesions. Although the clinical benefit from platin based chemotherapy was the same for ERCC1 positive and negative patients, survival times were statistically significantly better in ERCC1 negative gastric cancer patients.We suggest that IHC studies for ERCC1 may be useful in prediction of the clinical outcome of advanced gastric cancer patients treated with platin-based chemotherapy.

Here, we investigated the possible predictive value of stromal caveolin-1 (Cav-1) as a candidate biomarker for clinical outcome in triple negative (TN) breast cancer patients. A cohort of 85 TN breast cancer patients was available, with the necessary annotation and nearly 12 years of follow-up data. Our primary outcome of interest in this study was overall survival. Interestingly, TN patients with high-levels of stromal Cav-1 had a good clinical outcome, with >50% of the patients remaining alive during the follow-up period. In contrast, the median survival for TN patients with moderate stromal Cav-1 staining was 33.5 months. Similarly, the median survival for TN patients with absent stromal Cav-1 staining was 25.7 months. A comparison of 5-year survival rates yields a similar pattern. TN patients with high stromal Cav-1 had a good 5-year survival rate, with 75.5% of the patients remaining alive. In contrast, TN patients with moderate or absent stromal Cav-1 levels had progressively worse 5-year survival rates, with 40 and 9.4% of the patients remaining alive. In contrast, in a parallel analysis, the levels of tumor epithelial Cav-1 had no prognostic significance. As such, the prognostic value of Cav-1 immunostaining in TN breast cancer patients is compartment-specific, and selective for an absence of Cav-1 staining in the stromal fibroblast compartment. A recursive-partitioning algorithm was used to assess which factors are most predictive of overall survival in TN breast cancer patients. In this analysis, we included tumor size, histologic grade, whether the patient received surgery, radiotherapy or chemotherapy, CK5/6, EGFR, p53 and Ki67 status, as well as the stromal Cav-1 score. This analysis indicated that stromal loss of Cav-1 expression was the most important prognostic factor for overall survival in TN breast cancer. Virtually identical results were obtained with CK5/6 (+) and/or EGFR (+) TN breast cancer cases, demonstrating that a loss of stromal Cav-1 is also a strong prognostic factor for basal-like breast cancers. Our current findings may have important implications for the close monitoring and treatment stratification of TN and basal-like breast cancer patients.

Background: While it is well known that cyclooxygenase-2 (COX-2) expression is increased in colorectal adenoma and carcinoma, there is only limited information on its status in stromal tumours. Methods: Immunohistochemical COX-2 staining was performed on a total of 42 confirmed gastrointestinal stromal tumours (GISTs) in the Pathology Department of Gaziantep University and the findings were compared with various other parameters. Results: We found a statistically significant correlation between the tumor mitosis and COX-2 expression in GISTs. However, there was no relationship between COX-2 expression and death rate, presence of metastasis, tumour size, risk staging, usage of tyrosine kinase inhibitors, and complete resection rate. Conclusions: In the light of these findings, the usage of COX-2 inhibitors with or without tyrosine kinase inhibitors in GIST patients may be helpful in the adjuvant setting to prevent or delay recurrence. Moreover, we need more studies to define the status of COX-2 inhibitors in GISTs.

Carcinogenesis and tumor cell biology are very complex subjects. Recent findings on cancer stem cells may have a great impact on the understanding of the biology of malignancies and the development of future treatment approaches. Cancer stem cells are defined by their potential to self-renew and differentiate. Identification of cancer stem cells is possible by detecting expression of a certain combination of various cell surface markers and also by functional assays. The cancer stem cell concept was originally developed for hematological malignancies but is now becoming accepted for solid tumors as well. Emerging data indicates that cancer stem cells are responsible for the growth and spread of tumors. There is still a long way to go in characterizing cancer stem cells and understanding their role in carcinogenesis. Further studies should lead to a greater understanding of the biology of these cells with significant implications for diagnosis, treatment, and prevention of cancer. The recent studies regarding stem cell origin of various solid tumors will be discussed briefly in this review.

Sunitinib is a novel oral multitargeted tyrosine kinase inhibitor. It has higher response rates and progression-free survival in patients with metastatic renal cell carcinoma (RCC) when compared with standard chemotherapy and interferon-alpha. We report a case of paraneoplastic hypercalcemia, resistant to conventional treatment but recovers by sunitinib treatment as the first case in the literature, in a 33-years-old man with metastatic RCC. At the sixth month of follow-up period, in this case, serum calcium level was still in normal ranges. Besides sunitinib is effective in symptom control, it is also helpful in management of paraneoplastic hypercalcemia, a life-threatening entity.

Aim: Human epidermal growth factor receptor 2 (HER2) overexpression is associated with poor prognosis and the frequency of HER2 positivity in breast cancer patients varies among different regions of the world. We studied HER2 expression in Turkish breast cancer patients. Methods: HER 2 expression was evaluated immunohistochemically in 107 breast cancer patients. HER2 expression was reported as negative or positive (3+) according to cellular membrane staining characteristics. The frequency of HER2 overexpression, distribution according to clinical characteristics, effect on survival and effect of chemotherapy on survival in relation to HER2 overexpression was evaluated. Results: The median age of patients was 49 years (range 27–76). HER2 was 3+ in 34 patients (31.8%). There was no significant difference in age, menopausal status, histopathology, lymph node involvement, stage and estrogen and/or progesterone receptor positivity in relation to HER2 expression. Forty-three patients (40.2%) relapsed and 21 patients (19.6%) died during the follow-up period. There was no significant difference in the relapse rate, distribution of relapse sites and death rate in relation to HER2 expression. The 3- and 5-year disease free survival rates were 67.1 and 40.5%, and the overall survival rates were 87.5 and 66.1%, respectively. Survival rate and calculated survival time were relatively shorter in HER2 3+ patients than in non-HER2 3+ patients, but these differences were not statistically significant. HER2 status did not affect survival period according to chemotherapy group. Conclusion: Immunohistochemistry findings of HER2 expression in Turkish breast cancer patients were similar to those found in the published reports. A shorter survival period was observed in HER2 3+ patients, but the difference was not statistically significant.

Treatment of patients with platinum resistant/refractory ovarian cancer is a significant problem. In this study, we evaluated the efficacy and tolerability of the combination of gemcitabine and pegylated liposomal doxorubicin (PLD) in patients with platinum resistant/refractory ovarian cancer.We retrospectively evaluated the activity and toxicity of gemcitabine and PLD combination in 35 patients with recurrent platinum resistant/refractory ovarian cancer who had been treated and followed up in 7 centers in Turkey between December 2005 and June 2008. The patients received gemcitabine 1.000 mg/m(2) on day 1 and 8, and PLD 25 mg/m(2) on day 1 every 28 days.A total of 187 cycles (median, 6 cycles) were delivered. An objective response rate of 28,6 % (1 complete, 9 partial response) was achieved. Additionally, 16 patients (45.7 %) had disease stabilization. The median time-to-progression was 6 months (95 % confidence interval, 4-8) and the median overall survival was 17 months (95 % confidence interval, 12-22). Grade 3-4 hematologic toxicities were as follows: leucopenia (14.3%), neutropenia (8.6%), and anemia (2.9%). One febrile neutropenic episode (2.9%) was observed. Non-hematologic toxicity was well tolerated and easily managed and no grade 3-4 palmoplantar erytrodysestesia (PPE) was observed.The combination of gemcitabine and PLD is an effective and tolerable treatment option, with 74.3 % disease control rate for patients with platinum resistant/refractory ovarian cancer.

Aims and Background We aimed to evaluate the prevalence of and factors related to the use of complementary/alternative medicine among cancer patients undergoing or following conventional treatment at the Erciyes University Oncology Hospital in Central Anatolia. Study Design and Patients Face-to-face interview and a questionnaire were carried out with cancer patients attending the outpatient clinic of Medical Oncology. Questionnaire items included patients’ demographic data, treatment, use of complementary/alternative medicine and possible related factors. Multivariate analysis was performed to compare the factors related to use of complementary/alternative medicine. Results A total of 268 consecutive cancer patients were enrolled in the study. Overall, 43% of the patients were using or had used complementary/alternative medicine. Totally, 90% of the patients using complementary/alternative medicine utilized herbs, and most of the herbs used were stinging nettle. Nearly half of the patients using complementary/alternative medicine (46.1%) were aiming to fight the disease. Among users, nearly half of them regarded the method used as effective and 54 (50.5%) suggested the use of complementary/alternative medicine to other patients. Only 23.1% of the patients discussed the use of complementary/alternative medicine with their physician. In logistic regression analysis, younger age, higher educational status, advanced stage of the disease, longer duration of the disease and current treatment status were significantly associated with the use of complementary/alternative medicine. In our regression model, the predictivity rate of these variables was 72.2% for use of complementary/alternative medicine according to the backward Wald test. Conclusions Use of complementary/alternative medicine among cancer patients in our center is modestly high, and the most common method is herbal therapy. Communication between the patient and the physician shouldbe improvedon this subject.

Here, we show that functional loss of a single gene is sufficient to confer constitutive milk protein production and protection against mammary tumor formation. Caveolin-3 (Cav-3), a muscle-specific caveolin-related gene, is highly expressed in muscle cells. We demonstrate that Cav-3 is also expressed in myoepithelial cells within the mammary gland. To determine whether genetic ablation of Cav-3 expression affects adult mammary gland development, we studied the phenotype(s) of Cav-3(-/-)-null mice. Interestingly, Cav-3(-/-) virgin mammary glands developed lobulo-alveolar hyperplasia, akin to the changes normally observed during pregnancy and lactation. Genome-wide expression profiling revealed up-regulation of gene transcripts associated with pregnancy/lactation, mammary stem cells, and human breast cancers, consistent with a constitutive lactogenic phenotype. Expression levels of three key transcriptional regulators of lactation, namely Elf5, Stat5a, and c-Myc, were also significantly elevated. Experiments with pregnant mice directly showed that Cav-3(-/-) mice underwent precocious lactation. Finally, using orthotopic tumor cell implantation, we demonstrated that virgin Cav-3(-/-) mice were dramatically protected against mammary tumor formation. Thus, Cav-3(-/-) mice are a novel preclinical model to study the protective effects of a lactogenic microenvironment on mammary tumor onset and progression. Our current studies have broad implications for using the lactogenic microenvironment as a paradigm to discover new therapies for the prevention and/or treatment of human breast cancers.

Objective Among the subgroups of breast cancer, basaloid type has the shortest disease-free survival. Survivin is an apoptosis inhibitor and its prognostic and predictive value in breast cancer is under investigation. In this study, we examined the basaloid markers CK5/6, CK14, CK17, and EGFR in triplet-negative patients and evaluated the impact of survivin on survival. Materials and methods Thirty patients with breast cancer in triplet-negative form admitted to Erciyes University Medical Oncology Department between 2001 and 2005 were included in the study. Median follow up and age were 45 months (range 5–76 months) and 47 years (range 23–76), respectively. Eighteen patients (60%) were premenopausal and 12 (40%) were postmenopausal. In total, 2, 12, and 14 patients had stage I, II, and III disease, respectively. When cytokeratines and survivin were analyzed independently, association between CK5/6 positivity and lymph node involvement was statistically significant (P = 0.014). In 70% of patients, CK5/6 or EGFR was found positive, and positive results were only had statistically significant correlation with age and menopausal status (P = 0.049 and 0.049, respectively). Ten patients (33.3%) totally and nine patients (42.8%) in the basaloid subgroup had positive staining for survivin. Survivin was not correlated with any of the clinical or histopathological features. While correlation between the number of involved lymph nodes, lymphovascular invasion, histopathological grade, and disease-free survival was statistically significant (P = 0.036, 0.002, and 0.035, respectively), this is not valid for CK5/6, EGFR, and survivin. Conclusion CK5/6 or EGFR was accepted as determinants of basaloid breast cancer. The correlation between basaloid form and other histopathological markers did not reveal any significant difference with respect to prognostic and clinical parameters. We were unable to demonstrate the prognostic impact of survivin in patients with basaloid form or triplet-negative breast cancer.

We report a case of epidermoid-cell carcinoma of the lung that developed a metastatic lesion in the penis. A 50-year-old male patient was admitted to our hospital with bloody sputum and cough. He had a left pneumectomy and was diagnosed with epidermoid carcinoma of the lung at stage IIB (T2N1M0). He was started on an adjuvant chemotherapy protocol consisting of cisplatin and paclitaxel. He was admitted to our urology clinic with obstructive symptoms during urination and pain during penile erection. Physical examination revealed a firm, 3 cm x 2 cm palpable mass on the radix of his penis. A fine-needle aspiration biopsy of the penile mass revealed epidermoid carcinoma that was consistent with lung cancer. The patient was considered to have penile metastasis from epidermoid carcinoma of the lung.

Rectal carcinoids comprise 12.6% of all carcinoid tumors and represent the third largest group of the gut carcinoids. A 64-year-old woman was diagnosed as high-grade neuroendocrine carcinoma. She had liver, bone, and bone marrow metastasis. Carcinoid syndrome was diagnosed due to diarrhea, nausea, vomiting, tachycardia, and high level of 24-hour urinary 5-hydroxyindoleacetic acid (160 mg/24 hours). No response was obtained by octreotide treatment. Rectal carcinoid tumors usually show favorable prognosis; however, poorly differentiated tumors might have unusually aggressive behavior and resistance to treatment. Bone marrow involvement might be a poor prognostic factor in carcinoid tumor as has been the case in many other tumors.

Background: Treatment of patients with metastatic breast cancer (MBC) exposed to anthracyclines and taxanes is challenging. Effective and well-tolerated regimens are required. Gemcitabine plus capecitabine combination was assessed in MBC patients pretreated with anthracyclines and taxanes. Patients and Methods: A total of 31 patients treated between November 2004 and September 2005 were retrospectively evaluated in 4 institutions. The median age was 48 years (range 29–77). The patients were given gemcitabine 1,000 mg/m2 on days 1 and 8, and capecitabine 1,500 mg/m2 twice daily on days 1–14 every 3 weeks. Results: A total of 160 cycles of chemotherapy were administered with a median of 5 cycles per patient (range 2–12). Three patients achieved a partial response (10%) and 8 patients (26%) stable disease. The median time to disease progression was 6 months (95% CI 5–7), with a median survival of 18 months (95% CI 15–21) at a median follow-up of 16 months (range 2–28). One-year and 2-year survival rates were 67 and 28%, respectively. Grade 3–4 toxicities were as follows: neutropenia (n = 11, 35%), nausea and vomiting (n = 4, 13%), hand-foot syndrome (n = 2, 6%), anemia (n = 2, 6%), thrombocytopenia (n = 2, 6%) and asthenia (n = 1, 3%). Conclusion: The combination of gemcitabine plus capecitabine was a tolerable regimen with a mild but comparable survival efficacy to similar regimens in patients with MBC after anthracyclines and taxanes.

Brucellosis is a disease involving the lymphoproliferative system, which may lead to changes in the hematological parameters; however, pancytopenia is a rare finding. However, malignant diseases in association with brucellosis are rarely the cause of pancytopenia. Herein, two cases with fever and pancytopenia, diagnosed as simultaneous acute lymphoblastic leukemia and brucellosis are presented. Anti-leukemic therapy and brucellosis treatment were administered simultaneously, and normal blood parameters obtained. The first patient is in complete remission; the other recovered from the brucellosis, but later died due to a leukemic relapse.