Porównanie urazu tkanek podczas brzusznej, pochwowej i laparoskopowej histerektomii

Objective: The aim of the study was to compare the extent of tissue trauma after abdominal hysterectomy(AH), vaginal hysterectomy (VH), and total laparoscopic hysterectomy (TLH) using biochemical markers. Material and methods: Seventy-one patients requiring hysterectomy for benign uterine diseases were enrolled in the study and divided into three treatment groups: AH (n=24), VH (n=23), and TLH (n=24). Blood samples for assay of interleukin-6 (IL-6) and creatine phosphokinase (CPK) were collected pre-, intra-operatively, and 2, 6 and 24 h after surgery. Results: Serum levels of IL-6, and CPK were significantly elevated over basal values after surgery in all groups. IL-6 and CPK levels were significantly higher after AH as compared to VH and TLH. IL-6 concentrations were significantly higher in the VH group than the TLH group (p=0.001). There were no significant differences in CPK levels between the VH and TLH groups (p=0.824). TLH group had the smallest decrease in blood hemoglobin concentration and the shortest hospital stay. Conclusions: AH causes more tissue trauma as compared to VH and TLH. Owing to the fact that TLH is associated with less tissue trauma and offers significant clinical benefits, including less blood loss and shorter hospital stay, it should be considered in women with benign gynecologic conditions, especially in experienced centers.Cel pracy: Celem badania było porównanie rozległości urazu tkanek podczas brzusznej histerektomii (AH), pochwowej (VH) i laparoskopowej (TLH) przy pomocy biochemicznych markerów. Materiał i metoda: Do badania włączono siedemdziesiąt jeden pacjentek wymagających usunięcia macicy z powodu niezłośliwej patologii, które podzielono na trzy grupy badane: AH (n=24), VH (n=23), i TLH (n=24). Próbki krwi do badania w kierunku interleukiny 6 i kinazy fosfokreatynowej (CPK) pobierano przed-, podczas operacji, I 2,6 oraz 24 godziny po zabiegu. Wyniki: Poziom Il-6 i CPK w surowicy po operacji był istotnie podwyższony w porównaniu do poziomu wyjściowego we wszystkich grupach badanych. Poziom IL-6 i CPK były istotnie wyższe po AH niż po VH i TLH. Stężenie IL-6 było istotnie wyższe w grupie VH niż w grupie TLH (p=0.001). Nie stwierdzono istotnych różnic w poziomie CPK pomiędzy grupą VH i TLH (p=0.824). W grupie TLH odnotowano najmniejszy spadek hemoglobin I najkrótszy pobyt w szpitalu. Wnioski: AH powoduje większy uraz tkanek niż VH i TLH. Dzięki temu, że TLH jest związane z mniejszym urazem tkanek i daje istotne klinicznie korzyści, między innymi mniejszą utratę krwi i krótszy pobyt w szpitalu, powinno być rozważane u kobiet z niezłośliwą patologią, zwłaszcza w doświadczonych ośrodkach

GENERAL CHARACTERISTICS AND TREATMENT OPTIONS OF THE PATIENTS WITH GASTROINTESTINAL STROMAL TUMOR

Background: Gastrointestinal stromal tumors (GIST) are rare mesenchimal tumors may develop in any site in the gastrointestinal system. KIT gene mutations are detected in 95% of cases. In this study, we aimed to assess treatment options and general characteristics of patients with GIST. Methods: GIST patients admitted to Abdurrahman Yurtaslan Oncology Education and Training hospital’s oncology clinic between February 2009 and May 2012 are observed retrospectively. Demographic characteristics of the patients and the treatment they received were recorded from hospital’s database. Results: Eighteen patients included to study havinng Mean age of 57.8 years (32-78).  Five (28%) of the patients were female and thirteen (72%) were male. Diagnosis were made in 16 patients by pathological assessment of surgical material. Trucut biopsy and gastroscopic biopsy used for diagnosis in remaining two patients. Localizations of the tumor were as follows: small intestine in 9 patients, colon in 5 patients, stomach in 4 patients. All of the patients were KIT positive. Tumor was defined at high risk in 62%, at moderate risk in 17% and at low risk in 21% of the cases. Imatinib was administered in 5 patients with metastatic disease. Mean follow up period for the patients was 48 months. Relapse or progression developed in 4 of all patients in follow up period. Only one of the five patients with metastaic disease developed progression. Other 3 cases were relapsed. Conclusion: Surgical resection of tumor without fragmentatin is the main treatment of localized GIST cases. Imatinib, a tyrosine kinase inhibitor, is used in metastatic/ inoperable tumors and in cases at high risk for metastasis, recently. In conclusion, after surgical resection of the tumor, we suggest Imatinib treatment in patients considered at high risk

Prognostic & predictive factors for planning adjuvant chemotherapy of early-stage breast cancer

Breast cancer is a heterogeneous disease and may present with different clinical and biological characteristics. At present, breast cancer is divided into molecular subgroups besides its histopathological classification. Decision for adjuvant chemotherapy is made based on not only histopathological characteristics but also molecular and genomic characteristics using indices, guidelines and calculators in early-stage breast cancer. Making a treatment plan through all these prognostic and predictive methods according to risk categories aims at preventing unnecessary or useless treatments. In this review, an attempt to make a general assessment of prognostic and predictive methods is made which may be used for planning individualized therapy and also the comments of the guidelines used by the oncologists worldwide on these methods

Novel BRCA2 pathogenic genotype and breast cancer phenotype discordance in monozygotic triplets

BRCA1/2 genes with high-penetrance are tumor suppressor and tumor susceptibility genes that play important roles in the homologous recombination mechanism in DNA repair and increase breast cancer risk. Variants in BRCA1 or BRCA2 are the main causes of familial and early-onset breast cancer. This study investigated pathogenic variant belonging to the BRCA2 gene splice region in monozygotic triplets. A 44-year-old woman was diagnosed with breast cancer when she was 32 years old. Her monozygotic sister had a history of breast cancer. No malignancy was detected in the third one of the monozygotic triplets. Sanger sequencing was used to evaluate the BRCA1/2 gene status of the patient and family members. It was figured out that they had the same genetic variant, a heterozygous germ-line splice region variant (c.7008-1G > C) in the BRCA2 gene. This novel splice region variant may be a new pathogenic variant of the BRCA2 gene. Its association with breast cancers needs to be further verified in more patient cases

Well differentiated neuroendocrine tumors, a single center experience

Purpose: The aim of this study is to analyze the demographic, histopathologic features of Neuroendocrine tumor (NET) cases and to underline the treatment approaches over seven years period in a high-volume cancer center. Methods: This study designed as a retrospective evaluation of NET registry data from a single medical oncology clinic between January 2012 and November 2017. Results: A total of 72 patients'? data were registered. The median age was 54 (18–84) years. The three most common sites of diagnosis were pancreas (19 cases, 26.4%), unknown primary with liver metastasis (15 cases-20.8%) and lung (10–13.9%). There was no association between the extent of disease and grade of NET (p = 0.73). Apart from pancreatic NETs, there was no difference in the stages of disease presentation (p > 0.05). Globally, estimated 5-year overall survival (OS) rate was 77.5% and 10-year OS rate was 57.8%. There was no statistically significant difference in estimated 5- year OS rates of comparison between grade 1 and grade 2 NET's (69.9 vs. 91.8%, p = 0.19). In addition, Ki67 proliferative index did not make any difference in estimated 5- year OS rates (78.1 vs 77.7%, p = 0.71). Conclusions: The multimodality treatment, site specific approaches and radionuclide therapies lead to better response rates and a longer survival in patients. Although there is a difference in distribution and presentation of NET cases compared to previous publications, optimal treatment yields a good Results?. Wherever possible, treatment of NETs is optimally scheduled by a multidisciplinary team, data collection should be centralized and audited by the team to make a clear conclusion for a less acknowledged tumor type. Keywords: Neuroendocrine tumor, Grade, Ki67, Carcinoid tumo

First line modified Folfirinox versus gemcitabine for advanced pancreatic cancer: A single institution retrospective experience

Background: Advanced pancreatic cancer (APC) is a highly lethal malignancy which has one of the worst treatment outcomes. Modified (m)FOLFIRINOX is an intense but a proven treatment approach with a survival benefit for APC. Although mFOLFIRINOX demonstrated survival benefit compared with gemcitabine monotherapy, the standard treatment in previous years, toxicity is a difficult aspect of this treatment. Methods: A retrospective analysis of patients referred to Medical Oncology Clinics of Ankara Oncology Research and Training Hospital with the diagnosis of inoperable locally advanced or metastatic pancreatic cancer and treated with mFOLFIRINOX or gemcitabine monotheraphy from March 2013 to April 2018 was performed. Results: Forty three patients and 37 patients were included in mFOLFIRINOX and gemcitabine groups, respectively. The mean age of the patients was 53.74 years (range: 32–69) and 65,7 years (range: 47–82) for mFOLFIRINOX and gemcitabine, respectively (95% CI, p < 0.001). All patients, except one, had ECOG performance status of 0 or 1 in mFOLFIRINOX group. In contrast, nine patients had ECOG performance status of 2 in the gemcitabine group (95% CI, p = 0.002). When the patients were evaluated for response, 11 (25.6%) and 6 (16.2%) had partial remission with mFOLFIRINOX and gemcitabine, respectively. Median PFS and OS was 5,73 (95% CI, 2,57-8,90) months and 8.77 (95% CI, 6.54–10.99) months with mFOLFIRINOX and 2,77 (95% CI, 2,29-3,24) months and 5.80 (95% CI, 3.08–7.92) months with gemcitabine, respectively. mFOLFIRINOX regimen was more toxic than gemcitabine regimen. The incidences of all-grade neutropenia, neuropathy, and emesis were more prominent in the mFOLFIRINOX group. Conclusion: mFOLFIRINOX is a difficult regimen for both patients and physicians with significant toxicity with a greater survival benefit. The survival benefit was modest in this real-life experience. Patient selection bias and small sample size of this retrospective study should be considered. Keywords: Pancreatic cancer, First-line therapy, mFOLFIRINOX, Gemcitabin