151 research outputs found
Head and neck cancer: metronomic chemotherapy
In the era of personalized medicine, head and neck squamous cell carcinoma (HNSCC) represents a critical oncologic topic. Conventional chemotherapy regimens consist of drugs administration in cycles near or at the maximum tolerated dose (MDT), followed by a long drug-free period to permit the patient to recover from acute toxicities. Despite this strategy is successful in controlling the cancer process at the beginning, a significant number of HNSCC patients tend to recurred or progress, especially those patients with locally advanced or metastatic disease. The repertoire of drugs directed against tumor cells has greatly increased and metronomic chemotherapy (MC) could be an effective treatment option.It is the purpose of this article to review the concept of MC and describe its potential use in HNSCC. We provide an update of ongoing progress and current challenges related to this issue
The role of radiation therapy in bone metastases management
Bone metastases represent an important complication of malignant tumours. Despite improvement in surgical techniques and advances in systemic therapies, management of patients with bone metastatic disease remains a powerful cornerstone for the radiation oncologist. The primary goal of radiation therapy is to provide pain relief, preserving patient's quality of life
Adjuvant radiation therapy in stage I seminoma: 20 years of oncologic results
Aim: To report long term oncologic outcomes after adjuvant radiotherapy (RT) for stage I seminoma.
Method: We reviewed the complete data set for all patients treated at our institute between 1988 and 2005 for stage I seminoma with adjuvant RT after radical orchiectomy.
Results: A total of 85 patients were included. The median follow-3up was 15 years. The 20-3year overall survival (OS) and relapse free survival (RFS) were 92% and 96.3%, respectively. No severe acute and late complications were recorded. Overall 5.9% of patients had a second unrelated malignancy.
Conclusion: Adjuvant RT is an efficacious and safe treatment in stage I seminom
Radiation therapy and serum salivary amylase in head and neck cancer
Radiation therapy (RT) is a valid treatment option for head and neck cancer (HNC). The risk of RT-induced toxicities is significant, especially due to extended treatment fields. The raise in amylase activity is strictly dependent on the volume of salivary glands included in the irradiated target volume and it is firmly related to the dose. The aim of this review is to report the effects on salivary amylase activity after radiation exposure of salivary glands, in patients with HNC
The role of different adjuvant therapies in locally advanced gastric adenocarcinoma
Complete surgical resection remains the only curative treatment option in locally advanced gastric cancer (GC). Several studies were conducted to prevent local recurrence and to increase the chance of cure. The aim of this study was to summarize our experience in locally advanced GC patients treated with adjuvant chemoradiotherapy (CRT) and to evaluate overall survival (OS), disease-free survival (DFS), toxicity rate and compliance to treatment
Unusual presentation of metastatic adenocarcinoma of the lung
On September 2013, a 62-year-old man with metastatic adenocarcinoma of the lung complained tenderness and pain of the first terminal phalange of his right hand. The biopsy confirmed metastatic adenocarcinoma of the lung to the finger. A single 8-Gy fraction of palliative radiotherapy was delivered to the patient's right hand. The patient received magnetic resonance-guided focused ultrasound surgery treatment to the phalange because he showed few improvement of clinical symptoms and persistence of moderate pain after radiotherapy. After magnetic resonance-guided focused ultrasound surgery, the clinical symptoms improved significantly. No serious adverse effects were reported and the patient compliance was very high. Our patient showed improvement of clinical symptoms after combined treatment. The patient remains in good health conditions
Clinical benefit of adding oxaliplatin to standard neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a meta-analysis : Oxaliplatin in neoadjuvant treatment for rectal cancer
Abstract. Background: To evaluate the treatment tolerance
and clinical outcomes in patients aged 70 years and older with
locally advanced oropharyngeal cancer treated by definitive
intensity-modulated radiation therapy (IMRT). Patients and
Methods: We retrospectively analyzed 15 consecutive elderly
patients, with histologically-proven squamous cell carcinoma
of the oropharynx, staged T3-4 with or without involved lymph
nodes at diagnosis, who received definitive sequential IMRT
(70 Gy; 2 Gy/fraction). Adult Comorbidity Evaluation-27
(ACE-27) score was calculated and its influence on treatment
tolerance and clinical outcomes was analyzed. Results: A total
of 15 patients were included with a median age of 77 years
(range=70-88 years). At baseline, 8 patients (53.3%) had an
ACE-27 score of 1, and the remainder (n=7, 46.7%) had a
comorbidity index of 0. All patients completed programmed
IMRT treatment, without any reduction of total dose. Oral
pain and mucositis were the most common acute side-effects,
classified as grade 3 in 6 patients (40%) only. Xerostomia was
reported in 13 patients (86.7%), without severe manifestation.
There was no hematological toxicity. ACE-27 score was not
related to higher severe acute toxicity. No patients experienced
grade 3 or more late toxicity. Five-year overall survival and
disease-free survival rates were 63.6% (95% confidence
interval=32.7-83.3%) and 55% (95% confidence
interval=24.4-77.6%), respectively. Comorbidity score did not
influence survival outcomes, both overall survival (p=0.46)
and disease-free survival (p=0.55). Conclusion: Treatment
tolerance, as well as survival outcomes were good in elderly
oropharyngeal cancer patients treated with definitive
sequential IMRT. Due to age and comorbidity, no dose or
volume reduction for IMRT should be considered in this
setting of patients. A prospective randomized trial with a large
sample size should be conducted to confirm our result
A role for Separase in telomere protection
Drosophila telomeres are elongated by transposition of specialized retroelements rather than telomerase activity and are assembled independently of the sequence. Fly telomeres are protected by the terminin complex that localizes and functions exclusively at telomeres and by non-terminin proteins that do not serve telomere-specific functions. We show that mutations in the Drosophila Separase encoding gene Sse lead not only to endoreduplication but also telomeric fusions (TFs), suggesting a role for Sse in telomere capping. We demonstrate that Separase binds terminin proteins and HP1, and that it is enriched at telomeres. Furthermore, we show that loss of Sse strongly reduces HP1 levels, and that HP1 overexpression in Sse mutants suppresses TFs, suggesting that TFs are caused by a HP1 diminution. Finally, we find that siRNA-induced depletion of ESPL1, the Sse human orthologue, causes telomere dysfunction and HP1 level reduction in primary fibroblasts, highlighting a conserved role of Separase in telomere protection
Cytoreduction and HIPEC in the treatment of "unconventional" secondary peritoneal carcinomatosis
BACKGROUND:
Peritoneal metastasis (PM) is considered a terminal and incurable disease. In the last 30 years, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically changed the therapeutic approach for these patients and is regarded as the standard of care for pseudomyxoma peritonei from appendiceal cancer and peritoneal mesotheliomas. Improved survival has also been reported in treating PM from ovarian, gastric, and colorectal cancers. However, PM often seriously complicates the clinical course of patients with other primary digestive and non-digestive cancers. There is increasing literature evidence that helped to identify not only the primary tumors for which CRS and HIPEC showed a survival advantage but also the patients who may benefit form this treatment modality for the potential lethal complications. Our goal is to report our experience with cytoreduction and HIPEC in patients with PM from rare or unusual primary tumors, discussing possible "unconventional" indications, outcome, and the peculiar issues related to each tumor.
METHODS:
From a series of 253 consecutive patients with a diagnosis of peritoneal carcinomatosis and treated by CRS and HIPEC, we selected only those with secondary peritoneal carcinomatosis from rare or unusual primary tumors, excluding pseudomyxoma peritonei, peritoneal mesotheliomas, ovarian, gastric, and colorectal cancers. Complications and adverse effects were graded from 0 to 5 according to the WHO Common Toxicity Criteria for Adverse Events (CTCAE). Survival was expressed as mean and median.
RESULTS:
We admitted and treated by CRS and HIPEC 28 patients with secondary peritoneal carcinomatosis from rare or unusual primary tumors. Morbidity and mortality rates were in line with those reported for similar procedures. Median survival for the study group was 56 months, and 5-year overall survival reached 40.3 %, with a difference between patients with no (CC0) and minimal (CC1) residual disease (52.3 vs. 25.7), not reaching statistical significance. Ten patients are alive disease-free, and eight are alive with disease.
CONCLUSIONS:
Cytoreduction and HIPEC should not be excluded "a priori" for the treatment of peritoneal metastases from unconventional primary tumors. This combined therapeutic approach, performed in an experienced center, is safe and can provide a survival benefit over conventional palliative treatments
Weekly versus three weeks chemotherapy for advanced ovarian cancer. A meta-analysis
Aim: Three weeks paclitaxel and carboplatin has been considered the standard of care for primary treatment of ovarian cancer (OC). Whether weekly therapy will further improve the clinical outcomes or not is still unclear. We conducted a meta-analysis to compare the two regimens.
Method: Articles were selected with a systematic approach, using PubMed databases. Trials concerning comparison between carboplatin plus weekly paclitaxel (dose-dense regimen) and carboplatin plus paclitaxel every 3 weeks were considered. Outcomes included overall survival (OS), progression free survival (PFS) and severe acute toxicity.
Results: Dose-dense regimen was associated with significant improvement of PFS compared with standard schedule, with HR of 0.73 (95% CI 0.61-0.88, p = 0.001). There was no difference in OS between treatment regimens (HR 0.95, 95% CI 0.77-1.16, p=0.06), as well as in term of severe acute toxicity.
Conclusion: Dose-dense regimen is superior to standard schedule in terms of PFS. Further studies are necessary to firmly confirm this evidence in advanced OC treatment
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