Treatment of patients with distant metastases from phyllodes tumor of the breast

BACKGROUND: Here, the treatment methods and results of patients with phyllodes tumor of the breast (PT) with distant metastases at a single institution are presented. METHODS: A retrospective analysis was performed on a group of 295 patients with PT treated from 1952 to 2010. RESULTS: Distant metastases developed in 37 (12.5 %) patients; 3/160 (1.9 %) patients had benign PT, 6/36 (16.7 %) were considered borderline, and 28/99 (28.3 %) had malignant PT. Most frequently, the metastases were located in the lungs; 28 (75.7 %), bone 7 (18.9 %), brain 4 (10.8 %), and liver 2 (5.4 %). Metastases occurred on overage 21 months (2–57) after surgery. Patients with lung metastases were generally treated with monochemotherapy or polychemotherapy. In one patient Testosterone and in two patients resection of metastases combined with Doxorubicin were used. Patients with bones or brain metastases were treated with palliative radiotherapy only or combined with Doxorubicin. The mean survival (MS) from diagnosis of distant metastases (DM) was 7 months (2–17). The longest mean survival in patients with bones metastases was 11.8 months, the worst survival was for patients with brain metastases—2.8 months. Hormone therapy appeared to have low efficacy (MS: 2 months) as well as monochemotherapy (MS: 3–5 months). Improved MS was obtained using Doxorubicin (7 months) and Doxorubicin with Cisplatin, Cyclophosphamide, or Ifosfamide (9 months). CONCLUSION: The prognosis of patients with DM from PT is poor. The role of surgery and irradiation of such patients is very limited. There appears to be no role for the use of hormone therapy. This study showed that polychemotherapy with Doxorubicin and Ifosfamide suggest that it might be more effective than once thought

Poorly differentiated loco-regionally advanced naso – and oropharyngeal carcinoma: results of neoadjuvant chemotherapy followed by radiotherapy

Over the years 1986–1997, at the Centre of Oncology in Kraków, 82 patients (28 women, 54 men; mean age: 50.8 years) with poorly differentiatied naso- and oropharyngeal carcinoma with metastases to regional nodes (stage III and IV) received neoadjuvant chemotherapy followed by teleradiotherapy. The primary tumour was located in the nasopharynx in 57 patients (69.5%), in the tonsil – in 24 (29.3%), and in the base of the tongue (one patient). Chemotherapy cycles consisted of cisplatin in a dose of 100 mg/m2 administered intravenously on the first day, and 5-f1uorouracil in a dose of 1000 mg/m2 over days 1 to 5. Forty-seven (57.3%) patients received 3 cycles, 25 (30.5%) patients – 2 cycles, 8 (9.8%) patients – 1 cycle. After chemotherapy, patients received conventionally fractionated (200 cGy 5x a week) radiotherapy to the primary tumour (50–65 Gy) and regional nodes (50–70 Gy). The therapy was generally well tolerated, however two patients developed fatal late complications. Improvement in therapy results was observed when comparised with a historical group. Five-year overall survival was 52%. The degree of regression (PR + CR), following neoadjuvant chemotherapy, which appeared to depend on the number of chemotherapy cycles, is the main prognostic factor for this group of patients

Value of perfusion CT parameters, microvessl density and VEGF expression in differentiation of benign and malignant prostate tumours

The purpose of this study was to assess the correlation between parameters evaluated using computed tomography perfusion (CTP) and microvessel density (MVD), the vascular endothelial growth factor labelling index (VEGFLI), as well as known clinicopathological indicators of tumour malignancy, in non-advanced prostatic cancer. We included 110 patients with early stage prostate cancer who were subjected to CT examinations followed by radical prostatectomy between 2007 and 2011 (in this analysis we included only patients diagnosed with CT). Both in affected and in healthy tissue the following perfusion parameters were assessed: blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability-surface area product (PS). After surgery in the resected prostate tumour tissue the MVD and VEGFLI were assessed. The mean BF and PS values were significantly higher in carcinomas with high histological grade (p = 0.02). The sensitivity, specificity and accuracy of the threshold BF value, for the distinction between malignant and healthy prostate tissue, were: 67%, 54% and 59% respectively. For BV sensitivity was 71%, specificity was 52%, and accuracy was 48%. Microvessel density significantly correlated with BV, MTT and PS (p < 0.05), while VEGFLI did not correlate with any of the perfusion parameters. Our results suggest that BF and PS might be helpful in discrimination between benign and malignant prostate tissue, while the positive correlation between BV, MTT, PS and MVD might suggest their potential utility in assessment of cancer angiogenesis