PSYCHOLOGICAL ASSESSMENT IN CHILDREN WITH TUMORS OF POSTERIOR FOSSA: FROM DIAGNOSIS TO FOLLOW UP

Lesions of the posterior fossa account for 20 % of all the patients with brain tumors and although tumor related neuropsychological sequelae have been reported, few data describe the psychosocial consequences faced at the end of the treatment. We assessed emotional, behavioral and social impairments from diagnosis to follow-up (6-12 months), in children referred to our institution, using the Achenbach Child Behavior Checklist for ages 1-5 years (group-1) and 6-18 years (group-2). The possible correlation between impairments and tumor’s location was also evaluated. We enrolled 23 patients (14 M, 9 F), 11 (48%) in group-1 and 12 (52%) in group-2. Mean age was 89 months at diagnosis and 101 months at follow-up. The lo- cation was vermian in 8 patients (35%); emispheric in 2 (9%), vermian-emispheric in 3 (13%) and extending to the fourth ventricle in 3 (13%). Most frequent histology was medulloblastoma (74%), followed by pilocytic astrocytoma (18%) and ependymoma (8%). All the patients under- went surgical resection, 14 patients (61%) received chemotherapy, 8 (35%) chemotherapy and radiotherapy. Mean Internalizing scores were 52 at diag- nosis and 53 at first follow up in group-1, 57 and 64 respectively in group-2. Mean Externalizing scores were 47 and 53 for younger children and 46 and 51 for the other group (diagnosis and follow-up, respectively). Changes of emotional, behavioral and social profiles were not found to be significant in both groups. A trend toward increase of attention issues was found in patients with lesions involving the fourth ventricle. Our preliminary data suggest that emotional, behavioral or social impairments at diagnosis tend to stably persist throughout treatment and must then be target of early interven- tion. Moreover, specific neuropsychological rehabilitation might be benefi- cial in case of lesions involving the fourth ventricle. A larger cohort of patients and longer follow-up are required to better characterize our results

Immunohistochemical determination of p53 protein does not predict clinical response in advanced colorectal cancer with low thymidylate synthase expression receiving a bolus 5-fluorouracil-leucovorin combination.

We assessed the hypothesis that a compromised p53 function could account for the non response of colon cancer patients with low thymidylate synthase (TS) expression receiving a bolus 5-fluorouracil (5-FU) leucovorin (LV) combination.The study population consisted of 41 patients with unresectable metastatic colon cancer, homogeneously, treated with bolus 5-FU and LV.Twenty-seven patients (66\%) showed high levels of TS expression. The difference in the proportion of objective responses between patients with low (CR + PR: 7 of 14, 50\%) and high (CR + PR: 0 of 27) TS levels was statistically significant (P = 0.0001, chi-square test). p53 nuclear over-expression was found in 27 of 41 patients (66\%). No differences were observed in p53 overexpression in patients with high (66\%) or low (66\%) TS expression. p53 status was not found to be associated with response even in patients with low TS expression.p53 status measured by immunohistochemistry does not seem to be useful to identify unresponsive patients with low TS expression

Expression of vascular endothelial growth factor can predict event-free survival in stage II colon cancer.

The usefulness of chemotherapy in patients with stage II disease continues to be debated. Biological prognostic factors may allow further insight into the optimal treatment strategy for patients with node-negative disease. Vascular endothelial growth factor (VEGF) seems to be essential for angiogenesis and for the growth of colorectal cancer. Recently, it was shown able to predict disease recurrence in patients with stage II colon cancer. Specimens of surgically resected colon cancer were immunostained for VEGF. Consecutive patients referred to the study institutions were considered eligible for this study. The main inclusion criteria were stage II tumor, sufficient tumor material, and adequate follow-up information. Analysis was performed on 121 patients. The recurrence rate in the patients with VEGF-positive tumors was 50\% (18 of 36 patients), which was significantly higher than that observed in patients with VEGF-negative tumors [11.7\% (10 of 85 patients); P = 0.001]. Also the degree of VEGF immunoreactivity was significantly higher in 28 relapsing patients compared with 93 disease-free patients (mean VEGF score, 2.84 0.38 versus 0.66 +/- 0.17; P = 0.0001). VEGF may be used in a clinical setting to identify patients at high risk for relapse who may benefit from adjuvant treatment including new therapeutic strategies such as monoclonal antibody neutralizing VEGF

Effects of calcium and vitamin supplementation on colon cell proliferation in colorectal cancer.

Calcium and antioxidant vitamins, such as A, C, and E, have been shown to reduce colorectal epithelial proliferation and thereby to act as possible chemoprotective agents in colorectal cancer. We investigated the effects of an intervention with calcium and vitamins on cell proliferation in the colonic mucosa of patients operated on for colorectal cancer. Patients with resected colorectal cancer Dukes' stage B-C were randomized to receive daily 30,000 IU of axerophthol palmitate (vitamin A) plus 1 g ascorbic acid (vitamin C) plus 70 mg of dl-alpha-tocopherol acetate (vitamin E) and 2 g natural calcium daily or indistinguishable placebo for 6 months. At the time of surgery and after 6 and 12 months of treatment, cell kinetics of normal colonic mucosa were assessed by using proliferating cell nuclear antigen (PCNA). Ninety patients were enrolled and 77 were assessable: 34 in the treatment group and 43 in the placebo group. A significant reduction of mean total PCNA labeling index (PCNALI) was evident in both groups after 6 months (vitamins/calcium, from 16.11 +/- 2.43 to 10.71 +/- 2.81; placebo, from 17.30 +/- 2.63 to 12.53 +/- 3.40). The difference in the percentage of reduction of mean PCNALI between baseline and after 6 months was not statistically significant in the treatment and placebo groups: 34\% and 28\%, respectively. A second control, 6 months after discontinuation of vitamin and calcium supplementation, showed a further decrease of mean total PCNALI in both groups, but this was not statistically significant. Our randomized trial showed that calcium and vitamin supplementation does not reduce cell kinetics of colon epithelium. Furthermore, this study suggests the need for extreme caution in the interpretation and publication of studies on chemoprotectants in colon cancer without a control group

Effects of calcium and vitamin supplementation on colon cell proliferation in colorectal cancer.

Calcium and antioxidant vitamins, such as A, C, and E, have been shown to reduce colorectal epithelial proliferation and thereby to act as possible chemoprotective agents in colorectal cancer. We investigated the effects of an intervention with calcium and vitamins on cell proliferation in the colonic mucosa of patients operated on for colorectal cancer. Patients with resected colorectal cancer Dukes' stage B-C were randomized to receive daily 30,000 IU of axerophthol palmitate (vitamin A) plus 1 g ascorbic acid (vitamin C) plus 70 mg of dl-alpha-tocopherol acetate (vitamin E) and 2 g natural calcium daily or indistinguishable placebo for 6 months. At the time of surgery and after 6 and 12 months of treatment, cell kinetics of normal colonic mucosa were assessed by using proliferating cell nuclear antigen (PCNA). Ninety patients were enrolled and 77 were assessable: 34 in the treatment group and 43 in the placebo group. A significant reduction of mean total PCNA labeling index (PCNALI) was evident in both groups after 6 months (vitamins/calcium, from 16.11 +/- 2.43 to 10.71 +/- 2.81; placebo, from 17.30 +/- 2.63 to 12.53 +/- 3.40). The difference in the percentage of reduction of mean PCNALI between baseline and after 6 months was not statistically significant in the treatment and placebo groups: 34\% and 28\%, respectively. A second control, 6 months after discontinuation of vitamin and calcium supplementation, showed a further decrease of mean total PCNALI in both groups, but this was not statistically significant. Our randomized trial showed that calcium and vitamin supplementation does not reduce cell kinetics of colon epithelium. Furthermore, this study suggests the need for extreme caution in the interpretation and publication of studies on chemoprotectants in colon cancer without a control group