ISRN Oncology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Comparative Study between Measurement Data and Treatment Planning System (TPS) in Small Fields for High Energy Photon Beams Tue, 06 May 2014 10:03:36 +0000 To achieve tumor control for radiotherapy, a dose distribution is planned which has a good chance of sterilizing all cancer cells without causing unacceptable normal tissue complications. The aim of the present study was to achieve an accurate calculation of dose for small field dimensions and perform this by evaluating the accuracy of planning system calculation. This will be compared with real measurement of dose for the same small field dimensions using different detectors. Practical work was performed in two steps: (i) determination of the physical factors required for dose estimation measured by three ionization chambers and calculated by treatment planning system (TPS) based on the latest technical report series (IAEATRS-398) and (ii) comparison of the calculated and measured data. Our data analysis for small field is irradiated by photon energy matched with the data obtained from the ionization chambers and the treatment planning system. Radiographic films were used as an additional detector for the obtained data and showed matching with TPS calculation. It can be concluded that studied small field dimensions were averaged 6% and 4% for 6 MV and 15 MV, respectively. Radiographic film measurements showed a variation in results within ±2% than TPS calculation. Khaled El Shahat, Aziza El Saeid, Ehab Attalla, and Adel Yassin Copyright © 2014 Khaled El Shahat et al. All rights reserved. The Human Epidermal Growth Factor Receptor 2 Screening Tests for Breast Cancer Suggested by the New Updated Recommendation of the American Society of Clinical Oncology/College of American Pathologists Will Involve a Rise of the In-Situ Hybridization Tests for the European Laboratories of Pathology Tue, 22 Apr 2014 14:14:09 +0000 Aims. The differences between the 2007 and the 2013 ASCO/CAP HER2 guidelines have been compared. We also discussed the potential consequences in our pathological practice. Material and Methodology. 189 HER2 fluorescence in situ hybridisation (FISH) tests were performed from 1016 preliminary HER2 immunohistochemical tests (IHC). All cases were reviewed and reclassed following the 2007 and 2013 ASCO/CAP recommendations. Results. The 2013 version decreased false-negative IHC (3/118 versus 1/54, ) and created more 2+ IHC (40/186 versus 89/186, ) or more 3+ IHC (9/186 versus 39/186, ). One false-positive IHC was described for the 2013 version (0/9 versus 1/39, ). Equivocal FISH was reduced (8/186 versus 2/186, ). An estimation based on our data for 1000 patients showed a rise of our FISH tests for the control of 2+ IHC (180 tests for the 2007 version versus 274 tests for the 2013 version or FISH work overflow is +52%) and for the control of 2+/3+ IHC (300 for the 2007 version versus 475 for the 2013 version or FISH work overflow is +58%). Conclusions. The new 2013 ASCO/CAP guidelines have detected more HER2 positive cases but have increased the number of FISH tests. Christian Garbar, Aude-Marie Savoye, Corinne Mascaux, Eva Brabencova, and Hervé Curé Copyright © 2014 Christian Garbar et al. All rights reserved. Clinical Features and Outcome of Sporadic Colorectal Carcinoma in Young Patients: A Cross-Sectional Analysis from a Developing Country Tue, 01 Apr 2014 11:47:36 +0000 Background. Early onset colorectal carcinoma (CRC) is rare and has been hypothesized to be a biologically and clinically distinct entity personifying aggressive disease and worse survival. Methods. Data for 131 patients was collected by retrospective chart review. Cox proportional hazard model was used to compute prevalence ratios and 95% confidence intervals. Results. Early onset sporadic CRC accounted for 32% of all CRC treated in the specified time period. The mean age was years and the male to female ratio was . Colon and rectal cancers accounted for 55% and 45% of patients, respectively. 96% of rectal carcinoma patients received appropriate therapy as opposed to 65% of colon cancers. On multivariable analysis, appropriate reception of therapy (PR 4.99; 95% CI, 1.21–20.6) and signet ring morphology (PR 2.40; 95% CI, 1.33–4.32) were significantly associated with rectal cancers as opposed to colon cancer. Kaplan-Meier analysis revealed a trend towards inferior survival for rectal carcinoma 2 years after diagnosis. Conclusion.A high prevalence of early onset CRC was noted in the study. A trend towards inferior survival was seen in patients with rectal cancer. This finding raises the possibility of rectal carcinoma being an aggressive subset of young CRC. Muhammad Nauman Zahir, Eisha Mahpara Azhar, Sobia Rafiq, Kulsoom Ghias, and Munira Shabbir-Moosajee Copyright © 2014 Muhammad Nauman Zahir et al. All rights reserved. Idelalisib for the Treatment of Chronic Lymphocytic Leukemia Tue, 01 Apr 2014 08:45:55 +0000 Chronic lymphocytic leukemia is the most common leukemia in the United States. It is a slowly progressive disease, with an 82% five-year survival rate. The treatment strategies are highly individualized with patients in the early and stable stages typically not requiring treatment. However, those with progressive or clinically advanced disease will require treatment. Cytotoxic drugs, such as the alkylating agents, purine nucleoside antagonists, and immunotherapeutic agents, have been the mainstay of chemotherapeutic treatment in CLL. However, given the lack of therapeutic specificity, these medications (especially older ones) have limited tolerability due to side effects. In this paper, we will discuss the data on the use of phosphatidylinositol 3 kinase inhibitor Idelalisib in the management of patients with chronic lymphocytic leukemia. The preclinical and clinical data thus far demonstrate that Idelalisib produces a dramatic and durable response in patients with chronic lymphocytic leukemia and without causing significant toxicity. Moving forward, the ongoing clinical trials will help address the various questions currently being raised regarding the long-term application and safety of Idelalisib. With greater clinical experience following more widespread use of Idelalisib, we will be able to determine the optimal combination therapies in treatment-naïve and relapsed/refractory patients, resulting in more individualized therapeutic strategies for patients with chronic lymphocytic leukemia. Maliha Khan, Areeba Saif, Steven Sandler, and Aibek E. Mirrakhimov Copyright © 2014 Maliha Khan et al. All rights reserved. Update on Salvage Options in Relapsed/Refractory Hodgkin Lymphoma after Autotransplant Sun, 30 Mar 2014 13:39:51 +0000 Despite a high clinical success, relapse in Hodgkin lymphoma occurs in 10–30% of cases and 5–10% patients are nonresponsive to initial chemotherapy. The standard management of these patients includes high-dose chemotherapy followed by autologous stem cell transplant. However, 50% of patients ultimately relapse after autotransplant which poses a big challenge. Allogeneic stem cell transplantation offers the only chance of cure in these patients. For patients who are not candidates for allogeneic stem cell transplantation, achieving cure with other possible options is highly unlikely, and thus the treatment plan becomes noncurative. Various novel agents have shown promising results but the duration of response is short lived. A standard approach to deliver the most effective treatment for these patients is still lacking. This review focuses on the treatment options currently available for relapsed and refractory disease after autotransplant. Nida Iqbal, Lalit Kumar, and Naveed Iqbal Copyright © 2014 Nida Iqbal et al. All rights reserved. Palliative Radiotherapy with or without Additional Care by a Multidisciplinary Palliative Care Team: A Retrospective Comparison Sun, 30 Mar 2014 13:26:33 +0000 Purpose. To analyze pattern of care and survival after palliative radiotherapy (RT) in patients managed exclusively by regular oncology staff or a multidisciplinary palliative care team (MPCT) in addition. Methods. Retrospective analysis of 522 RT courses. Comparison of Two Groups: MPCT versus none. Results. We analyzed 140 RT courses (27%) with MPCT care and 382 without it. The following statistically significant differences were observed: 33% of female patients had MPCT care versus only 23% of male patients and 37% of patients <65 years had MPCT care versus only 22% of older patients. MPCT patients were more likely to have poor performance status and liver metastases. In the MPCT group steroid and opioid use was significantly more common. Dose-fractionation regimens were similar. Median survival was significantly shorter in the MPCT group, 3.9 versus 6.9 months. In multivariate analysis, MPCT care was not associated with survival. Adjusted for confounders, MPCT care reduced the likelihood of incomplete RT by 33%, . Conclusions. Patterns of referral and care differed, for example, regarding age and medication use. It seems possible that MPCT care reduces likelihood of incomplete RT. Therefore, the impact of MPCT care on symptom control should be investigated and objective referral criteria should be developed. Carsten Nieder, Kent Angelo, Astrid Dalhaug, Adam Pawinski, Gro Aandahl, Ellinor Haukland, and Kirsten Engljähringer Copyright © 2014 Carsten Nieder et al. All rights reserved. Vinorelbine with or without Trastuzumab in Metastatic Breast Cancer: A Retrospective Single Institution Series Sun, 30 Mar 2014 11:02:46 +0000 Background. We report our experience with vinorelbine, a widely used chemotherapeutic, in unselected metastatic breast cancer patients treated in clinical routine. Patients and Methods. The data of all patients with metastatic breast cancer receiving vinorelbine with or without trastuzumab during a six year period were reviewed. Patients received vinorelbine intravenous 25–30 mg/m2 or 60–80 mg/m2 orally in days 1 and 8 of a 21 day cycle. Results. Eighty-seven women were included. Sixty-two patients received vinorelbine alone and 25 patients received vinorelbine in combination with trastuzumab. In 67 patients this was the first line treatment for metastatic disease and in 20 patients it was 2nd or later line of treatment. The median TTP was six months (range: 1–45). The median overall survival was 11.5 months (range: 1–83). Seventy patients were evaluable for response. In patients receiving first line treatment 44.4% had a response while in the second and subsequent lines setting 12.5% of patients responded (). Objective response was obtained in 63.6% of patients receiving concomitant trastuzumab and in 25% of patients receiving vinorelbine alone (). Conclusion. This study confirms a high disease control rate. Response rate and TTP were superior in first line treatment compared to subsequent lines. Athina Stravodimou, Khalil Zaman, and Ioannis A. Voutsadakis Copyright © 2014 Athina Stravodimou et al. All rights reserved. Sarcoma Excision and Pattern of Complicating Sensory Neuropathy Mon, 24 Mar 2014 12:59:21 +0000 A potential complication of sarcoma excision surgery is a sensory neurological dysfunction around the surgical scar. This study utilised both objective and subjective sensation assessment modalities, to evaluate 22 patients after sarcoma surgery, for a sensory deficit. 93% had an objective sensory deficit. Light touch is less likely to be damaged than pinprick sensation, and two-point discrimination is significantly reduced around the scar. Results also show that an increased scar size leads to an increased light touch and pinprick deficit and that two-point discriminatory ability around the scar improves as time after surgery elapses. 91% had a subjective deficit, most likely tingling or pain, and numbness was most probable with lower limb sarcomas. Results also demonstrated that there were no significant relationships between any specific subjective and objective deficits. In conclusion, sensory disturbance after sarcoma surgery is common and debilitating. Efforts to minimize scar length are paramount in the prevention of sensory deficit. Sensation may also recover to an extent; thus, sensory reeducation techniques must become an integral aspect of management plans. Finally to obtain a comprehensive assessment of sensory function, both objective and subjective assessment techniques must be utilised. Neil R. Wickramasinghe, Nicholas D. Clement, Ashish Singh, and Daniel E. Porter Copyright © 2014 Neil R. Wickramasinghe et al. All rights reserved. Survival Prediction Score: A Simple but Age-Dependent Method Predicting Prognosis in Patients Undergoing Palliative Radiotherapy Wed, 19 Mar 2014 11:47:19 +0000 Purpose. Validation of a Canadian three-tiered prognostic model (survival prediction score, SPS) in Norwegian cancer patients referred for palliative radiotherapy (PRT), and evaluation of age-dependent performance of the model. Patients and Methods. We analyzed all 579 PRT courses administered at a dedicated PRT facility between 20.06.07 and 31.12.2009. SPS was assigned as originally described, That is, by taking into consideration three variables: primary cancer type, site of metastases, and performance status. Results. Patients with poor prognosis (non-breast cancer, metastases other than bone, and Karnofsky performance status (KPS) ≤ 60) had median survival of 13 weeks. Those with intermediate prognosis (two of these parameters) survived for a median of 29 weeks, and patients with good prognosis for a median of 114 weeks, . While this model performed well in patients who were 60 years or older, it was less satisfactory in younger patients (no significant difference between the good and intermediate prognosis groups). Conclusion. SPS should mainly be used to predict survival of elderly cancer patients. However, even in this group accuracy is limited because the good prognosis group contained patients with short survival, while the poor prognosis group contained long-term survivors. Thus, improved models should be developed. Kent Angelo, Astrid Dalhaug, Adam Pawinski, Ellinor Haukland, and Carsten Nieder Copyright © 2014 Kent Angelo et al. All rights reserved. Comparison of 3-Tier Cytological Grading Systems for Breast Carcinoma Wed, 12 Mar 2014 11:36:40 +0000 Background. Fine-needle aspiration cytology plays a major role in the primary diagnosis of breast carcinoma. Cytological grading of the smears can provide valuable prognostic information and aid in planning the management options. Aim. To evaluate various 3-tier cytological grading systems and to determine the best possible system which is reliable and objective for use in routine practice. Materials & Methods. 72 fine-needle aspiration smears of breast carcinomas were graded by two pathologists and compared with the histologic grading by Nottingham modification of Scarff-Bloom-Richardson method. Concordance and correlation studies were done. Kappa measurement of interobserver agreement was also done. Results. Robinson’s method showed a better correlation (77.7%) and substantial Kappa value of agreement with Bloom Richardson’s histological grading method in comparison to the other methods, closely followed by Fisher’s method. Fisher’s method showed better interobserver agreement (84.7%, ) compared to the other systems. Conclusions. Robinson’s method of cytological grading in fine-needle aspiration smears of breast carcinoma is simpler, multifactorial, and feasible, hence being preferable for routine use according to our study. Dinisha Einstien, B. O. Parijatham Omprakash, Hemalatha Ganapathy, and Sadaf Rahman Copyright © 2014 Dinisha Einstien et al. All rights reserved. Pediatric Sclerosing Rhabdomyosarcomas: A Review Wed, 05 Mar 2014 14:08:59 +0000 Sclerosing RMS (SRMS) is a recently described subtype of RMS that has not yet been included in any of the classification systems for RMSs. We did pubmed search using keywords “sclerosing, and rhabdomyosarcomas” and included all pediatric cases (age ≤ 18 years) of SRMSs in this review. We also included our case of an eleven-year-old male child with skull base SRMS and discuss the clinical, histopathological, immunohistochemical, and genetic characteristics of these patients. Till now, only 20 pediatric cases of SRMSs have been described in the literature. Pediatric SRMS more commonly affects males at a mean age of 9 years. Extremeties and head/neck regions were most commonly affected. Follow-up details were available for 16 patients with mean follow-up of 25.3 months. Treatment failure rate was 43.75%. Overall amongst these 16 patients, 10 were alive without disease, 4 were alive with disease, and two died. Thus, overall and disease-free survival amongst these 16 patients were 87.5% and 62.5%, respectively. The literature regarding clinical behaviour and outcome of pediatric patients with SRMSs is patchy. Detailed molecular/genetic analysis and clinicopathological characterization with longer follow-ups of more cases may throw some light on this possibly new subtype of RMS. Amandeep Kumar, Manmohan Singh, Mehar C. Sharma, Sameer Bakshi, and Bhawani S. Sharma Copyright © 2014 Amandeep Kumar et al. All rights reserved. Public Awareness of Colorectal Cancer Screening: Knowledge, Attitudes, and Interventions for Increasing Screening Uptake Wed, 05 Mar 2014 07:02:47 +0000 Colorectal cancer ranks as one of the most incidental and death malignancies worldwide. Colorectal cancer screening has proven its benefit in terms of incidence and mortality reduction in randomized controlled trials. In fact, it has been recommended by medical organizations either in average-risk or family-risk populations. Success of a screening campaign highly depends on how compliant the target population is. Several factors influence colorectal cancer screening uptake including sociodemographics, provider and healthcare system factors, and psychosocial factors. Awareness of the target population of colorectal cancer and screening is crucial in order to increase screening participation rates. Knowledge about this disease and its prevention has been used across studies as a measurement of public awareness. Some studies found a positive relationship between knowledge about colorectal cancer, risk perception, and attitudes (perceived benefits and barriers against screening) and willingness to participate in a colorectal cancer screening campaign. The mentioned factors are modifiable and therefore susceptible of intervention. In fact, interventional studies focused on average-risk population have tried to increase colorectal cancer screening uptake by improving public knowledge and modifying attitudes. In the present paper, we reviewed the factors impacting adherence to colorectal cancer screening and interventions targeting participants for increasing screening uptake. Antonio Z. Gimeno Garcia, Noemi Hernandez Alvarez Buylla, David Nicolas-Perez, and Enrique Quintero Copyright © 2014 Antonio Z. Gimeno Garcia et al. All rights reserved. Frequency and Spectrum of KRAS Mutations in Moroccan Patients with Lung Adenocarcinoma Wed, 05 Mar 2014 00:00:00 +0000 Background. In lung adenocarcinoma, the frequency of KRAS mutations is ethnicity dependent with a higher proportion in African Americans and white Caucasians than in Asians. The prevalence of these mutations among North Africans patients is unknown. The objective of this study was to report the frequency and spectrum of KRAS mutations in a group of Moroccan lung adenocarcinoma patients. Methods. Tumor specimens from 117 Moroccan patients with lung adenocarcinoma were selected to determine frequency and spectrum of KRAS mutations. KRAS mutations in codons 12 and 13 of exon 2 were analyzed using conventional DNA sequencing. Results. The overall frequency of the KRAS mutations was 9% (11/117). In the population with KRAS mutations, there was a trend towards more male () and more smokers () compared to patients with wild type KRAS. KRAS mutations were located at codon 12 in 10 out of 11 patients (91%). The G12C mutation was the most frequent KRAS mutation (73%). Conclusion. This is the first study to date examining the frequency and spectrum of KRAS mutations in lung adenocarcinomas in North African and Arab populations. KRAS mutation frequency in Moroccan patients was comparable with the frequency observed in East-Asian population. KRAS mutations are more likely observed in males and smokers and to be transversions. Further studies, in larger numbers of patients, are needed to confirm these findings. Ibrahim Elghissassi, Hanane Inrhaoun, Anwar Boukir, Fouad Kettani, Lamia Gamra, Amina Mestari, Lamia Jabri, Youssef Bensouda, Hind Mrabti, and Hassan Errihani Copyright © 2014 Ibrahim Elghissassi et al. All rights reserved. Association of Mammographic Breast Density with Dairy Product Consumption, Sun Exposure, and Daily Activity Tue, 04 Mar 2014 08:11:47 +0000 Background. Mammographic density is a risk factor, for breast cancer and its association with various factors is under investigation; we carried out a study to assess its relationship with daily dairy intake, sun exposure, and physical activities. Patients and Methods. Women ≥40 years of age were interviewed about habits of dairy product consumption, daily sun exposure and physical activity. Exclusion criteria consisted of history of breast cancer, consumption of calcium and vitamin D supplements, hormone replacement therapy, or renal disease. Mammographic densities were classified according to the classification system of the American College of Radiologists into 4 classes. Results. Overall 703 cases were entered in the study. The mean age was years. The most common and least frequent classes of mammographic density were classes 2 and 4, respectively. There was no significant association between mammographic density and rate of dairy consumption, amount of sunlight exposure, and daily physical activity. Conclusion. Relation of sunlight exposure and intake of milk products with mammographic density need further study, while the subject of physical activity can be evaluated by a systematic review and meta-analysis of the existing literature. Sadaf Alipour, Azin Saberi, Afsaneh Alikhassi, Leila Bayani, and Ladan Hosseini Copyright © 2014 Sadaf Alipour et al. All rights reserved. Undiagnosed Diabetes in Breast, Colorectal, Lung, and Prostate Cancer: Incidence and Risk Factors Tue, 04 Mar 2014 08:03:40 +0000 Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and End Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage. Robert I. Griffiths, Karla J. Lindquist, Cynthia D. O’Malley, Michelle L. Gleeson, Jennifer L. Duryea, José M. Valderas, and Mark D. Danese Copyright © 2014 Robert I. Griffiths et al. All rights reserved. Racial Disparities in Survival and Age-Related Outcome in Postsurgery Breast Cancer Patients in a New York City Community Hospital Wed, 12 Feb 2014 00:00:00 +0000 Breast cancer survival has significantly improved over the past two decades. However, the diagnosis of breast cancer is lower and the mortality rate remains higher, in African American women (AA) compared to Caucasian-American women. The purpose of this investigation is to analyze postoperative events that may affect breast cancer survival. This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center cancer registry from 1997 to 2010. Of the 1538 patients in the registry, 1226 are AA and 269 are Caucasian. The study was divided into two time periods, 1997–2004 (period A) and 2005–2010 (period B), in order to assess the effect of treatment outcomes on survival. During period A, 5-year survival probabilities of 75.37%, 74.53%, and 78.70% were seen among all patients, AA women and Caucasian women, respectively. These probabilities increased to 87.62%, 87.15% and 89.99% in period B. Improved survival in AA women may be attributed to the use of adjuvant chemotherapy, radiation, and hormonal therapy. Improved survival in Caucasian patients was attributed to the use of radiation therapy, as well as earlier detection resulting in more favorable tumor grades and pathological stages. Stacey Martindale, Awinder Singh, Hua Wang, Ashley Steinberg, Amer Homsi, Haidi Zhang, Alan Go, and Peter Pappas Copyright © 2014 Stacey Martindale et al. All rights reserved. Comparison of Reverse Transcription Quantitative Real-Time PCR, Flow Cytometry, and Immunohistochemistry for Detection of Monoclonality in Lymphomas Tue, 04 Feb 2014 12:40:03 +0000 In healthy humans, 60–70% of the B lymphocytes produce kappa light chains, while the remaining cells produce lambda light chains. Malignant transformation and clonal expansion of B lymphocytes lead to an altered kappa : lambda expression ratio, which is an important diagnostic criteria of lymphomas. Here, we compared three methods for clonality determination of suspected B cell lymphomas. Tumor biopsies from 55 patients with B cell malignancies, 5 B-lymphoid tumor cell lines, and 20 biopsies from patients with lymphadenitis were analyzed by immunohistochemistry, flow cytometry, and reverse transcription quantitative real-time PCR. Clonality was determined by immunohistochemistry in 52/53 cases, flow cytometry in 30/39 cases, and reverse transcription quantitative real-time PCR in 33/55 cases. In conclusion, immunohistochemistry was superior to flow cytometry and reverse transcription quantitative real-time PCR for clonality identification. Flow cytometry and reverse transcription quantitative real-time PCR analysis has complementary values. In a considerable number of cases tumor cells produced both kappa and lambda light chain transcripts, but only one type of light chain peptide was produced. Anders Ståhlberg, Pierre Åman, Linda Strömbom, Neven Zoric, Alfredo Diez, Olle Nilsson, Mikael Kubista, and Börje Ridell Copyright © 2014 Anders Ståhlberg et al. All rights reserved. [11C]-Methionine Positron Emission Tomography in the Postoperative Imaging and Followup of Patients with Primary and Recurrent Gliomas Tue, 04 Feb 2014 11:42:39 +0000 We investigated the sensitivity and specificity of [11C]-methionine positron emission tomography ([11C]-MET PET) in the management of glioma patients. We retrospectively analysed data from 53 patients with primary gliomas (16 low grade astrocytomas, 15 anaplastic astrocytomas and 22 glioblastomas) and Karnofsky Performance Status (KPS) > 70. Patients underwent [11C]-MET PET scans () and parallel contrast-enhanced MRI () and/or CT () controls. In low grade glioma patients, MRI or CT findings associated with [11C]-MET PET additional data allowed discrimination residual disease from postsurgical changes in 96.22% of these cases. [11C]-MET PET early allowed detection of malignant progression from low grade to anaplastic astrocytoma with high sensitivity (91.56%) and specificity (95.18%). In anaplastic astrocytomas, we registered high sensitivity (93.97%) and specificity (95.18%) in the postoperative imaging and during the followup of these patients. In GBM patients, CT and/or MRI scans with additional [11C]-MET PET data registered a sensitivity of 96.92% in the postsurgical evaluation and in the tumour assessment during temozolomide therapy. A significant correlation was found between [11C]-MET mean uptake index and histologic grading (). These findings support the notion that complementary information derived from [11C]-MET PET may be helpful in postoperative and successive tumor assessment of glioma patients. Matteo Santoni, Cristina Nanni, Alessandro Bittoni, Gabriele Polonara, Alessandro Paccapelo, Roberto Trignani, Mariagrazia De Lisa, Franco Rychlicki, Luciano Burattini, Rossana Berardi, Stefano Fanti, and Stefano Cascinu Copyright © 2014 Matteo Santoni et al. All rights reserved. Ultrasound Guided Core Biopsy versus Fine Needle Aspiration for Evaluation of Axillary Lymphadenopathy in Patients with Breast Cancer Tue, 04 Feb 2014 11:21:05 +0000 Rationale and Objectives. To compare the sensitivities of ultrasound guided core biopsy and fine needle aspiration (FNA) for detection of axillary lymph node metastases in patients with a current diagnosis of ipsilateral breast cancer. Materials and Methods. From December 2008 to December 2010, 105 patients with breast cancer and abnormal appearing lymph nodes in the ipsilateral axilla consented to undergo FNA of an axillary node immediately followed by core biopsy of the same node, both with ultrasound guidance. Experienced pathologists evaluated the aspirate cytology without knowledge of the core histology. Cytology and core biopsy results were compared to sentinel node excision or axillary dissection pathology. Sensitivities were compared using McNemar’s test. Results. Of 70 patients with axillary node metastases, FNA was positive in 55/70 (78.6%) and core was positive in 61/70 (87.1%) (). The FNA and core results were discordant in 14/70 (20%) patients. Ten cases were FNA negative/core positive. Four cases were FNA positive/core negative. Conclusion. Core biopsy detected six (8.6%) more cases of metastatic lymphadenopathy than FNA but the difference in sensitivities was not statistically significant. Core biopsy should be considered if the node is clearly imaged and readily accessible. FNA is a good alternative when a smaller needle is desired due to node location or other patient factors. This trial is registered with NCT01920139. Marie A. Ganott, Margarita L. Zuley, Gordon S. Abrams, Amy H. Lu, Amy E. Kelly, Jules H. Sumkin, Mamatha Chivukula, Gloria Carter, R. Marshall Austin, and Andriy I. Bandos Copyright © 2014 Marie A. Ganott et al. All rights reserved. Magnitude and Implications of Interfraction Variations in Organ Doses during High Dose Rate Brachytherapy of Cervix Cancer: A CT Based Planning Study Mon, 03 Feb 2014 06:28:42 +0000 Background. Quantifying the interfraction dose variations in the organs at risk (OAR) in HDR intracavitary brachytherapy (HDR ICBT). Methods. Rectum and bladder were contoured in 44 patients of cervical carcinoma on CT after each fraction of HDR ICBT (9 Gy/2 fractions). Interfraction dose variations (VARact) were calculated. Rigid image registration of consecutive fraction images allowed quantification of the hypothetical variation in dose (VARhypo) arising exclusively due to changes in applicator placement and geometry. VARhypo was regressed against the VARact to find out to what extent the applicator variation could explain the VARact in the OAR. The rest of the variation was assumed to be due to organ deformation. Results. The VARact in the dose to 2 cc of bladder and rectum were 1.46 and 1.16 Gy, respectively. Increased dose was seen in 16 and 23 patients in the subsequent fraction for bladder and rectum, respectively. Doses to OAR would have exceeded constraints in 16% patients if second fraction was not imaged. VARhypo explained 19% and 47% of the VARact observed for the bladder and rectum respectively. Conclusions. Significant interfraction variations in OAR doses can occur in HDR ICBT. Organ deformations are mostly responsible for this variation. Santam Chakraborty, Firuza D. Patel, Vijay M. Patil, Arun S. Oinam, and Suresh C. Sharma Copyright © 2014 Santam Chakraborty et al. All rights reserved. Therapy of Chronic Myeloid Leukemia: Twilight of the Imatinib Era? Thu, 30 Jan 2014 17:33:16 +0000 Chronic myeloid leukemia (CML) results from the clonal expansion of pluripotent hematopoietic stem cells containing the active BCR/ABL fusion gene produced by a reciprocal translocation of the ABL1 gene to the BCR gene. The BCR/ABL protein displays a constitutive tyrosine kinase activity and confers on leukemic cells growth and proliferation advantage and resistance to apoptosis. Introduction of imatinib (IM) and other tyrosine kinase inhibitors (TKIs) has radically improved the outcome of patients with CML and some other diseases with BCR/ABL expression. However, a fraction of CML patients presents with resistance to this drug. Regardless of clinical profits of IM, there are several drawbacks associated with its use, including lack of eradication of the malignant clone and increasing relapse rate resulting from long-term therapy, resistance, and intolerance. Second and third generations of TKIs have been developed to break IM resistance. Clinical studies revealed that the introduction of second-generation TKIs has improved the overall survival of CML patients; however, some with specific mutations such as T315I remain resistant. Second-generation TKIs may completely replace imatinib in perspective CML therapy, and addition of third-generation inhibitors may overcome resistance induced by every form of point mutations. Ewelina Trela, Sylwester Glowacki, and Janusz Błasiak Copyright © 2014 Ewelina Trela et al. All rights reserved. Prior-Cancer Diagnosis in Men with Nonmetastatic Prostate Cancer and the Risk of Prostate-Cancer-Specific and All-Cause Mortality Thu, 30 Jan 2014 16:44:46 +0000 Purpose. We evaluated the impact a prior cancer diagnosis had on the risk of prostate-cancer-specific mortality (PCSM) and all-cause mortality (ACM) in men with PC. Methods. Using the SEER data registry, 166,104 men (median age: 66) diagnosed with PC between 2004 and 2007 comprised the study cohort. Competing risks and Cox regression were used to evaluate whether a prior cancer diagnosis impacted the risk of PCSM and ACM adjusting for known prognostic factors PSA level, age at and year of diagnosis, race, and whether PC treatment was curative, noncurative, or active surveillance (AS)/watchful waiting (WW). Results. At a median followup of 2.75 years, 12,453 men died: 3,809 (30.6%) from PC. Men with a prior cancer were followed longer, had GS 8 to 10 PC more often, and underwent WW/AS more frequently (). Despite these differences that should increase the risk of PCSM, the adjusted risk of PCSM was significantly decreased (AHR: 0.66 (95% CI: (0.45, 0.97); ), while the risk of ACM was increased (AHR: 2.92 (95% CI: 2.64, 3.23); ) in men with a prior cancer suggesting that competing risks accounted for the reduction in the risk of PCSM. Conclusion. An assessment of the impact that a prior cancer has on life expectancy is needed at the time of PC diagnosis to determine whether curative treatment for unfavorable-risk PC versus AS is appropriate. Kristina Mirabeau-Beale, Ming-Hui Chen, and Anthony V. D'Amico Copyright © 2014 Kristina Mirabeau-Beale et al. All rights reserved. Mitochondrial DNA Haplogroups and Susceptibility to Prostate Cancer in a Colombian Population Tue, 28 Jan 2014 07:44:07 +0000 Prostate cancer (PC) is one of the most common cancers and the second leading cause of mortality from cancer in Colombian men. Mitochondrial DNA (mtDNA) haplogroups have been associated with the risk of PC. Several studies have demonstrated dramatic differences regarding the risk of PC among men from different ethnic backgrounds. The present study was aimed at assessing the relationship between mtDNA haplogroups and PC. The mitochondrial DNA hypervariable segment I (HSV-1) was sequenced in a population-based study covering 168 cases (CA) and 140 unrelated healthy individuals as a control group (CG). A total of 92 different mtDNA sequences were found in CA and 59 were found in the CG. According to the geographical origin attributed to each mtDNA haplogroup, 82% of the mtDNA sequences found in both groups were Native Americans (A, B, C, and D). The most frequent was A (41.1%CA–42.1%CG), followed by B (22.0%CA–21.4%CG), C (12.0%CA–11.4%CG), and D (6%CA–10.0%CG). A lower percentage of European haplogroups (U, H, K, J, M, T, and HV) were also found (13.1%CA–12.9%CG), likewise African haplogroups (L0, L1, L2, and L3) (6.5%CA–2.1%CG). There were no statistically significant differences between the distribution of mtDNA haplogroups in CA and the CG in this study. D. Cano, C. F. Gomez, N. Ospina, J. A. Cajigas, H. Groot, R. E. Andrade, and M. M. Torres Copyright © 2014 D. Cano et al. All rights reserved. Treatment Planning Methods in High Dose Rate Interstitial Brachytherapy of Carcinoma Cervix: A Dosimetric and Radiobiological Analysis Thu, 23 Jan 2014 12:20:03 +0000 Treatment planning is a trial and error process that determines optimal dwell times, dose distribution, and loading pattern for high dose rate brachytherapy. Planning systems offer a number of dose calculation methods to either normalize or optimize the radiation dose. Each method has its own characteristics for achieving therapeutic dose to mitigate cancer growth without harming contiguous normal tissues. Our aim is to propose the best suited method for planning interstitial brachytherapy. 40 cervical cancer patients were randomly selected and 5 planning methods were iterated. Graphical optimization was compared with implant geometry and dose point normalization/optimization techniques using dosimetrical and radiobiological plan quality indices retrospectively. Mean tumor control probability was similar in all the methods with no statistical significance. Mean normal tissue complication probability for bladder and rectum is 0.3252 and 0.3126 (), respectively, in graphical optimized plans compared to other methods. There was no significant correlation found between Conformity Index and tumor control probability when the plans were ranked according to Pearson product moment method (). Graphical optimization can result in maximum sparing of normal tissues. Surega Anbumani, Pichandi Anchineyan, ArunaiNambiraj Narayanasamy, Siddanna R. Palled, Sajitha Sathisan, Punitha Jayaraman, Muthu Selvi, and Ramesh S. Bilimagga Copyright © 2014 Surega Anbumani et al. All rights reserved. Use of Flattening Filter-Free Photon Beams in Treating Medulloblastoma: A Dosimetric Evaluation Tue, 21 Jan 2014 12:33:19 +0000 Aim. To evaluate the dosimetric benefits of flattening filter-free (FFF) photon beams in intensity modulated radiation therapy (IMRT) and Rapid Arc (RA) over conventional CSI methods. Methods and Materials. Five patients treated with IMRT using static multileaf collimators (MLC) were randomly selected for this retrospective study. Dynamic MLC IMRT, RA, and conformal therapy (3DCRT) were iterated with the same CT data sets with and without flattening filter photons. Total dose prescribed was 28.80 Gy in 16 fractions. Dosimetric parameters such as , , , , , DHI, and CI for PTV and , , , , , and for OARs were extracted from DVHs. Beam on time (BOT) for various plans was also compared. Results. FFF RA therapy (6F_RA) resulted in highly homogeneous and conformal doses throughout the craniospinal axis. 3DCRT resulted in the highest (SD) , whereas flattening filter (FF) and FFF dynamic IMRT had a minimum . 6F_RA and 6F_DMLC resulted in lesser doses to thyroid, eyes, esophagus, liver, lungs, and kidneys. Conclusion. FFF IMRT and FFF RA for CSI have definite dosimetric advantages over 3DCRT technique in terms of target coverage and OAR sparing. Use of FFF in IMRT resulted in 50% reduction in BOT, thereby increasing the treatment efficiency. Pichandi Anchineyan, Ganesh K. Mani, Jerrin Amalraj, Balaji Karthik, and Surega Anbumani Copyright © 2014 Pichandi Anchineyan et al. All rights reserved. Primary Synovial Sarcomas of the Mediastinum: A Systematic Review and Pooled Analysis of the Published Literature Mon, 20 Jan 2014 00:00:00 +0000 Background. The aim of this systematic review is to attempt to provide a descriptive analysis for cases of synovial sarcoma (SS) arising in the mediastinum and to analyze prognostic factors. Methods. We performed PubMed database search in July 2013. Twenty-two studies, which included 40 patients, form the basis of this review. Demographic and disease-related factors were analyzed for possible influence on survival. Findings were compared with extremity SS studies reported in literature. Results. Sixteen cases (40%) presented with locally advanced unresectable disease, 2 (5%) with metastatic disease, and 22 (55%) with localized resectable disease. Median tumor size was 11 cm (range: 5–20 cm). Thirty patients were assessable for survival and had a 5-year OS of 36%. Completeness of resection was the only factor associated with significant improvement in OS (5-year survival of 63% and 0% in favor of complete resection, ). Conclusion. Mediastinal SS is associated with poor prognosis as more cases are diagnosed at an advanced stage and with larger tumor size compared to extremity SS. Complete surgical resection is the only identified factor associated with better prognosis and may result in survival outcomes that are comparable with those for localized SS of the extremity. Samer Salah and Ahmed Salem Copyright © 2014 Samer Salah and Ahmed Salem. All rights reserved. Esophageal Cancer, the Topmost Cancer at MTRH in the Rift Valley, Kenya, and Its Potential Risk Factors Sun, 29 Dec 2013 14:48:40 +0000 Esophageal cancer at Moi Teaching and Referral Hospital (MTRH) is the leading cancer in men with a poor prognosis. A case control study aimed at the histology type, gender, and risk indicators was carried out at MTRH. Mantel Haenszel chi-square and logistic regression were employed for analysis. Squamous-cell carcinoma was the common histological type occurring in the middle third portion of the oesophagus. The occurrence of the cancer in males was 1.4 times that of females. The mean age was 56.1 yrs. Low socioeconomic, smoking, snuff use, alcohol, tooth loss, cooking with charcoal and firewood, hot beverage, and use of mursik were independently associated with esophageal cancer . Using logistic regression adjusted for various factors, alcohol consumption was associated with the increased risk of esophageal cancer. AHR was 0.45 and 95% CI: 0.205–0.985, . A societal component of low socioeconomic conditions, a lifestyle component with specific practices such as the consumption of mursik, chang’aa, busaa, snuff, smoking, hot tea, poor oral hygiene, and an environmental component with potential exposure to high levels of nitrosamines, passive smoking, and cooking with coal, could be involved. The increase in experts at MTRH capable of diagnosing could be responsible for the increase in reporting this neoplasm. Kirtika Patel, Johnston Wakhisi, Simeon Mining, Ann Mwangi, and Radheka Patel Copyright © 2013 Kirtika Patel et al. All rights reserved. Radiobiological Framework for the Evaluation of Stereotactic Radiosurgery Plans for Invasive Brain Tumours Sun, 29 Dec 2013 10:35:56 +0000 This study presents a radiobiological formalism for the evaluation of the treatment plans with respect to the probability of controlling tumours treated with stereotactic radiosurgery accounting for possible infiltrations of malignant cells beyond the margins of the delineated target. Treatments plans devised for three anaplastic astrocytoma cases were assumed for this study representing cases with different difficulties for target coverage. Several scenarios were considered regarding the infiltration patterns. Tumour response was described in terms of tumour control probability (TCP) assuming a Poisson model taking into account the initial number of clonogenic cells and the cell survival. The results showed the strong impact of the pattern of infiltration of tumour clonogens outside the delineated target on the outcome of the treatment. The treatment plan has to take into account the existence of the possible microscopic disease around the visible lesion; otherwise the high gradients around the target effectively prevent the sterilisation of the microscopic spread leading to low probability of control, in spite of the high dose delivered to the target. From this perspective, the proposed framework offers a further criterion for the evaluation of stereotactic radiosurgery plans taking into account the possible infiltration of tumour cells around the visible target. Helena Sandström, Alexandru Dasu, and Iuliana Toma-Dasu Copyright © 2013 Helena Sandström et al. All rights reserved. Increased Resistance of Breast, Prostate, and Embryonic Carcinoma Cells against Herpes Simplex Virus in Three-Dimensional Cultures Sun, 22 Dec 2013 18:38:37 +0000 In previous studies we found that uveal melanoma cells grown in extracellular matrix (ECM)-containing three-dimensional (3D) cultures have increased resistance against herpes simplex virus type 1 (HSV-1)-mediated destruction relative to cells cultured without ECM. Using additional tumor cell types including MB-231 human breast cancer cells, PC-3 human prostate cancer cells, and P19 mouse embryonal carcinoma cells, we show here that tumor cell lines other than melanoma are also more resistant to HSV-1-mediated destruction in 3D cultures than cells grown in 2D. We also demonstrate here that one mechanism responsible for the increased resistance of tumor cells to HSV-1 infection in 3D cultures is an ECM-mediated inhibition of virus replication following virus entry into cells. These findings confirm and extend previous observations related to the role of the ECM in tumor resistance against HSV-1 and may lead to improved strategies of oncolytic virotherapy. Andras Voros, Bernadett Kormos, Tibor Valyi-Nagy, and Klara Valyi-Nagy Copyright © 2013 Andras Voros et al. All rights reserved. Identification, Evaluation, and Treatment of Patients with Hereditary Cancer Risk within the United States Sun, 22 Dec 2013 09:41:31 +0000 Recognizing the importance of identifying patients at high risk for inherited cancer predisposition, the United States Preventive Services Task Force (USPSTF) has outlined specific family history patterns associated with an increased risk for BRCA mutations. However, national data indicate a need to facilitate the ability of primary care providers to appropriately identify high risk patients. Once a patient is identified as high risk, it is necessary for the patient to undergo a detailed genetics evaluation to generate a differential diagnosis, determine a cost-effective genetic testing strategy, and interpret results of testing. With identification of inherited predisposition, risk management strategies in line with national guidelines can be implemented to improve patient outcomes through cancer risk reduction and early detection. As use of genetic testing increasingly impacts patient outcomes, the role of primary care providers in the identification and care of individuals at high risk for hereditary cancer becomes even more important. Nevertheless it should be acknowledged that primary care providers face many competing demands and challenges to identify high risk patients. Therefore initiatives which promote multidisciplinary and coordinated care, potentially through academic-community partnerships, may provide an opportunity to enhance care of these patients. Deborah Cragun and Tuya Pal Copyright © 2013 Deborah Cragun and Tuya Pal. All rights reserved.