Treatment of Glioblastoma in “Elderly” Patients

The number of patients over 65 with newly diagnosed glioblastoma is anticipated to increase significantly in coming decades as a result of demographic shifts in the United States. Older patients with this disease have a significantly worse life expectancy compared with patients under 65. Mounting clinical evidence suggests that fit elderly patients with glioblastoma benefit from the addition of temozolomide to standard surgery and radiation. As a result, for healthy patients over 65 we recommend maximal surgical debulking followed by involved-field radiotherapy (60 Gy in 30 fractions) with concurrent temozolomide (75 mg/m²/day) and 6 months of adjuvant temozolomide (150–200 mg/m²/day for five consecutive days/month). Patients over 65 with newly diagnosed or recurrent glioblastoma should also be considered for inclusion in clinical trials. MGMT is a validated prognostic marker in patients over 65 and may be useful in clinical decision-making in frail elderly patients. Age alone should not be a factor in deciding how patients with newly diagnosed glioblastoma should be treated.     

Clinical Analysis of 57 Patients with Ovarian Dysgerminoma

Objective  Ovarian dysgerminoma is an uncommon ovarian malignancy, Its clinicai features are special and there are many factors affecting its prognosis. If treated properly, the patient can be cured. Otherwise it may endanger the patient’s life. The aim of this study is to investigate the clinical features and factors related to prognosis of ovarian dysgerminoma. Methods  Data from 57 patients with pure ovarian dysgerminoma were analyzed retrospectively. The patients were admitted to the Cancer Center, Sun Yat-sen University from January 1.1964 to December 31, 2000. Results  The main clinical features were abdominal mass (56.1% ), abdominal pain (21.1% ), abdominal swelling (17.5%.), vaginal bleeding (5.3% )and genital tract abnormalities (5.3%). Twenty-six patients had stage I diseases, 8 stage II.9 stage III.1 stage IV and 13 recurrent and persistent diseases. The uterus was involved in 41.2% of patients with stage II -III diseases. Combined modality was given to 52 cases and a single-method treatment to 5 cases. The total overall 5 and 10-year survival rates for stages I-IV was 80.1 % and 70.0% respectively. The 5-year survival rate for stage I was 100%, stage II 55.2%. stage III 55.6% and stage IV 0%; for recurrent and persistent diseases, 72.7%. The stage I group of 12 patients. received adnexectomy and 14 patients underwent hysterectomy and adnexa removal. There was no significant difference between the 5 and 10-year survival rates (all 100%). Of the 23 patients in the stage I group to whom oniy chemotherapy was given after operation, 19 cases received 3 or more courses and were well without recurrence; 4 patients received only one course and one of them recurred 21 months after the operation. In the group of stages II and III cases, the 5-year survival rate was 86.7% for those whose chemotherapy courses were 3≥ 4 and 25.0% for patients who received less than 4 courses of chemotherapy (P<0.05). Conclusions  The prognosis of ovarian dysgerminoma is closely related to the disease stage and treatment modality. A fertility-preserving operation can be considered in early -staged patients, but caution needs to be exercised in the middle to late staged cases. Good results can be achieved with an operation-based combined modality in recurrent patients.     

Analysis of Clinicopathologic Features of Esophageal Carcinoma Patients Undergoing Surgery-a Report of 4,329 Cases

OBJECTIVE To investigate the clinicopathological features of esophageal carcinoma (EC) patients, and to analyze epidemiologic characteristics and the current situation of esophageal cancioma in the southern area of Hebei Province.METHODS A total of 4329 patients with esophageal cancinoma,undergoing surgery in the Fourth Hospital of Hebei Medical University during a period from January 1996 to December 2005,were selected. Collection and statistical analysis of the pathologic data were performed using a SAS 6.0 software package.RESULTS Over the past ten years, there has been a tendency for an increase in the mean age of EC onset (P ＜ 0.05), a downtrend in the percentage of squamous cancer (SqCa) (P ＜ 0.05) and an uptrend in the frequency of small cell carcinoma (P ＜ 0.05). In clinical stages, there was a drop in the percentage of Stage-Ⅱsquamous EC patients (P ＜ 0.05), and an increase in that of Stage-Ⅳ patients (P ＜ 0.05). There were statistical differences in sex, age,pathologic types, depth of infiltration, ratio of stages and lymph node metastasis, etc. Among the superior, middle and inferior segments of the EC diseased region (P ＜ 0.05).CONCLUSION It was relatively late for the EC patients from this area to see a doctor, resulting in a drop in the ratio of SqCa and an ascensus in that of small cell cancer. However, due to a low incidence of adenocarcinoma, no obvious ascending tendency was found in the frequency of this carcinoma over the past ten years.     

A Snapshot of Patients’ Perceptions of Oncology Providers’ Cultural Competence

In this paper, we describe an anonymous cross-sectional survey with a sample of 100 racially diverse adult oncology patients using a newly developed patient-reported measure of providers’ cultural competence, the Physicians’ Cultural Competence for Patient Satisfaction Scale (PCCPS) [1, 2], which was developed using a US midwestern sample of primary care patients. Our primary aims were to examine the reliability of the PCCPS in a more racially diverse urban oncology clinical setting and to identify salient domains of oncology provider cultural competence based on patient-reported satisfaction with direct clinical encounters. Results suggest that patient-reported satisfaction was significantly associated with one of the four domains measured by the PCCPS, physician’s patient-centered cultural competence (r?=?0.40, p?=?0.01), and female patients were more satisfied (t (91)?=?5.23, p?=?0.02). The PCCPS demonstrated good reliability in an urban diverse cancer patient population. Results help to inform the development of clinical tools that can improve oncology providers’ cultural competency.     

Are Providers and Patients Following Hormonal Therapy Guidelines for Patients Over the Age of 70? The Influence of CALGB 9343

Background

The Cancer and Leukemia Group B (CALGB) 9343 clinical trial proved that omission of radiotherapy (RT) in patients 70 and older with T1cN0M0, estrogen receptor-positive tumors who undergo breast conservation therapy (BCT) and receive 5 years of endocrine therapy (ET) had no change in overall survival, distant disease-free survival, or breast preservation. We examined our institution’s practice with this patient subset.

Clinicopathologic Analysis of 2,889 Nanchang-Area Patients with Colorectal Polyps

OBJECTIVE To study the clinicopathologic characteristics, changes in the nature and incidence of colorectal polyps in the Nanchang area, Jiangxi, Province. METHODS We retrospectively investigated the patients with colorectal polyps who were diagnosed by colonoscopy and pathology in our hospital from 1990 to 2004. The analysis involved the incidence, average patient age, polyp location and pathological types. We recorded the changes of the polyp clinicopathologic features by comparing the clinicopathologic types of colorectal polyps over fi ve-year periods. RESULTS Of the 21,853 patients who received a colonoscopy, 2,889(13.2%) were diagnosed with colorectal polyps. Their average age was 46.6±16.5 years, with a male to female ratio of 1.8:1. The males were older than females (47.1±17.5 vs. 45.5±14.5, P<0.05). Location of the polyps: 41% in the rectum, 27.7% in the sigmoid colon, 35.8% in the left side verus 23.1% in the right side (P<0.05). Patients with polyps located in the transverse and ascending colon were older than those with polyps in the rectum and sigmoid colon (P<0.05). Adenomatous polyps comprised the most common type (67%) and the rectum was the most common site for each type, especially juvenile and retention polyps. Juvenile polyps were found in the youngest patients(12±4.8, P<0.05) and the adenomatous in the oldest (52±14, P<0.05). The ratio of patients with polyposis comprised 1.2%, and patients with polyps accompanied with colorectal cancer comprised 6.1%. Examination of the changes in the incidence, the average patient age, and adenomatous type showed that they had all increased, but the frequency of infl ammatory and retention polyps decreased. CONCLUSION Colorectal polyps are a common problem. The frequency is greater in males compared to females and the rectum and sigmoid colon had the highest incidence. Most juvenile and retention polyps were found in young patients, but most adenomatous occurred in adults. In recent years, the incidence of colorectal polyps, the average patient age, and the adenomatous type have increased in the Nanchang area, but inflammatory and retention types decreased.     

Clinical Analysis of 15 Patients with Adult-Type Pulmonary Blastoma

OBJECTIVE To study the clinical and histopathological characteristics of pulmonary blastoma(PB),and to review the diagnostic criterion and treatment methods.METHODS Clinical and histopathological data from 15 cases of PB in this hospital,from 1990 to 2006,were retrospectively analyzed.RESULTS Surgical procedures were conducted in all 15 patients,including pulmonary lobectomy in 9,lobectomy of the 2 right pulmonary lobes in 2,excision of pulmonary segments in 1,lobectomy and bronchoplasty in 1,lobectomy and angioplasty in 1,and excision of the whole left lung in 1.Of the 15 cases,11 were misdiagnosed as lung cancer,2 were doubted to be a benign tumor before surgery,1 was suspected to be a malignant mesenchymoma,and only 1 was diagnosed as a PB.CONCLUSION Preoperative final diagnosis of PB is very difficult,since the clinical symptoms of the disease are nonspecific.To confirm the diagnosis,comprehensive consideration of the factors,such as the clinical manifestations,morphological characteristics and immunohistochemical tumor markers,should be taken.Surgery is the treatment of choice for PB,and a thorough removal is the key to a cure.PB has a high malignancy and o en recurs and metastasizes,usually with a poor prognosis.     

Informational Needs of Breast Cancer Patients on Chemotherapy: Differences between Patients’ and Nurses’ Perceptions

Background: Cancer and chemotherapy are sources of anxiety and worry for cancer patients. Informationprovision is therefore very important to empower them to overcome and adjust to the stressful experience. Thus,nurses should be aware of the informational needs of the patients throughout the course of their care. Purpose:The purpose of the study was to identify the important information required by breast cancer patients during thefirst and fourth cycles of chemotherapy from both the patients’ and nurses’ perceptions. Methodology: This is alongitudinal study used a questionnaire adapted from the Toronto Informational Needs Questionnaires-BreastCancer (TINQ-BC). Some modifications were made to meet the specific objectives of the study. The study wasconducted in the Chemotherapy Day Care at the University of Malaya Medical Centre (UMMC), Malaysia. Atotal of 169 breast cancer patients who met the inclusion criteria, and 39 nurses who were involved in their carewere recruited into the study. Results: The overall mean scores at first and fourth cycle of chemotherapy were3.91 and 3.85 respectively: i.e., between 3 (or important) and 4 (or very important), which indicated a high levelof informational needs. There was no significant difference in information needed by the breast cancer patientsbetween the two cycles of chemotherapy (p=0.402). The most important information was from the subscale ofdisease, followed closely by treatment, physical care, investigative tests and psychosocial needs. Nurses haddifferent views on the important information needed by breast cancer patients at both time points (p = 0.023).Conclusions: Breast cancer patients on chemotherapy have high levels of informational needs with no significantdifferences in information needed at first cycle as opposed to fourth cycle. There were differences between theperceptions of the breast cancer patients and the nurses on important information needed. A paradigm shift,with an emphasis on patients as the central focus, is needed to enhance the information giving sessions conductedby nurses based on the perceptions of the patients themselves.     

Comparision Quality of Life of Turkish Cancer Patients and Their Family Caregivers

Aim: The purpose of this study was to compare the quality of life (QoL) of cancer patients and their familycaregivers and determine associations. Methods: A total of 93 paired patients and caregivers from an outpatientchemotherapy unit of the oncology units were recruited at a large university hospital in İzmir, all completing theQuality of Life Scale (QoLS). Results: The mean age of patients was 45.2 years, and of their family caregiverswas 40.5. The results indicated that the patients perceived a poorer quality of life than their family caregivers.There was a middle and positive correlation between the social participation and work performance dimensionsof patients’ QoL and social participation and work performance dimension of family caregivers’ QoL (r =0.273,p< 0.01). The study revealed that the gender, education level, employment and marital status were not statisticallysignificant factors affecting the patients’ quality of life (p> 0.05). Caregivers’ employment status was found tohave an affect on their quality of life (p < 0.05). Conclusions: Cancer affects not only the patients but also theirfamily caregivers. Both should be taught communication skills, financial planning and distress managementskills and be given spiritual support to decrease effects of cancer on their quality of life.     

Paget＇s Disease of the Breast： Clinical Analvsis of 45 Patients

Objective Paget’s disease is an uncommon breast malignancy and often misdiagnosed. If the patient is treated at an early stage, the prognosis is satisfactory. Our study analyzed the clinical characteristics of the disease and the factors influencing the prognosis. Methods Fourty-five patients with Paget’s disease who were admitted to our hospital were analyzed retrospectively. Results The most common symptoms of the disease were erosion and a bleeding-like eczematoid change at the nipple/areola. Of the 40 patients with an eczematoid change, 11 patients had verified Paget’s disease with a palpable mass on physical examination, and 29 patients had verified Paget’s disease with a nonpalpable mass. Only 5 patients manifested a mass with no eczematiod change. Thirteen patients had ipsilateral axillary lymphadenopathy. In this study, 25 cases were treated by radical mastectomy and 20 cases were treated by modified radical mastectomy. Five and 10-year survival rates for the patients with nonpalpable masses and for those with palpable masses were 95.5%, 78.6%, and 53.8%, 36.4% respectively. The former were significantly higher than the latter (P <0.01 and <0.05 respectively). Five and 10-year survival rates for the patients without underlying carcinoma (DCIS/IDC) and for the patients with underlying carcinoma were 100%, 88.9% and 69.6%, 43.8% respectively. The former were significantly higher than the latter ( P<0.05) Five and 10-year survival rates for the patients with negative lymph nodes and for the patients with positive lymph nodes were 92.0%, 76.5% and 50.0%, 25.0% respectively. The former were also significantly higher than the latter (P<0.05). Conclusion Treatment at an early stage is very important and influences the prognosis directly for Paget’s disease of the breast. The survival rates of patients with nonpalpable masses without underlying carcinoma and without lymphadenopathy, were significantly higher than patients with palpable masses with underlying carcinoma and with lymphadenopathy respectively. There was significant statistical difference between each of the 2 groups.     

Importance of Quality of Life in Patients with Non–Small-Cell Lung Cancer

The therapeutic options for patients with advanced non–small-cell lung cancer (NSCLC) are palliative. Therefore, the quality of life in oncology is considered as an endpoint in clinical trials, and several scales have been accepted for its measurement in parallel with other clinical determinations. However, its use in clinical practice is hindered by various obstacles that need to be overcome. In this article we examine the concept of the quality of life in patients with NSCLC, as well as giving an evaluation and interpretation of the results of various clinical trials. We describe the new technological methods used in daily clinical practice to measure the quality of life.     

Analysis of the Clonal Expansion of TCR VβT Cells in Patients

Objective To investigate the clonal expansion of T cell receptor(TCR)Vβ subfamily T cells which were considered as GVL effective cells after donor lymphocytes infusion(DLI)in patients with relapse chronic myelogenous leukemia(CML)after allogeneic bone marrow transplantation(allo-BMT).Methods The CDR3 of TCR Vβ24 subfamily genes were amplified in samples of peripheral blood mononuclear cells at different time points before and after DLI,which were drawn from 2 cases of relapse CML treated by allo-BMT,to observe the usage of TCR Vβrepertoire.The PCR products were further labeled with fluorescent and analyzed by genescan technique for identification of the CDR3 size,to evaluate the clonality of the detectable TCR VβT cells.Results Only 4-11 VβT subfamily T cells could be identified in CML cases before DLI,and 12-21 Vβ subfamily T cells could be deected in samples from CML which display remission after DLI.Genescan analysis showed that new clonal expansion TCR Vβ subfamily T cells could be found in samples after DLI.Conclusion The skew distribution of TCR Vβ subfamily T cells could be found on patients with relapse CML after allo-BMT,and this skewing pattern may stage to stage to normal pattern during the complete remission.The GVL effect may exert through some clonal expansion TCR Vβ subfamily T cells during the treatment of DLI in relapse CML.     

Effect of Intermittent Androgen Blockade on the Quality of Life of Patients with Advanced Prostate Carcinoma

OBJECTIVE To investigate the effect of intermittent androgen blockade (IAB)on the quality of life(QOL)of patients with advanced prostatic carcinoma(APC). METHODS Investigations on the QOL of 51 APC patients receiving IAB treatment,totaling 3 times,i.e.6 months before and after,and 12 months after treatment,were perform using the EORTC QLQ-C30 measuring scale and QLQ-PR25 scale. RESULTS Although IAB became an economic burden for the families,it was lessened during the intermission(P<0.05).The overall health status significantly improved 6 months after IAB treatment(P<0.01),especially during the intermission(P<0.05),with a total or local easement of pain(P<0.01)and an improvement of urinary function(P<0.01).Although there was impairment, to various degrees,in many functions of the patients on the 6th month of treatment,such as the physical function(P<0.05),role function(P<0.05),the emotional(P<0.01)and the social functions(P<0.01),with an enhancement of fatigue(P<0.01),these functions gradual y recovered by the 12th month as the intermission started.Treatment-related symptoms such as flushing and mammary swel ing significantly emerged on the 6th treatment month (P<0.01),and lessened on the 12th(P<0.01).During the treatment period, there was an notable drop in sexual interest(P<0.01),with a deprivation of sex life,but revived to various degrees during the intermission(P<0.01). CONCLUSION Although IAB treatment of APC patients did impair the physiologic and psychologic status of patients to varying degrees,these were improved and restored during the intermission.     

Clinical Analysis of 43 Patients with Ught Chain Multiple Myeloma

OBJECTIVE To investigate the clinical characteristics and laboratory findings of patients with light-chain multiple myeloma. METHODS Fourty-three patients with light chain myeloma over a 13year period were analyzed retrospectively and 43 cases with IgG type myeloma in the same period were used as control. RESULTS Of the 43 patients, 28 were male, 15 were female, with an overall mean age of 57 years (range, 36-71). At the time of onset, the main symptoms were fatigue and dizziness (23 cases, 53.5%) and bone pain (25, 58.1%). The main signs were anemia (28, 65.1%) and bone pressure pain (23, 53.5%). Of 39 patients with determined staging, 38 were in stage Ⅲ and 1 stage Ⅰ. Renal function examinations were performed for 31 patients. Among them, 16 were in stage ⅢB and 15 in ⅡA. Hypercalcemia (≥3 mmol/L) occurred in 2 cases. Of 18 patients, 3 had proteinuria ≥12 g per 24 hours. Osteolytic lesions appeared in 27 of 31 cases. No abnormal globulin peaks were found in the serum protein electrophoretic bands. Serum and urine immunoelectrophoresis showed that 10 cases were kappa light chain, 29 were lambda light chain and 4 were both. Nineteen patients received chemotherapy, of which 8 cases obtained complete remission and 11 had no remission. CONCLUSION Because of poor differentiation, skeletal destruction and renal dysfunction, light chain multiple myeloma patients have meager therapeutical efficacy and poor prognosis.     

Survival of Patients with Ewing’s Sarcoma in Yazd-Iran

Background: The Ewing’s sarcoma family is a group of small round cell tumors which accounts for 10-15% of all primary bone neoplasms. The aim of this study was to evaluate the survival of Ewing’s sarcoma patients in our province and to determine of influencing factors. Materials and Methods: All patients with documented Ewing’s sarcoma/ primitive neuroectodermal tumor(PNET) family pathology were enrolled in this study during a period of eight years. For all of them local and systemic therapy were carried out. Overall and event free survivaland prognostic factors were evaluated. Results: Thirty two patients were enrolled in the study. The median age was 17.5 years. Twenty (65.2%) were male and 9 (28.1%) were aged 14 years or less. Mean disease free survival was 26.8 (95%CI; 13.8-39.9) months and five year disease free survival was 26%. Mean overall survival was 38.7 months (95%CI; 25.9-50.6) and median overall survival was 24 months. Five year overall survival was 25%. From the variables evaluated , only presence of metastatic disease at presentation (p value=0. 028) and completeresponse (p value =0. 006) had significant relations to overall survival. Conclusions: Survival of Ewing’s sarcoma in our province is disappointing. It seems to be mostly due to less effective treatment. Administration of adequatechemotherapy dosage, resection of tumor with negative margins and precise assessment of irradiation volume may prove helpful.     

Molecular Characterization of β-lactam Resistance of Salmonella Isolates from Pediatric Patients in Romania

Abstract

The molecular characterization of 16 clinical isolates of Salmonella enterica (14 serotype Typhimurium and 2 serotype Kingston) obtained between January and June 1999 from feces of children hospitalized in Iasi, Romania were genotypically compared by pulse field gel electrophoresis of XbaI restricted bacterial DNA. The majority of the clinical isolates (12/16) belonged to cluster A and (4/16) to unrelated strains, correlating to the OMP profile. Two major different patterns of ß-lactamases were identified: the first with pI of 5.4, 8.2 in 6/16 strains and the second with pI of 5.4 in 5/16. The bla _TEM ß-lactamase was identified in 14/16 of the clinical isolates and the bla _SHV-5 gene in one strain. We concluded that extended spectrum ß-lactamase (ESBL) with pIs of 8.2 was the most frequent enzyme produced by serotype Typhimurium isolates which were related.     

The Use of Multiparametric Magnetic Resonance Imaging for Follow-up of Patients Included in Active Surveillance Protocol. Can PSA Density Discriminate Patients at Different Risk of Reclassification?

IntroductionThe objective of this study was to test Prostate Imaging Reporting and Data System (PI-RADS) classification on multiparametric magnetic resonance imaging (mpMRI) and MRI-derived prostate-specific antigen density (PSAD) in predicting the risk of reclassification in men in active surveillance (AS), who underwent confirmatory or per-protocol follow-up biopsy.Materials and MethodsThree hundred eighty-nine patients in AS underwent mpMRI before confirmatory or follow-up biopsy. Patients with negative (−) mpMRI underwent systematic random biopsy. Patients with positive (+) mpMRI underwent targeted fusion prostate biopsies + systematic random biopsies. Different PSAD cutoff values were tested (< 0.10, 0.10-0.20, ≥ 0.20). Multivariable analyses assessed the risk of reclassification, defined as clinically significant prostate cancer of grade group 2 or more, during follow-up according to PSAD, after adjusting for covariates.ResultsOne hundred twenty-seven (32.6%) patients had mpMRI(−); 72 (18.5%) had PI-RADS 3, 150 (38.6%) PI-RADS 4, and 40 (10.3%) PI-RADS 5 lesions. The rate of reclassification to grade group 2 PCa was 16%, 22%, 31%, and 39% for mpMRI(−) and PI-RADS 3, 4, and 5, respectively, in case of PSAD < 0.10 ng/mL²; 16%, 25%, 36%, and 44%, in case of PSAD 0.10 to 0.19 ng/mL²; and 25%, 42%, 55%, and 67% in case of PSAD ≥ 0.20 ng/mL². PSAD ≥ 0.20 ng/mL² (odds ratio [OR], 2.45; P = .007), PI-RADS 3 (OR, 2.47; P = .013), PI-RADS 4 (OR, 2.94; P < .001), and PI-RADS 5 (OR, 3.41; P = .004) were associated with a higher risk of reclassification.ConclusionPSAD ≥ 0.20 ng/mL² may improve predictive accuracy of mpMRI results for reclassification of patients in AS, whereas PSAD < 0.10 ng/mL² may help selection of patients at lower risk of harboring clinically significant prostate cancer. However, the risk of reclassification is not negligible at any PSAD cutoff value, also in the case of mpMRI(−).