Breast cancer characteristics—Comparison of preoperative and postoperative values

Breast cancer characteristics obtained at the time of diagnosis are important for setting the basic strategy of the treatment. Reliability of preoperative investigation differs for various features of the disease. The aim of this study was to ascertain the agreements and differences between preoperative and postoperative values.     

PET/CT significance for planning radiotherapy of head and neck cancer

The combination of positron emission tomography and computed tomography (PET/CT) offers metabolic mapping in addition to anatomic information of the primary lesion, nodal and distant metastases in patients with head and neck tumors, and may be therefore beneficial for radiotherapy planning. The aim of our study was to evaluate benefits of combined PET and CT imaging for staging and target volume delineation in this group of patients.Fifty three patients (40 men and 13 women) with confirmed advanced, inoperable or non-radically operated head and neck cancer were assessed based on the results of PET/CT as well as standard diagnostic examinations. All patients were subsequently treated with intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) of 6 MV X-rays. There was an agreement between the standard examinations results and results of PET/CT in 30 cases. In 23 cases there was disagreement either in tumor size, nodal involvement or presence of distant metastases. Results of the tumor size assessment differed significantly in 5 cases. There was no agreement found in nodal involvement in 10 cases. The cancer confirmed by standard examination was not found by PET/CT in 2 cases; 3 PET/CT positive findings were not confirmed by standard examinations. In 3 patients PET-CT revealed new distant metastatic disease. Based on PET/CT assessment we changed treatment strategy and applied potentially curative dose of radiotherapy to previously undiscovered regions in 9 patients. We decided to change the treatment intent in 3 cases and only palliative treatment was applied. Based on our experience and the literature review, PET/CT may be considerable contribution to the standard diagnostic procedures in approximately one third of cases.     

Oral ifosfamide/mesna versus intravenous ifosfamide/mesna in non-small-cell lung cancer: A randomized phase II trial of the EORTC lung cancer cooperative group

BACKGROUND:: Chronic oral administration of anticancer drugs may offer therapeuticadvantages. PATIENTS AND METHODS:: A total of 68 patients with advanced non-small-cell lung cancer,not previously treated by chemotherapy, were randomized to receiveeither ifosfamide given orally (OSI) at a dose of 1 g/day for14 days every 4 weeks, or as a 1-hour intravenous infusion (IVI)at a dose of 1.6 g/m²/day for 5 days every 4 weeks. Accordingto the route of ifosfamide administration, patients receivedeither mesna i.v. or mesna film-coated tablets for uroprotection. RESULTS:: Eight patients were found to be ineligible for the study andtherefore excluded for all analyses. Thirty-three patients receivedIVI, and 27 patients OSI. One patient randomized to OSI diedbefore treatment was initiated, leaving 59 patients fully evaluablefor toxicity. Hematological toxicity was less severe for patientson OSI, but CNS toxicity was reported more frequently on OSI(39%; 12% grade III/IV), than on 1VI (15%; 9% grade III/IV),which caused the premature close of the study. Other non-hematologicaladverse events were of modest clinical significance and comparablein both arms. Forty-nine patients were considered evaluablefor response: in the IVI arm, 5 (17%) of the 29 evaluable patientsobtained a partial remission, and 7 patients a no change (24%).In the OSI arm, 2 (10%) of the 20 evaluable patients obtaineda partial remission, and 11(52%) a stable disease. CONCLUSION:: Both arms have some activity in non-small-cell lung cancer;while OSI was less myelosuppressive than IVI, it was associatedwith a higher incidence of CNS toxicity. Oral administrationof ifosfamide, in the schedule and daily dose tested here cannotbe recommended. chemotherapy, ifosfamide, non-small-cell lung cancer, phase II trial     

KIT receptor is expressed in more than 50% of early-stage malignant melanoma: a retrospective study of 261 patients

The c-kit gene encodes a transmembrane receptor (KIT) with tyrosine kinase activity which is a specific target for anti-cancer therapy. We investigated KIT expression in a group of patients with early-stage malignant melanoma. Primary tumour specimens obtained from 261 radically resected patients with stage I and II malignant melanoma were examined for KIT expression. Formalin-fixed, paraffin embedded tissues were stained with the polyclonal rabbit anti-human anti-KIT antibody (Dako Cytomation Inc., Carpenteria, California, USA). Patients were classified into four groups according to the level of expression (0%, <30%, 30-60% and >60%). Univariate and multivariate analyses examining the impact of KIT expression, Breslow thickness, Clark level and microscopic ulceration on disease-free survival were performed. Within the population of 261 patients with early-stage melanoma with 62 recurrences during a follow-up of 64 months, KIT expression was found in 144 cases (55%). KIT was expressed in more than 60% of cells in 20 patients (8%), in 30-60% of cells in 64 patients (24%) and in less than 30% of cells in 60 patients (23%). KIT expression was not found in 117 patients (45%). In univariate analyses, the influence of KIT expression on disease-free survival was not proven (P=0.4956; log-rank test). Increasing Breslow thickness, a higher Clark level, the presence of microscopic ulceration and a higher stage were significantly associated with a shorter disease-free survival (P<0.0001; log-rank test in all cases). In multivariate analysis, Breslow thickness, stage and KIT expression were significant negative prognostic factors for a shorter disease-free survival (P<0.0001, P=0.0028, P=0.0488, respectively; stepwise Cox regression model). It can be concluded that KIT is expressed in more than one-half of early-stage malignant melanoma. KIT may serve as an additive prognostic factor to Breslow thickness and stage within the tested population. The therapeutic impact of KIT expression in malignant melanoma is uncertain. Results of ongoing pilot phase II studies may validate the efficacy of imatinib mesylate in malignant melanoma expressing KIT.     

Glutathione peroxidase-1 and homocysteine for cardiovascular risk prediction: results from the AtheroGene study

OBJECTIVES: This prospective study was designed to evaluate the effect of joint determination of two important contrary biomarkers--homocysteine and glutathione peroxidase (GPx)-1--on cardiovascular risk stratification. BACKGROUND: Homocysteine plasma levels have been associated with cardiovascular risk. Experimental data suggest that antioxidative GPx-1 activity modulates cardiovascular risk associated with homocysteine. METHODS: In 643 patients with coronary artery disease, we performed a prospective study to assess the risk of homocysteine plasma levels and GPx-1 activity on long-term cardiovascular risk with a median follow-up of 7.1 years. RESULTS: Both homocysteine and GPx-1 were among the strongest univariate predictors of future cardiovascular risk, even after adjustment for cardiovascular confounders. Homocysteine levels were significantly elevated in individuals with future cardiovascular events (15.4 vs. 13.4 micromol/l; p < 0.0001); GPx-1 activity was lower (45.3 +/- 13.1 vs. 50.2 +/- 11.0 U/g hemoglobin; p < 0.0001). In patients with GPx-1 activity below the median value, homocysteine plasma levels above the median were associated with a 3.2-fold (95% confidence interval 1.8 to 5.6; p < 0.0001) increase in cardiovascular risk, whereas it lost its independent risk prediction in individuals with increased antioxidative capacity, as reflected by high GPx-1 activity. In contrast to single determination, combined assessment revealed a significant increase in the area under the curve of cardiovascular risk predictive models from 0.72, including traditional risk factors to 0.75 and also including homocysteine levels and GPx-1 activity. CONCLUSIONS: Plasma homocysteine levels and GPx-1 activity are complementary in identifying individuals at high cardiovascular risk. Joint determination of both biomarkers provides substantial information on top of classic risk factors in cardiovascular risk assessment.     

UCM Urologie Centrum München AG

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