Survival effect of supportive care services for Turkish patients with metastatic gastric cancer.

BACKGROUND: Gastric cancer is the second most common cause of cancer- related deaths worldwide and ranks 11th or 14th among all deaths. Patients with advanced disease require supportive care along with the medical and/ or surgical treatment. AIM: To assess the need for palliative care for patients with advanced tumours along with standard clinical therapy. MATERIALS AND METHODS: Eighty-four patients with metastatic (stage 4) gastric cancer, including both patients who had received surgical treatment or not , were followed up in Bagcilar Training and Research Hospital, Division of Medical Oncology between 2011 and 2014. They were categorised as supportive care (-) (Group 1, n=37) and (+) groups (Group 2, n=47) and evaluated retrospectively. RESULTS: Demographic characteristics of the patients were as follows: mean age, Group 1, 65.2±10.5 years, Group 2,63.7±11.3 years; male/female ratio, Group 1, 21/16, Group 2, 28/19; distribution of Eastern Cooperative Oncology Group (ECOG) performance scores of 0 and 1, Group 1, ECOG 0 (n=9) and 1 (n=14), Group 2, ECOG 0 (34) and 1 (n=13) (p<0.0001); patients receiving second-line, Group 1 (n=7) and Group 2 (n=22) (p<0.008) or third - line chemotherapy,Group 2 (n=6) (p<0.02); mortality rates, Group 1, (n=28; 75.6%) and Group 2 (n=30; 63.8%); progression-free survival (PFS) rates, Group 1, 17.4±6 weeks, Group 2, 28.3±16.2 weeks; statistically significant overall survival rates, Group 1, 20.8±8.2 weeks and Group 2, 28.3 ± 162 weeks (p<0.01). CONCLUSIONS: The supportive care team (medical oncologist, general surgeon, internal medicine specialist, algologist, psychiatrist and radiologist) can play a role in the treatment of metastatic gastric tumours, with improvements shown in terms of the performance status of cases, eligibility of patients to be on chemotherapy programmes for longer duration and overall survival rates in Turkey.

[Effects of different statins, ezetimibe/simvastatin combination on hsCRP levels in unstable angina pectoris and non-ST elevation myocardial infarction patients: a randomized trial]. / Kararsiz anjina pektoris ve ST-elevasyonsuz miyokart enfarktüslü hastalarda degisik statinlerin, ezetimib/simvastatin kombinasyonunun hsCRP düzeyleri üzerine etkileri: randomize bir çalisma.

OBJECTIVE: The aim of our study was to evaluate the effects of two different statins and a statin/ezetimibe combination on high sensitive C-reactive protein (hsCRP) values, which were given at high doses in the early period of acute coronary syndromes. METHODS: A total of 150 patients with non-ST elevation myocardial infarction and unstable angina pectoris were enrolled to our prospective, randomized, single-blind study. Patients were divided into three groups by block randomization method. One group received 20 mg/day atorvastatin, one group received 10 mg/day rosuvastatin and the other group received 10 mg/day ezetimibe/simvastatin combination therapy, which was initiated within the first 24 hours of admission. Follow-up duration was 2 months . Biochemical investigations and hsCRP levels (by nephelometric method) were performed with 138 patients evaluated at baseline, 10th and 60th days of therapy. Decreases of hsCRP levels were analyzed with one-way MANOVA and repeated measures of ANOVA methods. Post-hoc Tukey HSD test was performed for finding the different group, when the difference was detected between the groups. RESULTS: Tenth day hsCRP levels in ezetimibe/simvastatin group was significantly lower than the other groups (p<0.001). Further, after 60 days of follow-up a significant reduction was seen in hsCRP levels in ezetimib/simvastatin group (in ezetimibe/simvastatin group the mean hsCRP was reduced from 38.4±15.0 mg/L to 2.4±1.3 mg/L, in atorvastatin group the mean hsCRP was reduced from 27.3±11.7 mg/L to 4.1±2.4 mg/L and in rosuvastatin group the mean hsCRP was reduced from 22.0±6.9 mg/L to 3.6±1.7 mg/L (F (1.1, 148.2) = 746.9, p<0.01 and the difference between drugs; F (2.2, 148.2) = 32.1, p<0.01). No side effects related to drugs were seen during follow-up in all three treatment groups. CONCLUSION: This study showed that ezetimibe/simvastatin 10 mg/day combination treatment was superior to atorvastatin 20 mg/day and rosuvastatin 10 mg/day treatment in reducing the inflammatory markers when high dose statins was started in the early period of unstable angina and non ST elevation myocardial infarction.

Signet-ring cell carcinoma of the colon with leptomeningeal involvement.

Primary signet-ring cell carcinoma of the colon is rare. Most patients with this type of cancer have a poor prognosis. We describe a patient with signet-ring cell carcinoma of the colon, for whom leptomeningeal metastasis presented a variety of clinical symptoms.

Management of elderly patients with advanced non-small cell lung cancer in Turkey.

OBJECTIVE: Non-small cell lung cancer is a disease that affects the elderly. However, most patients older than 70 years are less likely to receive standard therapy than their younger counterparts and the aim of the present study was to determine age-dependent variation in efficacy. SUBJECTS AND METHODS: Between 2004-2008, 40 consecutive patients older than 70 years received treatment for advanced non-small cell lung cancer. All were evaluated for response and toxicity. Chemotherapy was either with cisplatin or carboplatin and double or single agents (vinorelbine, gemcitabine). Docetaxel was used as a second line therapy in selected cases. Patients were grouped according to age: group 1 (70-74 years), group 2 (>or= 75 years). RESULTS: Except for 4 cases, all received chemotherapy, and 61 % were given a cisplatin-containing regimen. Second-line therapy was given to 42.5% and grades 3-4 neutropenia was seen in 17 (42.5%). Only one patient died due to neutropenic fever. Nephrotoxicity was observed in 2 (5%) and one underwent hemodialysis. Overall survival was 10 months, with median survival periods for groups 1 and 2 of 13 and 10 months, respectively (p> 0.05). No differences were found regarding type of chemotherapy administered or adverse events between the 2 groups. CONCLUSION: Patients older than 75 years appear to deserve the same standard therapy for non-small cell lung cancer as that given to younger cases.

Prognostic significance of the C-erbB-2 expression in turkish non-small cell lung cancer patients.

BACKGROUND: The prognostic value of c-erbB-2 expression in patients with non-small cell lung cancer (NSCLC) remains controversial. The prevalence of c-erbB-2 expression in NSCLC and relation to disease prognosis were therefore investigated. METHODS: Eighty-nine patients with NSCLC diagnosed at Baskent University, Adana Hospital, Medical Oncology Department, between 2000-2005 were investigated. Expression of c-erbB-2 was evaluated by immunohistochemistry in paraffin-embedded sections. Characteristics of patients, histology and stage of the disease were obtained from clinical records. RESULTS: C-erbB-2 expression was detected in 18 patients (20.2%). Median survival of the patients with c-erbB-2 negative was 13 months, as compared to 6 months for c-erbB-2 positive cases (p=0.02), the relative risk of death being 1.96 times higher. No correlation was found between c-erbB-2 positivity and stage of the disease or histology of the tumor (p> 0.05). CONCLUSIONS: C-erbB-2 positivity may indicate shorter survival and can be regarded as an unfavorable prognostic factor in NSCLC. Immunohistochemistry seems to be a readily applicable, inexpensive methodology for determining c-erbB-2 expression in NSCLCs.

The effect of HER2 expression on cisplatin-based chemotherapy in advanced non-small cell lung cancer patients.

INTRODUCTION: The prognostic value of HER2 expression in patients with advanced non-small cell lung cancer remains controversial. The relationship between HER2 expression, and platinum resistance and patient survival, was investigated. METHODS: Seventy-three consecutive patients (median age, 61 years) with stage IIIB and IV non-small cell lung cancer, admitted between February 2004 and December 2006, were included in this study. Sixty-one patients received gemcitabine, given as two 1250 mg/m2 doses on days 1 and 8 and, cisplatin, given as a 75 mg/m2 dose on day 8. Twelve patients received vinorelbine, given as two 25 mg/m2 doses on day 1 and 8, and cisplatin, given as a 75 mg/m2 dose on day 1. Both treatment paradigms were repeated on a 21-day cycle. Tumor response was evaluated by comparing tumor size on computerized tomography scans before and after three cycles of chemotherapy. HER2 status was examined by immunohistochemical analysis of paraffin-embedded specimens. RESULTS: HER2 was positive in 21 of 73 patients (28.8%). Of the 21 patients with HER2 positivity, 13 (61.9%) responded to chemotherapy with either a complete response, partial remission, or evidence of stable disease. Of 52 HER2-negative patients, 48 (92.3%) exhibited a response to chemotherapy. The difference in response to therapy between HER2-positive and -negative patients was statistically significant (p = 0.003). The median overall survival duration for all patients was 13 months. Median overall survival time was 14 months for HER2-negative patients and 10 months for HER2-positive patients (log-rank p = 0.007). CONCLUSION: Non-small cell lung cancer patients with high expression of HER2 exhibited resistance to cisplatin-based chemotherapies that are the standard treatment for this disease. Our results indicate that HER2 status may be a predictive and prognostic factor for cisplatin- based therapy response and disease survival.

Gemcitabine and cisplatin treatment of advanced-stage non-small-cell lung cancer in patients given cisplatin on day 8.

AIMS AND BACKGROUND: Gemcitabine and cisplatin treatment were administered to patients with advanced-stage, non-small-cell lung cancer. During phase II studies, the treatment is performed using a 28-day cycle, with gemcitabine administered on days 1, 8, and 15. Although it is advised that cisplatin not be administered on the first day, gemcitabine and cisplatin treatment is usually performed using a 21-day cycle, with gemcitabine administered on days 1 and 8, and cisplatin is given on the first day in most phase III studies. In contrast with previous phase III studies, cisplatin was administered on day 8 in our study. Dose density, drug toxicity, and efficacy were analyzed. METHODS AND STUDY DESIGN: Chemonaive patients with stage IIIB or stage IV nonsmall-cell lung cancer received gemcitabine (1250 mg/m2) on days 1 and 8 plus cisplatin (75 mg/m2) on day 8 every 3 weeks (1 cycle contained 2 applications). RESULTS: Sixty-seven patients received a total of 293 applications. Dose densities were 92.3% for gemcitabine and 93.9% for cisplatin. The types and rates of grade 3 and grade 4 hematologic toxicities were anemia (6%), granulocytopenia (46%), and thrombocytopenia (6%). Complete remission was seen in 2 patients (3%); partial remission was 40%, stable disease was 39%, and progression of disease, 10%. The median overall survival time was 13 months. The median progression-free survival time was 9.5 months. One-year survival rate was 54% and 2-year survival, 10.4%. CONCLUSIONS: In this 21-day treatment regimen, overall survival was longer than 1 year and the 1-year survival rate was more than 50%. Both the severity and rate of observed thrombocytopenia in the study were very low. Other adverse effects in the current study were comparable to those reported in the literature.

Lack of influence of cyclooxygenese-2 expression in hepatocellular carcinomas on patient survival.

Recent studies suggest that cyclooxygenese-2 (COX-2) enzyme activation may play a role in hepatocarcinogenesis. However, the clinical significance of COX-2 expression in hepatocellular carcinoma (HCC) remains obscure. This study evaluated COX-2 expression in hepatitis B and hepatitis C virus related HCC and in HCC patients with an unknown etiology. Liver tissue samples of 31 patients with HCC (27 men and 4 women; age range, 48-75 years) were analyzed. COX-2 expression was evaluated by immunohistochemically in the tumor tissues. Patient data including age, sex, Child score, stage, grade of the tumor and survival were analyzed. Of these patients 19 were positive for hepatitis B virus (HBV), 6 were positive for hepatitis C virus (HCV) and 6 patients were negative for all viral markers and other etiologic factors. COX-2 staining were evaluated in 2 groups (group 1: COX-2 expression less than 25% (grades 1-2 COX-2 expression), and group 2: Cox-2 expression 25% or more (grades 3-5 COX-2 expression). COX-2 expression was shown in all HCC samples with positive or negative viral markers. No difference was found between degree of COX-2 expression and the etiology of HCC. COX-2 expression was not correlated with number of lesion or stage of the disease or grade of the tumor. COX-2 expression was not related with Child score of the patients. Median survival of all patients was 32 months. Median survival of patients did not differ according to patient's viral marker status. No difference was observed in median survival of patients in group 1 and 2. As a result, COX-2 system seem to be shared part in hepatocarcinogenesis regardless factors that initiate the disease. Although COX-2 expression appears to be independent of disease's characteristics', treatments that target this system appear to be feasible in the management of HCC.

Value of whole-body turbo short tau inversion recovery magnetic resonance imaging with panoramic table for detecting bone metastases: comparison with 99MTc-methylene diphosphonate scintigraphy.

OBJECTIVE: The objectives of this study were to assess the efficacy and reliability of whole-body turbo short tau inversion recovery (STIR) magnetic resonance imaging (MRI) for detecting skeletal metastasis and to compare the results with those of bone scintigraphy. METHODS: Twenty-six patients with primary cancer (mean age=56 years, age range: 34-75 years) were assessed for bone metastasis with whole-body MRI and bone scintigraphy. Eight bone regions in each patient were assessed (total of 208 sites) with each of these 2 techniques. A turbo STIR sequence and panoramic table were used during MRI. Whole-body MRI and scintigraphy findings were compared with biopsy or follow-up imaging results. RESULTS: After at least 12 months of follow-up, 9 patients had bone metastases in a total of 31 sites. Whole-body MRI showed 29 metastases (94%) in the total 208 skeletal sites investigated in the 26 patients. Bone scintigraphy revealed metastases in 16 (52%) of the 208 sites. CONCLUSION: Whole-body turbo STIR MRI is a reliable method for screening patients with suspected skeletal metastases. This technique is also advantageous in that it reveals extraskeletal organ and soft tissue metastases.

Hodgkin's disease in an elderly patient with B-cell chronic lymphocytic leukemia.

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia worldwide. It is an indolent disease, almost exclusively of B-cell origin. Some CLLs evolve into a more aggressive lymphoid malignancy. The most common of these is Richter's syndrome. Transformation to acute lymphoblastic leukemia, plasma cell leukemia, multiple myeloma, or Hodgkin's disease (HD) may also occur. CLL patients are also at a significantly increased risk of developing a second malignant neoplasm later in life. One of the most common of these is HD. Herein, we report a case of HD in an elderly man with a history of B-cell CLL.

Prognostic importance of COX-2 expression in patients with colorectal cancer.

A relationship between cyclooxygenase-2 (COX-2) expression and the pathogenesis of colorectal cancer has been reported in recent studies. Moreover, it has been indicated that COX-2 expression may have a prognostic role in colorectal cancer patients. In this study, we investigated the prognostic significance of COX-2 expression in 83 patients with colorectal cancer. COX-2 expression was assessed using immunohistochemical methods and was evaluated by grading both staining intensity and staining extension. The relationships between COX-2 expression and clinicopathological features of the patients and patient survival were evaluated. There was no relationships between COX-2 expression and tumor size (tm < 3 cm or tm > or = 3 cm), tumor histopathological differentiation (poorly differentiated or moderately + well differentiated), number of metastatic lymph nodes (< 4 or 3 > or = 4), histopathology of the tumor, localization of the tumor (colon or rectum), distant metastasis, and vascular invasion of the tumor. In the multivariate analysis, COX-2 expression was not found as an independent prognostic factor. We demonstrated that COX-2 expression was not correlated with clinicopathological characteristics of colon carcinoma and disease outcome.

MALTOMA presenting with thrombocytopenia.

Immune thrombocytopenia of malignancy is most frequently associated with lymphoproliferative disorders. Thrombocytopenia generally does not develop in MALT subtype of lymphoma (MALTOMA) unless the tumor has infiltrated the bone marrow. Cytopenias resulting from immunologic causes in patients with MALT lymphoma were rarely reported in the literature. In this report, a woman was diagnosed with stage IIE gastrointestinal MALTOMA. Bone marrow infiltration was not present. Patient also had thrombocytopenia, which did not improve after intravenous steroid treatment. Thrombocyte count increased after a single gamma-globulin infusion, and 6 cycles of chemotherapy were given every 21 days. The patient has remained in complete remission.

Prognostically favorable abdominal breast cancer metastases with stomach involvement.

BACKGROUND: Abdominal metastases with stomach involvement are rare in breast cancer. The median disease free interval from the time of breast cancer diagnosis to gastric metastasis is usually very long. Treatment is generally palliative, and expected survival time is less than 1 year. CASE REPORT: A 59-year-old woman with breast cancer developed diffuse abdominal metastases involving stomach, abdominal lymph nodes, and omentum 9 years after she underwent mastectomy and adjuvant chemotherapy. The histopathologic diagnosis found by stomach specimen examination was invasive lobular carcinoma, and the cells expressed high levels of estrogen and progesterone receptors. The abdominal metastases were treated with surgery, postoperative chemotherapy, and further hormonal therapy. This was successful, and the patient has been in remission for more than 3 years. CONCLUSION: Once the definitive diagnosis of breast cancer metastases to the abdomen including the stomach is established, treatment that targets systemic breast cancer must be initiated. Our patient's extended survival time suggests that surgical treatment could be considered for selected patients.

Olive: fruit of peace against cancer.

The olive has a history almost as long as that of Western civilization and has been looked upon as a sign of hope, peace, and sacredness. Olive oil, extracted from the olive, is the principal source of dietary fat in the Mediterranean basin. The composition differs from that of other dietary fats in that olive oil is rich in monounsaturated fatty acids. Even other than as a source of monounsaturated fats, olive oil has own unique effects. Accumulating evidence suggests that olive oil may have beneficial health effects, especially when it comes to reducing risk factors for coronary heart diseases, preventing cancer, and modifying immune and inflammatory responses. However, evidence remains limited, definitive conclusions are difficult to draw, and there remains a significant need for further studies, particularly prospective cohort and well-designed, controlled intervention studies. In this manuscript, the beneficial health effects of olive oil are reviewed, with particular attention paid to cancer prevention and immune functions..

Primary squamous cell carcinoma of the stomach: a case report.

Squamous cell carcinoma (SCC) originating from the stomach is a relatively rare entity. There are theories regarding the development of this rare tumor, but its exact pathogenesis remains obscure. Fewer than 100 cases of primary SCC of the stomach have been presented in the literature. Due to the advanced stage at the time of diagnosis in most of these cases, the prognosis is generally poor. In the case presented here, dissemination of the tumor to the transverse colon, gallbladder and omentum was present at diagnosis. Despite the tumor's advanced stage, complete remission was achieved after six courses of adjuvant chemotherapy with 5-flourouracil and cisplatin. No recurrence has been detected during follow-up. The patient has been healthy with no sign of the disease for three years.

Hypercholesterolemia impairs angiogenesis in patients with breast carcinoma and, therefore, lowers the risk of metastases.

Our aim was to study the effect of hypercholesterolemia on angiogenesis induced by breast carcinoma. Of 51 patients with invasive ductal carcinoma, 28 had hypercholesterolemia and 23 had normocholesterolemia. The intratumoral microvessel density (MVD) was evaluated by using anti-CD31 antibody. The expression of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) on endothelial and tumor cells was examined and graded semiquantitatively. Patients with normocholesterolemia had a higher MVD (76.4 +/- 8.2) than those with hypercholesterolemia (54.6 +/- 5.1) (P < .01). The risks of recurrence and distant metastasis were higher in patients with normocholesterolemia than in patients with hypercholesterolemia (P < .01). Patients with hypercholesterolemia showed lower expression of endothelial VEGF and bFGF than patients with normocholesterolemia (P < .05 and P < .01, respectively). In addition, tumoral bFGF and VEGF expression showed negative correlation with the presence of hypercholesterolemia (P < .01). We suggest that hypercholesterolemia impairs angiogenesis by suppressing endothelial and tumoral bFGF and VEGF expression and, therefore, lowers the risk of metastases in cases of invasive breast carcinoma.