The current application of ACOSOG Z0011 trial results: Is further implementation of sentinel lymph node intra-operative histopathological examination mandatory in breast cancer patients - a single-centre analysis.

The main objective of the ACOSOG Z0011 trial was to determine the impact of abandoning complete axillary lymph node dissection (ALND) on survival of breast cancer patients with sentinel node lymph (SLN) metastasis in whom breast conserving therapy (BCT) had been performed. The aim of our study was to assess the clinical value of intra-operative histopathological examination of SLN. Our study comprised 1284 invasive breast cancer patients in whom sentinel lymph node biopsy (SLNB) was carried out. SLN intra-operative histopathological assessment was routinely performed in patients treated within the first period (07.2013-06.2014). However, the decision regarding intra-operative assessment was made by the surgeon for the patients who underwent this evaluation in the later period 07.2014-06.2015 and were submitted for BCT. BCT was performed in 72.4% of patients. In total, 316 patients (24.6%) developed SLN-metastasis. Within the period 07.2014-06.2015, SLN intra-operative microscopic evaluation was performed in 20.8% of patients submitted for BCT. ALND was omitted in 27.5% of patients demonstrating SLN metastasis, in comparison with 15.5% of the group from the previous period (p=0.0094). The proportion of patients demonstrating macrometastasis in SLN who received conservative treatment to the axilla increased from 5.4% to 23.1% (p=0.0007). The choice of SLN final histopathological assessment may allow for deferral of decision on more extensive surgery of the axilla in patients submitted for SLNB. The omission of routinely-performed SLN intra-operative histopathological evaluation has led to a statistically significant increase in the proportion of patients in whom complete ALND was avoided.

The outcomes of radiotherapy in patients with ovarian carcinoma.

Relapses of ovarian cancer have poor prognosis, overall survival (OS) after recurrence depends on patient's performance status, his- tological cell type, size and number of the relapse, and duration of the platinum-free interval. Pelvis, peritoneum, pleural effusion, liver, lung, lymph nodes, and central nervous system are the most frequent sites of relapse. The standard treatment for ovarian cancer is a com- bination of surgery and chemotherapy. This retrospective study aimed to describe incidence, characteristics, outcomes and prognostic factors of patients with ovarian cancer underwent radiotherapy. RESULTS: In 47 with ovarian cancer underwent radiotherapy. Treatment modalities were radiotherapy 8- 56 Gy. After optimal treatment the authors observed complete remission in seven patients, and progression and/or metastases in 40 patients. The present study confirmed that patients with low advancement stage had better prognoses than patients with advanced disease, as confirmed by OS rates in groups TI vs. T3 (p = 0.066) and T3 vs. T4 (p = 0.066). What was in- teresting was that the disease-free survival (DFS) in the group of patients with T3 cancer was longer than in the group of patients with TI cancer. Time to marker progression (Ca 125) was longer in groups with FIGO Stage I vs. II and I vs. III (p = 0.01 6,p = 0.044), while the time to progression in FIGO Stage II cancer patients was shorter than in FIGO Stage III cancer patients. An interesting result was also obtained in the analysis of 36-month survival where a larger number of patients without the disease symptoms had T3 Stage cancer. New prospective studies, designed to include the aspects of target volumes, total doses and fraction doses, together with the use of state of the art planning techniques, and therapeutic instrumentation are required.

Labeling of microvessel density, lymphatic vessel density and potential role of proangiogenic and lymphangiogenic factors as a predictive/prognostic factors after radiotherapy in patients with cervical cancer.

INTRODUCTION: Angiogenesis, formation of a new blood vessel from the existing vascular network, is essential for tumor growth, progression and metastasis. Vascular endothelial growth factor (VEGF) has been identified to be one of the most important factors of angiogenesis. VEGF-C, a novel member of the family, is a relatively specific lymphangiogenic growth factor. It is tempting to suggest that cervical cancer is one of the most common malignancies in a woman's life. Its prognostic factors are tumor stage, lymph node status, histologic type, level of hemoglobin. However, little is known about prognostic or/and predictive significance of angiogenesis in cervical cancer. OBJECTIVE: This prospective study is an attempt to evaluate serum VEGF-A, VEGF-C, microvessel density (MVD), and lymphatic vessel density (LMVD) in cervical cancer and the correlations with clinicopathologic features. MATERIAL AND METHODS: Blood samples were collected from 58 patients affected by FIGO I-IV stage cervical cancer, who were admitted to the Department of Oncology and Brachytherapy Collegium Medicum in Bydgoszcz of Nicolaus Copernicus University. Serum VEGF-A/VEGF-C concentrate was determined by means of a quantitative sandwich enzyme immunoassay (ELISA). All tumor samples were taken from cross section during the first brachytherapy. Then they were examined by immunohistochemical studies with podoplanin antibody and anti-CD31 antibody. The present analysis was used to evaluate MVD and LMVD. RESULTS: The median serum VEGF-A was 734.76 pg/ml (range from 86.39 pg/ml - 2200.00 pg/ml), and VEGF-A was only correlated with after treatment hemoglobin concentration (p = 0.046, R = -0.3450). The median serum VEGF-C was 145.72 pg/ml (range 131.08 - 233.60 pg/ml). Serum VEGF-C levels measured in patients were associated with primary tumor size. We observed significantly higher serum VEGF-C in localized disease (FIGO I, II) in comparison to advanced tumors (232.44 pg/ml vs 152.45 pg/ml; p = 0.034). The median LMVD was 6.25 (range 3.5-10.0) and median blood vessel density was 12.5 (range 9.5-23.0). We found significantly higher lymphatic vessel density in patients with Gl/G2 grade of differentiation than in those with G3 (9.93 vs 6.25; p = 0.0398). We observed a statistically significant correlation between MVD and LMVD; (p = 0.032). CONCLUSION: In conclusion, our study suggests that serum VEGF-A, VEGF-C, LMVD and MVD play an important role in tumor growth and progression in cervical cancer. Nonetheless, further studies are essential to explore the underlying mechanism.

Plasma concentration of angiopoietin-1, angiopoietin-2 and Tie-2 in cervical cancer.

PURPOSE OF INVESTIGATION: Angiogenesis is important in the promotion and progression of malignancy. The formation of new blood vessels is coordinated by many factors, angiopoietins among others. Overexpression of angiopoietins has been observed in various tumors. The aim of the study was to evaluate plasma concentration of Ang-1, Ang-2 and Tie-2 in cervical cancer. METHODS: The study group consisted of 34 patients with cervical cancer and the control group of 20 healthy volunteers. Plasma concentrations of Ang-1, Ang-2 and Tie-2 were evaluated by ELISA. RESULTS: Plasma concentrations of Ang-1, Ang-2, Tie-2 and Ang-1/Ang-2 ratios were significantly higher in cervical cancer patients than in controls. Although there was no correlation between concentration of Ang-1, Ang-2, Tie-2 and clinical stage (FIGO), the Ang-1/Ang-2 ratio was higher in Stage I than in II-III. Ang-1 correlated positively with Ang-2 and Tie-2 in a subgroup with Stage II-III and Ang-2 with Tie-2 in a subgroup with Stage I. CONCLUSION: Plasma concentrations of Ang- 1, Ang-2 and Tie-2 may be useful additional tumor markers in cervical cancer.