The impact of radiation therapy on the TCR Vß chain repertoire in patients with prostate cancer.

Radiation therapy (RT) is an essential component in the therapeutic treatment of patients with localized prostate cancer (LPCa). Besides its local effects, ionizing radiation has been linked to mechanisms leading to systemic immune activation. The present study explored the effect of RT on the T­cell receptor variable ß (TCR Vß) chain repertoire of peripheral blood T cells in patients with LPCa. High­throughput TCR Vß sequencing was performed on 20 blood samples collected from patients with LPCa at baseline and 3 months post­RT. The diversity index was altered, as were TCR Vß clonal evenness and convergence before and post­RT; however, these findings were not significant. Notably, marked changes in the frequencies among the top 10 TCR Vß clonotypes were detected and some patients developed new clonotypes of high abundance. These data provided initial evidence that RT in patients with LPCa may induce systemic immune changes, which could be exploited by future therapies for improved clinical results.

Impact of Radiation Therapy on Pain Relief of Cancer Patients Affected by on Malignant Psoas Syndrome: 26 Years of Experience.

AIM: The malignant psoas syndrome (MPS) is a rare and complex cancer-related clinical entity, with a significant impact on cancer patients' quality of life. The literature describing malignant infiltration of the psoas muscle as well as its management is limited. The primary endpoint of the study was the assessment of pain relief in symptomatic terminal-stage MPS patients. MATERIALS AND METHODS: Patients underwent hypofractionated (two- or three-dimensional conformal) radiotherapy as palliative treatment. A dose of 42.5 Gy in 17 daily fractions (2.5 Gy/fraction) was prescribed. Pain response was measured before 3 and 6 months after radiation delivery. RESULTS: Between May 1992 and April 2019, eight patients were treated. The median age was 75 years (range: 59-87 years). All patients had distant metastatic disease at the time of treatment. We found a significant pain relief (median duration of response of 105 days) and an improvement in health-related quality of life. CONCLUSIONS: Radiotherapy had a favorable outcome and can be considered an effective analgesic treatment in case of painful MPS.

Acute Leriche Syndrome in Pancreatic Adenocarcinoma: A Case Report.

INTRODUCTION: Coexistance of pancreatic carcinoma and Leriche syndrome is an extremely rare pathological condition. Leriche syndrome is defined as occlusion of the distal aorta at the bifurcation into the common iliac arteries. CASE REPORT: We report the case of a 57-year old male patient with a locally advanced pancreatic tumor that during chemotherapy presented Leriche syndrome. Four months after the diagnosis and although the initial staging by MRI had only revealed a few atheromatic lesions of the abdominal aorta, the patient complained about claudication of the legs and hypoesthesia. Angiography with multi-detector computed tomography (MDCTA) was performed using aortography protocol and three-dimensional reconstruction of the images followed, demonstrating the relationship between pancreatic carcinoma and Leriche syndrome. CONCLUSION: Review of the literature revealed that acute abdominal thrombosis is rare in cancer patients. To our knowledge, complete occlusion of the aorta in a patient with pancreatic cancer has not been reported yet.

Evaluation of quality of life outcomes following palliative radiotherapy in bone metastases: A literature review.

PURPOSE: To assess the quality of life (QoL) following palliative radiotherapy (RT) in patients with painful bone metastases. METHODS: A literature search limited to English-written publications was carried out, through the Cochrane Central Register of Controlled Trials (November 2018), OvidSP and PubMedCentral (1940-November 2018) databases. Subject headings and keywords included "quality of life"(QoL), "bone metastases", "palliative therapy", "pain" and "radiotherapy". Original articles, literature reviews, trials and meta-analyses revealing alterations in QoL post-RT using ratified measuring tools were examined. Studies referring to other types of metastases (e.g. brain metastases), or to other types of palliative therapy (e.g. the use of bisphosphonates alone), or focusing only on pain, or even reporting QoL only before or only after the use of RT were excluded. RESULTS: Twenty four articles were selected from a total of 1360 articles. Seven trials proceeded to patients' randomization. The most commonly used tool to evaluate QoL was EORTC, followed by Brief Pain Inventory (BPI) and Edmonton Symptom Assessment System (ESAS) questionnaires. All studies showed improvement in symptoms and functional interference scores after RT. The QoL between responders (Rs) and non-responders (NRs) has been juxtaposed in 10 studies. Rs had a significant benefit in QoL in comparison with the NRs. DISCUSSION: Palliative radiotherapy in painful bone metastases improves Rs' QoL.

Percutaneous computed tomography-guided localization of pulmonary nodules with hook wire prior to video-assisted thoracoscopic surgery.

PURPOSE: To evaluate the use of percutaneous computed tomography (CT)-guided localization of suspicious intrapulmonary nodules with hook wire prior to video-assisted thoracoscopic surgery (VATS). METHODS: From April 2010 to February 2011, 15 patients with suspicious subpleural pulmonary nodules underwent preoperative CT-guided hook wire localization of the lesions, prior to VATS. RESULTS: Histological analysis of the resected suspicious pulmonary nodules revealed malignancy in 12 cases, 2 cases with granulomas and 1 case with bronchiolitis obliterans organizing pneumonia (BOOP). Better results were achieved with the double-thorn hook wire. Conversion to thoracotomy was necessary in the patient with BOOP, due to limited hemorrhage at the site of the lesion. CONCLUSION: Preoperative CT-guided nodule localization using hook wire fixation is a useful and safe technique that helps in the precise localization of suspicious lesions, reduces the operation time, the postoperative complications, and the hospitalization.

Utilizing Yoga in Oncologic Patients Treated with Radiotherapy: Review.

PURPOSE: Several trials on noncancer population indicate that yoga is associated with meaningful clinical effects. This study evaluated the physical and psychosocial outcomes of yoga in oncologic patients treated with radiotherapy. METHODS: We focused on a research through Cochrane Register of Controlled Trials (CENTRAL), BioMed Central, and MEDLINE studies up to May 2017. RESULTS: Yoga was found to have a substantial benefit in cancer patients' distress, anxiety, and depression. It also demonstrated a moderate impact on fatigue and emotional function and a small and insignificant effect on functional well-being and sleep disturbances. As far as the effects on psychological outcomes are concerned, there was insufficient evidence. CONCLUSIONS: This systematic review of randomized controlled trials showed that yoga has strong beneficial effects on oncologic patients' quality of life. Results of the current review must be interpreted with caution due to the relative small sample sizes of most of the included studies, while a prospective randomized study stands in need for the confirmation of our results.

Toxicity and efficacy of a hypofractionated (3 weekly fractions of 850c Gy) irradiation schedule for stage IIIb / IV non-small cell lung cancer elderly patients with low performance status and unfit for chemotherapy.

PURPOSE: To evaluate in an observational way the clinical impact of a hypofractionated irradiation schedule in patients with unresectable non-small cell lung cancer (NSCLC). METHODS: Forty elderly patients (24 men/16 women) diagnosed with unresectable stage IIIb/IV NSCLC unfit for chemotherapy, were treated with once-a-week hypofractionation schedule. All patients had a poor performance status. A dose of 255 Gy in 3 weekly fractions was prescribed while a 3D conformal technique (3D-CRT) was used for irradiation. The primary study endpoints were to assess the therapeutic impact of this schedule in terms of relapse free survival (RFS), overall survival (OS) survival and palliation of symptoms. The secondary endpoints were the evaluation of acute toxicity of the lung, esophagus and the skin. The intended followup was 3 years. The median age was 73.5 years (range 71-85). RESULTS: The median RFS was 12 months, while the median OS was 17 months. Symptoms relief was up to 20% for cough, 52.5% for haemoptysis, 40% for thoracic pain and 17.5% for dyspnoea. Acute lung toxicity in terms of radiation pneumonitis was recorded as 6/40 (15%) grade 1, 26/40 (65%) grade 2 and 8/40 (25%) grade 3. Additionally, grade 1 and 2 acute esophageal toxicity was recorded in 10/40 (25%) and 30/40 (75%) patients, respectively. Acute skin toxicity with grade 2 erythema was recorded in only 2/40 (5%) patients while most patients developed grade 1 skin erythema. Grade 3 late lung toxicity was recorded in 10/40 (25%) patients. CONCLUSIONS: This study showed that the proposed scheme has a moderate radiation-induced lung toxicity rate and an acceptable therapeutic ratio. Taking into consideration its cost effectiveness, the proposed hypofractionated scheme is a good alternative to conventional fractionation.

The Significance of PET/CT in the Initial Staging of Hodgkin Lymphoma: Experience Outside Clinical Trials.

AIM: To examine the real-life impact of baseline positron-emission tomography/computed tomography (PET/CT) in Hodgkin lymphoma (HL). PATIENTS AND METHODS: A total of 162 consecutive patients with HL were retrospectively studied. RESULTS: Disease was up-staged in 26 patients (16%) and down-staged in 9 (6%). However, treatment strategy was modified in only 10 patients (6% of total). Involved field radiotherapy was delineated according to PET/CT in 36/66 patients (59%). These treatment modifications did not significantly affect outcome. Moreover, three potent prognostic parameters were identified: the number of involved sites, maximum standardized uptake value (SUVmax), and the product of SUVmax and maximal largest lesion diameter, as a surrogate of total lesion glycolysis. All three significantly correlated with 5-year freedom from disease progression p=0.004, p=0.009 and p=0.04, respectively). CONCLUSION: Baseline PET/CT findings may lead to treatment modification in <15% of patients with HL without a significant impact on outcome. Certain PET/CT parameters have potent prognostic significance.

A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer.

INTRODUCTION: The aim of this analysis was a retrospective evaluation of the efficacy and toxicity of 2 hypofractionated irradiation schedules compared to conventional therapy in post-mastectomy patients. METHODS: 3 irradiation schedules were analyzed: 48.30 Gy in 21 fractions (group A, n = 60), 42.56 Gy in 16 fractions (group B, n = 27) and 50 Gy in 25 fractions (group C, n = 30) of the front chest wall. All groups were also treated with a supraclavicular field, with 39.10 Gy in 17 fractions (group A), 37.24 Gy in 14 fractions (group B) or 45 Gy in 25 fractions (group C). RESULTS: No local recurrences were noted in any group during 36 months of follow-up. Acute skin toxicity presented in all groups, with 58.3%, 70.4% and 60% of grade I; 35%, 25.9% and 40% of grade II; 6.7%, 3.7% and 0% of grade III being seen in groups A, B and C, respectively. Late skin toxicity was noted only as grade I in 16.7%, 25.9% and 26.7% of groups A, B and C, respectively. No significant difference was noted among all groups for either acute or late skin toxicity, or for radio-pneumonitis (chi2 test, p > 0.05). CONCLUSION: All schedules were equally effective with equivalent toxicity. A prospective randomized study is needed to confirm our results.

Attachment orientations of Greek cancer patients in palliative care. A validation study of the Experiences in Close Relationships scale (ECR-M16).

PURPOSE: Health-care professionals may serve as attachment figures, nevertheless little research has been made in the palliative context. The psychometric properties of the brief ECR-M16 in Greek cancer patients were explored. METHODS: The ECR-M16 was translated into Greek (G-ECR-M16), and was administered to 100 patients before starting palliative care and 7 days later to test its stability. Patients (N=35) also completed the EORTC QLQ-C30 scales. RESULTS: Cronbach's alphas for the discomfort for closeness, anxiety and avoidance scales were 0.871, 0.762, and 0.761, respectively. Test-retest reliability was very satisfactory (p< 0.0005). Factor analysis yielded three factors (58.75% of the variance). Known-groups validity showed that discomfort with closeness had a statistically significant correlation with advanced disease stage (p=0.022). CONCLUSIONS: The G-ECR-M16 is a valid research tool for the attachment patterns' impact in Greek cancer patients.

Prognostic Significance of Serum Inflammatory Response Markers in Newly Diagnosed Non-Small Cell Lung Cancer before Chemoirradiation.

PURPOSE: To identify whether the serum's baseline C-reactive protein (CRP) and albumin (Alb) levels related to clinicopathological parameters and overall survival (OS) in non-small cell lung cancer (NSCLC). METHODS: In total, 100 consecutive patients (mean age = 68.38 ± 10.85 years) that underwent chemoradiotherapy were studied. Measurements of CRP and Alb were performed before any treatment. RESULTS: Serum CRP levels were significantly associated with histological grade (P < 0.001), TNM stage (P < 0.001), PS (P = 0.009), and Alb (P < 0.001). Additionally CRP and Alb levels were found significantly associated with overall survival in univariate analysis (log-rank test, P < 0.001 and P = 0.002, resp.) and CRP remained significant after controlling for age, alcohol, performance status, and TNM stage, whereas albumin showed a borderline effect on the hazard rate (P = 0.052). CONCLUSIONS: CRP and Alb are both promising biomarkers in identification of NSCLC patients with poor prognosis and form a possible target for intensifying their therapies.

Adjuvant chemotherapy and acute toxicity in hypofractionated radiotherapy for early breast cancer.

AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy (HFRT) schedule for breast cancer. METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0Mx. The patients received 3-D conformal radiotherapy with a total physical dose of 50.54 Gy or 53.2 Gy in 19 or 20 fractions according to stage, over 23-24 d. The last three to four fractions were delivered as a sequential tumor boost. All patients were monitored for acute skin toxicity according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group criteria. The maximum monitored value was taken as the final grading score. Multivariate analysis was performed for the contribution of age, chemotherapy and 19 vs 20 fractions to the radiation acute skin toxicity. RESULTS: The acute radiation induced skin toxicity was as following: grade I 27.6%, grade II 7.8% and grade III 2.6%. No significant correlation was noted between toxicity grading and chemotherapy (P = 0.154, χ(2) test). The mean values of acute toxicity score in terms of chemotherapy or not, were 0.64 and 0.46 respectively (P = 0.109, Mann Whitney test). No significant correlation was also noted between acute skin toxicity and radiotherapy fractions (P = 0.47, χ(2) test). According to univariate analysis, only chemotherapy contributed significantly to the development of acute skin toxicity but with a critical value of P = 0.05. However, in multivariate analysis, chemotherapy lost its statistical significance. None of the patients during the 2-years of follow-up presented any locoregional relapse. CONCLUSION: There is no clear evidence that chemotherapy has an impact to acute skin toxicity after an HFRT schedule. A randomized trial is needed for definite conclusions.

Evaluation of acute/late toxicity and local recurrence in T1-T2 glottic carcinoma treated with accelerated hypofractionated 3D-conformal external beam radiotherapy (3D-CRT).

BACKGROUND: The aim of the study was to evaluate the efficacy, as well as the acute and late toxicity of an accelerated hypofractionated 3DCRT schedule as radical treatment in patients with organ confined glottic cancer cT1-2N0. PATIENTS AND METHODS: Between June of 2004 and September 2010, 47 retrospectively selected patients (29 males, 18 females) diagnosed with organ confined T1 or T2 glottic cancer, were treated with external 3DCRT in an accelerated hypofractionation schedule. The median age was 70 years. A dose of 64.4 Gy in 28 daily fractions was prescribed. The primary study endpoints were to assess the acute and late effects of radiation toxicity, according to the EORTC/ RTOG scale, as well as the therapeutic impact of this schedule in terms of local recurrence. RESULTS: The median follow up was 36 months. At the end of radiotherapy, grade I, II and III acute toxicity was observed in 34, 9 and4 patients, respectively. Late grade I and II toxicity was observed in 25 and in 8 patients respectively. Only two local recurrences were observed, 15 and 24 months post 3DCRT respectively. CONCLUSIONS: Our radiotherapy schedule achieves a high locoregional control rate with the advantage of voice preservation. The proposed hypofractionated schedule can be recommended as a standard radiotherapy treatment, since these results are comparable with those of conventional fractionation schedules.

Three-dimensional conformal radiotherapy for hepatocellular carcinoma in patients unfit for resection, ablation, or chemotherapy: a retrospective study.

PURPOSE: The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT). METHODS: Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50-52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed. RESULTS: All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months. CONCLUSION: 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies.

Paraneoplastic cerebellar degeneration in a patient with pseudomyxoma peritonei and breast cancer: case report and literature review.

The case of a 31-year-old woman with progressive cerebellar degeneration preceding by several months the diagnosis and treatment of breast cancer initially and pseudomyxoma peritonei (PMP) with evidence of causative association with the latter is presented. Despite various chemotherapeutic and surgical manipulations, the patient did not substantially improve and succumbed 20 months following initial diagnosis of the neurological disorder. Interestingly, neurological symptoms partially regressed transiently only after surgical debulking of the PMP and not after the remission of breast cancer after various chemotherapeutic regimens suggesting an etiological relationship of the former and the cerebellar degeneration. Early recognition and appropriate therapy of this rare complication of PMP is imperative as it may be crucial for the outcome.