Reversible slurred speech related to capecitabine and lapatinib combination in patients with breast cancer.

Capecitabine plus lapatinib combination is an effective chemotherapy regimen in patients with advanced breast cancer. Neurological adverse effects secondary to this regimen were reported rarely in literature. A woman with breast cancer presented with complaints of slurred speech while using the capecitabine and lapatinib combination. Her major complaint was slurred speech. No other radiologic or laboratory disorders were detected in the patient. Slurred speech improved one week after the capecitabine and lapatinib combination was discontinued without any further intervention.

Survival analysis of biliary tract cancer cases in Turkey.

BACKGROUND: Because of the relative rarity of biliary tract cancers (BTCs), defining long term survival results is difficult. In the present study, we aimed to evaluate the survival of a series of cases in Turkey. MATERIALS AND METHODS: A totally of 47 patients with billiary tract cancer from Mersin Goverment Hospital, Acibadem Kayseri Hospital and Kayseri Training and Research Hospital were analyzed retrospectively using hospital records between 2006-2012. RESULTS: The median overall survival was 19.3±3.9 months for all patients. The median disease free and overall survivals were 24.3±5.3 and 44.1±12.9 months in patients in which radical surgery was performed , but in those with with inoperable disease they were only 5.3±1.5 and 10.7±3.2 months, respectively. CONCLUSIONS: BTCs have a poor prognosis. Surgery with a microscopic negative margin is still the only curative treatment.

Second-line gemcitabine-based chemotherapy regimens improve overall 3-year survival rate in patients with malignant pleural mesothelioma: a multicenter retrospective study.

In the present study, we aimed to evaluate the effectiveness of second-line gemcitabine-based chemotherapy regimens on overall survival (OS) in malignant pleural mesothelioma (MPM) patients receiving first-line pemetrexed-based regimens. A total of 73 patients with MPM from Akdeniz University, Acibadem Kayseri Hospital, Kayseri Training and Research Hospital, and Erciyes University were analyzed and evaluated retrospectively as two groups: second-line gemcitabine-based chemotherapy and no second-line chemotherapy. The median OS of patients who received second-line gemcitabine-based chemotherapy was 11.3 (5.1-17.5) months, while it was 9.9 (2.1-17.7) months in the patients who did not receive chemotherapy in the second-line setting (p = 0.056). When we evaluated the survival rate at the 6th, 12th, 18th, 24th, and 36th month, the OS rate of the 36th month was significantly higher in patients who received gemcitabine-based second-line chemotherapy (p = 0.041). When evaluating the OS from diagnosis to death, the median OS values were 20.8 (17.5-24.1) months for first-line pemetrexed-based regimens then second-line gemcitabine alone and 13.1 (9.0-17.1) months supportive care after first-line pemetrexed-based regimens (p = 0.005). According to our results, we may consider gemcitabine-based regimens as second-line chemotherapy after treatment with pemetrexed plus platinum in patients with MPM.

Lack of sunlight exposure influence on primary glioblastoma survival.

BACKGROUND: The prognosis of primary glioblastoma (GBM) is poor. Approximately 2/3 of primary brain tumor diagnoses are GBM, of which 95% are primary lesions. In this study, we aimed to evaluate whether more sunlight exposure has an effect on survival of patients with primary GBM. MATERIALS AND METHODS: A total of 111 patients with primary GBM were enrolled from Kayseri in inner Anatolia which has a cold climate (n: 40) and Mersin in Mediterranean region with a warm climate and more sunlight exposure (n: 71). The patients with primary GBM were divided into two groups as Kayseri and Mersin and compared for progression free survival (PFS) and overall survival (OS). RESULTS: The PFS values were 7.0 and 4.7 months for Kayseri and Mersin groups, respectively (p=0.10) and the respective OS values were 13.3 and 9.4 months (p=0.13). We did not found any significant difference regarding age, sex, comorbidity, smoking, surgery, resurgery, adjuvant chemoradiotherapy and palliative chemotherapy between the groups. CONCLUSIONS: We found that more sunlight exposure had no impact on prognosis of patients with primary GBM, adding inconsistency to the literature about the relationship between sunlight and GBM.

Sunitinib-induced reversible purpuric rash in a patient with gastrointestinal stromal tumor.

Sunitinib which is used in the treatment of kidney cancer, gastrointestinal stromal tumor, and advanced pancreatic neuroendocrine tumor is a multi-targeted tyrosine kinase inhibitor. Although sunitinib is associated with some side effects, it is generally well tolerated. In the present case, the diagnosis of gastrointestinal stromal tumor was four years ago. The patient had multiple liver metastases at the time of diagnosis. Sunitinib was initiated with a dose of 50 mg daily for four weeks and two weeks off, because of resistance of imatinib. The patient was admitted to the hospital with purpuric rash on her arms and body in the eighth week of treatment. No other disorders or drugs which may cause purpuric rash were detected in the patient. Purpuric rash disappeared two weeks after sunitinib discontinuation without any further intervention.

The optimal chemotherapy timing in patients with inoperable locally advanced non small cell lung cancer.

BACKGROUND: Only 20% of patients with stage III NSCLC are cured by surgery. There is a disagreement among the oncologists in terms of whether which regimen (induction chemotherapy followed chemoradiotherapy, concurrent chemoradiation or concurrent chemoradiation followed consolidation chemotherapy) is best choice in inoperable LA NSCLC. OBJECTIVE: To evaluate chemotherapy timing in inoperable LA NSCLC (before, only concomitant or after curative chemotherapy). MATERIALS AND METHODS: Total of 74 consecutive patient with LA NSCLC which was inoperable due to medical condition or stage from Kayseri Research and Training Hospital were analyzed retrospectively. The patients were divided into three groups according to treatment protocols: Induction chemotherapy followed chemoradiotherapy (Ind. CTàCRT), chemoradiotherapy (CRT) and chemoradiotherapy followed consolidation chemotherapy (CRTàCons. CT). RESULTS: When evaluating progression free survival (PFS), PFS did not significantly differed among the groups (p=0,078). We found significant difference among groups (p = 0.047) in terms of overall survival. While CRTàCons. CT arm had highest mean and median survival times, Ind. CTàCRT arm had worst OS. CONCLUSIONS: CRTàCons. CT treatment modality seems preferable regimen for treatment of inoperable LA NSCLC.

Staging with PET-CT in patients with locally advanced non small cell lung cancer is superior to conventional staging methods in terms of survival.

BACKGROUND: Of patients with non small cell lung cancer (NSCLC), around one third are locally advanced at the time of diagnosis. Because only a proprotion of stage III patients can be cured by surgery, in order to improve the outcomes, sequential or concurrent chemoradiation, or concurrent chemoradiation with induction or consolidation is offered to the patients with locally advanced NSCLC. Today, PET combined with computerized tomography (PET-CT) is accepted as the most sensitive technique for detecting mediastinal lymph node and extracranial metastases from NSCLC. We aimed to compare PET-CT and conventional staging procedures for decisions regarding curative treatment of locally advanced NSCLC. MATERIALS AND METHODS: A total of 168 consecutive patients were included from Acibadem Kayseri Hospital, Acibadem Adana Hospital and Kayseri Research and Training Hospital in this study. RESULTS: While the median PFS was 13.0 ± 1.9 months in the PET-CT group, it was only 6.0 ± 0.9 in the others (p<0.001). The median OS values were 20.5 ± 15.6 and 11.5 ± 1.5 months, respectively (p<0.001). DISCUSSION: As a result, we found that staging with PET CT has better results in terms of survival staging. This superiority leads to survival advantage in patients with locally advanced NSCLC.

Secondline chemotherapy versus best supportive care in patient with malignant pleural mesothelioma: a retrospective study.

INTRODUCTION: Mesothelioma is a rare neoplasm arising from mesothelial surfaces with the malignant pleural mesothelioma (MPM) as the most common form. Secondline chemotherapy in MPM is still controversial and in this study we evaluated whether it is superior to best supportive care. MATERIALS AND METHODS: A total of 51 patients with MPM from Acibadem Kayseri Hospital, Kayseri Training and Research Hospital and Erciyes University were analyzed retrospectively. The patients treated with secondline chemotherapies (SLCT) were compared with those treated with best supportive care (BSC) for overall survival. RESULTS: The median overall survival (OS) for firstline chemotherapy?SLCT and firstline chemotherapy?BSC groups were 20.3 and 14.7 months respectively (p=0.079). After firstline chemotherapy the median OS for SLCT and BSC were 5.9 and 4.7 months (p=0.355). DISCUSSION: Although there was a trend for improvement in overall survival in patients treated with secondline chemotherapy, the difference was not statistically significant. Our results do not support the proposal that secondline chemotherapy could be effective in patients with MPM.

Is season a prognostic factor in breast cancer?

BACKGROUND: Some studies have indicated an inverse relationship between cancer risk and sunlight exposure. Others have reported that the prognosis of some cancers such as prostate, colon, ovarian and non melanoma skin cancer, were affected by the season in which the cancer was diagnosed. In our study, we evaluated whether season is prognostic in Turkish patients with breast cancer. MATERIALS AND METHODS: A total of 517 patients from Kayseri Training and Research Hospital were analysed retrospectively. Patients were divided into 4 groups according to season of cancer diagnosis: winter, spring, summer and autumn. The prognostic factors for disease free survival and overall survival were investigated. RESULTS: No significant differences were found among groups regarding prognostic factors overall. Only estrogen receptor status and lymphovascular invasion were independent prognostic factors (p=0.001 and p=0.001 respectively). We found significantly differences for mean disease free survival among groups (p=0.019). Winter group had better mean DFS while summer group had worse DFS. Mean overall survival was similar in the four groups (p=0.637). CONCLUSIONS: The season is not an independent predictive factor. However, due to interaction with other factors, we think that the season of cancer diagnosis is important for cancer prognosis.

Is sunlight a predisposing factor for triple negative breast cancer in Turkey?

UNLABELLED: INTRADUCTION: There is known to be a relationship between vitamin D level and more aggresive breast cancer subtypes, especially triple-negative breast cancer (TNBC). It was reported that sunlight exposure has an effect on the prognosis of patients with cancer, possibly related to the conversion of vitamin D to its active form with sunlight. We aimed to evaluate the effect of sunlight exposure on patients with TNBC. MATERIALS-METHODS: A total of 1,167 patients with breast cancer from two different regions of Turkey (Antalya and Kayseri, regions having different climate and sunlight exposure intensity over the year) were analysed retrospectively. The ratio of patients with TNBC was identified in those two regions. RESULTS: The ratio of patients with TNBC was 8% and 12% for Kayseri and Antalya regions, respectively, and this difference between the two groups was statistically significant (p=0.021). DISCUSSION: Sunlight exposure may be associated with more prevalent TNBC. This finding should be investigated with a prospective study.

Alteration in mean platelet volume and platicrit values in patients with cancer that developed thrombosis.

Mean platelet volume (MPV) is an indicator of thrombocyte volume and tendency to thrombosis can be mentioned in case of MPV elevation. Cancers are one of the important groups of thrombotic diseases. In the present study, MPV value was scrutinized in patients with cancer that developed thrombosis. Totally 43 patients followed in Kayseri Training and Research Hospital, in who thromboembolus has been developed, were prospectively recruited in the study. Thrombocyte, MPV, and platicrit (PCT) values were recorded at the time of cancer diagnosis and thrombosis development. Frequency analysis, crosstabs, and paired samples t test were used. Analyses showed that MPV values at the time of thrombosis development were significantly low as compared to those at the time of cancer diagnosis (P = .041). Thrombocyte count and PCT values were also low but not significant. The result of the present study is likely to show that thrombocytes have ignorable effect on thrombosis development in patients with cancer.

SHOULD FISH TEST BE PERFORMED TO ALL PATIENTS WITH BREAST CANCER?

CerbB2 receptor determination is very important for the prognosis and treatment of breast cancer. The most used two methods for CerbB2 receptor determination are immunohistochemistry and FISH methods. FISH method is recommended for immunohistochemically CerbB2 (++) patient group. Therefore, even though the immunohistochemically CerbB2 (++) patients are in the same group, FISH test divides the results into two separate groups. Our study compared these two groups in terms of relaps duration. Total of 85 patients from The Kayseri Research and Training Hospital in Kayseri, Kayseri Erciyes University Hospital and Mersin State Hospital were included in this study. The relaps duration of the patients were determined and then compared statistically. When the mean disease free survival was compared for FISH(+) and FISH(-) groups, the mean DFS was 46±5 and 73±8 months. However, the median DFS was 38±9 months for the FISH positive group. No median PFS was reached for FISH (-) group. Immunohistochemically CerbB2 (++) breast cancer patients are considered as in the same group, however actually they have different prognostic features. Similarly, when the immunohistochemical tests and FISH tests are compared for CerbB2 positivity, different results are obtained. As a consequence of that, the therapy alternatives will be changed. Therefore, we conclude that the FISH test should be performed to all patients.

Does sunlight exposure improve survival in patients with non-small cell lung cancer?

BACKGROUND: Some epidemiological studies reported that sunlight exposure and highvitamin D levels may decrease the morbidity and mortality related to cancer. We aimed to evaluate whether sunlight exposure has an impact on survival in patients with non small cell lung cancer. MATERIALS AND METHODS: A total of 546 patients with NSCLC from two different regions (Kayseri and Adana) differing according to sunlight exposure were analysed retrospectively. RESULTS: The median overall survival (OS) rates were 11. 6 (CI: 9.50-13.6) and 15.6 months (CI: 12.4-18.8) for Kayseri and Adana, respectively, in all patients (p=0.880). CONCLUSIONS: There were no differences between groups in terms of OS. While there is strong evidence regarding inverse relationship between cancer incidence and sunlight exposure, it is still controversial whether sunlight exposure is a good prognostic factor for survival in patients with lung cancer.

The MRI findings of iris metastasis in patients with breast cancer.

Breast cancer and lung cancer are the most common tumors that metastasize to iris. The metastasis of iris was generally diagnosed on ophthalmologic examination. In this case, we reported iris metastasis of patients with adenocarcinoma of breast cancer and MRI findings. We report a case of a 51-year-old. She was diagnosed breast cancer two years ago. After adjuvant chemotherapy, radiotherapy and trastuzumab, she was admitted to hospital with the complaints of headache on February 2012. The magnetic resonance imaging (MRI ) revealed multiple brain metastasis. Whole brain radiotherapy and palliative chemotherapy were applied to the patients. In follow-up, on ophthalmological examination, there was a solid lesion on iris. The orbital MRI was performed and it revealed the thickness on iris of left eye. After diagnostic procedure final pathological rewiev reported that invasive ductal carcinom metastasis. Iris metastasis may be considered by MRI findings following: The thickness on iris and contrast enhanced lesion. This reason may be resulted that the fine niddle aspiration biopsy for diagnosis of iris metastasis is not need.

Treatment regimen with bevacizumab decreases mean platelet volume in patients with metastatic colon cancer.

The risk of thromboemboli is increased in patients with cancer, and this is precipitated by the chemotherapeutic agents. Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody and has an importance in the treatment of metastatic colon cancer. The association between bevacizumab, which is demonstrated to increase the risk of thromboemboli, and mean platelet volume (MPV), which is a marker of thrombocyte function, has been investigated within study. A total of 74 patients with metastatic colon cancer were included in the study and the levels of platelets (PLTs), MPV, and platecrit (PCT) values were recorded in SPSS 16.0 program both at baseline and at the >third month. There were significant decreases in 3 parameters (PLT, MPV, and PCT) during the treatment period with bevacizumab (P = .009, P = .001, and P = .000, respectively). Unlike cases with thrombosis, there is a significant decrease in MPV in combination treatments with bevacizumab.

The effect of seasonal differences on prognostic factors in Turkish patients with breast cancer.

Several studies have shown that solar light affects the prognosis of breast cancer. This effect is mostly associated with vitamin D. In-vitro studies showed that vitamin D analogs change the receptor expression in breast cancer cell lines. In our study, we studied the effect of solar light on prognostic factors of breast cancer. Patients with breast cancer from two different regions of Turkey were included in the study. These regions have different seasonal features and solar light exposures. Nine hundred and eighty-six patients were from the Akdeniz University Medical Faculty of Antalya region, and 463 patients were from the Kayseri Education and Research Hospital of Kayseri region. The Antalya region has warm climate and more solar light exposure. The Kayseri region has relatively colder climate and less solar light exposure. When histological features are considered, the estrogen and progesterone receptor expressions were higher in the Kayseri group, and a significant difference was observed for the progesterone receptor (P=0.013). No significant difference was observed for the estrogen receptor but a significant trend was observed (P=0.056). No significant difference was observed in CerbB2 expression between groups. There were significant differences for histological and nuclear grade (P<0.001 and P=0.002). The ratio of histological grade 3 was higher in the Kayseri group and the ratio of nuclear grade 1 was higher in the Antalya group. Our study showed that, due to seasonal differences, solar light exposure leads to significant changes in prognostic factors for breast cancer. This result may be interpreted as the reflection of in-vitro findings in a clinical setting and may be accepted as one of the first such reports in the literature.

Evaluation of Peripheral Blood Smear for Myelodysplasia in Breast Cancer Patients who Received Adjuvant Antracycline.

OBJECTIVE: Therapy-related myeloid neoplasms (t-MN) account for approximately 10% to 20% of all cases of AML (acute myeloid leukemia), MDS (myelodysplastic syndrome) and MDS/MPN (myelodysplastic syndrome/myeloproliferative neoplasms), MDS, and MDS/MPN. In our study, we evaluated peripheral blood smear samples and hemogram values in breast cancer patients who were receiving adjuvant anthracycline regimens and were in remission. MATERIALS AND METHODS: A total of 78 patients receiving anthracycline-based adjuvant chemotherapy treatment from Kayseri Research and Training Hospital and Mersin State Hospital were enrolled in the study. Their adjuvant treatments had been completed at least 18 months prior to the study. RESULTS: Two patients complained of anemia (2.2%) (Hb<11 mg/dl), leukopenia was observed in seven patients (7.7%) (leukocytes<4000/ mm(3)), and thrombocytopenia was observed in four patients (4.4%) (PLT<150.000/mm(3)). In the blood smear samples, the following were observed: ovalomacrocytes (14%), macrocytes (37%), acanthocytes (1%), stomatocytes (12%), teardrops (12%), nucleated erythrocytes (1%), basophilic stippling (14%), and Howell-Jolly bodies (1%). Additionally, hypo-granulation (38%), Pelger-Huet abnormalities (26%), hypersegmentation (20%), immature granulocytes (8%), and blasts (6%) were observed. We also confirmed the presence of giant platelets (50%) and platelet hypogranulation (19%). CONCLUSION: According to the peripheral blood smear assessments in our study, we suggest that breast cancer patients should be evaluated for MDS in the early stages, starting from month 18, even if the automated blood counts are normal.