SPARC: As a prognostic biomarker in rectal cancer patients treated with chemo-radiotherapy.

BACKGROUND: The aim of this study is to search the prognostic value of SPARC expression in rectum cancer cases receiving postoperative radiotherapy. METHODS: Forty three rectal cancer patients are recruited to this retrospective study. All patients received postoperative radiotherapy which the median dose was 5040 cGy and concomitant chemotherapy. Samples taken from their paraffin blocks were examined with immunohistochemical procedures. RESULTS: When the association between SPARC expression and the clinicopathological feature was examined, there was a significant association between age and expression levels. Overall survival of patients with low expression was found to be 67 months whereas the overall survival of the patients with high expression was 32 months and the difference was statistically significant. Time to local recurrence of patients with low expression was found to be 74 months whereas time to local recurrence of the patients with high expression was 31 months. Progression free survival of the patients with low expression and high expression were 67 months and 32 months, respectively. In multivariate Cox regression analyses, high expression of SPARC was found to be associated with a statistically significant shorter overall survival and progression free survival. CONCLUSIONS: High expression of SPARC is related to worse prognosis in rectal cancer patients.

Catalase, carbonic anhydrase and other biochemical parameters in esophageal cancers in Turkey.

PURPOSE: The main aim of our investigation is to show possible changes in antioxidant balance and selected biochemical parameters in esophageal cancers. MATERIALS AND METHODS: This study was performed for the determination of levels in 25 patients diagnosed as having cancer in the Yuzuncu Yil University (Medical Oncology) and 15 healthy volunteers at same department with negative cancer signs. RESULTS: The activity levels of catalase of sick and health groups were 33.8±4.31 (EU/gHg)-1, 122.4±31.7 (EU/gHg)-1, respectively. Th differance between the average levels was significant (p<0.001). CA (carbonic anhydrase) activity was 2.19±0.12 (EU/gHg)-1, 2.46±0.32 (EU/gHg)-1 in groups at same order with no statistical significance (p>0.05). The levels of albumin, globulin, ferritin, ALT, LDH, glucose, CRP, AST and uric acid were also determined in sick and healthy groups: 4.04±0.24, 4.04±0.43 gr/dl (p>0.05); 4.46±0.82, 3.17±0.10g/dl (p>0.05); 175.4±29.1, 260.4±15.45g/dI (p<0.001); 12.7±1.13, 19.5±1.91 ng/ml (p<0.001); 317.6±13.8, 298.0±12.1 mg/dl (p>0.05); 106.5±12.1, 89.7±2.2 (p>0.05), 5.94±1.04, 4.41±0.28 U/L (p>0.05); 19.4±1.68, 19.5±1.91 mg/dl (p>0.05); 30.0±3.24, 10.5±0.64 mg/dl (p<0.01) respectively. CONCLUSIONS: Consequently, in diagnosis of esophageal cancer, CA, CRP, uric acid and antioxidant examinations may be very important factors. Additional studies are needed to further address this important issue.

Prognostic factors and COX-2 expression in advanced stage esophageal squamous cell carcinoma.

Cyclooxygenase-2 (COX-2) is overexpressed in various types of human malignancies, including squamous cell carcinomas of the esophagus, but its clinicopathologic role in esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this study was to analyze expression of COX-2 in ESCC and to correlate this expression with clinicopathologic parameters and survival. From 1999 to 2003, endoscopic tissue samples from 110 patients with ESCC were collected for analysis. COX-2 expression was examined through immunohistochemical staining. Clinicopathologic data were analyzed to verify significance. COX-2 expression was detected in 50 of 110 ESCC specimens (45%). COX-2 expression was negative to weak in 73% (COX-2 low) and moderate to strong in 27% (COX-2 high) of tumors. Statistical differences between COX-2 high and COX-2 low were found according to status of the stage (stage IVM1a/IVM1b) (P=.001): cancer antigen (CA) 19-9 (normal/high) (P%.011), CA 12-5 (normal/high) (P=.011), and CA 15-3 (normal/high) (P=.035). Survival was significantly reduced among patients with high COX-2 expression (median overall survival, 3 mo) when compared with the COX-2 low group (median overall survival, 6 mo) (P=.0001). In the univariate analysis, age, body mass index, stage, COX-2, lactate dehydrogenase, CA 12-5, and CA 15-3 were significant factors for survival. With the use of COX regression analysis, only stage (P=.000), COX-2 (P=.000), lactate dehydrogenase (P=.023), and CA 15-3 (P=.002) were independent prognostic factors. Results showed that in patients with ESCC, COX-2 overexpression was significantly correlated with visceral metastases IVM1b). COX-2 overexpression is an unfavorable prognostic factor in ESCC.

Analysis of survival factors in patients with advanced-stage gastric adenocarcinoma.

BACKGROUND: Prognosis in patients with gastric cancer is determined by the tumor itself, as well as certain patient-related factors. MATERIAL/METHODS: In this study, 138 patients with high-grade gastric adenocarcinoma who were admitted to our hospital between September 1999 and April 2002 were retrospectively evaluated in terms of the effects of clinicopathological parameters and treatment approaches on survival by single and multiple variable analyses. Patients histopathologically diagnosed as having gastric adenocarcinomas with stage IV M0 (without distant organ metastasis) or stage IV M1, (with distant organ metastasis) were included in the study. RESULTS: Overall median survival time was 3.1 months and three-year survival rate was 8%. With single variable analysis, body mass index (BMI), clinical stage, surgery, type of surgery, and serum level of albumin were significant prognostic factors related to overall median survival time. Gender, clinical stage, surgery, type of surgery, hemoglobin concentration, and serum level of albumin were found to be significant prognostic factors related to survival without progression (p < 0.05). No surgical treatment, palliative surgery (compared with radical surgery), and BMI below 20 were found to be the statistically significant poor prognostic factors related to survival in multiple variable analysis. In terms of both overall survival and survival without progression, performing surgery or not was statistically the most significant independent prognostic factor. CONCLUSIONS: No surgical treatment, palliative surgery instead of radical surgery, and BMI below 20 on first admission were determined as poor prognostic factors related to survival in patients with high-grade gastric adenocarcinoma.

Deep intracranial extension of squamous cell carcinoma of the scalp.

We report a case of recurrent squamous cell carcinoma (SCC) of the scalp with deep cerebral invasion in a 15-year-old girl. Plain films and CT showed extensive, full thickness, and skull destruction at the vertex. Gadolinium-enhanced MRI revealed neoplastic invasion of the meninges and both cerebral hemispheres down to the lateral ventricle. This case represents an example of (SCC) imitating a primary brain tumor by exhibiting intracranial extension.

An accelerated radiotherapy scheme using a concomitant boost technique for the treatment of unresectable stage III non-small cell lung cancer.

BACKGROUND: We designed a phase II trial for evaluation of the efficacy and tolerability of an accelerated concomitant boost radiotherapy scheme for the treatment of the patients with non-small cell lung cancer (NSCLC). METHODS: Thirty patients with unresectable stage IIIA/IIIB NSCLC were prospectively enrolled in this protocol. All patients were scheduled to receive 15 fractions of conventional radiotherapy in doses of 1.8 Gy, to a total of 27 Gy. For the last 10 treatment days, an accelerated concomitant boost schedule was started that was composed of 1.8 Gy/fraction/day, 5 days/week to the large field and 1.8 Gy/fraction/day to the boost field 6 h apart, to a total dose of 63 Gy/35 fractions/5 weeks. RESULTS: Median follow-up time was 13 months (range, 5-50 months; 3-year overall, disease-free, loco-regional disease-free and metastasis-free survivals were 23%, 19%, 19% and 23%, respectively). The most common acute toxicity was esophagitis in 31% of patients with the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria grade 1, and in 54% with grade 2. Radiation pneumonitis developed in 16% of patients with RTOG/EORTC grade 1. Three-year actuarial rate of late pulmonary and skin-subcutaneous toxicity were 12% and 16%, respectively. No late radiotherapy complications of spinal cord or esophagus were recorded. CONCLUSION: Overall survival, local control and freedom from local progression were comparable with the results reported with pure hyperfractionated radiotherapy. The overall rate of acute and late toxicity was acceptable.

Incidence of renal insufficiency in cancer patients.

The frequency of chronic renal insufficiency among cancer patients is unclear. The aim of this study was to determine the frequency of impaired renal function within a population of cancer patients. One thousand two hundred seventeen patients (563 women, 654 men) with cancer underwent serum creatinine concentration and glomerular filtration rate (GFR) evaluations. The Cockcroft-Gault formula was used to estimate the GFR from the creatinine clearance (Cl(cr)). Renal insufficiency was defined as a GFR 1.2 mg/dL). According to the Cockcroft-Gault formula evaluations, however, 330 (27.1%) of the patients had an estimated GFR <90 mL/min. Among these, the Clcr was between 60 and 89 mL/min in 241 patients (19.8%); 30 and 59 mL/min in 75 patients (6.2%); and 15 and 29 mL/min in 7 patients (0.6%); 7 patients (6%) had a Cl(cr) <15 mL/min. As a result, 21.2% of patients demonstrating a normal serum creatinine level had abnormal renal function. Renal function should be evaluated in all cancer patients, regardless of their serum creatinine level, before any drug regimen is administered. The Cockcroft-Gault formula appears to be more accurate than serum creatinine concentration for diagnosing renal insufficiency in patients with cancer, but more prospective studies in this population will be necessary to confirm this finding.