Tolerance of combined radiochemotherapy in cervical cancer patients.

BACKGROUND: Radiochemotherapy in cervical cancer was implemented to clinical practice based on 5 randomized clinical trials, published at the end of the 20th century, which showed improvement in the total and symptomless survivals by about 10-18%. The increase of therapeutic index of such treatment can take place only when the efficiency of the treatment outweighs the increase of its toxicity. Thus, it is necessary to monitor treatment reaction during radiochemotherapy. OBJECTIVES: The aim of this study was to assess the acute post-radiation reaction during radiochemotherapy for cervical cancer and the to analyze the reasons of the unplanned course of combined treatment. MATERIAL AND METHODS: A group of consecutive 176 cervical cancer patients in the clinical stage from IB to IIIB acc. to FIGO classification who underwent radiochemotherapy were taken under prospective observation in Clinical Gynecologic Radiotherapy Ward of the Lower Silesian Cancer Center in Wroclaw between April 2010 and September 2012. Early post-radiation reaction was assessed in RTOG/EORTC scale once a week. RESULTS: During the treatment early post-radiation reaction of upper part of alimentary duct was observed in 74.4% of the patients, the reaction of lower part of gastrointestinal tract in 51.2%, and in bladder 44.8%. The most frequent symptoms of post-radiation reaction are: nausea (73.3% of the patients), diarrhea (51.2%) and vomiting (20.9%). Leucopenia was observed in 97.1% of the patients, granulocytopenia in 70.4%, anemia in 69.2%, and thrombocytopenia in 25.5%. The planned dose of radiotherapy was administered completely in 90.1% of the patients. A break in radiotherapy was necessary in 15.7% of the patients. In total, 44.8% of the patients did not receive radiochemotherapy according to the plan, because of the side effects of the treatment (most often leucopenia, thrombocytopenia and gastrointestinal reaction). CONCLUSIONS: The presented data shows that radiochemotherapy causes the intensification of acute side effects of treatment and may cause unplanned course of treatment and prolongation of the total treatment time.

Multiple neoplasms among cervical cancer patients in the material of the lower Silesian cancer registry.

BACKGROUND: According to the definition by the International Agency for Research on Cancer (IARC), primary multiple neoplasms are two or more neoplasms of different histopathological build in one organ, or two or more tumors occurring in one patient, regardless of the time of their occurrence (synchronic - up to 6 months, metachronous - after 6 months), coming from an organ or a tissue and not being an infiltration from another neoplasm, a relapse or a metastasis. OBJECTIVES: It was the aim of the study to analyze the frequency of the occurrence of multiple neoplasms among patients suffering from uterine cervix cancer, with a special interest in coexistent neoplasms, the time of their occurrence and total 5-year survivals. MATERIAL AND METHODS: The data from the Lower Silesian Cancer Registry concerning the years 1984-2009 formed the material of the present study. RESULTS: 5.3% of all cervix neoplasms occurred as multiple cancers. Cervix neoplasms were 13.4% of multiple neoplasms. On average, cervical cancer occurred as a subsequent cancer in 6 patients yearly (60.7% of the occurrences of cervical cancer were in the period of 5 years following treatment for the first neoplasm). 5-year survival in patients suffering from primarily multiple cervix neoplasms constituted 57% and was convergent with the results for all patients suffering from cervical cancer. Cervical cancer as the first neoplasm occurred in 287 patients, on average in 11 patients annually. In the period of the first 5 years after the treatment of cervical cancer, there were 42.8% occurrences of other cancers. Cervical neoplasms most frequently coexisted with cancers of the breast, lung and large intestine. CONCLUSIONS: The frequency of the occurrence of multiple neoplasm among cervical cancer patients is increasing. Most frequently they coexist with other tobacco-related neoplasms, those related to HPV infections and with secondary post-radiation neoplasms. These facts should be taken into consideration during post-treatment observation and when directing diagnostic and prophylactic tests. Synchronic neoplasms require detailed diagnostics and planning of treatment by a team of specialists. The occurrence of primary multiple cervical neoplasms does not worsen the prognosis as compared to patients suffering exclusively from cervical cancer.

Improvements in undergraduate oncology education introduced at Polish medical universities between 2004 and 2010 under Poland's "National Program for Combating Neoplastic Diseases".

Cancer patient treatment in Poland remains unsatisfactory when compared to that in other countries. In 2005, this alarming situation prompted the Polish government to launch the "National Program for Combating Neoplastic Diseases" (NPCND). One part of this project was to improve the quality of oncology instruction at the undergraduate level over the years 2006 and 2007 (subsequently extended until 2010 thanks to promising results and the relatively small financial outlay). The program's main aims were to improve existing oncology therapy and to ameliorate the quality of undergraduate oncology education. To evaluate the changes in the quality of undergraduate education as a result of the NPCND program, medical universities were asked to fill out a questionnaire. Responses indicate that the program had a major positive impact on the quality of cancer education mainly as a result of the introduction of a uniform program of training and an increase in the number of classes devoted to oncology. The main unresolved problem is that university hospitals seldom have integrated units catering in-house for surgery, radiotherapy, chemotherapy, etc., and most such "hands-on" teaching still has to be done externally.

Therapeutic radiation induces different changes in expression profiles of metallothionein (MT) mRNA, MT protein, Ki 67 and minichromosome maintenance protein 3 in human rectal adenocarcinoma.

AIM: The study aimed at the evaluation of the effects of radiotherapy on expression of metallothionein (MT) isoforms, both in the form of quantitative alterations in mRNA, and differences in expression of MTI/II proteins in rectal tumours. MATERIALS AND METHODS: Material for the study originated from 21 patients with rectal cancer at stage II or III. Material for immunohistochemical studies [MTI/II, Minichromosome Maintenance Protein 3 (MCM3), Ki-67] and real-time polymerase chain reaction (PCR) (mRNA of MT1F, MT1X and MT2A) was sampled twice: during rectoscopic examination before the start of the preoperative radiotherapy (samples A) and from the post operative specimen, following radiotherapy (samples B). RESULTS: The level of mRNA expression for each of the studied MT isoforms was higher in cancer cells subjected to irradiation. The most extensive differences were observed for the MT2A isoforms (p=0.09). No differences were disclosed between samples A and B in expression of MT I/II protein. The material sampled after radiotherapy manifested a tendency for reduced proliferative activity of the tumour cells: the decrease of MCM3 expression was significant (p=0.022), while in the case of Ki-67, the difference approached statistical significance (p=0.096). CONCLUSION: Application of radiotherapy to rectal adenocarcinoma cells is followed by an increase in MT mRNA expression level, affecting first of all the MT2A isoform. However, we failed to note an increased expression of MTI/II protein coded by the gene. Moreover, application of radiotherapy was followed by a decrease in expression of MCM3 protein. Our results cannot clearly confirm induction of MT after irradiation of human adenocarcinoma cells. The role of MT in radioprotection remains ambiguous.

Matrix metalloproteinase (MMP)-2 and MMP-9 expression in tumor infiltrating CD3 lymphocytes from women with endometrial cancer.

OBJECTIVE: In this study, we hypothesized that not only endothelial malignant cells but also lymphocytes infiltrating tumor epithelium, in patients with endometrial cancer, could be an important source of the gelatinases (matrix metalloproteinase [MMP]-2 and MMP-9) extensive production, which in turn, may facilitate tumor cells infiltration and progression due to the extracellular matrix degradation. MATERIALS AND METHODS: First, we isolated lymphocytes from the endometrial carcinoma samples taken from 41 patients who were operated on and from healthy endometrial tissue taken of the same patients after histological verification. Then, we detected the level of CD3-positive cells in endometrial tissues by flow cytometry. Simultaneously, we studied the messenger RNA expression of MMP-2 and MMP-9 in the isolated cells from malignant and unchanged endometrial tissues. Using immunohistochemistry, we compared the protein expression of MMP-2, MMP-9, and CD3 in the studied samples. RESULTS: We showed the enhanced abundance of CD3 lymphocytes both by flow cytometry and immunohistochemistry in the samples from malignant tissues. The expression of MMP-9 in the endometrial carcinoma was increased significantly at the protein level but not at the messenger RNA level. We could not observe any differences concerning MMP-2 expression in both methods of detection. CONCLUSIONS: CD-3 lymphocytes significantly infiltrate endometrial cancer tissue, but they do not seem to be the source of enhanced metalloproteinases 2 and 9 expression in the tumor environment. Still, owing to the immunohistochemistry staining, we could show the significant increase of MMP-9 protein in the very close vicinity of tumor-infiltrating CD3 lymphocytes. Could it be the result of CD3 lymphocyte action, or is it just the imperfection of the detecting method we used? This remains unclear. Further studies explaining the role of tumor infiltrating lymphocytes in mediating the endometrial cancer milieu are needed.

Dysregulated expression of both the costimulatory CD28 and inhibitory CTLA-4 molecules in PB T cells of advanced cervical cancer patients suggests systemic immunosuppression related to disease progression.

UNLABELLED: Cervical cancer (CC) occurs more frequently in women who are immunosuppressed, suggesting that both local and systemic immune abnormalities may be involved in the evolution of the disease. Costimulatory CD28 and inhibitory CTLA-4 molecules expressed in T cells play a key role in the balanced immune responses. There has been demonstrated a relation between CD28, CTLA-4, and IFN genes in susceptibility to CC, suggesting their importance in CC development. Therefore, we assessed the pattern of CD28 and CTLA-4 expression in T cells from PB of CC patients with advanced CC (stages III and IV according to FIGO) compared to controls. We also examined the ability of PBMCs to secrete IFN-gamma. We found lower frequencies of freshly isolated and ex vivo stimulated CD4 + CD28+ and CD8 + CD28+ T cells in CC patients than in controls. Loss of CD28 expression was more pronounced in the CD8+ T subset. Markedly increased proportions of CTLA-4+ T cells in CC patients before and after culture compared to controls were also observed. In addition, patients' T cells exhibited abnormal kinetics of surface CTLA-4 expression, with the peak at 24 h of stimulation, which was in contrast to corresponding normal T cells, revealing maximum CTLA-4 expression at 72 h of stimulation. Of note, markedly higher IFN-gamma concentrations were shown in supernatants of stimulated PBMCs from CC patients. CONCLUSIONS: Our report shows the dysregulated CD28 and CTLA-4 expression in PB T cells of CC patients, which may lead to impaired function of these lymphocytes and systemic immunosuppression related to disease progression.

Urinary complications in rectal cancer patients are related to the dissection tool.

BACKGROUND/AIMS: To assess the incidence and risk of urinary complications after anterior rectal cancer resection with regard to the surgical device used for total mesorectal excision (TME). METHODOLOGY: During the years 2004-2009 we operated 374 rectal cancer patients with TME and the intent of autonomic nerves sparing intent. Seventeen patients underwent mesorectal dissection with ultrasound scalpel (US). They were compared to the control series of 35 cases selected from the patients for whom electrocautery was used. Selection was done in the manner to eliminate any other significant differences between groups. RESULTS: Intraoperative complications, postoperative mortality, anastomotic leakage and infectious complications did not occur. Urinary bladder disturbances developed in US group in 1 patient (6%) while in 12 patients (34%) in EC group (p<0.05). In US group the character of complication was transient stress incontinence with symptoms being significantly reduced during six postoperative months. In EC group two patients had dysuria, two nycturia, one had both. Stress incontinence occurred in six patients, complete incontinence requiring catheterization in one. CONCLUSIONS: When compared to EC, TME with US is related to lower risk of urinary complications and facilitates autonomic nerve preservation due to minimized thermal lateral tissue damage.

Lobular neoplasia found on breast biopsy: marker of increased risk of malignancy or direct pre-cancerous lesion?

The aim of this study was to compare the imaging symptoms and microscopic findings in females with lobular neoplasia (LN) found on biopsy. 1,478 women who underwent primary open biopsy or surgical excision after percutaneous biopsy were reviewed. In 24 of them (1.6%), LN was found. In four patients, excisional biopsy with hook-wire localization was done primarily due to the radial scar. In 20 females, surgical excision of BIRADS 4 lesion was performed because of the presence of LN in specimens from the vacuum-assisted or core-needle percutaneous biopsy. Postoperative pathologic findings were compared to the radiological symptoms. In 13 women, LN did not produce any radiological symptoms and was an additional histologic finding existing near the other lesion: fibroadenoma and radial scar. In none of these lesions was an invasive cancer noticed. In one single patient, ductal carcinoma in situ was observed in the other segment of the breast. Invasive ductal cancer developed in the contralateral breast in one patient. In 11 patients, LN was diagnosed due to radiological symptoms produced by itself. In this group, the invasive lobular cancer was found in seven lesions (64%). Our finding suggests that LN producing suspicious radiological symptoms can be a different biologic type of this lesion when compared asymptomatic LN diagnosed which is usually found on biopsy as additional microscopic pathology. Symptomatic LN is probably associated with a higher potential of malignant transformation.

Duration time of vacuum-assisted biopsy for nonpalpable breast masses: comparison between stereotactic and ultrasound-guided procedure.

AIMS AND BACKGROUND: Minimally invasive biopsy should be a standard practice in the non-operative diagnosis of breast lesions that are suspicious for or highly suggestive of malignancy. The aim of this study was to compare the procedure duration time for different methods of minimally invasive image-guided vacuum-assisted breast biopsy (VABB). METHODS: Six hundred and ninety-one women with nonpalpable breast masses classified as BI-RADS IV or V were studied. All of them underwent minimally invasive percutaneous VABB with an 11-gauge needle. In 402 patients an ultrasound-guided procedure with a hand-held device was performed while in 289 women stereotactic biopsy was carried out using a dedicated prone table unit with digital imaging. In each case the duration of biopsy was measured in terms of the total procedure time, room time and physician time. RESULTS: There were no significant differences between the stereotactic and ultrasound-guided groups with regard to patient age, body mass index, menopausal status, history of parity, hormone replacement therapy, breast parenchymal pattern (according to Wolfe's classification), family history of breast cancer, mass size and number of samples. Ultrasound-guided biopsy was found to take significantly less time than prone stereotactic biopsy in every aspect of procedure duration. Mean total procedure time, room time, and physician time in minutes were 26.7 ± 8.2 vs 47.5 ± 9.4 (P <0.01), 23.1 ± 8.5 vs 36.5 ± 9.2 (P <0.05), and 12.3 ± 5.6 vs 18.6 ± 5.9 (P <0.05), respectively. CONCLUSIONS: Ultrasound-guided breast biopsy is less time-consuming than the stereotactic procedure for both the patient and the physician. Because of the shorter procedure time (as well as other well-known advantages: real-time imaging, lower cost), ultrasound-guided biopsy should be considered the method of choice for sampling suspicious nonpalpable breast masses.

Prognostic role of c-met expression in breast cancer patients.

BACKGROUND: Hepatocyte growth factor plays an important role in tumor growth, metastasis and angiogenesis. C-met is HGF's high affinity receptor. AIM: The aim of the study was to assess the correlations between c-met expression and clinic-pathological factors in breast cancer tissues. Furthermore, the purpose of the study was to evaluate the prognostic value of the hepatocyte growth factor receptor (HGFR, c-met) expressions in homogenous group of breast cancer patients. MATERIALS AND METHODS: Tumor samples were collected from 302 patients with breast carcinoma treated with primary surgery. We have assessed the percentage of tumor cells with c-met expression, the intensity of reaction and the ratio of these two factors-immunoreactivity according to the Remmele score. RESULTS: We have observed no correlations between HGFR immunoreactivities and clinical parameters (tumor size, grade, axillary lymph node status, age). In 5-year observation we have found prognostic value of assessing c-met immunoreactivity in primary tumor. CONCLUSION: Our study has revealed prognostic value of c-met. Unlike in other authors' studies, our patients' group is very homogenous which might contribute to obtained results.

[The importance of determining the prognostic marker YKL-40 in serum and tissues]. / Znaczenie rokownicze oznaczania markera YKL-40 W surowicy i tkankach.

YKL-40 is detected in the early nineties not only a glycoprotein secreted by cancer cells, but also of neutrophils, chondrocytes and endothelial cells. Biological function of YKL-40 are not exactly known, it is suggested that this protein participates in many physiological and pathological processes such as proliferation, angiogenesis, mitogenesis and remodelling. It is also a factor antyapoptotic and growth factor for some cells. Increased levels of YKL-40 in serum have been described in many diseases running with inflammation such as rheumatoid arthritis, systemic lupus erythematosus and Crohn's disease, and also in the group of cardiovascular diseases. Determination of the concentration of serum YKL-40 was also used in oncology. The tumors at various sites were found elevated levels of this marker in serum, as well as overexpression in tumor tissue. It was observed that higher titers YKL-40 levels are associated with shorter overall survival and disease-free period. It is suggested that measuring the concentration of YKL-40 in serum and its expression in tumor tissues may serve as a valuable and independent prognostic factor.

Correlation between hepatocyte growth factor receptor and vascular endothelial growth factor-A in breast carcinoma.

The aim of the study was to evaluate the prognostic value of the vascular endothelial growth factor A (VEGF-A) and hepatocyte growth factor receptor (HGFR, c-met) expressions in homogenous group of breast cancer patients. Tumor samples were collected from 98 patients with invasive ductal breast carcinoma stage II treated with primary surgery. We have observed a strong correlation between VEGF-A and c-met. No correlations were found between VEGF-A or HGFR expressions and clinical parameters (tumor size, grade, axillary lymph node status, age), 5- and 10-years DFS or OS. Our study did not reveal any prognostic value of c-met or VEGF. In addition they are not useful to separate a patients' subgroup with poor prognosis. Unlike in other authors' studies, our patients' group is very homogenous which might tribute to obtained results.

Serum vascular endothelial growth factors a, C and d in human breast tumors.

Available evidence suggests that vascular endothelial growth factor (VEGF) a potent regulator of vasculogenesis and tumor angiogenesis may be a predictor of recurrence in breast cancer patients. We sought to determine whether VEGF serum levels (VEGF-A, VEGF-C and VEGF-D) in 377 patients with malignant and benign breast tumors differ and whether there is association between vascular growth factors, clinicopathologic features and prognosis. There was no significant difference in investigated circulating angiogenic markers between patients with malignant and non malignant lesions. We found strong correlation between VEGF-A and VEGF-D and between VEGF- C and VEGF-D. Besides serum VEGF-D levels and estrogen receptor (ER) expressions no other correlations between VEGF and clinicopathologic variables were observed. However, elevated VEGF-A and VEGF-C concentrations were associated with increased number of erythrocytes, leukocytes and platelets. In Cox model values of angiogenic serum markers and recognized prognostic markers in breast cancer, VEGF-C turned out as independent prognostic factor. Our study is the first analysis showing correlation between serum concentrations of three angiogenic factors: VEGF-A, VEGF-C, VEGF-D. Associations between angiogenic cytokines and number of blood cells may be due to release of VEGF from platelets and leucocytes. Prognostic role of VEGF is still uncertain, though VEGF-C has a potential to serve as a prognostic marker.

Association between histological type of tumour growth and patient survival in t2-t3 lymph node-negative rectal cancer treated with sphincter-preserving total mesorectal excision.

For rectal cancer patients without nodal metastases the identification of unfavourable factors can be helpful for the better selection for adjuvant therapy and multimodality treatment. The aim of this study was to evaluate the impact of clinico-histological parameters on prognosis in node-negative rectal cancer patients. One hundred and thirty-nine consecutive node negative rectal cancer patients with complete five-year follow-up were studied prospectively. All of them underwent curative anterior resection with total mesorectal excision technique. Seventy-eight patients with tumour penetration beyond the bowel wall received neo-adjuvant short-course radiation (25 Gy) followed by surgery within 1 week and postoperative chemotherapy with 5-fluorouracil and folinic acid in six cycles or adjuvant radiochemotherapy: irradiation (50.4 Gy) combined with chemotherapy (as above). Cancer-specific survival was calculated according to the Kaplan-Meier method. Variables significant in univariate analysis by log-rank test (P < 0.05) entered the Cox proportional hazard model. Survival was decreased for males, older patients (>60 years) with extraperitoneal, poorly differentiated cancers, tumours with mucinous histology and with the absence of lymphocytic infiltration but with the lack of statistical importance. Prognosis was significantly improved for patients with T2 tumours versus T3 (P < 0.01) and with cancers with expanding growth comparing to diffusely infiltrating ones (P < 0.01). In multivariate analysis these parameters significantly and independently influenced survival (P < 0.01 and P < 0.05, respectively). Diffusely infiltrating growth of tumour can reflect the more aggressive cancer behaviour and unfavourable course of disease despite the optimised local control. Apart from the extent of tumour penetration the type of invasive margin can be an additional parameter helpful for the optimal treatment planning and better patient selection for postoperative chemotherapy.

Influence of CTLA-4/CD28/ICOS gene polymorphisms on the susceptibility to cervical squamous cell carcinoma and stage of differentiation in the Polish population.

Abnormal expressions of the costimulatory molecules CD28, "inducible co-stimulator" (ICOS), and inhibitory molecule cytotoxic T-lymphocyte antigen-4 (CTLA-4) lead to disturbances of immune response and entail an increased risk of cancer. This study was undertaken to evaluate the association between the polymorphisms CTLA-4c.49A>G, CTLA-4g.319C>T, CTLA-4g.*642AT(8_33), CTLA-4g.*6230G>A (CT60), CD28c.17+3T>C, and ICOSc.1554+4GT(8_15), and susceptibility to CSCC. The association between CTLA-4g.319C>T[T] allele and [TT+CT] genotype and susceptibility to CSCC was observed (OR = 1.99, p = 0.003, and OR = 2.07, p = 0.005, respectively). The CTLA-4g.319C>T[T] allele and [TT+CT] genotype increased the risk of well-differentiated CSCC by a factor of 3.84 and 4.44 (p = 0.00001, and p = 0.00001, respectively). In patients with moderately differentiated CSCC, a trend toward increased frequency of CTLA-4g.319C>T[T] allele and CTLA-4g.319C>T[TT+CT] genotype was noticed (OR = 1.68, p = 0.09, and OR = 1.75, p = 0.09, respectively), whereas in low differentiated CSCC such relation was not observed. Both CTLA-4g.*642AT(8_33) [(AT)(8)]/[(AT)(8)] homozygote and [(AT)(8)] allele were overrepresented in CSCC patients in comparison with healthy women (p = 0.004, OR = 1.93, and p = 0.03, OR = 1.41, respectively) but this polymorphism was not related to histologic grade of tumor. CD28c.17+3T>C polymorphism was not associated with susceptibility to CSCC in whole group of patients, but CD28c.17+3T>C[C] allele and CD28c.17+3T>C[CC+TC] genotype were more frequently observed among well differentiated CSCC patients compared with controls (OR = 1.89, p = 0.05, and OR = 2.05, p = 0.05, respectively). Other studied polymorphisms were not associated with susceptibility to CSCC and with histologic grade of CSCC. Our results suggest that the CTLA-4 gene is susceptibility gene to CSCC especially to well-differentiated tumor, while association between CD28 gene polymorphism and disease is restricted only to the well-differentiated CSCC.

Mastectomy approach with Y-shaped incision: a technique designed for women with obesity.

OBJECTIVE: To evaluate the access to axilla, postoperative complications, and cosmetic results of the modified radical mastectomy with a Y-shaped approach especially designed for women with obesity. METHODS: One hundred seventeen consecutive women with obesity with infiltrating breast cancer were studied. All of them were not eligible for breast-conserving therapy and underwent modified radical mastectomy. Operation was performed using a surgical technique designed to improve the axillary clearance and to eliminate the lateral dog ear deformity. Two oblique incisions were added to the traditional transverse Stewart incision at the lateral part forming the Y-shaped approach. After lateral flap retraction, the axillary dissection was done. Before closing the wound, the triangular flap was advanced medially, whereas superior and inferior areas of redundant skin overlying the latissimus dorsi muscle were excised. RESULTS: No intraoperative complications were observed. In each case, the axillary dissection (with level 3 node clearance when needed) was performed with ease. The wound was healed by primary adhesion, giving an excellent cosmetic result without lateral dog ear deformity. Skin flap necrosis was found in 2 elderly patients. Wound hematoma and surgical site infection developed in 1 patient each. Necrosis of the apex of axillary triangle occurred in one woman with diabetes. These rare complications were managed successfully in all the cases. CONCLUSIONS: The Y-shaped approach for modified radical mastectomy is a simple and safe technique. It facilitates the wide access to axilla and improves cosmesis in women with obesity by eliminating lateral dog ear deformity.

The prognostic role of tumor-infiltrating CD4 and CD8 T lymphocytes in breast cancer.

BACKGROUND: The aim of the study was to assess the prognostic role of CD4 and CD8 expression and the type, density, localization and distribution of tumor infiltrating lymphocytes (TILs) in patients with breast cancer. MATERIALS AND METHODS: Tissue samples were obtained from 88 breast cancer patients with operable disease and ductal histology. Forty-three women had pathologically confirmed axillary lymph node involvement. The TILs and expression of CD8 (cytotoxic T-cells) and CD4 (T-helper cells) were evaluated in the tumor samples using mouse monoclonal antibodies. RESULTS: Thirteen patients relapsed; nine of them had strong expression of CD4 and CD8, which was statistically significant. The patients with high expression of CD4 or CD8 had distinctly worse cancer specific overall survival (OS). High correlations between CD4 and CD8 expression and lymph node status and intensity of lymphatic infiltrate as well as between both markers were found. CONCLUSION: The analysis of tumor-infiltrating immune cells may be a valuable prognostic tool and a marker of lymph node involvement.

Correlation of metallothionein expression with clinical progression of cancer in the oral cavity.

UNLABELLED: This study aimed at finding out whether the expression of metallothionein (MT), laminin, Ki-67 antigen and minichromosome maintenance-2 (Mcm-2) protein changes with growing invasiveness of the tumour. The expression of these markers in primary tumours with no metastases to lymph nodes (PT N-) was compared with the expression in primary tumours with metastases in draining lymph nodes (PT N+). The difference in marker expression was also evaluated between metastatic lymph nodes (LN+) and the corresponding primary tumours (PT N+). PATIENTS AND METHODS: The studies were performed on tumour samples from 39 patients with squamous cell carcinoma of the oral cavity floor or of the oral part of the tongue. All the patients had been subjected to radical surgery, accompanied by the removal of lymph nodes. In 20 patients post-operative histopathology disclosed the presence of metastases in the draining lymph nodes (pN+), while in 19 patients the presence of such metastases was excluded (pN0). RESULTS: The PT N+ group was found to contain a significantly higher percentage of cells with cytoplasmic expression of MT, than the PT N- group. In turn, a significant increase in the intensity of reaction of cytoplasmic MT and an increased percentage of cancer cells demonstrating MT expression in the cell nuclei was demonstrated in the LN+ compared to the PT N+ group. The expression of the remaining parameters did not significantly differ between PT N-, PT N+ and LN+. CONCLUSION: A gradual increase in MT expression (both cytoplasmic and nuclear) takes place with progression of the tumour and the increased nuclear expression of MT in LN+ cells may suggest a role of MT in metastasis development in the studied tumours.

[The effectiveness of population-based breast cancer screening programme]. / Skutecznosc populacyjnego programu wczesnego wykrywania raka piersi.

UNLABELLED: Well-organised mammography screening programme can significantly reduce the breast cancer mortality However, changes in mortality rates take a long time thus some early indicators are usually used to monitor the effectiveness of the programme. If these operational objectives are accomplished then the programme can replicate the mortality reduction achieved in randomised trials. THE AIM OF THIS STUDY: To evaluate the quality of breast cancer screening programme in the region of Lower Silesia during the first year of its operating. MATERIAL AND METHODS: Centrally organised breast cancer screening has been introduced since the beginning of the year 2007. This population-based programme is designed for women aged 50-69. Females undergoing treatment or being followed-up due to breast cancer are not invited. Screen-film two-view mammography without clinical examination is used as a screening test which is to be performed every two years. The second level diagnostic tools are breast clinical examination and additional imaging (mammography and ultrasound). Following further assessment women are referred to the examination at the routine round length of the programme, at the less interval (short-term recall) or biopsy procedures. Quality assessment was done via early indicators according to the European guidelines. RESULTS: The attendance rate was 41% (79,143 women screened within 192,613 eligible population for one year). Technical repeat rate, further assessment rate, and short-term recall rate were: 0.26%, 6.85%, and 0.91%, respectively. Pathologically confirmed breast cancer was revealed in 364 women giving the detection rate 4.59 for 1000. Cancer detection rate to expected incidence ratio was 3.35. CONCLUSIONS: Mammography service performed during the first year of breast cancer screening programme in the region of Lower Silesia conforms to quality assessment parameters recommended by the European guidelines at the acceptable level. The main problem at the start of this programme is too low coverage. Invitation process must be strongly intensified to improve long-term effectiveness and to significantly reduce breast cancer mortality.