Purpose: To compare the positive margin rates for women with nonpalpable breast tumors who underwent breast conserving surgery with wire localization versus those with radioactive seed localization in a small community hospital and to compare the size of the corresponding breast specimens.Introduction: Wire localization (WL) has been the standard technique to assist in the removal of nonpalpable breast tumors for the past three decades for patients undergoing breast conserving surgery. Radioactive seed localization (RSL) is an alternative technique that provides advantages of patient comfort and scheduling convenience. There are numerous studies from large academic centers, but little information on how successfully this technique can be implemented in community hospitals.Methods: Thirty-five patients who underwent WL between September 18, 2013 and December 10, 2014 were compared to 110 patients who underwent RSL between February 12, 2014 and December 16, 2015. Results: Three of the 35 WL patients (8.5%) had a positive margin compared to 14 of the 110 RSL patients (12.7%), but this difference was not statistically significant (p-value 0.763). The breast specimen weight had a geometric mean of 30.26 g for the WL patients and 32.78 g for the RSL patients, a difference of 8.3%, which was not statistically significant. Positive margin rates did not depend on the surgeon or the radiologist placing the I-125 localization seed.Conclusion: The RSL technique can be implemented in community hospitals with the expectation of having the same positive margin rates as reported from academic centers.
{"title":"Initial Community Hospital Performance of Radioactive Seed Localization for Breast Cancer Patients","authors":"J. Wheeler, Fang Liu","doi":"10.5539/CCO.V6N1P51","DOIUrl":"https://doi.org/10.5539/CCO.V6N1P51","url":null,"abstract":"Purpose: To compare the positive margin rates for women with nonpalpable breast tumors who underwent breast conserving surgery with wire localization versus those with radioactive seed localization in a small community hospital and to compare the size of the corresponding breast specimens.Introduction: Wire localization (WL) has been the standard technique to assist in the removal of nonpalpable breast tumors for the past three decades for patients undergoing breast conserving surgery. Radioactive seed localization (RSL) is an alternative technique that provides advantages of patient comfort and scheduling convenience. There are numerous studies from large academic centers, but little information on how successfully this technique can be implemented in community hospitals.Methods: Thirty-five patients who underwent WL between September 18, 2013 and December 10, 2014 were compared to 110 patients who underwent RSL between February 12, 2014 and December 16, 2015. Results: Three of the 35 WL patients (8.5%) had a positive margin compared to 14 of the 110 RSL patients (12.7%), but this difference was not statistically significant (p-value 0.763). The breast specimen weight had a geometric mean of 30.26 g for the WL patients and 32.78 g for the RSL patients, a difference of 8.3%, which was not statistically significant. Positive margin rates did not depend on the surgeon or the radiologist placing the I-125 localization seed.Conclusion: The RSL technique can be implemented in community hospitals with the expectation of having the same positive margin rates as reported from academic centers.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"6 1","pages":"51"},"PeriodicalIF":0.0,"publicationDate":"2017-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V6N1P51","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42064991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Protocol BT-23, a Phase II study, was performed to determine the efficacy and safety of combination Antineoplaston A10 and Antineoplaston AS2-1 (ANP) in children with an optic pathway glioma (OPG). Sixteen patients (12 males, 4 females) ages 1 to 16 years (median age 4.5 years) were treated. The patients received ANP, by intravenous infusion, six times daily (i.e., every four hours). The length of treatment extended from a minimum of 4.1 weeks to a maximum of 210.0 weeks. The median dosage of A10 was 8.07 g/kg/d while for AS2-1 itwas 0.39 g/kg/d. Patients’ best response to ANP was determined: 12.5% of this patient population achieved a complete response, 18.8% achieved a partial response, and 31.3% maintained stable disease. The median overall survival was 78.5 months (95% CI: 37.6-92.3) while median progression-free survival was 45.4 months (95% CI: 7.1-71.4). ANPwas associated with a12% incidence of Grade 3 and a12% incidence of Grade 4 adverse drug experiences (ADEs). There were no Grade 5 ADEs. Grade 3 ADEs included somnolence and elevated SGOT; Grade 4 ADEsincluded hypernatremia and hypokalemia. Long-term quality of life was excellent with no chronic toxicity identified. Children with an OPG respond very well to ANP with good efficacy and toxicity profiles.
{"title":"Antineoplastons A10 and AS2-1 in the Treatment of Children with Optic Pathway Glioma: Final Report for Protocol BT-23","authors":"S. Burzynski, T. Janicki, Gregory S. Burzynski","doi":"10.5539/CCO.V6N1P25","DOIUrl":"https://doi.org/10.5539/CCO.V6N1P25","url":null,"abstract":"Protocol BT-23, a Phase II study, was performed to determine the efficacy and safety of combination Antineoplaston A10 and Antineoplaston AS2-1 (ANP) in children with an optic pathway glioma (OPG). Sixteen patients (12 males, 4 females) ages 1 to 16 years (median age 4.5 years) were treated. The patients received ANP, by intravenous infusion, six times daily (i.e., every four hours). The length of treatment extended from a minimum of 4.1 weeks to a maximum of 210.0 weeks. The median dosage of A10 was 8.07 g/kg/d while for AS2-1 itwas 0.39 g/kg/d. Patients’ best response to ANP was determined: 12.5% of this patient population achieved a complete response, 18.8% achieved a partial response, and 31.3% maintained stable disease. The median overall survival was 78.5 months (95% CI: 37.6-92.3) while median progression-free survival was 45.4 months (95% CI: 7.1-71.4). ANPwas associated with a12% incidence of Grade 3 and a12% incidence of Grade 4 adverse drug experiences (ADEs). There were no Grade 5 ADEs. Grade 3 ADEs included somnolence and elevated SGOT; Grade 4 ADEsincluded hypernatremia and hypokalemia. Long-term quality of life was excellent with no chronic toxicity identified. Children with an OPG respond very well to ANP with good efficacy and toxicity profiles.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"6 1","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2017-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V6N1P25","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45549553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aggressive Angiomyxoma (AA) is a rare locally aggressive soft tissue tumor with high chance of local recurrence occuring in young women of reproductive age group. These neoplasms are characterized by a mixture of spindle or stellate cells in a loosely myxoid stroma with prominent vascular component containing large, thickwalled blood vessels. A 35 year old multiparous lady presented with right vulval swelling which was rapidly progressing in size. Local examination revealed a soft fleshy mass occupying whole of the right labia majora. In view of the rapidly enlarging lesion over a short duration, we suspected a soft tissue neoplasm and preceded with wide local excision of the mass with adequate margins in all dimensions, eventhough we did not have a preoperative tissue diagnosis. To our surprise, final histopathology was Aggressive Angiomyxoma (AA). The treatment of choice for Aggressive Angiomyxoma is wide local excision with negative margins and the same was done in our case. Recurrence of the tumor may be avoided by wide local excision with adequate margins. It is possibly a hormonally responsive neoplasm. Treatment with Gonadotropin-releasing hormone is an emerging therapy.Overall prognosis of AA is good.
{"title":"Rare Case of Aggressive Angiomyxoma of the Vulva: A Case Report","authors":"G. Shanmugasundaram, S. Maharajan","doi":"10.5539/CCO.V6N1P8","DOIUrl":"https://doi.org/10.5539/CCO.V6N1P8","url":null,"abstract":"Aggressive Angiomyxoma (AA) is a rare locally aggressive soft tissue tumor with high chance of local recurrence occuring in young women of reproductive age group. These neoplasms are characterized by a mixture of spindle or stellate cells in a loosely myxoid stroma with prominent vascular component containing large, thickwalled blood vessels. A 35 year old multiparous lady presented with right vulval swelling which was rapidly progressing in size. Local examination revealed a soft fleshy mass occupying whole of the right labia majora. In view of the rapidly enlarging lesion over a short duration, we suspected a soft tissue neoplasm and preceded with wide local excision of the mass with adequate margins in all dimensions, eventhough we did not have a preoperative tissue diagnosis. To our surprise, final histopathology was Aggressive Angiomyxoma (AA). The treatment of choice for Aggressive Angiomyxoma is wide local excision with negative margins and the same was done in our case. Recurrence of the tumor may be avoided by wide local excision with adequate margins. It is possibly a hormonally responsive neoplasm. Treatment with Gonadotropin-releasing hormone is an emerging therapy.Overall prognosis of AA is good.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"6 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V6N1P8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70723531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose : An overview of the ultrasound imaging artifacts encountered in Mammosite balloon APBI is presented. Analysis of ultrasound measurement errors and the dosimetric impact of balloon leakage were used to determine whether clinically relevant changes in balloon size can be reliably detected. Methods : Ultrasound imaging of a Mammosite balloon phantom was performed to better understand measurement errors and accuracy. The dose to the prescription point as a function of balloon diameter was computed for different sized balloons. The results were compared to phantom measurements of balloon diameter versus filling volume to assess the dose change that would result from tissue moving inward with a shrinking balloon boundary. In APBI patients undergoing a course of 10 treatment fractions, the accuracy and variability of balloon size measured with ultrasound imaging was compared to CT. Results : Ultrasound artifacts combine to form a false image of the distal balloon boundary. Proper US probe orientation and choice of measurement point locations improved distance measurement accuracy. A 1 mm change in balloon diameter is measurable with ±0.1 mm error and corresponds to <4% change in dose 1 cm from the balloon. Measurement errors relative to CT averaged less than 1.4 mm and variability (standard deviation) over the course of treatment averaged 1.9 mm. Conclusions : Properly performed ultrasound image acquisition and analysis can detect dosimetrically relevant changes in the size of a leaking balloon. This study confirms that US imaging is a valid method of verifying APBI balloon integrity over the course of treatment.
{"title":"Verification of Balloon Integrity by Ultrasound Imaging in Accelerated Partial Breast Irradiation","authors":"J. Christensen, M. Trombetta, O. Gayou","doi":"10.5539/CCO.V5N2P60","DOIUrl":"https://doi.org/10.5539/CCO.V5N2P60","url":null,"abstract":"Purpose : An overview of the ultrasound imaging artifacts encountered in Mammosite balloon APBI is presented. Analysis of ultrasound measurement errors and the dosimetric impact of balloon leakage were used to determine whether clinically relevant changes in balloon size can be reliably detected. Methods : Ultrasound imaging of a Mammosite balloon phantom was performed to better understand measurement errors and accuracy. The dose to the prescription point as a function of balloon diameter was computed for different sized balloons. The results were compared to phantom measurements of balloon diameter versus filling volume to assess the dose change that would result from tissue moving inward with a shrinking balloon boundary. In APBI patients undergoing a course of 10 treatment fractions, the accuracy and variability of balloon size measured with ultrasound imaging was compared to CT. Results : Ultrasound artifacts combine to form a false image of the distal balloon boundary. Proper US probe orientation and choice of measurement point locations improved distance measurement accuracy. A 1 mm change in balloon diameter is measurable with ±0.1 mm error and corresponds to <4% change in dose 1 cm from the balloon. Measurement errors relative to CT averaged less than 1.4 mm and variability (standard deviation) over the course of treatment averaged 1.9 mm. Conclusions : Properly performed ultrasound image acquisition and analysis can detect dosimetrically relevant changes in the size of a leaking balloon. This study confirms that US imaging is a valid method of verifying APBI balloon integrity over the course of treatment.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"5 1","pages":"60"},"PeriodicalIF":0.0,"publicationDate":"2016-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V5N2P60","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70723340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Konomi Mizuguchi, Koich Sato, H. Maekawa, M. Sakurada, H. Orita, T. Kushida, K. Senuma, Tomoaki Ito, Hirokazu Matsuzawa, Syunsuke Watanabe, S. Tokuda, S. Ueda, R. Wada
The gastric cancer producing carbohydrate antigen 19-9 (CA 19-9) is a rare and unknown that characterize informations. 74-year-old woman who was admitted with complaints of epigastric discomfort. An advanced cancer was found in her lower gastric region; biopsy of the tumor revealed poorly-differentiated adenocarcinoma. Her serum CA 19-9 was extremely elevated at 2322 U/ml and computed tomography demonstrated enlargement of the para-aortic lymph node; thus the tumor was considered unresectable. The patient received 8 cycles of chemotherapy with S-1/cisplatin, which shrank the para-aortic lymph node dramatically, hence she underwent D2 gastrectomy. Immunohistochemical staining of the resected cancer revealed that a third of the cancer cells were positive for CA 19-9. In addition, her serum CA 19-9 decreased rapidly after surgery and she remains alive without recurrence three years after surgery. We report one high level of CA 19-9 gastric cancer case with dramatically chemosensitive.
胃癌产生碳水化合物抗原19-9 (CA 19-9)是一种罕见且未知的特征信息。74岁女性，因上腹不适入院。下胃区发现晚期肿瘤;肿瘤活检显示为低分化腺癌。血清CA 19-9异常升高至2322 U/ml，计算机断层扫描显示主动脉旁淋巴结肿大;因此，肿瘤被认为是不可切除的。患者经S-1/顺铂化疗8周期，主动脉旁淋巴结明显缩小，行D2胃切除术。切除肿瘤的免疫组化染色显示三分之一的癌细胞CA 19-9阳性。此外，术后患者血清CA 19-9迅速下降，术后3年无复发。我们报告一例高水平ca19 -9胃癌患者具有显著的化疗敏感性。
{"title":"A Case Report of Carbohydrate Antigen 19-9 Producing Advanced Gastric Cancer","authors":"Konomi Mizuguchi, Koich Sato, H. Maekawa, M. Sakurada, H. Orita, T. Kushida, K. Senuma, Tomoaki Ito, Hirokazu Matsuzawa, Syunsuke Watanabe, S. Tokuda, S. Ueda, R. Wada","doi":"10.5539/CCO.V5N2P49","DOIUrl":"https://doi.org/10.5539/CCO.V5N2P49","url":null,"abstract":"The gastric cancer producing carbohydrate antigen 19-9 (CA 19-9) is a rare and unknown that characterize informations. 74-year-old woman who was admitted with complaints of epigastric discomfort. An advanced cancer was found in her lower gastric region; biopsy of the tumor revealed poorly-differentiated adenocarcinoma. Her serum CA 19-9 was extremely elevated at 2322 U/ml and computed tomography demonstrated enlargement of the para-aortic lymph node; thus the tumor was considered unresectable. The patient received 8 cycles of chemotherapy with S-1/cisplatin, which shrank the para-aortic lymph node dramatically, hence she underwent D2 gastrectomy. Immunohistochemical staining of the resected cancer revealed that a third of the cancer cells were positive for CA 19-9. In addition, her serum CA 19-9 decreased rapidly after surgery and she remains alive without recurrence three years after surgery. We report one high level of CA 19-9 gastric cancer case with dramatically chemosensitive.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"5 1","pages":"49"},"PeriodicalIF":0.0,"publicationDate":"2016-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V5N2P49","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70722944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Watson, D. Kelly, E. Malone, J. Gleeson, G. Mcentee, J. Geoghegan, C. Kelly, R. McDermott, J. McCaffrey
Background: Gastrointestinal stromal tumours (GISTs) are unique neoplasms of the gastrointestinal (GI) tract. The development of targeted therapeutic agents such as imatinib mesylate (Glivec) has altered the way on how we now manage these rare malignancies. The aim of this study was to evaluate the management of GISTs in three Irish tertiary hospitals. Methods: We performed a retrospective, multicenter audit of patients diagnosed with gastrointestinal stromal tumours over a ten year period (2005-2015). Results: 110 patients were included in the study. Abdominal pain was the most common presenting symptom, reported in 30% of patients, while 31% were incidental findings. The stomach was the most common primary site of disease, observed in 77% of cases. 15 patients had metastatic disease at the time of diagnosis (14%), and 10 of these patients had liver involvement. More than half of patients (61%) were managed with surgical excision alone (61%), while 24 were managed with surveillance and 28 patients treated with adjuvant Glivec, which was generally well tolerated. 18 patients (20%) demonstrated recurrent or progressive disease after first line treatment. 102 patients (93%) are alive today. Conclusion: While surgery is widely regarded as the primary treatment modality for GISTs the addition of imatinib mesylate has enabled physicians to deliver more personalised treatment while optimising patient outcomes.
{"title":"Gastrointestinal Stromal Tumours: A 10 Year Multicenter Audit","authors":"G. Watson, D. Kelly, E. Malone, J. Gleeson, G. Mcentee, J. Geoghegan, C. Kelly, R. McDermott, J. McCaffrey","doi":"10.5539/CCO.V6N1P1","DOIUrl":"https://doi.org/10.5539/CCO.V6N1P1","url":null,"abstract":"Background: Gastrointestinal stromal tumours (GISTs) are unique neoplasms of the gastrointestinal (GI) tract. The development of targeted therapeutic agents such as imatinib mesylate (Glivec) has altered the way on how we now manage these rare malignancies. The aim of this study was to evaluate the management of GISTs in three Irish tertiary hospitals. Methods: We performed a retrospective, multicenter audit of patients diagnosed with gastrointestinal stromal tumours over a ten year period (2005-2015). Results: 110 patients were included in the study. Abdominal pain was the most common presenting symptom, reported in 30% of patients, while 31% were incidental findings. The stomach was the most common primary site of disease, observed in 77% of cases. 15 patients had metastatic disease at the time of diagnosis (14%), and 10 of these patients had liver involvement. More than half of patients (61%) were managed with surgical excision alone (61%), while 24 were managed with surveillance and 28 patients treated with adjuvant Glivec, which was generally well tolerated. 18 patients (20%) demonstrated recurrent or progressive disease after first line treatment. 102 patients (93%) are alive today. Conclusion: While surgery is widely regarded as the primary treatment modality for GISTs the addition of imatinib mesylate has enabled physicians to deliver more personalised treatment while optimising patient outcomes.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"6 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2016-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V6N1P1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70723382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Chermesh, N. Haim, A. Amit, M. Waterman, I. Papier, T. Mashiach
Malnutrition in patients with advanced cancer and gastrointestinal failure (ACGIF) is inevitable. This is a prospective study of a cohort of patients with ACGIF who were treated by home parenteral nutrition (HPN). Included were all patients with ACGIF treated with HPN since January 2003. Data concerning the primary disease, demographics, functional capacity, and PN-related complications were obtained. 125 patients, age's 60±12.9 years, were included. Seven (6%) had KPS<50. Median survival was 3.2 months. Cumulative survival was 0.95, 0.50, 0.25, and 0.09 at two weeks, three and six months, and one year after initiation of HPN, respectively. Multivariate analysis revealed higher mortality associated with male gender (HR 1.48 95% CI 1.03-2.14; p<0.05), albumin level<2.5 gr% (HR 1.73 95% CI 1.18-2.54 p<0.05), and low functional capacity (KPS<50) (HR 2.63 95% CI 1.21-5.74; p<0.05). Survival was not associated with age or BMI. More than 50% of patients survived more than three months, and more than 95% survived longer than two weeks. We cautiously suggest that HPN has prolonged survival and prevented starvation-related manifestations. The decision to initiate HTPN must be reached based on individual considerations, taking into account patient’s preferences.
晚期癌症合并胃肠功能衰竭(ACGIF)患者的营养不良是不可避免的。这是一项对ACGIF患者进行家庭肠外营养(HPN)治疗的前瞻性研究。纳入自2003年1月以来接受HPN治疗的所有ACGIF患者。获得有关原发疾病、人口统计学、功能能力和pn相关并发症的数据。纳入125例患者，年龄60±12.9岁。7例(6%)KPS<50。中位生存期为3.2个月。HPN开始后2周、3个月、6个月和1年的累积生存率分别为0.95、0.50、0.25和0.09。多因素分析显示，男性死亡率较高(HR 1.48, 95% CI 1.03-2.14;p<0.05)，白蛋白水平<2.5 gr% (HR 1.73 95% CI 1.18-2.54 p<0.05)，低功能容量(KPS<50) (HR 2.63 95% CI 1.21-5.74;p < 0.05)。生存率与年龄或体重指数无关。超过50%的患者存活超过三个月，超过95%的患者存活超过两周。我们谨慎地认为，HPN延长了生存期，并防止了饥饿相关的表现。启动HTPN的决定必须基于个人考虑，考虑到患者的偏好。
{"title":"Parenteral Nutrition in Patients with Advanced Cancer and Gastrointestinal Failure or Obstruction","authors":"I. Chermesh, N. Haim, A. Amit, M. Waterman, I. Papier, T. Mashiach","doi":"10.5539/CCO.V5N2P54","DOIUrl":"https://doi.org/10.5539/CCO.V5N2P54","url":null,"abstract":"Malnutrition in patients with advanced cancer and gastrointestinal failure (ACGIF) is inevitable. This is a prospective study of a cohort of patients with ACGIF who were treated by home parenteral nutrition (HPN). Included were all patients with ACGIF treated with HPN since January 2003. Data concerning the primary disease, demographics, functional capacity, and PN-related complications were obtained. 125 patients, age's 60±12.9 years, were included. Seven (6%) had KPS<50. Median survival was 3.2 months. Cumulative survival was 0.95, 0.50, 0.25, and 0.09 at two weeks, three and six months, and one year after initiation of HPN, respectively. Multivariate analysis revealed higher mortality associated with male gender (HR 1.48 95% CI 1.03-2.14; p<0.05), albumin level<2.5 gr% (HR 1.73 95% CI 1.18-2.54 p<0.05), and low functional capacity (KPS<50) (HR 2.63 95% CI 1.21-5.74; p<0.05). Survival was not associated with age or BMI. More than 50% of patients survived more than three months, and more than 95% survived longer than two weeks. We cautiously suggest that HPN has prolonged survival and prevented starvation-related manifestations. The decision to initiate HTPN must be reached based on individual considerations, taking into account patient’s preferences.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"5 1","pages":"54"},"PeriodicalIF":0.0,"publicationDate":"2016-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70723031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is estimated that as many as 30% of patients with primary CNS tumors have leptomeningeal, disseminated, and/or multicentric disease (LDM). These patients respond poorly to conventional therapy. Fifty-seven children with LDM (median age of 7.1 years) were treated in multiple prospective phase II clinical studies of high- and low-grade primary CNS tumors with Antineoplastons A10 and AS2-1 (ANP). Their inclusion in this analysis was based on MRI imaging. Patients with glioblastoma were excluded. The patients received ANP therapy 6 times daily; A10: 8.77 g/kg/d; AS2-1: 0.35 g/kg/d. The response to ANP was monitored by MRIs every 8 weeks. Patients evaluable for efficacy ( N = 40) received 12 or more weeks of ANP or developed progressive disease (PD) before 12 weeks. 10 patients (17.5%) achieved an objective response (OR) with 4 (7%) achieving a complete response (CR) and 6 (10.5%) had a partial response (PR). Stable disease (SD) was maintained in 7 patients (12.3%) and PD developed in 23 patients (40.4%). Survival analysis of the 57 children showed 2- and 5-year overall survival (OS) were both 28% while 10- and 15-year OS were both 26%. One of the patients achieving an OR had atypical teratoid/rhabdoid tumor (AT/RT) while nine had low-grade gliomas (LGGs). Grade 3 and 4 toxicities included hypokalemia (14.0%); fatigue, anemia, hypernatremia and leukopenia (3.5% each); diarrhea, hypertension, joint pain, thrombocytopenia, and somnolence (1.8% each). These findings suggest the need for a single-arm, phase II study of ANP in children with LDM.
{"title":"Primary CNS Tumors and Leptomeningeal, Disseminated and/or Multicentric Disease in Children Treated in Phase II Studies with Antineoplastons A10 and AS2-1","authors":"S. Burzynski, T. Janicki, Gregory S. Burzynski","doi":"10.5539/CCO.V5N2P38","DOIUrl":"https://doi.org/10.5539/CCO.V5N2P38","url":null,"abstract":"It is estimated that as many as 30% of patients with primary CNS tumors have leptomeningeal, disseminated, and/or multicentric disease (LDM). These patients respond poorly to conventional therapy. Fifty-seven children with LDM (median age of 7.1 years) were treated in multiple prospective phase II clinical studies of high- and low-grade primary CNS tumors with Antineoplastons A10 and AS2-1 (ANP). Their inclusion in this analysis was based on MRI imaging. Patients with glioblastoma were excluded. The patients received ANP therapy 6 times daily; A10: 8.77 g/kg/d; AS2-1: 0.35 g/kg/d. The response to ANP was monitored by MRIs every 8 weeks. Patients evaluable for efficacy ( N = 40) received 12 or more weeks of ANP or developed progressive disease (PD) before 12 weeks. 10 patients (17.5%) achieved an objective response (OR) with 4 (7%) achieving a complete response (CR) and 6 (10.5%) had a partial response (PR). Stable disease (SD) was maintained in 7 patients (12.3%) and PD developed in 23 patients (40.4%). Survival analysis of the 57 children showed 2- and 5-year overall survival (OS) were both 28% while 10- and 15-year OS were both 26%. One of the patients achieving an OR had atypical teratoid/rhabdoid tumor (AT/RT) while nine had low-grade gliomas (LGGs). Grade 3 and 4 toxicities included hypokalemia (14.0%); fatigue, anemia, hypernatremia and leukopenia (3.5% each); diarrhea, hypertension, joint pain, thrombocytopenia, and somnolence (1.8% each). These findings suggest the need for a single-arm, phase II study of ANP in children with LDM.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"5 1","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V5N2P38","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70722839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives : MTHFR polymorphism testing has been used by clinicians for thrombophilia risk assessment. We questioned the utility of such testing. Methods : 1,141 patients age 18 and above had MTHFR testing for both C677T and A1298C polymorphisms, 2006 through 2012. Available plasma homocysteine levels were obtained and ICD-9 billing codes were grouped to identify venous or arterial clots in these patients. Results : 901 women and 240 men were tested; median age in women was 33 years (range 18-86); median age in men was 47 years (range 18-83). County of residence mapping confirmed that this MTHFR tested population was from north-central Appalachia. Only 144 (13%) of the 1,141 patients had no polymorphism at either the C677T or the A1298C locus; only 4 patients (0.4%) had 3 or more polymorphisms; 993 patients (87%) had either one or two polymorphisms. We found polymorphism frequency pattern similar in both sexes. Although men had higher homocysteine levels, MTHFR polymorphisms did not associate with homocysteine levels in either sex. In 901 women tested, the ICD-9 coded incidence of arterial clots was 20%, and of venous clots was 21%; in 240 men tested, the incidence of arterial clots was 48% and of venous clots was 40%. MTHFR polymorphisms did not associate with arterial or venous clots in either sex. Based on CPT billing codes, a minimal cost estimate was $137,000 for performing these 1,141 MTHFR tests. Conclusions : MTHFR testing was costly and did not add useful information during thrombophilia evaluation in this patient population.
{"title":"Non-Association of Methylenetetrahydrofolate Reductase (MTHFR) Polymorphisms with Homocysteine Levels, Venous or Arterial Thromboses in 1,141 North-Central Appalachian Patients","authors":"F. Khimani, P. Perrotta, G. Hobbs, T. Hogan","doi":"10.5539/CCO.V5N2P21","DOIUrl":"https://doi.org/10.5539/CCO.V5N2P21","url":null,"abstract":"Objectives : MTHFR polymorphism testing has been used by clinicians for thrombophilia risk assessment. We questioned the utility of such testing. Methods : 1,141 patients age 18 and above had MTHFR testing for both C677T and A1298C polymorphisms, 2006 through 2012. Available plasma homocysteine levels were obtained and ICD-9 billing codes were grouped to identify venous or arterial clots in these patients. Results : 901 women and 240 men were tested; median age in women was 33 years (range 18-86); median age in men was 47 years (range 18-83). County of residence mapping confirmed that this MTHFR tested population was from north-central Appalachia. Only 144 (13%) of the 1,141 patients had no polymorphism at either the C677T or the A1298C locus; only 4 patients (0.4%) had 3 or more polymorphisms; 993 patients (87%) had either one or two polymorphisms. We found polymorphism frequency pattern similar in both sexes. Although men had higher homocysteine levels, MTHFR polymorphisms did not associate with homocysteine levels in either sex. In 901 women tested, the ICD-9 coded incidence of arterial clots was 20%, and of venous clots was 21%; in 240 men tested, the incidence of arterial clots was 48% and of venous clots was 40%. MTHFR polymorphisms did not associate with arterial or venous clots in either sex. Based on CPT billing codes, a minimal cost estimate was $137,000 for performing these 1,141 MTHFR tests. Conclusions : MTHFR testing was costly and did not add useful information during thrombophilia evaluation in this patient population.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"5 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2016-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V5N2P21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70722772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kenneth O. Simbiri, H. Jha, Giacomina Massaro-Giordano, E. Robertson
Ocular surface squamous neoplasia (OSSN) is a common cancer that has recently increased in incidence in HIV-1 infected patients. The rise has been more transparent in sub-Sahara Africa. Our recent publications showed the association of OSSN with multiple viral, bacterial and parasitic infections. Here we show through transfection with different viral constructs, the changes taking place in the primary conjunctival cells which involve some of the important markers associated with initiation and maintenance of the cancer. We transfected primary conjunctival cells with different oncogenic viral genes (HPV16-E6, HPV16-E7, HPV16-E6/E7, KSHV-LANA, and EBV-EBNA1) that have been associated with transformation of infected cells. The cells were tested for expression of different markers linked to oncogenesis. We used RT PCR to determine the expression of the markers. The level of expression was determined in each case. We also performed immunohistochemistry (IHC) on the primary cells using specific antibodies. The transfected conjunctival cells were demonstrated to be epitheliod as determined by expression of Cytokeratin-19 (C-19) and Vimentin markers. The primary conjunctival cells were efficiently transfected with the specific viral oncogenes resulting in expression of different cytokines, chemokine, cell cycle markers, and growth factors. The different constructs elicited expression and/or suppression of p53, p21, pRB, IL-10, IL-13, cyclinD1, TNF, TNF13B, and VEGF in specific transfected conjunctival primary cells. Our findings indicate that the viral oncogene expression in primary conjunctival cells contributed to the production of inflammatory cytokines, chemokines and dysregulation of cell cycle proteins in primary conjunctival tissues. This mirrors the transformation process in OSSN pathogenesis. Further studies should follow to identify pathways dysregulated that can be targeted for therapy or vaccine development.
{"title":"Transformation of Primary Conjunctival Cells Transfected with Papilloma and Herpesvirus Oncogenes","authors":"Kenneth O. Simbiri, H. Jha, Giacomina Massaro-Giordano, E. Robertson","doi":"10.5539/CCO.V5N2P6","DOIUrl":"https://doi.org/10.5539/CCO.V5N2P6","url":null,"abstract":"Ocular surface squamous neoplasia (OSSN) is a common cancer that has recently increased in incidence in HIV-1 infected patients. The rise has been more transparent in sub-Sahara Africa. Our recent publications showed the association of OSSN with multiple viral, bacterial and parasitic infections. Here we show through transfection with different viral constructs, the changes taking place in the primary conjunctival cells which involve some of the important markers associated with initiation and maintenance of the cancer. We transfected primary conjunctival cells with different oncogenic viral genes (HPV16-E6, HPV16-E7, HPV16-E6/E7, KSHV-LANA, and EBV-EBNA1) that have been associated with transformation of infected cells. The cells were tested for expression of different markers linked to oncogenesis. We used RT PCR to determine the expression of the markers. The level of expression was determined in each case. We also performed immunohistochemistry (IHC) on the primary cells using specific antibodies. The transfected conjunctival cells were demonstrated to be epitheliod as determined by expression of Cytokeratin-19 (C-19) and Vimentin markers. The primary conjunctival cells were efficiently transfected with the specific viral oncogenes resulting in expression of different cytokines, chemokine, cell cycle markers, and growth factors. The different constructs elicited expression and/or suppression of p53, p21, pRB, IL-10, IL-13, cyclinD1, TNF, TNF13B, and VEGF in specific transfected conjunctival primary cells. Our findings indicate that the viral oncogene expression in primary conjunctival cells contributed to the production of inflammatory cytokines, chemokines and dysregulation of cell cycle proteins in primary conjunctival tissues. This mirrors the transformation process in OSSN pathogenesis. Further studies should follow to identify pathways dysregulated that can be targeted for therapy or vaccine development.","PeriodicalId":89904,"journal":{"name":"Cancer and clinical oncology","volume":"5 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2016-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5539/CCO.V5N2P6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70723189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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