International Journal of Cancer Therapy and Oncology
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The breast cancer: a comparison among different diagnostic and therapeutic protocols
No full textPurpose: In breast cancer therapy diagnostic and therapeutic pathways may differ among different centres. The pathway chosen in our Department includes a stadiation through magnetic resonance imaging (MRI) for all the patients and the sentinel node biopsy (SNB) analysis made through an extemporaneous exam. This, even if more expensive at the beginning, allows in some cases to avoid further interventions. Aim of the study is the cost analysis of three different pathways.Methods: We studied the patients who underwent surgery for breast cancer in our department in the last 5 years (2006-2010); analyzed variables are: execution of MRI, kind and duration of surgery, duration of hospitalization. In case of mismatch MRI/basic exams (mammography, ultrasonography) or positive SNB, we indicated the necessary second surgery or the axillary lymphadenectomy. We considered the costs of any single procedure and then their sum, hypothesizing then the application of other different pathways to the same group of patients, calculating each one’s cost.Results: 767 patients, 489 quadrantectomies (63.7%) and 278 mastectomies (36.3%). Positive SNB in 90/559 cases (16.1%). Therapy modification after MRI happened in 63 cases (10.1% of 619 MRI). A single MRI costs 323€, hospitalization 570€/day. Operatory room cost/minute is 9,4€/quadrantectomy, 8,9€/mastectomy. SNB biopsy cost is 112€ if extemporaneous, 107€ if deferred. Surgery made for mistakes due to the absence of MRI exam costs 5394€, posponed axillary lymphadenectomy costs 4081€. The whole cost was 3.825.890€ for our pathway, 3.973.722€ for the one without MRI in every case, 4.339.588€ for the one without MRI in every case and without extemporaneous analysis of SN.Conclusion: Data considering avoided interventions and economic assessments show how, through a better organization, it is possible the objective to improve quality of health care and to cut down on costs.-----------------------------------------Cite this article as: Cattin F, Semprini G. The breast cancer: a comparison among different diagnostic and therapeutic protocols. Int J Cancer Ther Oncol 2015; 3(4):3408.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.
Angiomatous nasal polyp: Clinical diagnostic dilemma
Get PDFAngiomatous polyp (Angiectatic nasal polyps) is rare and its incidence is 4-5% of all nasal polyps. As it occurs with variable clinical features and there is no confirmatory preoperative investigation, clinical diagnosis can be a dilemma. Clinical picture of angiofibroma, simple antrochoanal polyp and inverted papilloma may resemble with each other. As polyps invade surrounding bone, these should be distinguished from a malignant mass. We present an interesting case of an infarcted angiectatic nasal polyp with extensive surrounding bony destruction. Correct preoperative radiological diagnosis is important to avoid unnecessary extensive surgery. Histopathological evaluation of polyps is mandatory since they require different treatment due to difference in the prognosis
High Impact Papers from October – December, 2014
No full textHigh impact papers from a particular Issue are selected based on the quality of the article and the number of citations. High impact papers are typically recognized once the Issue completes the publication time period of 12 months.Following articles are recognized as High Impact Papers from October - December, 2014: Ojala J. The accuracy of the Acuros XB algorithm in external beam radiotherapy – a comprehensive review. Int J Cancer Ther Oncol 2014; 2(4):020417. DOI: 10.14319/ijcto.0204.17Read Download Citations Rout BK, Muralidhar KR, Ali M, Shekar MC, Kumar A. Dosimetric study of RapidArc plans with flattened beam (FB) and flattening filter-free (FFF) beam for localized prostate cancer based on physical indices. Int J Cancer Ther Oncol 2014; 2(4):02046.DOI: 10.14319/ijcto.0204.6Read Download CitationsRana S, Pokharel S. Dose-to-medium vs. dose-to-water: Dosimetric evaluation of dose reporting modes in Acuros XB for prostate, lung and breast cancer. Int J Cancer Ther Oncol 2014; 2(4):020421. DOI: 10.14319/ijcto.0204.21Read Download CitationsPetrou EI, Narayanasamy G, Lavdas E, Stathakis S, Papanikolaou N, Lind BK, Mavroidis P. Evaluation of the generalized gamma as a tool for treatment planning optimization. Int J Cancer Ther Oncol 2014; 2(4):020418.DOI: 10.14319/ijcto.0204.18Read Download Citations (High impact papers from January-March, 2015 will be recognized in the next Issue of the IJCTO
Evaluation of a novel reference chamber “stealth chamber” through Monte Carlo simulations and experimental data
Get PDFPurpose: To evaluate a novel reference chamber (Stealth Chamber by IBA) through experimental data and Monte Carlo simulations for 6 and 15 MV photon energies. Methods: Monte Carlo simulations in a water phantom for field sizes ranging from 3×3 and 25×25 cm2 were performed for both energies with and without the Monte Carlo model of the Stealth Chamber in the beam path, and compared to commissioning beam data. Percent depth doses (PDDs), profiles, and gamma analysis of the simulations were performed along with an energy spectrum analysis of the phase-space files generated during the simulation. Experimental data were acquired in water with IBA three-dimensional (3D) blue phantom in a set-up identical to the one used in the Monte Carlo simulations. PDD comparisons for fields ranging from 1×1 to 25×25 cm2 were performed for photon energies. Profile comparison for fields ranging from 1×1 to 25×25 cm2 were executed for the depths of dmax, 5, 10 and 20 cm. Criteria of 1%, 1 mm to compare PDDs and profiles were used. Transmission measurements with the Stealth Chamber and a Matrixx detector from IBA were investigated. Measurements for 6 and 15 MV with fields ranging from 3×3 to 25×25 cm2 dimensions were acquired in an open field with and without the Stealth Chamber in the path of the beam. Profiles and gamma analysis with a 1%, 1 mm gamma analysis criterion were performed. Results: Monte Carlo simulations of the PDDs and profiles demonstrate the agreement between both simulations. Furthermore, the gamma analysis (1%, 1 mm) result of the comparison of both planes has 100% of the points passing the criteria. The spectral distribution analysis of the phase spaces for an open field with and without the chamber reveals the agreement between both simulations. Experimental measurements of PDDs and profiles have been conducted and reveal the comparability of relative dosimetric data acquired with the Stealth Chamber and our gold standard the CC13 chamber. Transmission data measured with an ion chamber array (Matrixx) showed the small attenuation caused by the use of the Stealth Chamber. Conclusion: Simulations and experimental results from this investigation indicate the benefits associated with chamber positioning and time expended during the acquisition of the relative measurements of PDDs and profiles for the beam commissioning of photon beams when the Stealth Chamber is used as a reference chamber to perform these tasks. The results demonstrate that relative profiles and PDDs scanned with the Stealth Chamber in place are consistent with those made using a CC13 chamber within a 1% and 1 mm criterion
Novel Approaches to the Treatment of Cancer in London UK
No full textAn intensive and in-depth two-day conference providing an advanced level updateKEY TOPICS TO BE COVERED:New paradigms for targeted therapiesNew anti-cancer agents ~ industry viewpointNovel approaches to the treatment of breast cancer, melanoma and pancreatic cancerDrug development and precision radiotherapyEuropean drug development initiativesMarket access to novel cancer drugsRegulatory issues in marketing authorisation of anti-cancer productsGene and cell therapies and trial endpointsDeveloping cancer vaccinesCLICK HERE for more information
Outcomes of advanced gastric cancer in young adult patients treated with first-line combination chemotherapy
No full textPurpose: Despite conflicting data regarding survival after curative surgery, little is known about the prognosis of metastatic gastric cancer (MGC) in young adults. The current study was performed to determine whether younger age is an independent prognostic factor among MGC patients receiving first-line chemotherapy and to evaluate how age relates to other known prognostic parameters. Methods: The records of 1843 MGC patients who were consecutively treated with first-line combination chemotherapy at Samsung Medical Center (Seoul, Korea) between 2000 and 2007, including 570 patients aged 45 years or younger, were retrieved from a prospective cancer chemotherapy database.Results: In the younger group, there were significantly more bone metastases, ascites, poor performance status, low albumin, elevated alkaline phosphatase, and resections that were non-curative than in the older patients. Progression-free survival (PFS) and overall survival (OS) was shorter in younger patients (PFS, 4.2 months; OS, 7.1 months) than in older ones (PFS, 5.1 months; OS, 8.4 months). Nonetheless, younger age did not show an independent association with PFS or OS. Stratified analyses showed that younger age was related with poor outcome in the subgroups of good performance status and no bone metastasis. Conclusion: When matched for other prognostic factors, the prognosis of younger MGC patients receiving first-line combination chemotherapy does not differ from that of older patients. The poor survival of younger patients may be attributed to the association with other adverse prognostic factors
Investigating dosimetric effect of rotational setup errors in IMPT planning of synchronous bilateral lung cancer
Get PDFPurpose: The purpose of this study is to evaluate the dosimetric effect of rotational setup errors on the synchronous bi-lateral lung cancer plans generated by the intensity modulated proton therapy (IMPT) technique.Methods: The original IMPT plans were generated in for the left planning target volume (PTV) and right PTV of the left lung and right lung, respectively. Each plan was generated using two beams (lateral and posterior-anterior) with an isocenter placed at the center of the corresponding PTV. The IMPT plans were optimized for a total dose of 74 Gy[RBE] prescribed to each PTV with 2 Gy(RBE) per fraction. Original plans were recalculated by introducing simulated rotational errors. For each PTV, 18 rotational plans (±1⁰, ±2⁰, and ±3⁰) for each of the yaw, roll, and pitch rotations were generated. Results: Rotational errors caused the reduction in the clinical target volume (CTV) and PTV coverage in new rotational IMPT plans when compared to the original IMPT lung plans. The CTV D99 was reduced by up to 13.3%, 9.1%, and 5.9% for the yaw (+3⁰), roll (-3⁰), and pitch (+3⁰), respectively. The PTV D95 was reduced by up to 8.7%, 7.3%, and 4.6% for the yaw (+3⁰), roll (-3⁰), and pitch (+3⁰), respectively. The PTV V100 showed the highest deviation with a reduction of dose coverage by up to 40.1%, 31.8%, and 33.9% for the yaw (-3⁰), roll (-3⁰), and pitch (+3⁰) respectively. Conclusion: The rotational setup errors with magnitude of ≥2⁰ can produce a significant loss of dose coverage to the target volume in the IMPT of a synchronous bi-lateral lung cancer. The yaw had the most severe impact on the dosimetric results when compared to other two rotational errors (roll and pitch)
Possible involvement of tyrosine kinase inhibitors on the expression of CXCR4 in chronic myeloid leukemia
Get PDFPurpose: Chronic myeloid leukemia (CML) treatment has improved significantly in the last decade with the introduction of tyrosine kinase inhibitors (TKIs), which target BCR/ABL oncoprotein. However, a large proportion of patients develop resistance to this treatment protocol, with frequent relapse cases. CXCR4 up-regulation in leukemic cells induced by TKIs has been reported as a mechanism of chemoresistance by promoting migration of these cells to bone marrow, where they receive pro-survival signals and persist as quiescent cells. In the present study, we investigated the possible influence of treatment on the expression of CXCR4 and CXCL12 in peripheral blood cells of CML patients. Methods: Relative expressions (RE) were calculated from mRNA obtained from leukocytes of 21 patients in chronic phase, under treatment, and 54 healthy individuals, used as controls.Results: CXCR4 expression was increased in CML patients compared to controls (RE: 1.931; p = 0.006). In CML patients, CXCR4 and CXCL12 expressions were correlated (r = 0.631; p = 0.002), and no differences in the expression of these genes were observed among different treatment protocols. However, CXCR4 expression was positively correlated with imatinib treatment period duration of treatment (r = 0.56; p = 0.02). Conclusion: This data has pointed peripheral blood CXCR4 expression as a possible marker for treatment monitoring, which may be useful to predict which patients would be benefit from newly developed treatments targeting CXCR4 and BCR/ABL concomitantly
Uranium and radium activities measurements and calculation of effective doses in some drinking water samples in Morocco
Get PDFPurpose: As a way of prevention, we have measured the activities of uranium and radium isotopes (234U, 238U, 226Ra, 228Ra) for 30 drinking water samples collected from 11 wells, 9 springs (6 hot and 3 cold), 3 commercialised mineral water, and 7 tap water samples. Methods: Activities of the Ra isotopes were measured by ultra-gamma spectrometry using a low background and high efficiency well type germanium detector. The U isotopes were counted in an alpha spectrometer.Results: The measured Uranium and radium activities are similar to those published for other non-polluting regions of the world. Except in one commercialised gaseous water sample, and in two hot spring water samples, the calculated effective doses during one year are inferior to the reference level of 0.1 mSv/year recommended by the International Commission on Radiological Protection. Conclusion: These activities don't present any risk for public health in Morocco. The sparkling water of Oulmes is occasionally consumed as table water and waters of warm springs are not used as main sources of drinking water.
An analysis of the demographic profile, clinical manifestations, investigations and outcome of paediatric myelodysplastic syndrome: A single centre, cross-sectional study
Get PDFPurpose: Pediatric myelodysplastic syndrome (MDS) is a relatively rare entity, with distinct clinical features and more aggressive course than its adult counterpart. The aim of this study was to analyze the incidence of pediatric myelodysplastic syndrome at a tertiary cancer care center in southern India along with clinical manifestations, investigations and outcome.Methods: On retrospective analysis of 1094 cases of pediatric hematological malignancies over a five-year period from September 2009 to August 2014, a total of seven cases of pediatric myelodysplastic syndrome were identified. Presenting complaints, physical examination, investigations including haemogram, biochemistry, bone marrow examination and cytogenetics were reviewed. The diagnosis of MDS was made if there was dysplasia in at least 10% of cells in two or more cell lineages. All patients were risk stratified using the revised IPSS. Results: Out of 1094 cases of pediatric hematological malignancies presenting at our institute within the study period, there were only seven cases of pediatric MDS with an incidence of 0.65%. There were no genetic predispositions nor any cases of therapy related MDS. The most common presentation was with fever and all patients had significant splenomegaly. All patients had anemia (Median-6.2 gm / dL) with elevated WBC counts (Median-30,900 / uL) and thrombocytopenia (Median-50,000 / uL). The marrow cytogenetics was normal in five patients. Most patients fell into the high and very high-risk category of the revised IPSS, with only two patients of low risk. All seven patients were given only supportive care but one progressed to AML for which he was treated with remission induction. Only two patients were alive at the time of analysis and median survival was 9 months. Conclusion: Pediatric MDS is a rare disease with a short clinical history, aggressive course and generally poor outcomes as compared to the adult variant. A hematopoietic stem cell transplant may be the only viable option for survival.