Journal of B.U.ON. : official journal of the Balkan Union of Oncology
To determine the time elapsed between the first notification of the disease and the access to the... more To determine the time elapsed between the first notification of the disease and the access to the diagnosis and treatment modalities and the associated factors in female patients with breast cancer in Turkey. Data was acquired from a questionnaire involving 535 patients who applied to 14 various oncology clinics in Turkey between 1st and 28th of February 2010. Analyses were performed by the participating clinics and were divided into 3 groups: centers located in metropolitan areas formed group 1 (n=161), those located in Marmara and central Anatolia region formed group 2 (n=189), and centers located in Karadeniz and East-Southeast Anatolia region formed group 3 (n=185). The groups of these centers were formed according to the socioeconomic development of the provinces. The median patient age was 48 years, 56.1% of patients were less than 50 years of age. Eighty-five percent of the patients detected a mass in their breast by self examination and 27% of the patients older than 50 year...
Tryptophan Metabolism: Implications for Biological Processes, Health and Disease, 2015
Cancer is the uncontrolled division and accumulation of cells in any part of the body. Surgery, r... more Cancer is the uncontrolled division and accumulation of cells in any part of the body. Surgery, radiotherapy, and systemic therapies are the main treatment strategies against cancers. However, systemic chemotherapy has various side effects, including nausea, vomiting, myelosuppression, cardiotoxicity (with anthracyclines), neurotoxicity (with mitotic spindle poisons), and nephrotoxicity (with platinum analogs). Although surgery can be curative in some cases, the main purposes of cancer treatments, especially in metastatic cancer patients, are the palliation of symptoms and increasing survival with better quality of life. Increasing the efficacy and decreasing the toxicity of chemotherapeutic agents are currently the main challenges in cancer treatment, for which substantial effort has been given for years. Melatonin is a hormone produced in the pineal gland from the essential amino acid tryptophan. It is one of the strongest antioxidants identified, with additional chemopreventive, oncostatic, and tumor inhibitory effects in a variety of in vitro and in vivo experimental cancer models. In addition to melatonin synthesis, tryptophan is involved in numerous metabolic activities in the human body, including the biosynthesis of serotonin, kynurenine, and nicotinamide, thereby regulating circadian rhythm, learning, memory, sleep, behavior, mood, appetite, aging, growth, reproduction, immune system, and cancer development. Therefore, tryptophan-related metabolic pathways and catabolites have gained considerable attention, especially in improving cancer treatment and predicting disease activity as well as patient survival. This chapter mainly focuses on the relationship between tryptophan metabolism and chemotherapy; the prognostic value of tryptophan catabolites as cancer biomarkers, tryptophan metabolism, and cancer-related fatigue; the association between melatonin and cancer therapy as well as chemotherapy side effects; and the significance of chronochemotherapy after an initial brief introduction about chemotherapeutic agents.
Metastasis to the breast from extramammary malignancies is rare. A 35-year-old woman presented wi... more Metastasis to the breast from extramammary malignancies is rare. A 35-year-old woman presented with bilaterally inflammatory breast involvement, 2 years after the diagnosis of stage IIIC epithelial ovarian cancer. Neoplastic tissue was immunohistochemically positive using antibodies against OC125 and negative for gross cystic disease fluid protein-15 (BRST-2) and estrogen receptor in biopsy material in the breast. Combination chemotherapy consisting of paclitaxel, cisplatin, and anthracycline was started. She died 18 months after the breast metastasis. Ovarian carcinoma usually presents with signs and symptoms related to the tumor burden within the abdominal cavity. The finding of isolated, distant metastases such as breast involvement without intraabdominal disease is extremely rare. Determining the origin of the primary tumor is important in directing the actual therapy.
... Catherine A Duggan BPharm (Hons) PhD MRPharmS Director Academic Department of Pharmacy Barts ... more ... Catherine A Duggan BPharm (Hons) PhD MRPharmS Director Academic Department of Pharmacy Barts and The London NHS Trust London, United Kingdom Pedro L Mata MD Medical Doctor, Imunoaerologist British Hospital Lisboa, Portugal Margarida Caramona PharmD ...
629 Background: Adjuvant trastuzumab (T) improves DFS in early breast cancer. However the optimal... more 629 Background: Adjuvant trastuzumab (T) improves DFS in early breast cancer. However the optimal duration of adjuvant T is under debate. Some of the oncologists in Turkey prefer to give 9 weeks of adjuvant T for several reasons. Turkish Oncology Group decided to compare the outcome of 9 weeks and 52 weeks of adjuvant T in an observational study. METHODS Names of the patients with c-ErbB2:3+ or FISH positive disease who were registered to receive adjuvant T were obtained from Ministry of Health.The records of 690 patients who received adjuvant T beginning from November 2006 to December 2009 were reached and follow-up were obtained from their oncologists. Nine weeks and up to 52 weeks of T was given to 204 and 486 patients respectively. In 34 out of 486 patients T was stopped before 52 weeks for several reasons other than toxicity and disease progression. RESULTS Patient characteristics are shown in the table. Median follow-up from initiation of T was 22 months. While no cardiac toxicity causing interruption T was observed in the 9 weeks T group, it was 3.3% in the >9 weeks T group. Disease-free survival (DFS) at 2 years was 85.6% and 85.4% in 9 weeks and >9 weeks groups respectively. According to unadjusted Cox regression analysis HR was 0.934 (95 %CI:0.552-1.580; p:0.28). Analysis with adjusted cox regression gave a HR of 0.727 (95 %CI:0.408-1.295;p:0.28). CONCLUSIONS No significant inferiority for 9 weeks of adjuvant T when compared to longer duration was observed at this time. Follow-up at 3 and 5 years were planned. [Table: see text].
The incidence of multiple primary cancers is reported to be 0.3-4.3%. A 70-year-old man was admit... more The incidence of multiple primary cancers is reported to be 0.3-4.3%. A 70-year-old man was admitted to the hospital because of fatigue, weight loss, epigastric pain with melena. A biopsy taken from a tumoral lesion in the gastric corpus revealed squamous cell carcinoma. A nodular lesion was also detected on the nasal columella and biopsy from this lesion also showed squamous cell carcinoma. Computed tomography performed as a part of metastatic work-up revealed a lesion in the left pulmonary lower lobe. Bronchoscopic biopsy from this lesion also demonstrated squamous cell carcinoma. We report a case with synchronous squamous cell carcinoma of the lung, skin and stomach and discuss the multiple synchronous occurrence of carcinoma with the same histopathology in different sites with a review of the literature.
Forty patients with primary malignant brain tumor were treated by combination chemotherapy after ... more Forty patients with primary malignant brain tumor were treated by combination chemotherapy after prior treatment with surgery and radiotherapy. The chemotherapy schedule consisted of PCV: procarbazine per os, 100 mg/m2, during 14 consecutive days; CCNU, per os, 80 mg/m2 on day 1 and vincristine, intravenously, 1.4 mg/m2 on days 1 and 14. This protocol was planned to be repeated every 45 days for 6 courses. Median 5 courses (range, 2-6) of chemotherapy was administered to patients. The median relapse free (RFS) and overall survival (OS) rates were found to be 28 and 79+ months, respectively. According to univariate analysis, performance status (PS) of patients was an important prognostic factor on RFS and OS where extent of surgery was an additional significant determinant of OS. Multivariate analysis of pretreatment factors revealed the influence of sex, type of histopathology and PS on RFS and that of PS on OS rates (P < 0.05). The toxicity of this regimen was mild to moderate. The major toxicity noted was myelosuppression. Severe (grade III-IV) neutropenia and thrombocytopenia has been observed in 13 (7%) and 6 courses (3.5%), respectively. In general, PCV is well tolerated and the median RFS and OS times elucidated are comparable with particular trials utilizing combination chemotherapy and longer than using radiotherapy alone.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
To determine the time elapsed between the first notification of the disease and the access to the... more To determine the time elapsed between the first notification of the disease and the access to the diagnosis and treatment modalities and the associated factors in female patients with breast cancer in Turkey. Data was acquired from a questionnaire involving 535 patients who applied to 14 various oncology clinics in Turkey between 1st and 28th of February 2010. Analyses were performed by the participating clinics and were divided into 3 groups: centers located in metropolitan areas formed group 1 (n=161), those located in Marmara and central Anatolia region formed group 2 (n=189), and centers located in Karadeniz and East-Southeast Anatolia region formed group 3 (n=185). The groups of these centers were formed according to the socioeconomic development of the provinces. The median patient age was 48 years, 56.1% of patients were less than 50 years of age. Eighty-five percent of the patients detected a mass in their breast by self examination and 27% of the patients older than 50 year...
Tryptophan Metabolism: Implications for Biological Processes, Health and Disease, 2015
Cancer is the uncontrolled division and accumulation of cells in any part of the body. Surgery, r... more Cancer is the uncontrolled division and accumulation of cells in any part of the body. Surgery, radiotherapy, and systemic therapies are the main treatment strategies against cancers. However, systemic chemotherapy has various side effects, including nausea, vomiting, myelosuppression, cardiotoxicity (with anthracyclines), neurotoxicity (with mitotic spindle poisons), and nephrotoxicity (with platinum analogs). Although surgery can be curative in some cases, the main purposes of cancer treatments, especially in metastatic cancer patients, are the palliation of symptoms and increasing survival with better quality of life. Increasing the efficacy and decreasing the toxicity of chemotherapeutic agents are currently the main challenges in cancer treatment, for which substantial effort has been given for years. Melatonin is a hormone produced in the pineal gland from the essential amino acid tryptophan. It is one of the strongest antioxidants identified, with additional chemopreventive, oncostatic, and tumor inhibitory effects in a variety of in vitro and in vivo experimental cancer models. In addition to melatonin synthesis, tryptophan is involved in numerous metabolic activities in the human body, including the biosynthesis of serotonin, kynurenine, and nicotinamide, thereby regulating circadian rhythm, learning, memory, sleep, behavior, mood, appetite, aging, growth, reproduction, immune system, and cancer development. Therefore, tryptophan-related metabolic pathways and catabolites have gained considerable attention, especially in improving cancer treatment and predicting disease activity as well as patient survival. This chapter mainly focuses on the relationship between tryptophan metabolism and chemotherapy; the prognostic value of tryptophan catabolites as cancer biomarkers, tryptophan metabolism, and cancer-related fatigue; the association between melatonin and cancer therapy as well as chemotherapy side effects; and the significance of chronochemotherapy after an initial brief introduction about chemotherapeutic agents.
Metastasis to the breast from extramammary malignancies is rare. A 35-year-old woman presented wi... more Metastasis to the breast from extramammary malignancies is rare. A 35-year-old woman presented with bilaterally inflammatory breast involvement, 2 years after the diagnosis of stage IIIC epithelial ovarian cancer. Neoplastic tissue was immunohistochemically positive using antibodies against OC125 and negative for gross cystic disease fluid protein-15 (BRST-2) and estrogen receptor in biopsy material in the breast. Combination chemotherapy consisting of paclitaxel, cisplatin, and anthracycline was started. She died 18 months after the breast metastasis. Ovarian carcinoma usually presents with signs and symptoms related to the tumor burden within the abdominal cavity. The finding of isolated, distant metastases such as breast involvement without intraabdominal disease is extremely rare. Determining the origin of the primary tumor is important in directing the actual therapy.
... Catherine A Duggan BPharm (Hons) PhD MRPharmS Director Academic Department of Pharmacy Barts ... more ... Catherine A Duggan BPharm (Hons) PhD MRPharmS Director Academic Department of Pharmacy Barts and The London NHS Trust London, United Kingdom Pedro L Mata MD Medical Doctor, Imunoaerologist British Hospital Lisboa, Portugal Margarida Caramona PharmD ...
629 Background: Adjuvant trastuzumab (T) improves DFS in early breast cancer. However the optimal... more 629 Background: Adjuvant trastuzumab (T) improves DFS in early breast cancer. However the optimal duration of adjuvant T is under debate. Some of the oncologists in Turkey prefer to give 9 weeks of adjuvant T for several reasons. Turkish Oncology Group decided to compare the outcome of 9 weeks and 52 weeks of adjuvant T in an observational study. METHODS Names of the patients with c-ErbB2:3+ or FISH positive disease who were registered to receive adjuvant T were obtained from Ministry of Health.The records of 690 patients who received adjuvant T beginning from November 2006 to December 2009 were reached and follow-up were obtained from their oncologists. Nine weeks and up to 52 weeks of T was given to 204 and 486 patients respectively. In 34 out of 486 patients T was stopped before 52 weeks for several reasons other than toxicity and disease progression. RESULTS Patient characteristics are shown in the table. Median follow-up from initiation of T was 22 months. While no cardiac toxicity causing interruption T was observed in the 9 weeks T group, it was 3.3% in the >9 weeks T group. Disease-free survival (DFS) at 2 years was 85.6% and 85.4% in 9 weeks and >9 weeks groups respectively. According to unadjusted Cox regression analysis HR was 0.934 (95 %CI:0.552-1.580; p:0.28). Analysis with adjusted cox regression gave a HR of 0.727 (95 %CI:0.408-1.295;p:0.28). CONCLUSIONS No significant inferiority for 9 weeks of adjuvant T when compared to longer duration was observed at this time. Follow-up at 3 and 5 years were planned. [Table: see text].
The incidence of multiple primary cancers is reported to be 0.3-4.3%. A 70-year-old man was admit... more The incidence of multiple primary cancers is reported to be 0.3-4.3%. A 70-year-old man was admitted to the hospital because of fatigue, weight loss, epigastric pain with melena. A biopsy taken from a tumoral lesion in the gastric corpus revealed squamous cell carcinoma. A nodular lesion was also detected on the nasal columella and biopsy from this lesion also showed squamous cell carcinoma. Computed tomography performed as a part of metastatic work-up revealed a lesion in the left pulmonary lower lobe. Bronchoscopic biopsy from this lesion also demonstrated squamous cell carcinoma. We report a case with synchronous squamous cell carcinoma of the lung, skin and stomach and discuss the multiple synchronous occurrence of carcinoma with the same histopathology in different sites with a review of the literature.
Forty patients with primary malignant brain tumor were treated by combination chemotherapy after ... more Forty patients with primary malignant brain tumor were treated by combination chemotherapy after prior treatment with surgery and radiotherapy. The chemotherapy schedule consisted of PCV: procarbazine per os, 100 mg/m2, during 14 consecutive days; CCNU, per os, 80 mg/m2 on day 1 and vincristine, intravenously, 1.4 mg/m2 on days 1 and 14. This protocol was planned to be repeated every 45 days for 6 courses. Median 5 courses (range, 2-6) of chemotherapy was administered to patients. The median relapse free (RFS) and overall survival (OS) rates were found to be 28 and 79+ months, respectively. According to univariate analysis, performance status (PS) of patients was an important prognostic factor on RFS and OS where extent of surgery was an additional significant determinant of OS. Multivariate analysis of pretreatment factors revealed the influence of sex, type of histopathology and PS on RFS and that of PS on OS rates (P < 0.05). The toxicity of this regimen was mild to moderate. The major toxicity noted was myelosuppression. Severe (grade III-IV) neutropenia and thrombocytopenia has been observed in 13 (7%) and 6 courses (3.5%), respectively. In general, PCV is well tolerated and the median RFS and OS times elucidated are comparable with particular trials utilizing combination chemotherapy and longer than using radiotherapy alone.
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