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Purpose: This phase II trial aimed to evaluate the efficacy and safety of docetaxel, cisplatin, and fluorouracil (DCF) combination in neoadjuvant setting in patients with locally advanced gastric adenocarcinoma. Methods: Fifty-nine patients with resectable or unresectable locally advanced gastric and gastroesophageal cancer were recruited in this multicenter, single-arm, open-label, local clinical phase II study conducted at three centers from Turkey between June 2006 and March 2012. Patients had T3-4 or lymph node-positive disease. After staging with imaging and laparotomy or laparoscopy, they received three cycles of DCF with lenograstim. Imaging studies were repeated after the last two cycles. Patients who underwent surgery were followed up for at least 1 year after the surgery. Toxicity and response were evaluated in accordance with NCI-CTC version3.0 and RECIST 1.0. Results: At baseline, 66.1 % of patients were considered resectable. In 47 patients evaluable, partial response in 16 (34.0 %), stable disease in 27 (57.5 %), and progressive disease in four (8.5 %) were observed. Forty-six patients underwent surgery. In 38 (64.4 %; 95 % confidence interval (CI) 52.2-76.6 %) out of 59 patients, complete resection (R0) was achieved. Median overall and disease-free survival were 19.1 months (95 % CI 13.5-24.7) and 11.6 months (95 % CI 5.9-17.4), respectively. The most frequent grade 3-4 adverse events were neutropenia (52.5 %), febrile neutropenia (11.9 %), leukopenia (39.0 %), and diarrhea (10.5 %). One patient died from an unknown cause. Conclusions: Classical DCF triplet with lenograstim showed a good clinical response with acceptable safety profile in the treatment of locally advanced gastric and gastroesophageal cancer with a significant R0 rate and manageable toxicity. [ABSTRACT FROM AUTHOR]

Background: Although neoadjuvant chemotherapy (NCT) is widely used, it is not clear which subgroup of locally advanced non-small-cell lung cancer (NSCLC) patients should be treated with this approach, and if a particular benefit associated with NCT exists. In this study, we aimed to investigate the potential correlates of benefit from NCT in patients with NSCLC. Methods: All randomized clinical trials (RCTs) utilizing a NCT arm (without radiotherapy) versus a control arm before surgery were included for metaregression analysis. All regression analyses were weighed for trial size. Separate analyses were conducted for trials recruiting patients with different stages of disease. Previously published measures of treatment efficacy were used for the purpose of this study, regardless of being published in full text or abstract form. Results: A total of 14 RCTs, consisting of 3,615 patients, were selected. Histology, stage, various characteristics of the NCT protocol, and different trial features including trial quality score were not associated with the benefit of NCT. However, in trials of stage 3 disease only, there was a greater benefit in terms of reduction in mortality from NCT, if protocols with three chemotherapeutics were used (B = ?0.18, t = ?5.25, P = 0.006). Conclusions: We think that patients with stage 3 NSCLC are served better with NCT before surgery if protocols with three chemotherapy agents or equally effective combinations are used. In addition, the effect of neoadjuvant chemotherapy is consistent with regard to disease and patient characteristics. This finding should be tested in future RCTs or individual patient data meta-analyses. [ABSTRACT FROM AUTHOR]

Although rare, thymoma is the most frequent type of malignancy in the anterior mediastinum. On most occasions, radiological diagnosis is easy, owing to current imaging studies like computerized tomography. Additionally, the radiological diagnosis of thymoma can be differentiated easily from malignant pleural mesothelioma in most cases. However, thymoma's differentiation from lymphoma, thymic hyperplasia, or thymic remnants sometimes may pose diagnostic challenges. Here, we report a case of advanced thymoma mimicking malignant pleural mesothelioma, with circumferential encasement of the lung. A brief review of the literature with special reference to radiological imaging on thymoma also is presented. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on metastatic granular cell tumor.

Examines the association between myasthenia gravis (MG) and lymphoblastic lymphoma in the thymus in a 26-year-old male patient. Disease background; Presenting signs and symptoms; Treatment regimen; Patient treatment response.

AbstractObjectiveMethodsResultsConclusion\nPLAIN LANGUAGE SUMMARYTo evaluate the efficacy and safety of nivolumab in the second-line (2L) or later-line (LL) treatment of patients with locally advanced/metastatic non-small cell lung cancer (NSCLC) in real-life setting in Türkiye.This study was designed as a national, multi-center, retrospective study. The study population was evaluated in two groups for the line of nivolumab therapy: those receiving nivolumab in the 2L (Group 2L) and third-line (3L) or LL (Group 3L/LL). Efficacy was evaluated based on one-year overall survival (OS) and progression-free survival (PFS). Safety was evaluated based on treatment-related adverse events (AEs) and nivolumab discontinuation rate.Of 244 patients, 52.9% were in Group 2L and 47.1% were in Group 3L/LL. Demographic and clinical characteristics did not differ between the groups. In Group 2L and Group 3L/LL, one-year OS and PFS rates were 60.8% and 61.4% (p = 0.592) and 31.2% and 21.3% (p = 0.078), respectively. The objective response rate (ORR) was 34.7% in Group 2L and 27.3% in Group 3L/LL (p = 0.262). The percentage of patients reporting at least one AE in Groups 2L and 3L/LL was 34.9% and 43.5%, respectively (p = 0.169). Fatigue was the most common (16.4%) treatment-related AE in each group. The groups were comparable regarding the AE frequency. Nivolumab was discontinued in 61 patients in Group 2L and 53 patients in Group 3L/LL, with the most common reason being disease progression (57.4% and 66.0%, respectively).Nivolumab is safe and effective in the 2L or 3L/LL treatment of locally advanced/metastatic NSCLC and associated with acceptable AEs in real-life setting.Non-small cell lung cancer (NSCLC) is the most common type of lung cancer (around 85% of all lung cancers). Patients with NSCLC are usually diagnosed at advanced or metastatic stages. When cancer cells spread to other areas from where they first formed, it is called metastatic cancer. Surgery may not be a treatment option for such patients. Currently, immunotherapeutic agents are used in the treatment of NSCLC. Nivolumab is one of the approved immunotherapeutic agents in the treatment of patients with metastatic NSCLC, who have failed after receiving chemotherapy. Our study explored the efficacy and safety of nivolumab in real-life setting in Türkiye. Nivolumab effectiveness was evaluated by overall survival (OS) and progression-free survival (PFS) rates. OS indicates the proportion of patients who are still alive at a given time after diagnosis or treatment initiation. PFS refers to “the length of time during and after cancer treatment that a person lives with the disease but does not get worse.” In the present study, one-year OS for 244 patients who received nivolumab was 61.1% and one-year PFS was 26.4%. Nivolumab safety was evaluated based on the frequency of adverse events observed during nivolumab therapy. Of the patients 38.9% had at least one side effect, with fatigue being the most common (16.4%). Our results support the earlier studies and showed that nivolumab was a safe and effective agent and is associated with acceptable side effects. [ABSTRACT FROM AUTHOR]

Observes a patient in whom idiopathic thrombocytopenic purpura (ITP) with central nervous system haemorrhage was the first manifestation of recurrence in a patient with Hodgkin's disease who was in seemingly complete haematological remission. Background on the case study; Percentage of patients treated with corticosteroids wherein primary ITP complete remission is achieved.

OBJECTIVE The Bahrain National Tumor Board (NTB) was established by a decree issued by the Bahrain Supreme Health Council. Cancer cases are regularly referred to the NTB from all health facilities across the Kingdom. Our aim is to investigate the epidemiological trends of cancer in Bahrain during the period between 2016 and 2020. METHODS We reviewed the NTB data collected between February 2016 and February 2020. All the cancer cases submitted to the NTB Office from private and public hospitals in Bahrain from 1 February 2016 to 29 February 2020 were collected. RESULTS A total of 2,061 cancer cases were recorded. The median age at diagnosis was 56 years. Of the 2,061 cancer cases, 1,367 (66.4%) were female and 694 (33.6%) were male. Our study only considered solid tumor cases, which were 2,024 from the initial 2,061 cases. Among the 2,024 solid tumor cases, the top 5 cancers were breast (37.1%), colorectal (11.8%), thyroid (6.5%), prostate (5.9%), and head & neck (4.8%). In males, the top 5 cancers were colorectal (19.2%), prostate (17.3%), head & neck (10.1%), urinary bladder (7.2%), and lung (6.6%). In females, they were breast (55.2%), colorectal (8.0%), thyroid (7.3%), uterine (6.2%), and ovarian (3.22%) cancers. In the 1,173 cases with recorded stage, 44 (3.8%) were at stage 0, 198 (16.9%) at stage I, 347 (29.6%) at stage II, 299 (25.5%) at stage III, and 285 (24.1%) at stage IV. CONCLUSION The frequency distribution of cancer in the Kingdom of Bahrain differs from the rest of the world, with much higher percentages of breast and thyroid cancer, and fewer lung cancers in our study. They also present at late stages. We believe that we need to focus on prevention and early detection of cancer in Bahrain. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Little dose, huge toxicity: profound hematological toxicity of intrathecal methotrexate," by Fatih Kose and colleagues.

The successful results obtained in trials may not necessarily translate into prolonged survival of metastatic colorectal cancer (mCRC) patients in real life. This multinational registry study aimed to evaluate the real-life data effecting the survival of patients with mCRC. This is a multinational, retrospective registry study. Turkish and Greek mCRC patients diagnosed between 2005 and 2012, with at least 3 years of follow-up data or who died before 3 years of follow-up were included in the study. A total of 364 were included in the study. RAS and BRAF mutation rates were found to be 36% and 39%, respectively. As first-line therapy, 196 (54%) patients received bevacizumab and Anti-EGFR treatments in combination with chemotherapy. The objective response rate was 42% (n = 152) and 32% (n = 78) for 1st line and 2nd line treatments, respectively. While the median progression-free survival (PFS) with the 1st line treatment was 10 months, it was 7 months with the 2nd line treatments. In the total study population median PFS and overall survival (OS) were 10 (95% CI, 8.3–11.6) and 35 (95% CI, 30.7–39.2) months, respectively. In Turkish and Greek patients, median OS (36 months versus 29 months, p =.81) and PFS (10.2 versus 9.2, p =.42) were not different. In multivariate analysis, ECOG PS of ≥2 and having metastases in more than one region decreased overall survival (p =.002 and p =.003), it was found that wild RAS and BRAF mutations and second metastasectomy contributed to overall survival (p =.047 and p <.001). In conclusion, it seems that the patient's performance status, tumor location, number of metastatic lesions at the time of diagnosis affect the prognosis of mCRC. Although access to molecular tests and first-line treatments differ between Greece and Turkey, no significant difference was found in survival times. [ABSTRACT FROM AUTHOR]

Metastatic insulinomasmay sometimes present with recurrent life-threatening hypoglycemia episodes. Such patients usually fail to respond to various therapeutic agents which causes constant dextrose infusion requirement. Herein, we present a resistant case of inoperable malignant insulinoma who was treated with many therapeutic agents and interventions including somatostatin analogues, Yttrium-90 radioembolization, everolimus, radiotherapy, and chemoembolization. Close blood sugar monitorization during these therapies showed themost favourable response with everolimus. Everolimus treatment resulted in rapid improvement of hypoglycemia episodes, letting us discontinue dextrose infusion and discharge the patient. However, experience with everolimus in such patients is still limited, and more precise data can be obtained with the increasing use of this agent for neuroendocrine tumours. [ABSTRACT FROM AUTHOR]

Limited number of experimental and clinical studies showed rapid tumor regrowth after bevacizumab cessation in advanced colorectal cancer. We retrospectively evaluated rapid regrowth phenomenon in 105 patients those who were treated with the predefined number of chemotherapy cycles and grouped according to whether the chemotherapy regimen in the first line setting included bevacizumab (CT-Bev arm) or not (CT arm). Median age was 55 years old. Median overall and progression free survival times were 27 and 11 months, respectively. Rapid progression rates were 42% and 40% in CT arm and CT-Bev arm without no statistically significant difference (p= 0.84). In CT arm, significantly more patients with stable disease (SD) progressed rapidly compared to patients with complete (CR) or partial response (PR) (53% vs. 27%, p= 0.04). This result was also similar in CT-Bev arm (48% vs. 30%, p= 0.27) but could not reach to the significant p-value. Overall survival 2, the time from the end of last dose of chemotherapy +/- bevacizumab to death, was significantly shorter in both CT and CT-Bev arms for patients who showed SD compared to CR or PR (15 vs 38 months) (p< 0.001). Current study supports that withdrawal of bevacizumab after predefined treatment cycles may not have any adverse effect on patients' outcome of advanced CRC. This result is particularly acceptable for the patients who show CR or PR to the treatment. [ABSTRACT FROM AUTHOR]

Purpose: Subcutaneous central venous port catheters (SCVPC) are of great importance in the treatment of patients with malignancies since they provide secure vascular access. Our aim was to assess the impact of long-term catheter care frequency on the frequency of port-related complications. Patients and methods: Two hundred and seven patients who had not been on active chemotherapy through their SCVPC for at least 3 months were enrolled into the study. Those who received catheter care every 3 months or more frequently were assigned to the frequent care group, and the others to the infrequent care group. The patients were examined for port-related complications and thrombosis including port occlusion. Routinely in our clinic, catheter care was done by using 300 IU of heparin. Results: According to the frequency of SCVPC care, 49 (23.7 %) patients were in the frequent care group and 158 (76.3 %) were in the infrequent care group. Median follow-up of all patients was 671 days (range 133-1712). Median frequency of port care in the frequent care group was 90 days (range 30-90), but 441.5 days in the infrequent care group (range 91-1630). None of the patients experienced port-related severe complications during the follow-up time. None of them presented with port occlusion. When the groups were analysed for thrombus (symptomatic and asymptomatic), there was no statistically significant difference (6.4 vs 13.8 %, p = 0.17). Those patients who had received more than first-line chemotherapy were found to have more thrombi than the patients who were treated with only one type of chemotherapy protocol (28.6 vs 10.2 %, p = 0.01), and the patients who had metastatic disease at the last control were found out to have thrombi more frequently than the non-metastatic patients (24.3 vs 9.3 %) ( p = 0.01). Conclusions: In the present study, there was no difference in port-related severe complications between frequent and infrequent care groups during follow-up. However, the rate of thrombosis was slightly higher in the infrequent port care group. [ABSTRACT FROM AUTHOR]

There is a new improvement in oncology nearly in every day as a result of preclinical or clinical. As the number of publication per capita, Turkey is far behind the other developed European countries. For example, the number of publications in oncology field is 2.134.964 in the world, it is 15.576 in our country. The most important obstacles for clinical trials in Turkey may be listed as financial problems, difficulties of working conditions, time limitation due to work intensity, inadequate experienced/trained man-power, absence of assistance team at all steps of a scientific trial, difficulties faced during project planning and ethics committee submissions, and lack of motivation. In this article, we, as young oncologists, aimed to discuss the place of Turkey in areas of scientific and clinical trials in the world; underlying causes for inadequate number, type and quality of national studies and possible solution proposals in our country. [ABSTRACT FROM AUTHOR]

The introduction of cisplatin-based chemotherapy into clinical practice has resulted in a substantial improvement of relapse-free and long-term survival of patients with testicular germ cell tumors. Late relapse (LR) of testicular cancer has recently been described as a unique entity. It is currently defined as tumor recurrence more than 2 years after complete remission following primary treatment, including chemotherapy. The incidence ranges from 2 to 6%, with a median relapse-free interval of 5.4-7.1 years from the initial treatment. Authors report a case of nonseminomatous germ cell tumor of the testis that recurred 15 years after the completion of first-line therapy. Though a few such late relapses have been observed, this condition remains extremely rare. Although the majority of recurrences are encountered in the first 2 years after treatment and later recurrences are rare, their time-course and pattern have implications for long-term follow-up. [ABSTRACT FROM AUTHOR]

The incorporation of a taxane into an anthracycline-containing regimen in the adjuvant treatment of breast cancer is a promising approach. In this study, we aimed to evaluate the safety and efficacy of four cycles of FEC (fluorouracil 500 mg/m2, epirubicin 70 mg/m2, cyclophosphamide 500 mg/m2, every 3 weeks) followed by four cycles of paclitaxel (175 mg/m2 every 3 weeks) in the adjuvant treatment of node-positive and other high-risk breast cancer patients. A total of 88 female patients were enrolled. Mean age (+/- SD) of the patients was 47 +/- 10 (min: 24; max: 71). The patients were followed for a median of 48 months (min: 20; max: 64). The most common side effects were nausea-vomiting (grade I-II: 91%; grade III: 2%), as well as hematological toxicity (grade I-II: 70%; grade III: 3%). Although all patients experienced some degree of toxicity, it was severe enough to be classified as grade III or IV in only 10 (11%) of the cases. Of note, six (8%) patients had grade I and only one (1%) had grade II cardiotoxicity. No grade III or IV cardiotoxicity was observed. The full eight cycles of study treatment could be administered to 75 patients (85%). Side effects necessitated the reduction of the doses of FEC and paclitaxel in one (1%) and three patients (3%), respectively. Median overall (OS) and disease-free survival (DFS) have not yet been reached. Five-year OS and DFS have been estimated to be 78% and 61%, respectively. We conclude that FEC followed by paclitaxel is a well-tolerated and feasible regimen in the adjuvant treatment of early breast cancer. Its efficacity is comparable with other commonly used regimens and merits evaluation in a phase III study. [ABSTRACT FROM AUTHOR]