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In Renal cell cancer biology (RCC), with vascular endothelial growth factor and diagnosing of mammalian target of rapamycin B pathway, new options (targeted drugs) are developed in therapy. With Targeted Drugs, new period started now in the RCC treatment which has limited treatment option at one time. Then bevasizumab, temsirolimus, everolimus and pazopanib were added to workings that initially started with sunitinib and sorafenib. Although antitumoral effects of drugs are similar in these treatment options, differences are seen in clinical effects and toxicity. Therefore, early determination of adverse effects that are associated with treatment and direction of treatment will improve patient's quality of life and unnecessary dose reduction won't occur., Renal hücreli kanser (RCC) biyolojisinde vasküler endotelyal growth faktör ve mammalian target of rapamycin B yolağının tanımlanması ile tedavide yeni seçenekler geliştirilmiştir. Bu yeni seçenekler (hedefe yönelik ilaçlar) ile birlikte, bir zamanlar sınırlı tedavi seçeneği olan RCC tedavisinde artık yeni bir dönem başlamıştır. Başlangıçta sunitinib ve sorafenib ile başlayan çalışmalara daha sonra bevasizumab, temsiroli-mus, everolimus ve pazopanib eklenmiştir. Hedefe yönelik ilaçların antitümoral etkileri benzer olsada klinik etki ve toksisitede farklılıklar vardır. Bu nedenle tedavi ile ilişkili yan etkilerin erken saptanması ve tedavinin yönlendirilmesi hastanın yaşam kalitesini artıracak, gereksiz doz redüksiyonları olmayacaktır.

In this study, patients who received adjuvant chemotherapy for locally advanced bladder cancer were retrospectively analyzed. A total of 32 patients received gemcitabine (%18.8), cisplatin plus gemcitabine (%50), carboplatin plus gemcitabine (%15,6) or MVAC (Methotrexate, vinblastine, doxorubicin, and cisplatin). The most common adverse effect was myelosuppression during chemotherapy administration. Treatment-related died was not observed. The median overall and disease-free survival was 23 months (range, 18.7-27.4) and 17.8 months (range, 12.7-22.9), respectively. We concluded that our results were comparable to those in the literature., Bu çalışmada, lokal ileri mesane kanseri nedeniyle adjuvant kemoterapi alan hastalar retrospektif olarak analiz edildi. Toplam 32 hasta gemsitabin (%18.8), sisplatin+gemsitabin (%50), carboplatin+gemsitabin (%15.6) veya MVAC (Metotreksat, vinblastin, doksorubisin ve sisplatin) (%15.6) tedavisi aldı. Tedaviler sırasında en sık görülen yan etki kemik iliği toksisitesi idi. Tedaviye bağlı ölüm gözlenmedi. Medyan genel ve hastalıksız sağkalım süreleri sırasıyla 23 ay (18.7-27.4) ve 17.8 ay (12.7-22.9) idi. Verilerimizin literatür ile uyumlu olduğu sonucuna varıldı.

Pre-treatment serum levels of AFP, CEA and CA 19-9 were retrospectively investigated in 70 patients with locally advanced and metastatic gastric cancer. The positivity rates for these markers were 55.7%, 40% and 32.9%, respectively. Multiple logistic regression analysis for positive levels of tumor markers indicates that AFP positivity is significantly related to the presence of hepatic metastasis and resectability rates (p=0.041), CEA positivity is related to advance stage (p=0.011), tumor size (p=0.004), presence of hepatic metastasis (p=0.001), the frequency of serosal invasion (p=0.004) and resectability rates (p=0.011). Finally, CA 19-9 positivity is related to advance stage (p=0.006), tumor size (p=0.002), the frequency of serosal invasion (p=0.002), the frequency of peritoneal metastasis (p=0.005) and ascites (p=0.005). In summary, in cancer patients, the use of tumor markers for the decision of treatment might indicate the existence of any organ metastasis which could not be clinically or radiologically revealed., Lokal ileri ve metastatik mide kanserli 70 hastanın tedavi öncesi AFP, CEA ve CA 19-9 serum seviyeleri retrospektif olarak araştırıldı. Bu markerlar için pozitiflik oranı sırasıyla %55.7, %40 ve %32.9 bulundu. Tümör belirteçlerinin pozitif seviyeleri için univaryet analizleri, AFP pozitifliğinin karaciğer metastaz varlığı (p=0.033) ve rezektabilite oranı ile anlamlı ilişkisinin olduğunu (p=0.041), CEA pozitifliğinin ileri tümör evresi (p=0.011), tümör boyutu (p=0.004), karaciğer metastaz varlığı (p=0.001), serozal invazyon sıklığı (p=0.004) ve rezektabilite (p=0.011) ile anlamlı ilişkisinin olduğunu ve son olarak CA 19.9 pozitifliğinin ileri tümör evresi (p=0.006), tümör boyutu (p=0.002), serozal invazyon sıklığı (p=0.002), periton metastaz sıklığı (p=0.005) ve asit gelişimi (p=0.005) ile anlamlı ilişkisinin olduğunu gösterdi. Sonuç olarak, kanser hastalarında tedavi kararı verilirken tümör markeri kullanımı, klinik ve radyolojik olarak tespit edilemeyen uzak organ metas-taz varlığını gösterebilir.

In solid organ tumors, the increasing use of alkalizing agents and topoisomerases have increased the incidence of secondary leukemia in connection with extension of the life expectancy of cancer patients. The treatment related leukemia forms 10-20% of all cases of leukemia. Our case was diagnosed with endometrium cancer in March 2008 and during follow up of sisplatin-doxorubisin-radiotherapy treatment thrombocytopenia was detected. Then upon investigation of the bone marrow material our case was diagnosed with AML M4 based on French American British (FAB) classification AML M4 and then the diagnoses was verified after molecular cytogenetic (FISH) analysis conducted on bone marrow material, since inv 16 was positive. Our patient died in a short time because of complications related to leukemia. If after treatment of primary malign tumors the hematologic conditions are monitored carefully, even for a short term, AML might be detected related to various treatments. To conclude, we consider our case to be of importance since acute leukemia has developed with inv 16 positivity within a very short period of five months after treatment, which is a case rarely observed in the literature., Solid organ tümörlerinde alkilleyici ajanların ve topoizomerazların yaygın kullanılmaya başlanması kanser hastalarının yaşam süresinin uzamasına bağlı olarak ikincil lösemi insidansını arttırmıştır. Tedavi ilişkili lösemiler tüm lösemilerin yaklaşık %10-20 sini oluşturur. Olgumuz Mart 2008 tarihinde endometrium kanseri tanısı almış olup, sisplatin-doksorubisin-radyoterapi tedavisi sonrası takiplerinde trombositopeni saptandı. Bunun üzerine yapılan kemik iliği materyali değerlendirilmesi sonucunda French American British (FAB) sınıflamasına göre AML M4 tanısı alan olgumuzun kemik iliği materyaline yapılan moleküler sitogenetik (FISH) analizinde de inv 16 pozitif olarak bulularak tanı doğrulandı. Olgumuz, kısa sürede lösemiye bağlı komplikasyonlar nedeniyle kaybedildi. Primer malignitenin tedavisi takibinde kısa süre bile olsa hematolojik durumlar dikkatli olarak incelenirse bir çok tedavi bağımlı AML saptanabilir. Sonuç olarak, tedaviyle ilişkili akut löseminin 5 ay gibi kısa sürede gelişen ve inv 16 pozitif saptanan endometrium kanserli olgumuz, literatürde nadir görülmesi sebebiyle önem taşımaktadır.

Primary mediastinal B-cell lymphoma (PMBL) is a rare neoplasm that develops from thymic medullary B cells in the mediastinum. It covers about 2-3% of all non-hodgin lymphomas. Despite its identification in 1980s, the optimal treatment is controversial. Although late relapse is rare, it usually develops within the first year of treatment. A 33 year-old woman had an anterior mediastinal mass was diagnosed with lymphoma, which was confirmed with biopsy. Despite not having lympoadenopathy and hepatosplenomegaly, PET was consistent with PMBL. The patient was treated with 6 cycles of R-CHOP and then with radiotherapy to mediastinum. After treatment, we observed a complete response. With close follow up, we did not see any relapse at the end of first year., Primer mediastinal B hücreli lenfoma (PMBL), mediastende timik meduller B hücrelerinden gelişen nadir görülen bir neoplazmdır. Tüm nonhodgin lenfomaların %2-3'ünü oluşturur. 1980'li yıllarda tanımlanmasına rağmen optimal tedavi tartışmalıdır. PMBL'da geç relaps nadir olup çoğunlukla tedavi sonrası ilk bir yılda gelişir. Ön mediastende kitle saptanan 33 yaşındaki kadın olguda çekilen positron emission tomografi sonucu ve yapılan biyopsi ile birlikte PMBL tanısı konuldu. Hasta 6 kür R-CHOP ve sonrasında mediastene radyoterapi ile tedavi edildi. Düzenli aralıklarla takip edilen olguda ilk bir yılın sonunda relaps gözlenmedi.

Adrenocortical carcinoma (ACC) is a rare and aggressive tumor with a poor prognosis. In this study, we retrospectively evaluated clinical features and treatment results of our ACC patients. A total of eight patients with ACC were treated in our department. All patients had metastatic disease. Patients received etoposide, doxorubicin and cisplatin (EAP) or etoposide and cisplatin regimen (EP). Stabile disease was observed in four patients and progressive disease in four. At a mean follow up 7.7 months (range, 3-15 months) 5 patients died from progressive disease. Our findings reflect the aggressive nature of ACC., Adrenokortikal karsinom (AKK) nadir ve agresif bir tümor olup prognozu kötüdür. Bu çalışmada, AKK hastalarımızın klinik özellikleri ve tedavi sonuçları retrospektif olarak değerlendirildi. Departmanımızda, toplam sekiz AKK'lu hasta tedavi edildi. Hastaların tamamında metastaz mevcuttu. Hastalara etoposid, doksorubisin ve sisplatin (EAP) veya etoposid ve sisplatin (EP) rejimi uygulandı. Dört hastada stabil hastalık, diğer dört hastada ise progresyon olduğu gözlendi. Ortalama 7.7 aylık (3-15 ay) takipte 5 hasta progresif hastalık nedeniyle öldü. Bulgularımız AKK'un agresif doğasını yansıtmaktadır.

Small cell carcinoma (SCC) of the prostate is a rare and extremely aggressive malignant disease. It constitutes less than 1% of all prostatic neoplasms. Frequently it presents at advanced stage with nodal or visceral metastasis and has a poor prognosis. From the existing data it is difficult to define an optimum treatment strategy for SCC of the prostate. Here, we present a case of SCC of the prostate with a brief review of the literature., Prostatın küçük hücreli karsinomu (KHK) nadir ve son derece saldırgan bir tümördür. Tüm prostat kanserlerinin %1'den daha azını oluşturur. Sıklıkla nodal veya visseral metastazlarla birlikte ileri evrede prezente olur ve kötü bir prognoza sahiptir. Mevcut verilerden yola çıkılarak prostat KHK için optimal bir tedavi şeklinin belirlenmesi zordur. Biz burada bir prostat KHK olgusunu literatür bilgileri ile birlikte sunuyoruz.

Association between H.pylori and gastric carcinoma was defined through retrospective and prospective epidemiological studies following the discovery of H.pylori, and it was described as a first-degree risk factor for gastric cancer by International Agency for Research on Cancer, a WHO Study Group, in 1994. However, the role of H.pylori in carcinogenesis remains unclear. A proposed mechanism is as follows: H.pylori associated chronic gastritis causes mutagenic free oxygen radicals to increase in the epithelial tissue and antioxidants acting in mucosal defence system to decrease. This in turn leads to mutagenic free oxygen radicals eventually causing DNA damage. It was also demonstrated that H. pylori results in hyperproliferation by changing epithelial kinetics. Thus, it can be concluded that the association of hyperproliferation with free radicals causes damages in the cell which could play a significant role in triggering carcinogenesis., H.pylori ile gastrik karsinogenez arasındaki ilişki retrospektif ve prospektif çalışmalarla ortaya konmuş ve 1994 yılında WHO çalışma grubu olan “International Agency for research on Cancer” tarafından, H.pylori gastrik kanser için Ι. derece risk faktörü olarak tanımlanmıştır. Buna rağmen H.pylori'nin gastrik karsinogenezdeki rolü açıklanamamıştır. Muhtemel kabul edilen mekanizma ise; H.pyloriye bağlı kronik gastritis sonucu gastrik epitelde serbest oksijen radikalleri artmakta ve mukozal antioksidan defans sistemi azalmaktadır ve serbest oksijen radikalleri DNA hasarına neden olmaktadır. H.pylori aynı zamanda gastrik epiteliyal hiperproliferasyona neden olduğu gösterilmiştir. Bu nedenle artmış serbest oksijen radikalleri ile gastrik hiperproliferasyonun birlikteliğinin gastrik karsinogenezde tetikleyici rol oynayabileceği düşünülmektedir.

The aims of the present study were to test activity and tolerability of cisplatin and etoposide in advanced non-small cell lung cancer (NSCLC) patients aged 70 years or higher. Twenty-four patients were enrolled. Cisplatin was given at a dose of 60 mg/m2 on day 1 and etoposide at a dose of 120 mg/m2 on days 1-3. Total 116 courses were administered. Twelve patients (50%) completed all six cycles of treatment. Three patients (12.5%) obtained a partial response, as well as 12 (50%) stable disease and 9 (37.5%) progressive disease. The median survival was 48.5 ± 6.06 weeks, and the 1 year survival rate was 38%. Grade 3-4 neutropenia occurred in 16.6% of patients, grade 4 thrombocytopenia in %4.1, and grade 1-2 neuropathy in 25%. One patient discontinued treatment due to grade 3 nephrotoxicity. In conclusion, cisplatin and etoposide regimen is active and relatively well-tolerated in the treatment of elderly NSCLC patients. New, active and well-tolerated combination regimens could improve present results., Bu çalışmanın amaçları 70 yaş ve üzeri ileri evre küçük hücreli dışı akciğer kanseri (KHDAK) hastalarında sisplatin ve etoposid tedavisinin aktivitesini ve tolerabilitesini araştırmaktı. Yirmi dört hasta çalışmaya alındı. Sisplatin 60 mg/m2 dozunda 1. günde ve etoposid 120 mg/m2 dozunda 1-3. günlerde verildi. Toplam 116 siklus uygulandı. On iki (%50) hasta altı siklus tedaviyi tamamladı. Üç hastada (%12.5) kısmi yanıt elde edilirken, 12 hastada (%50) stabil hastalık ve 9 hastada (%37.5) progresyon mevcuttu. Ortalama sağ kalım 48.5 ± 6.06 hafta ve 1 yıllık sağ kalım oranı %38'di. Grade 3-4 nötropeni hastaların %16.6'ında, grade 4 trombositopeni %4.1'nde ve grade 1-2 nöropati %25'inde görüldü. Bir hastada grade 3 nefrotoksisite nedeniyle tedavi sonlandırıldı. Sonuç olarak sisplatin ve etoposid yaşlı KHDAK hastalarının tedavisinde aktiftir ve nisbeten iyi tolere edilmektedir. Yeni, aktif ve iyi tolere edilen rejimler mevcut sonuçları iyileştirebilir.

It is known that Hodgkin's Disease has some epidemiological differences among countries. In our study, in Hematology Division of Medical Faculty of Uludağ University Hodgkin's Disease cases that were followed up and treated between the years 1978-1994 were assessed retrospectively according to parameters concerning age, sex, histopathologic subgroup, stage, occupation and region. It was established that of 86 Hodgkin's Disease cases (57% male, 43% female, mean age 38, the lowest age 14, the highest age 76), 61.6% were mixed cellularity. It was also determined that first peak was during 20-34 years of, second peak during 55-59 years of age. In accordance with Ann-Arbor stage classification 86% applied in advance stage (41.8% in stage III-B, 44.2% in stage IV). It was found that the rate of traders was 18.6%, workers 10.5%, farmers 16.3%, students 5.8%, civil servants 5.8%, housewives 43%. 74.4 percent of cases were living in the cities, 25.6% in the rural region. Consequently, we came to the conclusion that Hodgkin's Disease cases in southern Marmara region had bimodal age distribution, mixed cellularity type is predominant and that the cases applied to hospital during advance stages (stage III-B and IV)., Hodgkin Hastalığı'nın ülkeler arasında epidemiyolojik farklılıklar gösterdiği bilinmektedir. Çalışmamızda, Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı Hematoloji Bilim Dalı'nda 1978-1994 yılları arasında takip ve tedavi edilen toplam 86 Hodgkin Hastalığı olguları, yaş, cinsiyet, histolojik alt grup, evre ve yaşanılan bölge parametrelerine göre epidemiyolojik yönden incelendi. Erkeklerin %57, kadınların %43 oranlarını oluşturdukları, erkek/kadın oranı 1.3, ortalama yaş 38, en küçük yaş 14 ve en büyük yaş 71 olarak saptandı. Adolesan döneminden itibaren insidansın arttığı ve 20-34 yaşları arasında birinci, 55-59 yaşları arasında ikinci pik oluşarak bimodal yaş dağılımının bulunduğu tesbit edildi. Histolojik alt grup dağılımında %61.6 oranıyla mikst sellüler tipin hakim olduğu belirlendi. Ann Arbor Evrelemesine göre olguların %86 oranı ile ileri evrede (%41.8 evre III-B, %44.2 evre IV) müracaat ettikleri saptandı. Serbest meslek sahiplerinin (esnaf) %18.6, işçilerin %10.5, çiftçilerin %16.3, öğrencilerin %5.8, memurların %5.8, ev hanımlarının %43 oranlarını oluşturdukları ve olguların %74.4'nün kentte, %25.6'nın kırsal kesimde yaşadıkları tesbit edildi. Sonuç olarak; Güney Marmara Bölgesi Hodgkin Hastalığı olgularında bimodal yaş dağılımının bulunduğu, mikst sellüler alt grubun hakim olduğu ve olguların ileri evrede (evre III-B ve IV) hastahaneye müracaat ettikleri belirlendi.

Despite the demonstration of the protective effects of misoprostol, an oral prostaglandin E1 analogue, on the nephrotoxicity of non-steroidal antiinflammatory drugs (NSAID) and cyclosporine, its role in cisplatin nephrotoxicity has not been investigated. In our study, we planned to investigate cisplatin-induced acute renal failure and the efficacy of misoprostol on acute cisplatin nephrotoxicity. For this purpose, 28 lung cancer patients who had been planned to receive the cisplatin+etoposide chemotherapy regimen were included in the study. Patients then were divided into two groups. In addition to chemotherapy, Misoprostol group received misoprostol at the dose of 100 μg qid during the study. Control group received only chemotherapy. Renal functions were evaluated in both groups before the onset of chemotherapy and 2nd and 6th days of chemotherapy. In conclusion, it was demonstrated that misoprostol could not produce any protective effect on the functional disturbances due to cisplatin administration., Bir oral prostaglandin E1 analoğu olan misoprostolün steroid olmayan antienflamatuar ilaçlar (NSAID) ve siklosporin nefrotoksisitesinde protektif etkisi olduğu gösterilmesine karşın, cisplatin nefrotoksisitesindeki rolü incelenmemiştir. Çalışmamızda cisplatine bağlı gelişen akut böbrek yetmezliğinin ve misoprostolün akut cisplatin nefrotoksisitesindeki etkinliğinin incelenmesi amaçlanmıştır. Bu amaçla cisplatin+etoposid kemoterapi rejimi alması planlanan 28 akciğer kanserli hasta çalışmaya dahil edildi. Hastalar iki gruba ayrıldı. Misoprostol grubu kemoterapinin yanısıra çalışma süresince günde 4 kez 100 μg dozda misoprostol aldı. Kontrol grubu sadece kemoterapi aldı. Her iki grupta renal fonksiyonlar kemoterapi başlamasından önce ve kemoterapinin 2. ve 6. günlerinde değerlendirildi. Sonuç olarak, cisplatin kullanımına bağlı gelişen fonksiyonel bozukluklarda misoprostolün koruyucu etkinlik gösteremediği saptandı.

Aims and background To evaluate the efficacy and tolerability of a new treatment approach including induction chemotherapy (CT) and concurrent chemoradiotherapy (CRT) in unresectable, locally advanced pancreatic cancer (LAPC). Patients and methods Twenty-four patients with LAPC were enrolled in the study. They first received induction CT consisting of 5-fluorouracil (5FU) (500 mg/m2) and gemcitabine (1000 mg/m2), which were given weekly for 3 weeks of every 4. Patients showing a response or disease stabilization after 2 cycles of induction CT received CRT consisting of external beam radiotherapy (50.4-54 Gy in fractions of 1.8 Gy/day) and gemcitabine (350 mg/m2, weekly for 6 weeks). Patients without disease progression received 2 additional cycles of CT consisting of 5FU plus gemcitabine with the same doses and schedule as given in the induction CT. Results After the end of the study, 2 (8%) and 5 (21%) patients showed complete and partial responses, respectively. Five patients (21%) had disease stabilization. The grade 3 and 4 toxicities associated with CT were neutropenia (21%) and thrombocytopenia (4%). The grade 3 and 4 toxicities occurring in patients who received CRT were neutropenia (24%), thrombocytopenia (24%), diarrhea (18%), and nausea (12%). The median progression-free survival for all patients was 6 months (95% CI, 3.6-8.4), and the median overall survival was 11 months (95% CI, 8.16-13.84). Conclusions The CRT approach of this study is moderately active and has an acceptable toxicity profile. However, the incor-poration of combination CT into CRT at the present schedule could not produce any additional benefit over CRT alone. Newer agents with more systemic activity are clearly warranted.

Insulin resistance (IR) and obesity may be risk factors for breast cancer. The mechanism of IR in patients with cancer has not been fully clarified yet. This study was conducted to evaluate the possible role of circulating cytokines; tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6) in inducing IR in 20 overweight or obese patients with early stage breast cancer and to compare their levels with that of body mass index matched 20 healthy controls. IR was calculated by homeostasis model assessment (HOMA) method. Four groups were formed according to a 2.7 HOMA-IR cut-off value as breast cancer with or without IR and controls with or without IR. IL-6 and HOMA-IR values were found to be higher in breast cancer patients with IR compared to other groups. There was no significant difference in TNF-alpha levels between groups. HOMA-IR values correlated with estradiol and IL-6 levels in all breast cancer patients but not TNF-alpha. HOMA-IR values, serum insulin, estradiol and IL-6 levels in the receptor positive group were significantly higher than those of the receptor negative group. These results suggested a possible contribution of endogenous IL-6 production and hyperinsulinemia to the development of breast cancer in overweight or obese patients with prominent IR.

AimTo determine the activity and toxicity of a combination of weekly gemcitabine and 5-fluorouracil bolus intravenously in patients with metastatic pancreatic cancer.Patients and methodsTwenty-one patients with previously untreated metastatic pancreatic cancer were included in this phase II study. The schedule was gemcitabine (1000 mg/m2iv) and 5-fluorouracil (500 mg/m2bolus iv) weekly for 3 weeks every month.ResultsFour patients (19%) achieved a partial response and three stable disease. A clinical benefit was obtained in 7 patients (33%). Median survival for all the patients was 6 months. The treatment was well tolerated and toxicity was mild. WHO grade 3 leukopenia occurred in 2 (9.5%) patients, grade 3 anemia in 4 (19%) patients, grade 3-4 thrombocytopenia in 4 (19%) patients, grade 1 diarrhea in 1 (4.7%) patient and grade 1 mucositis in 3 (14.2%) patients.ConclusionThe weekly administration of gemcitabine combined with 5-fluorouracil bolus iv is an active and well-tolerated regimen in metastatic pancreatic cancer. However, its efficacy is relatively limited.

Aims and Background Small cell carcinoma of the bladder (SCCB) is a rare entity characterized clinically by an aggressive behavior with a high incidence of systemic metastases. We report the clinicopathologic findings of five cases. Methods We reviewed five consecutive patients with SCCB treated at our institute. In each case the following clinical data were recorded: age, sex, presenting symptoms, endoscopically determined location of the tumor, clinical staging, node involvement (if any), site of metastases (if any), treatment, follow-up and outcome. Results There were four male and one female patients, age range 42 to 68 years, mean 57.6 years. The clinical presentation was not different from conventional transitional cell carcinoma, with hematuria being the most frequent complaint (four cases). Microscopic examination revealed oat cells in three cases and an intermediate variant in one. At the time of diagnosis the tumors were staged as T3bN2M0, T2N2M0, T4N0M0, T3aN0M0, and T2N0M0. Primary therapy consisted of radical cystectomy alone (one case), transurethral resection (TUR) alone (one case), TUR with chemotherapy (two cases), or TUR with chemotherapy and radiotherapy (one case). Four patients died of progressive disease, with survival from the time of diagnosis ranging from 7 to 16 months (mean, 12.2 months). One patient died of myocardial infarction (unrelated to the primary disease) one month after diagnosis. Conclusion Our study indicates that primary small cell carcinoma of the urinary bladder is as aggressive as its pulmonary counterpart and the overall prognosis of this tumor is very poor.

Background: Pulmonary actinomycosis may create a diagnostic and therapeutic dilemma especially in cancer patients. Case Report: A 64-year-old male patient presented with a productive cough, bloody sputum, and weight loss. Thoracic computed tomography (CT) showed a 5-cm mass in the upper lobe of the right lung, and a 2-cm mass in the lower lobe of the left lung. Bronchoscopic examination did not show any endobronchial lesions. CT-guided needle biopsy of the right pulmonary lesion showed lung adenocarcinoma. Whole-body positron emission tomography/CT revealed an increase in fluorodeoxyglucose accumulation in the upper lobe of the right lung, in the lower lobe of the left lung, and in the right hilar and paratracheal lymph nodes. Before chemotherapy was initiated, the patient had to be admitted to the hospital because of massive hemoptysis. Bronchoscopic examination indicated persistent bleeding in the left lower lobe bronchus. The patient underwent diagnostic left thoracotomy, and wedge resection of the lower lobe mass. The diagnosis was pulmonary actinomycosis, and the patient received oral amoxicillin. He underwent successful surgery for the primary disease following 6 cycles of chemotherapy. Conclusion: Oncologists should be aware of rare diseases that may affect management approaches in the treatment of cancer.

Renal hücreli kanser (RCC) biyolojisinde vasküler endotelyal growth faktör ve mammalian target of rapamycin B yolağının tanımlanması ile tedavide yeni seçenekler geliştirilmiştir. Bu yeni seçenekler (hedefe yönelik ilaçlar) ile birlikte, bir zamanlar sınırlı tedavi seçeneği olan RCC tedavisinde artık yeni bir dönem başlamıştır. Başlangıçta sunitinib ve sorafenib ile başlayan çalışmalara daha sonra bevasizumab, temsirolimus, everolimus ve pazopanib eklenmiştir. Hedefe yönelik ilaçların antitümoral etkileri benzer olsada klinik etki ve toksisitede farklılıklar vardır. Bu nedenle tedavi ile ilişkili yan etkilerin erken saptanması ve tedavinin yönlendirilmesi hastanın yaşam kalitesini artıracak, gereksiz doz redüksiyonları olmayacaktır In Renal cell cancer biology (RCC), with vascular endothelial growth factor and diagnosing of mammalian target of rapamycin B pathway, new options (targeted drugs) are developed in therapy. With Targeted Drugs, new period started now in the RCC treatment which has limited treatment option at one time. Then bevasizumab, temsirolimus, everolimus and pazopanib were added to workings that initially started with sunitinib and sorafenib. Although antitumoral effects of drugs are similar in these treatment options, differences are seen in clinical effects and toxicity. Therefore, early determination of adverse effects that are associated with treatment and direction of treatment will improve patient’s quality of life and unnecessary dose reduction won’t occur.

20-24 Nisan 2011 tarihinde, 19. Ulusal Kanser Kongresi’nde bildiri olarak sunulmuştur. Lokal ileri ve metastatik mide kanserli 70 hastanın tedavi öncesi AFP, CEA ve CA 19-9 serum seviyeleri retrospektif olarak araştırıldı. Bu markerlar için pozitiflik oranı sırasıyla %55.7, %40 ve %32.9 bulundu. Tümör belirteçlerinin pozitif seviyeleri için univaryet analizleri, AFP pozitifliğinin karaciğer metastaz varlığı (p=0.033) ve rezektabilite oranı ile anlamlı ilişkisinin olduğunu (p=0.041), CEA pozitifliğinin ileri tümör evresi (p=0.011), tümör boyutu (p=0.004), karaciğer metastaz varlığı (p=0.001), serozal invazyon sıklığı (p=0.004) ve rezektabilite (p=0.011) ile anlamlı ilişkisinin olduğunu ve son olarak CA 19.9 pozitifliğinin ileri tümör evresi (p=0.006), tümör boyutu (p=0.002), serozal invazyon sıklığı (p=0.002), periton metastaz sıklığı (p=0.005) ve asit gelişimi (p=0.005) ile anlamlı ilişkisinin olduğunu gösterdi. Sonuç olarak, kanser hastalarında tedavi kararı verilirken tümör markeri kullanımı, klinik ve radyolojik olarak tespit edilemeyen uzak organ metastaz varlığını gösterebilir. Pre-treatment serum levels of AFP, CEA and CA 19-9 were retrospectively investigated in 70 patients with locally advanced and metastatic gastric cancer. The positivity rates for these markers were 55.7%, 40% and 32.9%, respectively. Multiple logistic regression analysis for positive levels of tumor markers indicates that AFP positivity is significantly related to the presence of hepatic metastasis and resectability rates (p=0.041), CEA positivity is related to advance stage (p=0.011), tumor size (p=0.004), presence of hepatic metastasis (p=0.001), the frequency of serosal invasion (p=0.004) and resectability rates (p=0.011). Finally, CA 19-9 positivity is related to advance stage (p=0.006), tumor size (p=0.002), the frequency of serosal invasion (p=0.002), the frequency of peritoneal metastasis (p=0.005) and ascites (p=0.005). In summary, in cancer patients, the use of tumor markers for the decision of treatment might indicate the existence of any organ metastasis which could not be clinically or radiologically revealed

Bu çalışma 13-14 Mart 2011, Uludağ Kış Günleri Kongresi'nde poster olarak sunulmuştur. Bu çalışmada, lokal ileri mesane kanseri nedeniyle adjuvant kemoterapi alan hastalar retrospektif olarak analiz edildi. Toplam 32 hasta gemsitabin (%18.8), sisplatin+gemsitabin (%50), carboplatin+gemsitabin (%15.6) veya MVAC (Metotreksat, vinblastin, doksorubisin ve sisplatin) (%15.6) tedavisi aldı. Tedaviler sırasında en sık görülen yan etki kemik iliği toksisitesi idi. Tedaviye bağlı ölüm gözlenmedi. Medyan genel ve hastalıksız sağkalım süreleri sırasıyla 23 ay (18.7-27.4) ve 17.8 ay (12.7-22.9) idi. Verilerimizin literatür ile uyumlu olduğu sonucuna varıldı. In this study, patients who received adjuvant chemotherapy for locally advanced bladder cancer were retrospectively analyzed. A total of 32 patients received gemcitabine (%18.8), cisplatin plus gemcitabine (%50), carboplatin plus gemcitabine (%15,6) or MVAC (Methotrexate, vinblastine, doxorubicin, and cisplatin). The most common adverse effect was myelosuppression during chemotherapy administration. Treatment-related died was not observed. The median overall and disease-free survival was 23 months (range, 18.7-27.4) and 17.8 months (range, 12.7-22.9), respectively. We concluded that our results were comparable to those in the literatur

Uludağ İç Hastalıkları Günleri 2010 toplantısında bildiri olarak sunulmuştur. Solid organ tümörlerinde alkilleyici ajanların ve topoizomerazların yaygın kullanılmaya başlanması kanser hastalarının yaşam süresinin uzamasına bağlı olarak ikincil lösemi insidansını arttırmıştır. Tedavi ilişkili lösemiler tüm lösemilerin yaklaşık %10-20 sini oluşturur. Olgumuz Mart 2008 tarihinde endometrium kanseri tanısı almış olup, sisplatin-doksorubisin-radyoterapi tedavisi sonrası takiplerinde trombositopeni saptandı. Bunun üzerine yapılan kemik iliği materyali değerlendirilmesi sonucunda French American British (FAB) sınıflamasına göre AML M4 tanısı alan olgumuzun kemik iliği materyaline yapılan moleküler sitogenetik (FISH) analizinde de inv 16 pozitif olarak bulularak tanı doğrulandı. Olgumuz, kısa sürede lösemiye bağlı komplikasyonlar nedeniyle kaybedildi. Primer malignitenin tedavisi takibinde kısa süre bile olsa hematolojik durumlar dikkatli olarak incelenirse bir çok tedavi bağımlı AML saptanabilir. Sonuç olarak, tedaviyle ilişkili akut löseminin 5 ay gibi kısa sürede gelişen ve inv 16 pozitif saptanan endometrium kanserli olgumuz, literatürde nadir görülmesi sebebiyle önem taşımaktadır. In solid organ tumors, the increasing use of alkalizing agents and topoisomerases have increased the incidence of secondary leukemia in connection with extension of the life expectancy of cancer patients. The treatment related leukemia forms 10-20% of all cases of leukemia. Our case was diagnosed with endometrium cancer in March 2008 and during follow up of sisplatin-doxorubisin-radiotherapy treatment thrombocytopenia was detected. Then upon investigation of the bone marrow material our case was diagnosed with AML M4 based on French American British (FAB) classification AML M4 and then the diagnoses was verified after molecular cytogenetic (FISH) analysis conducted on bone marrow material, since inv 16 was positive. Our patient died in a short time because of complications related to leukemia. If after treatment of primary malign tumors the hematologic conditions are monitored carefully, even for a short term, AML might be detected related to various treatments. To conclude, we consider our case to be of importance since acute leukemia has developed with inv 16 positivity within a very short period of five months after treatment, which is a case rarely observed in the literature

Aims and background. The aim of the study was to analyze the clinicopathological characteristics, treatment modalities, and clinical outcome of patients with primary small cell carcinoma of the breast. Methods. Fifty-three cases of primary small cell carcinoma of the breast were identified; 7 cases in this series and 46 from the English-language medical literature. Results. There were 52 females and 1 male. The mean age was 53 years. Tumor size ranged from 1 to 18 cm (mean, 4.53). Axillary node metastasis was present in 61.7%. Only one patient had distant metastases at presentation. The presence of hormone receptors was reported in 24.5% of the tumors. Modified radical mastectomy was the most common surgical procedure and was performed in 50.9% of the patients. Adjuvant radiotherapy was administered to 39.6% of the patients, and 69.8% underwent chemotherapy. Thirteen percent of patients received adjuvant tamoxifen therapy. The mean follow-up was 20.75 months (range, 3-60), and 10 of 53 cases (18.9%) died of metastatic disease. Conclusions. The prognosis of primary small cell carcinoma of the breast largely depends on the initial stage of the disease. Multimodality treatment including surgery, radiotherapy and chemotherapy seems to be the most appropriate strategy for early disease. Chemotherapy is usually unsuccessful in treating metastatic disease.

3-7 Kasım 2010 tarihinde 36.Ulusal Hematoloji Kongresi’nde sunulmuştur. Primer mediastinal B hücreli lenfoma (PMBL), mediastende timik meduller B hücrelerinden gelişen nadir görülen bir neoplazmdır. Tüm nonhodgin lenfomaların %2-3’ünü oluşturur. 1980’li yıllarda tanımlanmasına rağmen optimal tedavi tartışmalıdır. PMBL’da geç relaps nadir olup çoğunlukla tedavi sonrası ilk bir yılda gelişir. Ön mediastende kitle saptanan 33 yaşındaki kadın olguda çekilen positron emission tomografi sonucu ve yapılan biyopsi ile birlikte PMBL tanısı konuldu. Hasta 6 kür R-CHOP ve sonrasında mediastene radyoterapi ile tedavi edildi. Düzenli aralıklarla takip edilen olguda ilk bir yılın sonunda relaps gözlenmedi. Primary mediastinal B-cell lymphoma (PMBL) is a rare neoplasm that develops from thymic medullary B cells in the mediastinum. It covers about 2-3% of all non-hodgin lymphomas. Despite its identification in 1980s, the optimal treatment is controversial. Although late relapse is rare, it usually develops within the first year of treatment. A 33 year-old woman had an anterior mediastinal mass was diagnosed with lymphoma, which was confirmed with biopsy. Despite not having lympoadenopathy and hepatosplenomegaly, PET was consistent with PMBL. The patient was treated with 6 cycles of R-CHOP and then with radiotherapy to mediastinum. After treatment, we observed a complete response. With close follow up, we did not see any relapse at the end of first year.

Adiponektinin obezite ile ilişkili malignitelerin oluşumu ve progresyonunda anahtar rol oynayabileceğini düşündüren yayınlar vardır. Etiyolojik bir faktör olarak değerlendirilen adiponektinin opere kolon tümörlü hastalarda prognostik değeri araştırıldı.Merkezimizde 1997?2007 yılları arasında kolon kanseri nedeni ile opere edilmiş evre II ve III 53 hastanın parafin bloklarında İmmünohistokimyasal olarak adiponektin ekspresyonu ve prognoz üzerine olan etkileri değerlendirildi.Olguların 32'si (%60.4) erkek, 21'i (%39.6) kadın olup ortalama yaşı 58.3±10.1 (35- 78). Olguların ortalama takip süresi 41 ay (10 - 96 ay) idi. TNM sınıflamasına göre olguların 28'inin (%52.8) evre II ve 25'inin (%47.2) evre III olduğu belirlendi. İmmünohistokimyasal inceleme sonucunda 21 (%39.6) vakada tümör dokusunda adiponektin ile boyanma izlendi. Boyanmalar sitoplazmik olarak görüldü. Adiponektin ekspresyonunun olduğu 21 vakadan 9'unda (%42.9) nüks gelişirken, ekspresyonu olmayan 32 vakadan 11'inde (%34.4) nüks gözlendi. Ortalama HSK adiponektin ekspresyonu varlığında 60.3±9.03 ay iken yokluğunda 68.7±6.67 ay olarak hesaplandı (p:0.414).Epidemiyolojik çalışmalarda düşük adiponektin seviyelerinin meme, endometriyum, prostat ve kolorektal kanserlerde artmış risk ile ilişkisi gösterilmiştir. Adiponektin etkilerini hem kanser hücrelerini direkt etkileyerek hem de tüm vücutta insülin duyarlığını etkileyerek dolaylı olarak gösterir. Tümör dokusunda adiponektin ekspresyonun HSK üzerinde olumsuz etkisi gösterilse de ek çalışmalar ile desteklenmesi gerekmektedir. Some of the trials suggesting that adiponectin may play a key role in the genesis and progression of the obesity-related malignancies. The prognostic value of adiponectin, that assessing as an etiological factor, was evaluated on operated colon cancer patients.53 paraffin blocks of patients who have been operated for stage II/III colon cancer, were investigated with immunhistochemistry for adiponectin expression and the effects on prognosis.32 patients (60.4%) males and 21 (39.6%) were female, mean age 58.3 ± 10.1 (35 - 78). The median follow-up period was 41 months (10-96 months). According to TNM classification 28 (%52.8) cases were stage II, 25 (47.2%) cases were stage III. In immunohistochemical examination, 21 (39.6 %) patients were observed staining with adiponectin. The staining was seen as cytoplasmic. 9 of the 21(42.9%) patients with adiponectin expression had recurrence, 11 of the 32 (34.4%) with no adiponectin expression had recurrence. The mean DFS was 60.3 ± 9.03 months for patients who had adiponectin expression, and 68.7 ± 6.67 months for patients who had no adiponectin expression (p=0.414).In epidemiological studies showed that the association with low serum adiponectin levels and increased the risk in breast, endometrial, prostate and colorectal cancers. Adiponectin may act directly on cancer cells or indirectly by regulating whole-body insulin sensitivity. Tumor tissue adiponectin expression may indicate adverse outcomes on DFS, but this data should be supported with additional studies. 45

ÖZETKüçük hücre dışı akciğer kanseri, tüm akciğer kanserlerinin % 70-80' inden sorumlu olup, kanserler arasında en sık mortalite nedenidir. Tanı anında hastaların yaklaşık % 40-50'si ileri evredir. İleri evre akciğer kanseri sistemik bir hastalık olduğundan, birincil tedavisi sistemik kemoterapidir. Ortalama sadece % 5 hasta tedavisiz bir yıl yaşayabilmektedir. Metastatik akciğer kanserli hastalarda tam iyileşme mümkün olmadığından, kemoterapinin amacı öncelikle en az yan etki ile semptomlarda iyileşme sağlamak ve sağkalımın uzatılması olmalıdır. İleri evre akciğer kanserinde farklı kemoterapi rejimleri uygulanmasına rağmen, genel olarak kabul gören tipik tedavi rejimi platinum ve 3.jenerasyon ilaç kombinasyonlarıdır. Günümüzde farklı platinum ve 3.jenerasyon kombinasyonlarının birbirleri üzerine olan üstünlüğü net değildir.Çalışmamıza platinum içeren 4 farklı kombinasyon tedavileri (gemsitabin/sisplatin, paklitaksel/karboplatin, etoposid/sisplatin ve dosetaksel/sisplatin) uygulanmış, ECOG PS 0-1 olan, ileri evrede (evre IIIB, evre IV) toplam 91 hasta alındı. Tedavilerin yan etkileri, hematolojik olan ve hematolojik olmayan yan etkiler olarak belirlendi. Tedavilerin etkinliği de cevap oranları ve sağkalım analizleri ile değerlendirildi.Çalışma sonucunda kemoterapi rejimleri arasında yanıt oranında, progresyonsuz sağkalımda ve ortalama genel sağkalımda istatistiksel olarak anlamlı fark saptanmazken, 1 yıllık sağkalımda dosetaksel/sisplatin tedavisinin gemsitabin/sisplatin tedavisine oranla avantaj sağladığı tespit edildi (p

Akciğer kanseri tüm dünyada kansere bağlı ölümlerin en sık nedenidir. Irk, cinsiyet, yaş, coğrafi ve sosyoekonomik koşullar gibi faktörler görülme sıklığını etkilemektedir. Akciğer kanserlerinin % 80'ini küçük hücreli dışı akciğer kanseri oluşturmaktadır. Erken evre KHDAK' inde öncelikli tedavi cerrahidir. Postoperatif toraks ışınlaması ve sistemik kemoterapinin (KT) yaşam süresini uzattığı gösteren yeni çalışmalar mevcuttur.Memeli hücrelerinde farklı DNA hasarları farklı DNA tamir yolları ile tamir edilmektedir. Ekzisyon tamiri BER ve NER olmak üzere ikiye ayrılır. NER mekanizması en az 20 proteinin görev aldığı bir kesme ve yapıştırma mekanizmasıdır. Platinum grubu ilaçların oluşturduğu DNA hasarları daha çok NER ile onarılmaktadır. Bu da NER ile bu ilaç grubunun tedavi etkinliği arasında bir ilişki olabileceğini düşündürmektedir. NER tamir mekanizmasının en önemli ayağı ERCC1' dir. Literatürde ERCC1 gen düzeyi ile kanserlerin metastaz durumu, evresi, prognostik önemi, tedaviye yanıtları, progresyon zamanı, genel sağkalım ve hastalıksız sağkalım arasındaki ilişkiyi araştıran birçok çalışma mevcuttur. Over, kolon, serviks, testis, mesane ve küçük hücreli dışı akciğer kanserli hücre gruplarında ERCC1'in m RNA ekspresyonunun platinum rezistansı gösterdiği invitro çalışmalarla gösterilmiştir. Çalışmamızda retrospektif olarak adjuvan platin bazlı kemoterapi alan KHDAK `li hastalarda tümör dokusu ERCC1 gen düzeyi ile hastalıksız sağkalım ve genel sağkalım arasındaki ilişki araştırılmıştır.Çalışmaya 82 hasta dahil edilmiştir. Hastalara ait biyopsilerin parafin bloklarından kesitler alınarak immünohistokimyasal yöntemle ERCC1 gen ekspresyonu belirlenmiştir. Elde edilen veriler, hastaya ait demografik özellikler, evre, hastalıksız sağkalım ve genel sağkalım verileri göz önünde tutularak karşılaştırılmıştır.Çalışma sonucunda ERCC1 gen ekspresyonu olmayan grupta progresyonsuz sağkalım süresinin ve genel sağ kalım süresinin ERCC1 pozitif grupla karşılaştırıldığında daha uzun olduğu ancak bunun istatistiksel olarak anlamlılık ifade etmediği görüldü.Sonuç olarak bu sınırlı sayıda hasta ile yapılmış çalışmada, platin bazlı adjuvan kemoterapi alan KHDAK'li hastalarda ERCC1 aşırı ekspresyonun hastalıksız sağkalımı ve genel sağkalımı olumsuz yönde etkileyebileceği tespit edilmiştir. Lung cancers are the most common cause of death all over the world. Race, sex, age, geographic and economic status effects the frequency of lung cancer. 80 % of lung cancers are non-small cell lung cancer (NSCLC). Surgery is the primary management of early stage NSCLC. Recent studies show that post-operative Chemotherapy and radiotherapy extends the survival.Each DNA damages has different repair pathway in mammalian cells. Excision repair has 2 different pathways called BER and NER. NER pathway is a cut/paste pathway consists of 20 different proteins. Platinum based DNA damages are usually repaired by NER pathway. This information thought that there may be a relationship between NER pathway and efficiency of the treatment with this group of medications. The most important component of NER repair pathway is ERCC1. There are a lot of studies that shows the relationship between ERCC1 gene levels and the cancers stage, metastasis, prognosis, response to treatment, progression and survival. It has been reported in several invitro studies that ERCC1 mRNA expression shows platinum resistance in ovarian, colon, cervix, testicular, bladder and NSCL cancer group. In our study we retrospectively search the relationship between ERCC1 gene levels and disease free survival and survival in NSCLC patient treated with adjuvant platinum based chemotherapy.In our study we stain 82 patients paraphin block with immunohistochemical stains to determine ERCC1 gene expression. The obtained data compared with the patients stage, demographic properties, disease-free survival and general survival. We found that the overall survival is longer in ERCC1 gene expression negative group compared with ERCC1 positive group but this information is not statistically significant.As a result in our small sized study we established that ERCC1 gene expression is negatively effect the overall survival in NSCLC patients treated with platinum based adjuvant chemotherapy. 48

Objective: To investigate the association of cytokine gene polymorphism with the development of breast cancer. Methods: The study was carried out in Uludag University Medical School, Bursa, Turkey. The study included 38 patients with breast cancer admitted to the Medical Oncology outpatient clinic, and 24 healthy controls, age and sex matched, from the Internal Medicine Department between 2004 and 2005. All genotyping of tumor necrosis factor-cc (TNF-alpha), tumor growth factor-beta 1 (TGF-beta 1), interleukin (IL)-10, IL-6, and interferon-gamma (IFN-gamma) experiments were performed using polymerase chain reaction sequence-specific primers. Results: The frequencies of IL-6-174GC genotype and IL-10 (-1082, -819, -592) GCC/ATA haplotype were significantly higher in the patient group (p=0.0008) when compared with controls (p=0.020). Significantly lower frequencies of IL-10 (-1082,-819,-592) ACC/ATA haplotype were observed in the patient group in comparison to the controls (p=0.026). The distribution of IFN-gamma +874, TNF-a 308, and TGF-beta 1 codon 10-25 genotypes failed to show any statistical significant association with the development of breast cancer. Conclusion: Our data suggest that IL-10 (-1082, -819, -592) GCC/ATA haplotype and IL-6-174 GC genotype seem to be potential risk factors for the development of breast cancer. The presence of IL-10ACC/ATA haplotype may be protective for the oncogenesis of breast cancer.

Adrenokortikal karsinom (AKK) nadir ve agresif bir tümor olup prognozu kötüdür. Bu çalışmada, AKK hastalarımızın klinik özellikleri ve tedavi sonuçları retrospektif olarak değerlendirildi. Departmanımızda, toplam sekiz AKK’lu hasta tedavi edildi. Hastaların tamamında metastaz mevcuttu. Hastalara etoposid, doksorubisin ve sisplatin (EAP) veya etoposid ve sisplatin (EP) rejimi uygulandı. Dört hastada stabil hastalık, diğer dört hastada ise progresyon olduğu gözlendi. Ortalama 7.7 aylık (3-15 ay) takipte 5 hasta progresif hastalık nedeniyle öldü. Bulgularımız AKK’un agresif doğasını yansıtmaktadır. Adrenocortical carcinoma (ACC) is a rare and aggressive tumor with a poor prognosis. In this study, we retrospectively evaluated clinical features and treatment results of our ACC patients. A total of eight patients with ACC were treated in our department. All patients had metastatic disease. Patients received etoposide, doxorubicin and cisplatin (EAP) or etoposide and cisplatin regimen (EP). Stabile disease was observed in four patients and progressive disease in four. At a mean follow up 7.7 months (range, 3-15 months) 5 patients died from progressive disease. Our findings reflect the aggressive nature of ACC.

Objective: Capecitabine exerts considerable therapeutic efficacy in metastatic breast cancer (MBC) patients previously treated with anthracyclines and taxanes. Materials and Methods: In this study, the efficacy and safety of lower dose capecitabine (2000 Mg/m(2)/d) in patients with anthra-cycline- and taxane-pretreated MBC were studied with a special emphasis on the potential predictors of time to tumor progression (TTP) and response to the capecitabine treatment. Results: The overall response rate (ORR) was 17%. The median TTP was 5 months. Among various factors analyzed, univariate analysis showed that a performance status (PS) of 2 and the presence of visceral metastases were inversely correlated with TTP. Multivariate analysis showed that a poor PS score was associated with impaired TTP. Conclusions: Our study indicates that lower dose capecitabine has substantial antitumor activity and a favorable safety profile in the treatment of anthracycline- and taxane-pretreated MBC. Also, only performance score was demonstrated to be a significant parameter affecting TTP.

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The M30-monoclonal antibody recognizes a neo-epitope of cytokeratin 18 which is formed after caspase-cleavage during apoptosis. Caspase-cleaved cytokeratin 18 is released from apoptotic cells into circulation. The aim of this study was to evaluate the relationship between M30-antigen level and chemotherapy response in neoadjuvant treatment of breast cancer. Forty-two patients with invasive breast carcinoma received 4 cycles of anthracycline based neoadjuvant chemotherapy. Serum samples were obtained for assessment of M30-antigen levels before the administration of first chemotherapy cycle (baseline), and then after 24 and 48 hours for determination of chemotherapy induced apoptosis. M30-antigen levels at 24 and 48 hours were found to be significantly higher than baseline (p < 0.001, p = 0.003, respectively). M30-antigen levels in responders showed statistically significant increases at 24 and 48 hours (p < 0.001; p = 0.004, respectively), while statistically significant increases were not observed in nonresponders. Percentage change of M30-antigen levels was significantly higher in responders than nonresponders at 24 hours (p = 0.020). In conclusion, our study revealed a significant relationship between increases of M30-antigen levels in serum and overall response to therapy.

A healthy 31-years-old man presented with a three-year history of abdominal discomfort. Radiological examinations revealed multifocal tumoral lesions in the spleen. The patient underwent splenectomy for differantial diagnosis and treatment. During the operation, in addition to the splenic masses, there were also multiple milimetric purpuric-like lesions on the colonic serosal surfaces adjacent to the splenic hilus. One of them was excised. Histologic examination showed hemangiopericytoma of the spleen and cavernous hemangioma of the adjacent colon. This is the first report showing the close association of these two distinct lesions with vascular origin in the literature. Despite not having any apparent evidence, there may be a sequential relationship between the hemangio-pericytoma of the spleen and cavernous hemangiomas.

respectively. The reticulocyte count reached 3%. Computed tomography of the chest showed a minimal response to chemotherapy. Two additional cycles of paclitaxel were given. The patient’s haematological values and disease have remained stable for 6 months. The best therapy for thymomaassociated cytopenia has not yet been established. We think that antitumour therapies may be effective as in other paraneoplastic syndromes. To our knowledge, this is the first report showing that paclitaxel may be beneficial in the treatment of thymoma-associated haematologic dyscrasias. The role of paclitaxel in the treatment of thymoma is unknown. On the basis of this case, we suggest that paclitaxel at 175 mg/m 2 every 3 weeks may be a promising chemotherapy for advanced or recurrent thymoma.

Aim There is no comprehensive study that compares the different usage strategies of recombinant human erythropoietin (rHuEPO) in platinum-induced anemia. In order to clarify this issue, we conducted a prospective clinical study. Material and methods Seventy-seven patients were studied in three main groups. Group 1 (n = 17) consisted of cancer patients without anemia. These patients received rHuEPO starting from the first chemotherapy cycle. Group 2 (n = 26) consisted of patients whose hemoglobin (Hb) values decreased by at least 1 g/dL after the first cycle of chemotherapy. Group 3 (n = 34) consisted of patients whose Hb values dropped below 10.5 g/dL after the second chemotherapy cycle. Groups 2 and 3 were each divided into two subgroups. In groups 1, 2A and 3A rHuEPO (5000 U/day subcutaneously three times a week) treatment was continued until three weeks after the completion of chemotherapy. In groups 2B and 3B, rHuEPO was given for 12 weeks only. Results There were no prominent differences between the Hb values of these groups throughout the chemotherapy cycles. Transfusion rates and the number of patients who became anemic were also not different between groups. Conclusion No rHuEPO usage strategies are superior to others in terms of Hb levels and transfusion requirements. The decision as to when rHuEPO is to be added to platinum-containing therapy should be tailored to the health conditions of individual patients.

Aim/Background: nm23 is suggested to represent a new class of metastasis suppressor genes. An inverse correlation between nm23 expression level and metastatic potential has been demonstrated in different malignancies. This study evaluated the prognostic value of nm23 in gastrointestinal stromal tumors (GISTs). Methods: Imummohistochemical expression level of nm23 was studied in a total of 32 patients with localized GISTs. The relationship between the expression level of nm23 and patient outcome was investigated. Results: A tumor size of 10 cm or more and a mitotic rate of 10 or more per 50 high-power fields were not significantly associated with the metastasis risk (p = 0.60 and 0.55, respectively). Tumors with high expression of nm23 tended to have significantly lower metastatic potential (p = 0.02). The median survival was significantly longer in patients with high expression of nm23 (p = 0.007). Conclusion: These results suggest that expression level of nm23 may be considered as a prognostic predictor in GISTs. Future studies with larger patient numbers will be essential to confirm the prognostic significance of nm23 in patients with GIST.

Aim To investigate the activity and toxicity of irinotecan (CPT-11) as a single agent in patients with advanced gastric cancer after failure of previous 5-fluorouracil-based combination chemotherapy. Patients and methods Sixteen patients with advanced gastric received CPT-11, 350 mg/m2 every 21 days. The median age of the patients was 54.6 years; ECOG performance status was 0-1 in 14 patients and 2 in 2 patients. Dominant metastatic sites included liver, lung, lymph nodes and peritoneum. Results No complete response was observed. Two patients (12.5%) achieved a partial response to treatment. One patient (6.25%) had a minor response. Ten patients (62.5%) had progressive disease on therapy, and 3 patients (18.75%) had stable disease. The median survival of all 16 patients was 5 months. Grade 3 neutropenia was observed in 3 patients (18.75%), grade 4 thrombocytopenia in 1 patient (6.25%), and grade 3 anemia in 1 patient (6.25%). Three patients (18.75%) suffered from grade 3 diarrhea. Conclusions CPT-11 is moderately active and a well-tolerated regimen for selected advanced gastric cancer patients who experience disease progression after receiving first-line treatment.