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Foraminal and far lateral disc herniations are rarer cause of nerve root compression. There are reports regarding the outcome, however long-term follow-up results of surgically treated patients are few. The purpose of this retrospective study is to analyze the clinical characteristics and long-term surgical outcomes of the foraminal and far lateral disc herniations. The 114 patients who underwent an operation for foraminal and far lateral disc herniaitions were reviewed. Visual analogue scale of back and leg pain, the ocurrence of motor deficit and sensory dysesthesia before and after operations were used to compare the results of early and long-term outcome. A total of 114 telephone interviews were conducted. The mean follow up was 134 months. Complete relief of symptoms were reported by 77 patients (67.1%). The average VAS of radicular leg pain was 7.5 Post-operatively the average VAS of radicular pain decreased to 2.2. Preoperatively, 9 patients (7.6%) had motor deficit and 17 (14.4%) patients had sensory dysesthesia. Post-operatively 9 (100%) of the patients showed motor, and 12 (70.6%) of the patients showed sensory improvement. In 17 patients with hypoesthesia the complaints continued during 2 weeks to 6 months. They were given gabapentin as medical treatment, however 5 of these patients still have sensory dysesthesia. The outcome was: 67.1% excellent (77 patients), 26.3% good (30 patients), 6.1% fair (7 patients). The far lateral approach is a minimally invasive and safe procedure with low complication rates. [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults. GBM extraneural metastases occur in only approximately 0.2–0.4% of patients. We present a case of a cervical metastasis of glioblastoma after cranial tumor resection. In concord with case presentation, we reviewed the metastatic location and metastasis time of the gliablastomas seen in the literature. [ABSTRACT FROM AUTHOR]

Sir, Idiopathic spinal cord herniation is a rare disease of middle-aged patients presenting with myelopathy. After three weeks, she began to ambulate with support and she was referred for physical therapy.{Figure 3} Idiopathic spinal cord herniation is recognized as herniation of the spinal cord through a ventral or ventrolateral defect. J Spinal Cord Med 2009;32:86-94. 3 Alkhamees A, Proust F. Idiopathic spinal cord herniation: A case report. [Extracted from the article]

Background and Study Aim Basic neurophysiologic principles of the light reflex are well known. However, the effects of degenerated axon densities of oculomotor nerves (OMNs) secondary to posterior communicating artery (PComA) vasospasm following subarachnoid hemorrhage (SAH) have not been investigated. Our aim was to study this subject. Methods This study was conducted on 19 rabbits. There was a control group of five animals, a sham group of five animals in which saline was injected into the cisterna magna and a study group of nine animals in which homologous blood was injected into the cisterna magna. Pupillary diameters were measured for 1 week, then the animals were decapitated. The normal and degenerated axon densities of the OMNs were examined by stereological methods. Vasospasm indexes (VSIs) of posterior communicating arteries (PComAs) supplying OMNs were estimated and analyzed statistically. Results The pupillary diameter was 5.439 ± 368 μm, and the mean axon density of the OMNs was 0.924 ± 324/mm3 in the control group. The pupillary diameter and degenerated axon density of the OMNs in animals of the shamgroup were 6.980 ± 0.370 μm and 36 ± 8/mm3, respectively. The pupillary diameter was 9.942 ± 653μm, and degenerated axon density of theOMNswas 265 ± 57/mm3 in animals with SAH. The mean VSI values of PComAs were 0.927 ± 0.224 in the control group, 1.542 ± 0.257 in the shamgroup, and 2.321 ± 0.324 in the SAH group. Conclusion We found a linear relationship between the axon density of the OMNs and pupillary diameters. High degenerated neuron density in the OMNs may be responsible for an unresponsive pupillary that has not been mentioned in the literature. [ABSTRACT FROM AUTHOR]

Background Gadolinium-based contrast agents are relatively safe for use in magnetic resonance imaging (MRI) of nervous system pathology. Few reports have been reported regarding the severe adverse effects. These are mostly mild anaphylactoid reactions, especially in the vulnerable group. Case Description We report a case of an adverse effect of gadoteric acid concerning the misuse as intraventricular administration. To our knowledge, this is the first report related to intraventricular spillage and its results. A 38-year-old male patient with a complaint of headache and drowsiness was admitted to the hospital, after which cranial MRI revealed that he had a posterior fossa mass. An operation was performed with the catheterization of the lateral ventricule as a safety device at the beginning, and later mass was evacuated gross totally. Frozen pathology result showed the tumor was medulloblastoma. On the first postoperative day a control contrasted cranial and total spinal MRI was planned. He was observed to have a tonic-clonic generalized seizure soon after returning to the ward. After giving the acute management with antiepileptics, the patient was stabilized and it was recognized that the patient was administered contrast media by the intraventricular route. Symptomatic treatment and cerebrospinal fluid irrigation by external ventricular drainage helped the patient's improvement. After a week his symptoms were relieved and he had no complications during outpatient controls. Conclusions In addition to formal basic supportive treatment, cerebrospinal fluid irrigation of the toxic contrast material is the best management method in case of such an unexpected misadministration of gadoteric acid. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to analyse the clinical characteristics, effectiveness and safety of nivolumab monotherapy in patients aged ≥ 65 years with metastatic melanoma. Materials and Methods: This study involved patients aged ≥65 years who were diagnosed with metastatic cutaneous or mucosal melanoma. Patients with BRAF wild type, ECOG performance status 0-1, and who had previously received one line of chemotherapy were included, irrespective of PD-L1 expression. The study analyzed PFS, OS, and adverse event profiles. Results: Twenty-one patients, with a median age of 70, were analysed in the study. The median PFS for nivolumab as second-line therapy in elderly patients was 3.5 months (95% CI, 1.5 to 5.6 months), while the median OS was 14.5 months (95% CI, 10.3 to 18.6 months). The most common grade 1-2 adverse events were anemia (66.7%) and serum creatinine increase (23.8%). Additionally, the rate of grade 3-4 adverse events due to all causes was 28.6%. There was no grade 5 adverse event. Conclusion: Nivolumab is effective and safe as second-line therapy in patients aged ≥65 years with metastatic melanoma. It is a tolerable and effective treatment choice for elderly patients who cannot received nivolumab in first line therapy. [ABSTRACT FROM AUTHOR]

Docetaxel-cisplatin-5-fluorourasil (DCF) protocol is one of the standard regimen at present however it is difficult to administer owing to high toxicity rates. The aim of study was to modify the dose of DCF regimen in order to render it more tolerable and to evaluate the efficacy and tolerability of modified DCF (mDCF) protocol. 267 patients followed in Ankara Numune Hospital were included in the study. All patients were administered mDCF regimen as metastatic first line treatment. Doses in mDCF arm was as follows: docetaxel 60 mg/m2 1. day, cisplatin 60 mg/m2 1. day and 5-fluorouracil 600 mg/m2/day (1-5 days) every three weeks In the study, files of overall 267 patients who did not previously receive treatment were evaluated retrospectively. Median number of cycles in all patients was 6 (range 2-10). Median age of patients was 55 (range 22-76). Median follow up period was 9 months. Complete response 5 (1.9%) patients, partial response 74 (27.7%) patients and stable disease 95 (35.6%) patient. Median PFS was 6.0 (95%CI, 5.3-6.6) months, and median OS 10.0 (95% CI, 8.8-11.1) months. Parameters effect in univariate analysis were submitted to multivariate analysis results were CEA, grade, ECOG effective on OS. Grade 3-4 neutropenia was found 28.1%, anemia 11.6%, thrombocytopenia 4.1% and Febrile neutropenia 4.9%. Although mDCF regimen seems to be as effective as original DCF regimen, grade 3-4 toxicity rates were found to be lower. mDCF may be preferred as a tolerable and effective regimen in ECOG 0-2 metastatic gastric cancers. [ABSTRACT FROM AUTHOR]

The purpose of this study is to assess the incidence of symptomatic and asymptomatic venous thromboembolism (VTE) and their prognostic effect on survival in patients with gastric cancer. A total of 201 VTE cases from 1420 eligible patients with gastric cancer were enrolled in this study. VTE events were divided into two groups as symptomatic or asymptomatic according to the symptomatology of thrombosis. Trombus Overall Survival (TOS) was defined as the period between the date of VTE diagnosis and the date of death or the date of last visit of patient. Of these 201 VTE cases, 101 were symptomatic. Metastatic period (61.7%) and the first 6 months (67.7%) after the cancer diagnosis were associated with the highest incidence of VTE. Extremity (97.7%), port-related (100%) and pulmonary (59.7%) thrombosis were found to be clinically symptomatic, while visceral thrombosis (97.3%) were mostly asymptomatic. TOS for stage I-III patients with symptomatic VTE was found to be 26.4 months in comparison to 33.2 months for those with asymptomatic VTE (p= 0.29).TOS for symptomatic and asymptomatic groups with metastatic disease were 3.4 months and 6 months, respectively (p= 0.01). In multivariate analysis of metastatic patients, symptomatic thrombosis was statistically significant factor for poor TOS. In conslusion, metastatic stage and first 6 months after cancer diagnosis are the crucial periods in which the thrombosis mostly occurs. Although symptomatic thrombosis in patients with metastatic gastric cancer had an adverse prognostic effect, asymptomatic VTE had no significant impact on the prognosis, hence asymptomatic VTE may be followed without anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Background Hydrocephalus is a serious complication of subarachnoid hemorrhage (SAH). Obstruction of the cerebral aqueduct may cause hydrocephalus after SAH. Although various etiologic theories have been put forward, choroidal artery vasospasm–related ependymal desquamation and subependymal basal membrane rupture as mechanisms of aqueductal stenosis have not been suggested in the literature. Methods This study was conducted on 26 hybrid rabbits. Five rabbits were placed in a control group, 5 were placed in a sham group, and the remaining rabbits ( n = 16) were placed in the SAH group. In the first 2 weeks, 5 animals in the SAH group died. The other 21 animals were decapitated after the 4-week follow-up period. Choroidal artery changes resulting from vasospasm, aqueduct volume, ependymal cell density, and Evans index values of brain ventricles were obtained and compared statistically. Results Mean aqueduct volume was 1.137 mm 3 ± 0.096, normal ependymal cell density was 4560/mm 2 ± 745, and Evans index was 0.32 ± 0.05 in control animals ( n = 5); these values were 1.247 mm 3 ± 0.112, 3568/mm 2 ± 612, and 0.34 ± 0.15 in sham animals ( n = 5); 1.676 mm 3 ± 0.123, 2923/mm 2 ± 591, and 0.43 ± 0.09 in animals without aqueductal stenosis ( n = 5); and 0.650 mm 3 ± 0.011, 1234/mm 2 ± 498, and 0.60 ± 0.18 in animals with severe aqueductal stenosis ( n = 6). The choroidal vasospasm index values were 1.160 ± 0.040 in the control group, 1.150 ± 0.175 in the sham group, 1.760 ± 0.125 in the nonstenotic group, and 2.262 ± 0.160 in the stenotic group. Aqueduct volumes, ependymal cell densities, Evans index, and choroidal artery vasospasm index values were statistically significantly different between groups ( P < 0.05). Conclusions Ependymal cell desquamation and subependymal basal membrane destruction related to choroidal artery vasospasm may lead to aqueductal stenosis and hydrocephalus after SAH. [ABSTRACT FROM AUTHOR]

Objective: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. Materials and Methods: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. Results: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. Conclusion: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis. [ABSTRACT FROM AUTHOR]

Goal: The olfactory region function disorders and olfactory bulb volume changes in neurodegenerative and neuropsychiatric disorders are defined. In this study, the olfactory bulb values of patients diagnosed with major depression in accordance with DMS-IV criteria, are measured with MRI, and these values are compared with the values of healthy volunteers to see if there are any statistically significant changes. Method: The study was carried out with 20 healthy volunteers and 20 patients who had been diagnosed with acute major depression in accordance with 'diagnostic and statistical manual of mental disorders' (DMS) IV criteria and have been getting treatment for more than 2 years in Istanbul Education and Research Hospital. 1,5 Tesla MRI were used in 40 cases, and the olfactory bulb volume on two hemispheres were measured separately. Results: Contrary to the former studies, we found no statistically significant difference between the olfactory bulb volume measurements of the control group and the group diagnosed with major depression. [ABSTRACT FROM AUTHOR]

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]

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]

The article discusses all aspects of prophylactic cranial irradiation (PCI) in management of extrapulmonary small cell carcinoma (EPSCC). Topics discussed include a computerized search performed of the PubMed database, a list of selected reports of PCI for gastrointestinal SCC, and the frequency of brain metastasis of small cell lung cancer and EPSCC.

A letter to the editor is presented in response to the article "Targeted Therapies are New Hope for Patients with Spinal Radionecrosis".

Aim: To determine whether there are any clinicopathological or prognostic differences between mucinous gastric carcinoma (MGC) and signet ring cell carcinoma (SRCC).Methods: Pathological parameters, clinical parameters, and treatment efficacy were compared in patients with MGC and SRCC.Results: In total, 193 patients (51 with MGC and 142 with SRCC) were included in this study. Patients with SRCC in particular had notably higher lymphovascular invasion, perineural invasion, rate of Borrmann types III and IV, and stage III-IV cancer (according to its TNM stage) compared with patients with MGC. However, tumor size was larger in patients with MGC (tumor size ≥5 cm). Median overall survival (OS) was 29.8 months in the MGC group and 16.6 months in the SRCC group (p = .04). The median OS in stage I-III patients was 59.9 and 42.5 months in the MGC and SRCC groups, respectively (p = .35). Comparing OS between MGC and SRCC stage IV patients revealed that the median OS was 10.1 and 8.8 months, respectively (p = .96). Multivariate analysis of the entire patient group revealed that the presence of weight loss at diagnosis, distant metastasis, and lymph node involvement were significantly related to OS. Multivariate analysis also revealed that weight loss at the diagnosis and T3-4 tumors were significant factors influencing OS in the stage I-III group.Conclusions: Patients with SRCC had generally poorer prognosis and lower survival rates compared with patients with MGC. Further studies on the prognosis and treatment plan based on the pathological subtypes of SRCC and MGC are still needed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the Controlled Study of Lanreotide Antiproliferative Response in Neuroendocrine Tumors (CLARINET), which appeared in the July 17, 2014 issue.

A portion of castration-resistant prostate cancer patients are given abiraterone acetate treatment after docetaxel chemotherapy. In this study, we analyzed the association of patient characteristics and time to castration-resistant prostate cancer (TTCRPC) with secondary hormonal treatment-related progression-free survival. Data of patients whom were treated with Abiraterone Acetate (AA) for metastatic castration-resistant prostate cancer (mCRPC) in two different oncology centers between 2010 and 2018 were analyzed retrospectively. The entire patient group consisted of 76 patients however 13 of them were excluded due to incomplete data. Comparative results were obtained in 63 patients. Mean duration of primary hormonal therapy was 20 months. Docetaxel chemotherapy was administered as 7 cycles and mean duration of remission was 9 months. Mean progression-free survival post-AA treatment was calculated as 27 months. In univariate analysis, prostate specific antigen (PSA) level lower than median PSA at the time of initial diagnosis and a total Gleason score of below 8 was significantly consistent with prolonged progression-free survival (PFS). In multivariete analysis, it was observed that only PSA level at the time of initial diagnosis affected the PFS. Progression-free survival after Abiraterone Acetate treatment in patients with previous hormonal therapy duration longer than 18 months was better than the survival in the patient group who had a shorter hormonal therapy duration. The former group experienced a 39% risk reduction. In the light of these findings, we may recommend the administration of the Androgen Receptor (AR)-targeted treatment option in patients with low PSA levels at the time of diagnosis and patients with long castration duration after chemotherapy. [ABSTRACT FROM AUTHOR]

Tamoxifen-induced ocular complications including cataracts, keratopathies, retinopathy, impaired visual acuity, ocular irritation, optical neuritis, and retinal vein occlusion are uncommonly reported in the literature. Herein, we report on a premenopausal patient with right-side breast carcinoma who received adjuvant tamoxifen therapy (20 mg/day) for 1.5 years and developed sudden visual loss. Fundal examination revealed an obstruction in the branch of the retinal vein. The diagnosis was confirmed by fluorescein angiography and optical coherence tomography. Thus, tamoxifen was switched to an aromatase inhibitor. Tamoxifen-induced ocular complications should be kept in mind when visual symptoms are seen in patients undergoing tamoxifen therapy. In such cases, a complete ocular examination should be performed. [ABSTRACT FROM AUTHOR]

Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death and have extremely poor prognosis. Although, declining trends for some major cancers, death rates are rising in both sexes for pancreatic cancer. Surgical resection is the only curative treatment of pancreatic cancer, but only 10 to 20 percent of patients are candidates for curative surgery. Fifty to sixty percent of patients with pancreatic cancer diagnosed in metastatic stage and 5-year overall survival (OS) rate is less than 5% for metastatic pancreatic cancer. Gemcitabine was the first chemotherapeutic agent that superior to 5-Fluorouracil. In most of the phase II trials combination gemcitabine with cytotoxic chemotherapy or targeted therapy showed promising results, but phase III trials with gemcitabine in combination with cisplatin, oxaliplatin, capacitabine, pemetrexed, irinotecan, bevacizumab, aflibercept, axitinib and cetuximab failed to improve primary endpoint OS. Monotherapy with S-1 demonstrated noninferiority to gemcitabine in OS and S-1 approved for pancreatic cancer in Japan. In a randomized phase II/III ACCORD trial median progression free survival (PFS), response rate (RR), median OS and quality of life were significantly prolonged in FOLFIRINOX arm compared to gemcitabine alone arm. In phase III (MPACT) trial, like FOLFIRINOX regimen, median PFS, RR and OS significantly prolonged with the combination nab-paclitaxel and gemcitabine compared to gemcitabine arm alone. As a targeted agent erlotinib is the first and only agent that demostrate signifiacnt activity with gemcitabine combination in patients with metastatic pancreatic cancer. Gemcitabine plus erlotinib combination significantly prolonged PFS and OS compared to gemcitabine alone arm. Although some combination regimens showed significant OS benefit compared to single-agent gemcitabine, the median OS was less than 1 year. On these grounds, future directions are needed to integrate new targeted agents and combination protocols for metastatic pancreatic cancer. [ABSTRACT FROM AUTHOR]

Background/Aims: The association between platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and survival with response rates were evaluated in metastatic gastric cancer (MGC). Patients and Methods: MGC patients on firstline modified docetaxel/cisplatinum/5‑fluorourasil [mDCF; docetaxel 60 mg/m2 (days 1-5), cisplatin 60 mg/m2 (day 1), 5FU 600 mg/m2 (days 1-5), q3w] were evaluated retrospectively. The cutoff values were 160 for PLR and 2.5 for NLR. Progression‑free survival (PFS) and overall survival (OS) were estimated for group I (PLR >160), group II (PLR ≤ 160), group III (NLR ≥ 2.5), group IV (NLR < 2.5), group V (PLR > 160 and NLR ≥ 2.5), group VI (PLR ≤160 and NLR <2.5), and group VII [VIIa (PLR > 160 and NLR < 2.5) and VIIb (PLR ≤160 and NLR ≥ 2.5)]. Results: One hundred and nine MGC patients were evaluated for basal hematological parameters and survival analysis, retrospectively. Most of the patients were male in their fifties with grade III adenocarcinoma (62.9%) and liver metastasis (46.7%). Patients with PLR > 160 and/or NLR ≥ 2.5 had significantly shorter PFS and OS (P = 0.04, 0.01, 0.019, and P = 0.003, 0.002, 0.000, respectively). Conclusion: High PLR (> 160) and/or NLR (≥ 2.5) seem to be poor prognostic factors in MGC. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to efficacy of hedgehog (Hh) pathway inhibitor vismodegib in basal cell carcinoma (BCC). Topics discussed include increment in the response rate in BCC by cisplatins chemotherapy, less progression of the disease in patients taking the drug and its adverse events such as hyponatremia, fatigue and atrial fibrillation.

Introduction: Trastuzumab is the first anti-HER-2 humanized monoclonal antibody. The benefit of adjuvant trastuzumab has been shown in randomized phase III trials. Despite trastuzumab being recommended for 52 weeks in the adjuvant treatment of HER-2 positive breast cancer according to the current breast cancer guidelines, there is still no consensus on the optimal duration of adjuvant trastuzumab. The aim of our study is to investigate the efficacy and safety of adjuvant trastuzumab for 9 weeks and 52 weeks in axillary lymph node positive HER-2 positive breast cancer patients. Patients and methods: A total of 271 HER-2 and axillary node positive breast cancer patients who received trastuzumab in adjuvant treatment between the years 2005 and 2013 were retrospectively analyzed. Patients with axillary node positive HER-2 positive breast cancer who were non-metastatic were enrolled to the study. Patients were allocated to the 9 week trastuzumab group (n?155) or the 52 week trastuzumab group (n?116). Kaplan? Meier survival analysis was carried out for disease free survival (DFS) and overall survival (OS). Two-sided p values of50.05 were considered statistically significant. The most important limitation of our manuscript is the retrospective design. Results: The median follow-up time for this analysis was 34 (4?95) months. Patients? clinical and pathological characteristics were well balanced between the two treatment arms. In the 9 week trastuzumab treatment group, the DFS rate was 96.7%, 84.8% and 74.9% in the first, third and fifth years respectively, whereas in the 52 week trastuzumab treatment group it was 94.3%, 80.0% and 80.0% (P?0.76). In the 9 week trastuzumab treatment group, the OS rate was 99.3%, 92.2% and 88.3% in the first, third and fifth years respectively, whereas in the 52 week trastuzumab treatment group it was 99.0%, 94.7% and 78.6% (P?0.99). In both groups, symptomatic heart failure was not reported but asymptomatic left ventricular ejection fraction (LVEF) decline was observed 3 (1.9%) and 18 (15.5%) patients in the 9 week and 52 week trastuzumab treatment groups, respectively (P50.001). [ABSTRACT FROM AUTHOR]

Lung cancer still has a big proportion of cancer related deaths inspite of improvements in chemotherapeutic and surgical treatment approaches. It has a strong relationship with tobacco comsumption so that it can be regard as a common health problem. The survival rates of lung cancer at earlier stages are higher than later stages, so it is worth to effort detect lung cancer at an early stages which can cause mortality reduction and survival improvement. Some screening methods were used in screening trials to achieve a satisfactory mortality reduction with increased survival rates. We discussed about the results of important big trials which have different methods and qualities. There are two important screening tools to discuss about including; chest x-ray and low dose computed thomography (CT). Although there were many randomized or non-randomized trials used these tools for screening programs, few studies have enough power and quality to interpret the results. In this review, we discuss about the latest and detailed data of screening trials including, The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, Mayo Lung Project, The National Lung Screning Trial (NLST), The NELSON trial, The International Early Lung Cancer Action Program (I-ELCAP). Among the results of the trials we discussed about, only screening with low dose CT showed a statistically significant reduction of lung cancer deaths with increased early detection in high risk patients. Of these trials, the NLST which showed 20% mortality reduction in lung cancer and 6.7% mortality reduction from any cause has enough power to achieve this target and this results have affected nearly all of guidelines and recommendations of experts. The results of studies with low dose CT, especially of the NLST, changed thoughts about lung cancer screening. According to these results, the high risk individuals are suggested to be screened with low dose CT by almost experts and societies. In contrast, there should be further evaluations to clarify costs, harm effects of screening with low dose CT programs or related consequence procedures. Smoke cessation is still the most important strategy for reducing the burden of lung cancer, despite the promising results of screening trials. [ABSTRACT FROM AUTHOR]

Background/Aim: Gastric cancer (GC) is considered to be a disease of elderly patients. It has been suggested that GC in young adults has more aggressive clinical and pathologic features than in adults. In this study we aimed to evaluate clinical and pathologic features of GC under age 40 years. Patients and Methods: Patients included in this study were those treated and followed up for GC under age 40 years in Ankara Numune Education and Research Hospital from 2002 to 2011. Results: Clinical and pathologic features of 82 patients have been evaluated retrospectively. Of the patients 44 were male (54%) and 38 were (46%) female, and the median age was 35 years (min-max: 18-40 years). The tumor was grade 3 in 77% of the patients, 79% had diffuse type tumor, 64% had lymphovascular invasion, and 76% had perineural invasion. Forty-seven patients (57%) were metastatic at the time of diagnosis. The median follow up was 9 (1-101) months. The median overall survival (OS) was 9 months in metastatic patients and 8-year OS was 64% in nonmetastatic patients. Conclusions: We observed that young GC patients had more aggressive histopathologic features and more than half was metastatic at the time of diagnosis. We need more studies comparing young and elderly patients to confirm that young patients had more aggressive disease. [ABSTRACT FROM AUTHOR]

Eventually, all patients with malignant gliomas recur or progress. Unfortunately, the optimal regimen in the salvage setting has not yet been defined. We retrospectively evaluated 52 patients with malignant gliomas who failed temozolomide therapy and were treated with a combination of intravenous carboplatin and oral cyclophosphamide. The median age of all patients, including those with glioblastoma multiforme (GBM) (n= 40) and anaplastic glioma (AG) (n= 12), was 45.5 years (range 23-68). All patients were treated with consolidation temozolomide after chemoradiotherapy. After temozolomide failure, second surgery was performed on 15, reirradiation on four and radiosurgery on three patients. The median number of chemotherapy cycles was 4 (range 1-8), the clinical benefit was 67.3%, a partial response was achieved in 26.9% and stable disease in 40.4%. In the GBM group, median progressionfree survival (PFS) and overall survival (OS) were 3 (95% CI, 2.31-3.69) and 8 (95% CI, 4.76-11.24) months, respectively. In the AG group, median PFS and OS were 5 (95% CI, 3.51-6.49) and 11 (95% CI, 6.38-15.62) months, respectively. The six-month PFS rate was 25%. Only one patient survived 18 months after treatment. Serious toxicity was mainly hematological. The combination of carboplatin and oral cyclophosphamide is a valuable option in temozolomide refractory patients with malignant glioma. [ABSTRACT FROM AUTHOR]

Background: Combination of gemcitabine and nab-paclitaxel has superior clinical efficacy than gemcitabine alone. Nevertheless, health-related quality of life. (QoL) associated with this combination therapy when administered at first-line in advanced pancreatic adenocarcinoma is unknown.Methods: A total of 125 patients were randomized to combination therapy (1000 mg/m2 gemcitabine + 125 mg/m2 nab-paclitaxel) and single-agent gemcitabine (1000 mg/m2) arms to take treatment weekly for 7 of 8 weeks, and following 3 of 4 weeks, until progression or severe toxicity. Primary endpoints were three-months of definitive deterioration free percent of patients, and QoL.Results: Overall QoL analyses showed that 34 and 58.3% of cases in gemcitabine and gemcitabine+nab-P arms had no deterioration in 3rd month QoL scores (p = 0.018). These proportions were 27.3 and 36.6% in 6th month assessments, respectively (p = 0.357). Median overall survivals in combination and single-agent arms were 9.92 months and 5.95 months, respectively (HR: 0.64, 95% CI: 0.42-0.86, p = 0.038). Median progression free survivals in these treatment arms were 6.28 and 3.22 months, respectively (HR: 0.58, 95% CI: 0.39-0.87, p = 0.008). Median time-to-deterioration were 5.36 vs 3.68 months, and objective response rates were 37.1% vs 23.7% (p = 0.009), respectively in combination and single-agent arms.Conclusions: Combination therapy with gemcitabine + nab-paclitaxel had better overall and progression-free survival than gemcitabine alone. Also, combination therapy showed increased response rate without toxicity or deteriorated QoL. Combination treatment with gemcitabine and nab-paclitaxel may provide significant benefit for advanced pancreatic cancer.Trial Registration: This study has been registered in ClinicalTrials.gov as NCT03807999 on January 8, 2019 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Objective: To evaluate prognostic factors associated with the use of ipilimumab in patients with mucosal and uveal melanoma. Methods: In this multicenter, retrospective study, 31 patients with uveal and mucosal melanoma diagnosed between 2010 and 2017 were enrolled. Patients' characteristics, metastatic disease sites, treatment before ipilimumab therapy, performance status, hemoglobin, lactate dehydrogenase levels, B-RAF and c-kit mutation status, toxicity, and survival data were assessed for patients with mucosal and uveal melanoma. SPSS version 17 was used for statistical analysis. Kaplan–Meier method was used for survival analysis. The log-rank test was used for univariate analyses. The Cox regression analysis was used to test the association between multivariate variables and survival. The p-value of less than 0.05 was considered statistically significant. Results: Twenty patients had uveal and eleven patients had mucosal melanoma. The median overall survival was seven months (95% confidence interval: 1.1–12.7). In univariate analysis, while bone metastasis, anemia, high lactate dehydrogenase level, and more metastatic sites were associated with lower overall survival, better treatment response and administration of ipilimumab in first or second lines were associated with favorable overall survival. In multivariate analysis, only treatment response status and administration of ipilimumab in first or second lines were found to be significant as independent prognostic factors for survival. Conclusion: Ipilimumab therapy may be associated with increased survival, but this retrospective small N study makes that hard to definitely conclude. [ABSTRACT FROM AUTHOR]

Our study aimed to evaluate the efficacy and demonstrate the real-life outcomes of the combination of modified Docetaxel, Cisplatin, and Fluorouracil (mDCF) as perioperative chemotherapy in patients with locally advanced gastric cancer. The study included 151 patients diagnosed with locally advanced gastric cancer. Modified Docetaxel, Cisplatin, and Fluorouracil was given to patients every 21 days with the following dosages per medication: Docetaxel: 60 mg/m2, Day 1; Cisplatin: 60 mg/m2, Day 1; 5-Fluorouracil: 600 mg/m2 X 5 days. After perioperative chemotherapy patients considered resectable underwent subtotal/total gastrectomy. One hundred and thirty-four (88.7%) of the 151 patients receiving perioperative treatment were operated on. Complete resection was achieved in 123 (81.4%) of the 151 patients. The median disease-free survival (DFS) was 16 months (95% CI 22.5-31.5) and 5-year DFS was 25%. Median overall survival (OS) was 29 (95% CI, 21.9-36.0) months and 5-year OS was 29%. The presence of lymphovascular invasion and postoperative metastatic lymph node rate being = 0.15 in the multivariate Cox regression analysis were determined as independent prognostic factors in terms of both DFS and OS. Our study has provided significant data in terms of sharing long-term real-life outcomes of perioperative mDCF. With mDCF combination in locally advanced gastric cancer, high R0 resection rates were obtained. Furthermore, our study put forward that MLR and LVI are two parameters that could be used in determining the prognosis of patients receiving perioperative mDCF. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is a rare disease amongst children and adolescents. Previous studies have reported a number of differences between children/adolescents, young adults, and adult patients with CRC. However, none of these studies compared these age groups according to their clinicopathologic and prognostic characteristics. In the current study, we compare these three age groups. Methods:A total of 173 (1.1% of 15,654 patients) young CRC patients (≤25 years) were included in the study. As a control group, 237 adult CRC patients (>25 years) were also included. Patients were divided into three age groups: child/adolescent (10–19 years), young adult (20–25 years), and adult (>25 years). Results: Statistical differences amongst the three groups in terms of gender (p = 0.446), family history (p = 0.578), symptoms of presentation (p = 0.306), and interval between initiation of symptoms and diagnosis (p = 0.710) could not be demonstrated. Whilst abdominal pain (p < 0.001) and vomiting (p = 0.002) were less common in young adults than in other groups, rectal bleeding and changes in bowel habits were relatively less common in adolescents than in other groups. Rectal localisation (p = 0.035), mucinous adenocarcinoma (p < 0.001), and a poorly differentiated histologic subtype (p < 0.001) were less common in the adult group than in other groups. The percentage of patients with metastasis and sites of metastasis (e.g., peritoneum and lung) differed between groups. The median overall survival was 32.6 months in the adolescent group, 57.8 months in the young adult group and was not reached in the adult group (p = 0.022). The median event-free survival of the adolescent, young adult, and adult groups was 29.0, 29.9, and 61.6 months, respectively (p = 0.003). Conclusions: CRC patients of different age groups present different clinicopathologic and prognostic characteristics. Clinicians should be aware of and manage the disease according to these differences. [ABSTRACT FROM AUTHOR]

Purpose: Studies in the last decade show survival improvement with checkpoint blocker therapy in patients with metastatic malign melanoma. Our purpose was to define the efficacy of ipilimumab according to the patient's baseline characteristics including absolute lymphocytes count. Methods: We collected the data of 97 patients with advanced malign melanoma treated with ipilimumab (3 mg/kg, q3w) retrospectively. Log-rank test was used to analyze the univariate effects of patient's characteristics (age, gender, metastatic sites, ECOG PS, type of melanoma, lactic dehydrogenase levels, anemia, lymphocytes (L), neutrophils (N), N/L ratio), c-kit and BRAF status. Survival analyses were estimated with Kaplan–Meier method. Cox regression analysis was used to assess the possible factors identified with log-rank test. Results: The median age was 58, and 58% were male and 90% of patients had at least one prior systemic therapy. The median survival was 9.7 months for all patients; and the 12- and 24-month survival rates were 43% and 19%, respectively. Absolute lymphocytes count, lactic dehydrogenase level, bone metastasis, the number of metastatic sites, and RECIST response were significantly related to survival. After Cox regression analysis, RECIST response (complete or partial response), absolute lymphocytes count (more than 1500/mm3) and the number of metastatic sites (less than three sites) remained as significant independent prognostic factors for longer survival. Conclusion: Ipilimumab improved survival of patients with metastatic malign melanoma. However, patients with fewer metastatic sites and higher absolute lymphocytes count have a significantly better benefit. To determine if these markers could be used to direct patient therapy, further validation analysis is needed. [ABSTRACT FROM AUTHOR]

Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH) were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS) at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU), length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36%) patients, 9-13 in 23 (46%) patients and 3-8 in 9 (18%) patients. The reasons for emergency department admissions were fall from high in 29 (58%) patients, assault in 11 (22%) patients and motor vehicle accident in 10 (20%) patients. The average cost per ICU stay was 2838 $ (range=343-20571 $). The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients). Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH. [ABSTRACT FROM AUTHOR]

Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH) were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS) at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU), length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36%) patients, 9-13 in 23 (46%) patients and 3-8 in 9 (18%) patients. The reasons for emergency department admissions were fall from high in 29 (58%) patients, assault in 11 (22%) patients and motor vehicle accident in 10 (20%) patients. The average cost per ICU stay was 2838 $ (range=343-20571 $). The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients). Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine whether there are any clinicopathological or prognostic differences between patients with α-fetoprotein-secreting gastric carcinoma (AFP-SGC) and non-AFP-SGC. Pathological parameters, clinical parameters, and treatment efficacy were compared in patients with AFP-SGC and non-AFP-SGC. In total, 362 patients (53 with AFP-SGC and 309 with non- AFP-SGC) were included in the present study. Patients with AFP-SGC had significantly higher levels of lymphovascular invasion, perineural invasion (PNI), rate of liver metastasis, and stage IV cancer compared with patients with non-AFPSGC (P<0.05). The median overall survival (OS) rate was 12.6 months in the AFP-SGC group, and 22.1 months in the non-AFP-SGC group (P<0.001). The median OS and disease free survival (DFS) of patients with stage I-III AFP-SGC were 28.1 and 13.4 months, respectively, whereas for patients with non-AFP-SGC, the OS and DFS were 45.3 and 38.0 months, respectively (P=0.01; P=0.02). The median OS for the stage IV AFP-SGC and non-AFP-SGC groups was 9.3 and 11.5 months, respectively (P=0.14). Multivariate analysis of the entire patient group revealed that the Eastern Cooperative Oncology Group (ECOG) performance score of ≥2, lymph node involvement, presence of PNI, high levels of carcinoembryonic antigen, and distant metastasis were significantly correlated with OS. The lymph node involvement, ECOG performance score of ≥2, AFP-SGC type, and weight loss at diagnosis were also significant factors influencing the DFS in the stage I-III group. In conclusion, patients with AFP-SGC had more aggressive clinicopathological features and biological behavior with an increased tendency of liver metastasis compared with patients with non-AFP-SGC. In the near future, AFP may become an important surrogate marker to manage therapies of patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Multiple myeloma and other plasma cell disorders are characterized by production of a large number of plasma cells in the bone marrow. On the other hand, plasmacytoma results from proliferation of abnormal plasma cells in the soft tissue or skeletal system. Neurological complications are frequently observed in these diseases. The most commonly known complications among those complications are spine fractures, spinal cord compressions, and peripheral neuropathies. Although neurological involvements are common in plasmacytomas, extramedullary spinal epidural localizations have been reported very rarely. In this case report, we aimed to present a plasmacytoma case that presented with acute onset of upper extremity monoparesis. A 40-year-old woman was admitted to our clinic with complaints of sudden weakness and numbness in her left arm following neck and left arm pain. Emergency cervical magnetic resonance imaging (MRI) revealed an epidural mass and the patient underwent emergency surgery. The patient showed improvement postoperatively and the pathology was reported as plasmacytoma. Following hematology consultation, systemic chemotherapy was initiated and radiotherapy was planned after wound healing. [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]

Aim of the study: Data are available indicating that red blood cell distribution width (RDW) is higher in cancer patients compared to healthy individuals or benign events. In our study, we aimed to investigate the influence of different RDW levels on survival in lung cancer patients. Material and methods: Clinical and laboratory data from 146 patients with lung cancer and 40 healthy subjects were retrospectively studied. RDW was recorded before the application of any treatment. Patients were categorised according to four different RDW cut-off values (median RDW, RDW determined by ROC curve analysis, the upper limit at the automatic blood count device, and RDW cut of value which used in previous studies). Kaplan-Meier survival analysis was used to examine the effect of RDW on survival for each cut-off level. Results: The median age of patients was 56.5 years (range: 26-83 years). The difference in median RDW between patients and the control group was statistically significant (14.0 and 13.8, respectively, p = 0.04). There was no difference with regard to overall survival when patients with RDW ≥ 14.0 were compared to those with RDW < 14.0 (p = 0.70); however, overall survival was 3.0 months shorter in low values of its own group in each of the following cut-off values: ≥ 14.2 (p = 0.34), ≥ 14.5 (p = 0.25), ≥ 15 (p = 0.59), although no results were statistically significant. Discussion: We consider that the difference between low and high RDW values according to certain cut-off values may reflect the statistics of larger studies although there is a statistically negative correlation between RDW level and survival. [ABSTRACT FROM AUTHOR]

The article offers information on a study conducted by the authors on comparison of long term cardiac effects of trastuzumab in HER2-positive breast cancer. It mentions permanent loss of left ventricular ejection fraction and higher cardiac biomarkers in patients having trastuzumab induced cardiotoxicity (TIC). It mentions that TIC can be permanent in patients and can cause long term cardiac damage.

Aim of the study: Gastrointestinal lymphoma is the most common type of extranodal lymphoma and commonly involved site is the stomach. We have compared the superiority between treatment modalities for primary gastric lymphoma and we want to investigate efficacy of rituximab in gastric lymphoma. Material and methods: Between April 2002 and December 2011, 146 patients with a histologically confirmed primary gastric lymphoma, initially diagnosed at eight different Cancer Centers within Turkey were evaluated retrospectively. According to the treatment modality, the patients were divided into chemotherapy (CT) alone, chemotherapy and radiotherapy (CRT), surgery and chemotherapy (SCT), surgery along with chemotherapy and radiotherapy (SCRT), and surgery (S) alone groups. Results: Median follow-up period was 25.5 months. The 5-year EFS (event free survival) and OS (overall survival) rates for the patients were 55% and 62.3% respectively. In Log rank analysis of OS and EFS, we have identified levels of albumin and hemoglobine, IPI score, stage at diagnosis as factors influencing survival. In multivariate analysis of OS and EFS, only albumin and stage at diagnosis were factors independently contributing to survival. There was no statistically significant difference in terms of survival between different treatment modalities (p = 0.707 in EFS and p = = 0.124 in OS). In analysis of patients treated with chemotherapy alone, there was no a statistically significant difference in terms of EFS and OS between chemotherapy regimens with or without rituximab in localized and advanced stage groups (p = 0.264 and p = 0.639). There was no statistical difference in survival rate (EFS and OS) between surgical or non-surgical treatment modalities for localized/advanced stage gastric lymphoma groups (p = 0.519 / p = 0.165). Conclusions: There are several treatment options due to similar results in different treatment modalities. Also benefit of rituximab treatment in gastric lymphoma is still a controversial subject. Additional prospective trials are definitely required in order to clarify use of rituximab in treatment of extranodal gastric lymphoma. [ABSTRACT FROM AUTHOR]

Purposes: The overall prognosis for recurrent malignant glioma (MG) is extremely poor, and treatment options are limited. We evaluated our multicenter retrospective experience for patients with recurrent MG administering bevacizumab and irinotecan in combination therapy. Methods: A total of 115 patients with grade IV glial tumor ( n = 93) and grade III glial tumor ( n = 22) were retrospectively evaluated at 14 centers in Turkey. Primary objectives of the study were to evaluate the efficacy and toxicity of the bevacizumab and irinotecan as salvage treatment based on response to therapy, progression-free survival (PFS), 6 months of PFS, overall survival (OS), and 6 months of OS (OS6). Results: Bevacizumab and irinotecan were performed as second line (79.1 %) and third line treatment (20.9 %). Median chemotherapy cycle was 6 (range 1-37), and median follow-up was 6 months (range 1-36 months). Objective response rate was 39.1 %. Six-month PFS and OS6 were 46.3 % and 67.5 %, respectively. Median PFS was 6 months (95 % CI 2.5-9.5) and 6 months (95 % CI 4.9-7.1) in the grade III and IV groups, respectively ( p = 0.773). Median OS was 9 months (95 % CI 7.1-10.9) and 8 months (95 % CI 6.6-9.4) in the grade III and IV groups, respectively ( p = 0.450). Serious toxicities were observed in 7.8 % of patients. Treatment-related toxic death was observed in 3 patients. There was no treatment related to central nervous system hemorrhage or other serious hemorrhages. Conclusions: Present study results were consistent with previous studies. In addition, we detected similar outcomes in grade III and IV glial tumors. [ABSTRACT FROM AUTHOR]

Purposes: Trastuzumab is known to be effective for early and advanced stages of breast cancer but optimal duration for early-stage breast cancer (EBC) is not well known. We evaluated the efficacy and toxicity of 9- and 52-week trastuzumab therapy for EBC retrospectively. Methods: In this multicenter study, the medical records of all patients with EBC were analyzed in 8 centers retrospectively. Totally consecutive, 479 female patients who received trastuzumab in the adjuvant treatment were evaluated for disease-free survival (DFS), overall survival (OS), efficacy, and toxicity. Results: There were 181 (37.8 %) and 298 (62.2 %) patients in the 9- and 52-week trastuzumab groups, respectively. Median follow-up was 30.6 months (5.7-68.9) in the 9-week trastuzumab group and 29.3 months (5.9-59.6) in the 52-week trastuzumab group. Thirty-six month DFS was 90 and 85 % ( P = 0.132) in the 9- and 52-week trastuzumab treatment groups, respectively, and 36-month OS was 96 and 97 % in the 9- and 52-week trastuzumab groups, respectively ( P = 0.779). Symptomatic cardiotoxicity was observed in 1 (0.6 %) patient in the 9-week trastuzumab group and in 4 (1.3 %) patients in the 52-week trastuzumab group. Conclusions: In this study, similar outcomes were found in the 9- and 52-week trastuzumab treatment groups. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the impact of adjuvant systemic therapy with modern chemotherapy combinations on survival outcomes in patients with resected liver-confined metastases from colorectal carcinomas, and whether addition of bevacizumab (BEV) provides further benefit. Methods: A total of 229 consecutive patients who underwent resection for liver-confined colorectal liver metastases were retrospectively analyzed. Results: Of 229 patients, 204 who received chemotherapy with fluoropyrimidine-based (n = 27), irinotecan-based (n = 84) and oxaliplatin-based (n = 93) combinations were analyzed. Among these, 87 patients received BEV while 117 did not (NoBEV). With a median follow-up of 27 months after metastasectomy, the median recurrence-free survival (RFS) and overall survival (OS) were 17 and 53 months, respectively. OS rates at 3 and 5 years were 71% and 40%, respectively. No significant differences were found in the median RFS (p = 0.744) and OS (p = 0.440) among different chemotherapy regimens. The median RFS (p = 0.375) and OS (p = 0.251) were similar in BEV and NoBEV arms. In multivariate analysis, having 4 liver metastases was the only negative independent factor on both RFS and OS, while positive surgical margin was another negative independent factor for RFS. Conclusion: Chemotherapy type and addition of BEV have no impact on both RFS and OS in the adjuvant setting following complete resection of colorectal liver metastases. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Non-Hodgkin lymphomas of the breast are uncommon cancers that occur as either primary extranodal diseases or secondary localizations of a systemic disease. The term 'primary breast lymphoma' (PBL) is used to define malignant lymphomas primarily occurring in the breast in the absence of previously detected lymphoma localizations. In this report, we analyzed nine patients with primary diffuse large B cell lymphoma (DLBCL) of breast. Patients and methods: Patients with newly diagnosed PBLs treated between 1997 and 2009 in five institutions were retrospectively evaluated. Results: The median age of the patients with PBL was 49 years (range 30-82 years), and four patients had left-sided and five had right-sided disease. All of the nine patients were classified as DLBCL. Five patients with DLBCL received chemotherapy followed by involved-field or elective-field radiotherapy and four received chemotherapy alone. Complete remission (CR) following primary treatment for all patients with PBL except for two cases was obtained. In two patients, recurrence occurred. At the median follow-up of 24.2 months, the 5-year OS rate was 76.2%. Univariate analysis indicated that age, ECOG PS, clinical stage, international prognostic index score, lactate dehydrogenase levels and the presence of B symptoms were not important prognostic factors in our study. Conclusions: Our series contained a small sample size, but it is interesting because it included only DLBCL cases. However, definitive conclusions about treatment and follow-up options of patients cannot be made in such a small series of patients. There are very few reports of patients with PBL treated with R-CHOP rather than CHOP alone. The followup is probably still too short and sample size very few to know how R-CHOP compares with CHOP-treated patients in other series, but this is definitely worth looking at in more detail when reasonable median follow-up has been achieved and sample size are sufficient. [ABSTRACT FROM AUTHOR]

Goals: It is generally recommended to wait for at least 24 h before starting chemotherapy after implanting venous port catheters (VPC). Our aim was to evaluate whether it is safe to start chemotherapy on the day of implantation.Patients and Methods: One hundred eighty patients who had to be given chemotherapy on the day of VPC implantation at our institution from June 2005 to April 2007 were included.Main Results: Of patients, 122 were male (67.8%) and median age was 55 years. Majority (133, 72.8%) had colon and gastric adenocancer. Median time to chemotherapy onset from VPC implantation was 102 min (minimum-maximum, 12-402). One hundred sixty-four (91.1%) received prolonged chemotherapy infusions beyond 48 h. No life-threatening acute complications like pneumothorax and hemothorax developed. In one patient extravasation (empty saline extravasation secondary to wrong insertion of the needle), in 17 (9.4%) pain, and in 41 (22.8%) minor bleeding as echymosis were seen. Thrombosis developed in 11 (6.1%). Reasons for VPC removal were thrombosis (2), sepsis (2), cellulitis (1), skin dehiscence (1), and patient will (1).Conclusion: Chemotherapy administration immediately after VPC implantation appears safe without increased acute and chronic complications in inpatient setting. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding colorectal cancer, the third leading cancer all around the world following lung and prostate cancer.