Epidemiology of colorectal cancer in Turkey: A cross-sectional disease registry study (A Turkish Oncology Group trial)

BACKGROUND/AIMS

This study aimed to determine the epidemiological characteristics of colorectal cancer in Turkey.

MATERIALS AND METHODS

In this multicenter, prospective, and cross-sectional registry study, data for 968 patients with colorectal cancer from 21 centers in 7 geographic regions were analyzed.

RESULTS

Diagnosis was colon cancer in 662 (68.4%) and rectum cancer in 306 (31.6%) patients. In total, 60.9% of patients was male; mean age was 58.9±12.6 years. Among patients, 15.0% was drinking alcohol, 17.5% was smoking, 1.5% had familial history of polyposis, 15.0% had diabetes mellitus, 1.0% had inflammatory bowel disease. Fruit and vegetable consumption was low (<3 times/week) in 35.5% and red meat consumption was high (≥3 times/week) in 47.4% of the patients. Median time-to diagnosis was 3.0 months and 4.0 months for patients with colon and rectum cancer, respectively. Mean body mass index was >25 in all group of patients. Distal rectum (61.3%) and sigmoid colon (36.8%) were the most common locations of cancer, for rectum and colon respectively. In total, 85.6% of patients were operated; 25.8% had emergency surgery. Low anterior resection rate was 64.2% in rectum cancer. In majority (89.8%) of the patients with rectum cancer who received preoperative treatment, conventional chemo-radiotherapy regimen was given. pTNM staging at diagnosis showed that stage III and IV patients were in majority (35.9% and 29.7%, respectively).

CONCLUSION

Colon cancer is more frequent than rectum cancer in Turkey. Colorectal cancer patients are diagnosed at later stages. Most of the cases were operated. Interregional differences for risk factors are worthwhile for evaluation in future trials.

Associations between clinicopathological prognostic factors and pAkt, pMAPK and topoisomerase II expression in breast cancer

This study aimed to examine the associations between mitogen activated protein kinase (MAPK), Akt, and topoisomerase II expression and other well established clinical and pathological prognostic factors in patients with breast cancer. A total of 42 women with breast cancer who underwent anthracycline based chemotherapy were included in this retrospective study. Immunohistochemical methods were utilized to examine the expression of phosphorylated MAPK (pMAPK), phosphorylated Akt (pAkt), HER-2/neu and topoisomerase IIα (topo IIα) in tissue blocks. Subsequently, the associations between pMAPK, pAkt, and topoisomerase IIα (topo IIα) expression characteristics and disease stage (T and N), tumor grade, estrogen/progesteron receptor status, and HER-2/neu expression were explored. Median age of the patients was 63 years (range, 37-82). There was a significant association between N stage and topoisomerase IIα expression (P = 0.021), with increasing rates of positivity in higher grades: N0, 22.7%; N1, 11.1%; N2, 42.9%; N3, 100%. In addition, topo IIα expression was higher in estrogen receptor-positive versus estrogen receptor-negative tumors (50% vs. 0%, P = 0.0004) and MAPK expression was more frequent among progesteron receptor-positive versus negative tumors (64.0 versus 20.0%, P = 0.027). Our results show that the tissue expression of topo IIα and MAPK, which play a role in the intracellular signal pathways, is associated with certain established prognostic factors in breast cancer. Further studies examining survival rates and involving larger sample populations are warranted to better define the importance of the observed associations.

An evaluation of lifestyle changes in cancer patients after diagnosis

PURPOSE

Cancer is an increasingly important health problem, and is second only to cardiovascular disease as cause of death. Cancer diagnosis causes significant changes in patients and their families, and social relationships are affected. For this reason, we examined the lives of patients subsequent to their diagnosis and sought to determine any changes in their lifestyles.

METHODS

Between March 16th and September 30th, 2011, a questionnaire consisting of 20 questions was distributed via a face-to-face interview to 150 patients at the Marmara University Hospital Oncology Unit. Each patient was queried during the administration of his/her chemotherapy. Six of the questions were independent choices, and 14 were dependent (multiple choice). A Local Ethics Committee approval was obtained.

RESULTS

Of the 150 patients, 70 (46%) were male and 80 female, and their median age was 55 years (range: 22-82). Following their diagnosis, 71% of males and 50% of females reported that they were complying with guidelines for a healthy lifestyle, and 19% of the patients said that they were eating healthier food. At the time they filled in the questionnaire, 61% said that they were hopeful; however, close to 10% said that they felt hopeless. Approximately 53% of the participants said that following their diagnosis they had a more sympathetic view of the underserved and underprivileged.

CONCLUSIONS

It was surprising that an unexpectedly high percentage of the respondents reported that they did not make any changes in their lifestyles after their diagnosis of cancer, including eating healthier food. It appears Turkish cancer patients are coping with cancer in different means and ways than we expected of them.

Primary renal carcinoid: treatment and prognosis

Primary carcinoid tumors of the kidney are very rare, malignant tumors consisting of neuroendocrine cells. The pathogenesis of renal carcinoid is unclear because neuroendocrine cells are not normally found in adult renal parenchyma. Electron microscopy, immunohistochemistry, octreotide scan, positron emission tomography along with conventional radiographic imaging techniques are used in diagnosis and follow-up. Presenting symptoms usually include flank pain and haematuria. Early stage disease is treated with surgery only. However, randomized trials are lacking because of the very low number of reported cases. Thus, the role of debulking surgery, chemotherapy, radiotherapy, octreotide and targeted therapy in the management of advanced disease remains an open question. In this article the clinicopathologic features and prognosis of this very rare disease along with treatment outcomes of the reported cases are reviewed. In addition, we report a new case of a metastatic primary renal atypical carcinoid tumor treated with octreotide therapy.

Efficacy, safety and prognostic features of resected colon carcinoma treated in "real world" practice: a retrospective cohort-study

PURPOSE

Treatment outcomes and prognostic features of a specific cancer generally come from prospective randomized studies. It seems reasonable to ask the question whether the results of prospective randomized studies entirely reflect the results of the population treated in "real world" practice. Therefore we performed a retrospective cohort analysis in order to find out the efficacy of adjuvant chemotherapy as well as the prognostic factors of our patient population treated in daily practice, and compared these findings with those defined in the prospective studies.

METHODS

Data of patients with high risk stage II and all stage III colon cancers treated with adjuvant chemotherapy were retrospectively analyzed.

RESULTS

A total of 190 patients were retrospectively analyzed. The rates of T2, T3, and T4 tumors were 4.2, 77.9, and 17.9%, respectively. Over 35% of the patients had stage II disease. Of the 5- fluorouracil (5-FU)-based chemotherapy group (n=141), 15% had a dose reduction because of toxicity and 73% were given the total planned dose and cycles, whereas these rates were 18.5 and 66% for oxaliplatin+5-FU treated group, respectively (p=0.66 and 0.44, respectively). The 3-year disease-free survival (DFS) and 5-year cancer-specific overall survival (OS) for all patients were 69.4 and 73%, respectively. In multivariate analysis, cancer-specific OS showed significant correlation with T stage (p=0.015) and with perineural invasion (p=0.024). Also patients ≥ 65 years old had significantly lower OS (p= 0.003)

CONCLUSION

This study is the fi rst to report the efficacy of adjuvant treatment in a curatively resected Turkish colon carcinoma population treated in "real world" practice. Our study showed that the treatment results and the prognostic parameters of Turkish colon carcinoma patients treated in "real world" practice are not different from those of selected patients treated in randomized prospective studies.

Anxiety and depression in Turkish breast cancer patients

PURPOSE

we investigated the anxiety and depression rates in breast cancer patients (BCPs) and compared their rates with a group of unemployed women attending courses at a local government agency to increase their chances for employment.

METHODS

a total 129 BCPs were included [60 were treated and followed up in Marmara University Hospital (PHG), 69 were from a private oncology clinic (POG)] and 101 healthy people (control group; CG) came from a course for the unemployed. All participants completed the Turkish-language version of the Hospital Anxiety and Depression Scale.

RESULTS

The mean ages of the BCPs and CG were 52.7 ± 13.1 and 38.9 ± 11.9 years, respectively (p=0.001). Compared to the CG, the percentage of housewives was significantly higher in the BCP group (p=0.04). These 2 factors (age and profession) were not independent factors predicting anxiety or depression (p>0.05). The rates of anxiety and depression were 27.9 and 35.7% for BCP, 28.7 and 34.7% for CG, 33.3 and 51.7% for PHG, and 23.2 and 21.7% for POG, respectively. The difference of the rates of depression between the POG and the PHG was significant (p=0.0001).

CONCLUSION

the anxiety and depression rates were not higher in BCPs than in the CG who had a risk factor (such as unemployment) for psychosocial ill health. Being treated and/ or followed up in a private office was related to lower depression rates.

ERCC1 is not expressed in hepatocellular cancer: A turkish oncology group, gastrointestinal oncology subgroup study

PURPOSE

hepatocellular cancer (HCC) is a common malignancy with a high mortality rate. Existence of excisional repair cross complementation1 (ERCC1) is implicated in resistance to cisplatin treatment. Expression of ERCC1 in HCC is not known. In this study we aimed to find out whether a subset of HCC patients can be identified to benefit from cisplatin.

METHODS

sixty-one patients with HCC who had enough tissue to do immunohistochemistry were identified in 3 institutions. Immunohistochemical staining was performed manually using the standard streptavidin-biotin-peroxidase method. Monoclonal anti-ERCC 1 (D-10) antibody from Santa Cruz Biotechnology (Santa Cruz, CA) was used.

RESULTS

only one out of 61 patients (1.6%) had ERCC1 expression.

CONCLUSION

although around 10% of HCC patients respond to cisplatin, this is unlikely to be due to ERCC1 negativity. Pathways other than ERCC1 should be searched to find ways to help these patients' treatment strategies.

Cancer-related false knowledge in relatives of cancer patients and the general public

PURPOSE

Although there are many myths about cancer in Turkey, there is no study evaluating Turkish public's knowledge about cancer. The goals of our research were to: 1) measure the extent of knowledge of cancer among the Turkish public; 2) determine the differences in extent of cancer-related knowledge between participants who have relatives with cancer and those who do not; and 3) determine the sources of knowledge possessed.

METHODS

Data were obtained from a total of 415 participants (244 female, 171 male), all of them sitting at the Marmara University Faculty of Medicine Hospital (MUFMH) outpatient clinic waiting area for non-cancer-related reasons. Each participant completed a 3-part questionnaire. Appropriate statistical tests were used for comparison.

RESULTS

The mean age was 41 years. Of 415 participants, 65.3% stated that they had one or more cancer patient in their immediate family; 70.1% of the participants had a high-school education or greater. The questionnaire showed that, depending on the question, anywhere from 1.7% to 88.5% of the general public possesses some false information; furthermore, the difference in accuracy between relatives of cancer patients and non-relatives was marginal. Only 3 specific questions, related to the following ideas, rendered answers that were statistically significantly different between these 2 groups: breast cancer is only seen in females (p <0.005), cell phones cause cancer (p <0.001), and cancer is always very painful (p <0.001).

CONCLUSION

The proportion of false knowledge about cancer was unacceptably high in our cohort. Broader efforts should be made to inform the Turkish public about cancer.

Prolonged interval in prophylactic heparin flushing for maintenance of subcutaneous implanted port care in patients with cancer

The long-term use of subcutaneous implanted ports for chemotherapy in cancer patients has been associated with the occurrence of thrombosis and infection. In this study, we compared the safety and efficacy of administration of 1000 U of heparin flushes in prolonged interval (every 6 weeks) with standard dose and schedule (500 U every 4 weeks) for port-related infections and thrombosis during periods of non-use. Data were collected retrospectively from patients treated for various cancer types (matched as 2:1 for age, gender, stage of the disease). Patients who had diseases that could cause thrombosis or bleeding in their past medical history, or were taking oral anticoagulants, or had contraindications for heparin usage were excluded. After completing their chemotherapy, 59 patients received prolonged interval, while 30 patients received standard schedule. All patients were followed for at least 1 year. No clinically documented port-related infection or thrombosis has been found in both groups. Also, none of the devices was removed during this time. Prophylactic flushing of central venous ports with 1000 U of heparin in every 6 weeks might be a safe, easy, cheaper, comfortable and effective alternative to standard dose and schedule for preventing thrombosis and infections.

Synchronous renal cell carcinoma and multiple myeloma: report of two cases and review of the literature

Coexistence of renal cell carcinoma (RCC) and multiple myeloma (MM) is an extremely rare condition. Appearance of synchronous RCC and MM was not reported independently so far. In this brief communication, we report 2 cases of synchronous RCC and MM, discuss common risk factors or pathogenetic mechanisms seen in either RCC or MM, point out the importance of IL-6 in this coexistence and provide some descriptive properties of all reported synchronous RCC and MM cases.

A case of Kikuchi-Fujimoto disease misdiagnosed as Hodgkin's lymphoma: the importance of second opinion

Kikuchi-Fujimoto disease (KFD), a rare clinicopathological entity, is a benign and self-limiting disease. It was first described in 1972 by Kikuchi and Fujimoto in Japan independently. KFD is prevalent in Asia, although it may be seen in wide geographical areas, including Turkey. It mainly affects young women. Cervical lymphadenopathy is the most prominent sign and should be differentiated from lymphoproliferative, autoimmune, and infectious diseases. We report on a 30-year-old female patient who was referred to our medical oncology unit for chemotherapy and/or radiotherapy with diagnosis of Hodgkin's lymphoma. Ultimately her diagnosis was corrected as KFD after second opinion of the pathology specimens. We herein provide a brief review about KFD and the importance of second opinion of the pathology specimens.

Toxicity and feasibility analysis for cisplatin-based concomitant chemoradiotherapy in locally advanced nasopharyngeal carcinoma

PURPOSE

To assess the side effects of cisplatin-based concurrent chemoradiotherapy (CRT) for locally advanced nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS

From 2001 through 2007, 34 (27 males; 7 females) patients received a median of 70 Gy curative radiotherapy (RT) with conventional fractionation. Twenty-one (62%) patients received induction chemotherapy (CT): 8 of them received 2 courses of cisplatin (75 mg/m(2), day 1) and 5-fluorouracil (5-FU) (750 mg/m(2), days 1-5) every 3 weeks and 13 patients received 3 courses of cisplatin (75 mg/m(2), day 1) and docetaxel (75 mg/m(2), day 1) every 3 weeks. Concomitant cisplatin was administered either 40 mg/m(2) weekly (n=8) or 75-80 mg/m(2) every 3 weeks (n=26) during RT. Median Karnofsky performance status (KPS) prior to RT was 80 (range 70-90). Patient, disease and treatment-related factors were analysed in relation to termination of concurrent CT.

RESULTS

Concurrent CT was administered to 13 (38.2%) patients without cisplatin termination, whereas 10 (29.4%) patients received 2 cycles of the 3-weekly schedule. Grade 3 oral mucositis (47.1%), grade 2-3 weight loss (44.2%) and grade 2 fatigue (44.1%) were the most frequently dose-limiting side effects during concurrent therapy. The rate of receiving cisplatin cycles as planned was 85% for patients with KPS >80, whilst it was 15% only for patients with KPS < or = 80 (p=0.006). None of the patients suffering of grade 2 fatigue could complete all cycles compared to 68% of patients with < grade 2 fatigue who completed all cycles (p <0.001). The severity of mucositis was significantly related to initial haemoglobin level (p=0.02) and weight loss during RT (p=0.04). Median follow-up was 20 months (range 5-65). Three-year locoregional relapse free (LRRFS), disease free (DFS) and overall survival (OS) rates were 79.3%, 68.8% and 79.2%, respectively.

CONCLUSION

Concurrent administration of CT during RT reveals better outcome but requires careful consideration for toxicity. Initial performance status prior to CRT might be a predictor for unplanned CT stopping due to side effects.

Impact of body mass index on cancer development

PURPOSE

To determine the impact of body mass index (BMI) on cancer in a hospital-based Turkish population.

PATIENTS AND METHODS

The study group consisted of 2015 (1172 females: 423 pre- and 749 postmenopausal; and 843 males) patients with histologically proven cancer who applied to Marmara University Medical School, Medical Oncology Clinic. The control group included 305 healthy caregivers (192 females: 110 pre- and 82 postmenopausal; and 113 males).

RESULTS

Mean BMI of the patients with breast, ovarian and cervical carcinoma was significantly higher than that of the healthy female controls (p<0.001, 0.003, <0.001, respectively). Postmenopausal breast cancer patients had significantly higher BMI than postmenopausal female controls (odds ratio [OR] 1.3; 95% confidence interval [CI], 1.06-1.6; p=0.012), while this was not seen in premenopausal patients. When compared with controls obese postmenopausal female patients had 3.26-fold (95% CI 1.54-6.90) increased risk for breast cancer (p=0.002). Mean BMI of lung, stomach, esophagus, pancreas and head and neck carcinoma patients was significantly lower than that of the healthy controls. Female patients with lung and colorectal carcinoma had higher BMI than female controls.

CONCLUSION

Elevated BMI might be a risk factor for breast cancer in postmenopausal women. Case-control studies may not show the actual association between BMI and cancers that present with pre-diagnosis weight loss and advanced stage.

Vascular endothelial growth factor, hypoxia-inducible factor 1 alpha and CD34 expressions in early-stage gastric tumors: relationship with pathological factors and prognostic impact on survival

BACKGROUND

Angiogenesis is one of the key steps in solid tumor growth and metastasis. We planned to investigate the prognostic significance of vascular endothelial growth factor (VEGF), hypoxia-inducible factor 1alpha (HIF-1alpha) and CD34 expressions as markers of angiogenesis in gastric cancer.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 51 gastric cancer patients who had total or subtotal gastrectomy at Marmara University Hospital from 1990 to 2004 and evaluated the expression of VEGF, HIF-1alpha and CD34 by immunohistochemistry in their archival tumor tissues. We recorded the clinical and pathological characteristics of these patients and analyzed their survival outcome.

RESULTS

Thirty out of 51 patients were males. The median age was 63 years (range 34-81). The median follow-up was 17 months. Thirty-six patients had node-positive disease. The majority of patients (n = 43) had T2 and T3 disease. Vascular and lymphatic invasions were present in 57 and 77% of tumors, respectively. VEGF and HIF-1alpha were positive in 65 and 71% of tumors. The median CD34 staining score was 19 (3-68). VEGF, HIF-1alpha and CD34 expressions were more frequent in tumors without serosal invasion (p = 0.01, p = 0.01 and p = 0.003, respectively). CD34 expression was significantly more frequent in tumors with VEGF and HIF-1alpha expression (p = 0.00, p = 0.00). HIF-1alpha expression was more frequent in tumors with VEGF expression (p = 0.00). The 5-year overall survival was 45%. VEGF, HIF-1alpha, CD34 expressions and other pathological characteristics were found to have no impact on survival.

CONCLUSION

VEGF, HIF-1alpha and CD34 expressions were more common in tumors without serosal invasion. As a future perspective, biological agents targeting VEGF and HIF-1alpha might be more effective at earlier stages of gastric cancer.

Vascular endothelial growth factor, hypoxia-inducible factor 1 alpha and CD34 expressions in early-stage gastric tumors: relationship with pathological factors and prognostic impact on survival

BACKGROUND

Angiogenesis is one of the key steps in solid tumor growth and metastasis. We planned to investigate the prognostic significance of vascular endothelial growth factor (VEGF), hypoxia-inducible factor 1alpha (HIF-1alpha) and CD34 expressions as markers of angiogenesis in gastric cancer.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 51 gastric cancer patients who had total or subtotal gastrectomy at Marmara University Hospital from 1990 to 2004 and evaluated the expression of VEGF, HIF-1alpha and CD34 by immunohistochemistry in their archival tumor tissues. We recorded the clinical and pathological characteristics of these patients and analyzed their survival outcome.

RESULTS

Thirty out of 51 patients were males. The median age was 63 years (range 34-81). The median follow-up was 17 months. Thirty-six patients had node-positive disease. The majority of patients (n = 43) had T2 and T3 disease. Vascular and lymphatic invasions were present in 57 and 77% of tumors, respectively. VEGF and HIF-1alpha were positive in 65 and 71% of tumors. The median CD34 staining score was 19 (3-68). VEGF, HIF-1alpha and CD34 expressions were more frequent in tumors without serosal invasion (p = 0.01, p = 0.01 and p = 0.003, respectively). CD34 expression was significantly more frequent in tumors with VEGF and HIF-1alpha expression (p = 0.00, p = 0.00). HIF-1alpha expression was more frequent in tumors with VEGF expression (p = 0.00). The 5-year overall survival was 45%. VEGF, HIF-1alpha, CD34 expressions and other pathological characteristics were found to have no impact on survival.

CONCLUSION

VEGF, HIF-1alpha and CD34 expressions were more common in tumors without serosal invasion. As a future perspective, biological agents targeting VEGF and HIF-1alpha might be more effective at earlier stages of gastric cancer.

HPV DNA frequency and subset analysis in human breast cancer patients' normal and tumoral tissue samples

Viruses are known to be associated with human malignancies, e.g., Epstein-Barr virus, human papillomavirus (HPV) and human T-cell leukemia virus type I. We conducted a prospective study to define the role of HPV in breast cancer. The malignant and normal breast tissue samples of 50 consecutive breast cancer patients were obtained postoperatively. DNA extracted from all tissues was amplified with the polymerase chain reaction using HPV primers. HPV 11, 16, 18, 33 subtypes were searched in HPV-DNA positive samples. Thirty-seven samples (74%) of tumoral breast tissue expressed HPV-DNA, 16 normal breast tissue samples (32%) were positive as well. There was a significant difference in HPV-DNA positivity between normal and tumoral breast tissue samples. HPV 18 was detected in 20 of the HPV-DNA positive tumoral tissue (54.4%) and in 9 of the HPV-DNA positive normal tissue (56.3%). HPV-33 also was detected in 35 (94.6 %) of the HPV-DNA positive tumoral tissue and in 14 (87.5 %) of the HPV-DNA positive normal tissue samples. HPV DNA was significantly associated with breast tumor tissue compared to normal breast tissue. Additional studies looking at HPV and HPV subtypes are needed to clarify the etiological role of the HPV in breast cancer.

Colorectal cancer care in the Balkan countries

PURPOSE

The aim of this survey was to assess the status of colorectal cancer (CRC) care in the Balkans by contacting cancer care specialists in the Balkan Union of Oncology (BUON) member states.

MATERIALS AND METHODS

The authors searched the 2004 membership directories of the ASCO and ESMO and identified members from the Balkan countries. They then sent them a 3-page questionnaire via e-mail or fax.

RESULTS

Fifty-two responses from 8 countries were received and analysed. The response rate varied from 25% (Turkey) to 3% (Bulgaria). No Bosnian (n=13), Croatian (n=16) and Albanian (n=1) participated. The results showed that, despite variations on the state of development among Balkan countries, there were some striking similarities and also some similar difficulties that CRC specialists are facing in their individual countries.

CONCLUSION

Combined and coordinated efforts at solving some of these common problems may help CRC patients receive better and higher quality care.

Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer

The purpose of this study was to define the measurement properties and clinical validity of the European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to assess health-related quality of life (HRQL) in gastric cancer. The EORTC gastric cancer module, QLQ-STO 22, was administered with the QLQ-C30, core questionnaire, to 219 patients undergoing treatment with curative or palliative intent before and after treatment. Reliability and validity of the module was tested and patients' debriefing comments analysed. Compliance rates were high, questionnaires well accepted and less than 4% of items had missing data. Multi-trait scaling analyses and face validity refined the module to five scales and four single items. Scales distinguished between clinically distinct groups of patients and demonstrated treatment-induced changes over time. Test-retest scores demonstrated good reliability. The EORTC QLQ-STO 22 demonstrates psychometric and clinical validity that supports its use to supplement the EORTC QLQ-C30 to assess quality of life in patients with gastric cancer undergoing surgery, surgery and chemoradiotherapy, palliative chemotherapy, palliative surgery and best supportive care.

Outcome of rectal and sigmoid carcinoma patients receiving adjuvant chemoradiotherapy in Marmara University Hospital

Adjuvant chemoradiotherapy is the standard treatment in resected stage II/III rectosigmoid carcinoma. We report a retrospective analysis of 33 patients who received adjuvant chemoradiotherapy. Patients received 5-fluorouracil (375mg/m2/day x 5days) and calcium leucovorin (20mg/m2/day x 5days), q4weeks, two courses before and two courses after radiotherapy. The 5-fluorouracil dose was reduced to 225mg/m2/day given continuously as protracted short-term infusion on the first and last 3 days during radiotherapy. Radiotherapy was started at 7th week and 45-50.4 Gy was given to pelvic region. Median age was 63 years. Median follow-up was 38 months starting from the operation date. Four-year local and distant control rates were 78% and 69%, respectively. Four-year disease-free survival and overall survival were 60% and 62%, respectively. Protracted short-term infusion of 5-fluorouracil during pelvic irradiation is a safe treatment modality. Further studies are needed to improve the local control of high-risk rectal and sigmoid carcinomas.

Port needles: do they need to be removed as frequently in infusional chemotherapy?

Protracted chemotherapy regimens are new treatment modalities used to treat patients with cancer. These treatments are preferred because of the ease of administration and limited side effects in the outpatient setting. Sixty patients were treated with continuous infusion chemotherapy via implanted infusion ports at Marmara University Hospital Outpatient Chemotherapy Unit in Istanbul, Turkey, from January 2000 to December 2001. Although usage of Huber needles for central venous catheters was limited to between 48 and 72 hours, needles were not removed unless there were signs of inflammatory reaction. The needles remained in place for 28 days (1-49 days) on average. No catheter infections, signs of local irritation, or thrombus formation were observed despite prolonged stay of the Huber needles. Huber needles can be left in place up to several weeks without any untoward effects as long as proper aseptic technique is used.

Neoplastic diseases prevalence in a turkish university hospital

PURPOSE

The purpose of this study was to register the different cancer cases diagnosed in our hospital with an aim to define the most common and treatable cancer types and help define accurate targets for the allocation of the already limited resources of the Ministry of Health.

MATERIALS AND METHODS

We surveyed 12 months of the hospital's pathology records to determine the prevalence of various cancer types.

RESULTS

Out of 9720 biopsy and cytology samples, 662 were cancer cases. Breast and gastric cancers were higher and colorectal cancers were lower than the series reported from the United States. Of the pulmonary malignancies, lung cancer in general was not particularly higher in proportion to other cases, something interesting for a country with smoking rates exceeding 60% of the adult population. Squamous cell lung cancer was more common compared to the rates reported in the western world statistics.

CONCLUSION

Although biases may exist, as certain cancers are more amenable to surgical intervention and physician groups may have special interest toward a particular cancer, distribution of cancer cases in Turkey is probably similar to the western world.

Pancreatic duct cell carcinoma with positive 111In Octreotide uptake

Duct cell adenocarcinomas may produce neuroendocrine markers such as pancreatic polypeptide, gastrin and gastrin releasing hormones. A 53 year old patient, with a history of insulin dependent diabetes, was found to have a pancreatic mass which was later pathologically demonstrated to be a duct cell adenocarcinoma. The tumor produced elevated circulating neuroendocrine markers specifically gastrin and pancreatic polypeptides. An 111In Octreotide imaging showed definite uptake of Octreotide by the tumor. The patient was subsequently treated with Somatostatin analog which resulted in the reduction of some of the circulating endocrine markers. The patient had essentially six months of asymptomatic clinical remission but then she relapsed. Octreotide scanning could be useful for selected patients with pathologic diagnosis of duct cell adenocarcinoma, because some tumors may have neuroendocrine features and can be imaged, and might even respond to Somatostatin analog therapy.

Efficacy of treatment to relieve mucositis-induced discomfort

To determine the efficacy of a mouthwash in relieving mucositis-induced discomfort in patients receiving chemotherapy, 31 (16 male, 15 female) with a mean age of 45 (range 16-80) were given an in-house three-drug (lidocaine, diphenhydramine and sodium bicarbonate in normal saline) mouthwash when they developed mucositis of any severity. The complications were assessed on the CALGB (Cancer and Leukemia Group B) scale. The response to the mouthwash was reported on a self-assessment scale. Patients' response data were analyzed with reference to: (1) relief throughout the duration of mucositis and (2) relief during the worst stage (for each episode) of mucositis. Five patients with fungal, viral or bacterial oral infection were excluded from study. Overall, 4 patients had grade I, 16 patients had grade II, 10 patients had grade III and 1 patient had grade IV mucositis. The average duration of mucositis was 7.9 days (range 3-23 days), and the mean duration of the worst stage of mucositis was 4.81 days (range 2-13 days). The mean mucositis severity score was 1.9 (range 1-4), and the average self-assessment (response) score was 0.81 (range 0-2). The mean mucositis score during the worst stage of mucositis was 2.25 (range 1-4), and the average self-assessment (response) score during the worst stage of mucositis was 0.91 (range 0-2.7). These results suggests that this three-drug mouthwash provides effective symptomatic relief in patients with chemotherapy-induced mucositis.

Cyclosporin A and imipenem associated seizure activity in allogeneic bone marrow transplantation patients

Imipenem is an antibiotic used with cilastatin in the bone marrow transplant (BMT) setting. Cyclosporin A (CsA) is an immunosuppressive agent. Seizures can be seen with both imipenem/cilastatin and CsA. Our hypothesis for study was that CNS toxicity and seizures are increased by the concomitant administration of CsA and imipenem/cilastatin. Between December of 1989 and 1996, all of the 166 stem cell BMTs performed at Mount Sinai Hospital in New York were evaluated for this study. Three groups were studied: 77 patients received CsA alone (Group 1); 89 patients received imipenem/cilastatin, and of these, 45 received concomitant CsA (Group 2); and 44 patients who underwent autologous BMT received imipenem/cilastatin only (Group 3). We observed a total of 5 seizure episodes. There were no statistical differences in frequency between the groups. Adverse effects may be difficult to relate to a particular drug, especially for patients on multidrug regimens but the use of imipenem/cilastatin and CsA did not cause a significant rise in the frequency of seizures when compared to CsA alone.