Faculty of Medicine

To identify the outcomes of prognostic factors of solitary plasmacytoma mainly treated with local radiotherapy (RT). The data were collected from 80 patients with solitary plasmacytoma (SP). Forty patients (50.0%) received radiotherapy (RT) alone while 38 of them (47.5%) were treated with surgery (S) and RT. The median radiation dose was 46 Gy (range 30–64). The median follow up was 2.41 years (range 0.33–12.33). Ten-year overall survival (OS) and local relapse-free survival (LRFS) were 73% and 94%, respectively. The median progression-free survival (PFS) and multiple myeloma-free survival (MMFS) were 3.5 years and 4.8 years, respectively. On multivariate analyses, the favorable factors were radiotherapy dose of ≥50 Gy and RT + S for PFS and younger age for MMFS. For the patients with medullary plasmacytoma, the favorable factor was younger age for MMFS. RT at ≥50 Gy and RT + S may be favorable prognostic factors on PFS. Younger patients, especially with head-neck lesion and without pre-RT macroscopic tumor, seem to have the best outcome when treated with RT ± S. Progression to MM remains as the main problem especially for older patients. Am. J. Hematol., 2008. © 2008 Wiley-Liss, Inc.

Purpose: Brachytherapy is one of the most efficient methods of overcoming endobronchial obstruction in palliative treatment of lung cancer. In single cases, brachytherapy is performed as radical treatment, however in most of cases, due to advanced clinical stage it has a palliative aim. In the absence of clear consensus regarding the value of doses used in brachytherapy different fraction doses are used in clinical treatment. The aim of this work is to compare results of palliative high dose rate brachytherapy using various treatment protocols with the view to analysing differences in survival and diminishing breathing difficulties.

Purpose: To assess the outcome in patients with olfactory neuroblastoma (ONB). Methods and Materials: Seventy-seven patients treated for nonmetastatic ONB between 1971 and 2004 were included. According to Kadish classification, there were 11 patients with Stage A, 29 with Stage B, and 37 with Stage C. T-classification included 9 patients with T1, 26 with T2, 16 with T3, 15 with T4a, and 11 with T4b tumors. Sixtyeight patients presented with N0 (88%) disease. Results: Most of the patients (n = 56, 73%) benefited from surgery (S), and total excision was possible in 44 patients (R0 in 32, R1 in 13, R2 in 11). All but five patients benefited from RT, and chemotherapy was given in 21 (27%). Median follow-up period was 72 months (range, 6-315). The 5-year overall survival (OS), disease-free survival (DFS), locoregional control, and local control were 64%, 57%, 62%, and 70%, respectively. In univariate analyses, favorable factors were Kadish A or B disease, T1-T3 tumors, no nodal involvement, curative surgery, R0/R1 resection, and RT-dose 54 Gy or higher. Multivariate analysis revealed that the best independent factors predicting the outcome were T1-T3, N0, R0/R1 resection, and total RT dose (54 Gy or higher). Conclusion: In this multicenter retrospective study, patients with ONB treated with R0 or R1 surgical resection followed by at least 54-Gy postoperative RT had the best outcome. Novel strategies including concomitant chemotherapy and/or higher dose RT should be prospectively investigated in this rare disease for which local failure remains a problem. Ó

Aim The relation of anxiety and depression levels with characteristics of coping with the disease and quality of life were evaluated in women under follow-up for breast cancer. Materials and Methods Patients who had presented to the breast cancer polyclinics for follow-up were evaluated. The Beck Depression and the State-Trait Anxiety inventories were used in the evaluation of depression and anxiety levels. In order to evaluate their power to cope with cancer, the patients were questioned for a social support network. EORTC QLQ-C30 and QLQ-BR23 questionnaires were applied for quality of life evaluations. Results There were 23 (19%) patients with depression; 3 (2.5%) with grade I anxiety, 94 (77%) grade II, and 23 (19%) grade III anxiety, respectively. Depression and anxiety levels were affected by the following parameters: being unaccompanied by spouse for hospital follow-ups (P < 0.0001); request to get help by a psychologist (P = 0.02); presence of a person to share their problems (P < 0.0001); and using an alternative treatment (P = 0.04). In the quality of life evaluations, difficulty in sleeping, emotional status, fatigue, and body appearance were related with both depression and anxiety (P < 0.05 for all), whereas physical function (P = 0.002), role performance (P = 0.005), cognitive condition (P < 0.0001), social position (P < 0.0001), pain (P < 0.0001), general health (P < 0.0001), treatment methods (P = 0.001), future anxiety (P < 0.0001), and arm symptoms (P = 0.001) were negatively affected in patients with depression. Conclusion High depression and anxiety levels in patients under follow-up for breast cancer influence the coping with cancer and quality of life adversely.

Purpose: To assess the outcome in patients with olfactory neuroblastoma (ONB). Methods and Materials: Seventy-seven patients treated for nonmetastatic ONB between 1971 and 2004 were included. According to Kadish classification, there were 11 patients with Stage A, 29 with Stage B, and 37 with Stage C. T-classification included 9 patients with T1, 26 with T2, 16 with T3, 15 with T4a, and 11 with T4b tumors. Sixtyeight patients presented with N0 (88%) disease. Results: Most of the patients (n = 56, 73%) benefited from surgery (S), and total excision was possible in 44 patients (R0 in 32, R1 in 13, R2 in 11). All but five patients benefited from RT, and chemotherapy was given in 21 (27%). Median follow-up period was 72 months (range, 6-315). The 5-year overall survival (OS), disease-free survival (DFS), locoregional control, and local control were 64%, 57%, 62%, and 70%, respectively. In univariate analyses, favorable factors were Kadish A or B disease, T1-T3 tumors, no nodal involvement, curative surgery, R0/R1 resection, and RT-dose 54 Gy or higher. Multivariate analysis revealed that the best independent factors predicting the outcome were T1-T3, N0, R0/R1 resection, and total RT dose (54 Gy or higher). Conclusion: In this multicenter retrospective study, patients with ONB treated with R0 or R1 surgical resection followed by at least 54-Gy postoperative RT had the best outcome. Novel strategies including concomitant chemotherapy and/or higher dose RT should be prospectively investigated in this rare disease for which local failure remains a problem. Ó

S329 32), IVA (n = 8) and IVB (n = 4). Pelvic lymph nodes were present in 24 pts Squamous~cetl carcfnoma were: grade 1'(40%), 2 (19%)'and 3 (41%). Pelvic external b&m therapy (EBli was t3fdOnned in 99 pts (m&tan total dose = 59 Gy (9-60)) 'and-low dose rate brachytherapy (t3$ in 86 pts. BT was delivered in one time (n = .72), 2 times (n = 13) or 3 times (n = 1). lntracavitary irradiation using person@md mould was associated with iridium implants in 32 applicattons. The median number of sources used for one application was 3 (l-6) with a median total radioactive length of 115 mm. Surgery and chemotherapy were performed in 7 and 5 pts. Results:

define regional LN groups by CT. Lymphotrophic nanoparticle enhanced MRI (LN-MRI) allows for radiographic identification of LN containing metastasis and also allows visualization of normal regional lymphatics with high accuracy for patients with breast cancer. We seek to determine coverage of malignant and benign breast lymphatics as defined LN-MRI using standard RT fields based on bony anatomy and generally accepted CT nodal volumes. Materials/Methods: Twenty-three patients with pathologically confirmed breast cancer underwent MRI with and without Ferumoxtran-10 administration (Combidex; AMAG Pharmaceuticals, Cambridge, MA). The MRIs were anatomically registered to a reference CT scan and benign and malignant LN according to LN-MRI were contoured. Contoured nodes were resampled in the reference patient, replacing actual LN with 5 mm spherical "reference" LN employing a center-of-mass sampling algorithm to allow for a statistical analysis according to nodal position, removing patient specific bias resulting from variation in volumes. Standard RT fields including tangents, supraclavicular (SCV), and posterior axillary boost (PAB) were placed based on bony anatomy. SCV, level 1-3 LN, and internal mammary LN were contoured on CT. Fields and isodose lines were chosen without visualization of LN-MRI LN. Coverage and contribution of fields were assessed. Results: Eighty-one percent of all LN defined by LN-MRI were covered by the 45 Gy isodose line; 82% of malignant and 79% of benign. The 50 Gy isodose line encompassed only 60% of LN-MRI defined lymphatics; 64% of malignant and 59% benign. For nodal volumes contoured in the absence of a margin, only 70% of malignant LN and 71% of benign LN were within contoured volumes. However, when a 5 mm expansion was added, 95% of malignant LN and 96% of benign LN were included in this volume. Conclusions: An LN-MRI may be a useful tool for better delineating the location of the regional lymphatics for breast cancer patients. These results suggest a margin is advisable when defining nodal volumes by CT. The use of IMRT and trials examining the role of axillary RT in lieu of surgery makes accurately defining the location of breast regional lymphatics of paramount importance.

Solitary plasmacytoma (SP) is characterized by a mass of neoplastic monoclonal plasma cells in either bone (SBP) or soft tissue without evidence of systemic disease attributing to myeloma. Biopsy confirmation of a monoclonal plasma cell infiltration from a single site is required for diagnosis. The common presentation of SBP is in the axial skeleton, whereas the extramedullary plasmacytoma (EMP) is usually seen in the head and neck. The ratio of SP seen at males to females is 2 : 1 and the median age of patients is 55 years. The incidence rate of SP in black race is approximately 30% higher than the white race. Incidence rate increases exponentially by advancing age. SBP has a significant higher risk for progression to myeloma, and the choice of treatment is radiotherapy (RT) that is applied with curative intent at min. 4000 cGy. By only RT application, long-term disease-free survival (DFS) is possible for approximately 30% of patients with SBP and 65% of patients with EMP.

The primary aim of this study was to evaluate the risk of osteoporosis (OP) in patients who had received adjuvant chemotherapy for breast cancer. The secondary aim was to investigate the effect of OP on the quality of life of these patients. Twenty-six patients with breast cancer and 21 healthy controls were recruited into the study. All breast cancer patients were treated with 6 cycles of adjuvant chemotherapy. Bone mineral density (BMD) was measured by Dual-energy X-ray absorptiometry (DXA). Short Form-36 (SF-36) questionnaire was used to assess the quality of life. The mean lumbar area BMD value was significantly lower in patients with breast cancer than in healthy controls (p=0.017). There were no significant differences in the femoral area BMD measurements between the groups. OP was more pronounced after 24 months of the last chemotherapy course than in the first 12 months (p=0.04). The most affected domain of the SF-36 in patients with breast cancer was the physical role. Adju...

Oral Sessions / Radiotherapy the whole lungs volume The PTV included the GTV with a standard margin of 0.5 mm on axial plan and 10 mm on longitudinal direction. All patients were treated with 3 fractions of 15 Gy over 5 days. The dose was prescribed to the 80% isodose line and delivered with 6-8 noncoplanar static multiple fields The average Conformity Index according to RTOG definition was 0.65 (range 0 53-0 76). Dose-Volume Histograms (DVHs), TCP and NTCP (LKB model) were obtained and evaluated for each case RTOG toxicity scoring system was employed. Follow-up included CT scans after 45 days from treatment and then every 3 months, pulmonary function tests after 3 months, PET after 4 months Patients were considered in complete response (CR) if radiologlcally negative, in partial response (PR) if lesion axial diameter was reducted of at least 30%, in stable disease (SD) if no change, in progressive disease (PD) if increased of more than 20% Patients with radlologically evaluable lesions but with negative PET findings were also considered in CR Results: 17 out of 20 patients with primary neoplasms and 12 patients with 13 metastatic tumors were considered for analysis Three patients were excluded due to limited follow up. Median follow up time was 9.5 months (range 1.5-19). Treatment was feasible in all patients regardless the site of lesions (peripheral or central) Two patients experienced grade II subacute radiation pneumonitis, requiring steroid treatment. One was treated for 2 lesions on the same lobe, in the other one a concomitant infection was diagnosed. Local control patients was 94.05% (4 CR, 8 PR, 4 SD) in the 17 NSCLC and 100% (6 CR, 2 PR, 5 SD) in 13 metastlc tumors. Conclusions: Stereotactic radiotherapy for limited-stage primary and metastatic lung cancer is a feasible, safe and effective procedure. It promises high local control rates with a very low toxicity profile.

planning system made the detection of subtle shifts in applicator position possible. In this selected group of patients, applicator movement occurred in all three dimensions, and particularly in the y and z dimensions. The majority of movement occurred in the first 24 hours of treatment.

Filamin A (FLNA) is the most abundant and widely expressed isoform of filamin in human tissues. It is cleaved by calpain at the hinge 1 and 2 domains, producing a 90-kDa carboxyl-terminal fragment (FLNA). Recently, it has been shown that FLNA mediates cell signaling and transports transcription factors into the cell nucleus. However, the significance of cleavage of FLNA by calpain has not been studied in cancer cell growth. Calpeptin is a chemical inhibitor of both calpain 1 and 2 that cleaves FLNA. In this study, we questioned if inhibiting calpain using calpeptin would decrease tumor cell proliferation, migration, invasion, and colony formation. Human melanoma (A7), prostate cancer (PC3), mouse fibrosarcoma (T241) and endothelial (MS1) cells were assayed for proliferation, migration, invasion and colony formation after treatment with calpeptin. Cell lysates were immunoblotted for FLNA and FLNA Results: Calpeptin treatment of these cells resulted in a decreased production of FLNA C...

Aim. This study aims to investigate the recovery of penile erectile functions of the rats with spinal cord injury (SCI) following transplantation of endogenous neural precursors cell (neuronal restricted precursors [NRP]/glial restricted precursors [GRP]) into the injured area of spinal cord. Methods. Twenty-two rats were experimented in three groups. Group 1 (N = 6): Sham; Group 2 (N = 10): SCI + NRP/GRP transplanted in day 9 after operation; Group 3 (N = 6): SCI + culture medium transplanted in day 9 after operation.