Prostate
cancer represents a disease with diverse clinical outcomes. Treatment
strategies that optimize benefit and minimize morbidities depend
on accurate estimates of disease status and likelihood of progression.
Emerging technologies, such as microarrays, capable of qualitatively
and quantitatively profiling genes expressed by neoplastic tissues
may provide insights into tumor behavior.
We focus here on microarray data generated from prostate cancer
studies, potentially important for the discovery of progression
and aggressiveness biomarkers, and of signalling pathways whose
activation or inhibition could be of significant therapeutic value.
Chiorino G.*, Acquadro F.*, Mellogrand M.*, Ostano P.*, Dotto GP.** *Laboratorio di Farmacogenomica dei Tumori,
Fondo Edo Tempia di Biella, via malta 3 - 13900 Biella (Italy)
** Department of Biochemistry,
Lausanne University, Epalinges 1066 (Suisse)
Age-specific reference ranges
for prostate specific antigen level total and free in patients
with prostatitis symptoms.
M.N.G. Battikhi
Prostatic specific antigen (PSA) is a tumor marker helpful in
the diagnosis and follow-up of prostate cancer however level of
PSA may rise due to other causes than prostate cancer such as
benign prostatic hyperplasia (BPH), acute prostatitis, chronic
bacteria and a bacterial prostatitis.
Total serum PSA (TPSA) and free prostatic specific antigen (FPSA)
levels of patients with prostatitis symptoms as well as these
levels in male population at risk but without clinical prostatic
diseases (>40 years old) with regard to age should be documented
in order to increase the sensitivity and specificity of PSA in
prostate carcinoma.
One hundred and fifteen male patients over the age of 40 with
prostatism symptoms from the random-sample community based in
with no diagnostic prostate cancer were analyzed.
Men with 4.1 ng/ml or greater were referred for biopsy and those
with positive biopsies or with medical record, cancer registry,
or self-reported evidence of prostate cancer were excluded. We
studied the data as a function of age to determine the usefulness
of measuring TPSA and FPSA as screening tests for risk patient’s
cancer. Because of the greater variability at older ages, the
95th percentile increased faster than the median, leading to the
following age-specific reference ranges of TPSA and FPSA of patients
with prostatism symptoms were as follow: 3.1 and 0.7 ng/ml for
the age group 40-49 y, 4.4 and 0.89 ng/ml for the age group 50-59
y, 5.6 and 1.3 ng/ml for the age group 60-69 y and 6.3 and 1.8
ng/ml for age group 70-79 y.
There was a continuous increase in TPSA and FPSA means and medians
with significant correlation (P< 0.001, P< 0.005) and advancing
age group. The aim of this study was to find out agespecific values
and ranges of TPSA and FPSA in patients with prostatism symptoms
to ensure low false-positive biopsy rates.
M.N.G. Battikhi * , I. Hussein** (MD) *Hashemite University, Faculty of Allied Health Sciences, Department of Medical Laboratory Sciences,
Zarqa ,Jordan,,
** Private clinic, Al-Khalidi street , Jabal
Amman.t, P.O. Amman, Jordann
Bone marker in advanced prostate
cancer.
G. Francini
Background
One of the greatest problems in treating advanced prostate carcinoma
is monitoring the therapeutic response of bone metastases. As
these metastases are mainly osteosclerotic and lead to a markedly
increased bone calcium requirement that may give rise to an imbalance
in calcium homeostasis, the authors investigated whether changes
in calcium balance may be useful for evaluating the response of
bone metastases to treatment.
Methods
The study involved 268 prostate carcinoma patients: 142 in Stage
A-C2 (International Union Against Cancer [UICC] staging system,
1998) and 126 with bone metastases who had failed to respond to
hormone therapy and were receiving chemotherapy. Prostate-specific
antigen (PSA), calcium and phosphate metabolism, and the main
bone formation and resorption markers were all assayed before
and after chemotherapy. Results
Of the 126 patients on chemotherapy, 109 were evaluable for response:
according to standard criteria, 25 (23%) had improved, 43 (39.5%)
were unchanged, and 41 (37.5%) had worsened. All of the improved
and 16 unchanged patients had decreased PSA and bone marker levels
and an increased urinary calcium/creatinine ratio (UCa/Cr); the
worsened patients had increased PSA and bone marker levels, and
their UCa/Cr decreased after only six treatment cycles. PSA and
UCa/Cr were the biochemical markers whose changes showed the best
agreement with treatment response. Conclusion
The UCa/Cr ratio was the most useful marker of clinical response,
mainly because it allowed an early decision to continue or to
stop chemotherapy. Furthermore, UCa/Cr and PSA together identified
a percentage of patients classified as unchanged on the basis
of standard criteria but whose condition had actually improved.
Prof. Guido Francini Medical Oncology Division,
Institute of Internal
Medicine, University of Siena,
Siena, Italy.
Extracranial Stereotactic Radiation
Therapy for
early NSCLC and lung metastases :experience of University of Turin.
U. Ricardi
Background
Extracranial Stereotactic Radiation Therapy (ESRT) offers a non-invasive
treatment modality to patients with early stage primitive non
small cell lung cancer (NSCLC, stage IA-IB), not amenable for
surgery due to medical reasons or patient’s refusal, as
well as for small metastatic lesions. The aim of this prospective
study was to analyze feasibility, toxicity and response rate to
an expressively designed hypofractionated ESRT regimen.
Methods
Between June 2003 and December 2004, 32 patients with primary
(20) or metastatic lung tumors (12) were included in the treatment
protocol. Staging workup included CT scan,
PET scan and pulmonary function tests. Patients were immobilized
in a stereotactic body frame (ELEKTA®
Oncology System) and breathing motility was reduced mechanically
by the use of a "diaphragm control" device, when necessary.
Gross Tumor Volume (GTV), Planning Target Volume (PTV) and organs-at-risk
were defined in accordance with ICRU-62 on a CT data set acquired
with 2.5 mm slices thickness over 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 radiologically 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 radiologically
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 metastic 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.
Ricardi U., Guarneri A., Ragona R.,Giglioli
F.R. Institute of Radiotherapy of the
Univversity of Turin, Italy.
Surgery for liver metastases from
colorectal carcinoma.
V. Visokai
Introduction La chirurgia resta l’unica opzione per un trattamento
curativo radicale delle metastasi epatiche derivanti dal carcinoma
colorettale. La strategia per la resezione delle metastasi epatiche
sincrone derivanti dal carcinoma colorettale è ancora motivo
di discussione. Aims and methods
Aim of this lecture is to present our experience with simultaneous
resections of synchronous liver metastases in one stage procedure
with resection of colon or rectum. Since the year 1996 till 2004,
95 patient were operated for liver metastases from colorectal
carcinoma. Fourtyeight patient were operated for synchronous liver
secondaries and 40 of them underwent simultaneous operation. In
9 patients the liver resection was postponed and performed in
6-8 weeks after resection of the primary tumor. Fourtyfive patients
were operated for metachronous liver colorectal secondaries. In
the group of synchronous secondaries operated in one stage the
primary tumor was located in right colon in 9 (18,4%) patients,
in left colon 13(26,5%) and rectum was the site of primary tumor
in 16 (32,7%) of patients. In 2 patients the subtotal colectomy
was performed. Radical lymphadenectomy of the resected colorectal
primary up to apical nodes was abligatory. Lymphadenectomy of
the hepatoduodenal ligament was optional. Alltogether 71 metastatic
lesions were removed, 3 right hepatectomies, 2 left hepatectomies,
2 bisegmentectomies and 33 nonanatomical resections were performed.
Two patients were operated urgently due to large bowel obstruction.
The mean blood loss was 600 ml, postoperative morbidity was 25%
and mortality 2,5 %. Overall survival rate in 3 years is 36%,
in 5 years 19%. The multivariation analysis was performed for
prognostic factors. Statistically significant factors were nodal
status of primary colorectal carcinoma (p=0,0008), R status of
hepatic resection (p=0,0043), resection of further relaps (p=0,0090)
and number of metastases (p=0,0370). The most significant hazard
ratio is 7,498 for nodal status of primary carcinoma N0 versus
N1 a N2 and 3,261 for number of metastases.In the group of metachronous
metastases the overall 3 year survival is 66 %, 5 year survival
is 52%. Conclusion
Simultaneous liver and colorectal resections are feasible. The
benefit for patient is only one operation.
Vladimir Visokai, Ludmila Lipska,
Miroslav Levy, Stanislav Kormunda Department of Surgery of the First
Faculty of Medicine and Thomayer
Teaching Hospital,
Prague, Czech Republic
Prostate
cancer represents a disease with diverse clinical outcomes. Treatment
strategies that optimize benefit and minimize morbidities depend
on accurate estimates of disease status and likelihood of progression.
Background
Background
PET scan and pulmonary function tests. Patients were immobilized
in a stereotactic body frame (ELEKTA®
Oncology System) and breathing motility was reduced mechanically
by the use of a "diaphragm control" device, when necessary.
Gross Tumor Volume (GTV), Planning Target Volume (PTV) and organs-at-risk
were defined in accordance with ICRU-62 on a CT data set acquired
with 2.5 mm slices thickness over 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 radiologically 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 radiologically
evaluable lesions but with negative PET findings were also considered
in CR.
Introduction