कैंसर विज्ञान एवं चिकित्सा

Primary breast lymphoma is a rare tumor that presents commonly as a large mass with no specific mammographic appearance and can be confused with poorly differentiated carcinoma on frozen section. With appropriate treatment, this breast malignancy has a relatively good prognosis. We report a case of primary mammary non-Hodgkin lymphoma (NHL) in a 30-year-old young female presented with the complaint of painless lump in the right breast. Fine needle aspiration cytology (FNAC) suggested malignancy. Investigations ruled out metastasis, hence mastectomy was done. Immunochemistry of specimen revealed NHL of breast. Investigations to rule out any other site of lymphoma proved it to be primary NHL of breast with no metastasis. Anticancer drugs are main treatment rather than surgery so it is very important to accurately diagnose primary lymphoma of breast.

Purpose: The purpose of this prospective phase III study was to compare the role of concomitant chemoradiation using paclitaxel versus cisplatin in locally advanced head and neck cancers. Patients and methods: 52 patients were randomly assigned to one of the two concomitant chemoradiation arms: arm I (n=26) and arm II (n= 26) who received injection of paclitaxel 20 mg/m2 I/V 1 hour infusion before radiation, repeated weekly for 6 cycles, and cisplatin 30 mg/m2 I/V 1 hour infusion before radiation, repeated weekly for 6 cycles, respectively. The planned radiotherapy dose was 66-70 Gy, 1.8-2 Gy/day, 5#/Week in 6-7 weeks. Results: Response rates were 76 and 69.2% in arm I and arm II, respectively (P = 0.53). The hematological toxicity was generally mild. On the contrary, non-hematologic toxicities were severe. Grade III mucositis occurred in 32% in arm I and in 23.1% in arm II (P = 0.04). Moreover, grade III dermatitis were encountered in 28% in arm I and 11.5% in arm II (P = 0.03). The 2-year local-regional control figures were 60 and 57.1% in arm I and arm II, respectively(P=0.52) ; however the 2-year progression-free survival figures were 36.8 and 33.3% in arm I and arm II, respectively(P=0.43), while the 2-year overall survival figures were 56 and 50% in arm I and arm II, respectively (P = 0.68). Conclusion: Both concomitant chemoradiotherapy regimens were easily given in the outpatient clinic. The regimen based on paclitaxel was more effective; however, the difference was insignificant.

Study background: Cathepsins are lysosomal cysteine proteases that have increased expression in tumor cells, may translocate to the cell surface and be secreted. They play a role in tumor angiogenesis. Cystatins are natural cysteine protease inhibitors that can inhibit tumor development, growth and metastasis. In the present work we evaluated the potential therapeutic use of sugarcane cystatin CaneCPI-4 as an anticancer drug. Methods: Viability, migration, invasion and anchorage-independent growth were investigated in B16F10-Nex2 melanoma and HUVEC cells in the presence of CaneCPI-4. The in vivo effect of CanceCPI-4 on tumor development was assessed using a murine model. Angiogenesis in vitro was evaluated using HUVEC cells plated on Matrigel. Immunohistochemical analysis of CD34 expression in primary melanoma was also carried out. Results: Sugarcane cystatin CaneCPI-4 was not cytotoxic to melanoma or HUVEC cells growing in vitro, but efficiently inhibited melanoma cell development in vivo. CaneCPI-4 inhibited melanoma and endothelial cell migration and tumor invasion in vitro. Using a Matrigel angiogenesis assay, CaneCPI-4 at 1 mM was able to completely abolished endothelial cell sprouting in vitro. Angiogenesis inhibition was confirmed in vivo by immunohistochemistry. Conclusions: Sugarcane cystatin CaneCPI-4 inhibits melanoma development in vivo by angiogenesis disruption and inhibition of melanoma invasion, migration and anchorage-independent growth.

Anal canal tumor has different prognosis depending on the histological type. Cancer of the anal canal is an uncommon condition in digestive tumors, representing small cell cancers of the anal canal less than 0.2% of all colorectal tumors. The histological type of tumors of the anal canal will determine treatment and prognosis. We report the case of a male aged 71 who presented with rectal bleeding and constipation. It revealed a tumor 2 cm from the anal margin, with pathological diagnosis of small cell undifferentiated carcinoma. Despite treatment with chemotherapy and radiotherapy, the disease progressed to develop multiple metastases, and the patient died due to pulmonary thromboembolism and multiorgan failure. Centralized management of these tumors would allow the creation of specific guidelines for treatment and follow-up with the aim of achieving better morbidity and mortality rates.

It is important to investigate whether other clinical endpoints, such as response rate, disease stabilization rate, or progression free survival could replace overall survival as the primary endpoint for the patients with advanced or metastatic cancer. Before a surrogate end point can replace a so-called 'true' end point of interest, it must be formally validated, a process that has caused considerable controversy in the past two decades. The aim of this review manuscript is to discuss some of the limitations encountered when survival is used as the primary study end point for evaluating the efficacy or effectiveness in phase II or III trials for advanced or metastatic cancer tumors.