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Background There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). Methods A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n :175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n :202), second-line (group B, n : 153) and ≥ 3rd-line (group C, n : 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. Results The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0–14.0) months in the ET arm of group A, and 5.3 (3.9–6.8) months in the CT arm ( p  = 0.073). It was 6.7 (5.8–7.7) months in the ET arm of group B, and 5.7 (4.6–6.7) months in the CT arm ( p  = 0.311). It was 5.3 (2.5–8.0) months in the ET arm of group C and 4.0 (3.5–4.6) months in the CT arm ( p  = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 ( p  = 0.047), 6.7 vs. 5.0 ( p  = 0.164), 6.7 vs. 3.9 ( p  = 0.763) months. Conclusion Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.

IntroductionBreast cancer is the most common malignancy in women, and it is the second leading cause of malignancy-related mortality in women after lung cancer. Locally advanced breast cancer is a clinically heterogeneous group with a broad spectrum. Neoadjuvant chemotherapy (NAC) is the standard treatment at this stage. The present study aimed to evaluate the efficacy of NAC in terms of histopathologic molecular subtypes.MethodsThe study included 183 patients receiving NAC. Patients were studied in three groups: Luminal tumors, human epidermal growth factor receptor-2 (HER-2)-positive tumors, and triple-negative tumors based on the expressed receptor status. In our retrospective review, we only examined pathological complete response (pCR) based on breast tumor shrinkage before and after chemotherapy. In this study, we evaluated factors affecting pathologic complete response in patients receiving NAC.ResultsAccording to breast cancer subtypes based on biopsy results, pCR developed in 8 of 20 patients with triple-negative tumors (40%), 24 of 61 patients with HER-2-positive tumors (39.3%), and 22 of 102 patients with luminal tumors (21.5%) (p=0.030). The pCR rate was available in 5 of 40 patients with lymphovascular invasion (LVI) (12.5%) and 49 of 143 patients without LVI (34.2%) (p=0.008). pCR was available in 1 of 16 patients with perineural invasion (PNI) (6.6%) and 53 of 168 patients without PNI (31.5%) (p=0.043). PCR was available in 2 of 25 patients with extracapsular lymph node invasion (8%) and in 52 of 158 patients without extracapsular lymph node invasion (32.9%) (p=0.011).ConclusionThe NAC pCR rate of hormone-positive tumors was lower than that of hormone-negative tumors in breast cancer. This finding was related to the biological response of the tumor in heterogeneous breast cancer.

[LANGUAGE= \"English\"] Objectives: This study aimed to compare the diagnosis stage, tumor characteristics, treatments, COVID-19 positivity and vaccination rates in pre-pandemic and post-lockdown periods in newly diagnosed breast cancer patients. Methods: A total of 200 patients from the pre-pandemic (from July 1, 2018 to July 1, 2019) and post-lockdown (from July 1, 2020 to July 1, 2021) groups were included in this retrospective single center study.The clinical and pathological characteristics, treatment modalities, vaccination rates against covid-19 and covid-19 positivity of the patients were analyzed and compared between the pre-pandemic group and the post-lockdown group. Results: There was no statistically significant difference between the demographic and pathological characteristics of the two groups, such as age at diagnosis, tumor diameter, T and N staging, stage at diagnosis, ER status, PR status, HER2 status, ki67 expression index. The rates of treatment modalities such as NACT, primary breast surgery, adjuvant CT, palliative CT, and palliative RT were similar between the two groups and there was no significant difference. How?ever, there was a significant difference between the groups in terms of axillary surgical procedure, adjuvant RT and endocrine treatments (p=0.001, p=0.029 and p=0.047, respectively). There was a significant increase in the rate of SLNB in the post-lockdown group. COVID-19 vaccination rates and COVID-19 positivity rates were similar to Turkey's rates in both breast cancer patient groups. Conclusion: The fact that there was no significant difference between the pre-pandemic and post-lockdown groups in the characteristics and treatments of breast cancer patients may be related to the continuation of oncology patient care and cancer detection methods even in the lockdown period. However, the rate of SLNB increased significantly in the post-lockdown group.

Background and Aims: During liver transplantation, hepatocellular carcinoma (HCC) recurrence remains a critical challenge for patient survival. Targeted therapies, such as sorafenib and regorafenib, have been utilized to manage relapsed HCC in this unique setting. This study aimed to assess the efficacy of Sorafenib and Regorafenib in patients with HCC who experienced recurrence after liver transplantation. We focused on survival outcomes, treatment responses, and the management of side effects in this patient group. Methods: We conducted a retrospective analysis of 73 patients who experienced HCC recurrence post-liver transplantation between 2012 and 2022 across 11 oncology centers in Turkey. Patients were categorized according to Child–Pugh classification and treated with sorafenib as first-line therapy and Regorafenib in case of progression. Survival rates were analyzed using the Kaplan–Meier method, and risk factors were evaluated using Cox regression analysis. Results: Of the 73 patients included in the study, 62 were male (84.9%), and 11 were female (15.1%), with a mean age of 61.5 ± 10.9 years. All patients received sorafenib as first-line treatment. Among patients who experienced progression with sorafenib or discontinued treatment due to toxicity, 45.2% (n = 33) continued treatment with regorafenib. The median progression-free survival (PFS1) time with sorafenib was 5.6 months, and the one-year survival rate was 24.3%. The median progression-free survival (PFS2) time with regorafenib, which was administered as second-line treatment, was also calculated as 5.9 months. Overall survival (OS) duration was determined as 35.9 months. The most common side effects associated with both drugs included fatigue, hand and foot syndrome, and hypertension. Significantly better survival outcomes were shown in the Child–Pugh A group compared to other patients. Conclusions: These results suggest that Sorafenib and Regorafenib treatments offer a survival advantage in patients with relapsed HCC post-transplantation. However, individualized treatment strategies and close follow-up are crucial for optimizing outcomes. Further studies are needed to refine therapeutic protocols and enhance the care of this specific patient group.

ObjectiveCisplatin-paclitaxel and bevacizumab is a frequently used treatment regimen for metastatic or recurrent cervical cancer, and carboplatin-paclitaxel and bevacizumab are also among the recommended regimens. In this study we aimed to evaluate the efficacy of these two regimens for the treatment of metastatic or recurrent cervical cancer.MethodsPatients with metastatic or recurrent cervical cancer treated with cisplatin-paclitaxel and bevacizumab or carboplatin-paclitaxel and bevacizumab were retrospectively evaluated in this study. The clinical and demographic characteristics of patients in each group were evaluated. Median overall survival, progression-free survival, and response rates between the two groups were compared.ResultsA total of 250 patients were included. Overall, the numbers of patients with recurrent disease and metastatic disease were 159 and 91, respectively. The most common histologic subtype was squamous cell carcinoma (83.2%). The median duration of follow-up was 13.6 (range 0.5–86) months. The median progression-free survival was 10.5 (95% CI 9.0 to 11.8) months in the cisplatin-paclitaxel and bevacizumab group (group 1), and 10.8 (95% CI 8.6 to 13.0) months in the carboplatin-paclitaxel and bevacizumab group (group 2) (HR 1.20; 95% CI 0.88 to 1.63; p=0.25). The median overall survival was 19.1 (95% CI 13.0 to 25.1) months in group 1 and 18.3 (95% CI 15.3 to 21.3) months in group 2 (HR 1.28; 95% CI 0.91 to 1.80; p=0.15).ConclusionsThere is no survival difference between cisplatin or carboplatin combined with paclitaxel and bevacizumab in metastatic or recurrent cervical cancer.

Advanced gastric cancer has a poor prognosis, and only chemotherapy improves survival. Further chemotherapy after progression is controversial. Eastern Cooperative Oncology Group performance status is an important indicator for new chemotherapy decision. Complete response (CR) after recurrent disease is very rare, but could occur in some cases with chemotherapy. The 68-year-old male received chemotherapy for metastatic gastric adenocarcinoma. He received epirubicin, cisplatin and fluorouracil in the first line, capecitabine in the second line and cisplatin-capecitabine in the third line. CR was observed after third-line chemotherapy with four courses. Mediastinal and abdominal metastases were completely resolved. We decided to report this patient because it is very unusual to achieve CR in a patient in whom the best supportive care might be reasonable.

The main reason for the increased risk of thromboembolism in pregnancy is hypercoagulability, which has likely evolved to protect women from the bleeding challenges of miscarriage and childbirth. Women are at a 4- to 5-fold increased risk of thromboembolism during pregnancy and the postpartum period compared with when they are not pregnant. Risk factors include a history of thrombosis, inherited and acquired thrombophilia, maternal age greater than 35, certain medical conditions, and various complications of pregnancy and childbirth. In this report, a case of a 25-year-old woman diagnosed with deep vein thrombosis in the fourth week of the postpartum period is presented. After the investigating the reasons of deep vein thrombosis, heterozygote factor V Leiden mutation and heterozygote activated protein c resistance were detected. This case is presented in order to emphasize that hereditary risk factors must be investigated, especially in young patients, although the patient already had an acquired risk factor such as pregnancy. (JAREM 2015; 5: 28-30)

Introduction Straight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the sternal instability and bone healing. Materials and methods We enrolled 31 sheep, weighing 18–30 kg. For all animals a midline skin incision was made. In group I (n = 16 animals), straight median sternotomy and in group II (n = 15 animals), S-shaped incision was marked on the periosteum of the sternum by new created device for standard S-shaped sternotomy. Sternum biopsies were performed on second surgery month for all survived animals from the sternum and the surrounding soft tissue. Results No early superficial wound complications were observed. Overall mortality in the initial approach group was 19.3% (6 sheep). In group I; 3 sheep had died on first surgery day, the reason may be hemorrhage and in group II; 3 sheep developed intractable VF during surgery procedure or immediately afterwards so died. There were statistically significant differences in the scores of bone healing between group 1 and group 2 (4.2 vs.7.3, ANOVA, p < 0.001). Discussion Our work is based on the use of a standard S-shaped sternotomy procedure on sheep sternum. In our experience with the sternal healing in the sheep model, the process of new bone formation was accelerated with S- shaped cut than straight sternotomy procedure.