Objective: It was the aim of this study to evaluate maintenance therapy with bevacizumab + capecitabine following induction with bevacizumab + capecitabine + oxaliplatin (XELOX) versus bevacizumab + XELOX until progression as first-line therapy in metastatic colorectal cancer (mCRC). Methods: Patients received either bevacizumab (7.5 mg/kg) + XELOX (capecitabine 1,000 mg/m² twice daily on days 1-14 + oxaliplatin 130 mg/m² on day 1 every 3 weeks) until disease progression (arm A) or the same doses of bevacizumab + XELOX for 6 cycles followed by bevacizumab + capecitabine until disease progression (arm B). The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate (ORR) and safety. Results: One hundred and twenty-three patients were randomized. Treatment compliance was similar in both groups. Median PFS was significantly longer for arm B than for arm A (11.0 vs. 8.3 months; p = 0.002). There was no significant difference between the two arms for ORR (66.7 vs. 59.0%; p = 0.861) or median OS (23.8 vs. 20.2 months; p = 0.100). Tolerability was acceptable in both treatment arms; the most frequent grade 3/4 treatment-related adverse events (arm B vs. arm A) were fatigue (6.6 vs. 16.1%), diarrhoea (3.3 vs. 11.3%), anorexia (3.3 vs. 11.3%), and neuropathy (1.6 vs. 8.1%). Conclusions: Maintenance therapy with bevacizumab + capecitabine can be considered an appropriate option following induction bevacizumab + XELOX in patients with mCRC instead of continuation of bevacizumab + XELOX.

Brunch Regimen for locally advanced rectal cancer consisting of neoadjuvant chronomodulated capecitabine and concurrent radiation therapy is effective and well tolerated with good safety profile, particularly with regard to the occurrence of hand and foot syndrome, in patients with locally advanced rectal cancer.

According to the findings of this study, nurses declared that working with cancer patients increase burnout, they are insufficient in managing work stress and giving psychological care to patients, but their job satisfaction, clinical skills and awareness regarding priorities of life has increased.

BackgroundThe role of methylation status of the thyroid stimulating hormone receptor gene (TSHr) in the discrimination of benign and malignant thyroid nodules has already been studied using paraffin blocks and cell lines. As cytological sampling plays an important role in assessment of thyroidal nodules, we have investigated the potential clinical use of TSHr methylation status of fine needle aspiration specimens reported according to Bethesda System.MethodSixty nine patients who had both cytological and pathological diagnosis of the same nodule were selected. Four groups were composed according to cytological and pathological diagnoses: Benign (B), papillary thyroid carcinoma (PTC), atypia of unknown significance (AUS) and follicular neoplasia (FN). The latter 2 groups were further sub-classified into 2 as benign (AUS-B and FN-B) and malignant (AUS-M and FN-M) according to final pathological diagnosis. DNAs were isolated from the fine needle aspiration cytology specimens and the methylation status of TSHr promotor region was investigated by using methylation specific polymerase chain reaction.ResultsOverall, TSHr methylation was present in 58 % of cases; 71 % of malignant and 46 % of benign nodules. PTC group showed the highest TSHr methylation rate (87 %), followed by 61 % in AUS, 44 % in B, and 30 % in FN (p = 0.016). TSHr methylation rate was significantly higher in PTC group when compared to B (p = 0.013) and FN-B (p = 0.004) groups; but not in FN-M (p = 0.115) or AUS (p = 0.096) groups. All 9 cases of papillary thyroid carcinoma with lymph node metastasis showed TSHr methylation. Positive predictive value, negative predictive value, sensitivity and specificity of TSHr methylation in determination of malignancy were calculated as 60, 66, 71 and 54 %, respectively.ConclusionThe eminent ratio of TSHr methylation in well-differentiated thyroid carcinoma against benign thyroidal nodules adduced that TSHr methylation status can be utilized as a tumor marker for well-differentiated thyroid cancer; however, it has a limited value. The determination of methylation status of TSHr gene had no efficiency on decision of the malignant potential for the nodules which are cytologically classified as atypia of undetermined significance.

Background: Tumor lymphocyte infiltrates (e.g. Immunoscore) and systemic inflammatory indices (SII) are highly prognostic in colon cancer but combined assessment is less well studied. The aim of this study was to investigate the prognostic and predictive value of CD8 + tumor-infiltrating lymphocytes (TIL) in combination with SII in patients with resected stage II-III colon cancer (CC).Methods: Patients with stage II-III CC (n¼304) diagnosed between 2008-2016 in our hospital were included. Pan-immune inflammation value (PIV) was calculated as; (neutrophil count  platelet count  monocyte count)/lymphocyte count. The mean density of CD8 + TILs in the periphery and center of the tumor was assessed and dichotomized at the 75 th percentile. Combined inflammation score (CIS) was classified as "high" in patients with high PIV (>median) and low mean CD8 + TIL density, and "low" in the remaining patients.Results: Five year DFS was 71% (78% in stage II, 64% in stage III). CD8 + TIL density was lower in node positive tumors and higher in mismatch repair deficient tumors, no association was observed with age, tumor sidedness or systemic inflammation indices. High PIV (>491), low CD8 + (<46 /mm 2 ) and high CIS were associated with shorter disease-free survival (DFS). In multivariate analysis; age > 65 (vs <65) years (HR: 3.12 95% CI 1.78-5.48 p <0.001), stage 3 (vs. 2) disease (HR: 1.82 95% CI 1.06 3.12 p ¼ 0.029) and high (vs low) CIS (HR: 3.82 95% CI 2.21-6.61 p <0.001) were associated with shorter DFS. Among patients with stage II disease, 78 patients (52%) received adjuvant chemotherapy. Patients with high CIS derived significant benefit from adjuvant chemotherapy (5 yr DFS 100% vs 60%, p¼0.008) while those with low CIS derived no benefit (5 yr DFS 88 vs 89% p¼0,94). (Table ) Conclusions: Combined inflammation score may represent a new prognostic factor for localized colon cancer and predictor of chemotherapy response in patients with stage II disease.Legal entity responsible for the study: The authors.