Journal of Oncology Translational Research

Purpose: This report was designed to review the critical complication following gastrectomy that can cause devastating problems in duodenal stump leakage patients. Although a non-operative approach might effectively manage such a complication without compromising patients’ clinical conditions, it is not always uneventful.

Presentation of case: A 47 year old male with not known comorbidities diagnosed to have early gastric cancer and underwent a laparoscopic distal gastrectomy with Billroth-1 reconstruction. On postoperative day 9, the patient visited emergency department with a new history of persistent nausea, fatigue, and severe abdominal pain. His diagnostic workup revealed evidence of anastomotic site leak, which was initially treated by an endoscopic stent. Unfortunately, the clinical condition of the patient worsens and complicated by stent migration. One day later, the patient underwent laparoscopic exploration; drainage and gastrojejunostomy were performed uneventfully.

Discussion: The leaking duodenal stump following gastric resection presents a definite and critical problem in gastric surgery and especially with gastric cancer. An anastomotic leak is one of the most serious complications following gastric surgery cases. It is associated with intra-abdominal sepsis which can result in significant morbidity and mortality. Early appropriate management should be categorized and management strategy should be implemented according to the size of the leak, extent of the abscess, and clinical status of the patient of the patient. It can be planned with a less invasive procedure. This is no always an uneventful procedure and close observation is mandatory.

Conclusion: Anastomosis or duodenal stump leaks must be diagnosed as early as possible, and treated appropriately with non-operative methods if possible. Non-operative methods not always uneventful intervention and complication of each procedure should be always expected. Regardless of the operative technique the key to appropriate treatment stabilizes the patient, repair the anastomosis leak site, and adequate drainage.

Objective: To investigate outcomes and prognostic factors in patients treated with once daily high-dose (≥ 60 Gy) radiation therapy (HDRT) and concurrent platinum-based chemotherapy in limited stage small cell lung cancer (LSSCLC). While we await current phase III trials to determine optimal radiation dose fractionation schemes in LS-SCLC, we report our experience in LS-SCLC with once daily HDRT. We hypothesized that HDRT would achieve similar efficacy and tolerability as twice daily therapy.

Methods: We conducted a single institution retrospective review of all patients with LS-SCLC who underwent curative intent treatment from 2005-2013. Patients treated with HDRT (≥ 60 Gy) and concurrent chemotherapy (cisplatin or carboplatin and etoposide) were included in our analysis. Clinicopathologic variables assessed include gender, performance status, time to treatment, response to treatment, toxicity, volumetric tumor response at 3 months and use of prophylactic cranial irradiation (PCI).

Results: 42 patients with LS-SCLC who initiated concurrent chemoradiation from 2005 to 2013 were included in the analysis. 38 patients (90%) completed definitive treatment to the lung; 16 (38%) also completed PCI. Median failure free survival (FFS) and overall survival (OS) were 11.9 and 23.1 months, respectively. Two-year and 5 year OS rates were 47% (CI=30-62%) and 21% (CI=7-38%), respectively. On univariate analysis, PCI was associated with improved FFS but this was not significant (p=0.18). Gender was the only co-variate significantly associated with statistical differences in FFS (p=0.03) and OS (p=0.02). Grade 3 and 4 esophagitis were 10.5% and 2.6%, respectively. Pre-HDRT tumor volume and 3-month post-treatment tumor volume were both associated with FFS (p<0.01) but not OS.

Conclusion: In this single institution series, daily HDRT demonstrated a 2 year OS of 47% in LS-SCLC. This compares well to the historical survival of daily fractionation (47%) from INT 0096 reported by Turrisi et al. Male gender was predictive of significantly worse FFS and OS. Once daily HDRT has similar OS to twice-daily radiation schemes; however, further studies assessing once daily HDRT for LS-SCLC are warranted.

Objective: Borderline ovarian tumors (BOTs) are generally considered to be non-invasive tumors with low malignancy potential. However, studies show that BOTs have the ability to progress to low-grade carcinomas and gain the potential to invade surrounding tissue and to metastasize. Here, we investigate whether a patient derived serous BOT (SBOT) could progress in low-grade serous carcinoma (LGSC) through in vitro and in vivo characterization.

Methods: Ovarian cancer cell line from a SBOT, named OCAM, were isolated and characterized by PCR, migration assay and chick chorioallantoic membrane (CAM) assay.

Results: OCAM cells express carcinoma characteristics and form a tumor in CAM. Moreover, OCAM cells get into membrane of chicken suggesting invasive properties.

Conclusion: SBOTs could a precursor of LGSC involving consequences in adaptation of treatment provided by clinician.

Patients with hematological malignancies (HMs) and that undergoing hematopoietic stem cell transplantation (HSCT) for HMs or other disorders require multiple blood product transfusions. Approximately 30% of these patients develop platelet transfusion refractoriness (PTR), which increases the risk of serious and potentially fatal bleeding complications. The incidence of PTR in the Saudi population is unknown.

To determine the occurrence of PTR in adult HMs and HSCT patients at King Abdul-Aziz Medical City (KAMC), Riyadh, we performed a study of 29 HMs and HSCT patients. Platelet counts were determined prior to and one hour after each platelet transfusion event. Four (13.8%) patients qualified for PTR, as they had corrected count increment of less than 5000 following two consecutive platelet transfusions. PTR was detected following 17 of the 102 (16.7%) platelet transfusion events. Subgroup analysis showed a significant association between the patient’s diagnosis and the development of PTR (75.0% CML, 18.9% NHL, 16.7% AML, 7.1% ALL, 0.0% HL p=0.011). No significant correlations between the development of PTR and either age, history of HSCT or previous exposure to blood products were found. Our observed incidence of PTR in Saudi HM and HSCT patients is significantly lower than the reported worldwide incidence (24-34%), which might be attributable to consanguinity within the community. Patients with AML and NHL might be at a higher risk of developing PTR.