פרופסור עפר מרימסקי
מומחה באונקולוגיה קלינית וקרינתית
מאמרים בתחום סרטן השד
1. Expert Rev Anticancer Ther. 2014 Jun;14(6):705-10. doi:
10.1586/14737140.2014.895667. Epub 2014 Mar 10.
Optimal management of sarcomas of the breast: an update.
Nizri E(1), Merimsky O, Lahat G.
(1)The Department of General Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv,
Breast sarcomas are rare mesenchymal-derived breast tumors. The small number of
patients, the different histological subtypes, and the variation in clinical
practice impairs the ability to draw firm practice recommendations. Patient
management is often extrapolated from other soft tissue sarcomas, mostly of the
extremities in which more clinical data is available. Surgical resection with
negative margins is the goal of treatment, irrespective of the surgical
procedure; the implication of radiation and chemotherapy is variable. Further
advances in treatment should follow the assembly of breast sarcoma patients in
specific cancer networks in specialized sarcoma referral centers. The
characterization of molecular pathways active in tumorogenesis of these tumors
may pave the way for the application of novel therapeutic agents.
PMID: 24611696 [PubMed - indexed for MEDLINE]
2. Oncol Lett. 2013 Feb;5(2):424-426. Epub 2012 Dec 5.
The evolution in melanoma treatment as a reflection of precision-oriented
Kushnir I(1), Merimsky O.
(1)Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239,
Until recently, metastatic melanoma was a disease with limited treatment options
and a poor prognosis. Dacarbazine was accepted as the standard treatment for
melanoma in the 1970s, and despite inducing an overall survival of approximately
7.4 months, it remained so until relatively recently. In the last few years,
significant advances in the molecular understanding of this disease have
facilitated the development of novel and promising drugs. Precision-oriented
medicine is currently revolutionizing the practice of oncology. Targeted
therapies have demonstrated great potential in treating melanoma and various
other types of cancer, including breast, colorectal and non-small cell lung
cancer. Here, we review the evolution of melanoma treatment from single-agent
chemotherapy to combination therapy, the emergence of immunotherapy in melanoma
and the development of targeted therapies, such as the use of the BRAF inhibitor
as a treatment agent. The ability to treat melanoma according to the fingerprint
of the tumor reflects an overall change in the practice of oncology.
PMID: 23420786 [PubMed]
3. Lancet Oncol. 2013 Jan;14(1):72-80. doi: 10.1016/S1470-2045(12)70525-9. Epub 2012
Adjuvant docetaxel, doxorubicin, and cyclophosphamide in node-positive breast
cancer: 10-year follow-up of the phase 3 randomised BCIRG 001 trial.
Mackey JR(1), Martin M, Pienkowski T, Rolski J, Guastalla JP, Sami A, Glaspy J,
Juhos E, Wardley A, Fornander T, Hainsworth J, Coleman R, Modiano MR, Vinholes J,
Pinter T, Rodríguez-Lescure A, Colwell B, Whitlock P, Provencher L, Laing K,
Walde D, Price C, Hugh JC, Childs BH, Bassi K, Lindsay MA, Wilson V, Rupin M,
Houé V, Vogel C; TRIO/BCIRG 001 investigators.
Collaborators: Martinez JL, Mickiewicz E, Roffo H, Orti R, Schuller J, Teixeira
LC, Allan S, Chang J, Drolet Y, Dufresne J, Gelmon K, Holland D, Lesperance B,
Mackinnon J, Potvin C, Rubin S, Sehdev S, Trudeau M, Verma S, Spadafora S, Yelle
L, Abrahamova J, Finek J, Azim HA, El Zawahry H, Oberhoff C, Georgoulias V, Boer
K, Lurie H, Merimsky O, Steiner M, Karnicka-Mlodkowska H, Chumbo M, Goncalves I,
Koza I, Moodley D, Alba Conejo E, Lopez IA, Torres AA, Aguilar EA, Cassinello J,
Samper FL, Vega JM, Lopez RL, Gandia BM, Rosales AM, Torres A, Nylen U, Sherwin
E, Garbino C, Viola A, Avery B, Beck T, Begas A, George C, Glaspy J, Chap L,
Graham B, Iannotti N, Hainsworth J, Limentani S, Marcom K, O'Rourke M, Robert N,
Schnell F, Theall K, Tongol J, Beeker T, Kerns R, George C, Dobbs T, Campos L.
BACKGROUND: We compared standard adjuvant anthracycline chemotherapy with
anthracycline-taxane combination chemotherapy in women with operable
node-positive breast cancer. Here we report the final, 10-year follow-up analysis
of disease-free survival, overall survival, and long-term safety.
METHODS: BCIRG 001 was an open label, phase 3, multicentre trial in which 1491
patients aged 18-70 years with node-positive, early breast cancer and a Karnofsky
score of 80% or more were randomly assigned to adjuvant treatment with docetaxel,
doxorubicin, and cyclophosphamide (TAC) or fluorouracil, doxorubicin, and
cyclophosphamide (FAC) every 3 weeks for six cycles. Randomisation was stratified
according to institution and number of involved axillary lymph nodes per patient
(one to three vs four or more). Disease-free survival was the primary endpoint
and was defined as the interval between randomisation and breast cancer relapse,
second primary cancer, or death, whichever occurred first. Efficacy analyses were
based on the intention-to-treat principle. BCIRG 001 is registered with
ClinicalTrials.gov, number NCT00688740.
FINDINGS: Enrolement took place between June 11, 1997 and June 3, 1999; 745
patients were assigned to receive TAC and 746 patients were assigned to receive
FAC. After a median follow-up of 124 months (IQR 90-126), disease-free survival
was 62% (95% CI 58-65) for patients in the TAC group and 55% (51-59) for patients
in the FAC group (hazard ratio [HR] 0·80, 95% CI 0·68-0·93; log-rank p=0·0043).
10-year overall survival was 76% (95% CI 72-79) for patients in the TAC group and
69% (65-72) for patients in the FAC group (HR 0·74, 0·61-0·90; log-rank
p=0·0020). TAC improved disease-free survival relative to FAC irrespective of
nodal, hormone receptor, and HER2 status, although not all differences were
significant in these subgroup analyses. Grade 3-4 heart failure occurred in 26
(3%) patients in the TAC group and 17 (2%) patients in the FAC group, and caused
death in two patients in the TAC group and four patients in the FAC group. A
substantial decrease in left ventricular ejection fraction (defined as a relative
decrease from baseline of 20% or more) was seen in 58 (17%) patients who received
TAC and 41 (15%) patients who received FAC. Six patients who received TAC
developed leukaemia or myelodysplasia, as did three patients who received FAC.
INTERPRETATION: Our results provide evidence that the initial therapeutic
outcomes seen at the 5-year follow-up with a docetaxel-containing adjuvant
regimen are maintained at 10 years. However, a substantial percentage of patients
had a decrease in left ventricular ejection fraction, probably caused by
anthracycline therapy, which warrants further investigation.
Copyright © 2013 Elsevier Ltd. All rights reserved.
PMID: 23246022 [PubMed - indexed for MEDLINE]
4. Ann Oncol. 2012 Oct;23 Suppl 7:vii92-9.
Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for
diagnosis, treatment and follow-up.
ESMO / European Sarcoma Network Working Group.
Collaborators: Blay JY, Blomqvist C, Bonvalot S, Boukovinas I, Casali PG, De
Alava E, Dei Tos AP, Dirksen U, Duffaud F, Eriksson M, Fedenko A, Ferrari A,
Ferrari S, del Muro XG, Gelderblom H, Grimer R, Gronchi A, Hall KS, Hassan B,
Hogendoorn P, Hohenberger P, Issels R, Joensuu H, Jost L, Jurgens H, Kager L, Le
Cesne A, Leyvraz S, Martin J, Merimsky O, Nishida T, Picci P, Reichardt P,
Rutkowski P, Schlemmer M, Sleijfer S, Stacchiotti S, Taminiau A, Wardelmann E.
PMID: 22997462 [PubMed - indexed for MEDLINE]
5. Oncologist. 2011;16(9):1197-202. doi: 10.1634/theoncologist.2011-0150. Epub 2011
A prospective, controlled study of the botanical compound mixture LCS101 for
chemotherapy-induced hematological complications in breast cancer.
Yaal-Hahoshen N(1), Maimon Y, Siegelmann-Danieli N, Lev-Ari S, Ron IG, Sperber F,
Samuels N, Shoham J, Merimsky O.
(1)Refuot Integrative Medical Center, 18 Feinstein Street, Tel Aviv 69123,
Oncologist. 2012;17(5):740-1; author reply 742-3.
BACKGROUND: This prospective, controlled study evaluated the safety,
tolerability, and efficacy of the mixture of botanical compounds known as LCS101
in preventing chemotherapy-induced hematological toxicity in breast cancer
METHODS: Female patients diagnosed with localized breast cancer were randomly
allocated to receive treatment with either LCS101 or placebo capsules, in
addition to conventional chemotherapy. The study intervention was initiated 2
weeks prior to the initiation of chemotherapy and continued until chemotherapy
was completed, with participants receiving 2 g of LCS101 capsules thrice daily.
Subjects were assessed for the development of hematological and nonhematological
toxicities, as well as the tolerability and safety of the study intervention.
RESULTS: Sixty-five breast cancer patients were recruited, with 34 allocated to
LCS101 and 31 allocated to placebo treatment. Patients in the treatment group
developed significantly less severe (grades 2-4) anemia (p < .01) and leukopenia
(p < .03) when comparing grades 0-1 with grades 2-4, with significantly less
neutropenia (p < .04) when comparing grades 0-2 with grades 3-4. This effect was
more significant among patients undergoing a dose-dense regimen. No statistically
significant effect was found with respect to nonhematological toxicities, and
side effect rates were not significantly different between the groups, with no
severe or life-threatening events observed in either group.
CONCLUSION: The addition of LCS101 to anthracycline- and taxane-based
chemotherapy is safe and well tolerated, and may significantly prevent some
chemotherapy-induced hematological toxicities in early breast cancer patients.
These results should encourage further larger and more extensive clinical trials.
PMID: 21712486 [PubMed - indexed for MEDLINE]
6. Am J Clin Oncol. 2009 Feb;32(1):34-7. doi: 10.1097/COC.0b013e31817b6087.
The co-occurrence of breast cancer and soft tissue sarcoma in a single cohort
Geva R(1), Jiveliouk I, Inbar M, Meller I, Friedman E, Merimsky O.
(1)Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel-Aviv Sourasky
Medical Center, Tel-Aviv, Israel.
BACKGROUND: The incidence of breast cancer (BC) and soft tissue sarcoma (STS) in
the Israeli general population is 97/10 women and 1.5/10 persons. It is expected
that 1.5/10 x 49/10 of the women in the general population will have both BC and
METHODS: A retrospective search of 1350 adult STS patient files that were
recorded between 1995 and 2005.
RESULTS: One hundred thirty-four patients with STS had multiple primary
malignancies. BC was observed in 27/64 patients (42%) before/after the STS:
BC-first in 19/27, BC-later in 8/27. Of 19 with BC-first the STS was related to
radiotherapy in 2, and to lymphedema in 1. Of 8 STS-first, only 1 got
chemotherapy before BC. Median interval between first to second malignancies was
6.9 years for BC-first, and 3.8 for BC-later. The incidence of BC among all
patients with STS-first followed by a second malignancy is 8/58 (14%), or 27/890
(3%) of all women STS-patients in the registry. The incidence of STS among the BC
patients was low, and most of our cases were therapy unrelated. Median survival
for BC-first was 305 months, versus 213 for STS-first.
CONCLUSIONS: BC and STS may naturally occur in the same individual. The etiology
for this phenomenon is unclear. Practically, BC screening in patients with STS is
PMID: 19194122 [PubMed - indexed for MEDLINE]
7. Oncology. 2009;76(1):30-5. doi: 10.1159/000178162. Epub 2008 Nov 26.
Ductal carcinoma in situ of the breast in Israeli women treated by
breast-conserving surgery followed by radiation therapy.
Jiveliouk I(1), Corn B, Inbar M, Merimsky O.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, affiliated with the
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
BACKGROUND: Lumpectomy followed by radiation therapy (RT) has become an accepted
local management strategy for patients with small, mammographically detected
ductal carcinoma in situ (DCIS) of the breast. The aim of this analysis is to
describe control rates and patterns of relapse in a cohort of Israeli women with
mammographically detected DCIS treated at a single medical center.
PATIENTS AND METHODS: The files of 107 consecutive patients with DCIS were
retrieved from the cancer registry of the unit of RT. All women underwent
lumpectomy followed by definitive RT, administered in conventional dose
fractionation regimens. Oral tamoxifen, 20 mg/ day, was prescribed to all but 2
patients with positive receptors.
RESULTS: Within a median follow-up time of 52 months, no local recurrence of any
breast tumor was found. There was no correlation between event-free survival and
tumor size, focality, grading, hormone receptor status, administration of
adjuvant hormonal therapy, timing of RT, and RT boost delivery. The 8-year
overall survival, disease-free-survival, and event-free survival were 100, 100,
and 87%, respectively.
CONCLUSIONS: The results reported herein are consistent with short-term and
intermediate-term outcomes that are better than the reported benchmarks from
prospective randomized trials. Although this could reflect selection factors at a
single institution, it is also plausible that a genetically distinct disease is
present in this local population.
PMID: 19033713 [PubMed - indexed for MEDLINE]
8. Anticancer Res. 2008 Sep-Oct;28(5B):3147-52.
Invasive breast cancer treated with taxol and epirubicin neo-adjuvant
chemotherapy: the role in the outcome of the "crosstalk" between Erb receptors
Sarid D(1), Ron IG, Shoshan L, Barnea I, Shina S, Baratz M, Greenberg J, Merimsky
O, Ben-Yosef R, Lev-Ari S, Keidar Y, Yaal-Hahoshen N.
(1)Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
PURPOSE: To correlate p53 and ErbB receptors status with disease-free survival
(DFS) and overall survival (OS) in locally advanced breast cancer.
PATIENTS AND METHODS: Sixty patients were included in a single-center,
open-label, phase II trial (1998-2003). Analysis of Erb receptors and p53 status
and estrogen receptor/progesterone receptor data were available for 33 patients.
Neoadjuvant epirubicin 75 mg/m2 and paclitaxel 175-200 mg/m2 were administered
every 21 days. The patients underwent surgery and radiation therapy and adjuvant
RESULTS: Approximately two thirds of the patients demonstrated overexpression of
ErbB receptors and had mutant p53 overexpression. The disease recurred in 11/33
patients and 7 died (median follow-up 56 months). Detrimental effects on OS were
established in cases of combined defective p53 expression and ErbB1-ErbB3
heterodimeric receptor overexpression. In contrast, normal p53 together with the
same overexpressed heterodimeric combination of ErbB receptors showed no
statistically significant effect.
CONCLUSION: In terms of the clinical impact of combinations of ErbB receptors
with or without mutant p53, only the overexpressed various ErbB1-ErbB3 dimeric
combinations and the ErbB1/ErbB2/ErbB3 triplet combination with mutated p53 were
related to a significantly poorer outcome. This observation may help in the
development of new strategies required for blocking these molecular pathways and
improving the outcome of patients with locally advanced breast cancer.
PMID: 19031973 [PubMed - indexed for MEDLINE]
9. Br J Ophthalmol. 2007 Jan;91(1):74-5. Epub 2006 Aug 30.
Decreased prevalence of asymptomatic choroidal metastasis in disseminated breast
and lung cancer: argument against screening.
Barak A(1), Neudorfer M, Heilweil G, Merimsky O, Lowenstein A, Inbar M,
(1)Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty
of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv 64239, Israel.
AIM: To determine the frequency of visually asymptomatic choroidal metastases in
patients with disseminated breast and lung carcinomas in order to establish
optimal patient management policies.
METHODS: All patients with confirmed metastatic disease treated in our
institution between January 2002 and December 2003 were invited to undergo a
funduscopic examination and a B-scan ultrasound evaluation.
RESULTS: Of the 169 study participants, 77 had breast cancer (64 with metastases
in one organ and 13 with multiple-organ involvement) and 92 had lung cancer (85
with metastases in one organ and 7 with multiple-organ involvement). No patient
with metastatic breast cancer and two patients with metastatic lung disease (each
with multiple-organ involvement) were found to have choroidal metastases. The
choroidal metastases were detected by both the funduscopic and ultrasound
CONCLUSIONS: The 2.17% incidence of choroidal metastasis in disseminated lung
cancer and the 0% incidence in disseminated breast cancer speaks against the
practicality of screening for early detection of choroidal metastasis among these
patients, even though it would lead to early implementation of appropriate, often
vision saving, therapeutic management. Its low incidence probably testifies to
progress achieved by enhanced systemic oncological treatment policies that have
been introduced into routine patient management over the past few years.
PMID: 16943227 [PubMed - indexed for MEDLINE]
10. Isr Med Assoc J. 2000 Oct;2(10):786.
Herceptin-taxol related hand and foot syndrome.
Merimsky O(1), Inbar MJ.
(1)Department of Oncology, Tel Aviv Sourasky Medical Center and Sackler Faculty
of Medicine, Tel Aviv University, Israel. email@example.com
PMID: 11344738 [PubMed - indexed for MEDLINE]
11. Cancer. 2001 Apr 1;91(7):1363-71.
Multiple primary malignancies in association with soft tissue sarcomas.
Merimsky O(1), Kollender Y, Issakov J, Bickels J, Flusser G, Gutman M,
Lev-Chelouche D, Inbar M, Meller I.
(1)Department of Oncology, The Tel-Aviv Sourasky Medical Center, the Sackler
School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. firstname.lastname@example.org
BACKGROUND: Modern cancer treatment has increased the survival of patients with
various malignancies substantially. One of the late sequelae of successful
treatment is the development of a second malignant tumor. However, in many cases
of second primary tumors, exposure to chemotherapy or radiation therapy is not
evident, and it should be postulated that the putative mechanism for the
development of the second tumor is different. In the current series, the
association between soft tissue sarcoma (STS) in adults and the development of
other primary malignancies was studied.
METHODS: A retrospective search of the data files of 610 patients with STS or
bone sarcomas who were treated at the study institution between January 1995 and
December 1999 was performed. All files regarding patients with STS who developed
a second malignant tumor were retrieved for analysis.
RESULTS: Of 375 patients with STS, 28 (7.5%) developed other malignant neoplasms
either before or after the diagnosis of STS. STS as the first tumor occurred in
14 patients (ages 16-72 years). Only three patients were treated with
chemotherapy for their sarcoma. Radiation therapy was administered to five
patients as an adjuvant to surgery for the first tumor. The second tumor types
mainly included STS and renal cell carcinoma. The time interval between the
diagnosis of the STS and the second malignancy was 0 (for synchronous tumors) to
21 years. Three patients developed a third primary tumor within 3 years after the
diagnosis of the second tumor. The median overall survival was > 78 months.
Fourteen patients (ages 35-87 years) had a first primary tumor other than STS
(mainly breast carcinoma and genitourinary malignancies). The second tumors
(mainly STS) appeared within 0 (for synchronous tumors) to 27 years. The median
overall survival for the 14 patients in this group from the time of diagnosis of
the first tumor was > 102 months.
CONCLUSIONS: The phenomenon of two or three primary neoplasms developing in
patients in whom one of the tumors was STS occurs at a rate of 7.5%, a
significantly higher rate than that reported for the occurrence of STS among the
general cancer population (1%). The majority of cases occur incidentally. The
clinical implication includes the need to search for an occult second primary
tumor in patients with STS as an integral part of their follow-up. This is
especially true in patients with primary malignant fibrous histiocytoma who
demonstrate a risk for developing a renal cell carcinoma.
Copyright 2001 American Cancer Society.
PMID: 11283938 [PubMed - indexed for MEDLINE]
12. Eur J Surg Oncol. 1999 Oct;25(5):483-6.
Clips and scar as the guidelines for breast radiation boost after lumpectomy.
Kovner F(1), Agay R, Merimsky O, Stadler J, Klausner J, Inbar M.
(1)Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv
University, Israel. email@example.com
BACKGROUND AND AIMS: Breast-conserving therapy in early breast cancer is equally
effective as mastectomy, with advantages of cosmesis and quality of life over
mastectomy. Local control is improved when entire breast irradiation is combined
with a radiation boost to the tumour bed.
METHODS: Localization of the tumour bed was compared in 45 consecutive patients
using surgical scar and radiopaque clips placed intra-operatively in the
RESULTS: The area (A) of the radiation boost field and volume (V) of the tumour
bed, designed on the basis of scar (AS and VS), were 1.4 times larger than those
designed on the basis of the clips (AC and VC). AS and VS missed about
one-quarter of the tumour bed which had been delineated by clips
intra-operatively, while about one-half of it encompassed tissues beyond the AC
CONCLUSIONS: A boost planned by scar dimensions can miss a substantial portion of
the tumour bed, compromising local control. On the other hand, a substantial
amount of breast tissue beyond the tumour bed can be unnecessarily irradiated,
compromising cosmetic treatment results. Thus, the scar provides an inadequate
landmark for radiation boost planning in breast-conserving therapy.
PMID: 10527596 [PubMed - indexed for MEDLINE]
13. J Neurooncol. 1999 Mar;42(1):85-92.
Radiation therapy of metastatic spinal cord compression. Multidisciplinary team
diagnosis and treatment.
Kovner F(1), Spigel S, Rider I, Otremsky I, Ron I, Shohat E, Rabey JM, Avram J,
Merimsky O, Wigler N, Chaitchik S, Inbar M.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of
Medicine, Tel-Aviv University, Israel. firstname.lastname@example.org
PURPOSE: To evaluate the effectiveness of a multidisciplinary approach to spinal
cord compression (SCC) in accordance with prospective protocol, providing a
uniform approach to diagnosis, decision making concerning optimal treatment
modality in any particular case of SCC, treatment performance and evaluation of
treatment results. The SCC patients treated by radiation therapy are described.
MATERIALS AND METHODS: Patients with SCC were examined and treated by a
multidisciplinary team consisting of a neurologist, radiologist, oncologist,
orthopedic surgeon, and neurosurgeon. Seventy-nine patients for whom radiation
was recommended received a 30 Gy radiation dose to a compression-causing mass and
course of high dose dexamethasone. Three fractions of 5 Gy and 5 fractions 3 Gy
each were delivered by Co60 or 8 MV photon beam in 12 days. Treatment outcome was
essentially evaluated by ambulation capabilities which were considered to be the
main problem of SCC. Changes in other neurologic motor, sensory and autonomic
disturbances were also evaluated.
RESULTS: Seventy-two percent of the patients were already non-ambulatory at
diagnosis. The first symptom was motor deficiency in only 33% of them while in
all other cases it was pain. Ambulation capability was the main prognosticator of
treatment outcome; 90% of patients who were ambulatory before treatment remained
so while 33% of the non-ambulatory patients regained their ability to walk. The
grade of motor disturbance was also an important variable: among the
non-ambulatory patients, 50% of the paretic but only 14% of the plegic ones
became ambulatory. Overall, 51% of the study patients were ambulatory after
undergoing radiation. The ambulatory state after treatment was the main predictor
CONCLUSION: Close cooperation of a multidisciplinary team in diagnosis and
treatment according to the above protocol enabled the achievement of good results
of radiation treatment in SCC. Early diagnosis and early treatment should further
enhance therapeutic outcome.
PMID: 10360483 [PubMed - indexed for MEDLINE]
14. J Neurooncol. 1998 Jan;36(1):79-83.
Primary intramedullary spinal melanoma: diagnostic and treatment problems.
Salame K(1), Merimsky O, Yosipov J, Reider-Groswasser I, Chaitchik S, Ouaknine
(1)Department of Neurosurgery, Tel-Aviv Sourasky Medical Center and Sackler
School of Medicine, Israel.
A 76-year old female patient with 9 year history of right mastectomy for an
infiltrating ductal breast cancer and no evidence of recurrent nor metastatic
disease, was admitted due to pain in the lower thoracic area radiating
bilaterally to the posterior aspect of the chest wall at the same level,
difficulties in micturition, urinary hesitancy, and progressive weakness of the
lower limbs. Primary intramedullary spinal tumor was demonstrated by a MRI study
of the spine, partially resected, and found to be a malignant melanoma on
pathological study. Postoperative irradiation and administration of dexamethasone
did not improve the neurologic status.
PMID: 9525829 [PubMed - indexed for MEDLINE]
15. Oncol Rep. 1997 Jul-Aug;4(4):843-7.
Tamoxifen for disease-negative but MCA-positive breast cancer patients.
Merimsky O, Kovner F, Inbar M, Hareuveni M, Rosenboim Y, Chaitchik S.
Increased levels of mucin-like carcinoma-associated antigen (MCA) in breast
cancer patients with no evidence of disease following the treatment of the
primary disease created a dilemma of 'to treat' or 'wait and see'. One might
assume that early treatment of clinically undetectable disease on the basis of an
elevated serum level of a sensitive and reliable tumor marker, may improve the
treatment results, and even prolong the patient's survival. 'Wait and see' on
acceptance of the notion that even early metastatic disease, still manifested
only by uprising MCA levels, is incurable, and treatment should be kept in
reserve for palliation of symptomatic disease. Sixty-one breast cancer patients
with increasing MCA levels but without evidence of metastatic disease were
randomized for tamoxifen 20 mg b.i.d. or to follow-up till relapse. The results
for a median follow-up period of one year were encouraging. The non-treated
patients experienced a significantly higher relapse rate (24.1%) than the
tamoxifen-treated subjects (0%; p=0.012). The results for a median follow-up of 5
years were disappointing. The overall relapse rate was 22.2%. The relapse rate
among the control patients was 25.8% while in the treatment arm it was 17.4%
(p=0.46). The event-free survival and the pattern of relapse were similar in both
arms. Tamoxifen may therefore be reserved for overt metastases, and not wasted on
asymptomatic subclinical disease. It seems that there is no yield in terms of
event-free survival for MCA measurements in breast cancer patients during the
5-year follow-up period.
PMID: 21590154 [PubMed]
16. Oncol Rep. 1997 Jul-Aug;4(4):829-32.
Elevated breast cancer serum markers in otherwise healthy women.
Merimsky O(1), Hareuveni M, Barak V, Sperber F, Eshkol Z, Chaitchik S.
(1)TEL AVIV UNIV,SACKLER FAC MED,TEL AVIV SOURASSKY MED CTR,DEPT ONCOL,IL-69978
TEL AVIV,ISRAEL. TEL AVIV UNIV,SACKLER FAC MED,TEL AVIV SOURASSKY MED CTR,DEPT
RADIOL,IL-69978 TEL AVIV,ISRAEL. HADASSAH MED CTR,TUMOR MARKER RES UNIT,IL-91120
JERUSALEM,ISRAEL. HEBREW UNIV JERUSALEM,JERUSALEM,ISRAEL.
A high value of mucin-like carcinoma associated antigen (MCA), CA-15.3 or H23, in
a woman known to have a diagnosis of breast cancer, may reflect presence of
disease. A low level in a breast cancer patient may be accepted for remission,
but a false negative result cannot be excluded. On the other hand, a low level of
serum tumor marker in the general population actually lacks any significance.
However, what is the meaning of an elevated level of marker, known to have a
relatively high sensitivity and specificity, in an otherwise healthy woman? Does
it mean an occult breast cancer or a false positive? Sera samples were obtained
from 155 consecutive, otherwise healthy women, who were referred for mammography,
and assayed for tumor markers. MCA was elevated in 15-24% of patients with normal
mammogram, depending on their ages. Lack of elevation of a second marker in most
of the cases supported the assumption that the elevation of the MCA was
insignificant. Elevation of H23 occurred more frequently in younger women than in
the elders, but was not associated with elevation of a second marker. In the
cases with abnormal mammogram due to histologically proven benign disorders,
serum tumor markers were generally within the normal ranges. Our results pointed
to the lack of diagnostic significance of an elevated level of serum tumor
marker, as far as the mammogram was normal or benign, there was no history of
cancer nor any other systemic disease (including malignancy), and a second tumor
marker was within the normal range. The women with presently false positive
marker level may, however, be followed, because of the possible risk for future
development of breast cancer.
PMID: 21590151 [PubMed]
17. Oncol Rep. 1996 Jan;3(1):197-9.
Fluorescence polarization changes in the lymphocytic cytoplasm in the various
stages of breast cancer.
Ron I(1), Deutsch M, Merimsky O, Tirosh R, Rachmani H, Kaufman M, Weinreb A,
(1)TEL AVIV UNIV,TEL AVIV SOURASKY MED CTR,DEPT ONCOL,IL-69978 TEL AVIV,ISRAEL.
TEL AVIV UNIV,SACKLER FAC MED,IL-69978 TEL AVIV,ISRAEL. BAR ILAN UNIV,DEPT
PHYS,JEROME SCHOTTENSTEIN CELLSCAN CTR EARLY DETECT CA,RAMAT GAN,ISRAEL. TEL AVIV
UNIV,BEILINSON HOSP,DEPT SURG B,IL-69978 TEL AVIV,ISRAEL.
Post-surgical pathological staging and ancillary tests determine the initial
treatment of breast cancer. Because change in the structuredness of the
cytoplasmic matrix (SCM) of peripheral lymphocytes (as assessed by measurement of
fluorescein fluorescence polarization, FFP) has already emerged as diagnostic for
breast cancer and an aid to staging in other cancers, testing was carried out in
113 pre-surgical patients to see whether such change could contribute to accurate
staging of breast cancer. The FFP test was able to distinguish grouped stages of
locoregional disease from metastatic disease but was unable to distinguish
between any single locoregional stage and the metastatic stage. Technological
improvements now underway may create a role for assessment of SCM changes in
breast cancer staging.
PMID: 21594343 [PubMed]
18. Eur J Cancer. 1996 Jan;32A(1):174.
Adjuvant tamoxifen: 5 year control of dormant disease?
Merimsky O, Inbar M, Kovner F, Chaitchik S.
PMID: 8695228 [PubMed - indexed for MEDLINE]
19. Oncol Rep. 1995 Sep;2(5):781-5.
Breast-cancer associated brachial plexopathy - still a diagnostic and treatment
Merimsky O(1), Rabey J, Inbar M, Chaitchik S.
(1)ICHILOV HOSP,TEL AVIV SOURASKY MED CTR,DEPT NEUROL,IL-64239 TEL AVIV,ISRAEL.
TEL AVIV UNIV,SACKLER FAC MED,IL-69978 TEL AVIV,ISRAEL.
Brachial plexopathy (BP) in breast cancer patients is a rare event, attributed
mainly to radiation damage or tumor infiltration of the plexus. Differentiation
between these etiologies is a diagnostic challenge. We have studied
retrospectively eight female patients with breast cancer who developed a clinical
syndrome of brachial plexopathy following the treatment of the primary disease,
out of more than 900 during the last 10 years. None of the available ancillary
tests such as plain films, CT or MRI studies, EMG or tumor markers, provided
reliable data regarding the cause of the plexopathy. Biopsy, on the other hand,
was not always feasible. In our series, all the patients who developed BP did not
have any blood-borne metastases before developing the syndrome. In 3 of the
patients BP was the first sign of recurrence. In the other 5, only local or
locoregional relapse preceded. In 7 of the 8 patients the left side was affected.
Treatment should be tailored in each case according to course of the disease. The
optimal treatment has not yet been defined.
PMID: 21597816 [PubMed]
20. Anticancer Drugs. 1994 Dec;5(6):666-9.
Chemotherapy-related persistent indirect hyperbilirubinemia.
Inbar M(1), Merimsky O, Chaitchik S.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Israel.
In spite of the improvement on chemotherapy results in treating testicular cancer
and the introduction of adjuvant chemotherapy to node negative (as well as node
positive) breast cancer patients, there is still present a wide spectrum of early
and late toxic manifestations. The combination of cisplatin, vinblastine and
bleomycin given to testicular cancer might result in cariovascular, neurological,
gastrointestinal and renal problems. Late effects of cyclophosphamide,
methotrexate and 5-fluorouracil given to breast cancer patients might cause
obesity, amenorrhea and infertility. We report a persistent asymptomatic indirect
hyperbilirubinemia which was observed in two cancer patients (breast; testis) 3
and 14 months following the cessation of chemotherapy. Metastatic liver disease
and involvement of other sites, as well as other causes of hyperbilirubinemia,
were excluded. The exact cause of the indirect hyperbilirubinemia remained
PMID: 7888704 [PubMed - indexed for MEDLINE]
21. Int J Radiat Oncol Biol Phys. 1994 Nov 15;30(4):831-7.
Postoperative high dose-rate intravaginal brachytherapy combined with external
irradiation for early stage endometrial cancer: a long-term follow-up.
Nori D(1), Merimsky O, Batata M, Caputo T.
(1)Department of Radiation Oncology, New York Hospital Medical Center of Queens,
PURPOSE: To evaluate the long-term control of disease and cure rate,
complications, second malignancy, and survival of early-stage endometrial cancer
patients treated with surgery, high dose-rate brachytherapy, and external beam
METHODS AND MATERIALS: From 1969 through 1979, 300 patients with clinically
staged Stage I-II endometrial cancer underwent total abdominal hysterectomy and
bilateral salpingo-oopherectomy, followed by high dose-rate intravaginal
radiation, 7 Gy x 3 to 0.5 cm from the mucosal surface, using a remote
afterloading technique. External beam radiation therapy, 40 Gy to midplane in 4
weeks, was delivered to high risk patients through AP/PA and lateral fields.
RESULTS: The patients were followed for 5-24 years (median 12). The actuarial
progression-free survival rate was 96.6%. Post-treatment grade 1-2 actuarial
complication rate was 9.5%, including cystitis (4.5%), vaginal stenosis (2.5%),
proctitis (1.5%), vaginal necrosis (0.5%), and partial bowel obstruction (0.5%).
Neither grade 3-4 complications nor additional late complications were observed
in any of our patients. Relapse rate was only 3.7%, of which 45.5% were local,
45.5% were distant, and 9% were mixed. All the patients with relapse were
postmenopausal, age range of 58-77 years, with tumor grade 2-3 in 64%. Second
primary cancer rate was 12.8% (mostly breast and colon). Factors that were
associated with improved prognosis were young age, premenopausal, low grade, no
extrauterine disease, and a histology of adenocarcinoma (adenocarcinoma with
CONCLUSION: High dose rate intravaginal radiation therapy combined with surgery
and external beam radiation therapy achieved a high cure rate small number of
minor complications. No long-term treatment-related complications were noted in
any of the patients. This treatment combination may be safely applied to patients
with early stage endometrial cancer.
PMID: 7960984 [PubMed - indexed for MEDLINE]
22. Cancer Chemother Pharmacol. 1994;35(1):80-3.
Treatment of disease-negative but mucin-like carcinoma-associated
antigen-positive breast cancer patients with tamoxifen: preliminary results of a
prospective controlled randomized trial.
Kovner F(1), Merimsky O, Hareuveni M, Wigler N, Chaitchik S.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Israel.
Increasing levels of tumor markers such as carcinoembryonic antigen, mucin-like
carcinoma-associated antigen (MCA), CA 15.3, and monoclonal antibody H23 in
breast cancer patients following the treatment of the primary disease and
adjuvant radiation and chemotherapy reflect subclinical development of metastatic
disease. Overt metastatic disease is usually incurable and prolongation of life
at this stage is impossible, and the treatment is only palliative. The efficacy
of tamoxifen, a least-toxic agent, in the treatment of early and minimal
metastatic disease detected only by increasing serum levels of MCA was studied
prospectively in a randomized study. Our preliminary, albeit encouraging, results
showed that the rate of relapse within a median follow-up period of 11 months was
24.1% in the control arm as compared with 0% in the tamoxifen arm (Fisher's exact
test, P = 0.012). None of the patients with a relapse had positive progesterone
receptors (PR). We may carefully conclude that early treatment may be warranted
in young patients with negative PR and continuously increasing serum levels of
PMID: 7987981 [PubMed - indexed for MEDLINE]
23. Tumori. 1992 Dec 31;78(6):407-8.
Kaposi's sarcoma on a lymphedematous arm following radical mastectomy.
Merimsky O(1), Chaitchik S.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Israel.
Chronic lymphedema predisposes for local immune incompetence, manifested by
development of Stuart-Treves syndrome, Kaposi's sarcoma and fibroma-like lesions.
A 91-year-old female with multiple cancers developed classic Kaposi's sarcoma on
a chronically lymphedematous arm 26 years after radical mastectomy and
irradiation of the involved axilla. The Kaposi lesion partially responded to
electron beam irradiation.
PMID: 1297238 [PubMed - indexed for MEDLINE]
24. Eur J Cancer. 1991;27(11):1440-4.
Serial serum MCA measurements in the follow-up of breast cancer patients.
Merimsky O(1), Inbar M, Hareuveni M, Witenberg B, Wolman Y, Chaitchik S.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of
Medicine, Tel-Aviv University, Israel.
Mucin-like carcinoma-associated antigen (MCA) was serially assayed in 58 women
with histologically proven breast cancer after their treatment for primary
disease. MCA sensitivity and specificity were 87.5% and 76.9%, respectively, and
the positive predictive value 82.4%. 10 patients had elevated MCA and no evidence
of disease (NED) during their follow-up, of whom 4 finally developed overt
metastases. The 4 had a mean (S.D.) MCA value of 46.48 (18.26) U/ml during the
lead time, versus 18.76 (2.69) U/ml in the other 6, who are still at high risk
for developing overt metastases. Raised levels of MCA in patients with NED create
a dilemma of "treat" versus "wait and see". Early treatment of patients with
serially uprising MCA levels should be evaluated in a prospective randomised
study to assess its ability to prevent or delay the development of overt
metastatic disease and influence survival.
PMID: 1835861 [PubMed - indexed for MEDLINE]
25. Tumori. 1990 Dec 31;76(6):548-51.
Metastatic disease of the cavernous sinus: contribution of computed tomography
and magnetic resonance imaging to diagnosis.
Merimsky O(1), Reider I, Inbar M, Kovner F, Chaitchik S.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Israel.
The clinical presentation of metastatic disease to the cavernous sinus includes
ophthalmoplegia, pain and sensory deficit along the optic or maxillary branches
of the trigeminal nerve. The role of a CT scan and magnetic resonance imaging in
the diagnosis is discussed. It was found that magnetic resonance imaging is
superior to CT scan in demonstrating the cavernous sinus and pontine borders,
especially in lymphomatous involvement of these structures.
PMID: 2284690 [PubMed - indexed for MEDLINE]
26. Tumori. 1990 Aug 31;76(4):407-9.
Recurrent solitary metastasis of renal cell carcinoma in skeletal muscles.
Merimsky O(1), Levine T, Chaitchik S.
(1)Department of Oncology, Ichilov Hospital Tel-Aviv Medical Center, Israel.
Metastatic carcinoma to skeletal muscle is uncommon and may originate from
breast, colon, lung, pancreas and other sources. Recurrent solitary metastases of
renal cell carcinoma in the biceps femori and gluteus muscles are described in a
69 year-old man. The tendency of metastases to occur merely in muscles could not
be explained in our case. The relative immunity of muscle to the metastatic
process should be further investigated.
PMID: 2399572 [PubMed - indexed for MEDLINE]