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Intra-operative Ultrasound Vs multiparametric Magnetic Resonance Imaging for assessment of resectability of Liver tumors: Prospective Comparative Study.

Mostafa M. Sayed1, MD, Gehan S Seifeldein2, MD, Mohamed Zidan2, MD, and Mohamed G. Taher, Murad A Jabir3, MD

1General Surgery Department, Faculty of Medicine, Assiut University, Egypt
2Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Egypt
3Surgical Oncology Department, Assuit University, Egypt
mostafa.sayed1974@gmail.com; gehanseifeldein@yahoo.com; mzidan74@yahoo.com mohamedamin022@aun.edu.eg; muradjab2010@gmail.com

Abstract: Background: Intra-operative ultrasound (IOUS) provides real-time tagging of liver lesions, especially those that lie deep within the liver during surgery. It also, detects relation of liver lesion (s) to major hepatic vessels and bile ducts and their segmental distribution according to Couinaud’s liver segmentation. Thus, it is very useful during liver surgery. Additionally, it may detect occult lesions, not identified by pre-operative imaging, thus it may change the decision of completing the liver resection. However, IOUS is operator dependent. It should have high sensitivity and specificity to liver lesions at least similar to those offered by advanced preoperative imaging like dynamic MRI with DWI. Otherwise, its use could cause false safety and adequacy of liver resection. Purpose: Comparison between intra-operative ultrasound (IOUS) and pre-operative dynamic magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) for assessment of liver tumors resectability. Materials and Methods: This study included 74 patients (43 females and 31 males; mean age 47.2±12.66 years (19–70 years) who have been explored for liver resection with curative intent for liver tumors. All patients had pre-operative dynamic MRI with DWI, done within 2 weeks of planned surgery, to assess resectability. IOUS of the liver was performed by the surgeon, supervised by a radiologist with interest in hepatobiliary imaging. Ultrasound was done by a T-shape 7.5-MHz linear-array transducer. All focal hepatic tumors identified in preoperative MRI or IOUS were resected. The gold standard for final diagnosis was histopathological analysis. Results: The sensitivity of pre-operative dynamic MRI with DWI on one hand and the IOUS on the other hand for liver lesion depiction were 81.6% and 94.4%, respectively. Of the 74 patients considered to have resectable liver tumor (s) on pre-operative dynamic MRI, IOUS helped change the decision in 4 (5.4%). Two (2.7%) patients deemed to have irresectable liver tumors after the use of IOUS. These patients were saved potentially hazardous, non-beneficial liver resections. In the other 2 (2.7%) patients, IOUS helped modify the planned resection by adding more segments to be resected to achieve potentially curative liver resection. Conclusion: The use of IOUS before proceeding into liver resection for liver tumors is beneficial. It can detect new lesions and major vessel invasion that, in some cases preclude proceeding into non-beneficial liver resection. Moreover, it may change the designed hepatectomy, by either more or less segments to be involved into the resection process. Meanwhile, IOUS carries no harm and doesn’t add much to the time of surgery.
[Mostafa M. Sayed, Gehan S Seifeldein, Mohamed Zidan, and Mohamed G. Taher, Murad A Jabir. Intra-operative Ultrasound Vs multiparametric Magnetic Resonance Imaging for assessment of resectability of Liver tumors: Prospective Comparative Study. Cancer Biology 2018;8(4):1-8]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 1. doi:10.7537/marscbj080418.01.

Key words: IOUS, MRI-DWI, pathology, hepatic focal lesion

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Ameliorative effects of honey and venom of honey bee on induced colon cancer in male albino rats by1,2 dimethylhydrazine

Nagy S. Tawfek, Diaa B. Al-Azhary, Hanaa F. Hassan and Esraa G. Mostafa

Zoology Department, Faculty of Science, Minia University, Egypt

egm_1990@yahoo.com

Abstract: Aim of the work: The present study was carried out to evaluate the role of bee honey and bee venom (BV) separately or in combination in ameliorating promotion of colon carcinogenesis induced by 1,2 dimethylhydrazine (DMH) in albino rats. Materials and methods: Rats were subcutaneously injected by DMH (20 mg/kg b. wt.) once a week for 15 weeks. DMH-treated animals received either oral administration of bee honey (500 mg/kg b. wt.) or intraperitoneal injection of BV (3 mg/kg b. wt.) or both together every other day along the period of DMH- treatment. At the end of 15^th week treatment, blood samples and colon tissues were taken for biochemical analysis of lipid peroxide, glutathione peroxidase (GPx), alakaline phosphatase (ALP), carcinoemberyonic antigen (CEA) and alpha fetoprotein (AFP); and also for histopathological and immunohistochemical investigations. Results: The results showed an increase in the levels of lipid peroxide, ALP, CEA and AFP and a decrease of GPx level in DMH-treated rats as compared to control, while honey and BV treatments modulated the DMH-induced changes of these parameters. Moreover, they showed remarkable reduction in dysplasia, inflammatory cells infiltration and loss of acinar patterns of colon glands and abnormalities of P53 expression which were clearly observed in DMH-treated group. Conclusion: Findings of the present study indicate significant roles for reactive oxygen species (ROS) in pathogenesis of DMH-induced colon toxicity and initiation of colon cancer. Also, it suggested that honey, BV or the combination of both have a positive beneficial effect against DMH induced colonic cancer in rats. Honey and BV inhibit oxidative stress and enhance antioxidant status suggesting a growing application of these natural compounds as an alternative medicine treatment of colon tumor.

[Nagy S. Tawfek, Diaa B. Al-Azhary, Hanaa F. Hassan and Esraa G. Mostafa. Ameliorative effects of honey and venom of honey bee on induced colon cancer in male albino rats by1,2 dimethylhydrazine. Cancer Biology 2018;8(4):9-20]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 2. doi:10.7537/marscbj080418.02.

Key words: Colon cancer, 1,2dimethylhydrazine, oxidative stress, honey, bee venom

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Chemoprotective Efficacy of Curcumin and Flax Seed Oil in 1, 2-Dimethylhydrazine Induced Rat Colon Cancer

Diaa B. Al-Azahary, Nagy S. Tawfik, Hanaa F. Hassan and Shimaa A. Kamal

Zoology Department, Faculty of Science, Minia University, Egypt

shimaa_ahmed_89@yahoo.com

Abstract: The Aim: The study was carried out to examine the protective roles of curcumin and flax seed oil against 1,2-dimethylhydrazine (DMH) induced colon carcinogenesis in albino rats. Methods: Rats were injected by DMH (20 mg/kg b. wt.) once a week for a duration period of 15 weeks. Animals were treated by oral administration of curcumin (100 mg/kg b. wt.) and / or flax seed oil (2 ml/kg b. wt.) each alternate day along the duration period of DMH- treatment. At the end of experimental period, all rats were sacrificed to obtain samples of blood and colon for biochemical, histopathological and immunohistochemical investigations. Malanodialdehyde (MDA), glutathione peroxidase (GPx), alakaline phosphatase (ALP), alpha fetoprotein (AFP) and carcinoemberyonic antigen (CEA) were estimated. Cellular alternations and expression of P53 in colon tissue of different groups were also examined. Results: The results revealed an increase of serum MDA, ALP, AFP and CEA and a decrease of GPx levels in DMH-treated rats as compared to control. On the other hand, separate or co-treatment of DMH-treated rats by curcumin and flax seed oil reduced the changes of these parameters. Moreover, they show obvious reduction and amelioration of necrotic areas, dysplastic zones and loss of acinar patterns of colon glands and abnormalities of P53 expression which appeared in DMH-treated group. Conclusion: It could be therefore concluded that inhibition of oxidative stress, enhancement of antioxidant status and amelioration of colon tissue by curcumin and flax seed oil suggest their potential efficacy as protective naturally occurring agents against colon carcinogenesis.

[Diaa B. Al-Azahary, Nagy S. Tawfik, Hanaa F. Hassan and Shimaa A. Kamal. Chemoprotective Efficacy of Curcumin and Flax Seed Oil in 1, 2-Dimethylhydrazine Induced Rat Colon Cancer. Cancer Biology 2018;8(4):21-31]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 3. doi:10.7537/marscbj080418.03.

Key words: Colon cancer, Curcumin, Dimethylhydrazine, Flax seed oil, Oxidative stress

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Reactive Bone Lesions in Postchemotherapy Pediatric Bone Tumor Specimens: Implications on Surgical Planning by Preoperative MRI

Iman Gouda¹, Iman Zaki², Ahmed El Ghoneimy³^,4, Magdy El Sherbiny³, Ranin Soliman⁵, Manal Zamzam^6,7

¹Department of Pathology, Children’s Cancer Hospital 57357- Egypt (CCHE); ²Department of Radiology, CCHE; ³Division of Orthopedic Oncology, CCHE;⁴ Department of Surgery, Kasr Elainy, Cairo University, Egypt; ⁵Department of Health Economics & Value, CCHE; ⁶Department of Pediatric Oncology; CCHE, ⁷Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt. manal.zamzam@gmail.com

Abstract: Background: Therapy-associated changes in the specimens of bone tumor comprise alterations in the size of tumor and reactive changes liked with tumor necrosis in addition to bone marrow changes and periosteal effect. Aim: This work was aimed to assess the precise of pre-operative MRI images in estimating the degree of local cancer before operation in patients having high-grade osteosarcoma (OS) and Ewing sarcoma (ES) post neo-adjuvant chemotherapy. Patients and Methods: We conducted a prospective study from January 2009 till January 2011 on 75 children patients admitted at the Children Cancer Hospital Egypt diagnosed as malignant cancers in long bones; 56 High- grade OS and 19 ES were administered neo-adjuvant chemotherapy and definitive operation. The precision of the intra-osseous degree of the cancer as measured by pre-operative MRI were compared with traditional gross and histopathological methods of the biopsy samples. Variation in intra-osseous tumor extent measurements between MRI and pathology specimen of more than 1 cm was determined as inconsistency. Results: The degree of intra-osseous cancer was distinct precisely by preoperative MRI in 50 (89%) OS patients and in 15 (78%) ES patients. The average overestimation among traditional histopathological technique and MRI extents was 3.2 cm (median=2.5) in OS, while it averaged 2 cm (median=2.5) in ES. The correlation coefficient among maximum tumor size measurement estimated by pre-operative MRI and by histopathology was 0.967 and 0.973 (p< 0.001) in OS and ES, respectively. Erroneous in dimensions from MRI were caused by periosteal reactive changes, bone marrow alterations such as false positive epiphyseal infiltration and focal infarction or edema. Conclusion: Preoperative assessment of extent of cancer using MRI is a dependable tool to evaluate the local extent of bone cancers in children. The obtained data are valuable in scheduling surgical limb rescue processes and stress the incompetence of reactive alterations in bone biopsy samples on preoperative radiological assessment of cancer extent.

[Iman Gouda, Iman Zaki, Ahmed El Ghoneimy, Magdy El Sherbiny, Ranin Soliman, Manal Zamzam. Reactive Bone Lesions in Postchemotherapy Pediatric Bone Tumor Specimens: Implications on Surgical Planning by Preoperative MRI. Cancer Biology 2018;8(4):32-39]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 4. doi:10.7537/marscbj080418.04.

Keywords: Reactive; Bone Lesion; Postchemotherapy Pediatric Bone; Tumor Specimen; Surgical Planning; Preoperative MRI

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Concurrent Chemo-Radiotherapy in Treatment of Brain Secondries

Samia Abd-Elkarem Ali MD¹, Roshdy Abdulaziz Elkhyat MD², Taha Zaki M. Mahran MD¹, Mervat Mohamed MD¹ and Ahmad Abd-Elrhman Abd-Elhafez MSc³

¹clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Assiut University, Egypt

²neurosurgery Department, Faculty of Medicine, Assiut University, Egypt

³Department of Clinical Oncology and Nuclear Medicine, Assiut University Hospital, Egypt

Abstract: Background: Brain metastases are the most common cause of intracranial mass lesions. As primary cancer treatments such as surgery, radiation therapy and chemotherapy have become more effective in the past few decades, people with cancer are living longer after initial treatment than ever before. Treatment efficacy is determined by the sensitivity of tumor cells to chemotherapeutic agents and whether or not these drugs can cross the blood brain barrier (BBB). The present study evaluated the efficacy and toxicity of gemcitabine given concurrently with whole brain radiation therapy in patients with brain metastases. Patients & Methods: This is a phase II prospective study included 50 patients with radiologically proven brain secondries of pathologically proven primary solid tumor, who presented to Clinical Oncology Department, Assiut University Hospital from November 2004 to October 2006. Each patient was subjected to medical decompression, and was given palliative whole brain irradiation aiming at 30 Gy/10 fractions/2 weeks with gemcitabine 50 mg/ m2 weekly by 30 minutes IV infusion. Results: With mean age of 59.71 years, (23; 46.0%) were male patients, with distribution of ECOG PS was (14 patients; 28.0%) in grade 1, (30 patients; 60.0%) in grade 2 and (6 patients; 12.0%) in grade 3. Regarding response to treatment, one patient (2.0%) had complete response, 3 patients (6.0%) had partial response, 18 patients (36.0%) had stable disease and 28 patients (56.0%) had progressive diseases. The median PFS was 9 months and OS was 14 months. All patients tolerated treatment regimen well with only two patients (4%) suffered from grade 2 thrombocytopenia. Conclusions: Gemcitabine based concurrent chemo-radiation with 50 mg/ m2 weekly resulted in favorable response rate, and satisfactory median PFS and OS with accepted toxicity profile.

[Samia Abd-Elkarem Ali, Roshdy Abdulaziz Elkhyat, Taha Zaki M. Mahran, Mervat Mohamed and Ahmad Abd-Elrhman Abd-Elhafez. Concurrent Chemo-Radiotherapy in Treatment of Brain Secondries. Cancer Biology 2018;8(4):40-44]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 5. doi:10.7537/marscbj080418.05.

Keyword: Brain metastasis, Gemcitabine, Survival, treatment

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Surgical management of esophageal cancer: Experience of the National Cancer Institute, Egypt

Dr. Ihab Saad Hussein Ahmed, Omar Muhammed Hossam El-Sabbagh, Prof. Dr. Abdel Rahman Mohamed Abdel Rahman

Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt

Ihab.saad@nci.cu.edu.eg, drihab2013@gmail.com

Abstract: Objective: This study demonstrated the experience of the National Cancer Institute, Cairo University with esophageal cancer over a period of 7 years. Methods: This retrospective chart review included all patients diagnosed as esophageal cancer and had surgery at the National Cancer Institute (NCI) in the period from 2009-2015. Results: During the study period, 275 patients were diagnosed as esophageal cancer fulfilling the inclusion criteria. Squamous cell carcinoma (SCC) accounted for 61% of cases. Males were more commonly affected than females (1.5:1). Near half of the cases presented with locally advanced disease, while 16.7% of patients had metastatic deposits on presentation.Direct surgical exploration was done for 96 patients (34.9%), as 66 patients (24%) were referred to receive neoadjuvant therapy; 17 of them showed regressive course and referred for surgical resection. After surgical exploration, 84 patients had surgical resection. Transthoracic approach was done 10 about 60% of cases. Postoperative morbidities were recorded in 55 patients (65.5%) and in-hospital mortality in 17 patients (20.2%). Common surgical complications recorded were anastomotic leakage and massive intraoperative blood loss. Twenty five patients (29.8%) developed postoperative pneumonia; 10 of them died in-hospital. The cumulative overall survival was 56.7%. Postoperative morbidity, lymph node involvement, and inadequate lymphadenectomy were the independent factors affecting survival. Conclusion: Surgical resection of esophageal cancer was possible in only 30% of cases. Postoperative complications and mortalities are rather high. Overall survival is low and unacceptable. Improvement of management modalities and early diagnosis are the required for better outcome in this high-volume hospital.

[Ihab Saad Hussein Ahmed, Omar Muhammed Hossam El-Sabbagh, Abdel Rahman Mohamed Abdel Rahman. Surgical management of esophageal cancer: Experience of the National Cancer Institute, Egypt. Cancer Biology 2018;8(4):45-55]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 6. doi:10.7537/marscbj080418.06.

Keywords: Surgical; management; esophageal cancer; Experience; National Cancer Institute; Egypt

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Development of a Prognostic Model to Predict the Response to Treatment of Neutropenic Fever in Patients with Hematological Malignancies

Hamdy Zawam¹, Rasha Salama¹, Wael Edessa¹, Nivin Hanna¹ and Samy ALsiray²

¹Clinical oncology department, Kasr Al-Ainy Center of Clinical Oncology, Egypt

²Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology, Kasr Al-Ainy School of Medicine, Cairo University, Egypt.

Abstract: Background: A febrile neutropenia remains one of the most commonly encountered oncological emergencies in patients with hematological malignancies. Development of a prognostic system is very critical in those patients Aim of the study: The aim of this study was to describe febrile neutropenia in a cohort of Egyptian patients with hematological malignancies and to develop a predictive model for its outcome. Methods: This is a prospective observational study including 142 patients with haematological malignancies who presented to Kasr Al Ainy Center of Clinical Oncology during the period of 1st of June 2014 untill October 2015. This group of patients suffered from 270 episodes. According to the MASCC score, high risk patients were treated inpatients. All admitted patients were subjected to blood, sputum, stool and urine culture withdrawal and Galactomann test. PCR (polymerase chain reaction) of sepsis and BAL (broncho alveloar lavage ) were done in certain cases. Empirical antibiotics were started immediately, antifungal and antiviral were received according to the guidelines. Results: The different diagnostic modalities were analysed in addition to the results of treatment by different classes of antibiotics. The most frequent diagnosis in our study were AML (55 patients), followed by ALL (27 patients, and NHL (35 patients) and others diagnosis (HL, MM, CLL,CML). The disease status of hematological malignancy patient was found highly significant and affects the control of neutropenic fever episode. The more the patient develop neutropenic episodes the more the risk of mortality. In our study, the MASCC score were highly significant. 62% of the identified pathogens were gram positive detected by blood culture. while gram negative bacteria were the commonest pathogens identified by other diagnostic modalitie. The most encountered organisms were MRSA, CONS and Klebsiella. Conclusions The management of febrile neutropenia requires the cooperation between several departments. Many risk factors affect the outcome of febrile neutropenia and should be taken in consideration for every pts.

[Hamdy Zawam, Rasha Salama, Wael Edessa, Nivin Hanna and Samy ALsiray. Development of a Prognostic Model to Predict the Response to Treatment of Neutropenic Fever in Patients with Hematological Malignancies. Cancer Biology 2018;8(4):56-62]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 7. doi:10.7537/marscbj080418.07.

Keys words: Febrile neutropenia- outcome- prognostic score

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The predictive value of PET-scan in diffuse large B-cell in optimizing the treatment decision

Sherif El Refaei MD¹, Mahasen Abougabal MD¹, Rasha Salama MD², Hussam Zawam MD², Maha Salama MSc¹

¹Nuclear medicine unit, Kasr Al-Ainy center of clinical oncology and nuclear medicine, Faculty of Medicine, Cairo University, Egypt.

² Clinical oncology unit, Kasr Al-Ainy center of clinical oncology and nuclear medicine, Faculty of Medicine, Cairo University, Egypt

E-mail: roshy.salama@yahoo.com

Abstract: Introduction Diffuse large B cell lymphoma (DLBCL) is the main subtype of histologically destructive non-Hodgkin lymphomas. The role of 18F-FDG PET/CT scan is well established at the baseline and at the end of DLBCL patients therapy. Many studies reported that patients with a negative scan after initial 2-3 cycles of chemotherapy demonstrated both a an improvement in overall survival (OS) and an improvement in progression-free (PFS). Therefore it is important to determine an accurate predictive tool to stratify patients who are more likely to relapse, to allow clinicians to modify their treatment accordingly. Aim of the work In our study we are concentrating on the prognosticrate of interim 18F-FDG PET/CT in patients with recently diagnosed pathologically proven DLBCL treated with chemotherapy as first line. Patients and Methods This prospective study was performed in Kasralainy Center of Clinical Oncology and nuclear medicine after being approved by the ethical committee. The study included thirty-nine patients, with newly diagnosed pathologically proven DLBCL. Patients were subjected to whole body 18F-FDG PET/CT as a baseline and after 3 cycles of their 1st line chemotherapy (interim PET). Results Between June 2015 and July 2017, the study included 39 patients. Thirty-one patients received R-CHOP-21 and 8 patients received R-EPOCH-21). All patients were subjected for a complete assessment with interim PET-I scan (PET-I), a baseline scan and an end-of`-treatment scan (PET-E). According to PET-I (interim PET) results, patients were subdivided into metabolic responders (PET-negative patients) including patients with complete and partial response and metabolic non-responders (PET-positive patients) with progressive and stable disease using Deauville criteria. PET-negative patients 92.3% (36 patients) received three additional courses, whereas in PET-positive patients (3 patients) 2^nd line chemotherapy was prescribed (two patients received GEMOX and the other one received ESHAP). Two of them were still non-responder at the end-of-treatment study while the other one became responder. PET/CT scan post therapy was, 89.7% of patients (n=35) were metabolic responders and 10.3% (n = 4) were metabolic non-responders. Two patients of the end treatment non-responders were also non-responder at the interim study while the other two patients were responders at the interim study. Conclusion In DLBCL, optimization of the management of patients has been considered of great importance as conventional chemotherapy has been shown to be effective only in 60% of patients. Using PET-CT is of value in treatment decision and early shift for non-responding patients.

[Sherif El Refaei, Mahasen Abougabal, Rasha Salama, Hussam Zawam, Maha Salama. The predictive value of PET-scan in diffuse large B-cell in optimizing the treatment decision. Cancer Biology 2018;8(4):63-70]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 8. doi:10.7537/marscbj080418.08.

Key words: PET-CT, Predictive value, DLBCL.

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Modified FOLFIRINOX Regimen as Front-Line Therapy for Metastatic Pancreatic Adenocarcinoma

Mohamed El-Shebiney M.D. and Alaa Maria M.D.

Clinical Oncology Department, Faculty of Medicine, Tanta University Hospital, Egypt.

alaamaria1@hotmail.com

Abstract: Purpose: we conducted this prospective study of using modified FOLFIRINOX regimen [5-fluorouracil (5-FU), leucovorin, irinotecan, and oxaliplatin] as a front-line therapy for metastatic pancreatic cancer (MPC) patients aiming at a safer therapy with maintained efficacy. Patients and Methods: A prospective phase II single-arm study including 28 patients with MPC treated with modified FOLFIRINOX regimen between March 2016 and October 2017 was conducted at our department. Modified FOLFIRINOX regimen consisted of oxaliplatin 85 mg/m², irinotecan 135 mg/m², and leucovorin 400 mg/m² infused intravenously (IV) on day 1, and 5-FU 2400 mg/m² infused IV over 46 hours on days 1–2 with cycles repeated every 2 weeks. Results: The median follow-up period for all patients was 10.75 (range 5.5–18) months. Only 4 (14.3%) patients were alive at the time of data analysis. The median overall survival (OS) and progression free survival (PFS) times were 10.5 (95% CI, 8.4–12.6) and 7.7 (95% CI, 6.8-8.6) months respectively. The 1-year OS and PFS rates were 39.3% and 10.7% respectively. The objective response rate (ORR) was 28.6%, and the disease control rate (DCR) was 67.9%. Grade 3 adverse events occurred in 9 (32.1%) patients with the incidence of grade 3 neutropenia was 21.4%. No grade 4 adverse events or treatment-related death were recorded. Conclusions: The front-line modified FOLFIRINOX regimen has an acceptable safety profile with maintained efficacy in MPC.

[Mohamed El-Shebiney and Alaa Maria. Modified FOLFIRINOX Regimen as Front-Line Therapy for Metastatic Pancreatic Adenocarcinoma. Cancer Biology 2018;8(4):71-77]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 9. doi:10.7537/marscbj080418.09.

Key Words: Metastatic pancreatic cancer, chemotherapy, FOLFIRINOX, modified FOLFIRINOX

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Sox2 and Cancer Biology Research Literatures

Mark Herbert, PhD

39-06 Main Street, Flushing, Queens, New York 11354, USA, ma8080@gmail.com

Abstract: Cancer is the general name for a group of more than 100 diseases. Although there are many kinds of cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause serious illness and death. The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person’s life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries. This article introduces recent research reports as references in the related studies.

[Herbert M. Sox2 and Cancer Biology Research Literatures. Cancer Biology 2018;8(4):78-133]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 10. doi:10.7537/marscbj080418.10.

Key words: cancer; Sox2; life; research; literature; cell

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Intensity Modulated Radiotherapy with Simultaneous Integrated Boost (IMRT-SIB) in treatment of Nasopharyngeal Carcinoma. Dosimetric Advantage over 3-Dimentional Conformal Radiotherapy (3D-CRT). Clinical impact on Survival, Toxicity and Quality of life

Radwa Awad¹, Omnia Abd Elkhalek¹, Samar Yonis¹, Gamal Attia² and Laila Korashi¹

¹Clinical Oncology Department, Faculty of Medicine, Tanta University, Egypt

²Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt

radwa.awad@med.tanta.edu.eg, rodi_11_21@hotmail.com

Abstract: Aim: To compare intensity modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) with 3-dimentional conformal radiotherapy (3D-CRT) dosimetrically as well as to evaluate treatment outcome, acute & late toxicities and quality of life in patients with nasopharyngeal carcinoma (NPC) treated by IMRT-SIB. Patients & methods: A total of 30 patients of histologically proof of stage II, III, IVb NPC were included in this study, IMRT-SIB plans as well as 3D-CRT plans were generated for every patient, compared dosimetrically with each other. All patients treated with concurrent chemo radiotherapy using IMRT-SIB. Acute and late toxicities were graded using RTOG/EORTC. Chemotherapy related toxicity was scored using CTCAE, 2017. Tumor response was evaluated according to WHO criteria. Quality of life assessed by QLQ-H & N35 module. Kaplan, Meier method estimated OS, LRPF and DMPF at 2 years. Results: IMRT-SIB was superior in PTV coverage with more sparing of spinal cord, brain stem and parotid glands compared to 3D-CRT. Acute grade 3 xerostomia, laryngitis, dysphagia, pain and mucositis recorded in 30%, 20%, 16.7%,16.7% and 13.3% respectively. At the 9^th month follow up, only one patient suffered from grade 3 xersotomia and another one had grade 3 dysphagia. Deterioration in most QOL scales was observed during RT with recovery at 12 month even below that at baseline except in sticky saliva and dry mouth. The 2-year locoregional progression free rate, metastasis progression free rate and overall survival were 89.3 %, 92.86% and 86.7% respectively. Univariate analysis with respect to PFS and OS showed that N-stage (N1 is better than N2-3, P = 0.001) and AJCC-stage (II is better than III than IV, P = 0.001) were significantly associated with OS. PFS was significantly influenced by AJCC-stage (P < 0.001). However, multivariate analysis showed that AJCC-stage was the only independent prognostic factor for both PFS and OS. Conclusion: IMRT-SIB is significantly better than 3D-CRT in terms of PTVs coverage as well as spinal cord, brain stem and parotid glands sparing with reduction of the incidence and severity of toxicity mainly that of xerostomia in nasopharyngeal carcinoma patients with maintenance of tumor control and survival benefits. These benefits persiste on longitudinal follow-up with patients showing significant recovery of QOL over time, SO, strongly supporting the widespread adoption of IMRT-SIB in head and neck radiotherapy practice.

[Radwa Awad, Omnia Abd Elkhalek, Samar Yonis, Gamal Attia and Laila Korashi. Intensity Modulated Radiotherapy with Simultaneous Integrated Boost (IMRT-SIB) in treatment of Nasopharyngeal Carcinoma. Dosimetric Advantage over 3-Dimentional Conformal Radiotherapy (3D-CRT). Clinical impact on Survival, Toxicity and Quality of life. Cancer Biology 2018;8(4):134-145]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 11. doi:10.7537/marscbj080418.11.

Keywords:IMRT, 3D-Conformal radiotherapy, Nasopharyngeal carcinoma

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Definitive Radiotherapy Concurrent with Carboplatin in the Treatment of Locally Advanced Head and Neck Cancers in Patients Ineligible for Cisplatin

Alaa Maria and Amro Ghannam

Clinical Oncology Department, Faculty of Medicine, Tanta University, Egypt.

alaamaria1@hotmail.com

Abstract: Purpose: The objective of this work is to analyze the clinical outcomes and practicability of concurrent carboplatin plus radiation therapy (RT) in patients diagnosed as locally progressive squamous cell carcinoma of the head and neck (LA-SCCHN) that are ineligible for cisplatin treatment. Patients and methods: Thirty-one patients with histologically confirmed LA-SCCHN were eligible. All patients received carboplatin concurrent with conventionally fractionated RT. Results: The median age of our patients was 65 (range: 40–75) years with malepredominance. Laryngeal cancer constitutes 51.6% with 61.3% had ECOG-PS 2 and 71% had stage IV disease. Carboplatin administered tri-weekly in 22 (71%) patients. The main causes for choosing carboplatin were advanced age and performance status (PS) of 2 (61.3%). Twenty-five (80.6%) patients received the pre-specified dose of carboplatin. Twenty-seven (87.1%) patients received RT to 70 Gya total dose. The median duration of RT was 54 days (range, 47–65). Complete response was observed in 32.3% of patients. The commonest grade 3/4 toxicities were oral mucositis and vomiting (22.6%), nausea (19.4%), dysphagia (12.9%), and anemia (19.4%). At the end of the study, 21 (67.7%) patients were alive with a median duration of follow-up to 25 (range, 9-44) months. The median overall survival (OS) and progression-free survival (PFS) were not reached with 2-year OS & PFS rates were 74.7% and 54.8% respectively. Conclusion: Concurrent radiation therapy plus carboplatin is feasible and is a treatment option for LA-SCCHN patients who are ineligible for cisplatin treatment.

[Alaa Maria and Amro Ghannam. Definitive Radiotherapy Concurrent with Carboplatin in the Treatment of Locally Advanced Head and Neck Cancers in Patients Ineligible for Cisplatin. Cancer Biology 2018;8(4):146-151]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 12. doi:10.7537/marscbj080418.12.

Key Words: Locally advanced, head and neck cancer, squamous cell carcinoma, carboplatin

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Comparison of Clinicopathological Characteristics and Survival Outcome between Right and Left Sided Colon Cancer Patients

Amr Ghannam and Rasha Abd El-Ghany Khedr

Clinical Oncology Department, Faculty of Medicine, Tanta University, Egypt

Amro_ghannam@yahoo.com

Abstract: Aim: The purpose of our study was the evaluation of the difference in clinicopathological characteristics and survival between primary stage I-III right-sided colon (RCC) and left-sided colon (LCC) cancer. Patients and methods: A retrospective analysis of 375 Egyptian patients with pathological stage I-III colon cancer who underwent curative colectomy from January 2012 and December 2016 was performed. Our objective was to explore if there was any difference in clinicopathological characteristics and survival outcome of colon cancer based on tumor side. Results: A total of 375 patients were analyzed with 160 (42.7%) had RCC and 215 (75.3%) had LCC. RCC had higher grade with poor differentiation (p=0.01) while signet ring type was more common in left side (p=0.08). the Mucinous adenocarcinoma (MAC) were more common in RCC than LCC. The mean number of lymph node ratio for RCC was higher than that for LCC (0.15±0.27 vs. 0.10±0.24; p=0.02). The median survival was not reached. The mean overall survival (OS) for the RCC and LCC patient groups was 54.5 and 59.5months, respectively (p=0.02). The mean disease free survival (DFS) was 46.2and 54.9months, for the RCC and LCC respectively (p=0.03). Multivariate analysis revealed that tumor location, tumor stage and the lymph node ratio (LNR) are independent prognostic factors. Conclusion: Tumor located at right side, higher stage and higher positive LNR were significantly associated with worse survival.

[Amr Ghannam and Rasha Abd El-Ghany Khedr. Comparison of Clinicopathological Characteristics and Survival Outcome between Right and Left Sided Colon Cancer Patients. Cancer Biology 2018;8(4):152-158]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 13. doi:10.7537/marscbj080418.13.

Key Words: colon cancer; tumor location, prognosis.

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Prognostic impact of immunohistochemical expression of PD-1 and PD-L1 on outcomes in classic Hodgkin lymphoma patients

Omnia Abd Elfattah¹, Tamer A. Elbedewy², Heba F. Harras³, Ayman Elsaka³ and Mohamed Elrashidy³

Departments of Clinical Oncology¹, Internal Medicine² and Pathology³, Tanta University, Tanta, Egypt

omniaabdelfattah@yahoo.com

Abstract: Objective: Hodgkin lymphoma (HL) constitutes for about 11% of all lymphoma and 0.5% of all cancers worldwide. Conventional treatment of newly recognized HL involves a combination of multi-agent therapy, tailored to the stage of disease and the hazard of relapse; this treatment help about 80% of patients to be recovered. Unfortunately, approximately 20% of HL patients developed relapse or still refractory, thus one effective treatment choice are restricted. So, substitutional   treatment, such as immune checkpoint blockade drugs (anti-PD-1 and anti-PD-L1) may be needed. Our aim is to investigate the immunohistochemical (IHC) expression of PD-1and PD-L1 in the classic HL (cHL) microenvironment along with their correlation with clinicopathological characteristics and focus on their prognostic impact on survival. Patients and Methods: Sixty nine histologically confirmed newly diagnosed adult patients with cHL were enrolled in this study. Histological examination of tissue biopsy was reviewed followed by IHC staining of tissue biopsy specimens using rabbit monoclonal antibody Anti- PD1 antibody and rabbit monoclonal antibody Anti- PD-L1 antibody. Results: Out of 69 patients, 18.8% had high PD-1 ≥10% and 40.6 % had high PD-L1 ≥5. The patients with tumors with high proportions of PD-1 and PD-L1 had shorter PFS and shorter OS compared with patients with low proportions of PD-1 and PD-L1.  Conclusion: PD1 and PDL1 have a prognostic value in cHL and this provides opportunities for novel targeted therapies, targeting these agents in earlier lines of therapy may improve the overall outcome of patients with cHL.

[Omnia Abd Elfattah, Tamer A. Elbedewy, Heba F. Harras, Ayman Elsaka and Mohamed Elrashid. Prognostic impact of immunohistochemical expression of PD-1 and PD-L1 on outcomes in classic Hodgkin lymphoma patients. Cancer Biology 2018;8(4):159-166]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 14. doi:10.7537/marscbj080418.14.

Keywords: Prognostic impact; immunohistochemical expression; PD-1; PD-L1; outcome; classic Hodgkin; lymphoma patient

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