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The prognostic value of Serum CD163, TARC, and 𝛽2 Microglobulin as response biomarkers in Hodgkin's lymphoma

Hossam Darwish¹, Mohamed A. Alm El-Din², Lamiaa A. Barakat³, Rania M. Bondok³ and Sheren Waly⁴

¹Department of Medical Oncology, Ismailia Teaching Hospital, Ismailia, Egypt

²Department of Clinical Oncology, Tanta Faculty of Medicine, Tanta, Egypt

³Department of Biochemistry Faculty of Science, Portsaid University, Egypt

⁴Department of Biochemistry Faculty of Science, Damietta University, Egypt

almeldin@gmail.com

Abstract: Background: Precise diagnosis and prediction of the prognosis is crucial for determining the optimal treatment strategy for Hodgkin's lymphoma (HL). This study aimed to investigate the prognostic utility of serum TARC, CD163 and Serum 𝛽�2MG in HL. Methods: a multicenter prospective observational study was conducted on 84 patients with HL. Serum TARC and CD163 were quantified using ELISA techniques, while 𝛽2MG was assessed using radioimmunoassay. Results: Among the included patients, 32 were with advanced stages and 23 were treated with ABVD only. There were significant differences between either early and advanced stages or partial and complete disease response regarding the baseline of these three biomarkers (P<0.05). The ROC analysis showed that TARC, CD163, and 𝛽2MG had high diagnostic values in highlighting the advanced stages (AUC=0.84; P<0.001, AUC=0.79; P<0.001, and AUC=0.78; P<0.001, respectively). TARC showed the highest specificity, while 𝛽2MG showed the highest sensitivity. The Kaplan-Meier analysis showed that 𝛽2MG, CD163, and TARC were associated with good prognostic function and disease response prediction. Conclusion: Serum TARC and CD163 are good prognostic biomarkers for follow up of HL. Serial TARC, CD163, or 𝛽2MG measurements accurately reflected disease activity and response. Furthermore, the levels of TARC, CD163, and 𝛽2MG were reported to be highly associated with the disease severity.

[Hossam Darwish, Mohamed A. Alm El-Din, Lamiaa A. Barakat, Rania M. Bondok and Sheren Waly. The prognostic value of Serum CD163, TARC, and 𝛽2Microglobulin as response biomarkers in Hodgkin's lymphoma. Cancer Biology 2019;9(2):1-8]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 1. doi:10.7537/marscbj090219.01.

Keywords: TARC, CD163, 𝛽2MG, Hodgkin's lymphoma

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Assessment of Sentinel Lymph Nodes in Early Breast Carcinoma

Alaa Abbass Sabry, Medhat Mohamed Helmy, Karim Fahmy Abd-Elmoaty and Ahmed Farag Nasr

General Surgery Department, Faculty of Science, Ain Shams University, Cairo, Egypt

email:doctorahmednasr@gmail.com

Abstract: Background and Aims: Sentinel lymph node biopsy is the best method for assessment of axillary involvement in early stages of breast cancer. It helps in determining nodal status and staging of the disease as the sentinel lymph node is the first site to receive metastases from primary site of tumor. The main function of SLNB is to anatomically classify patients to determine the treatment algorithm and prognosis. The previous studies established this method of biopsy as the effective way to give standard care of axillary condition in patients with early breast cancer and clinically negative ALNs. Accuracy of axillary staging is very important to compare the treatment results among the studies. Using methylene blue as a one of many dyes used in this biopsy to find the sentinel lymph node. Methylene blue dye (MBD) is the one of the least risk of anaphylaxis, the cheapest and widely available. Aim of the Work: We assessed the role of sentinel lymph node detection in early breast carcinoma management, assessed methylene blue dye in sentinel lymph node biopsy and its complications and detected axillary level of SLN. Methods: This was a prospective study, included 50 female Egyptian patients with early breast carcinoma (T1, T2) stage and clinically negative axilla by palpation (N0) or high grade ductal carcinoma in situ. Results: The rate of SLN detection was 84%, sensitivity of methylene blue dye was 93.31%, specificity was 93.1%. Complications of methyline blue dye were observed in 10 patients (20%). More than one lymph node was sometimes found in SLNB specimen. Level of axillary LN (where SLN was detected in 42 cases) was 33 cases at level I, 8 cases at level II and one case had SLN at level III and also another SLN at level II. Surgical procedures for axilla were 22 cases underwent ALND and 28 cases underwent only SLNB with P- value = 0.00001. Complications of the surgery were observed in 15 patients (30%). Conclusion: In most of early stage breast cancer patients, SLNB is used instead of ALND and has the same disease free survival rate and much improve in quality of life as it results in a significant reduction of postoperative morbidities. Skip metastases rarely detected in early stage breast cancer patient. The learning curve was clearly observed and the rate of SLN detection increased with experience.

[Alaa Abbass Sabry, Medhat Mohamed Helmy, Karim Fahmy Abd-Elmoaty and Ahmed Farag Nasr. Assessment of Sentinel Lymph Nodes in Early Breast Carcinoma. Cancer Biology 2019;9(2):9-13]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 2. doi:10.7537/marscbj090219.02.

Keywords: Methylene blue dye (MBD), sentinel lymph node (SLN), sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND).

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FDG PET/CT versus contrast enhanced CT in the management and post therapeutic follow up of lymphoma

Prof. Dr. Rawhia Taha Hasan¹, Prof. Dr. Osama Zein Eldin Mohamed², Prof. Dr. Hoda Mahmoud Abd Elwahab¹ and Sara Abd Elghaffar Rabii Hassan¹

¹Radiodiagnosis Department, Faculty of Medicine, Al-Azhar University ( for Girls), Cairo, Egypt

²Radiodiagnosis Department, Military Medical Academy, Cairo, Egypt

saraabdelghaffar_rabee3@yahoo.com

Abstract: Lymphoma comprises a histologically heterogeneous group of cancers derived from the cells of the immune system. The hallmark of the disease is the enlargement and proliferation of lymph nodes or secondary lymphoid tissues.

While CT and MR imaging rely on anatomic changes for diagnosis, staging and follow-up of lymphoma, PET-CT provides anatomic and metabolic information and has several advantages over other techniques. PET-CT has faster attenuation correction and lower location mis­matches compared with the PET system alone.

In our study PET-CT provided its greatest benefit in the staging and restaging of lymphoma. PET-CT findings led to upstaging of 8 patients (27.6%) from stage I to stage II.

The sensitivity of CECT for detection of sites of involvement decreases as the number of sites of involvement increases in every case. PET-CT was much more sensitive than CECT in detecting extranodal site of involvement.

At mid treatment assessment the number of patients with discordant findings between PET-CT and CECT was only 2 cases while the number of patients with discordant findings at the Post-treatment assessment was 1 case.

Our study concluded that PET-CT may be better than contrast enhanced CT for routine baseline investigation of Stage I & II of Lymphoma. Also in our study there was no significant discordance between interim PET-CT and contrast-enhanced CT results therefore, either PET-CT or contrast-enhanced CT may be used for response assessment and predicting outcome in early stages of Lymphoma.

[Rawhia Taha Hasan, Osama Zein Eldin Mohamed, Hoda Mahmoud Abd Elwahab and Sara Abd Elghaffar Rabii Hassan. FDG PET/CT versus contrast enhanced CT in the management and post therapeutic follow up of lymphoma. Cancer Biology 2019;9(2):14-23]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 3. doi:10.7537/marscbj090219.03.

Keywords: FDG PET/CT versus, enhanced CT, therapeutic, lymphoma.

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Prognostic Impact of pathological subtypes in children with Classic Hodgkin Lymphoma: A comprehensive analysis

Emad Moussa¹, Nesreen Ali ², Eman Attia ², Iman Khorshed ³, Engy Mohamed⁴

¹ Clinical Oncology, Menofya University, Egypt, Children Cancer Hospital, Egypt.

² Pediatric Oncology and Hematology Department, National Cancer Institute, Cairo University, Egypt, Children Cancer Hospital, Egypt.

³ Pathology Department– National Cancer Institute -Cairo University, Children Cancer Hospital, Egypt.

⁴Clinical Research Department - Children Cancer Hospital, Egypt.

nesreenalinci@hotmail.com

Abstract: Introduction: Hodgkin lymphoma (HL) is a highly curable malignancy. Different pathological subtypes of classic Hodgkin lymphoma (CHL) are all treated with the same multimodality treatment, although they all do not have the same outcome. Our aim in this retrospective study was to highlight the presentation and prognosis of lymphocyte-depleted subtype and to compare it with the rest of subtypes in childhood CHL. Patients and methods: The data of 1197 children with biopsy-proven Hodgkin's lymphoma diagnosed from 2007 till 2017 at children cancer hospital Egypt were revised retrospectively. The outcome of different pathological subtypes are compared with other subtypes. Results: From a total of 1197 children with HL, ten patients (0.835%) were diagnosed as Lymphocyte Depleted Classic Hodgkin´s Lymphoma (LDCHL). All patients with LDCHL were diagnosed as high risk or advanced stages (3B, 4A, or 4B). Patients presented more often with advanced (high risk) disease as compared to other subtypes (100% versus 29.7%, respectively) and B symptoms (70% versus 32.3%, respectively). Risk factors as large mediastinal mass (50% versus 19%, respectively), high ESR (5 Out of 6 had elevated ESR), and involvement of more than three lymph nodes (80%). LDCHL cases showed an involvement of bone marrow in 22% of cases. The 5 years overall (OS) and Event-free survival (EFS) for LDCHL is the worst as compared to other pathologic subtypes CHL, 68.57% and 48% respectively. Conclusion: Children with LDCHL had a much aggressive presentation, responds inadequately to standard therapy, as well as having the worst outcome of all pathological subtypes CHL. Our results denote that children with LDCHL should receive more intensive chemotherapy.

[Emad Moussa, Nesreen Ali, Eman Attia, Iman Khorshed, Engy Mohame. Prognostic Impact of pathological subtypes in children with Classic Hodgkin Lymphoma: A comprehensive analysis. Cancer Biology 2019;9(2):24-29]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 4. doi:10.7537/marscbj090219.04.

Keywords: Hodgkin lymphoma, Lymphocytic depletion, Pathological subtypes, Children

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Detection of Cell-Free DNA In the Blood of Breast Cancer Patients in an Egyptian Hospital by Real Time PCR

Kareman Ahmed Eshra¹, Radwa Mahmoud El-Sharaby², Fatma Gharib Khirallah³, Rowida Raafat Ibrahim⁴

¹Department of Microbiology and Immunology, Faculty of Medicine, Tanta University, Egypt,

²Department of Clinical Pathology, Faculty of Medicine, Tanta University, Egypt,

³Department of Clinical Oncology, Faculty of Medicine, Tanta University, Egypt,

⁴Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Tanta University, Egypt.

Drkaremaneshra2004@hotmail.com

Abstract: Introduction: In females the most common cancer is Breast cancer with high mortality rate so there is a strong need for early noninvasive method for diagnosis, apoptotic tumor cells may release circulating cell free DNA (CCFDNA) into the peripheral blood and detection of this released CCFDNA in blood of cancer patients may be useful in early cancer diagnosis. Subjects and Methods: The present study included 80 female patients and 20 healthy controls from Clinical Oncology Department, Faculty of Medicine, and Tanta University and for all subjects CCFDNA was measured by Real Time PCR. Results: Our study showed that CCFDNA increased with breast cancer patients when compared to patients with benign breast lesions and control groups and these differences were statistically significant, and detection of CCFDNA in breast cancer patient’s blood has the highest sensitivity and specificity when compared to CEA and CA 15.3. Conclusion: The blood levels of CFDNA were significantly increased in patients with breast cancer compared with those of patients with benign breast lesions and healthy controls. Furthermore CFDNA levels were observed to increase as breast cancer progressed to later disease stages thus the quantitative detection of CFDNA may possess value for early detection of breast cancer.

[Kareman Ahmed Eshra, Radwa Mahmoud El-Sharaby, Fatma Gharib Khirallah, Rowida Raafat Ibrahim. Detection of Cell-Free DNA In the Blood of Breast Cancer Patients in an Egyptian Hospital by Real Time PCR. Cancer Biology 2019;9(2):30-34]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 5. doi:10.7537/marscbj090219.05.

Keywords: CCFDNA, breast cancer, Real Time PCR, Tumor marker; Detection; Cell-Free; DNA; Blood; Breast; Cancer; Patient; Egyptian; Hospital

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Continuous Transversus Abdominis Plane block versus caudal epidural analgesia in paediatric patients undergoing abdominal surgeries for Wilms’ tumours

Ayman A. Ghoneim, MD.¹; Ahmed Elaffandi, MD. ²; Samah Mohamed, MD, Frcr³ and Kareem Sallam, Mrcs⁴

¹ Department of Anesthesia & Pain Management, National Cancer Institute, Cairo University, Egypt.

²Surgical Oncology. National Cancer Institute. Cairo University, Egypt.

³Diagnostic Radiology, National Cancer Institute, Cairo University, Egypt.

⁴Surgical Department, Helwan University, Egypt.

ahmedaffandy@gmail.com

Abstract: Background: Caudal epidural analgesia is the most common postoperative analgesia used in paediatrics undergoing abdominal surgeries being simple and safe. However, the analgesia provided by this technique lasts only for the duration of action of the local anaesthetics. The aim of this study was to compare between continuous transversus abdominis plane block and single dose caudal epidural analgesia regarding duration of analgesia, total morphine consumption, and postoperative pain in paediatric patients undergoing nephrectomy for renal nephroblastoma tumours. Methods: Sixty paediatric patients with renal nephroblastoma and scheduled for surgical excision were enrolled in this study. Patients were randomly allocated into either C- group in which caudal block was done at the end of surgery or T- group in which epidural catheter was inserted into the dissected plane between transversus abdominis and internal oblique muscles to receive continuous TAP block on the side of surgical incision. (30 patients each). The primary endpoint was Duration of analgesia from time of discontinuation of anaesthesia till 1st intravenous morphine dose. The secondary endpoints included the total morphine consumption, the intensity of pain throughout the study period (48 hours after operation); the sedation and the duration of motor block which was assessed by observing the time the patients began to move their legs from discontinuation of anaesthesia. During the study, intravenous morphine 50 µg/kg was administered when FLACC score > 3. Results: the first narcotic period needed was significantly longer (P< 0.05) in T group (13 h) than in C group (4 h). The mean morphine consumption within 24 hrs after surgical operations was higher significantly in control (2.76 ± 1.2) than that in T group (1.32 ± 1.1) (P< 0.05). Meanwhile, the mean morphine consumption lowered significantly in the second postoperative day in both groups than that in the first day postoperative. However, In the same day, a non-significant difference not detected between the two groups (0.75 ± 0.32 in C group versus 0.64 ± 0.12 in T group). In group (T) The average pain scores were steadily lesser, but merely with statistically significant difference from 12 hours till 36 hours postoperatively. Conclusion: the continuous transversus abdominis plane block as a part of multimodal analgesia has a possible role in improving the analgesic action and decreasing the required dosage of narcotics during the first 24 h post-surigical operation more than the single dose caudal analgesia in paediatric patients undergoing abdominal surgeries.

[Ayman A. Ghoneim; Ahmed Elaffandi; Samah Mohamed and Kareem Sallam. Continuous Transversus Abdominis Plane block versus caudal epidural analgesia in paediatric patients undergoing abdominal surgeries for Wilms’ tumours. Cancer Biology 2019;9(2):35-40]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 6. doi:10.7537/marscbj090219.06.

Key words: TAP block, Continuous TAP block, Caudal block

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Clinicopathological Characteristics of Triple Negative breast cancer in Suez Canal University Hospital

Maha Lotfy Zamzam¹ and Heba Mohamed Wagih²

¹Clinical Oncology & Nuclear Medicine Department, Faculty of Medicine, Suez Canal University, Egypt.

²Pathology Department, Faculty of Medicine, Suez Canal University, Egypt.

mahalZamzam@hotmail.com

Abstract: Introduction: Worldwide, breast cancer is the most common malignant tumor in females. It represents 25% of all types of cancers. Triple – negative breast cancer (TNBC) represents 15% of all breast cancers TNBC occurs in younger age, of high grade and shows a more aggressive course. In this study, we identified the frequency, clinical and pathological characteristics of TNBC in patients attending Clinical Oncology Department at Suez canal university hospital. Methods: A retrospective study was done between 2013 and 2016 at Clinical Oncology Department Suez Canal University hospital. Among 688 cancer breast patients, 144 women had a TNBC. Clinical and pathological features were analyzed. Results: 20.9% of patients had TNBC. The age range was 26-67 years. Mean age was 46 years.59% were post menopausal. Only 8.3% of patients had a family history of breast cancer. Majority of cases were represented grade 2, T2, positive lymph nodes and stage 2. 83.3% of patients had modified radical mastectomy, 91% received adjuvant chemotherapy. 9% of patients have received neoadjuvant chemotherapy and 72.2% have received radiation therapy. Conclusion: TNBC group is associated with high grade, large tumor size, high stage and node positivity. Most of TNBC characteristics in our department is consistent with literature data. More research should be directed to understand the complexity of this type of breast cancer.

[Maha Lotfy Zamzam and Heba Mohamed Wagi. Clinicopathological Characteristics of Triple Negative breast cancer in Suez Canal University Hospital. Cancer Biology 2019;9(2):41-47]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 7. doi:10.7537/marscbj090219.07.

Key words: Breast cancer, Triple negative, clinical characteristics, Suez Canal University hospital.

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Impact of neutrophil/lymphocyte and platelet/lymphocyte ratios on patient survival in pancreatic cancer

Mohamed Abu-Nuwar¹, Walid Elmoghazy^1,2, Mohammed Said Ghali^1,3, Alshimaa Alaboudy⁴, Khalid Ahmed¹, Ahmed Elaffandi^1,5, Hatem Khalaf¹

¹ Department of Surgery, Hamad Medical Corporation, Doha, Qatar

²Department of Surgery, Sohag University, Sohag, Egypt

³ Department of General Surgery, Ain Shams University, Cairo, Egypt

⁴ Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Sohag, Egypt

⁵ Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt

ahmedaffandy@gmail.com

Abstract: Background: The value of various systemic inflammatory biomarkers has been studied across multiple cancers. These include albumin, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR). We aimed to study multiple clinical characteristics and diagnostic tools and their correlation with overall survival time in a multiethnic community, with the goal to identify prognostic factors in patients with pancreatic cancer. Methods: Our study is a retrospective analysis of all patients diagnosed with histologically-proven pancreatic adenocarcinoma from 2004 to 2016 with at least 6 months of follow-up. Patients with AJCC stage I-II were labelled as early pancreatic cancer; those with Stage III-IV were grouped as advanced pancreatic cancer. The NLR was defined as the absolute neutrophil count in peripheral blood divided by the absolute lymphocyte count and PLR was defined as the platelet count divided by the absolute lymphocyte. Both ratios were calculated at time of diagnosis. Results: A total of 112 patients who had pancreatic duct adenocarcinoma were identified, 81 patients (72.3%) were males and 31 (27.7%) were females. The mean age at diagnosis was 55.6 ± 10.8 years. Out of the 112 patients, 34 (30.4%) were diagnoses as early pancreatic cancer and ultimately underwent surgery. The remaining 78 patients (69.6%) had advanced pancreatic disease. Mean follow up in patients with early pancreatic cancer was 2.2 ± 2.1 years; in the advanced cancer group, it was 1.3 ± 1.0 years. Undergoing an R0 resection was significantly related to improvement of overall survival in early stages while serum albumin and CA-19-9 were potential predictors of survival in advanced pancreatic cancer. Conclusion: We found a strong correlation between low levels of CA19-9, low CEA, high albumin and an R0 surgical resection with an improved overall patient and disease-free survivals in patients with pancreatic adenocarcinoma. NLR and PLR showed no relation to patient or disease-free survivals.

[Mohamed Abu-Nuwar, Walid Elmoghazy, Mohammed Said Ghali,, Alshimaa Alaboudy, Khalid Ahmed, Ahmed Elaffandi,, Hatem Khalaf. Impact of neutrophil/lymphocyte and platelet/lymphocyte ratios on patient survival in pancreatic cancer. Cancer Biology 2019;9(2):48-53]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 8. doi:10.7537/marscbj090219.08.

Keywords: Impact; neutrophil/lymphocyte; platelet/lymphocyte ratio; patient; survival; pancreatic cancer

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Role of Minimal Invasive Techniques in Detection of Cancer Stem Cells Related Genes (CSCs) in Breast Masses

Nagham N Omar¹, Mohammed Zidan¹, Heba M Saad Eldien², Maha Salah Elnaggar³, Hayam Yahia Hamed¹.

¹ Radiology department, Faculty of Medicine, Assiut University, Egypt.

² Histology and Cell Biology department, Faculty of Medicine, Assiut University, Egypt

³Clinical Oncology department, Faculty of Medicine, Assiut University, Egypt.

naghamnomar@gmail.com

Abstract: Aims: To study the role of minimal invasive techniques in the diagnosis of breast masses and detection of breast cancer stem cells (CSCs) related genes in correlation with different interventional breast sampling. Materials & Methods: This prospective study includes one hundred (100) cases of breast lumps in female patients of different age groups. The detailed history of the patient i.e. age, sex, site and other findings were recorded. In these cases fine needle aspiration biopsy (FNAB) and true cut needle biopsy (TCNB) were obtained for which histopathology and hormonal receptors study were done associated with real time PCR study for suitable samples to detect the breast CSCs (Periostin and AGBL2). Results: True cut needle biopsy (TCNB) gave correct histopathological diagnosis in 100% in addition to hormonal receptor detection with adequate number of cores; it also could identify breast cancer stem cells related genes. On the other side fine needle aspiration cytology (FNAC), however it gave the correct diagnosis in 76.9%, it has no role neither in hormonal receptor study nor in identification of cancer stem cells related genes (AGBL and PERIOSTIN). Regarding breast CSCs, we found Significant up regulation of Periostin was observed in 23.3% of cases. However Significant up regulation of AGBL was observed in 10% only of cases. We found a positive correlation between CD44+ CD24- expression and Periostin up regulation. Conclusion: In accordance with recent publications, we conclude that CNB is far superior to FNAC in the diagnostic approach of breast cancer as regard histopathology, hormonal receptor study and identification of cancer stem cells related genes. Results indicate that the aberrant gene expression of periostin in breast cancer tissue may induce significant biological effects. The present study found that AGBL2 was highly expressed in CSC and could be a potential biomarker for the lymph node metastasis and chemotherapy resistance of breast cancer tumors. The underlying genetic mechanism of periostin and AGBL2 in regulating the breast cancer CSC is still unclear and needs further investigation.

[Nagham N Omar, Mohammed Zidan, Heba M Saad Eldien, Maha Salah Elnaggar, Hayam Yahia Hamed. Role of Minimal Invasive Techniques in Detection of Cancer Stem Cells Related Genes (CSCs) in Breast Masses. Cancer Biology 2019;9(2):54-63]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 10. doi:10.7537/marscbj090219.10.

Keywords: Role; Minimal; Invasive; Technique; Detection; Cancer Stem Cells Related Genes (CSCs); Breast

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Dosimetric comparison between VMAT and 7 fields IMRT in preoperative hypofractionated radiotherapy for rectal cancer

Ehab Saad^1,2, Khaled Elshahat^2,3, Hussein Metwally^2,4

¹ Department of Clinical Oncology, and nuclear medicine, Cairo University, Egypt

² Department of Radiation Oncology, Dar Al Fouad Hospital, Egypt

³ Department of Clinical Oncology, Azhar University, Egypt

⁴Department of Clinical Oncology, Fayoum University, Egypt

hussein.metwally@hotmail.com

Abstract: Introduction: The hypo-fractionated short course radiotherapy has been considered as preoperative treatment in patients with locally advanced rectal cancer (LARC). The aim of this study is to compare the dosimetric differences between volumetric modulated arc therapy (VMAT), 7 fields intensity modulated radiotherapy (IMRT), regarding the target coverage and preservation of organs at risk (OARs) in patients with locally advanced rectal cancer planned for neoadjuvant short course radiotherapy. Methods: Thirty LARC patients were retrospectively evaluated in this study. For each patient dual Arc VMAT and 7 fields IMRT plans were generated. In all patients, the target consisted of clinical target volume (CTV) including pelvic LNs and the whole rectum with the mesorectum. Planning target volume (PTV) was created from the CTV with a margin of 5mm in all directions. The dose prescription was 25 Gy in 5 fractions in 5 successive days. OARs were delineated: bladder, small bowel, bilateral femoral heads and pelvic bone marrow (PBM). Conformity index (CI) and homogeneity index (HI) for both plans were compared. The dose-volume histogram (DVH) of PTV and OARs for both techniques was compared. Results: No significant difference between RA and IMRT plans in PTV25Gy coverage. (p = 0.72764). Both CI and HI are better with VMAT than IMRT. The maximum and minimum bladder doses are less with VMAT compared to IMRT. The mean dose to femurs, bowel and pelvic bone marrow were significantly less with VMAT. Conclusion: In preoperative hypofractionated radiotherapy of LARC, VMAT technique can offer better conformity and homogeneity than IMRT with better OARs preservation. Further randomized clinical trials are needed to translate this dosimetric data into significant clinical benefit.

 [Ehab Saad, Khaled Elshahat,, Hussein Metwally. Dosimetric comparison between VMAT and 7 fields IMRT in preoperative hypofractionated radiotherapy for rectal cancer. Cancer Biology 2019;9(2):64-70]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 10. doi:10.7537/marscbj090219.10.

Key words: Rectal cancer, Preoperative radiotherapy, VMAT, IMRT

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Evaluation Physical Characteristics of Electron Beam at Extended Distances for Total Skin Electron Irradiation Technique

Aida Salama¹, Khaled M. El Shahat², Ehab M. Attalla³, Ayat M. Saadeldin⁴, Hussein M. Metwally^5,6

¹Biophysics Branch, Faculty of Science, Al-Azhar University, Egypt

²Clinical Oncology Department, Faculty of Medicine, Al-Azhar University, Egypt

³Radiotherapy Department, National Cancer Institute, Cairo University, Egypt

⁴Radiation Oncology Department, El-Hussein University Hospital Egypt

⁵Clinical Oncology Department, Faculty of Medicine, Fayoum University, Egypt Cairo, Egypt

⁶Dar Al Fouad Hospital-Radiation Unit, Cairo, Egypt

hussein.metwally@hotmail.com

Abstract: Background Electron beam radiotherapy, still the first option for the treatment of superficial tumors. Characteristics of electron beams from a Varian Medical linear accelerator are presented at extended SSD and the change of output with SSD was estimated. Aim of the work: was to present a full description of total skin electron irradiation technique applied with special Holder (tray for TSI), the dosimetry steps, Patient-specific in-vivo QA and monitor time calculations. Materials and Methods: The defining Z_ref for electron 6 MeV at extended distances to define the physical parameters required for the application of Total Skin Electron Irradiation (TSEI) technique including an effective SSD (SSD_eff) and the mean dose/MU at extended distance. Results and Discussion: There is no significate difference between PDD for standard energy and High dose rate ( 10Gy/min ) and there no difference in value x- ray contination between two PPD curves one treated case was represented with before, during and after photo showing the positive response appears through the application of Stanford technique as a treatment course. Conclusion: The application of Total Skin Electron Irradiation Technique is applicable even without adding applicator to the gantry, however the complete dosimetry required for each treatment machine and mandatory for accurate application of the technique especially with narrow range of treatment.

[Aida Salama, Khaled M. El Shahat, Ehab M. Attalla, Ayat M. Saadeldin, Hussein M. Metwally. Evaluation Physical Characteristics of Electron Beam at Extended Distances for Total Skin Electron Irradiation Technique. Cancer Biology 2019;9(2):71-79]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 11. doi:10.7537/marscbj090219.11.

Keywords: total skin irradiation – electron beam therapy – treatment planning system

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Comparison between 3D Conformal Radiotherapy, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy Treatment Plans for Left Sided Breast Cancer Patients Using Deep Inspiration Breath Hold Technique

Moahmed Mahmoud, M.D^{1, 2}, Shaimaa Abdelgelil, M.D ^3, Mahmoud Shosha, Msc², Abdullah Megahed, Msc², Nabila Elsayed, Msc²

^1.Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt.

^2.Radiation Oncology Department, Shefaa Alorman Hospital, Luxor, Egypt.

^3.Epidemiology and Cancer biostatistics Department, National Cancer Institute (NCI), Cairo University, Egypt

m_mahmoud1973@hotmail.com

Abstract: Aim: Comparing between 3-Dimentional conformal radiotherapy (3DCRT), Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (VMAT) using Deep Inspiratory Breath Hold (DIBH) techniques regarding target volume coverage and dose to heart and left lung for patients with left sided breast cancer. Patients and Methods: C-T simulation was done for 25 patients with left sided breast cancer using DIBH through the use of Active breath coordinate device (ABC), 3 plans were done for every patients, one by 3DCRT, second by IMRT and the third using VMAT techniques, comparison between these techniques was done regarding target volume coverage and dose to left lung and heart. Results: The VMAT plans showed significantly higher mean dose coverage to the PTV than that of 3DCRT and IMRT plans (p< 0.001). The VMAT plans demonstrated significantly lower mean doses to OARs than that of 3DCRT and IMRT plans. The maximum heat dose was the least in VMAT plans (p<0.001). Whereas the median dose of the V25 of the heart was also less in the VMAT plans than that of 3DCRT and IMRT plans (p=0.015). Regarding the ipsilateral (left) lung, the median dose of V20 of left lung was the same of the 3 plans with no significant difference between them. Conclusion: The use of VMAT technique with DIBH technique showed better target volume coverage and significant reduction in the heart dose compared to 3DCTH and IMRT using DIBH.

[Moahmed Mahmoud, Shaimaa Abdelgelil, Mahmoud Shosha, Abdullah Megahed, Nabila Elsayed. Comparison between 3D Conformal Radiotherapy, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy Treatment Plans for Left Sided Breast Cancer Patients Using Deep Inspiration Breath Hold Technique. Cancer Biology 2019;9(2):80-84]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 12. doi:10.7537/marscbj090219.12.

Key words: 3DCRT, IMRT, VMAT, DIBH

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The Role of Diffusion MRI in differentiation between benign and malignant Bone Tumors

Ahmed Mostafa Mohamed, Samer Malak Botros, Ahmed Mohamed Osman, Haidy Alaa El-Hadidy

Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, Egypt

haidyalaa@hotmail.com

Abstract: Aim of the Work: Is to assess the ability of diffusion MRI in differentiation between benign & malignant bone tumors and to correlate diffusion patterns & Apparent diffusion coefficient (ADC) values of different lesions with their pathological nature. Patients and Methods: A prospective study was conducted on thirty patients with clinically suspected and radiologically proven bone tumor. The patients were referred to the MRI unit in Ain Shams University from the surgery and radiotherapy departments. These patients were selected on clinical bases indicating or suggesting presence of bony tumors as a primary diagnosis. The patients were investigated using 1.5 Tesla magnetic resonance device. They were subjected to conventional MRI and dynamic contrast enhancement (DCE) MRI. Results: The ADC values of solid malignant tumors (n= 11) ranged from 0.56 to 1.48 x 10-3 mm2/s, with mean ADC (1.04 x 10-3 mm2/s) were significantly lower than that of the benign bony tumors (n=19) which ranged from 1.36 to 2.6 x 10-3mm2/s, with mean ADC (1.96 x 10-3 mm2/s). Diffusion weighed imaging with ADC values measurement were able to discriminate between benign and malignant lesions with sensitivity of 90.9% specificity of 89.5% and diagnostic accuracy of 90%. The results according to ROC curve for the discrimination between benign and malignant lesions using the ADC value showed that the best cut-off criterion is ADC of 1.18 with overall sensitivity of 81.8% specificity of 84.2% and diagnostic accuracy of 83.3%. Conclusion: We proved high specificity and sensitivity of DWI as a complementary sequence with conventical MRI and ADC value measurements in discrimination between benign and malignant bone tumors with significant cut-off value, making it a noninvasive tool for increasing the accuracy in identifying bone lesions. Also, they can be used in the follow up of tumors and their response to therapy. However, further studies with larger patient groups are needed to find an optimal cut‑off ADC value for differentiation between begin and malignant bone tumors.

[Ahmed Mostafa Mohamed, Samer Malak Botros, Ahmed Mohamed Osman, Haidy Alaa El-Hadidy. The Role of Diffusion MRI in differentiation between benign and malignant Bone Tumors. Cancer Biology 2019;9(2):85-95]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 13. doi:10.7537/marscbj090219.13.

Keywords: Magnetic Resonance Imaging (MRI) - Bone tumors - Diffusion weighted imaging (DWI) - Apparent diffusion coefficient (ADC) – Dynamic study- Dynamic contrast enhancement (DCE).

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Immunohistochemical Expression of Epidermal Growth Factor Receptor And Androgen Receptor in Triple Negative Breast Carcinoma

Mosad Mohamed El-lithy¹, Ahlam Abo Elenain², Hassan Sheir², Asmaa E Bedeer²

¹Pathology Department, Tanta Cancer Center, Tanta, Egypt

²Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

mosadelity@gmail.com

Abstract: Background: Triple negative breast cancer (TNBC) is a heterogeneous group of breast cancer, this mandates thorough search for a variety of biological markers that might serve as possible predictors for the biological behavior of the tumors and targets for possible therapeutic agents. Materials & Methods: The present study included 60 cases of TNBC that were obtained as paraffin blocks from the department of Pathology, Tanta cancer center, in the period from December 2011 to December 2015. Cases were stained by hematoxylin and eosin staining to estimate their histological type, grade, DCIS component, necrosis and vascular invasion and also by EGFR and AR for immunohistochemical study. Data concerning with age, size and number of invaded LN were taken from archive of Tanta cancer center. Results: EGFR expression was associated with high tumor grade, nodal metastasis and large tumor sizes (P value 0.02, 0.01, 0.01 respectively). These findings prove the bad prognostic impact of EGFR in TNBC. AR expression was inversely correlated with necrosis, vascular invasion and tumor sizes (P value 0.004, 0.007, 0.05 respectively). These findings prove the good prognostic impact of AR in TNBC. Correlative study, to evaluate the expression of AR and EGFR immunostaining in different clinicopathological prognostic factors revealed a statistical significant inverse correlation between AR and EGFR expression regarding tumor size, vascular invasion, axillary L.N metastasis and necrosis (p value 0.02, 0.02, 0.05, 0.001 respectively). Conclusion: Our study proved that EGFR expression in TNBC was associated with bad prognostic impact while AR expression was associated with good prognostic impact and there is a statistical significant inverse correlation between AR and EGFR expression regarding tumor size, vascular invasion, axillary L.N metastasis and necrosis. Eventually, proper subtyping of TNBC using basal markers as well as AR receptor expression in different subtypes of TNBC will provide proper diagnosis and prognosis of cases with TNBC as well as a potential therapeutic target. However, large scale studies are needed to verify these results.

[Mosad Mohamed El-lithy, Ahlam Abo Elenain, Hassan Sheir, Asmaa E Bedee. Immunohistochemical Expression of Epidermal Growth Factor Receptor And Androgen Receptor in Triple Negative Breast Carcinoma. Cancer Biology 2019;9(2):96-105]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 14. doi:10.7537/marscbj090219.14.

Keywords: TNBC, Epidermal growth factor receptor (EGFR), Androgen Receptor (AR).

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Comparative study of radiation doses exposure to Organs at Risk between Multiple Field-In-Field and Intensity Modulated Radiation Therapy techniques in left breast cancer

Sahar E. Abo-Neima¹, Sabbah I. Hammoury ², Eslam G. Omar ¹, Hussein A. Motaweh ¹

^1. Department of physics, Faculty of Science, Damanhur University, Egypt

^2. Department of Medical physics, Alexandria Ayadi Almostakbl Oncology Center, Alexandria, Egypt.

sahar_amr2002@yahoo.com

Abstract: The Breast cancer is the most common cancer in females worldwide. It is considered as the second diagnosed type of cancer “after non-melanoma skin cancer” in women with about 23% of total new cancer cases. Also it represents about 14% of cancer death among women. Radiation therapy should not only be directed to improve the local control, which has a survival benefit, but also should be directed to minimize the risk of complications, which may develop in critical organs. Several studies have reported that multiple field-in-fields (MFIF) radiotherapy technique improves the dose homogeneity, decreases doses to lungs, heart and contralateral breast compared with conventional wedged technique. Purpose: to compare the dosimeter for the left breast cancer radiotherapy using two different radiotherapy techniques, Segmented field (MFIF) and inverse planning IMRT (IP-IMRT). Material and Methods: Twenty patients have undergone left breast-conservative surgery and received a prescribed dose of 50 Gy/25 fractions. Results: The mean PTV receiving 107% (V107) dose was 0.0275% for MFIF, and 2.7345% for IMRT; the difference is statistically significant through paired comparison between MFIF vs. IMRT. The mean V95% was 98.366% for MFIF, and 98.513% for IMRT; the difference is statistically not significant. Better homogeneity index for MFIF and IMRT, where mean of (HI) are 0.100979, 0.110807 in MFIF and IMRT respectively. The conformity index (CI) values in case of MFIF, and IMRT were 2.44, 2.11 respectively, the difference is statistically not significant (p= 0.268027). The conformity index should be equal to (one) when the ideal dose coverage or high conformity. The conformity index greater than one indicate that the irradiated volume exceeds the target to a part of the healthy tissue, but when the conformity index is less than one, it means that the target volume is partially radiated. Regarding to organs at risk, left lung and heart, they have higher Values of V5, V10, and V20 for IMRT compared to MFIF; the differences are statistically significant, for the left lung mean dose (D mean) was (8.0105±2.1375) for MFIF compared to (10.335±1.3792) for IMRT, the differences are statistically not significant. For contralateral lung and contralateral breast the V2, V3, V4, V5, Dmean and D max values are higher for IMRT than MFIF, the difference is statistically highly significant (P <0.00001). Conclusion: MFIF technique is an efficient and reliable method for achieving a uniform dose throughout the whole breast resulting in improved coverage, sparing of organs at risk and reduction of acute and late toxicities.

[Sahar E. Abo-Neima, Sabbah I. Hammoury, Eslam G. Omar, Hussein A. Motaweh. Comparative study of radiation doses exposure to Organs at Risk between Multiple Field-In-Field and Intensity Modulated Radiation Therapy techniques in left breast cancer. Cancer Biology 2019;9(2):106-114]. ISSN: 2150-1041 (print); ISSN: 2150-105X (online). http://www.cancerbio.net. 15. doi:10.7537/marscbj090219.15.

Keywords: Breast Cancer, Radiation therapy, multiple Field-in-Field, Intensity Modulated Radiation Therapy

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