Journal of the Egyptian National Cancer Institute最新文献

Background: Immunocompromised individuals, such as those affected by and treated for hematological malignancies, face a higher risk of prolonged SARS-CoV-2 infection. Increased disease risk is further compounded by limited treatment options. Currently, approved antiviral monotherapies against COVID-19 include remdesivir (Veklury) and nirmatrelvir/ritonavir (Paxlovid) which have stringent recommended prescribing windows within 7 and 5 days of symptom onset, respectively. Furthermore, these two antiviral therapies are approved for treatment lengths of 3 (remdesivir) and 5 days (Paxlovid).

Case presentation: Herein, we describe the successful treatment of prolonged COVID-19 in a patient with a history of diffuse large B-cell lymphoma with an extended combination therapy; remdesivir and nirmatrelvir/ritonavir. The patient presented with symptomatic COVID-19 that was unsuccessfully treated with a 10-day course of remdesivir. After 2 months of symptomatic infection, the patient was treated with remdesivir in combination with nirmatrelvir/ritonavir for 10 days, which quickly resolved the cough and cleared viral load.

Conclusion: Our case highlights the efficacy of administrating a combination treatment of remdesivir and nirmatrelvir/ritonavir outside recommended guidelines for the treatment of persistent COVID-19 infection in an immunocompromised individual. High-quality studies evaluating the usefulness of this combinatory therapy as a longer-course treatment in patients with neoplasms is warranted.

Introduction: Oral cancer (OC) is one of the major global health problems with a high incidence rate in developing countries. Early detection can improve the prognosis and survival rate of the disease.

Aim: The current study evaluates dentists' general awareness, knowledge, attitude, and practice regarding oral cancer.

Methods: In the current cross-sectional study, a self-reported questionnaire was distributed to a sample of dentists in Egypt. A total of 700 dentists participated. The questionnaire included 27 questions on oral cancer knowledge, opinions, attitudes, and practices.

Results: The highest awareness of risk factors concentrated around tobacco and alcohol consumption, and the most acknowledged clinical presentations were non-healing ulcers, red lesions, white lesions, and induration. The tongue was considered a high-risk site by 69% of participants, followed by the floor of the mouth and the buccal/lip mucosa. Only 37% of the participants carried out proper clinical screening for OC, while only 31% carried out routine lymph node examinations. Sixty-six percent of participants considered themselves incompetent regarding detection of OC. Ninety-two percent of participants acknowledged the important role of dentists in the early detection of oral cancer, and 99% of them thought that oral cancer awareness campaigns are needed and would be effective. Awareness was significantly associated with years of practice.

Conclusion: Awareness regarding OC among the Egyptian dentists participating in the current survey showed definitive defects. Hence, efforts to raise awareness of OC among dental practitioners are an important factor in improving/early detection of OC, with the resultant increase in survival rate and decrease in morbidity. This can be reached only through more solid undergraduate syllabi and training as well as workshops and campaigns.

Triple-negative breast cancer (TNBC) accounts for 10-20% of all breast cancers. These tumors are heterogeneous, highly aggressive, and associated with a poor prognosis and a high risk of recurrence. In both hematologic and solid malignancies, immune checkpoint inhibitors (ICIs) have demonstrated the ability to enhance long-term survival and sustain robust anti-tumor responses. Immunotherapy has also been introduced as a treatment option for TNBC, a subtype characterized by a high presence of intra-tumoral tumor-infiltrating lymphocytes (TILs) and stromal immune cells. This heightened immune activity within TNBC serves as a prognostic marker, indicating a potential for better responses to immunotherapy due to increased tumor immune infiltration. This review provides an overview of the current landscape of immunotherapy in TNBC, exploring its rationale and application across different disease stages. Trial registration NCT02555657.

Background: Hepatocellular carcinoma during pregnancy is rare and poses significant potential risks to both the pregnant individual and the fetus. Here, we report a case of hepatocellular carcinoma during pregnancy. The 28-week gestational is a critical point of fetal maturation. A literature review revealed no similar case with survival exceeding 2 years, following resection of a large hepatocellular carcinoma diagnosed in late-stage pregnancy. This article may contribute to future research aimed at extending the survival time of patients with hepatocellular carcinoma diagnosed in late pregnancy.

Case presentation: A 33-year-old pregnant woman was diagnosed with hepatocellular carcinoma at 34 weeks of pregnancy. A cesarean section was performed at 34 weeks of pregnancy. Under general anesthesia, a right lobectomy of the liver was conducted after 15 days. The patient received continuous support from the clinical psychology team throughout the entire perioperative period. The postoperative recovery was smooth, and the patient was discharged without any significant complications. Approximately 2 years post-surgery, follow-up indicated that the patient remained alive and in good health.

Conclusions: The physiological changes associated with pregnancy can promote rapid tumor growth, leading to poor prognoses. Expert decision-making should be guided by the growth and maturation status of the fetus in relation to hepatocellular carcinoma development. For patients in the late stage of pregnancy, timely termination of pregnancy and tumor resection surgery, along with obtaining assistance from the clinical psychology team during the perioperative period, followed by post-discharge treatment with a combination of Sintilimab and Lenvatinib, constitutes an effective strategy for prolonging patient survival.

HCC is one of the most life-threatening human cancers in the world. It is considered the major malignant tumor of the liver in adults and is the most common cause of death in people with cirrhosis. Chemotherapy is widely used for HCC treatment, but it has many side effects. Therefore, an alternative, safe method with low side effects, low toxicity, and a higher anti-cancer effect is in demand. In our study, we used Se-NPS alone and combined it with Gamma and UV radiation at different doses. We also used the chemotherapeutic drug sorafenib on Hep G2 cell lines to compare the effect of Se-NPS (with and without radiation) with the sorafenib group. Our results showed that Selenium alone without radiation had a lesser effect on eliminating cancer cells, with high cell viability and fewer apoptotic effects. On the other hand, Selenium combined with radiation, especially at high doses of UV (180 s) and gamma (0.2 Gy), had the highest effect on killing cancer cells. This combination resulted in significantly lower cell viability, high DNA fragmentation, and a high apoptotic effect due to a significant elevation of P53 and cytosolic cytochrome C, which was better than the Radiation-only groups.

Background: Pleural mesothelioma (PM) is an aggressive cancer with poor prognosis, often driven by asbestos exposure. Mutations in the NF2 gene, a key regulator of the Hippo signaling pathway, are frequently observed in PM. However, their impact on tumor biology, immune infiltration, cytokine signaling, and therapeutic response remains poorly understood.

Methods: Using data from The Cancer Genome Atlas, we analyzed 82 PM cases to assess the prevalence and consequences of NF2 mutations. Logistic regression was used to evaluate associations with clinical variables, while transcriptomic differences were examined through differential expression and functional enrichment analyses. Immune and stromal infiltration were inferred via the xCell algorithm, cytokine signaling analyzed with Cytosig, and chemotherapeutic sensitivity predicted using the pRRophetic R package. Single-cell RNA sequencing data provided further insights into transcriptional patterns in NF2-mutated tumors.

Results: NF2 mutations were present in 22% of cases, with no significant correlations to histological subtype, stage, or age. NF2-mutated tumors exhibited increased infiltration of basophils, naïve B cells, and pericytes, along with altered cytokine profiles, including NRG1, TGFB3, and reduced FGF2. Differentially expressed genes, such as MYL7 and HOXA11, were linked to poorer survival. Chemotherapy modeling indicated higher sensitivity to camptothecin and vinblastine in NF2-mutated tumors.

Conclusions: NF2 mutations influence the tumor microenvironment, transcriptional landscape, and predicted therapeutic response in PM, underscoring their potential as prognostic biomarkers. These findings support tailored therapeutic strategies targeting NF2-related pathways, including Hippo signaling and cytokine modulation.

Background: The tumor microenvironment has an important role in the growth and progression of diffuse large B-cell lymphoma (DLBCL). Immune checkpoint molecules, including PD1, LAG3, and CTLA4, are crucial to regulate the T cells function in the tumor microenvironment. Exploring the expression of these molecules in DLBCL microenvironment is crucial for developing targeted therapies enhancing anti-tumor immune responses.

Aim: This study aims to evaluate the immunohistochemical (IHC) expression of PD1, LAG3, and CTLA4 in DLBCL, assess the relation of their expression to different clinicopathological parameters and evaluate their prognostic significance.

Methods: This retrospective study encompassed 103 cases diagnosed as de novo DLBCL. Clinicopathologic and survival data were gathered. IHC for PD1, LAG3, and CTLA4 was performed.

Results: PD1, LAG3, and CTLA4 positive reaction was observed in tumor-infiltrating lymphocytes (TILs) in 68.9% (71/103), 82.5% (85/103), and 92.2% (95/103) of DLBCL cases, respectively. PD1 expression in TILs was significantly associated with hepatitis C virus (HCV) positivity and prolonged overall survival (OS) in univariate analysis. LAG3 expression in TILs was significantly associated with IPI score and tended towards shorter OS (not statistically significant). LAG3 expression in tumor cells was significantly associated with shorter disease-free survival (DFS). CTLA4 expression in TILs was significantly associated with advanced disease stage (III/IV).

Conclusion: PD1 and LAG3 are expressed mainly in TILs. PD1 expression (in TILs and tumor cells) is associated with prolonged OS, while LAG3 expression (in tumor cells) is associated with shorter DFS and its expression in TILs tended towards shorter OS. CTLA4 expression is associated with advanced disease stage but not associated with OS. These findings may suggest that immune checkpoint inhibitors targeting LAG3 may offer therapeutic potential in DLBCL by enhancing the antitumor immune response. Additional research is needed to assess the effectiveness of inhibition of these checkpoint molecules in combination with existing treatment modalities.

Objectives: Following external beam radiation therapy (EBRT) with concurrent chemotherapy, we analyzed the benefits of surgical resection for locally advanced cervical carcinoma in terms of the frequency and severity of complications and disease-free survival, including cases of adjuvant hysterectomy after failure of resolution post-brachytherapy.

Patient and methods: Retrospective analysis was utilized to determine the eligibility of 145 cases treated at the National Cancer Institute between January 2015 and June 2021. Of those, 17 patients did not match the requirements, and 8 patients declined to take part in the study. Depending on the major treatment technique, 120 FIGO stage IB3-FIGO stage IVA cervical cancer patients were split into two equal groups of 60 patients each. Sixty patients (50%) received neo-adjuvant EBRT and concurrent platinum-based chemotherapy followed by hysterectomy (group A) and 60 (50%) received definitive radiotherapy only (group B).

Results: The age at diagnosis of patients was similar, with a mean of 52.5 (range 34-77) and 53.4 (range 25 81) years in group A and group B, respectively (P = 0.675). Majority of the cases in both groups were pathologically squamous cell carcinomas (88.3% in group A and 83.3% in group B) and of grade II differentiation (73.7% in group A and 71.2% in group B). Majority of cases in both groups being FIGO stage II (45% in group A and 40% in group B) and FIGO stage III (40% in group A and 43.3% in group B). Only 17 patients (28.3%) in group A had postoperative complications, while 37 patients (61.7%) in group B suffered from post-treatment complications (P value < 0.001). In group B, 14 patients (23.3%) failed to show complete remission of the disease after completion of treatment, with a mean residual disease of 4.3 cm in diameter (range 2-6 cm), either local or nodal. Salvage hysterectomy post-definitive radiotherapy was done for 8 patients with residual disease (13.3%). In group A, 48 patients had no recurrence during follow-up (80%), while 11 of the patients had either locoregional or metastatic recurrences, or both (18.3%). DFS was comparable between both groups (P = 0.493), excluding 23.3% of group B where failure of complete remission of the disease after completion of treatment barred the patients from the disease-free calculations. The 1-year DFS was 88.1% in group A and 82.6% in group B, while the 3-year DFS was 74.1% in group A and 70.1% in group B.

Conclusion: There was no difference in disease-free survival or the incidence of locoregional and metastatic recurrence between patients with cervical cancer who had surgery and those who received brachytherapy following EBRT and concomitant chemotherapy. In almost 50% of cases, the surgical patients showed full pathological recovery.

Leukemia, a heterogeneous group of hematologic malignancies, poses significant challenges in terms of early diagnosis and effective treatment. Recent advancements in nanotechnology have paved the way for innovative approaches in leukemia management, with a particular focus on IONPs. This review paper explores the diverse designs of IONPs and their multifaceted applications in the diagnosis and treatment of leukemia. Focused discussions on the synergistic combination of IONPs with conventional chemotherapy, targeted drug delivery, and hyperthermia-based approaches provide insights into the evolving landscape of IONP-mediated leukemia therapy. The role of IONPs in overcoming drug resistance mechanisms and minimizing off-target effects is critically evaluated. The later review section provides an overview of the unique physical, chemical, and magnetic properties of IONPs, emphasizing their biocompatibility, tunable magnetic properties, and surface functionalization capabilities. The review finally addresses the challenges and prospects associated with the clinical translation of IONP-based diagnostic approaches. By addressing the challenges and opportunities in this burgeoning field, this paper aims to guide future research endeavors toward the development of effective and personalized nanotherapeutics for leukemia patients.

Purpose: This review assesses the efficacy and safety of EBRT + VBT versus VBT alone in intermediate- to high-risk endometrial cancer.

Methods: A systematic review and meta-analysis were conducted using PubMed, EMBASE, ProQuest, Ovid, and Scopus (until February 18, 2025). Studies comparing EBRT + VBT to VBT alone were included. The primary outcome was pelvic recurrence rate, while secondary outcomes included distant recurrence, overall survival, and toxicity. Data extraction, risk of bias assessment (RoB-2, ROBINS-I), and meta-analysis (random-effects models in RevMan) were performed. Certainty of evidence was evaluated using GRADE. PROSPERO registration: CRD420250654411.

Results: Eight studies comprising 2,672 patients met inclusion criteria (1,347 received EBRT + VBT; 1,325 had VBT alone). EBRT + VBT significantly reduced pelvic recurrence (OR 0.14, p = 0.001) but showed no difference in vaginal recurrence (OR 0.25, p = 0.14), distant metastasis (OR 0.78, p = 0.45) or overall survival (HR 0.82, p = 0.29, I² = 72%). EBRT + VBT was associated with higher gastrointestinal, genitourinary, and hematologic toxicity.

Conclusion: EBRT + VBT improves pelvic control but does not enhance survival and increases toxicity. VBT alone remains a viable option, highlighting the need for individualized treatment strategies.