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Simultaneous Bilateral Chest Wall Irradiation, Can Helical Tomotherapy Improve Dose Distribution? 同时双侧胸壁照射,螺旋断层治疗能改善剂量分布吗?
Pub Date : 2018-11-07 DOI: 10.21608/RESONCOL.2018.5667.1066
A. Elashwah, A. Mousa, Ghadeer Nazer
Background: Radiotherapy to bilateral breast cancer (BBC) is technically challenging because of the proximity to organs as the heart and lungs. Aim: We conducted this study tocompare helical tomotherapy (HT) to 3-dimensional conformal radiation therapy (3D-CRT) technique in bilateral chest wall irradiation regarding the coverage of target volume and the doses recorded at adjacent organs at risk. Methods: Ten patients with synchronous BBC who underwent bilateral mastectomy were included. Two plans were performed for each patient using HT and 3D-CRT. Results: Target volume included bilateral chest wall, bilateral supraclavicular and level III axillary lymph nodes. Prescription dose was 50 Gy/25 fractions in 5 weeks. The mean chest wall planning target volume (PTV) homogeneity index and conformality index were 0.15 and 1.09 in HT versus 0.37 and 1.43 in 3D-CRT plans (p= 0.012 and 0.031). At least 95% of the prescribed dose was covering 96% and 92% of the chest wall PTV for HT and 3D-CRT plans (p= 0.026). Helical tomotherapy plans achieved significant decrease in all cardiac parameters compared to 3D-CRT plans. Helical tomotherapy also achieved reduction in mean dose and V20 for both lungs in expense of higher low dose to normal healthy tissue and longer treatment time in comparison to 3D-CRT.  Conclusion: For BBC patients treated with bilateral chest wall and supraclavicular lymph nodes irradiation, HT provides more conformal and homogenous plan than conventional 3D-CRT plans. Helical tomotherapy improves chest wall PTV coverage and decreases the dose to the heart and lungs in expense of more volume of normal tissues exposure to low doses of radiation and longer treatment time.
背景:双侧癌症(BBC)的放射治疗在技术上具有挑战性,因为它靠近心脏和肺部等器官。目的:我们进行了这项研究,比较了螺旋断层治疗(HT)和三维适形放射治疗(3D-CRT)技术在双侧胸壁照射中的目标体积覆盖率和在邻近危险器官记录的剂量。方法:对10例同期接受双侧乳房切除术的乳腺癌患者进行回顾性分析。使用HT和3D-CRT为每位患者执行两个计划。结果:靶体积包括双侧胸壁、双侧锁骨上和III级腋窝淋巴结。处方剂量为5周50Gy/25次。HT的平均胸壁规划目标体积(PTV)均匀性指数和一致性指数分别为0.15和1.09,而3D-CRT计划为0.37和1.43(p=0.012和0.031)。HT和3D-CRT方案中,至少95%的处方剂量覆盖了96%和92%的胸壁PTV(p=0.026)。与3D-CRT相比,螺旋断层治疗方案的所有心脏参数均显著降低计划。与3D-CRT相比,螺旋断层治疗还降低了两肺的平均剂量和V20,以牺牲对正常健康组织更高的低剂量和更长的治疗时间为代价。结论:对于接受双侧胸壁和锁骨上淋巴结放疗的BBC患者,HT比传统的3D-CRT方案提供了更一致、更均匀的方案。螺旋断层治疗提高了胸壁PTV的覆盖率,并减少了对心脏和肺部的剂量,以牺牲更多体积的正常组织暴露于低剂量辐射和更长的治疗时间。
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引用次数: 0
Clinical Value of C-reactive Protein and Erythrocyte Sedimentation Rate in Advanced Bladder Cancer c反应蛋白和红细胞沉降率在晚期膀胱癌中的临床价值
Pub Date : 2018-10-21 DOI: 10.21608/RESONCOL.2018.4152.1060
M. Shehata, E. Elkhouly, H. Alagizy, S. Gohar, Radwa M. Shalaby
Background: The identification of biomarkers would improve the management of advanced urinary bladder carcinoma. Aim: The current study assessed the potential prognostic role of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in advanced stage bladder cancer. Methods: Forty-six patients with advanced urinary bladder carcinoma were included in the study. After consent, CRP and ESR were measured before treatment, after 2 cycles of chemotherapy and at the end of treatment. The relation between CRP and ESR serum measurements and patients' characteristics and treatment response were assessed. Results: Both CRP and ESR were elevated in all included patients with mean values ± standard deviation: 35.43 ± 12.65 and 57.17 ± 18.15, respectively. The baseline CRP level was higher in patients with metastatic disease. ESR was significantly elevated in association with squamous cell carcinoma pathology and hydronephrosis and in patients who died within one year of diagnosis (p = 0.003, 0.001 and 0.03; respectively). Patients who experienced disease progression after 2 cycles of platinum-based chemotherapy had higher levels of CRP and ESR. Serial measurements during the course of treatment revealed that both CRP and ESR levels declined significantly during treatment mainly among responding patients (p = 0.001). Conclusion: CRP and ESR might be useful noninvasive biomarkers in advanced urinary bladder carcinoma.
背景:生物标志物的鉴定将提高晚期膀胱癌的治疗水平。目的:本研究评估C-反应蛋白(CRP)和血沉(ESR)在晚期癌症中的潜在预后作用。方法:46例晚期膀胱癌患者纳入本研究。同意后,在治疗前、化疗2个周期后和治疗结束时测量CRP和ESR。评估CRP和ESR血清测量值与患者特征和治疗反应之间的关系。结果:所有纳入的患者CRP和ESR均升高,平均值±标准差分别为35.43±12.65和57.17±18.15。转移性疾病患者的基线CRP水平较高。ESR与鳞状细胞癌病理和肾积水相关,以及在诊断后一年内死亡的患者中显著升高(分别为p=0.003、0.001和0.03)。在2个周期的铂类化疗后出现疾病进展的患者,其CRP和ESR水平较高。治疗过程中的一系列测量显示,治疗期间CRP和ESR水平均显著下降,主要发生在有反应的患者中(p=0.001)。
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引用次数: 0
Role of MEK1 and DIAPH3 Expression in Colorectal Carcinoma MEK1和DIAPH3在大肠癌中的表达
Pub Date : 2018-08-12 DOI: 10.21608/RESONCOL.2018.4042.1059
A. Foda, Mohamed A. Ahmed, H. Elkalla, Eman El-zahaf, H. Abdallah, H. Wagih, M. Sami
Background: Colorectal carcinoma (CRC) is one of the serious causes of morbidity and mortality worldwide. It is characterized by activating mutations in genes encoding Receptor Tyrosine Kinases (RAS, RAF, MEK1 or MEK2) which act as driving oncogenes. DIAPH3 deficiency has been reported to enhance cancer cell motility, invasion and metastasis and also correlates with aggressive behaviour of cancer. Aim: To study the overexpression of MEK1 and DIAPH3 in CRC patients and their prognostic significance. Methods: We examined the immunohistochemical expression of MEK1 and DIAPH3 using tissue microarray technique in 150 CRC specimens divided into two groups. The mucinous group (MG) included specimens of 56 mucinous adenocarcinoma and 19 signet ring cell carcinoma, while the non-mucinous group (NMG) included 75 non-mucinous adenocarcinoma specimens for comparison. Results: MEK1 and DIAPH3 were strongly expressed in >50% of the studied specimens. The positivity of MEK1 expression was significantly higher in NMG compared to MG (66.7% and 34.3%, respectively; p<0.001). In all cases, the overexpression of MEK1 was significantly associated with peri-tumoral and intra-tumoral lymphocytic response (p=0.005 and 0.008, respectively). Furthermore, MEK1 overexpression showed statistically significant correlation with better OS (p=0.023) in the whole group of patients. The expression of DIAPH-3 did not differ significantly between NMG and MG (53.3% and 47.1%, respectively; p=0.456). There was strong relation between the overexpression of MEK1 and DIAPH3 (p<0.001). Conclusion: The results suggest a potential synergistic role of MEK1 and DIAPH3 overexpression and the development of CRC. Further large scale studies are warranted.
背景:结直肠癌(CRC)是全球发病率和死亡率的重要原因之一。其特征是激活编码受体酪氨酸激酶(RAS、RAF、MEK1或MEK2)的基因突变,这些基因起驱动致癌基因的作用。据报道,DIAPH3缺乏可增强癌症细胞的运动、侵袭和转移,并与癌症的侵袭行为相关。目的:研究MEK1和DIAPH3在CRC患者中的过度表达及其预后意义。方法:应用组织微阵列技术检测150例CRC组织中MEK1和DIAPH3的免疫组织化学表达。粘液组(MG)包括56例粘液腺癌和19例印戒细胞癌标本,而非粘液组(NMG)包括75例非粘液腺癌标本进行比较。结果:MEK1和DIAPH3在50%以上的研究标本中强烈表达。与MG相比,NMG中MEK1的表达阳性率显著更高(分别为66.7%和34.3%;p<0.001)。在所有病例中,MEK1的过度表达与肿瘤周围和肿瘤内淋巴细胞反应显著相关(分别为0.005和0.008)。此外,在整个患者组中,MEK1过表达与更好的OS显示出统计学上显著的相关性(p=0.023)。DIAPH-3的表达在NMG和MG之间没有显著差异(分别为53.3%和47.1%;p=0.456)。MEK1和DIAPH3的过表达之间存在强烈的相关性(p<0.001)。需要进行进一步的大规模研究。
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引用次数: 3
Children Exposed to Treatments in Utero in Pregnant Patients with Breast Cancer: Experience from Two Large Egyptian Hospitals 儿童暴露于子宫内治疗的怀孕乳腺癌患者:从两家大型埃及医院的经验
Pub Date : 2018-08-02 DOI: 10.21608/RESONCOL.2018.3244.1052
S. Talima, M. El-Daly, Mohammed Hammam, A. Bader
Background: Pregnancy-associated breast cancer (PABC) is one of the common malignancies during pregnancy. Limited data is present about the effect of anticancer therapy on children born to mothers exposed to in utero treatments. Aim: To describe the outcome of pregnancy in a cohort of Egyptian patients treated for PABC. Methods: We reviewed all breast cancer cases diagnosed during pregnancy at two large Egyptian institutions between January 2009 and December 2016. Thirty-eight patients with complete obstetric and fetal data were included. Results: All patients received anthracycline-based chemotherapy in the 2nd and 3rd trimesters and 9 of them received paclitaxel. The mean gestational age at delivery was 35.7 ± 3.4 weeks. The mean birth weight was 2736 ± 768 grams. Congenital anomaly (cleft lip and tongue tie) was reported in only one (4%) child. Perinatal death occurred in one (4%) baby due to prematurity. One (4%) child was exposed to trastuzumab in utero in the 1st trimester and he was completely healthy. Two (8%) other children were exposed to tamoxifen with no complications either neonatal or postnatal.Conclusion: Chemotherapy during pregnancy may be used with minimal maternal and fetal complications. Multidisciplinary approach is crucial for better management. Continued long-term follow-up of the children in this cohort is required.
背景:妊娠相关乳腺癌(PABC)是妊娠期常见的恶性肿瘤之一。目前关于抗癌治疗对子宫内接受治疗的母亲所生的孩子的影响的数据有限。目的:描述一组接受PABC治疗的埃及患者的妊娠结局。方法:我们回顾了2009年1月至2016年12月在埃及两家大型机构诊断的所有孕期乳腺癌病例。38例患者有完整的产科和胎儿资料。结果:所有患者均于妊娠2、3月接受蒽环类化疗,其中9例接受紫杉醇化疗。平均胎龄35.7±3.4周。平均出生体重为2736±768克。先天性异常(唇裂、舌结)仅1例(4%)。1名(4%)婴儿因早产而死亡。一名(4%)儿童在妊娠早期在子宫内暴露于曲妥珠单抗,他完全健康。另外两名(8%)儿童暴露于他莫昔芬,没有新生儿或产后并发症。结论:妊娠期化疗可减少母胎并发症。多学科方法对更好的管理至关重要。需要对该队列中的儿童进行持续的长期随访。
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引用次数: 0
Four versus Six Cycles of Pemetrexed/Platinum as a First Line Treatment of Malignant Pleural Mesothelima: Results of a Randomized Phase II Study 培美曲塞/铂作为恶性胸膜间皮瘤一线治疗的4 vs 6个周期:一项随机II期研究的结果
Pub Date : 2018-07-12 DOI: 10.21608/resoncol.2018.4306.1062
A. Nagy, Hesham Elwakeel, O. Abdel-Rahman
Background: Pemetrexed-platinum is the standard first line treatment of patients with malignant pleural mesothelioma (MPM). Optimal number of pemetrexed-platinum chemotherapy cycles is not yet known with certainty. Aim: To compare 4 cycles versus 6 cycles of pemetrexed-platinum regimen as a 1st line treatment in MPM. Methods: This was a randomized phase II study (1:1) which was conducted at a single institution. Arm A received 4 cycles of pemetrexed-platinum, while Arm B received 6 cycles. The 1ry outcome of the current study was overall survival. It was assessed through Kaplan-Meier survival estimates as well as a multivariate Cox regression model adjusted for other relevant baseline clinicopathological characteristics. Results: A total of 60 patients were included into the current study (30 in each arm). Kaplan-Meier survival analysis according to the number of cycles of chemotherapy did not reveal a significant survival difference between both subsets (p = 0.194). Multivariate Cox regression analysis for factors affecting overall survival did not show an overall survival difference based on treatment arm (p = 0.105). Conclusions: Six cycles does not appear to improve the overall survival of MPM patients compared to four cycles. Shorter course of treatment should be considered in resource-limited settings like Egypt.
背景:培美曲塞铂是恶性胸膜间皮瘤(MPM)患者的标准一线治疗药物。培美曲塞-铂化疗周期的最佳次数尚不确定。目的:比较培美曲塞-铂方案作为MPM一线治疗的4个周期和6个周期。方法:这是一项在单一机构进行的随机II期研究(1:1)。A组接受4个周期的培美曲塞铂治疗,而B组接受6个周期。目前研究的第一个结果是总生存率。通过Kaplan-Meier生存估计和其他相关基线临床病理特征调整的多变量Cox回归模型进行评估。结果:本研究共纳入60例患者(每组30例)。根据化疗周期数进行的Kaplan-Meier生存分析未显示两个亚组之间的显著生存差异(p = 0.194)。对影响总生存的因素进行多因素Cox回归分析,未发现治疗组的总生存差异(p = 0.105)。结论:与4个周期相比,6个周期似乎并不能提高MPM患者的总生存期。在埃及等资源有限的环境中,应考虑较短的疗程。
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引用次数: 0
Perioperative Algorithm as a Novel Method for Lymph Node Assessment in Stage I Endometrial Cancer 围手术期算法作为一期子宫内膜癌淋巴结评估的新方法
Pub Date : 2018-07-08 DOI: 10.21608/RESONCOL.2018.3345.1053
Hayam E. S. Atta, H. Hegab, O. Elashkar, M. Meleis, D. Abdallah
Background: The uterus has a complex lymphatic drainage consisting of many groups that are in danger of endometrial cancer (EC) spread. Lymph node metastasis is a genuine pointer of poor prognosis requiring adjuvant therapy. Lymphatic mapping surgically can be done by blue dye labeling and perioperative algorithm. Aim: To assess the role of perioperative sentinel lymph nodes (SLN) mapping algorithm in reducing the necessity of pelvic lymphadenectomy. Methods: Fifty patients with early stage I EC underwent surgical staging. Transcervical injection of methylene blue was used, laparotomy was done and retroperitoneal spaces were opened. All lymph nodes were histopathologically examined and the negative SLN were ultrastaged. Results: Methylene blue dye injection resulted in blue lymph nodes in 20 (40%) cases, suspicious in 2 (4%) and negative in 28 (56%). Histopathological examination of sampled lymph node showed metastases in 18/20 (90%) of blue nodes, 1/2 (50%) of suspicious nodes and 0/28 (0%) of negative nodes. There were no false negative cases in this study and the detection rate was 89%. Conclusion: Perioperative algorithm accuracy and simplicity make it a reliable approach for lymph node assessment in early stage EC.
背景:子宫有一个复杂的淋巴引流系统,由许多有子宫内膜癌(EC)扩散危险的组织组成。淋巴结转移是预后不良的真正指标,需要辅助治疗。手术淋巴定位可通过蓝色染料标记和围手术期算法完成。目的:探讨围手术期前哨淋巴结(SLN)定位算法在减少盆腔淋巴结切除术必要性中的作用。方法:对50例早期ⅰ期EC患者进行手术分期。经宫颈注射亚甲蓝,开腹,打开腹膜后间隙。对所有淋巴结进行组织病理学检查,并对SLN阴性进行超分期。结果:亚甲基蓝染色致蓝色淋巴结20例(40%),可疑2例(4%),阴性28例(56%)。淋巴结组织病理学检查显示18/20(90%)蓝色淋巴结转移,1/2(50%)可疑淋巴结转移,0/28(0%)阴性淋巴结转移。本研究无假阴性病例,检出率为89%。结论:围手术期算法准确、简便,是早期EC淋巴结评估的可靠方法。
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引用次数: 0
Impact of Exogenous Neurotropic Factor Administration on Occurrence and Severity of Paclitaxel-Induce Neuropathy in Breast Cancer Patients. An open label Pilot Study. 外源性神经营养因子对紫杉醇诱导的乳腺癌患者神经病变发生及严重程度的影响。一项开放标签试点研究。
Pub Date : 2018-06-29 DOI: 10.21608/RESONCOL.2018.3375.1055
M. Ellithy, Lamia Elwakil, M. Schaalan, Yomna A. El Hossamy
Background: Paclitaxel-induced peripheral neuropathy (PIPN) is a common toxicity with no proven agent beneficial for prevention. The potentiality of Nerve Growth Factor (NGF) as a protective agent for PIPN was suggested by several studies. Aim: This study aimed to test the impact of exogenously administered NGF on PIPN and to assess NGF levels in relation to PIPN severity. Methods: Forty patients were prospectively randomly allocated to paclitaxel alone (control group) or paclitaxel + exogenous NGF (test group). Neuropathy occurrence and severity was assessed before enrollment and after each cycle using the European Association for Treatment of Cancer Quality of Life Questionnaire for Chemotherapy Induced Peripheral Neuropathy (EORTC QLQ-CIPN20). Nerve Growth Factor level was assessed in both groups at baseline and at the end of the study. Nerve Growth Factor safety was assessed by laboratory investigations and the occurrence of adverse drug reactions. Results: There was significant increase in the EORTC QLQ-CIPN20 score in the control group (p<0.001) and a stabilization in the score in the test group. Nerve Growth Factor levels significantly increased in the test group (p<0.001) and declined in the control group. A highly significant negative correlation existed between NGF level and the EORTC QLQ-CIPN20 score (r=-0.781, p<0.001). No significant difference was observed between the two groups in the occurrence of adverse drug reactions or other toxicities. Conclusion: Exogenous NGF may have a potential neuroprotective effect against PIPN in breast cancer patients. Higher endogenous NGF level is inversely correlated with the occurrence and severity of PIPN.
背景:紫杉醇诱导的周围神经病变(PIPN)是一种常见的毒性,目前尚无有效的预防药物。神经生长因子(NGF)作为PIPN的保护剂的潜力是由几项研究提出的。目的:本研究旨在测试外源性给予NGF对PIPN的影响,并评估NGF水平与PIPN严重程度的关系。方法:40例患者前瞻性随机分为紫杉醇单独组(对照组)或紫杉醇+外源性NGF组(试验组)。在入组前和每个周期后,使用欧洲癌症治疗协会化疗诱导的周围神经病变生活质量问卷(EORTC QLQ-CIPN20)评估神经病变的发生和严重程度。在基线和研究结束时对两组的神经生长因子水平进行评估。通过实验室调查和药物不良反应的发生来评估神经生长因子的安全性。结果:对照组EORTC QLQ-CIPN20评分显著升高(p<0.001),试验组评分稳定。神经生长因子水平在试验组中显著升高(p<0.001),在对照组中下降。NGF水平与EORTC QLQ-CIPN20评分呈极显著负相关(r=-0.781,p<0.001),两组药物不良反应或其他毒性的发生率无显著差异。结论:外源性NGF可能对癌症患者PIPN具有潜在的神经保护作用。较高的内源性NGF水平与PIPN的发生和严重程度呈负相关。
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引用次数: 0
Clinical Value of Serum Neopterin in Breast Cancer 血清新蝶呤在乳腺癌中的临床价值
Pub Date : 2018-04-01 DOI: 10.1016/S0959-8049(18)30363-0
S. Gohar, S. Alhassanin, A. Shehata, Shaimaa Soliman
{"title":"Clinical Value of Serum Neopterin in Breast Cancer","authors":"S. Gohar, S. Alhassanin, A. Shehata, Shaimaa Soliman","doi":"10.1016/S0959-8049(18)30363-0","DOIUrl":"https://doi.org/10.1016/S0959-8049(18)30363-0","url":null,"abstract":"","PeriodicalId":33915,"journal":{"name":"Research in Oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0959-8049(18)30363-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41430422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
期刊
Research in Oncology
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