Hematopoietic Stem Cell Transplantation for Adult Philadelphia-Negative Acute Lymphoblastic Leukemia in the First Complete Remission in the Era of Minimal Residual Disease

Abstract

Purpose of Review

The purpose of this review is to discuss the potential role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for Philadelphia-negative (Ph⁻) adult acute lymphoblastic leukemia (ALL) in first complete remission (CR1) in the era of minimal residual disease (MRD).

Recent Findings

Allo-HSCT continues to have a role in the therapy of a selected group of high-risk adult patients with ALL in CR1. Although the clinical significance of MRD has been studied less extensively in adults with ALL than in children, recent studies support its role as the strongest prognostic factor that can identify patients that are unlikely to be cured by standard chemotherapy and benefit from undergoing allo-HSCT. In addition, MRD status both pre- and post-HSCT has been found to correlate directly with the risk of relapse.

Summary

Currently, the clinical challenge consists on applying MRD and molecular failure to integrate novel agents and immunotherapy to lower MRD before allo-HSCT and to modulate the graft versus leukemia (GVL) effect after transplant.

https://ift.tt/2IUf9ym

Hematopoietic Stem Cell Transplantation for Adult Philadelphia-Negative Acute Lymphoblastic Leukemia in the First Complete Remission in the Era of Minimal Residual Disease

Abstract

Purpose of Review

The purpose of this review is to discuss the potential role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for Philadelphia-negative (Ph⁻) adult acute lymphoblastic leukemia (ALL) in first complete remission (CR1) in the era of minimal residual disease (MRD).

Recent Findings

Allo-HSCT continues to have a role in the therapy of a selected group of high-risk adult patients with ALL in CR1. Although the clinical significance of MRD has been studied less extensively in adults with ALL than in children, recent studies support its role as the strongest prognostic factor that can identify patients that are unlikely to be cured by standard chemotherapy and benefit from undergoing allo-HSCT. In addition, MRD status both pre- and post-HSCT has been found to correlate directly with the risk of relapse.

Summary

Currently, the clinical challenge consists on applying MRD and molecular failure to integrate novel agents and immunotherapy to lower MRD before allo-HSCT and to modulate the graft versus leukemia (GVL) effect after transplant.

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Recurrent Adult Intraabdominal Undifferentiated High-Grade Pleomorphic Sarcoma Infiltrated the Descending Colon: a Case Report and Review of the Literature

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Novel Variants and Copy Number Variation in CDH1 Gene in Iranian Patients with Sporadic Diffuse Gastric Cancer

Abstract

Introduction

The aim of this study was to survey the nucleotide changes and copy number variations (CNV) in the CDH1 gene in Iranian patients with sporadic diffuse gastric cancer (SDGC).

Materials and Methods

In this study, 28 patients were examined who upon gastrectomy had been diagnosed with SDGC according to the familial history and histopathological criteria which was confirmed by the pathologist. DNA extraction was performed from formalin-fixed paraffin-embedded tissues using a phenol-chloroform method following xylene deparaffinization. Determination of DNA sequence by Sanger was performed using PCR amplification of 16 exons and boundaries of intron/exon of CDH1 gene. Multiplex ligation-dependent probe amplification (MLPA) was performed on patients with pathogenic disorders in the sequence.

Results

In total, patients included 20 males and 8 females. Of all patients, 12 patients were under 45 years old (early onset gastric cancer, EODC) and 16 patients were older. The tumor was diagnosed in the early TNM stage (I, II) in six patients and in late stages (III, IV) in 19 cases. Altogether, 16 variants (three exonic with one new variant and 13 intronic with nine new variants) were found in DNA sequencing of the CDH1 gene in five samples. Also, using MLPA, a new duplication in exon 9 and one deletion in exon 2 were detected in two other patients. Altogether, CDH1 variants were identified in seven out of 28 patients (25%).

Conclusion

Our study revealed several novel somatic variants in the CDH1 gene in Iranian patients with sporadic diffuse GC. Our data supports the hypothesis that mutations in CDH1 gene, and particularly the mutations we describe, should be considered, even in sporadic cases of gastric cancer. The presence of these mutations in patients raises important issues regarding genetic counseling and diagnostic test in DGC patients.

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Gastroesophageal Cancer During Pregnancy: a Case Report and Review of the Literature

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Recurrent Adult Intraabdominal Undifferentiated High-Grade Pleomorphic Sarcoma Infiltrated the Descending Colon: a Case Report and Review of the Literature

https://ift.tt/2I0eJp5

Novel Variants and Copy Number Variation in CDH1 Gene in Iranian Patients with Sporadic Diffuse Gastric Cancer

Abstract

Introduction

The aim of this study was to survey the nucleotide changes and copy number variations (CNV) in the CDH1 gene in Iranian patients with sporadic diffuse gastric cancer (SDGC).

Materials and Methods

In this study, 28 patients were examined who upon gastrectomy had been diagnosed with SDGC according to the familial history and histopathological criteria which was confirmed by the pathologist. DNA extraction was performed from formalin-fixed paraffin-embedded tissues using a phenol-chloroform method following xylene deparaffinization. Determination of DNA sequence by Sanger was performed using PCR amplification of 16 exons and boundaries of intron/exon of CDH1 gene. Multiplex ligation-dependent probe amplification (MLPA) was performed on patients with pathogenic disorders in the sequence.

Results

In total, patients included 20 males and 8 females. Of all patients, 12 patients were under 45 years old (early onset gastric cancer, EODC) and 16 patients were older. The tumor was diagnosed in the early TNM stage (I, II) in six patients and in late stages (III, IV) in 19 cases. Altogether, 16 variants (three exonic with one new variant and 13 intronic with nine new variants) were found in DNA sequencing of the CDH1 gene in five samples. Also, using MLPA, a new duplication in exon 9 and one deletion in exon 2 were detected in two other patients. Altogether, CDH1 variants were identified in seven out of 28 patients (25%).

Conclusion

Our study revealed several novel somatic variants in the CDH1 gene in Iranian patients with sporadic diffuse GC. Our data supports the hypothesis that mutations in CDH1 gene, and particularly the mutations we describe, should be considered, even in sporadic cases of gastric cancer. The presence of these mutations in patients raises important issues regarding genetic counseling and diagnostic test in DGC patients.

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Gastroesophageal Cancer During Pregnancy: a Case Report and Review of the Literature

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Financial impact of oral chemotherapy wastage on society and the patient

Journal of Oncology Pharmacy Practice, Ahead of Print.


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Toward eradicating misconceptions on matching in etiological studies

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Toward eradicating misconceptions on matching in etiological studies

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Toward eradicating misconceptions on matching in etiological studies

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Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study, Published online: 26 March 2018; doi:10.1038/s41416-018-0037-6

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

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The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin, Published online: 26 March 2018; doi:10.1038/s41416-018-0043-8

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

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Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry, Published online: 26 March 2018; doi:10.1038/s41416-018-0033-x

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

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Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma, Published online: 26 March 2018; doi:10.1038/s41416-018-0061-6

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

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Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

Targeting glutaminolysis in chondrosarcoma in context of the <i>IDH1/2</i> mutation, Published online: 26 March 2018; doi:10.1038/s41416-018-0050-9

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

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The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin, Published online: 26 March 2018; doi:10.1038/s41416-018-0043-8

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

https://ift.tt/2DXlJkk

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry, Published online: 26 March 2018; doi:10.1038/s41416-018-0033-x

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

https://ift.tt/2G6rSfF

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma, Published online: 26 March 2018; doi:10.1038/s41416-018-0061-6

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

https://ift.tt/2Gnz62l

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study, Published online: 26 March 2018; doi:10.1038/s41416-018-0037-6

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

https://ift.tt/2GawMIu

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

Targeting glutaminolysis in chondrosarcoma in context of the <i>IDH1/2</i> mutation, Published online: 26 March 2018; doi:10.1038/s41416-018-0050-9

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

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Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

https://ift.tt/2pEMwNI

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

https://ift.tt/2pJAXEv

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

https://ift.tt/2pDPoKH

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

https://ift.tt/2HZIk1V

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

https://ift.tt/2pGZafh

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

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Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

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Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

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The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

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Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

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[Benign aggressive vascular anomalies in children].

[Benign aggressive vascular anomalies in children].

Bull Cancer. 2018 Mar 20;:

Authors: Boccara O, Maruani A, Léauté-Labrèze C

Abstract
Superficial vascular anomalies constitute a large group of malformative and tumoral conditions developed from all types of vessels. Vascular tumors are the result of cellular hyperplasia, whereas vascular malformations (VMs) are constituted of dysplastic vessels. The classification from International Society for the Study of Vascular Anomalies (ISSVA) is based on this pathogenic difference. The most common vascular tumor is infantile hemangioma, which treatment, when necessary, is propranolol. Congenital hemangiomas and tumors that might be complicated with Kasabach-Merritt phenomenon, i.e. deep thrombocytopenia, are much rarer. Management of Kasabach-Merritt phenomenon is now largely based on sirolimus. Low-flow VMs include capillary, venous and lymphatic malformations; arteriovenous malformations are high-flow malformations. These different types of VMs might be combined. Currently, there is an increasing work in delineating the different entities based on molecular findings. Treatment of VMs depends on the impairment linked to them, and is decided case by case, in pluridisciplinary consultations. Interventional treatments, especially surgery and sclerotherapy, are usually partially efficient, and management of patients with VMs increasingly involves medical drugs. First-line treatment of coagulation disorders associated with venous malformations is based on low molecular weight heparin; sirolimus seems efficient in hemorrhagic complications refractory to usual treatment. Sirolimus is about to become the standard treatment in painful inflammatory manifestations of mixed and/or complicated lymphatic malformations.

PMID: 29571951 [PubMed - as supplied by publisher]

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A hydatic cyst of the appendix mimicking a uterine lateral mass: a case report

Hydatic cyst is a zoonotic disease caused by Echinococcus granulosus. It is a public health problem in Tunisia and remains endemic. It occurs in intra-abdominal organs in 10–15% of the cases, particularly in t...

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A Case of Congenital Syphilis Presenting with Unusual Skin Eruptions

Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis.

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Optimization of treatment planning workflow and tumor coverage during daily adaptive magnetic resonance image guided radiation therapy (MR-IGRT) of pancreatic cancer

To simplify the adaptive treatment planning workflow while achieving the optimal tumor-dose coverage in pancreatic cancer patients undergoing daily adaptive magnetic resonance image guided radiation therapy (M...

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Optimization of treatment planning workflow and tumor coverage during daily adaptive magnetic resonance image guided radiation therapy (MR-IGRT) of pancreatic cancer

To simplify the adaptive treatment planning workflow while achieving the optimal tumor-dose coverage in pancreatic cancer patients undergoing daily adaptive magnetic resonance image guided radiation therapy (M...

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Osteosarcoma of the jaw: Challenges in the diagnosis and treatment

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mohamed Atef ElKordy, Tarek Sherif ElBaradie, Hisham Ismael ElSebai, Ayman Abd ElWahab Amin, Sheriff Mohamed KhairAlla
PurposeOsteosarcomas rarely affect jaw bones. Patients are usually older than those who suffer long bone sarcomas, with a rare incidence of metastasis. This is suggestive of a different pattern of behavior compared with long bone sarcomas. This study aimed to present NCI, Cairo University experience in treating patients diagnosed with osteosarcomas of the jaw, including the diagnostic challenges and treatment outcome.Patients and methodsThis is a retrospective case series study of all cases of osteosarcomas of mandible and maxilla that were treated at the NCI, in the period between 2006 and 2013. Patients' data, including demographic data, various clinical presentations, results of investigations, treatment modalities performed and outcomes, were collected from hospital records kept in the Biostatistics Department at NCI.ResultsRecords showed 21 cases of osteosarcoma of the jaw. The mandible was affected in 15 cases, the maxilla in six. Two cases had sun-ray periosteal reactions. Erroneous biopsy results were found in 4 cases compared with final pathology reports of surgical resections. All cases underwent surgical resections, with 8 cases having positive margins. The median follow-up period was 19.3 months (range 0.3–98.0 months). The cumulative disease-free survival (DFS) was 27.5% and the median DFS was 72 months. The cumulative overall survival at end of the study was 77.4%.ConclusionsOsteosarcoma of the jaw is challenging both to diagnose and manage. This is due to the high incidence of mistakes in biopsy results, rare specific radiological features and difficulties in proper resection due to proximity to vital structures.



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First-line paclitaxel and cisplatin used sequentially or in combination in metastatic breast cancer: A phase II randomized study

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mostafa M. Elserafi, Ahmed A. Zeeneldin, Ibrahim M. Abdelsalam, Hanan R. Nassar, Manar M. Moneer, Wafa H. Buhoush
IntroductionBreast cancer (BC) is the commonest cancer among females worldwide. Some patients present initially at advanced stages and more than 50% of them will develop metastasis (MBC) at some point. Compared to single agents, combination chemotherapy produces higher response rates (RR), longer progression-free survival (PFS) than single agents. This is associated with remarkably higher toxicities. At the same time, overall survival (OS) is comparable. This study aimed to compare safety and efficacy of combination and sequential chemotherapy.Patients and MethodsForty-six MBC patients were randomized to receive 6 cycles of the combination of paclitaxel (175 mg/m²) and cisplatin (70 mg/m²) (combination PC) or paclitaxel for 3 cycles followed by cisplatin for 3 cycles (sequential PC). Endpoints were RR, PFS, OS and safety.ResultsBoth combination and sequential PC produced similar RR (52% in both arms) and disease control rates (78.3% vs. 73.9%, p = .652). Responses were faster in the combination arm. Median PFS was 8.2 months in the combination compared to 5.0 months in the sequential arm (p = .064). The median OS was 16.5 and 18.8 months in the combination and sequential arms, respectively (p = .866). The combination was more toxic than sequential PC. Grade 3 toxicities were higher with combination PC than to sequential PC (48% vs. 4.3%; p < .001).ConclusionSequential agent chemotherapy may provide similar response rate and overall survival to combination chemotherapy with much lower toxicities. The former can be considered the standard practice in most instances.



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Survival outcome of intermediate risk neuroblastoma at Children Cancer Hospital Egypt

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Hossam Elzomor, Gehad Ahmed, Salma Elmenawi, Naglaa Elkinaai, Amal Refaat, Sonya Soliman, Mai Amr Abdelwahab, Mohamed Saad Zaghloul, Mohamed Fawzy
AimThe study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neuroblastoma patients treated at the Children Cancer Hospital – Egypt and their relation to various clinical and pathological factors.MethodsThe study included stage 3 patients <1.5 years, children 1.5 years or older with stage 3 disease and favorable histopathological features, infants (<1 year) with International Neuroblastoma Staging System (INSS) stage 4 disease, stage 4 children 1–1.5 years with favorable biology, and infants stage 4 s (with unfavorable biologic features). Patients received systemic chemotherapy, in the form of etoposide and carboplatin alternating with cyclophosphamide, doxorubicin and vincristine, administered at 3-week intervals, with a total of 6 or 8 cycles guided by reaching objective overall response (complete/very good partial/partial response).ResultsThe study included 136 patients, 67 males and 69 females. 101 patients had abdominal primary tumors, 28 had mediastinal masss and 7 with masses in the neck; 68% were stage 3 and the remaining (n = 44) had metastatic disease.The three-year overall survival (OS) and event-free survival (EFS) estimates were 94% ± 2% and 90.9% ± 2.5%, respectively. OS and EFS by gender, age, pathology and INPC were all statistically not significantly different. Moreover, OS for patients having surgery versus no surgery (inoperable residual only) was statistically significant (98.4% ± 1.6% & 88.7% ± 5.3%, respectively, p = .034).ConclusionA very high rate of survival is currently achievable in patients with intermediate risk neuroblastoma by chemotherapy or chemotherapy and surgery. In addition to response, our plan is to adopt biologically-based treatment to reduce treatment-induced complications among survivors.



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Comparative study on the analgesic effect of acute ipsilateral shoulder pain after open thoracotomy between preoperative ultrasound guided suprascapular nerve block (SNB) and intraoperative phrenic nerve infiltration (PNI) in cancer lung patients

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Bassel M. Elfokery, Sahar A. Tawfic, Abdelrahman M. Abdelrahman, Dina N. Abbas, Ikramy M. Abdelghaffar
IntroductionAcute ipsilateral shoulder pain (ISP) is a common complaint in patients after thoracotomy. The incidence ranges from 21% to 97%. Unfortunately, clinical studies did not put enough focus on ISP post thoracic surgery.Aim of the workThis study was designed to compare the effectiveness of suprascapular nerve block (SNB) and phrenic nerve infiltration (PNI) for controlling ISP.Patients and methodsOne hundred and thirty-five lung cancer patients (135) scheduled for open-lung surgery were randomly allocated into three equal groups; control group: received thoracic epidural with general anesthesia, suprascapular group: (SNB) one hour before the operation with 10 ml bupivacaine plus thoracic epidural with general anesthesia and phrenic nerve group: (PNI) was performed by the operating surgeon with 10 ml bupivacaine plus thoracic epidural with general anesthesia.The visual analogue score (VAS) of ISP, rescue of ketorolac for break through shoulder pain, peak expiratory flow rate (PEFR) and arterial blood gases were measured every 6 h postoperatively for 48 h.ResultsThe VAS, rescue doses of ketorolc and PEFR were significantly lower in the phrenic nerve group (P-value <0.05). There was no statistically significant difference between the three groups postoperatively as regards arterial blood gases (P-value >0.05).ConclusionPNI is more effective than SNB for ISP.



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Radiotherapeutic factors affecting the incidence of developing hypothyroidism after radiotherapy for head and neck squamous cell cancer

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mohamed El-Shebiney, Nehal El-mashad, Wael El-mashad, Ahmed A. El-Ebiary, Abdallah E. Kotkat
PurposeThe purpose of this study is to determine radiotherapy (RT) dose-volumetric threshold of radiation-induced hypothyroidism (HT) in head and neck squamous cell carcinoma (HNSCC) patients.Patients and methodsThe diagnosis of HT in 78 HNSCC patients treated with RT was based on a thyroid stimulating hormone (TSH) level greater than the maximum value of laboratory range. In all patients, dose-volumetric parameters were analyzed according to their relation to development of HT, and thyroid volumes spared from doses ≥10, 20, 30, 40 and 50 Gy (V10, V20, V30, V40 and V50) were analyzed from the dose volume histograms (DVHs).ResultsMedian follow-up duration was 31 months. At the end of study, 33 patients (42.3%) developed HT and the cumulative incidence of HT was 24.6%, 36.5% and 42.3% at one, two and three years, respectively. V30 of 42.1% (P = 0.005) was defined as dose-volumetric threshold of radiation-induced HT in HNSCC patients. Our analysis showed that V30 separates patients into low- and high-risk groups; the incidence of radiation-induced HT in the group with V30 < 42.1% and V30 ≥ 42.1% was 29.4% and 71.4%, respectively (P = 0.002).ConclusionsThe V30 may predict risk of developing HT after RT for HNSCC patients. V30 of 42.1%, defined as dose-volumetric threshold of radiation-induced HT, can be useful in treatment planning of HNSCC patients.



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Reinforcing the utility of chick embryo model to in vivo evaluate engraftment of human leukemic stem cells

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Arwa Farhat, Eiad Ali-Deeb, Amin Sulaiman, Majd Aljamali
Background and ObjectiveDevelopment of appropriate translational in vivo models is a prerequisite for personalized management of leukemic patients. Indeed, several immunodeficient mice models were developed for leukemias with main limitations due to their high cost, demanding management, and elongated assessment intervals. In this report, we aimed at evaluating the engraftment of CD34⁺ cells, isolated from an acute myeloid leukemia (AML) patient, in naturally immunodeficient chick embryo model.Methods and ResultsMononuclear cells or immunomagnetic sorted CD34⁺ cells were injected into chick embryo chorioallantoic membrane (CAM) veins. Seven days post-injection, human CD34 transcript was detected by reverse transcription polymerase chain reaction (RT-PCR) in blood, bone marrow (BM), spleen and liver from embryos injected with human leukemic cells. Interestingly, an amplicon of the same length has been detected in both BM and spleen from PBS injected embryos, although analysis via bioinformatics tools revealed no matches in chicken; neither in transcriptome nor in genome databases. Importantly, splenomegaly and hepatic lesions were observed in some CD34⁺ cells injected embryos.ConclusionCollectively, our data confirm the engraftment of primary human CD34⁺ leukemic cells in chick embryo liver, but other experiments are required to verify engraftment in BM and spleen, and to confirm the identity of a putative CD34 orthologous transcript in these two organs.



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Osteosarcoma subtypes: Magnetic resonance and quantitative diffusion weighted imaging criteria

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Rania Zeitoun, Ahmed M. Shokry, Sahar Ahmed Khaleel, Shaimaa M. Mogahed
IntroductionOsteosarcoma (OS) is a primary bone malignancy, characterized by spindle cells producing osteoid. The objective of this study is to describe the magnetic resonance imaging (MRI) features of different OS subtypes, record their attenuation diffusion coefficient (ADC) values and to point to the relation of their pathologic base and their corresponding ADC value.Patients and methodsWe performed a retrospective observational lesion-based analysis for 31 pathologically proven osteosarcoma subtypes: osteoblastic (n = 9), fibroblastic (n = 8), chondroblastic (n = 6), para-osteal (n = 3), periosteal (n = 1), telangiectatic (n = 2), small cell (n = 1) and extra-skeletal (n = 1). On conventional images we recorded: bone of origin, epicenter, intra-articular extension, and invasion of articulating bones, skip lesions, distant metastases, pathological fractures, ossified matrix, hemorrhage and necrosis. We measured the mean ADC value for each lesion.ResultsAmong the included OS lesions, 51.6% originated at the femur, 29% showed intra-articular extension, 16% invaded neighboring bone, 9% were associated with pathological fracture and 25.8% were associated with distant metastases. On MRI, all lesions showed ossified matrix, 35.5% showed hemorrhage and 58% showed necrosis. The mean ADC values for OS lesions ranged from 0.74 × 10⁻³ mm²/s (recorded for conventional osteoblastic OS) to 1.50 × 10⁻³ mm²/s (recorded for telangiectatic OS) with an average value of 1.16 ± 0.18 × 10⁻³ mm²/s. Conventional chondroblastic OS recorded higher values compared to the other two conventional subtypes.ConclusionOsteosarcoma has different pathologic subtypes which correspondingly vary in their imaging criteria and their ADC values.



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Reinforcing the utility of chick embryo model to in vivo evaluate engraftment of human leukemic stem cells

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Arwa Farhat, Eiad Ali-Deeb, Amin Sulaiman, Majd Aljamali
Background and ObjectiveDevelopment of appropriate translational in vivo models is a prerequisite for personalized management of leukemic patients. Indeed, several immunodeficient mice models were developed for leukemias with main limitations due to their high cost, demanding management, and elongated assessment intervals. In this report, we aimed at evaluating the engraftment of CD34⁺ cells, isolated from an acute myeloid leukemia (AML) patient, in naturally immunodeficient chick embryo model.Methods and ResultsMononuclear cells or immunomagnetic sorted CD34⁺ cells were injected into chick embryo chorioallantoic membrane (CAM) veins. Seven days post-injection, human CD34 transcript was detected by reverse transcription polymerase chain reaction (RT-PCR) in blood, bone marrow (BM), spleen and liver from embryos injected with human leukemic cells. Interestingly, an amplicon of the same length has been detected in both BM and spleen from PBS injected embryos, although analysis via bioinformatics tools revealed no matches in chicken; neither in transcriptome nor in genome databases. Importantly, splenomegaly and hepatic lesions were observed in some CD34⁺ cells injected embryos.ConclusionCollectively, our data confirm the engraftment of primary human CD34⁺ leukemic cells in chick embryo liver, but other experiments are required to verify engraftment in BM and spleen, and to confirm the identity of a putative CD34 orthologous transcript in these two organs.



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Osteosarcoma of the jaw: Challenges in the diagnosis and treatment

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mohamed Atef ElKordy, Tarek Sherif ElBaradie, Hisham Ismael ElSebai, Ayman Abd ElWahab Amin, Sheriff Mohamed KhairAlla
PurposeOsteosarcomas rarely affect jaw bones. Patients are usually older than those who suffer long bone sarcomas, with a rare incidence of metastasis. This is suggestive of a different pattern of behavior compared with long bone sarcomas. This study aimed to present NCI, Cairo University experience in treating patients diagnosed with osteosarcomas of the jaw, including the diagnostic challenges and treatment outcome.Patients and methodsThis is a retrospective case series study of all cases of osteosarcomas of mandible and maxilla that were treated at the NCI, in the period between 2006 and 2013. Patients' data, including demographic data, various clinical presentations, results of investigations, treatment modalities performed and outcomes, were collected from hospital records kept in the Biostatistics Department at NCI.ResultsRecords showed 21 cases of osteosarcoma of the jaw. The mandible was affected in 15 cases, the maxilla in six. Two cases had sun-ray periosteal reactions. Erroneous biopsy results were found in 4 cases compared with final pathology reports of surgical resections. All cases underwent surgical resections, with 8 cases having positive margins. The median follow-up period was 19.3 months (range 0.3–98.0 months). The cumulative disease-free survival (DFS) was 27.5% and the median DFS was 72 months. The cumulative overall survival at end of the study was 77.4%.ConclusionsOsteosarcoma of the jaw is challenging both to diagnose and manage. This is due to the high incidence of mistakes in biopsy results, rare specific radiological features and difficulties in proper resection due to proximity to vital structures.



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First-line paclitaxel and cisplatin used sequentially or in combination in metastatic breast cancer: A phase II randomized study

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mostafa M. Elserafi, Ahmed A. Zeeneldin, Ibrahim M. Abdelsalam, Hanan R. Nassar, Manar M. Moneer, Wafa H. Buhoush
IntroductionBreast cancer (BC) is the commonest cancer among females worldwide. Some patients present initially at advanced stages and more than 50% of them will develop metastasis (MBC) at some point. Compared to single agents, combination chemotherapy produces higher response rates (RR), longer progression-free survival (PFS) than single agents. This is associated with remarkably higher toxicities. At the same time, overall survival (OS) is comparable. This study aimed to compare safety and efficacy of combination and sequential chemotherapy.Patients and MethodsForty-six MBC patients were randomized to receive 6 cycles of the combination of paclitaxel (175 mg/m²) and cisplatin (70 mg/m²) (combination PC) or paclitaxel for 3 cycles followed by cisplatin for 3 cycles (sequential PC). Endpoints were RR, PFS, OS and safety.ResultsBoth combination and sequential PC produced similar RR (52% in both arms) and disease control rates (78.3% vs. 73.9%, p = .652). Responses were faster in the combination arm. Median PFS was 8.2 months in the combination compared to 5.0 months in the sequential arm (p = .064). The median OS was 16.5 and 18.8 months in the combination and sequential arms, respectively (p = .866). The combination was more toxic than sequential PC. Grade 3 toxicities were higher with combination PC than to sequential PC (48% vs. 4.3%; p < .001).ConclusionSequential agent chemotherapy may provide similar response rate and overall survival to combination chemotherapy with much lower toxicities. The former can be considered the standard practice in most instances.



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Survival outcome of intermediate risk neuroblastoma at Children Cancer Hospital Egypt

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Hossam Elzomor, Gehad Ahmed, Salma Elmenawi, Naglaa Elkinaai, Amal Refaat, Sonya Soliman, Mai Amr Abdelwahab, Mohamed Saad Zaghloul, Mohamed Fawzy
AimThe study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neuroblastoma patients treated at the Children Cancer Hospital – Egypt and their relation to various clinical and pathological factors.MethodsThe study included stage 3 patients <1.5 years, children 1.5 years or older with stage 3 disease and favorable histopathological features, infants (<1 year) with International Neuroblastoma Staging System (INSS) stage 4 disease, stage 4 children 1–1.5 years with favorable biology, and infants stage 4 s (with unfavorable biologic features). Patients received systemic chemotherapy, in the form of etoposide and carboplatin alternating with cyclophosphamide, doxorubicin and vincristine, administered at 3-week intervals, with a total of 6 or 8 cycles guided by reaching objective overall response (complete/very good partial/partial response).ResultsThe study included 136 patients, 67 males and 69 females. 101 patients had abdominal primary tumors, 28 had mediastinal masss and 7 with masses in the neck; 68% were stage 3 and the remaining (n = 44) had metastatic disease.The three-year overall survival (OS) and event-free survival (EFS) estimates were 94% ± 2% and 90.9% ± 2.5%, respectively. OS and EFS by gender, age, pathology and INPC were all statistically not significantly different. Moreover, OS for patients having surgery versus no surgery (inoperable residual only) was statistically significant (98.4% ± 1.6% & 88.7% ± 5.3%, respectively, p = .034).ConclusionA very high rate of survival is currently achievable in patients with intermediate risk neuroblastoma by chemotherapy or chemotherapy and surgery. In addition to response, our plan is to adopt biologically-based treatment to reduce treatment-induced complications among survivors.



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Comparative study on the analgesic effect of acute ipsilateral shoulder pain after open thoracotomy between preoperative ultrasound guided suprascapular nerve block (SNB) and intraoperative phrenic nerve infiltration (PNI) in cancer lung patients

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Bassel M. Elfokery, Sahar A. Tawfic, Abdelrahman M. Abdelrahman, Dina N. Abbas, Ikramy M. Abdelghaffar
IntroductionAcute ipsilateral shoulder pain (ISP) is a common complaint in patients after thoracotomy. The incidence ranges from 21% to 97%. Unfortunately, clinical studies did not put enough focus on ISP post thoracic surgery.Aim of the workThis study was designed to compare the effectiveness of suprascapular nerve block (SNB) and phrenic nerve infiltration (PNI) for controlling ISP.Patients and methodsOne hundred and thirty-five lung cancer patients (135) scheduled for open-lung surgery were randomly allocated into three equal groups; control group: received thoracic epidural with general anesthesia, suprascapular group: (SNB) one hour before the operation with 10 ml bupivacaine plus thoracic epidural with general anesthesia and phrenic nerve group: (PNI) was performed by the operating surgeon with 10 ml bupivacaine plus thoracic epidural with general anesthesia.The visual analogue score (VAS) of ISP, rescue of ketorolac for break through shoulder pain, peak expiratory flow rate (PEFR) and arterial blood gases were measured every 6 h postoperatively for 48 h.ResultsThe VAS, rescue doses of ketorolc and PEFR were significantly lower in the phrenic nerve group (P-value <0.05). There was no statistically significant difference between the three groups postoperatively as regards arterial blood gases (P-value >0.05).ConclusionPNI is more effective than SNB for ISP.



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Radiotherapeutic factors affecting the incidence of developing hypothyroidism after radiotherapy for head and neck squamous cell cancer

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Mohamed El-Shebiney, Nehal El-mashad, Wael El-mashad, Ahmed A. El-Ebiary, Abdallah E. Kotkat
PurposeThe purpose of this study is to determine radiotherapy (RT) dose-volumetric threshold of radiation-induced hypothyroidism (HT) in head and neck squamous cell carcinoma (HNSCC) patients.Patients and methodsThe diagnosis of HT in 78 HNSCC patients treated with RT was based on a thyroid stimulating hormone (TSH) level greater than the maximum value of laboratory range. In all patients, dose-volumetric parameters were analyzed according to their relation to development of HT, and thyroid volumes spared from doses ≥10, 20, 30, 40 and 50 Gy (V10, V20, V30, V40 and V50) were analyzed from the dose volume histograms (DVHs).ResultsMedian follow-up duration was 31 months. At the end of study, 33 patients (42.3%) developed HT and the cumulative incidence of HT was 24.6%, 36.5% and 42.3% at one, two and three years, respectively. V30 of 42.1% (P = 0.005) was defined as dose-volumetric threshold of radiation-induced HT in HNSCC patients. Our analysis showed that V30 separates patients into low- and high-risk groups; the incidence of radiation-induced HT in the group with V30 < 42.1% and V30 ≥ 42.1% was 29.4% and 71.4%, respectively (P = 0.002).ConclusionsThe V30 may predict risk of developing HT after RT for HNSCC patients. V30 of 42.1%, defined as dose-volumetric threshold of radiation-induced HT, can be useful in treatment planning of HNSCC patients.



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Osteosarcoma subtypes: Magnetic resonance and quantitative diffusion weighted imaging criteria

Publication date: March 2018
Source:Journal of the Egyptian National Cancer Institute, Volume 30, Issue 1
Author(s): Rania Zeitoun, Ahmed M. Shokry, Sahar Ahmed Khaleel, Shaimaa M. Mogahed
IntroductionOsteosarcoma (OS) is a primary bone malignancy, characterized by spindle cells producing osteoid. The objective of this study is to describe the magnetic resonance imaging (MRI) features of different OS subtypes, record their attenuation diffusion coefficient (ADC) values and to point to the relation of their pathologic base and their corresponding ADC value.Patients and methodsWe performed a retrospective observational lesion-based analysis for 31 pathologically proven osteosarcoma subtypes: osteoblastic (n = 9), fibroblastic (n = 8), chondroblastic (n = 6), para-osteal (n = 3), periosteal (n = 1), telangiectatic (n = 2), small cell (n = 1) and extra-skeletal (n = 1). On conventional images we recorded: bone of origin, epicenter, intra-articular extension, and invasion of articulating bones, skip lesions, distant metastases, pathological fractures, ossified matrix, hemorrhage and necrosis. We measured the mean ADC value for each lesion.ResultsAmong the included OS lesions, 51.6% originated at the femur, 29% showed intra-articular extension, 16% invaded neighboring bone, 9% were associated with pathological fracture and 25.8% were associated with distant metastases. On MRI, all lesions showed ossified matrix, 35.5% showed hemorrhage and 58% showed necrosis. The mean ADC values for OS lesions ranged from 0.74 × 10⁻³ mm²/s (recorded for conventional osteoblastic OS) to 1.50 × 10⁻³ mm²/s (recorded for telangiectatic OS) with an average value of 1.16 ± 0.18 × 10⁻³ mm²/s. Conventional chondroblastic OS recorded higher values compared to the other two conventional subtypes.ConclusionOsteosarcoma has different pathologic subtypes which correspondingly vary in their imaging criteria and their ADC values.



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