International Journal of Cancer Therapy and Oncology
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Suboptimal Vitamin D levels among adult survivors of childhood cancers
Get PDFPurpose: Vitamin D plays an important role in many bodily systems, with increasing evidence suggesting its importance for the prevention of chronic diseases and cancer. The identification of vitamin D levels in childhood cancer survivors becomes, therefore, particularly relevant, given that optimizing levels may contribute to the prevention of secondary malignancies and chronic diseases.Methods: A cross - sectional analysis of serum 25 - hydroxyvitamin D levels among adult survivors of childhood cancers living in New York State and surrounding areas (n = 139) was performed. Independent variables included gender, race/ethnicity, cancer site, year of diagnosis, past medical and surgical history, prior radiation therapy; prior chemotherapy, age at diagnosis, age at last clinic visit, year of last clinic visit, height, weight, body mass index, and vitamin D supplementation.Results: Overall, 34% of survivors were vitamin D deficient (< 20 ng/ml), 39% were classified as insufficient (20 - 29 ng/ml) and 27% (≥ 30 ng/ml) were classified as having sufficient levels. Despite vitamin D supplementation among 41 patients, 68.3% continued to have insufficient or deficient levels. Participants with a BMI > 25 demonstrated lower levels of vitamin D (p < 0.05). Vitamin D levels did not vary by age group, race, ethnicity, diagnosis, or years since diagnosis.Conclusion: Given the growing awareness of the role of vitamin D and the documented late effects of treatment for childhood cancers, the high prevalence of vitamin D deficiency within the childhood cancer survivor population is of concern. Vitamin D represents an important target for surveillance and intervention to help improve long - term outcomes of childhood cancer survivors
Long term survival after brain metastases from malignant melanoma
Get PDFWe present the case of a 32-year-old patient with malignant melanoma who relapsed with an unresectable brain metastases (BM). He was managed with whole brain radiotherapy (WBRT) and temozolomide chemotherapy. A metabolic positron emission tomography (PET-scan) complete response was achieved. He is living disease-free more than 6 years after the diagnosis of BM. He is now 51 years old and remains asymptomatic and free of disease since then. However, a pronounced residual image still appears on magnetic resonance imaging (MRI) ant PET-scan
Low-dose versus high-dose radioactive iodine ablation of differentiated thyroid carcinoma: a prospective randomized study
Get PDFPurpose: Following total thyroidectomy of differentiated thyroid carcinoma (DTC), some patients are ablated with radioactive iodine I-131 (RAI). We compare the success of ablation with 30 millicurie (mCi) versus 80 mCi.Methods: We randomized the patients to 30 mCi or 80 mCi RAI after surgery. T1-T3, N0-N1, M0 tumors were included (based on the AJCC 7th edition). Pre-ablation baseline serum thyroglobulin (sTg), and thyroglobulin antibody (Tg Ab) were performed. Six months post-ablation successful thyroid ablation was defined as a negative whole body scan (WBS) and undetectable sTg.Results: Out of 50 patients with DTC, 45 patients fulfilled the eligibility criteria. Total thyroidectomy was performed in 27/ 45 (60%). 26/45 (57.8%) of patients received 30 mCi while 19/45 (42.2%) patients received 80 mCi. The median age was 37 and 36.5 years in the arms 80 and 30 mCi respectively. Papillary carcinoma predominated in 42/45 (93.3%) of patients. T2 tumors predominated in 10/19 (52.6%), and 15/26 (57.7%) of the 80 and 30 mCi arms respectively. According to the American Thyroid Association (ATA) risk classification, all of the patients had low risk disease. Success of ablation was achieved in 15/19 (78.9%), and in 15/26 (57. 7%) of the arms 80 and 30 mCi respectively. No patients developed distant metastases in both arms. The patients who received 80 mCi had longer hospital isolation than the 30 mCi arm (p 0.008). 6/26 (23.1%) patients in the 30 mCi arm were isolated for 2-4 days, whereas all the 80 mCi arm patients were isolated for 3-5 days.Conclusion: Both 80 mCi and 30 mCi RAI have similar success rate in the ablation of thyroid remnant of low risk DTC patients. The low dose is associated with fewer side effects, shorter hospital admission duration, and is less expensive in low risk DTC patients.
Quantitative expression of the eukaryotic translation initiation factor 4E (eIF4E) in egyptian acute leukemia patients and its clinical significance
Get PDFPurpose: The eukaryotic translation initiation factor eIF4E is part of the eIF4F protein complex, which includes, in addition to eIF4E, eIF4G (a scaffolding protein) and eIF4A (an ATP-dependent RNA helicase). The eukaryotic translation initiation factor eIF4E is a potent oncogene elevated in many cancers including leukemias.Methods: In this study, the expression level of eIF4E gene was analyzed in 20 normal healthy controls and 64 patients with de novo acute leukemia (33 Acute myeloid leukemia (AML) and 31 Acute lymphoblastic leukemia (ALL)) using a real-time quantitative reverse-transcriptase polymerase chain reaction (RTQ-PCR) to investigate a possible relation, association or correlation with the clinical features at diagnosis, such as age, gender, lineage, hemoglobin (Hb), total leucocytic count (TLC), platelet count and bone marrow (BM) blast cell infiltration as well as its effect on patients̒ outcome.Results: Comparing AML and ALL patients as regards their clinical and laboratory data showed no statistical significance for TLC and hemoglobin (p-0.838 and 0.920) respectively, but was of statistically significant difference for platelets (p = 0.022) and bone marrow blasts percentage (p = 0.007). Comparison between the 2 groups as regards eIF4E level was of no statistically significant difference, p-value being (p = 0.257) but there was statistically significant difference between eIF4E expression level in AML/Control (p = 0.002), ALL/Controls (p = 0.025). Also analysis of overall survival (OS) time and disease free survival (DFS) in each group and its relation to eIF4E gene showed no statistical significance (p = 0.843 and 0.310) respectively in AML group and (p = 0.971 and no p-value for DFS in ALL as all cases remained alive except for one case while 3 cases were relapsed) in ALL group. Correlation studies showed no significant correlation between AML group and eIF4E gene level as regards age, TLC, hemoglobin and platelets (r = -0.064, p = 0.722; r = 0.062, p = 0.732; r = 0.068, p = 0.712; and r = -0.318, p = 0.071) respectively, while there was significant positive moderate correlation on comparing bone marrow blast% and eIF4E gene level (r = 0.545 and p = 0.001). There was no significant correlation between ALL group and Eif4e gene level as regards age, TLC, hemoglobin, platelets and bone marrow blasts% (r = -0.214, p = 0.248; r = 0.175, p = 0.347; r = -0.056, p = 0.766; r = -0.072, p = 0.700; and r = -0.0004, p = 0.983) respectively.Conclusion: eIF4E was found to be elevated in acute leukemia patients in relation to normal controls and its levels were more in myeloid than lymphoid leukemia and positively correlated with the blast percentage in AML thus its level may contribute to leukemogenesis. eIF4E levels and translation initiation may be an attractive target for anticancer therapeutics
Serum vascular cell adhesion molecule-1 (VCAM1) level is elevated in colorectal cancer regardless of the tumor stage
Get PDFPurpose: Vascular cell adhesion molecule-1 (VCAM1) is a transmembrane glycoprotein, which is expressed on endothelium and plays role in inflammation. It is over-expressed on colorectal cancer (CRC) cells and plays role in metastasis development and angiogenesis. We aimed to compare serum VCAM1 levels of CRC patients with heathy controls and evaluate its relationship with clinicopathological parameters, treatment response and overall survival (OS).Methods: The study enrolled 111 patients with histopathologically confirmed CRC followed-up in our clinic and 30 sex- and age-matched healthy controls. Pre-treatment serum VCAM1 levels were determined by the solid-phase sandwich ELISA method.Results: Metastatic disease was present in 57 patients. Forty percent of 40 metastatic patients receiving systemic therapy had partial or complete response. The median serum VCAM1 level was significantly higher in CRC patients than controls (p<0.001). In addition, serum VCAM1 level was significantly higher in diabetic CRC patients than those without diabetes (p = 0.03). There was no significant relationship between VCAM1 and other clinicopathological parameters including stage and response to systemic therapy. The median follow-up period was 12 (±8.2) months. Twenty patients were dead at the time of analysis. The presence of metastasis (p < 0.001) and elevated CEA level (p < 0.001) were factors affecting OS significantly. However, serum VCAM1 did not have a significant impact on OS (p = 0.55).Conclusion: Serum VCAM1 level is significantly elevated in CRC patients regardless of the tumor stage. However, it has no prognostic or predictive role for response to systemic therapy
Commissioning and quality control of a dedicated wide bore 3T MRI simulator for radiotherapy planning
Get PDFPurpose: The purpose of this paper is to describe a practical approach to commissioning and quality assurance (QA) of a dedicated wide-bore 3 Tesla (3T) magnetic resonance imaging (MRI) scanner for radiotherapy planning.Methods: A comprehensive commissioning protocol focusing on radiotherapy (RT) specific requirements was developed and performed. RT specific tests included: uniformity characteristics of radio-frequency (RF) coil, couch top attenuation, geometric distortion, laser and couch movement and an end-to-end radiotherapy treatment planning test. General tests for overall system performance and safety measurements were also performed.Results: The use of pre-scan based intensity correction increased the uniformity from 61.7% to 97% (body flexible coil), from 50% to 90% (large flexible coil) and from 51% to 98% (small flexible coil). RT flat top couch decreased signal-to-noise ratio (SNR) by an average of 42%. The mean and maximum geometric distortion was found to be 1.25 mm and 4.08 mm for three dimensional (3D) corrected image acquisition, 2.07 mm and 7.88 mm for two dimensional (2D) corrected image acquisition over 500 mm × 375 mm × 252 mm field of view (FOV). The accuracy of the laser and couch movement was less than ±1 mm. The standard deviation of registration parameters for the end-to-end test was less than 0.41 mm. An on-going QA program was developed to monitor the system’s performance.Conclusion: A number of RT specific tests have been described for commissioning and subsequent performance monitoring of a dedicated MRI simulator (MRI-Sim). These tests have been important in establishing and maintaining its operation for RT planning
What should we know about photon dose calculation algorithms used for radiotherapy? Their impact on dose distribution and medical decisions based on TCP/NTCP
Get PDFThe dose calculation algorithms, integrated in a radiotherapy treatment planning system, use different approximations to swiftly compute the dose distributions. Any biological effect is somehow related to the dose delivered to the tissues. Thus, the optimization of treatment planning in radiation oncology requires, as a basis, the most accurate dose calculation to carry out the best possible prediction of the Normal Tissue Complication Probability (NTCP), as well as Tumor Control Probability (TCP). Presently, a number of bio-mathematical models exist to estimate TCP and NTCP from a physical calculated dose using the differential dose volume histogram (dDVH). The purpose of this review is to highlight the link between any change of algorithms and possible significant changes of DVH metrics, TCP, NTCP and even more of estimated Quality-adjusted life years (QALY) based on predicted NTCP. The former algorithms, such as pencil beam convolution (PBC) algorithm with 1D or 3D density correction methods, overestimated the TCP while underestimating NTCP for lung cancer. The magnitude of error depends on the algorithms, the radiobiological models and their assumed radiobiological parameters setting. The over/under estimation of radiotherapy outcomes can reach up to 50% relatively. Presently, the anisotropic analytical algorithm (AAA), collapsed cone convolution algorithm (CCC), Acuros-XB or Monte Carlo are the most recommended algorithms to consistently estimate the TCP/ NTCP outcomes and QALY score, to rank and compare radiotherapy plans, to make a useful medical decision regarding the best plan. This paper points out also that the values of the NTCP radiobiological parameters should be adjusted to each dose calculation algorithm to provide the most accurate estimates.
Clinical characteristics of triple negative breast cancer in Egyptian women: a hospital-based experience
Get PDFPurpose: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer with poor prognosis despite the high rates of response to chemotherapy. We aim to study the clinical features, factors influencing recurrence and survival outcomes of TNBC patients.Methods: We retrospectively studied the charts of patients with biopsy proven TNBC treated at The Clinical Oncology Department Ain-Shams University between 2009 and 2012.Results: One hundred and forty five patients fulfilled the eligibility criteria. The incidence of TNBC was 10.5% - 15% with a mean of 12% of all breast cancer patients. The follow-up duration ranged from six months to four years. The age range was 26 to 78 years. Infiltrating ductal carcinoma represented 93.1% of the pathologic types. 87% of patients were free of metastases (M0) at presentation. Clinical stages II and III represented 38 and 39.5% of the patients. 66% of patients had modified radical mastectomy. Following surgery, 77.5% of patients received adjuvant chemotherapy while 61% of the patients had adjuvant radiation therapy. Anthracyclines based chemotherapy was given to 52% of patients. Disease-free survival (DFS) of the M0 patients at 20 and 30 months was 92% and 80% respectively. Relapse occurred in 23% of M0 patients. After a mean duration of DFS of 15.1 months, the most common sites of metastases for relapsed M0 patients were pulmonary (44.8%), bone (41.4%), and locoregional (13.8%). The median overall survival (ORS) of patients was 18 months (1 - 45 months), whereas for the M1 group of patients the median ORS was 9 months (2 - 29 months).Conclusion: The incidence, pathological characteristics, and clinical behavior of TNBC were similar to what is mentioned in the literature. Adding taxanes to the chemotherapy protocols and using postoperative radiotherapy were both associated with a significant increase in the mean period of DFS, while did not significantly affect the ORS
Preliminary experience of fractionated stereotactic radiosurgery with extend system of Gamma Knife
Get PDFPurpose: The purpose of this study is to present multisession stereotactic radiosurgery with initial experience using custom made extend system (ES) of Gamma Knife.Methods: The ES is comprised of a carbon fiber frame also called extend frame, vacuum head rest cushion, patient surveillance unit and a configurable front piece with dental impression tray. The extend frame is a rigid connection between patient's head and patient positioning system (PPS) of Gamma Knife. A dental impression of patient was created and attached to the frontal piece of extend system. The treatment setup involves positioning the patient within the extend frame using patient specific headrest cushion and front piece. The reference patient’s head position was recorded through measurements of repositioning check tool (RCT) apertures using a high precision digital probe before computed tomography (CT) scan. The RCT measurements taken before treatment were compared with recorded reference position to ensure appropriate patient treatment position. Volumetric magnetic resonance (MR) scan was co-registered with stereotactic CT scan on Leksell Gamma plan. Fused MR to CT images on Gamma Plan was utilized to delineate regions of interest and prepare a precise treatment plan. The presented study includes positional reproducibility check and dosimetric evaluation of ten patients treated with ES.Results: Forty-three fractions on ten patients with prescribed treatment format were delivered successfully. An average tumor volume of 11.26 cm3 (range, 340 mm3 to 59.12 cm3) was treated with ES. The mean tumor coverage of 91.91% (range, 90% to 95%) was able to achieve at 50% prescription isodose without compromising adjacent normal structure radiation dose tolerances. The mean inter-fraction positional variation of 0.69 mm influences an inherent strength of immobilization technique. Follow-up of seven patients at a median interval of 16 months (range, 9 months to 26 months) showed evidence of 100% radiographic control with improved clinical results.Conclusion: Conjugative clinical outcome shows the efficacy of fractionation in various clinical indications
Ductal carcinoma In-Situ in turner syndrome patient undergoing hormone replacement therapy: A case report
Get PDFTurner’s syndrome is a rare congenital disease which affects about 1 in every 2500-3000 live-born females. This happens due to chromosomal abnormalities in a phenotypic female, causing increased gonadotropin concentrations and low concentrations of estrogens from infancy. As a result, hormone replacement therapy is started in most adolescent Turner syndrome patients to initiate and sustain sexual maturation. Accordingly, most Turner’s syndrome patients undergo several decades of estrogen replacement therapy, from puberty to post-menopausal age. The highly publicized findings of the Women’s Health Initiative have called into question the appropriateness of hormone replacement therapy in adolescents with Turner’s syndrome. Those concerns were mostly theoretical extrapolations, as few prospective studies of cancer occurrence in women with Turner syndrome have been reported. Consequently, several recent publications have challenged those extrapolations, based on the assertion that the levels of hormone replacement in Turner syndrome patients are well below the physiologic levels observed in normal menstruating women, as well as the fact that these women are significantly younger than those studied by the Women’s Health Initiative. In discord to those reports, we present a case of ductal carcinoma in-situ in a 40-year-old Turner patient, who had undergone over two decades of combined hormone replacement therapy. The patient underwent an elective excisional biopsy for a palpable mass, with histopathology revealing a complex fibroadenoma with a nidus of ductal carcinoma in-situ. The lesion was noted to be estrogen receptor positive and progesterone receptor negative, with heavy staining for HER-2/Neu receptor. The patient was treated with tamoxifen. While a rare case, it is imperative for the astute clinician to keep in mind the consequences of long-term hormone replacement therapy in Turner’s syndrome patients in order to avoid missed diagnosis of breast cancer for optimum management of these patients