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Multiple myeloma in Africa: review of an under-diagnosed carcinoma

Muhammad Sagir Shehu ¹, Idris Abdullahi Nasir ², Anthony Uchenna Emeribe ³, Jessy Thomas Medugu ²

^1. Immunology Unit, Department of Medicine, Ahmadu Bello University, PMB 05 Zaria, Kaduna State, Nigeria

^2. Department of Medical Laboratory Science, University of Maiduguri, PMB 1069 Maiduguri, Borno state, Nigeria.

^3. Department of Medical Laboratory Science, University of Calabar, PMB 1115 Calabar, Cross River State, Nigeria

Email address: eedris888@yahoo.com

Abstract: Multiple myeloma (MM) is a blood carcinoma and gammopathy that develops in the bone marrow. Normal antibody-producing plasma cells transform into malignant myeloma cells. MM is the most common hematologic cancer in African descends. Previous MM findings suggest low survival rate in blacks. In MM, malignant cells crowd out and inhibit the production of normal blood cells and antibodies in the bone marrow. Since, this condition has been established as a common blood cancer, it is crucial for healthcare professionals in African nations to consider MM in differential diagnosis of blood-related disorders. This mini-review summarized pertinent key concepts of epidemiology, diagnosis and state of affairs of multiple myeloma in Africa with the aim to suggest the need to use the information herewith to incorporate MM international best pathological practice.

[Muhammad Sagir Shehu, Idris Abdullahi Nasir, Anthony Uchenna Emeribe, Jessy Thomas Medugu. Multiple myeloma in Africa: review of an under-diagnosed carcinoma. Cancer Biology 2015;5(4):1-5]. (ISSN: 2150-1041). http://www.cancerbio.net. 1. doi:10.7537/marscbj050415.01.

Keywords: Multiple myeloma; Immunopathology; Blood cancer; diagnosis; Africa

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Clinical outcomes of Basal versus Non-Basal clone in Triple Negative Breast Cancer patients

Ashraf F. Barakat¹, Fatma Z. Hussien¹, Dareen A. Mohamed² and Radwa M. Orbey²

Clinical Oncology¹ and Pathology Department², Tanta University

FatmaZ_555@yahoo.com

Abstract: Objective: The aim of this study was to investigate the co-expression of basal markers in triple negative breast cancer (TNBC) patients and to assess its impact on survival, disease free and overall (DFS and OS). Methods: This study was conducted on 51 patients with TNBC subtype who were treated from January 2009 until March 2013. All patients were evaluated by immunohistochemical analysis for steroid hormones (ER, PR, HER.2 & Ki 67) and basal markers (CK5/6 & EGFR). They were subsequently subdivided into two groups: basal group (n=24, 47.1%) and non-basal group (n=27, 52.9%). Basal markers expression were correlated with clinicopathological factors analyzed using the Chi square test and survival (DFS and OS) using kaplan -meier. Cox proportional hazard model was used to assess variables in multivariate analysis. Results: The mean age of all patients was 45.6 years. The median follow-up period was 27 months. Basal group showed 20/24 patients (83.3%) with positive CK5/6, 21/24 patients (87.5%) with positive EGFR and 17/24 patients (70.8%) with positive both CK5/6 and EGFR. For recurrent event, 23/24 patients (95.8%) in basal group versus 10/27 patients (37%) in non-basal group, P=0.001. For death event, 19/24 patients (79.2%) in basal group versus 5/27 patients (18.5%) in non-basal group, P=0.001. There were significant worsened survival with basal group compared to non-basal group (DFS and OS), P≤0.001. There was negative significant impact of all prognostic factors on DFS in basal group. Multivariate analysis revealed that rate of metastases (95% C1 (1.603-3.370), OR= 2.307, P=0.001), high grade (95% C1 (1.631-8.52), OR= 3.729, P=0.002) and positive Ki 67> 14% (95% C1 (0.029-0.634), OR=0.135, P=0.011) had retained their independent prognostic value for DFS with basal-like tumors. Conclusion: TNBC basal-like is a poor prognostic factor for DFS and OS, need more trials to support this prognostic power and allow the use of effective specific therapeutic targets to improve future image of this subtype.

[Ashraf F. Barakat, Fatma Z. Hussien, Dareen A. Mohamed and Radwa M. Orbey. Clinical outcomes of Basal versus Non-Basal clone in Triple Negative Breast Cancer patients. Cancer Biology 2015;5(4):6-16]. (ISSN: 2150-1041). http://www.cancerbio.net. 2. doi:10.7537/marscbj050415.02.

Keywords: Triple negative breast cancer, immunohistochemistry, Basal markers expression, CK5/6, EGFR, Survival.

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Assessment of costs and burden associated with cancer chemotherapy in patients attending a tertiary hospital in Zaria, Nigeria

Auwal A. Ahmad ¹, Titus Shekarau ¹, Idris Abdullahi Nasir ², Zayyad Muhmmad Aminu ³, Shafi’u Muhammad ³, Umar Mukhtar Danmusa ¹

¹ Department of Pharmaceutical services, Ahmadu Bello University Teaching Hospital, Shika-Kaduna State, Nigeria

² Department of Medical Laboratory Science, College of Medical Sciences, University of Maiduguri, PMB 1069 Maiduguri, Borno state, Nigeria

³ Department of Clinical Pharmacy, Faculty of Pharmaceutical sciences, Ahmadu Bello University, Zaria-Kaduna State, Nigeria

Correspondence address: eedris888@yahoo.com

Abstract: This study aimed to determine the costs and burden associated with cancer chemotherapy by calculating the direct costs with or without co-morbidities in patients attending Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria. This was retrospective observational study conducted on cancer patients’ data as well as cost details through the use of structured questionnaire interview. These data were reviewed and analyzed for relevant inferences. Healthcare associated cost were calculated based on the total amount spent by the patients to that of total number of patients. A total of 31 patients were enrolled, out of which 26 supplied complete health care-related cost details required for the study. The average cost for cancer chemotherapy was 29034.4 (Nigerian Naira), they cost was least among those within the age group 26-35 years, 20405 (Nigerian Naira) and highest among 51-70 years, 62550 (Nigerian Naira). 19 (69.3%) of patients complained of loss of productivity for over > 7 days/ month while 4, (13.4%) never had any decline in their productivity. 13 (50%) of the patients strongly agreed with difficulty in financing cancer chemotherapy while all strongly supports the need for inclusion of chemotherapeutic agents in the national health insurance scheme and the need for government and non-government interventions through cost relieve programs. The average cost of cancer chemotherapy at ABUTH Zaria was 29034.4 (Nigerian Naira). Considering the per capita income of average Nigerian, cancer chemotherapy places high financial burden in these patients. This thus justify the need for governmental and non-governmental interventional programs towards relieving these patients.

[Auwal A. Ahmad, Titus Shekarau, Idris Abdullahi Nasir, Zayyad Muhmmad Aminu, Shafi’u Muhammad, Umar Mukhtar Danmusa. Assessment of costs and burden associated with cancer chemotherapy in patients attending a tertiary hospital in Zaria, Nigeria. Cancer Biology 2015;5(4):17-21]. (ISSN: 2150-1041). http://www.cancerbio.net. 3. doi:10.7537/marscbj050415.03.

Key words: Health care cost, cancer chemotherapy. Cost analysis

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Second Malignancy in a Patient with Long Survival from Solitary Plasmacytoma Previously Treated with Radiation

 * A. A. Adenipekun **M.A Jimoh, *T.N Elumelu

*Department of Radiotherapy College of Medicine, University of Ibadan

**Dept. of Radiotherapy, University College Hospital, Ibadan.

Email- adenipek2000@yahoo.com

Abstract: We report a case of a 39 year- old man with second malignancy 13 years after chemo-radiation therapy for solitary plasmacytoma of the fontal bone. The risk of second cancers is a well- known adverse late effect of radiation therapy. However, this risk may be less with the use of proton- beam therapy, the patient actually presented with nasal bleeding of 5 years duration and progressive swelling of the face of 2 years duration with associated nasal obstruction and weight loss.  Examination revealed a bilateral purulent conjunctival hyperemia. Direct examination revealed swelling on the frontal sinus and swelling over the antrum. CT brain showed malignant and vascular tumor of the frontal bone involving the nasal bones and paranasal sinuses and compressing the frontal brain tissues. This was histologically confirmed. The frontal bone was completely destroyed and frontal brain tissue was covered only by skin. He received 6 courses of 3 weekly combination chemotherapy with total of 60Gy of radiotherapy to the left and lateral face and 10Gy to the anterior face with complete regression. He was on follow up for 3 years during which the lesion was controlled with no evidence of recurrence nor neutral deficit. Patient was however lost to follow up for 10 years. He presented again after 13 years of treatment with complaints of painful ulcer on the right lower mandible and biopsy of lesion came as squamous cell carcinoma. This was completely different from the firs histology of plasmacytoma for which he received external beam radiotherapy, however the site of present disease was in the field of previous treatment. This is therefore suggestive of a second malignancy appearing 13 years after the initial external beam radiotherapy. He received cisplatin and 5fluorourasil in preparation for further radiotherapy after chemotherapy patient lost to follow up again and eventually was confirmed to have died at home.

[A. A. Adenipekun, M.A Jimoh, T.N Elumelu. Second Malinancy In A Patient With Long Survival From Solitary Plasmacytoma Previously Treated With Radiation. Cancer Biology 2015;5(4):22-25]. (ISSN: 2150-1041). http://www.cancerbio.net. 4. doi:10.7537/marscbj050415.04.  

Keywords: External beam,  Radiotherapy, Chemotherapy, Radiation, Oral cavity cancer, Second cancer.

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Cyclophosphamide with Adjuvant Chemotherapeutic Drugs Induces Epigenetic Changes in Hepatocellular Carcinoma Cells

Hussein Sabit^1*, Arwa S. Abdel-Sattar¹, Shimaa E. Abdel-Ghany², Asmaa M. Abushady³, Osama A. M. Said¹

¹ College of Biotechnology, Misr University for Science and Technology, Giza, Egypt,

² Research and Development Center, Misr University for Science and Technology, Giza, Egypt,

³ Department of Genetics, Fac. Agric., Ain Shams University, Cairo Egypt.

* Corresponding author: mailto: hussein.sabit@must.edu.eg.

Abstract: Cancer remains the major health threat worldwide; therefore, the extensive search for potent cancer-controlling agents are still a big demand. Hepatocellular carcinoma (HCC) is a type of cancer widespread in the developing countries. In the present study, the role of Cyclophosphamide and drug combinations (including Erlotinib, Temozolomide, Vorinostat, and Sodium Phenylbutyrate) as DNA methyltransferase (DNMT) and Histone deacetylase (HDAC) inhibitors was evaluated. Two concentrations of each drug i.e., 3µM and 5µM for one incubation period of 72 h were applied. Trypan blue test was used to count the number of viable cells before and after treatments. DNA degradation assay was employed to evaluate the effect of Cyclophosphamide and a combination of drugs on the integrity of genomic DNA. Global methylation was also quantified via measuring the concentration of 5-Methylcytidin in the treated and un-treated HCC cells. Data obtained indicated that treating HCC cells with Cyclophosphamide either alone or in combination with other drugs has resulted in a significant decrease in the number of viable cells. Meanwhile, global DNA methylation data analysis showed that three combinations have resulted in hypomethylating the whole genome of HCC cells (Cyclophosphamide with Erlotinib, Cyclophosphamide with Sodium Phenylbutyrate, and Cyclophosphamide with Vorinostat). Although in vitro data need to be tested on the pre-clinical level, the best combination, Cyclophosphamide combined with Sodium Phenylbutyrate, might be recommended to be used in treating HCC in vivo.
[Hussein Sabit, Arwa S. Abdel-Sattar, Shimaa E. Abdel-Ghany, Asmaa M. Abushady and Osama A. M. Said. Cyclophosphamide with Adjuvant Chemotherapeutic Drugs Induces Epigenetic Changes in Hepatocellular Carcinoma Cells. Cancer Biology 2015;5(4):26-34]. (ISSN: 2150-1041). http://www.cancerbio.net. 5. doi:10.7537/marscbj050415.05.
 

Keywords: Hepatocellular carcinoma, HCC, Epigenetics, chemotherapeutic drugs.

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Bladder preservation by neoadjuvant chemotherapy followed by gemcitabine as radiosensitizer for muscle-invasive transitional cell carcinoma of the urinary bladder after maximal TURBT

Alaa fayed, M.D.¹, Abd el motaleb mohammed, M.D.¹, Maged M. Ali, M.D.², Esam E.A. Dessoky, M.D.²

¹Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Zagazig University , Egypt.

²Urology Department, Faculty of Medicine Zagazig University, Egypt.

fayed_alaa@yahoo.com

Abstract: Objectives: To evaluate prospective phase II study of neoadjuvant chemotherapy and gemcitabine as radiosensetizer in conservative management of muscle-invasive transitional cell carcinoma of the urinary bladder. Patients and methods: Forty eight patients with transitional cell carcinoma, stage T2b-T4aN0M0, bladder cancer underwent maximal TURBT followed by neoadjuvant chemotherapy carboplatin AUC5 D1 and gemcitabine 1000 mg/m² D1and D8 repeated every 21 days for 2 cycles followed by concurrent radiation 65Gy with Gemcitabine given intravenously at 100 mg/m² on days 1, 8, 15, 22, 29, 36. The end points were tumor response, toxicity and survival. Results: The neoadjuvant as well as concurrent chemoradiotherapy were tolerated with low toxicity rates as the following, Urinary Bladder irritative symptoms developed in 2 patients (4.1%) and successfully managed with antimuscarinic. Neutropenia occurred in 4 patients (8.3%) while febrile neutropenis in 1 patient (2%). Nausea and vomiting occurred in 6 patients (12.5%) while nephrotoxicity occurred in 2 patients (4.1%). Complete response was noted in 28 patients (58.3%). Partial response was observed in 15 patients (31.25%). At time of analysis, there were fourteen deaths (29.1%) due to bladder cancer. Three-year cancer specific survival (CSS) and overall survival (OS) were 69.9% and 66.6%. Twenty one patients (43.7%) were tumor free and kept their bladder at time of analysis. Conclusion: Neoadjuvant chemotherapy followed by gemcitabine as radiosensitizer for muscle-invasive transitional cell carcinoma of the urinary bladder was tolerable with good bladder preservation and overall survival.

[Alaa fayed, Abd el motaleb mohammed, Maged M. Ali, and Esam E.A. Dessoky. Bladder preservation by neoadjuvant chemotherapy followed by gemcitabine as radiosensitizer for muscle-invasive transitional cell carcinoma of the urinary bladder after maximal TURBT. Cancer Biology 2015;5(4):35-41]. (ISSN: 2150-1041). http://www.cancerbio.net. 6. doi:10.7537/marscbj050415.06.

Keywords: Bladder cancer, gemcitabine, radiosensetizer

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Prevalence Of Helicobacter pylori And Its Association With Abo Blood Group In Asymptomatic, Ulcer Students Of Western Delta University, Oghara, Nigeria

Mordi Raphael Mbadiwe ² Braimah Mikalu Rashidat ¹ Igere Bright ¹

¹ Western Delta University, Oghara, Delta State.

² Benson Idahosa University, Benin city, Edo State

Corresponding author: Mordi Raphael Mbadiwe

Email: Raphael_mordi@yahoo.com

Abstract: This study aims to determine the involvement of Helicobacter. pylori as a cause of abdominal discomfort and peptic ulcer, and also to determine if there is any correlation with ABO blood group in asymptomatic individuals. Blood samples were collected from (fifty) healthy individuals, consisting of 8 males and 42 females aged between 17-30 years (mean 23.5 years). This was accompanied with a questionnaire for demographic data. H. pylori one step test kit was used. ABO blood group and rhesus factors were determined by slide agglutination using serum that was serially diluted. Results showed that 64⁰/₀ were sero-positive for H pylori. Of the seropositive subjects, 62.5⁰/₀ (n=5/8) were male and 35.7% (n=15/42) were females. The frequency of the ABO and rhesus positive (Rh+) blood groups among seropositive subject was (A=6%, B=8%, AB=4% with rhesus positive 58% and rhesus negative 6%) and among seronegative subjects it was (A=8%, B=0%, AB=0%, 0=28% with rhesus positive 34% and rhesus negative 2%). The results of this study, showed that ABO blood group and rhesus compatibility greatly influenced the seropositivity for H pylori infection. Further dilution of the blood samples showed a clear significant rise in titer up to 1:160. The prevalence of cases after the dilution dropped in the following manner (1:20=26%, 1:40=12%, 1:80=8%, and 1:160=2%) the seronegative cases increased during the dilution as (1: 20=74%, 1:40=92%, and 1:160=98%). Prevalence of H. pylori infection still remains high after serial dilution. Conclusion: The detection of high prevalence of H. pylori infection among asymptomatic individuals and the involvement of ABO blood groups necessitates blood screening for every individual especially those that possess the blood groups that are at most risk of infection.

[Mordi Raphael Mbadiwe , Braimah Mikalu Rashidat, Igere Bright. Prevalence Of Helicobacter pylori And Its Association With Abo Blood Group In Asymptomatic, Ulcer Students Of Western Delta University, Oghara, Nigeria. Cancer Biology 2015;5(4):42-67]. (ISSN: 2150-1041). http://www.cancerbio.net. 7. doi:10.7537/marscbj050415.07.

Key words: Seroprevalence; Asymptomatic individuals; ABO blood group; Helicobacter pylori; Infection.

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Prognostic Value of Doppler Perfusion Index in Early Colorectal Cancer for Adjuvant Chemotherapy

Ahmad Alhosainy ¹, Ahmed Z Alattar¹, Abd Elmotaleb Mohamed¹ Inas M.Elfiki², Jihan A. Shawky³ and Abd Elhafez M. Elsheweal⁴

¹Clinical Oncology & Nuclear Medicine, ² Radiology, ³ Tropical Medicine, and ⁴ General Surgery Departments, Faculty of Medicine, Zagazig University, Zagazig, Egypt

ahmedenbedo@hotmail.com

Abstract: Objective: Until now there is no clear recommendation for the application of adjuvant chemotherapy in patients with colorectal cancer stage Dukes A, despite undergoing apparently curative resection, are at high risk of recurrence. We assessed whether the doppler perfusion index (DPI; ratio of hepatic arterial to total liver blood flow) could be used to select patients who should receive adjuvant chemotherapy. Aim: to assess the value of DPI for selecting patients with early stage colorectal cancer undergoing curative surgery to receive adjuvant chemotherapy. Patients and methods: fifty patients (40 males and 10 females, median age 61, range 23-68) undergoing apparently curative surgery for colorectal cancer were staged using Dukes' classification. In addition, DPI was measured before surgery by means of a duplex/color Doppler sonography. A DPI value of at least 0.3 was defined as abnormal. After surgery patients were followed up for recurrences every three months for 3 years. Results: patients with normal DPI had recurrence-free survival of 80% and overall survival of 85%, compared with 43.3% and 60% for those with abnormal DPI values. Conclusion: we conclude that; DPI can be used to identify patients with early stage colorectal cancer at high risk of recurrence who are in need for adjuvant treatment

[Ahmad Alhosainy, Ahmed Z. Alattar, Abd Elmotaleb Mohamed, Inas M. Elfiki, Jihan A. Shawky, and Abd Elhafez M. Elsheweal. Value of Doppler Perfusion Index in Early Colorectal Cancer for Adjuvant Chemotherapy. Cancer Biology 2015;5(4):68-75]. (ISSN: 2150-1041). http://www.cancerbio.net. 8. doi:10.7537/marscbj050415.08.

Key words: DPI, colorectal cancer, Dukes’ stage A and B.

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Environmental Risk Posed by Heavy Metal Concentration in the Tissue of Tympanotonus fuscatus from Calabar River, Nigeria.

George, Ubong Uwem.

¹Department of Zoology and Environmental Biology University of Calabar, Calabar, Cross River State, Nigeria.

*Corresponding author: talk2georgeubong@gmail.com

Abstract: Environmental pollution associated with heavy metal concentrations is an emerging issue in most developed and undeveloped countries. Calabar River has been reported to be open to several inputs from industrial activities within the environment. This research was therefore carried out to determine the heavy metal concentrations in tissues of Tympanotonus fuscatus within the following months (August, September and October, 2014). From the results it was found out that the mean concentration of heavy metal in month of August followed the trend: Zn>Cu>Fe>Cd>Pb>Cr, while in September: Fe>Cu>Zn>Pb>Cd>Cr and October trend was Fe>Cu>Zn>Pb>Cr>Cd. The high concentration of Zn (0.091 mg/l) in month of August can be attributed to dissolution of zinc from oil pipelines fixed across the water body by oil companies that are accumulated in tissues of T. fuscatus. Fe concentration was found to be higher as compared to other metals in month of September (0.073 mg/l) and October (0.075 mg/l) and can be traced to the use of iron coagulants or the corrosion of steel and cast iron pipes during the process of water distribution.

[George, U. U. Environmental Risk Posed by Heavy Metal Concentration in the Tissue of Tympanotonus fuscatus from Calabar River, Nigeria. Cancer Biology 2015;5(4):76-79]. (ISSN: 2150-1041). http://www.cancerbio.net. 9. doi:10.7537/marscbj050415.09.

Keywords: Environmental Risk, Heavy Metal, Concentration, Tissue, Tympanotonus fuscatus, Calabar River

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High or Low Ligation of the Inferior Mesenteric Artery during Curative Surgery for Rectal Cancer

Ali Zedan¹, Haisam Atta², Adel gabr³, and Tareq Salah⁴

¹Department of Surgical Oncology, South Egypt Cancer Institute (SECI), Assiut University, Egypt

²Department of Radiology / Oncoradiology South Egypt Cancer Institute (SECI), Assiut University, Egypt

³Department of Medical Oncology, South Egypt Cancer Institute (SECI), Assiut University, Egypt

⁴Department of Clinical Oncology, Faculty of Medicine, Assiut University, Egypt.

alizedan73@yahoo.com

Abstract: Background: In rectal cancer surgery. The position of arterial ligation can affect genito-urinary function, bowel function, oncological outcomes, and the incidence of anastomotic leakageInlow ligation preservation of the autonomic nerve, increased blood supply, decrease in anastomotic leakage. Oncological safety and tension-free anastomosis remain drawbacks. High ligation decrease perfusion and innervation of the proximal limb allows for enbloc dissection of the node metastases at and around the origin of the IMANo conclusive evidence to. Improved survival Objective compare complication and Oncological outcomes between high and low tie of IMA Methods a retrospective analysis of 114 patients who were operated on for rectal cancer during the period of 5 years [1 January 2007 – 31 December 2011] at the south Egypt cancer Institute of Assuit University..In 38 patients (33.3%), a high ligation76 patients (66.7%) were treated low IMA ligation). in which the fatty tissue and metastatic nodes at the root of the inferior mesenteric are removed (Dumpy) The pathologic grade and stage of tumors was quite similar in both groups. Results Nine patients (24%) in the high tie (HT) group and twenty patients (26%) in the LT(low tie group)group received a defunctioning stoma. The mean number of lymph nodes harvested in the high tie group was 21 in the LT group, 18 (p = 0.35). The mean number of positive lymph nodes in the high tie group was 4 in the LT group, 3 (1–5); (p = 0.32). Two patients had positive lymph nodes at the root of IMA, one in the High tie group (2.7%) and one in the LT group (1.3) Urinary dysfunction (7.9%) in Low tie group and (10.5%) in high group p value (0.73). Sexual Dysfunction (10.5%) in LT group (13.2%) in a high group (0.76), Gastrointestinal Dysfunction (3.9%) in LT group, (5.3%) in a high group p value (1.0) Anastomotic leakage (5.3%) in LT group (7.9%) in a high group p value (0.68). Five years overall survival in low IMA = 78.2±2.7% versus 79.7±3.3%, p value = 0.98 (NS) Five years recurrence free survival in low IMA = 86.2±4.0% versus 86.3±6.1%, p value = 0.82 (NS) Recurrence (11.8%) in LT group, and (10.5%) in high group. Mortality occur in (2.6%) in LT group, and (2.6%) in high group. Conclusion. High ligation of the IMA does not significantly improve the survival, when high ligation is not necessary, we prefer low ligation. With the fatty tissue and metastatic nodes at the root of the IMA are removed.

[Ali Zedan, Haisam Atta,Adel gabr, and Tareq Salah. High or Low Ligation of the Inferior Mesenteric Artery during Curative Surgery for Rectal Cancer. Cancer Biology 2015;5(4):80-86]. (ISSN: 2150-1041). http://www.cancerbio.net. 10. doi:10.7537/marscbj050415.10.

Keywords:Rectal Cancer, Inferior Mesenteric Artery

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Prognostic Impact of Lymph Nodes Metastases in Hepatocellular Carcinoma

Alaa Maria and Walid Al-Morsy.

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

alaamaria1@hotmail.com

Abstract: Purpose: Explore the clinicopathological characteristics of HCC patients and evaluate the impact of lymph node (LN) metastasis on survival. Material and Methods: Clinical data of 261 HCC patients treated at Clinical Oncology Department, Tanta University were retrieved from the collected database. Patients with LNs metastases were compared with those without LNs metastases. Results: Patients without LNs metastases had a significantly better Child-Pugh score (p=0.004), smaller size of intra-hepatic focal lesion (p=0.003), and better tumor morphology (p=0.003). The most frequent extra-hepatic metastases sites were LNs (44.4%) and bone (43.3%). The commonest LN sites were the para-aortic (25.7%), porta-hepatis (21.8%). Patients received active treatment to control intra-hepatic disease had significantly higher median survival than patients underwent only supportive and palliative measures (p<0.001). The 1- and 2-year overall survival (OS) rates were 28.7% and 5.3% respectively. Six factors (performance status, size of primary intra-hepatic tumor, ascites, Child-Pugh score, portal vein thrombosis, and LNs metastases) significantly affect the OS rate in univariate analysis (p<0.001, =0.001, <0.001, <0.001, =0.048 and <0.001, respectively). On multivariate analysis, performance status, ascites and LN metastases were independent risk factor of OS (p<0.001, =0.017, and =0.008 respectively). Conclusion: Lymph node metastasis was the commonest site of extra-hepatic spread of HCC and presented with a multifocal, large tumor size (≥ 5 cm) with poor Child-Pugh score and was one of the independent risk factors affecting OS. Selected patients with extra-hepatic spread may gain benefit from treatment of intra-hepatic lesions.

[Alaa Maria and Walid Al-Morsy. Prognostic Impact of Lymph Nodes Metastases in Hepatocellular Carcinoma.

Cancer Biology 2015;5(4):87-93]. (ISSN: 2150-1041). http://www.cancerbio.net. 11. doi:10.7537/marscbj050415.11.

Key words: Hepatocellular carcinoma, lymph nodes metastases, prognostic factors.

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Molecular and Cytogenetic Markers in Acute Myeloid Leukemia

Mohammed Albalawi¹, Mohammed Al Shahrani² and Ghaleb Elyamany³

¹Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia

²Dept. of Pediatric Hematology/Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

³Dept. of Central Military Laboratory and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia and Department of Hematology, Theodor Bilharz Research Institute, Egypt.

albalawi_21@hotmail.com

Abstract: Acute myeloid leukemia (AML) is a disease of hematopoietic progenitor cells with acquisition of heterogeneous genetic abnormalities that cause abnormal cell growth, proliferation and differentiation. Cytogenetic abnormality is considered an important prognostic factor in AML patients. AML patients are prognostically classified into three groups (favorable, intermediate, and poor) based on their molecular and cytogenetic analysis. Clonal chromosomes alterations are detected in approximately 50-55% of adults with AML. However, 40% to 49% of adults and 25% of children with AML, have no detectable chromosomal abnormality can be found on standard cytogenetic analysis. These cytogenetically normal (CN) patients have been classified as an intermediate-risk. Recently, with the advent of next generation sequencing, different molecular genetic abnormalities have been found in AML such as DNMT3A, TET2, IDH1/2, NRAS, KRAS, BCOR, RUNX1, and WT1. However, the significance of many of these gene mutations is unclear.

[Mohammed Albalawi, Mohammed Al Shahrani and Ghaleb Elyamany. Molecular and Cytogenetic Markers in Acute Myeloid Leukemia. Cancer Biology 2015;5(4):94-106]. (ISSN: 2150-1041). http://www.cancerbio.net. 12. doi:10.7537/marscbj050415.12.

Keywords: Acute myeloid leukemia (AML); Molecular Genetic Markers; NPM1; FLT3-ITD; CEBPA

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Concurrent Chemoradiotherapy with Weekly Docetaxel and Cisplatin for Locally Advanced Head and Neck Cancer

Ola Nabih¹, Hoda H. Essa¹, Reham Abdel-Wahab^1,4, Nagham Nabil², Dalia G.Yasien³

¹Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt

²Radio-Diagnosis, Faculty of Medicine, Assiut University, Assiut, Egypt

³Otolaryngology, Faculty of Medicine, Assiut University, Assiut, Egypt

⁴Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

olanabih1980@gmail.com

Abstract: Background: Concurrent chemoradiotherapy (CCRth) using cisplatin-based regimens are the standard of care in head and neck squamous cell carcinoma (HNSCC). However, the addition of docetaxel to the treatment regimen showed survival improvement. Objectives: Our study aims to evaluate the efficacy and toxicity of CCRth with weekly docetaxel and cisplatin in patients with locally advanced HNSCC. Patients and Methods: Between March 2010 and April 2012, we enrolled thirty stage III and IVA HNSCC patients. We treated them with 70Gy conventionally fractionated radiotherapy (Rth) concurrently with weekly cisplatin and docetaxel, both given as one hour infusion of 20mg\m² that administered 30 min before Rth. Results: The median follow-up period was 23months (range, 2 –53 months).The mean age of the patients was 59 years (range, 29–72 years). The most common primary tumor site was the larynx (53.3%), followed by the hypopharynx (26.7%). 64.5% of patients had N2/N3 disease and 76.7% had T3/T4 disease. Among 30 patients, 13 (43.3%) achieved complete response (CR), 11(36.7%) achieved a partial response (PR), 2(6.7%) had stable disease (SD) and 4 patients (13.3%) had progressive disease (PD). The 2-year overall survival (OS) and progression-free survival (PFS) was 83.3% and 66.7%, respectively with well tolerable toxicities. Conclusions: Our study concluded that concurrent administration of weekly cisplatin and docetaxel is a well tolerable promising regimen that can induce only minimal myelosuppression.

[Ola Nabih, Hoda H. Essa, Reham Abdel-Wahab, Nagham Nabil, Dalia G. Yasien. Concurrent Chemoradio therapy with Weekly Docetaxel and Cisplatin for Locally Advanced Head and Neck Cancer. Cancer Biology 2015;5(4):107-112]. (ISSN: 2150-1041). http://www.cancerbio.net. 13. doi:10.7537/marscbj050415.13.

Keywords: Locally advanced head and neck cancer, chemoradiotherapy, cisplatin, docetaxel.

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The impact of concurrent chemo-irradiation followed by surgery for locally advanced cervical carcinoma

Ahmad M. Alhosainy¹, Nabila Hefzi¹, Hussein M. Abdeldayem², Esam M. Hemat³

¹Clinical Oncology & Nuclear Medicine, ²Gynecology & Obstetrics, and ³Radiology Departments, Faculty of Medicine, Zagazyg University, Egypt.

ahosainy40@yahoo.com

 Abstract: Background: In 1999, five randomized clinical trails of concurrent platinum-based chemoirradiation showed an overall survival benefits in patients with stage IB2 to IVA disease. Consequently in the same year; a subsequent trial performed by the National Cancer Institute of Canada demonstrated no survival advantage for concurrent platinum-based chemoradiation in stage IB to IVA cervical cancer patients. The aim of this study was to evaluate the results and morbidities of concurrent chemoirradiation followed by surgery in those locally advanced disease patients. Patients and methods: patients fulfilling the inclusion criteria were planned to receive concurrent chemoirradiation in the form of whole pelvis and para aortic lymph nodes (PALNs) external beam irradiation with delivery of 45 Gy concurrently with platinum, 40 mg /m² per week, followed by completion surgery 6-8 weeks post the end of chemoirradiation. Results: fifty patients with a median age of 48 years (range, 41-67 years), were assessed at the time of surgery; 35 patients (70%) had histologic residual disease (RD) in the cervix. The sizes of the cervical RD were < 1 cm in 18 patients (51.4%) while 48.6% (17 patients) had a residual disease ≥ 1 cm. Postoperative complications were noted in 23 patients (46%). The factors increasing the risk of post-operative complications were radical hysterectomy compared with an extrafascial hysterectomy, odds ratio (OR)1, (OR)2-1 (1.7-4); P=0.04 and the presence of cervical RD>1 cm (OR2) (1.2-6.9), compared with no RD (P=0.011). Conclusion: In this study, the size of the residual disease (RD) and histologic nodal involvement were the strongest, statistically significant risk factors. These results confirm that the survival of patients treated with concurrent chemoirrdiation followed by surgery in locally advanced cervical carcinoma could potentially be enhanced by improving the rate of complete response in the irradiated area (cervix, pelvis, and PALNs) and by initially detecting patients with para-aortic spread. So that treatment could be adapted in such patients, as the completion of surgery increases the morbidities.

[Ahmad M. Alhosainy, Nabila Hefzi, Hussein M. Abdeldayem, Esam M. Hemat. The impact of concurrent chemo-irradiation followed by surgery for locally advanced cervical carcinoma. Cancer Biology 2015;5(4):113-123]. (ISSN: 2150-1041). http://www.cancerbio.net. 14. doi:10.7537/marscbj050415.14.

Keywords: locally advanced cervical carcinoma, concurrent chemoirradiation, surgery

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Feasibility of qualitative low dose multidetector row computed tomography in the diagnosis of breast cancer

Mahmoud H. El shoieby¹, G. Seifeldein², M. Abd Ellah³, Tark. M. Elsabaa⁴ and Momin M. Aly⁵

Departments Surgical Oncology¹, Radiology³, Pathology⁴ and Radiotherapy and Nuclear Medicine ⁵ South Egypt Cancer Institute, Egypt.

²Department Radiology, Faculty of Medicine, Assiut University, Egypt.

E-mail: elshoieby@live.co.uk

Abstract: Objective: To evaluate the role of low dose multidetector row computed tomography (MDCT) in detection and diagnosis of breast lumps and axillary lymph node (ALNS). Patients and methods: Twenty patients with 15 breast lumps pathologically proven malignant underwent low-dose MDCT in supine position. Morphological analysis of MDCT images (multiplanar reformation, maximal intensity projection and 3-dimensional reconstruction) to assess shape, size and attenuation and quantitative analysis was done by measurement of time-density curves of both breast lumps and abnormal ALNS. The results are confirmed by postoperative histopathological reports. Results: 10 (50%) showed a washout pattern, 6 (30%) showed a plateau pattern, and 4 (20%) showed a persistent pattern. Fifteen out of 20 patients underwent surgery, where 3 patients underwent modified radical mastectomy and 12 patients performed breast conservative surgery, and the pathologic findings revealed 10 invasive ductal carcinoma, 4 invasive lobular carcinoma and 1 metaplastic. Significant mean difference was found between the MDCT measurement of the mass and measurement of pathological specimen as well as ALNS measurement (p <0.001). Regarding detection of positive ALNS, MDCT has accuracy 80.4%, sensitivity 80.4% and specificity 80%, positive predictive value 76.7% and negative predictive value 83.3%. Conclusion: MDCT may represent a useful investigative tool for the diagnosis of breast cancer and accompanying ALNS.

[Mahmoud H.El shoieby, G. Seifeldein, M. Abd Ellah, Tark. M. Elsabaa and Momin M. Aly. Feasibility of qualitative low dose multidetector row computed tomography in the diagnosis of breast cancer. Cancer Biology 2015;5(4):124-129]. (ISSN: 2150-1041). http://www.cancerbio.net. 15. doi:10.7537/marscbj050415.15.

Key words: MDCT, time-density curve, Hounsfield unit, ALNS, breast cancer

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