Thrombophilic risk factors in breast cancer patients

Activation of the coagulation system in cancer patients is a long known but still poorly understood phenomenon. To clarify the role of some thrombophilic risk factors in cancer patients, activated protein C sensitivity ratio [APC-SR], protein C activity and antithrombin III [AT III] activity, protein S activity as well as antiphospholipid activity [IgG, IgM] were assessed in 24 women with lymph node positive breast carcinoma, 12 of them had proven distant metastases and another 12 of them had no evidence of distant metastases, in addition to 20 matched healthy control subjects. From this study, there is significant decrease in APC-SR, protein C activity, protein S activity in breast cancer patients compared to control group. Also, there is a significant decrease in the same parameters in patients with metastases compared to those without metastases. The odds ratio for risk of thrombosis associated with breast cancer patients in presence of APC resistance phenotype is 3 and 95% confidence interval [C.l.] is 0.633- 16.89. From this study, we can conclude that APC-resistant phenotype is the most frequent thrombophilic risk factor in cancer breast patients. So, screening assay of APC-SR should be encouraged in cancer breast patients especially those having distant metastases, aiming to reduce the risk of thrombosis

Radiation therapy by different fractionation schedules in the management of pain due to osseous metastases

Sixty patients with histologically proved malignancy and radiologically proved bone metastases were included in this study. Male to female ratio was 1:1.6, the mean age was 57.7. The relief of pain was assessed after two weeks, one month, three and six months after treatment. The patients were divided into three treatment groups: Group I included 26 patients treated by 30 Gy in 10 fractions over two weeks; group II included 19 patients treated by 20 Gy in five fractions in one week and group III included 15 patients treated by 8 Gy in single fraction either localized or as half body irradiation. The lowest overall response rate was achieved in group III [53.3%] at two weeks and one month. Patients treated with multiple fractions showed a higher overall response rate than those treated with single fraction at three months after treatment. The highest cumulative complete pain relief was 40.9% in patients with performance grade 1. The overall response rate [complete and partial] radiological response was 90% in group I patients. The relapse rate at three months after treatment was high in group I [23%]; while, at six months after treatment, group II showed the highest relapse rate [47%]