Comparative estimation of serum osteopontin tumor necrosis factor-alpha and IL-6 as an indictor for immune dysregulation in nasopharyngeal carcinoma

The present study was designed to evaluate serum levels of osteopontin [OPN], tumor necrosis factor-alpha [TNF-alpha] and interleukin-[IL]-6 in pre-treatment samples obtained from patients with biopsy confirmed nasopharyngeal carcinoma [NPC]. The study included 28 NPC patients; 20 males and 8 females with mean age of 56.8 +/- 8 years. Cervical lymphadenopathy was the main presenting symptom in 19 patients [67.9%], recurrent unexplained attacks of epistaxis in 16 patients [57.1%] and 7 patients [25%] had secretory otitis media. Patients were clinically categorized using TNM staging and underwent nasopharyngoscopy and biopsy taking for pathological examination and grading according to the World Health Organization [WHO] types. All patients received chemo-radiotherapy and completed their follow-up at ENT outpatient clinic. Pre-and post-treatment blood samples were collected for estimation of serum level of osteopontin [OPN], tumor necrosis factor-a [TNF-alpha] and interleukin-[lL]-6. Blood samples were obtained from 10 healthy volunteers as control group. Pretreatment serum levels of estimated parameters were significantly higher compared both to control levels and to post-treatment levels. However, despite treatment induced significant decrease of serum levels of estimated parameters, their levels still significantly higher compared to control levels. There was a positive significant correlation between TNM clinical staging and serum levels of OPN, TNF alpha and IL-6, Also, WHO pathological types showed a positive significant correlation with serum levels of OPN and lL-6, but the correlation with TNF-alpha was positive non-significant. Using ROC analysis for estimated parameters as screening test for WHO type I lesions defined estimation of serum OPN as a good screening test to detect early lesions and defined 2 cutoff points for serum OPN; namely: 265 and 298 ng/ml, had identical screening power however, cutoff point at 265 ng/ml showed significantly higher of sensitivity rate [89.3%]. NPC is associated with immune dysregulation in favor of Th1 side and elevated OPN pre-treatment serum levels that could be used as screening test for early cases of NPC as a preliminary screening test with cutoff point at 265 ng/ml as discriminative value

Preradiation chemotherapy versus radiotherapy in the treatment of adult meduloblastoma

To determine whether preradiotherapy [RT] chemotherapy would improve outcome for medulloblastoma when compared with RI alone. Chemotherapy comprised vincristine 1.5 mg/m2 days], 7 and 14, etaposide 100 mg/m2 days1.2. and 3 and carboplatin 500 mg/m2 days] and 2. Patients age ranged between 16 and 45 years inclusive were randomly assigned to receive 35 Gy craniospinal RT with a 19 Gyposteriorfossa boost, or chemotherapy followed by RT. Ls 0i5[i paienzs randomly assigned to treatment, 25 were treated with RT alone and the other 25 patients were treated with chemotherapy and Irradiation. There was a statistically significant difference in overall survival at 3 years between both arms 58% and 75% respectively. Acute toxicity was limited to alopecia, nausea and hematological toxicities. High grade nausea and vomiting was reported in 4 patients and neuropathy in two patient. Grade 3 or 4 [anemia, neutropenia and thrombocytopenia were recorded in group B, this is attributed to chemotherapy. Improved EFS and OS for chemotherapy group patients compared with RT alone were noticed. Chemotherapy was well tolerated. It is anticipated that this regimen could reduce atotaxicity and nephrotoxicity compared with cisplatin-containing schedule