ABSTRACT
Vascular endothelial growth factor [VEGF] is a potent regulatory molecule of the process of new blood vessel formation [angiogenesis]. It is a critical process for tumor growth and metastasis. It might represent a promising therapeutic target in hematologic malignancies. The aim of this study is to assess serum level of VEGF, and its prognostic significance in non-Hodgkin's lymphoma [NHL], acute lymphoblastic leukemia [ALL] and acute myeloid leukemia [AML] patients. VEGF level was assessed in the sera of 47 patients before treatment [NHL; n=20, ALL; n=13, and AML; n=14] and controls [n=13]. Samples were collected again from patients with remission after chemotherapy [25 patients: 10 NHL, 8 ALL and 7 AML patients]. Before treatment serum VEGF levels in NHL and AML patients revealed significant elevation compared with control group [P-values: 0.048 and 0.032 respectively]. On the contrary, a highly significant reduction of serum VEGF was elicited in ALL patients compared with control group [P= 0.009]. After treatment, the serum VEGF levels were significantly reduced nearly to the control values in NHL and AML patients. ALL patients exhibited increasing trend of serum VEGF level in remission approaching control values. In NHL patients the correlation statistics revealed a significant positive correlation between serum VEGF level and serum LDH, uric acid, ESR, B-symptoms, and BM lymphocytes [P- 1 values: 0.007, 0.028, 0.001, 0.003, I and 0.023 respectively]. ALL patients I elicited non-significant correlation between serum VEGF and all other studied parameters. In AML patients, a significant correlation was found between serum VEGF level, and both -ESR [r sr 0.49, P= 0.024] and absoIute neutrophilic count [r = 0.617, P= 0.019]. Serum VEGF levels I showed prognostic information in predicting response to treatment of NHL and AML patients. In ALL patients serum VEGF level could be an early predictor of renewal of normal hematopoiesis after remission induction. Serum level of VEGF may be used to predict clinical outcome and/or monitor treatment of hematologicai malignancy
Subject(s)
Humans , Male , Female , Lymphoma, Non-Hodgkin , Prognosis , Endothelium, Vascular , Endothelial Growth Factors/blood , Neovascularization, PathologicABSTRACT
P53 gene mutation occurs in about 50-60% of colorectal carcinoma [CRC] patients. The key enzymes responsible for extracellular matrix breakdown are matrix metalloproteinases [MMPs]. These have been reported to plug an important role in tumor cell invasion and metastasis, which are major factors in the morbidity and mortality of CRC. The study included 46 patients with CRC who were diagnosed and treated in Mansoura University Hospital d w the period between January 1999 to January 2001. They were treated with left or right hemicolectomy, anterior resection or total mesolectal excision. These included 24 males and 22 females with age ranged from 22-70 year with median age of 46 years [+/- 1 4] Immunohistochemically staining of both tumor and positive lymph nodes was performed on paraffin sections for p53 and MMP2. Twenty one patients were stage C with lymph node metastasis. P53 diffuse positive staining of the tumor cell nuclei was identified in 16 out of 46 [3596] tumor cases and 10 out of 21 [48%] of metastatic tumors. Cytoplasmic MMP-2 expression was positive in 20 out of 46 [43%] tumors, where its expression in the stroma was positive in 17[37%] In lymph node metastasis, cytoplasmic MMP-2 was positive in 11 out of 21 [52%] of tumors. There was a statistical correlation between p53 and MMP-2 expression in lymph node metastatic tumors [p<0.05]M. MP-2 was seen more in tumor cells invading the muscular is with little staining in more superficial areas. Poor survival was associated with MMP2, p53 expression in patients with 1ymph node metastasis. Lymph node metastatic tumors have higher incidence of p53 and MMP2 staining. These data suggest a role for MMP-2 in colorectal cancer with lymph node metastasis. These results confirm the prognostic value of MMP-2 and p53 on survival of CRC
ABSTRACT
The results of two prospective randomized studies 1, 2 indicate survival advantages for patients with single brain metastases treated with surgery and radiotherapy compared with radiotherapy alone. Radiosurgery - a minimally invasive technique that uses multiple convergent beams to deliver a high dose of radiation to a small volume precisely localized stereotactically - can serve as a surgical alternative. The biological and physical characteristics of metastases [radiographically discrete, small, spherical, non- invasive] render them ideal targets for radiosurgery, with the potential advantages of reduced morbidity, short hospitalization and reduced health care costs. At Mansoura we treated [10] patients with brain metastases, [7] had single lesions and [3] had multiple lesions [up to 5]. The age ranged between 51 and 68ys. The primary lesion was known in [8] cases. Each received a dose of 20 Gy to the tumor edge and a supplementary whole brain dose of 2000 cGy divided over 10 fractions. All patients, except one, tolerated the treatment well and were discharged from hospital within 3 days on average. One case who had five lesions developed hydrocephalus that was shunted, he died a few days later. Nine Patients showed subsequent radiological evidence of tumor shrinkage and central tumor necrosis. The peritumoural edema subsequently subsided and most patients became steroid independent within 3 months of radiosurgery .We acknowledge the small number of cases and short period of follow up that negate any statistical significance. However our limited experience shows that stereotactic radiosurgery is a safe alternative to open surgery, particularly for lesions in deep location, near eloquent cortex and for multiple lesions. Surgical resection would be more advantageous for metastatic lesion of size greater than 35 mm in diameter with significant edema and mass effect, particularly if there is significant mass effect on fourth ventricle