Glypican 3 amino terminal marker for early detection of hepatocellular cacinoma

HCC is the 5[th] common cancer worldwide. Due to global increase of hepatitis B and C infection, the incidence of hepatocellular carcinoma [HCC] has been steadily increasing. The seroprevalence of HCV in Egypt is currently between 20 -35%. Because Alfa Feto protein [AFP] has limited sensitivity for small hepatocellular carcinoma foci, Glypican-3 [GPC-3] oncofetal protein which is over expressed in HCC could represent a hope for early detection. Evaluating the validity of Glypican-3 as an early detector of HCC. 10 healthy controls and 40 HCV positive patients distributed as follows: 10 patients with chronic hepatitis C virus infection [CH], 10 patients with compensated cirrhosis [CC], 10 patients with decompensated cirrhosis [DC] and 10 patients with HCC. Liver functions: ALT, AST, Bilirubin [T], Albumin, gamma GT. Tumor markers: AFP and GPC-3.Viral markers: HCV antibodies, HBs Ag and HBc Ab. AFP mean was126 ng/ml and GPC-3 mean was 34.63 ng/ml in HCC group which were significantly higher than the other studied groups. No significant correlation was found between AFP and GPC-3.The area under ROC of GPC-3 was higher than AFP suggesting increased GPC-3 sensitivity. AFP showed sensitivity of 70% in HCC, 30% in D.C and 20% in C.C with 100% PPV, also AFP had 100% specificity with low NPV compared to GPC-3. GPC-3 was detected in all HCC groups, DC and CH showing 100% diagnostic performance. GPC-3 in C.C revealed 70% sensitivity with 100% PPV and 100% specificity with low NPV. GPC-3 was elevated in context of patients with CH, CC and DC as it is an oncofetal protein produced by regenerating liver cells. GPC-3 and AFP improve the prediction accuracy of HCC in those seronegative to AFP

Three dimensional conformal radiotherapy [3-D crt] for non-functioning pituitary tumors

Introduction: Although pituitary adenomas are histologically benign, the unrelated neurological and physiological consequences can be devastating. Pituitary adenomas are common lesions and represent 10 to 20% of all primary brain tumors. Non-functioning pituitary adenomas comprise approximately 30% of all pituitary tumors. Modern radiotherapy technique, as three dimensional conformal radiotherapy [3-D CRT], have shown efficacy in all aspects of treatment with better immobilization, imaging, planning and treatment. Improvements aim to reduce normal tissue irradiation whilst preserving dose to the target

Methods: Fifty patients with residual or recurrent non functioning pituitary adenoma [29 male, 21 females]; median age 54 years [range 26-76 years], were treated with 3D-CRT at the Alexandria armed forces Hospital between June 2002 and June 2005. All patients had nan-functioning pituitary adenomas. Thirty-two patients with large residual tumor following primary surgery received 3D-CRT. Eighteen patients were treated at a later time following evidence of tumor recurrence. All patients were treated to a total dose from 45 to 54Gy. Most of the patients had six-fzeld technique using computer based 3-D CRTplanning. All tumors were > 1 cm and typically 3-4 cm superiar-inferior dimension

Results: Forty-six patients [92%] experienced continuous regression or stabilization of their tumors. Only four patients showed progressive disease. Patients with symptoms related to mass effect did well. A total of 19 of 24 patients with visual impairment and 17 of 18 with headache improved. All patients with cranial nerve palsies secondary to cavernous sinus compression also improved. Both early and late side effects occurred as results of radiation, which were mostly manageable

Conclusion: The results showed the efficacy of three-dimensional conformal radiotherapy to a dose from 45 to 54 Gy for pituitary adenomas from the standpoint of both clinical outcomes and imaging. F urther study of the neurocognitive sequelae of limited field irradiation to the pituitary region is needed as well as a prolonged follow up period to consolidate results

Caelyx [CA] and paraplatin [PA] for patients with advanced ovarian cancer in late relapse

Introduction: 0varian cancer is the sixth most common malignancy [4.4% of cases] and also cause of death from cancer [4.5 %] in women worldwide. Epithelial tumors, arising from the swface of the ovary, account for approximately 90% of all ovarian malignancies. The vast majority [approximately 70%] of those patients with ovarian cancer present with advanced [stage III/IV] disease. Platinum-based chemotherapy, as a front-line therapy, is recommended for advanced-stage patients and those with high-risk early-stage disease. Liposomal doxorubicin has been evaluated in phase II trials with a good safety profile and efficacy

Methods: A total of 26 patients were accrued in this study between July 2002 and September 2003, they were clinically diagnosed and pathologically confirmed epithelial ovarian tumors. Liposomal doxorubicin [Caelyx] was given at a dose of 30 mg/m2, 1 hour infusion and, Paraplatine AUC 5, 30 minutes infusion day one every 3 weeks for at least 3 cycles. Univariate and multivariate analysis were conducted and 5% level of significance was adopted

Results: The most common adverse event was Palmar-Plantar erythrodysesthesia [PPE, 42.3 %], with severe grade 3/4 PPE observed in 23% of patients. However, in the majority of patients PPE was managed successfully, There was an overall response rate of 42.3% [11/26 patients], with a median progression-free survival of 4.9 months [ with 1 patient in complete response at 21 months] and a median overall survival 11 months

Conclusion: Based on survival and toxicity advantages, liposomal doxorubicin is the first choice non platinum agent for relapsed ovarian cancer. It may also have clinical application in combination regimens for platinum sensitive ovarian cancer, as consolidation / maintenance therapy for ovarian cancer and as a component of first line therapy. Liposomal doxorubicin is an active, well tolerated agent, when combined with paraplatine as a salvage therapy for recurrent ovarian carcinoma

Obesity and cancer

Background: Many researches lately warned that carrying extra weight means carrying extra cancer risk specially breast cancer. It is well known that obesity is related to cardiovascular disease and diabetes, but not many who are aware that shedding pounds could reduce their risk of getting cancer

Methods: In Alexandria clinical oncology department [ ACOD] , One hundred and twenty obese breast cancer patients' were prospectively recruited, they received FAC chemotherapy calculated according to either the actual [group I ] or ideal body surface area [group II] and the treatment outcome was analyzed. Pretreatment demographics and clinical characteristics collected included body mass index [BMI], actual and ideal bodysurface area [BSA], tumor stage and grade, estrogen receptor status, ECOG performance status, planned dose and schedule. Also, pretreatment complete blood picture, liver function tests, renal function test and ECHO Ejection Fraction was requested. The patients were followed prospectively during chemotherapy to evaluate the treatment outcome and the toxicity profile. Results were collected and statistically analyzed

Results: This study confirmed that the FAC standard regimen dosed according to the ideal body surface area is characterized by an accepted degree of hematopoietic toxicities that was much less than that took place in the actual body sulface area dosed arm and can be applied very closely to the intended dose and time schedule. The most common acute laboratory toxicity was the hematological toxicity that was significant on comparing the Hemoglobin level between the first cycle and sixth cycle [p value = 0.002 ] in the actual body surface area arm but of no significance in the ideal body surface area dosed arm. There was an overall significant dijfererzce as regard the hemoglobin level between group I and II with p value of <0.0001. Also, there was an overall significant difference as regard the WBCs counts between groups I and II with p value of 0.002. Regarding the liverfunction tests, there was an overall significant difference as regard the ALT level between group I and II with p value of < 0.0001. The same pattern was also noted between the 2 groups as regards renal toxicity, gastrointestinal toxicity, nail discoloration and hair loss

Conclusion: Based on our study; there was a trend towards a higher toxicity profile in the obese females who received FAC adjuvant chemotherapy for breast cancer dosed according to the actual body surface area than those who were dosed according to the ideal surface area who had better tolerance. On the other hand no significant differences as regard the treatmentfailure and disease free survival so far.Still further trials to specmcally investigate the most appropriate tool for calculating the chemotherapy dosage in obese patients. These studies need to be prospectively randomized studies with innovative approach and good scienujic conduct. On the other hand Concrete efforts and substantial investment on the part of policymakers, educators. clinicians. employers, and schools to promote physical activity and healthful dietary practices as a cultural norm is of utmost importance to maintain normal body weight, and should be set as a global public health priority