Metformin addition to androgen deprivation therapy effect on cancer prostate patients with type 2 diabetes.

AIMS: Patients with prostate cancer (PC) have a higher rate of non-cancer mortality than cancer-related, which could be partially attributed to the treatment they receive. We aimed to evaluate the effect of metformin addition to androgen deprivation therapy (ADT) among cancer prostate patients with type 2 DM. METHODOLOGY: This prospective, two-arm study included 95 PC patients with type 2 DM who had ADT. The patients were divided into 2 groups: the Metformin group includes 48 patients and the non-metformin group includes 47 patients. We compared the anthropometric, diabetic status; tumour status, survival rate, and biochemical relapse between metformin and non-metformin groups. RESULTS: We observed significant differences in fold changes of anthropometric parameters including weight, BMI, and waist circumference between both groups. We found significant differences in fold change of PSA levels in metformin groups in comparison with non-metformin groups. Overall survival comparison between metformin users and non-users showed better statistically insignificant survival in the metformin users group. We observed a significantly lower relapse rate in the metformin group in comparison with the non-metformin. CONCLUSION: Metformin could decrease some of the unfavourable metabolic consequences of ADT. Moreover, Metformin could enhance the tumour-suppressive effect of ADT and decrease the PSA relapse rate.

Trichomonas vaginalis serostatus and prostate cancer risk in Egypt: a case-control study.

Trichomonas vaginalis is one of the most common non-viral sexually transmitted infections (STIs) that has been associated with prostate cancer in some countries. This study aims to investigate if T. vaginalis infection can be a risk factor for prostate cancer in Egypt and its possible relationship with cancer prognostic factors and overall survival. Serum samples were collected from a total of 445 age-matched males; 126 with prostate cancer, 108 with bladder cancer, 91 with different types of cancers, and 120 healthy controls, and then analyzed by ELISA for detection of anti-Trichomonas IgG and prostate-specific antigen (PSA). The results revealed that only 8.3% of controls were seropositive for trichomoniasis, compared with 19% of prostate cancer patients (P = 0.015). There were positive associations between the levels of PSA and tumor stage with T. vaginalis IgG optical density scores among the seropositive cases (P < 0.001 and < 0.05, respectively). However, no significant correlations were detected between seropositivity of T. vaginalis and other prognostic factors or overall survival in those patients. In conclusion, chronic T. vaginalis infection may be associated with prostate cancer, but it does not seem that this STI aggravates the cancer status.

Clinical outcome and toxicity evaluation of simultaneous integrated boost pelvic IMRT/VMAT at different dose levels combined with androgen deprivation therapy in prostate cancer patients.

BACKGROUND: The role of dose escalation in patients receiving long-term androgen deprivation therapy (ADT) is still a controversial issue. The aim of the current study was to evaluate whether dose escalation for ≥76-80 Gy had any advantage in terms of biochemical disease-free survival (BDFS), distant metastasis-free survival (DMFS), or overall survival outcomes over the dose levels from 70 to <76 Gy. PATIENTS AND METHODS: The study included a cohort of 24 patients classified with high- and intermediate-risk localized prostate cancer. All patients received ADT, starting at 4-6 months before radiation therapy and continued for a total period of 12-24 months in high-risk patients. The treatment plan was given in two phases. In the first phase, the nodal planning target volume (PTV) and the prostate PTV received 48.6 and 54 Gy, respectively, over 27 fractions. The treatment was applied through intensity-modulated radiation therapy or volumetric modulated arc therapy with a simultaneous integrated boost technique. RESULTS: More than half of the patients were in T3-T4 stage, 79.1% of the patients were in the high-risk category, and all patients received ADT. The rate of acute grade II gastrointestinal and genitourinary toxicities in all patients were 41.7% and 62.5%, respectively. The rate of freedom from grade II rectal toxicity at 2 years was 89% and 83% for patients treated with dose levels <76 and ≥76 Gy, respectively. The rate of BDFS at 2 years was 90% and 85% for doses <76 and ≥76 Gy, respectively. The DMFS at 2 years was 100% and 76% for dose levels <76 and ≥76 Gy, respectively. CONCLUSION: In the current study, there were no significant differences in the BDFS and DMFS between patients treated with a dose of <76 and ≥76 Gy, including elective pelvic lymph nodes irradiation combined with ADT.

Second-line panitumumab as a triweekly dose for patients with wild-type KRAS exon 2 metastatic colorectal cancer: a single-institution experience.

OBJECTIVE: Panitumumab administered as monotherapy in colorectal cancer (CRC) has shown response and disease stabilization rates of approximately 30%. The current study aimed to evaluate the progression-free survival (PFS) and overall survival (OS) of patients with metastatic colorectal cancer (mCRC) treated with panitumumab every 3 weeks as a second line treatment. METHODS: This study is a retrospective analysis of 18 patients, aged more than 18 years, with wild-type KRAS exon 2 mCRC treated with panitumumab as a second-line single agent after progression on first-line chemotherapy. RESULTS: The median number of courses received was 10 (range, 4-29), and the median duration of treatment was 30 weeks (range, 12-96 weeks). After a median follow-up period of 13 months, the median PFS was 6 months (range, 4.3-7.7 months) and the median OS was 11 months (range, 7.4-14.5 months). The median PFS was 4 months for patients with < grade 2 skin toxicity and 6 months (range, 4.5-7.5 months) for patients with ≥grade 2 skin rash (P=0.05). The median OS was 9 months (range, 6.4-11.5 months) and 14 months (range, 11.6-16.3 months) for the two groups of patients (P=0.002). CONCLUSIONS: Panitumumab given every 3 weeks is effective and well tolerated in patients with advanced CRC that progressed after standard chemotherapy.

Early parathyroid hormone laboratory abnormalities related to therapeutic radiation of neck: an Egyptian experience.

The effect of neck radiation on parathyroid hormone (PTH) is studied on concern as late effect of radiotherapy for benign or malignant diseases. However, the early effect on PTH is still in debate and need further evaluations. We aimed, in our study, to assess early effect of neck radiation on PTH, and related calcium and phosphorus levels. Patients diagnosed with breast or head and neck cancer who planned to received radiotherapy to neck as a definite or a part of their treatment enrolled in this prospective single-arm study from June 2012 to June 2013. Laboratory assessment of PTH, serum calcium, phosphorus and albumin was obtained before starting radiotherapy, 3 weeks and 3 months after radiation. Fifty-two patients included 24 (46.2 %) males and 28(53.8 %) females. Median age of diagnosis was 55 years. Thirty-six patients had head and neck cancer, while 16 patients were diagnosed as breast cancer. The difference in PTH and calcium levels before and after radiotherapy was statistically significant (P = 0.014 and P = 0.001 for 3 weeks and P = 0.015 and P = 0.004 for 3 months, respectively); even after correction of calcium level according to albumin level, the same results were obtained, while there was no significant difference in their levels after 3 weeks in comparison with 3 months after radiotherapy. The variation of level of phosphorus was not significant. PTH and calcium can be affected early with neck radiation, so follow-up of calcium and PTH level is mandatory for cases that will receive neck radiotherapy.

Difference between papillary and follicular thyroid carcinoma outcomes: an experience from Egyptian institution.

OBJECTIVE: Differentiated thyroid carcinomas (DTCs) are classified into papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). DTCs are analyzed as a single group in clinical studies that investigated the prognostic factors and prognosis of these malignancies. However, the biological behaviors of these carcinomas significantly differ. In the present study, we aimed to detect differences in the outcomes between PTC and FTC in Mansoura University Hospital in Egypt. METHODS: A total of 558 patients with histologically proven thyroid carcinomas from January 2003 to December 2012 were retrospectively enrolled. The clinical and pathological data of patients were reviewed. RESULTS: Large primary tumor size, lymph node involvement, extrathyroid extension, and distant metastasis were significant poor prognostic factors for overall survival (OS) in old PTC patients. Cox hazard analysis showed that the patient's age, extra thyroid extension, and distant metastasis were the only independent prognostic factors. In FTC patients, only the distant metastasis and degree of tumor invasion were significant poor prognostic factors in OS univariate analysis. However, these factors were nonsignificant in multivariate analysis. The 10-year OS rates were 97% and 89% for PTC and FTC, respectively (P=0.003). The 10-year disease-free survival (DFS) rates were 77.2% in PTC vs. 65% in FTC (P=0.179). CONCLUSION: The significant prognostic factors vary between the two types of DTCs. Therefore, PTC and FTC patients need to be analyzed and reported independently. PTC survival is widely and significantly affected by age, extrathyroid extension, and distant metastasis. By contrast, these factors were nonsignificant in FTC, which showed poorer survival than PTC.

Induction FOLFOX followed by preoperative hyperfractionated radiotherapy plus bolus 5-fluorouracil in locally advanced rectal carcinoma: single arm phase I-II study.

Induction chemotherapy has many benefits of in locally advanced rectal cancer (LARC); one of these is the better control of distant failure. Hyperfractionated radiotherapy (HFRT) is new approach still on evaluation in preoperative setting of rectal cancer. We aimed to evaluate the efficacy of induction FOLFOX followed by HFRT in LARC. From September 2011 to December 2013, 27 patients with LARC were enrolled in this prospective, phase I-II study. Induction FOLFOX bolus was given for two cycles followed by HFRT (1.5 Gy twice day for 30 fractions over 3 weeks for a total of 45 Gy). 5-fluorouracil (5-FU) bolus was administrated during first and last 3 days of radiotherapy. Surgical resection was performed in 4-5 weeks further and followed by adjuvant FOLFOX bolus regimen. Twenty-one (77.8 %) patients were males and 22. 2 % of patients were females, and the median age at diagnosis was 46 years. Low sited tumor was the most presenting site (55.6 %). Clinically positive lymph nodes were presented in 70.4 % of patients. Twenty patients (74.1 %) underwent sphincter sparing procedure. Pathological complete response (pCR) was achieved in seven patients (25.9 %). Tumor and nodal downstaging were recorded in (70.3 %) and (42.1 %) of patients, respectively. Acute and late toxicities were in acceptable range. Two-year disease-free survival was 70.2 %, and overall survival was 87.5 %. Induction FOLFOX followed by HFRT and concurrent 5-FU improves pCR in LARC, and this combination was feasible with acceptable toxicity. Further evaluations are mandatory for this new approach.

Thyroid cancer in Egypt: histopathological criteria, correlation with survival and oestrogen receptor protein expression.

Thyroid cancer represents approximately 1% of new cancer and oestrogen may play a role in the pathogenesis of thyroid neoplasm. We aimed to study the clinicopathological criteria and ER expression of thyroid cancer in Mansoura University (Egypt), and to correlate the survival to these clinicopathological data and ER expression. This retrospective study reviewed 644 patients with histologically proven thyroid carcinoma during the period from 2003 to 2011. 152 cases during the period between 2008 and 2011 were retrieved from the archive and examined by immunohistochemistry for oestrogen receptor-α (ER) expression. ER-α expression is significantly associated with the female sex, lymph node metastasis, TNM stage, extrathyroid extension, multifocality disease and recurrence and in the whole series (p < 0.5). The same was noticed in papillary carcinoma (PTC) except the gender of the patient. Tumour type, extrathyroid extension and ER expression were the independent prognostic factors of DFS, while in PTC, only ER expression was the independent one. The histological type was the only independent prognostic factor for OAS in the series were studied for ER expression, while extrathyroid extension was the only one that affected OAS of PTC. There was significant positive correlation with lymph node metastasis and ER expression in whole patient and PTC cases. No difference in survival between the low and high ranges of positive oestrogen expression. The prognosis of thyroid carcinoma in Egypt is similar to that occurs worldwide. ER-α expression was a significant prognostic marker for DFS in thyroid cancer and can be used as a predictive factor of lymph node metastasis.