Abstract :

Background: For endometrial carcinoma, the main surgical treatment is total hysterectomy and bilateral salpingo -oophorectomy. Women with high-risk endometrial cancer have a relatively higher recurrence rates and poor prognosis  following  hysterectomy alone. Therefore, pelvic external beam radiotherapy has bee n the standard adjuvant treatment for these patients. This is a prospective study on patients with high-risk endometrial cancer evaluating the benefit of adding concurrent weekly paclitaxel with adjuvant radiotherapy, versus radiotherapy alone. 

Methods: Eligible patients were randomized to Arm A; Concurrent chemotherapy with radiotherapy [CCRT], and Arm B; External beam pelvic radiotherapy alone [RTH]. Pelvic radiotherapy was 50.4Gy over 28 fractions, and chemotherapy course was weekly paclitaxel (50mg/m2) for 5 weeks. Patients were evaluated for treatment related toxicities, disease failures and survival.  

Results: Seventy-one patients met the eligibility criteria of study protocol; 34 patients received CCRT; and 37 patients received RTH alone. The median age at time of diagnosis is 66 years. Regarding to tumor staging; 47% were Stage Ib, and other patients were stage II or III. Grade 3 toxicity were more in CCRT arm, and no grade 4 toxicity were recorded. The most common events were diarrhea and hematological affection. No significant difference in acute toxicities between treatment groups; except for hematological affection with concurrent paclitaxel [p=0.025]. Ten patients [14%] had a treatment failure; treatment failures are more in RTH group, but without statistical significance [p-value =0.51]. Estimated 2-years OS was around 86% with no statistical significance between both treatment arms [p-value = 0.83], and estimated 2-years DFS was; 83.2% for CCRT arm and 77.1% for RTH arm, with no statistical significance [p-value = 0.48]. 

Conclusion: Adding concurrent paclitaxel to pelvic radiotherapy in high-risk endometrial cancer patient is safe and tolerable, and tends to decrease treatment failures, even though this not translated to OS nor DFS improvement.

 

Keyword: Endometrial Carcinoma; Radiotherapy; Concurrent Chemotherapy

 

Background: Post-operative chest wall irradiation improves local control &  survival with higher techniques (conformal & intensity modulated) are  recommended in left side. These techniques involve mastectomy bed Clinical  Target Volume (CTV) delineation which varied clearly among guidelines especially for the lateral margin with subsequent possible effects on dose  received by lung & heart (in left sided cases). Aim of work: Comparison  between American & European guidelines to a more anatomical (from our point of view) method using wire following anatomical lines regarding post left mastectomy chest wall CTV volume & doses received by the heart & left lung. Methodology: One oncologist had delineated 10 cases referred for radiation therapy of the chest wall & peripheral lymphatics following left modified radical mastectomy. He delineated every case according to Radiation Therapy Oncology Group (RTOG), European Society of Therapeutic Radiology and Oncology (ESTRO) & according to an anatomically set wire during scanning. Plans were set for each delineation by an expert radiation physicist. Results of the 3 plans were compared regarding coverage, homogeneity of CTV & doses to risk organs.

Results: The three CTVs were well covered & homogeneously treated. Statistically significant less left lung  V20Gy & V30Gy for anatomical wire based delineation (16.0 +/- 4.1% &12.75 +/- 2% respectively) compared to  ESTRO (19.1 +/- 1.73 & 15.2 +/- 5.1 respectively) & RTOG (18.22 + 1.6 & 14.52 + 5.3 respectively), p=0.001 for V20Gy & 0.01 for V30Gy. Cardiac D50% was statistically significantly lower (101.6 + 41.2cGy) vs (141 +/- 81cGy & 132 +/- 93 cGy, p= 0-00001) for ESTRO & RTOG respectively. Conclusion: Delineation of left mastectomy chest wall CTV based on anatomical landmarks guided by wire set during patient scanning may reduce cardiac & pulmonary doses compared to ESTRO & RTOG. Clinical follow up of cases treated based on this delineation is highly recommended specially to evaluate local recurrence.

 

Key words: Left breast cancer, Conformal radiotherapy, delineation lateral border.

Abstract

Background: measuring the extent to which the breast setup error contributed to the total delivered dose discrepancies in all patients treated with Volumetric modulated arc therapy (VMAT) both in deep inspiration breath-hold technique (DIBH) and free breathing (FB) and to compare the dosimetric stability of each technique. Methods: the dose distribution parameters of the mean of 90 cone-beam computer tomographies (CBCTs) reshaped by deformable image registration (DIR) compared to the mean of their reference plan (RP) in left (Lt) sided breast cancer (BC) patients treated with adjuvant loco-regional radiation. 50 CBCTs in the first group treated in DIBHT and 40 CBCTs in the second group treated in FB compared also to the mean of their RP. Deviations in the delivered from the planned dose distributions have been analyzed. The average of this difference has been calculated for all cases and in each group of patients.

Results: 1% reduction in PTV-total D95% caused by -4% decrease in the PTV-supraclavicular (supra). 13% and 3% increase in Dmean of heart and Lt lung, respectively. 8% and 6% increase in spinal cord Dmax and right (Rt) breast D2%, respectively. The difference between both techniques was significant in heart with its sub-volume, Rt breast and spinal cord.

Conclusions: The dosimetric impacts of breast setup errors during Lt BC loco-regional radiation by VMAT technique using DIR was significant for the heart with its sub-volume in the FB group only.

 

Keywords CBCT, VMAT, Breast setup error, deformable image registration

 

Background: CD44, a cell hyaluronic acid transmembrane glycoprotein implicated in cell growth, differentiation, survival as well as the metastatic behavior of some cancer cells. Its expression is upregulated in subpopulations of cancer cells and is identified as a molecular marker for cancer stem cells (CSC). Methodology: This retrospective study investigated CD44 immunoreactivity in 85 cancer colon patient’s specimens at diagnosis obtained from the pathology department, South Egypt Cancer Institute. All specimens were stained by Anti CD44 antibody. Patients were followed up for 3 years. Aim: The study aims at inspecting CD44 immunoreactivity in the epithelium of colorectal cancer specimens and at detecting its association with the patients’ survival function by calculating disease free survival and overall survival of patients.

Results: In our current study there was a statistically significant association between low epithelial expression of CD44 marker (H score≤ 150) and 3-year OS (p= 0.009) as well as a statistically significant association between low CD44 epithelial expression and 2-year DFS (P= 0.041). In multivariate analysis the high epithelial expression of CD44 is the only independent factor for early recurrence (HR: 9.393, P= 0.031) concluding that high epithelial expression of CD44 is a bad prognostic factor and the likelihood of death is 9 times more with CD44 overexpression.

Conclusion: CD44 positivity in non-metastatic colorectal cancer specimens at diagnosis is associated with worse overall survival of patients and more likelihood of progression or death.

Background

Colorectal cancer (CRC) is a common and lethal disease; it remains the third most frequently occurring cancer among both genders. In Egypt, colon cancer represents the ninth most common cancer while rectal cancer ranks the 18th most common cancer by incidence. The application of cancer stem cells (CSC) as prognostic markers in CRC is now studied, among which is CD44, which is implicated in cellular growth, differentiation, survival as well as the metastatic behavior of cancer cells. The prognostic role of CD44 in CRC is still controversial. The study aims at inspecting CD44 immunoreactivity in the epithelium of colorectal cancer specimens and to detect its association with the patients’ clinicopathological features as well as its prognostic significance.

Methods

This retrospective cross-sectional study included 85 CRC specimens and 16 adenoma specimens collected from the Pathology Department, South Egypt Cancer Institute, during the period from 2018 to 2020. All specimens were stained by anti-CD44 antibody.

Results

CD44 epithelial expression in colon cancer tissue specimens was substantially higher than in normal mucosa. It was observed that 95% (n = 81) of the studied colorectal carcinoma cases showed positive CD44 epithelial expression compared to distant normal mucosa as controls as well as adenoma cases where only 43.8% (n = 7) of adenoma cases showed positivity with highly significant p-value P = 0.000 and it correlates with cancer progression and aggressiveness. Low H score expression H ≤ 150 had better 3 years disease-free survival DFS estimated by 83.3% compared to 79.6% with high H score expression with significant P-value (P = 0.041).

Discussion

Our current study showed a statistically significant association between CD44 expression and tumor size (T), lymph node metastasis (N) as well as disease stage with P-values (P = 0.009), (p = 0.000) and (p = 0.000), respectively. CD44 epithelial immunostaining showed to be of an adverse prognostic significance in early CRC associated with more aggressive behavior and worse survival.

Background Tumor microenvironment, specifically tumor-associated macrophages, plays an important role in tumor initiation and progression. CD163 has been recognized as a valuable specific macrophage marker. Cyclooxygenase-2 (Cox2) plays a role in tumor progression. CD31 is reliable for estimation of the density of microvesseles (MVD), which has prognostic importance in several malignant tumors. Thus, the current study was conducted to test the association between CD163, Cox2, and CD31 expression with the prognosis of classical Hodgkin lymphoma (cHL) patients and their potential correlation with clinicopathological variables. Method CD163, Cox2, and CD31 expressions were examined in newly diagnosed patients with cHL through immunohistochemistry on tissue biopsy and the results were correlated with the patients’ outcome after the median follow-up, which was about 35 months. Results 104 patients were included in this study. High CD163 was found in 32.7% of the patients. Cox2 was positive in 42.3% of them. CD 31 with high MVD (≥10%) was found in 51% of the subjects. A significant association was detected between CD163 and Cox2 with tumor stage (P = 0.001, and P = 0.001) and IPS score. Regarding CD31, we could not find any significant associations with disease parameters, except with histological subtype (P = 0.001). A significant relationship was observed between Cox2 and CD163 expression and the relapse rate (P = 0.001, P = 0.01, respectively). Regarding survival, only Cox2 showed a significant association with disease-free survival (P = 0.0379). Conclusion These findings suggested that Cox2 and …