Clinical experience in pediatric neuroblastoma intensity modulated radiotherapy

BackgroundIn spite of the numerous publications of dosimetric comparison of intensity modulated radiotherapy (IMRT) versus conventional radiotherapy in pediatrics, few data exist regarding the clinical use of IMRT and its potential late effects.ProcedurePediatric neuroblastoma patients treated between November 2008 and October 2010 with IMRT were reviewed. Treatment plans, clinical, laboratory and radiological data at the last follow up date were evaluated.ResultsThirteen patients received IMRT. The mean age was 4.9 ± 2 years. The radiation dose ranged from 21 to 25.5 Gy with a mean dose of 24.06 Gy. The mean liver dose was 9.81 Gy. The V8 of the liver was 51 ± 20%, and the V15 of the liver was 21 ± 12%. V18 of the right and left kidneys were 32 ± 27% and 23 ± 18% respectively. The minimum and maximum vertebral point doses were 12.82 and 24.87 Gy respectively. The IMRT treatment was well tolerated in terms of acute toxicity. At 26 month follow up, second malignancy and skeletal asymmetry were not noted, and the liver and the kidney functions showed no significant abnormalities.ConclusionsThe use of IMRT in pediatric neuroblastoma confers higher target conformality with better sparing of the kidneys and it did not show any considerable short term side effects.     

Different Patterns in Health Care Use Among Immigrants in Spain

This study aims to analyze the differences in the use of primary care (PC), hospital, and emergency services between people born in Spain and immigrants. Data were obtained from the 2006 Spanish National Health Survey. The sample was composed of individuals aged 16–64 years from Spain and the seven countries with most immigrants in Spain (n = 22,224). Hierarchical multiple logistic regression models were fitted. Romanian men were less likely to use health care at all levels compared to men from other countries. Women from Argentina, Bolivia and Ecuador reported a lower use of PC. Among women, there were no differences in emergency visits or hospitalizations between countries. Bolivian men reported more hospitalizations than Spanish men, whereas Argentinean men reported more emergency visits than their Spanish counterparts. In Spain, most immigrants made less than, or about the same use of health care services as the native Spanish population.     

Long-term results of low-dose-rate interstitial-intracavitary brachytherapy in the treatment of carcinoma of the cervix

PURPOSE: Brachytherapy plays a major role in the treatment of patients with carcinoma of the cervix. However, routine intracavitary brachytherapy may not be feasible or adequate to treat locally advanced disease. The purpose of this retrospective study (spanning a 20-year period) was to determine the outcome of interstitial low-dose-rate brachytherapy in the treatment of bulky or locally advanced cervical cancer. The long-term survival and safety of this technique were evaluated, along with its impact on local and locoregional control, disease-free survival, and complications. METHODS AND MATERIALS: A total of 185 previously untreated patients with cervical cancer were treated between 1977 and 1997. According to the International Federation of Gynecology and Obstetrics classification, 21 patients had Stage IB (barrel), 77 Stage II, 77 Stage III, and 10 Stage IV disease. All patients were treated by a combination of external megavoltage irradiation to the pelvis to a dose of 5040 cGy followed by interstitial-intracavitary implants to a dose of 40-50 Gy to the implanted volume in two applications. RESULTS: Clinical local control was achieved in 152 (82%) of the 185 patients. A 5-year disease-free survival rate of 65%, 67%, 49%, and 17% was achieved for patients with Stage IB, II, III, and IV disease, respectively. Eighteen (10%) of the 185 patients developed Radiation Therapy Oncology Group Grade 3 or 4 late complications. CONCLUSION: Patients with locally advanced cervical cancer, or with distorted anatomy, may be treated adequately with interstitial brachytherapy to achieve excellent locoregional control and a reasonable chance of cure with acceptable morbidity.     

Effect of Magnetic Resonance Myelography on the Target Volume in Craniospinal Irradiation in Children

AimsTo examine the potential role of magnetic resonance myelography (MRM) in defining the clinical target volume for the spinal field in craniospinal irradiation in children.Materials and methodsOf the 42 patients for whom magnetic resonance imaging (MRI) of the spine was carried out, 12 patients had MRM. The width of the cerebrospinal fluid (CSF) with any lateral extension at different levels was measured from the coronal MRM. The clinical target volume was defined using MRM and the conformal field surface area was compared with the direct conventional field. The inferior border of the thecal sac was determined from MRI spine of 42 patients.ResultsCoronal MRM showed variation in the width of the CSF at different levels. The maximum width was 2.9 cm (level of C2). In the same case, the width of the CSF at the level of D8 was 1.7 cm. The mean surface area of the conventional field that covered the CSF was 190.6 cm², as compared with 150.5 cm² using conformal field, with an 18.5% reduction in the irradiated surface area. The thecal sac ended at S2 in 40.4% of the patients, whereas it ended above and below this level in 28.6 and 31%, respectively.ConclusionsImplementation of coronal MRM during the treatment planning will improve target definition and lead to a more conformal field. Planning systems with the ability to fuse MRM with reconstructed coronal computed tomography are highly desirable. The use of MRI is highly recommended to individualise the lower border of the spinal field in craniospinal irradiation.     

The effect of co-administration of Lawsonia inermis extract and octreotide on experimental hepatocellular carcinoma

Objectives

To investigate the effect of Lawsonia inermis total methanolic extract (LIE) and octreotide (OC) on hepatocellular carcinoma (HCC) progression, depending on somatostatin receptor 2 (SSTR-2) and Alfa fetoprotein (AFP) perturbations.

Methods

Sixty albino mice, divided into five groups (12/each); all except control were injected with single diethyl nitrosamine (DENA) dose of 90 mg/kg body weight, intraperitoneally (IP). DENA group was killed at the last day of week 18. LIE group was given 200 mg/100 ml drinking water from first day of DENA injection until end of week 18. OC group received OC (0.1 mg/kg body weight, twice daily by subcutaneous injection, SC from the first day of week 17 till end of week 18. LIE + OC was given medications till the last day of week 18. Serum AFP, liver tissue SSTR-2 mRNA, its protein expression, reduced glutathione (GSH) and malondialdehyde (MDA) were analyzed.

Results

A significant increase in plasma AFP and hepatic mRNA, associated to liver tissue neoplastic changes, SSTR-2 expression and MDA with decreased hepatic GSH were observed in DENA group. These changes were significantly improved by LIE and/or OC.

Conclusions

LIE and/or OC treatment has effective chemopreventive action due to their ability to alleviate oxidative stress, desensitizing cellular growth receptor to SST.     

Impact of IL-27p28 (rs153109) and TNF-α (rs1800629) Genetic Polymorphisms on the Progression of HCV Infection in Egyptian Patients

Background: Hepatitis C virus (HCV) is a universal health problem. HCV infection may proceed to liver fibrosis, cirrhosis, and eventually hepatocellular carcinoma (HCC). The latest is the third leading global cause of cancer-related mortality. Cytokines including IL-27 and TNF-α play a major role as a link between innate and adaptive immunity which in turn deduct the outcome of HCV infection.

Aim: The present study examined the role of both (-964 A/G) single-nucleotide polymorphism (SNP) of IL-27p28 rs153109 and (-308 G/A) SNP of TNF-α rs1800629 on the progression of HCV infection in genotype 4a infected patients.

Patients and Methods: The patients enrolled in the study were divided into three main groups group I: 38 fibrotic patients, group II: 51 cirrhotic patients, and finally group III: 29 HCC patients. Sixteen healthy volunteers were used as controls. IL-27p28 rs153109 and TNF-α rs1800629 genotyping were performed using polymerase chain reaction-restriction fragment length polymorphism assay.

Results: There was no statistically significant difference between the studied groups regarding the IL-27p28 genotypes. However, TNF-α (-308) studied polymorphism showed a significant difference between the HCC and fibrosis group (p = 0.00), and also between the cirrhosis and fibrosis group (p = 0.031) revealing that AA genotype is the genotype of risk. Furthermore, the association found between allele frequencies of two studied SNPs and the four studied groups were non-significant.

Conclusion: TNF-α rs1800629 polymorphism is a potential genetic-susceptibility factor for HCV related cirrhosis and HCC progression.     

Can methanolic extract of Nigella sativa seed affect glyco-regulatory enzymes in experimental hepatocellular carcinoma?

Background and aim

To investigate the possible modulating role of “Nigella sativa” (NS), a plant commonly used in Egyptian traditional medicine, on premalignant perturbations in three glycol-regulatory enzymes in an experimental rat model of hepatocellular carcinoma (HCC).

Methods

Thirty-six (36) male albino rats were divided into four groups (n = 9). Group 1 served as a normal control, group 2 was treated with methanolic extract of Nigella sativa (MENS) (1 g/kg/day, orally) for 14 weeks, group 3 received a single intraperitoneal dose of diethyl nitrosamine (DENA) (200 mg/kg), followed 2 weeks later by a subcutaneous injection of carbon tetrachloride (CCl₄, 3 ml/kg/week/6 weeks) and group IV was treated with MENS for 2 weeks prior to administration of the carcinogenic combination (DENA + CCl₄, as in group 3) until the end of the experiment. The total period of the experiment was 14 weeks.

Results

In the DENA + CCl₄-treated group, there was a significant increase in the relative liver weight, serum alpha fetoprotein level and the activities of hexokinase, glyceraldehyde phosphate dehydrogenase and glucose 6 phosphate dehydrogenase in both the serum and liver homogenate; this was accompanied by a subsequent decrease in body weight. Pre-treatment with MENS significantly maintained these parameters close to the normal condition.

Conclusion

Based on these results, we conclude that MENS has a chemo-preventive effect against the progression into liver malignancy through its modulation of the energy metabolic pathways (i.e. glycolysis) that may be involved in hepatocarcinogenesis.