कैंसर विज्ञान एवं चिकित्सा

Medical marijuana is currently a contentious debatable issue. There are strong opponents and proponents opinions but relatively little scientific data on which to base medical decisions. Unfortunately, classifying marijuana as a Schedule I drug result in limiting research studies and only serves to fuel the debate. This position statement paper frames the opponents and proponents viewpoints toward medical use of marijuana, and support the cautious and compassionate use of medical marijuana to treat patients with debilitating medical conditions and symptoms who have failed to respond to other therapies. Based on the reviewed literature, the evidence demonstrates a connection between therapeutic use of marijuana and symptom relief. Thus, many patients, physicians, and researchers have voiced support for the use of medical marijuana. Health care providers should be educated toward the efficacy and safety of medical marijuana. Also, further research is needed to improve the knowledge of potential therapeutic benefits and health negative outcomes of marijuana.

Treatment planning is one of the main steps in radiotherapy. It includes dose, isodose and monitor units (MUs) calculations. The dose calculation is based on algorithms implemented in the treatment planning system (TPS). For a suitable clinical use, these algorithms must calculate the dose as accurately as possible. The aim of this work is the assessment of treatment planning system installed in Aswan Oncology Institute to perform dosimetric validation of various parameters.

Measurements have been performed using existing Elekta linear accelerator, (scanditronix-wellhofer dosimetry) system, and water phantom. A variety of 3D conformal fields were created in Xio TPS on a combined Polymethyl methacrylate (PMMA) phantom and validated against measurements with a calibrated ion chamber. Some of the parameters such as (Tissue phantom ratio (TPR), surface dose, buildup, flatness, symmetry, penumbra, contamination dose) varied including source to surface distance, field size, gantry angle, and depth for all photon and electron energies. The difference between measurements and calculation of flatness and symmetry values at different electron energies were between -0.4% to 1.7% and 6 MV didn’t exceed ± 0.8%. The mean difference in value of penumbra of electron beams was -4.97% and 6 MV was ± 5%. TPR and surface dose at 6 MV increased with the field size (FS) increasing. All the resulted difference of measurements and calculation were in agreement with IAEA-TRS430 and Venselaar et al. which didn’t exceed ± 2% at flatness, symmetry and ±15% at penumbra. This investigation on dosimetric validation ensures accuracy of Xio TPS thereby improving patient safety.

Background: Bladder cancer is the second most common malignancy among Egyptian males.

Patients and methods: To investigate the factors affecting survival in Egyptian patients suffering from urinary bladder cancer, we analyzed the geographical patterns of 564 bladder cancers patients from Oncology Departments of Ain Shams University, Mansoura University, Zagazig University and Damietta oncology centerover a period of 7 years between January 2006 and September 2013.

Results: Among the included 564 patients, Males represented 72.5% of the patients. While, 27.5% were female with a male to female ratio of 2.6, 227 patients presented with non-metastatic and 337 patients with metastatic urinary bladder cancer. Grade III was found in 36% of our patients and 60% of them had stage IV. Mean DFS was (9.15 ± 0.5) and (4.4 ± 0.1) while, mean OS was (13.5 ± 0.7) and (7.5 ± 0.15) months for non-metastatic, and metastatic patients, respectively. In univariate analysis, patients with no bilharzial infection, Non-SCC, responding patients had significant better DFS and OS vs. patients with bilharzial infection, SCC, non-responding patients (respectively, p=0.001 for all). In multivariate analysis, response (OS and PFS), SCC (OS and PFS) and bilharzias is (OS and PFS) where found to be highly statistically significant (Cox regression, P<0.001 for all) in the metastatic and non-metastatic group of patients.

Conclusion: Non-responding, SCC type and bilharzial infected patients had significant independent poor prognostic factors for OS and PFS in the metastatic and non-metastatic group of patients.

Purpose: Because of the scarcity of suitable brain cancer drugs, researchers are frantically trying to discover novel and highly potent drugs free of side effects and drug-resistance. Rhenium compounds are known to be nontoxic and exhibit no drug resistance. For that reason, we have developed a series of novel rhenium acetylsalicylato (RAC or ASP) complexes to test their cytotoxicity on brain cancer cells. Also we have attempted to explore the DNA binding properties of these compounds because many drugs either directly or indirectly bind to DNA. Methods: We have treated the RAC series compounds on human astrocytoma brain cancer cell lines and rat normal brain astrocyte cells and determined the efficacy of these complexes through in vitro cytotoxicity assay. We carried out the DNA-binding study through UV titrations of a RAC compound with DNA. Also we attempted to determine the planarity of the polypyridyl ligands of the RAC series compounds using DFT calculations. Results: RAC6 is more potent than any other RAC series compounds on HTB-12 human astrocytoma cancer cells as well as on Glioblastoma Multiforme D54 cell lines. In fact, The IC-50 value of RAC6 on HTB-12 cancer cells is approximately 2 μM. As expected, the RAC series compounds were not active on normal cells. The DFT calculations on the RAC series compounds were done and suggest that the polypyridyl ligands in the complexes are planar. The UV-titrations of RAC9 with DNA were carried out. It suggests that RAC9 and possibly all RAC series compounds bind to minor grooves of the DNA. Conclusion: Because of the very low activity of RAC6 on normal cells and low IC50 value of on astrocytoma (HTB-12) cell lines, it is possible that RAC6 and its derivatives may potentially find application in the treatment of brain cancers. The DFT calculations and UV titrations suggest that RAC series compounds either bind to DNA intercalatively or minor grooves of the DNA or both. However, it is highly premature to make any definite statement in the absence of other techniques.

Aim: Demonstrate that preoperative tumor markers are prognostic factor in colon rectal cancer and their high levels are correlated with bad prognosis.
Methods: We retrospectively analyzed two hundred and thirty-one patients affected by colorectal cancer who underwent radical surgery between January 2012 and August 2016 from a prospectively collected database. The study group consisted of 224 patients: 132 men and 92 women. Demographic details, surgical procedure, histopathologic diagnosis, and survival data were prospectively collected and retrospectively reviewed for this study. Normal cut off values for Carcinoembryonic antigen (CEA) and Carbohydrate Antigen 19.9 (CA 19.9) were respectively 5 ng/ml and 35 UI/ml. A P-value<0.05 was deemed to be statistically significant.
Results: Tumor location was 94 times on ascending colon (42%), 13 on transverse colon (5.8%), 77 on descending colon (34.4%) and 40 on rectum (17.8%). All tumors were histologically diagnosed as adenocarcinoma of the colon-rectum and staged according to the TNM staging system. Preoperative serum CEA level was significantly associated only with T stage and serum albumin level; whereas there were no statistically significant differences between preoperative serum CA19.9 and patients’ clinical pathologic characteristics. Overall survival (OS) and disease-free survival (DFS) showed a statistically significant difference in the two groups of patients who are dichotomized according to the normal cut-off value of CEA and Ca 19.9. At the multivariate analysis both preoperative CEA and Ca 19.9 resulted as independent prognostic factor for survival with a p<0.05.
Conclusion: These two tumor markers could have a role as prognostic factors leading to a stricter postsurgical follow up in those patients with elevated preoperative values.
Core tip: Preoprative measurement of Cea and Ca19.9 is a cheap and routine exam. Their role could help to identify patients with poor prognosis in the preoperative period and to strictly follow up them in the post-surgical setting.

Objective: To determine the indication for lymph node dissection in patients with endometrial cancer, we investigated the incidence and distribution of single metastatic lymph nodes in patients who underwent systematic pelvic and para-aortic lymph node dissection.
Methods: This study involved 910 patients with endometrial cancer who were treated at the Cancer Institute Hospital, Japan, between January 1994 and December 2015. All patients underwent an open hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymph nodes dissection.
Results: Lymph node metastasis was observed in 199 patients (21.9%), 45 (5%) of whom had single lymph node metastasis. Single lymph node metastasis accounted for 22.6% of all metastatic cases. Myometrial invasion >50% was observed in 30 patients, whereas 15 patients had <50% myometrial invasion. When mapping single lymph node metastatic sites, the para-aortic area had a frequency of 31.1% (14 cases). The distribution of single metastatic lymph nodes spanned a wide area between the pelvic and para-aortic regions. Considering single metastatic nodes and myometrial invasion, 8 patients (53.3%) who had myometrial invasion <50% had a single metastatic node in the para-aortic region. Four of 9 patients (45%) considered low-risk (endometrioid Grade 1-2, invasion depth <50%, no lymphovascular space invasion) showed metastasis to the para-aortic areas.
Conclusion: Single metastatic lymph nodes were widely distributed between the pelvic and para-aortic regions, suggesting that detection of a sentinel lymph node in patients with endometrial cancer could be problematic.

Objective: Calibrate the FFQ and evaluate its performance in relation to the consumption of energy, carbohydrate, protein, fat, alcohol, folate, vitamin B2, vitamin B6, vitamin B12, methionine, choline and betaine in the study population “Folate and nutrients involved in the 1-carbon cycle in the pretreatment of patients for colorectal adenocarcinoma in a referral center for oncology in southeastern Brazil.
Materials and methods: For calibration, we used three 24-hour dietary recalls (R24s; n=270) and the second FFQ (n=90) collected in a previous study. The R24 data were used as a reference method and subjected to linear regression, with β1 values used as a calibration factor for the FFQ data collected.
Results: Comparing the R24 data to observed FFQ data and observed FFQ data to calibrated FFQ data; the means were significantly different for all nutrients. When comparing calibrated FFQ data to R24 values, the means were statistically similar for carbohydrates, vitamin B2, vitamin B6, natural folate, synthetic folate, DFE diet and betaine.
Conclusion: The calibration coefficients were low, however the reference method used may not have been the best way to eliminate measurement errors found in the FFQ.