कैंसर विज्ञान एवं चिकित्सा

The management of cancer in human yet remains a major challenge in contemporary medicine. Natural products have been identified as one of the sources of numerous therapeutic agents. Camel’s milk and urine are among such natural products enriched with molecules that are safe to humans and endowed with profound anti-cancer properties. In vitro studies of the anticancer effects of these products are mainly attributed to inhibition of carcinogenesis and mutagenesis, proliferation, and induction of apoptosis. Camel products also showed an improvement in the life span and the survival of animals among the in vivo studies recorded, an effect caused mainly via clearance of malignant tumors in various organs and inhibition of progression to metastasis. Furthermore, prospects of harvesting promising therapeutic nanoparticles/nano-bodies/nano-rods are now being explored from such natural products for cancer therapy. Yet, prominent gap is evident in regard to advanced research geared towards identifying and designing suitable nano-materials. Therefore, a multi-pronged approach entailing a deeper understanding of cancer biology, nanomaterial’s molecular characteristics on tumor environment, and further formulation of nano-clones is underscored to position them as clinically useful pharmaceuticals.

Introduction: skin sparing mastectomy with immediate autologous breast reconstruction has a positive psychosocial and sexual effect, however postoperative radiotherapy could adversely affect its cosmetic results.

Patients and methods: This study included 24 female breast cancer patients underwent skin sparing mastectomy with or without scarifying NAC and immediate reconstruction by autologous TRAM and latissimus dorsi myocutaneous flap. They received adjuvant chemotherapy followed by 3DCRT, we evaluated them for skin complications and cosmoses.

Results: Faint erythema or dry desquamation detected in 16 patients (66.6%), while 8 patients (29.2%) had moderate to brisk erythema. Two patients (8.3%) had skin edema and one patient (4.2%) had telangiectasia. Two patients complained from moderate pain Fat necrosis within the flap detected only in one patient (4.2%). Twentytwo patients (83.3%) had acceptable cosmoses while 2 patients had unsatisfactory cosmetic results.

Conclusion: Postoperative radiotherapy is safe with acceptable rate of complications and very good patients satisfactions after skin sparing mastectomy and immediate autologous breast reconstruction.

Purpose: This research looks at inflammatory response biomarkers in the context of their prognostic potential, derived neutrophil to lymphocyte ratio (dNLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in patients suffering from rectal cancer and being administered neoadjuvant chemoradiation preceding surgical resection.

Methods: This work offers a retrospective review of “T3/T4, or N+ rectal cancer receiving neoadjuvant chemoradiation 50.4 Gy concurrently with either 5 FU (1 g/m2/d) or Capecitabine 825 mg/m2 twice daily. Pretreatment NLR, dNLR, PLR and LMR measured with the help of peripheral blood cell counts were correlated to clinicopathological parameters. Baseline NLR, dNLR, PLR and LMR prognostic value for disease free survival (DFS) and overall survival (OS) were studied through Cox regression and Log rank.

Results: This study revolved around 80 participants who had undergone resection subsequent to neoadjuvant chemoradiation. ROC or receiver operating curve cut off values for baseline were NLR (3), dNLR (2.1), LMR (4.9) and PLR(169). “Augmented NLR, dNLR, PLR, LMR , age ≥50 years , depth of invasion ≥T3 , lymph node N1-N2, stage III , grade 3 tumors, and partial response to pre-operative chemo-radiation were significantly correlated to reduced OS and DFS. A multivariate evaluation highlighted that risen NLR and dNLR stood as independent elements for worsened OS with an HR (hazard ratio) of 2.34 (95% CI= 3.41-7.24), 4.53 (95% CI, 2.61-8.32) and poor DSF with HR 1.64 (95% CI= 2.27-5.36), 4.23 (95% CI= 3.49-9.52), respectively.”

Conclusion: The baseline inflammatory prognosticators revealed substantial link to various prognostic clinicpathological parameters in the context of rectal cancer patients who had undergone neoadjuvant chemo-radiation. Moreover, both NLR and dNLR can be seen as possible independent indicators for prognosis in the given patient group.

Objectives: This document aims to identify the clinical, therapeutic, and prognostic features of this association and to provide the up-to-date management.

Methods and materials: Our study design is retrospective based on 25 cases of pregnancy-associated breast cancer, carried out at the Maternity and Neonatology Center of Tunis over a period of 10 years, between January 2001 and December 2013.

Results: The mean age of the patients was 35.84 years. Breast cancer was diagnosed during pregnancy in fourteen patients and after delivery in eleven patients. Pathohistological diagnosis was established by ultrasoundguided biopsy and surgical biopsy in fourteen and seven patients, respectively. The most common histological type was infiltrating ductal carcinoma (96% of cases). Pregnancy was completed in nine patients. The mean gestational age at which delivery occurred was 35.4 weeks. Twenty patients underwent surgical treatment by mastectomy and breast-conserving surgery (lumpectomy) associated with axillary lymph node dissection was performed in three cases. Chemotherapy was allowed during pregnancy, and was given to 23 patients. On the other hand, radiotherapy, antiestrogens (Tamoxifene) and targeted therapies (Herceptin) must be postponed after delivery because of their teratogenic effects. After a 5-year follow-up, two of eighteen patients died and six were lost to follow-up.

Conclusion: The poor prognosis of the pregnancy-associated breast cancer is no longer attributed to pregnancy but rather to the young age of the patients and the delay in the diagnosis of cancer. Treatment should be started promptly during pregnancy.

Background: Nasopharyngeal carcinoma (NPC) is a radiosensitive and radio curable cancer, the radiation therapy (RT) is the mainstay of treatment with significant improvement in survival of patients. The aim of this study was to report the experience of Military Hospital Mohamed V in the management of NPC and their results.

Materials and methods: 83 no metastatic NPC patients managed at the radiotherapy department of Military Hospital Mohammed V of Rabat in Morocco, between January 2005 and December 2009, were included for investigation of their demographic, histological, therapeutic and follow-up characteristics. Statistical analysis of the data was carried out by the SPSS for Windows.

Results: The mean age was 44.5 ± 12.5 years with sex ratio 4:1. At diagnosis, rhinologic symptoms represented the most common clinical presentation, reported by 56 (67, 5%) patients. Almost ninety percent (n=74) of patients presented UCNT histology. Most of the patients (85.5%) presented a locally advanced disease; stage III and IV. Therefore, forty patients (48.2%) were treated by concurrent chemoradiotherapy and 35 patients (42.2%) received induction chemotherapy. With a mean follow up of 70 ± 32 months, twenty nine patients (34.9%) died, 6 (7.2%) presented local or locoregional relapse. While 11 (13.2%) patients presented distant recurrences. The five years overall survival (OS) was 68% ranging from 91% for both stage I and II, 79.3% for stage III to 40% for stage IV. The five years disease free survival (DFS) was 81.1%, whereas distant failure free survival (DFFS) was 84.1%. In multivariate analysis, the disease stage according to the seventh edition of the AJCC system was an independent prognostic factor.

Conclusion: Our outcomes in NPC are similar to the literature. Patients’ survival is directly impacted by the disease staging which is the most important prognostic factor. We hope to improve these results with the recent acquisition of volumetric-modulated arc therapy machines.

cancer with locoregional relapse in 40% to 60%. The frequency of relapses makes regional radiotherapy an attractive possibility for adjuvant therapy. The survival benefit of adjuvant chemoradiation over surgery alone was first established by the US Intergroup 0116 study. Patients and methods: Between January 2010 and December 2014, 48 patients with localized gastric adenocarcinoma, managed at radiotherapy department of the national institut of oncology, they underwent adjuvant chemoradiation according the classical MacDonald regimen. Results: This series consisted of non-metastatic patients, 68.8% (33) males with a mean age 51 years. 20.8% (10) of patients had relapses (all distant relapse). 22 (45.8%) patients died, only 8(16.6%) patients were lost to follow up. Almost all patients complete full course chemoradiation. The median follow-up duration was 25.4 (15.6- 48) months. The 5 years OS and DFS was 40.8% and 49% respectively. Disease stage, operative procedure on primary tumor was an independent prognostic for both 5-year OS and DFS. The pN, surgical margin had a significant impact on OS. Conclusion: Adjuvant chemo-radiation may be an effective and safe regimen for patients who have undergone gastrectomy with curative intent in locally advanced stomach cancer and did not receive preoperative chemotherapy.

Reverse total shoulder arthroplasty (rTSA) initially faltered because of glenoid component failure. Modern design utilizes a large glenosphere component and relies upon a functional deltoid for arm elevation. We report novel use of rTSA to revise a chronically dislocating TSA. The patient underwent proximal humeral resection for chondrosarcoma, requiring sacrifice of the deltoid and all proximal insertions including the latissimus dorsi. Twoyears post-operatively, he had good stability, no pain, and was using his arm more than he had in years. rTSA is a salvage option for failed TSA, even with absent deltoid function and lack of a latissimus.

Objective: Tumor establishment, metastatic spreading and poor survival in ovarian cancer is strongly associated with progressive derangement of the patient’s immune system. Accumulating evidence suggests that immune impairment is influenced by the production and presence of cytokines in the tumor microenvironment. Methods: Cytokine mRNA profiles in tumor tissue and peripheral blood mononuclear cells (PBMC) were analyzed in patients with high grade serous carcinoma (HGSC) of the ovary and compared it to patients with benign ovarian conditions and controls with normal ovaries. Cytokine assessment was done by real-time quantitative RT-PCR and specific primers and probes for 12 cytokines-IFN-γ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, TNF-β/LTA, TGF-β1, and GM-CSF chosen to distinguish between cytotoxic Th1, humoral Th2, regulatory Th3/Tr1 and inflammatory responses. Results: The cytokine mRNA response in the HGSC patients was significantly up regulated compared to patients with benign ovarian conditions and normal ovary controls confirming the immunogenicity of HGSC and implying immune recognition and reaction locally in the tumor microenvironment and systemically in the peripheral blood.There was an up-regulation of inflammatory and inhibitory cytokine mRNA promoting tumor progression, T-regulatory cell priming and T-regulatory cell-mediated immune suppression. In contrast, there was an inability to mount the crucially important IFN gamma response needed for upregulation of the cytotoxic anti-tumor response in the local microenvironment. In addition, systemic IL-4- mediated Th2 response prevailed in the peripheral blood deviating the systemic defense towards humoral immunity. Conclusions: Taken together, these results suggest local and systemic cytokine cooperation promoting tumor survival, progression and immune escape. Our study confirms and extends previous investigations and contributes to the evaluation of potential cytokine candidates for diagnostic cytokine mRNA profiles and for future therapeutic interventions based on cytokine inhibition.