Correlations between MHLC scores and Indicators of Immune Response in Egyptian Women with Breast Cancer.

BACKGROUND: Recent studies indicate the immune dysfunction in cancer patients in comparison with healthy individuals. The quality and quantity of this dysfunction are not equal in all patients even with similar cancer type. AIM: This study aims to correlate health locus of control (HLC) beliefs with CD4+ helper T (Thelper) cells, T regulatory (Treg) cells, NK cells, IL-1ß and TNF-a in breast cancer patients. PATIENTS AND METHODS: The study included 30 early diagnostic breast cancer patients who responded to Form C of the MHLC questionnaire that assessed internal (IHLC), chance (CHLC), doctor (DHLC) and other person's (OHLC) control of the patient's health status. Peripheral blood samples were collected to analyze the numbers and phenotype of Thelper cells, Treg cells and NK cells by flow cytometry and to measure gene expression of IL-1ß and TNF-a with real time PCR. RESULTS: A significant positive correlation was found between IHLC with Thelper cells and NK cells. However, a significant inverse correlation was found between DHLC with NK, Thelper and Treg cells. CONCLUSION: There is strong probability that the quality of immunity in cancer patients is related to their MHLC beliefs. Further research is recommended for studying whether MHLC beliefs of patients with other types of cancer can improve their immune responses and how beliefs control immune system.

Radiotherapeutic factors affecting the incidence of developing hypothyroidism after radiotherapy for head and neck squamous cell cancer.

PURPOSE: The purpose of this study is to determine radiotherapy (RT) dose-volumetric threshold of radiation-induced hypothyroidism (HT) in head and neck squamous cell carcinoma (HNSCC) patients. PATIENTS AND METHODS: The diagnosis of HT in 78 HNSCC patients treated with RT was based on a thyroid stimulating hormone (TSH) level greater than the maximum value of laboratory range. In all patients, dose-volumetric parameters were analyzed according to their relation to development of HT, and thyroid volumes spared from doses ≥10, 20, 30, 40 and 50 Gy (V10, V20, V30, V40 and V50) were analyzed from the dose volume histograms (DVHs). RESULTS: Median follow-up duration was 31 months. At the end of study, 33 patients (42.3%) developed HT and the cumulative incidence of HT was 24.6%, 36.5% and 42.3% at one, two and three years, respectively. V30 of 42.1% (P = 0.005) was defined as dose-volumetric threshold of radiation-induced HT in HNSCC patients. Our analysis showed that V30 separates patients into low- and high-risk groups; the incidence of radiation-induced HT in the group with V30 < 42.1% and V30 ≥ 42.1% was 29.4% and 71.4%, respectively (P = 0.002). CONCLUSIONS: The V30 may predict risk of developing HT after RT for HNSCC patients. V30 of 42.1%, defined as dose-volumetric threshold of radiation-induced HT, can be useful in treatment planning of HNSCC patients.

C-Kit, CD34 & α-SMA Immunohistochemical Features in Classic Kaposi Sarcoma and Kaposiform Hemangioendothelioma.

PURPOSE & METHODS: The aim of this work was to study the clinicopathological features of Kaposi sarcoma (KS) & kaposiform hemangioendothelioma (KHE) and analyze their immunohistochemical expression of c-Kit, CD34, α-SMA. The study was performed on cutaneous 10 classic KS & 8 KHE. RESULTS: KHE shows several dilated lymphatic channels, focal capillary formation, lack of nuclear atypia and mitosis within tumor cells. These features help to exclude Kaposi sarcoma in spite of the kaposiform pattern of tumor cells. C-Kit was expressed by tumor cells in all KHE cases and in 60% only of KS. All elements within both tumor groups expressed CD34 antibody. α-SMA was expressed by tumor cells in 70% of KS cases and none of KHE. CONCLUSION: C-Kit and CD34 seem to be reliable at labeling KS and KHE as they can help in diagnosis of these tumors in routinely processed tissue but they don't differentiate between them. If α-SMA also labeled the tumor, then KHE diagnosis can be ruled out. KS & KHE exemplify stem cell tumors that could give smooth muscle cell-like phenotype in KS. Anti C-kit therapy should be tested in KS & KHE to prevent recurrence.

Pre-emptive value of methylprednisolone intravenous infusion in patients with vertebral metastases. A double-blind randomized study.

CONTEXT: The vertebral column is the most common site of bone metastases irrespective of the primary tumor. Vertebral metastases are a major cause of motor deficit of the lower extremities. The use of radiotherapy is the treatment of choice in these patients. A temporary worsening of pain shortly during the course of palliative radiotherapy is clinically a common problem. Steroid infusion has well-documented neuroprotective effects. OBJECTIVES: Our study objective is to evaluate the effect of pre-emptive infusion of methylprednisolone on pain flare and motor function in patients with vertebral metastases. METHODS: One hundred twenty patients with vertebral metastases received short-course external beam radiotherapy as high-voltage irradiation with a 6 MeV, via linear accelerator. In addition to the short-course radiotherapy, 60 patients received pre-emptive methylprednisolone infusion (5 mg/kg) the day just before initiation of radiotherapy (Group 1 [G1]). The other 60 patients received short-course radiotherapy without pretreatment methylprednisolone infusion, and only normal saline was infused (Group 2 [G2]). The Brief Pain Inventory, incidence of pain flare during radiotherapy, and motor functions were evaluated using the Tomita scale at the time of initial assessment, at the end of external beam radiotherapy, and after two weeks. RESULTS: Four patients (6.6%) in G1 experienced pain flare compared with 12 patients (20%) in G2 during the two-week short-course radiotherapy. The mean values of pain scores were significantly reduced in both groups at the end of radiotherapy; the mean value of worst, average, and current pain scores in G1 remained statistically significant in comparison to pretreatment and G2 mean values two weeks later. Significant increase was noticed in patients with normal motor and ambulatory status in G1 at two and four weeks of initial assessment. CONCLUSION: Pre-emptive methylprednisolone infusion is an effective prophylactic agent in the prevention of radiation-induced pain flare and improves functional motor status after short-term radiotherapy in patients with vertebral metastases.