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Hassan H, Hosni A, Mammdoh YM, Fathy E. Serum Galectin-3: A novel predictor of treatment response to cryotherapy in cutaneous warts. Cryobiology 2023; 113:104790. [PMID: 37924930 DOI: 10.1016/j.cryobiol.2023.104790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Heba Hassan
- Dermatology, Venereology, and Andrology at the Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Egypt.
| | - Amal Hosni
- Clinical Pathology at the Department of Clinical Pathology, Faculty of Medicine, Assiut University, Egypt
| | - Yousra M Mammdoh
- Clinical Pathology at the Department of Clinical Pathology, Faculty of Medicine, Assiut University, Egypt
| | - Eman Fathy
- Dermatology, Venereology, and Andrology at the Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Egypt
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Peltenburg J, Hosni A, Bahij R, Böke S, Braam PM, Hall WA, Intven MPW, Nicosia LD, Sonke JJ, Nowee ME, Janssen T. Interobserver Variation in Tumor Delineation of Liver Metastases using Magnetic Resonance Imaging. Int J Radiat Oncol Biol Phys 2023; 117:e145. [PMID: 37784723 DOI: 10.1016/j.ijrobp.2023.06.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Magnetic Resonance (MR-) guided stereotactic body radiotherapy enables accurate treatment of liver metastases. Despite the accuracy of treatment delivery, one of the main uncertainties is the variation in tumor delineation, which requires additional treatment margins. The aim of this study was to quantify the interobserver variation (IOV) in MRI based delineation of the gross tumor volume (GTV) of liver metastases. MATERIALS/METHODS A cohort of 20 liver metastases treated on a MR-Linac were consecutively selected per primary tumor (colorectal (6), breast (6) and lung (8)). Planning MRI scans (T1 weighted with IV-contrast) were collected and anonymized. GTV delineation guidelines and case-specific information were provided to 8 radiation oncologists from 8 institutions. All cases were quantitatively reviewed and delineations with major violations of the guidelines were marked as outliers (such as contours including a vein or excluding obvious parts of a tumor). IOV was quantified by comparing individual delineations with the median contour and calculating the standard deviation (SD) and 95th percentile Hausdorff distance (HD95). Analyses were conducted on all delineations and on a subgroup excluding outliers per case to distinguish between accuracy of delineation and individual guideline interpretation. Sphericity was calculated from the volume and surface area of all delineations. Correlation between SD and sphericity was determined using Spearman's rs. Differences in SD between primary tumors were analyzed using the Kruskal-Wallis test. RESULTS The median volume of all metastases was 6.5 cc (IQR 3.7 - 29.8 cc) and sphericity was 0.84 (IQR 0.80 - 0.87) based on all contours (Table 1). The SD was 1.6 mm and the median HD95 was 2.7 mm. In the subgroup analysis, one (in 15 cases) or two (in 5 cases) delineations were excluded. Subgroup analyses showed a SD of 1.1 mm and median HD 95 of 2.6mm. The Kruskal-Wallis test showed no difference (p = 0.59) in SD between primary tumors. There was a significant negative correlation between IOV (SD) and sphericity (rs = -0.70; p = 0.008). Table 1: Overview of SD (mm), HD95 (mm) and volume (cc) of all observers and subgroup per primary tumor and in total CONCLUSION: MRI based GTV delineation variation of liver metastases is 1.1 - 1.6 mm, which is smaller than anticipated, although significant outliers (HD95 up to 3.9 mm) were present. Use of common delineation guidelines will ensure consistency in contouring and have the potential to decrease treatment margins when taking IOV into account.
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Affiliation(s)
- J Peltenburg
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Noord-Holl, The Netherlands
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R Bahij
- Odense University Hospital (OUH), Odense, Denmark
| | - S Böke
- Tübingen University Hospital, Tübingen, Germany
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L D Nicosia
- Advanced Radiation Oncology Department - Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - J J Sonke
- The Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands, Amsterdam, The Netherlands
| | - M E Nowee
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - T Janssen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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Stutheit-Zhao E, King I, Huang SH, Rey-McIntyre K, Cho J, Eng L, Hahn E, Hosni A, Kim J, Tadic T, McNiven AL, McPartlin A, Ringash JG, O'Sullivan B, Siu LL, Spreafico A, Tsai CJ, Waldron J, Hope AJ, Bratman SV. Plasma EBV DNA in Nasopharyngeal Cancer (NPC) Treated with Definitive Radiotherapy (RT). Int J Radiat Oncol Biol Phys 2023; 117:e627-e628. [PMID: 37785875 DOI: 10.1016/j.ijrobp.2023.06.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) EBV DNA has well-studied roles in NPC including early detection and surveillance. There are limited North American data on EBV DNA testing. Our center has used EBV DNA testing since 2010. We hypothesized: (1) higher first post-RT EBV DNA level is associated with worse prognosis, and (2) surveillance EBV DNA is specific for recurrence at a low detection threshold. MATERIALS/METHODS We retrospectively reviewed all patients with non-metastatic (TNM-7 stage I-IVB) NPC treated with definitive RT/chemoRT (CRT) ± adjuvant chemotherapy (AC) between 2010-2017. EBV DNA was assayed by quantitative PCR in a CAP/CLIA-certified laboratory and reported in copies/mL of plasma. Pre-RT is defined as 0-90 days before the first RT fraction and post-RT within one year after RT. We report log odds ratios (LOR) from a linear model of T- and N-category with log-adjusted EBV DNA as the response variable. Survival outcomes were analyzed with log-rank tests and Cox multivariate analyses (MVA) adjusted for age, stage, and treatment, reporting hazard ratios (HR). A total of 95% confidence intervals of LOR and HR are reported. The detection threshold that maximized the F1 accuracy score was considered optimal. RESULTS Of 271 patients in the study window, 179 had pre-RT +/- post-RT EBV DNA testing. Six received RT, 43 CRT, and 130 CRT+AC. With 7-yr median follow-up, 37 recurred and 37 died. Detectable pre-RT EBV DNA was found in 154 (86%) with a median of 928 copies/mL (range: 1-239214). EBV DNA level correlated with higher N category (LOR: 0.28, 0.15-0.42, p<0.001), but not T category (0.04, -0.06-0.13, p = 0.5). Above-median pre-RT EBV DNA was associated with worse recurrence-free survival (RFS) by log-rank test (p = 0.016) and Cox MVA (HR: 2.2, 1.1-4.8, p = 0.03) along with N category, age, and no AC. Post-RT EBV DNA was available in 99 patients at a median of 54 days. RFS, progression-free survival (PFS), and overall survival (OS) were worse in patients with detectable post-RT EBV DNA (Table). RFS and PFS drop further to 20% if EBV DNA was detectable after the full treatment (RT±AC, n = 71). In Cox MVA, post-RT EBV DNA remained independently prognostic (Table). EBV DNA was performed within 30 days of recurrence in 30 patients, and 24 were detectable (80% sensitivity). Conversely, of 152 patients without recurrence and at least 3-yr follow-up, 95 had post-RT EBV DNA testing and 84 were undetectable (88% specificity). An EBV DNA threshold of 31 copies maximized F1 accuracy metric, yielding 74% sensitivity and 97% specificity. CONCLUSION Pre-RT EBV DNA is prognostic and associated with higher N-category. Post-RT EBV DNA is a strong, independent predictor of RFS, PFS, and OS; 31 copies/mL may be a useful threshold to detect recurrence.
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Affiliation(s)
| | - I King
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - S H Huang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - J Cho
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - L Eng
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - T Tadic
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - A L McNiven
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - A McPartlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B O'Sullivan
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - L L Siu
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Spreafico
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - C J Tsai
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Salunkhe RR, O'Sullivan B, Huang SH, Su J, Xu W, Hosni A, Waldron J, Irish J, de Almeida J, Witterick I, Montero E, Gilbert RW, Razak AA, Zhang L, Brown D, Goldstein D, Gullane P, Tong L, Hahn E. Dawn of Staging for Head and Neck Soft Tissue Sarcoma: Validation of the Novel 8 th Edition AJCC T Classification and Proposed Stage Groupings. Int J Radiat Oncol Biol Phys 2023; 117:S149. [PMID: 37784378 DOI: 10.1016/j.ijrobp.2023.06.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) After decades of stagnation, the 8th edition TNM (TNM8) introduced a new T classification for head and neck (HN) soft tissue sarcomas (STS). New size cutoffs of 2 and 4 cm define T1-3, and a novel T4 category is defined by local invasion of adjoining structures. These size cutoffs had been chosen arbitrarily to advance data collection in this unique disease site since literature showed approximately 70% of HN STS did not reach the previous size threshold (5 cm) for the existing T1 category. The definition of the TNM8 T categories also align with mucosal HN cancers. No stage grouping for HN STS was defined since this new classification required more data collection to derive stage groups. This study aims to validate the TNM8 T classification and to propose stage groupings. MATERIALS/METHODS Clinical data of all adult (>16 years) HN STS patients treated from 1988 - 2019 with curative intent in our tertiary cancer center were retrieved from a prospective database, and supplemented with chart review. As per TNM8, cutaneous angiosarcoma, embryonal and alveolar rhabdomyosarcoma, Kaposi sarcoma, and dermatofibrosarcoma protuberans were excluded due to their different behavior. Multivariate analysis (MVA) identified prognostic factors for overall survival (OS). Adjusted hazard ratios (AHR) and recursive partitioning analysis (RPA) were used to derive stage groupings. Stage grouping performance for OS was assessed and also compared against the existing TNM8 groups for non-HN STS. RESULTS A total of 221 patients (N1: 2; M1: 2) were included. Of the 219 M0 patients, 63% were males; median tumor size was 3.0 cm (range: 0.3-14.0); the proportion of TNM8 T1-T4 were 35%, 34%, 26%, and 5%, respectively. Median follow up was 5.9 years. Five-year OS was 79%. MVA confirmed the prognostic value of T category (T4 HR 7.73, 95% CI 3.62-16.5) and grade (G2/3 vs G1 HR 3.7, 95% CI 1.82-7.53), in addition to age (HR 1.03, 95% CI 1.01-1.04) (all p<0.001) for OS. AHR model derived T1-3_Grade 1 as stage 1; T1-3_Grade 2/3 as stage II; and T4_any Grade or any T_N1 as stage III (Table 1); the corresponding 5-year OS was 93%, 73%, and 38%, respectively. Both patients with M1 died within 1.5 years after diagnosis and M1 disease was designated stage IV. The AHR-grouping outperformed the RPA and non-HN TNM8 stage grouping for hazard consistency, hazard discrimination, percent variance explained, hazard difference, and sample size balance. CONCLUSION The novel T4 category introduced in TNM8 is associated with a >7 fold increased risk of death. Grade continues to be a critical prognostic factor in HN STS. The TNM8 HN STS T classifications have been validated, and the proposed new stage groupings with TNM8 incorporating grade have excellent performance for OS.
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Affiliation(s)
- R R Salunkhe
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - B O'Sullivan
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S H Huang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Irish
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - I Witterick
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - E Montero
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - R W Gilbert
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A A Razak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - L Zhang
- Mount Sinai Hospital, Toronto, ON, Canada
| | - D Brown
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - D Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - P Gullane
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L Tong
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - E Hahn
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Barcelona MVN, Huang SH, Su J, Tong L, Bratman SV, Cho J, Hahn E, Hope AJ, Hosni A, Kim J, McPartlin A, O'Sullivan B, Ringash JG, Siu LL, Spreafico A, Eng L, Yao CM, Xu W, Waldron J, Tsai CJ. Outcomes after Contemporary Definitive Radiotherapy Alone in Patients with TNM-7 Stage III/IV Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e565-e566. [PMID: 37785730 DOI: 10.1016/j.ijrobp.2023.06.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study was undertaken to determine outcomes and prognostic factors of definitive intensity-modulated radiotherapy (IMRT) alone for patients with TNM-7 stage III/IV HNSCC who did not receive concurrent chemotherapy. MATERIALS/METHODS We evaluated TNM-7 stage III/IV HNSCC patients treated with definitive IMRT alone in our institution from 2004-2019. Patients were reclassified according to TNM-8 staging. Stage II HPV+ oropharyngeal cancers (OPC) were subdivided into T1-2N2 and T3N0-2 for analysis. The rationale for chemotherapy omission was obtained retrospectively from clinical documentation. Recurrence-free survival (RFS) and overall survival (OS) were estimated stratified by HPV status (determined by p16 staining, sometimes supplemented by HPV DNA testing). Multivariable analysis (MVA) identified prognostic factors for RFS and OS, taking into account stage and IMRT regimen. Age, performance status, and smoking were also examined for OS. RESULTS A total of 1083 patients were included (460 HPV+ and 623 HPV-). Reasons for omission of chemotherapy were: age >70 years or frailty (n = 551, 51%), cisplatin contraindication (n = 241, 22%), patient refusal (n = 106, 10%), and clinician's decision (n = 185, 17%). Median age was 67 years for HPV+ and 70 years for HPV- cohorts. IMRT mostly utilized altered fractionation regimens (n = 1016, 94%): moderately accelerated (Acc) (70 Gy/35 fractions [f]/6 weeks [w], 55%), hypofractionated (Hypo) (60 Gy/25f/5w, 14%), and hyperfractionated-accelerated (Hyper) (64 Gy/40f/4w, 25%). Median follow-up was 5 years. Five-year RFS and OS for HPV+ TNM-8 stage I/T1-2N2/T3N0-N2/III were 89%/86%/76%/52% and 83%/80%/64%/33% respectively (p<0.01). The same outcomes for HPV- TNM-8 stage III/IVA/IVB were 58%/52%/39% and 47%/27%/13%, respectively (p<0.01). MVA confirmed that HPV+ T3N0-2 subset within stage II and stage III (vs stage I) had lower RFS, and HPV- stage IVA and IVB (vs stage III) carried worse RFS and OS (Table). CONCLUSION Despite the retrospective nature and inherent selection bias, this large single institutional study shows that altered fractionated IMRT alone is an acceptable alternative for elderly, frail or cisplatin ineligible patients with HPV+ stage I/IIA (T1-2N2) OPC. Patients with HPV+ T3N0-2/stage III OPC and HPV- stage III/IV HNSCC have poor outcomes with IMRT alone and may benefit from alternative strategies.
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Affiliation(s)
- M V N Barcelona
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S H Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - S V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A McPartlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L L Siu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Spreafico
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L Eng
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - C M Yao
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - C J Tsai
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Westley R, Peltenburg J, Aitken KL, Awan MJ, Braam PM, Daamen LA, Hosni A, Intven MPW, Janssen T, Schytte T, Sonke JJ, Straza MW, Paulson ES, Hall WA, Nowee ME. Outcomes of Tolerability, Acute Toxicity and Quality of Life from MR-Guided Radiation Therapy (1.5T MR-Linac) for Liver Metastases in the MOMENTUM Study. Int J Radiat Oncol Biol Phys 2023; 117:e156. [PMID: 37784746 DOI: 10.1016/j.ijrobp.2023.06.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiation therapy (SBRT) offers an important treatment option for metastatic liver tumors. The introduction of magnetic resonance (MR) guided SBRT has paved the way for optimal tumor visualization and daily plan adaptation. The purpose of this study is to review tolerability of MR-guided SBRT of liver metastases and to present early toxicity and quality of life outcomes. MATERIALS/METHODS All patients with liver metastases who were treated on a 1.5T MR-Linac and enrolled in the MOMENTUM study (NTC04075305) were included. Patients were treated between April 2019 and December 2022 in 5 different institutes across 3 countries. Descriptive statistics were used to present the tolerability of treatment, toxicity (CTCAE v5.0) and quality of life outcomes (QLQ C30 and EQ 5D-5L) at baseline and 3 months after treatment. RESULTS A total of 127 patients with liver metastases were included in the analysis. There were 64 females and 63 men, with a median age of 66 years (range 31 to 93). The median ECOG-score was 0 (range 0-2). The most common primary origin was colorectal cancer (66%), followed by bronchus and lung cancer (12%), with ocular melanoma, pancreatic and breast cancer being joint third (all 6-7%). Fractionation schedules ranged from 12 - 67.5 Gy in 2 - 12 fractions. The most commonly prescribed fractionation dose was 60 Gy in 3-5 fractions (53% and 13% respectively) and 50 Gy in 5 fractions (11%). Completion data was available for 116 patients. 112 patients (97%) received all fractions. 4 Patients (3%) did not complete treatment due to technical issues and 2 of the 4 receiving no treatment on the MR-Linac. Physician reported toxicity at 3 months was recorded for 82 patients (66%). No grade 4 or 5 toxicities were reported. There were 12 grade 3 toxicities reported in 6 (7%) patients with 5 deemed radiation therapy related (Table 1) and 34 grade 2 toxicities in 21 (26%) patients. CONCLUSION We have presented the largest cohort (to our knowledge) of 127 patients treated using 1.5 Tesla MR Guidance for metastatic liver tumors. 97% of treatments were completed successfully with all treatments being well tolerated. Acute grade 3 toxicity was reported in 7% of patients with no grade 4 or 5 toxicities present. These outcomes suggest radiotherapy on the MR-Linac is a safe and promising treatment for patients with liver metastases. Additional prospective follow up is ongoing for late toxicity events and long-term control data. Table 1: Grade ≥3 toxicity at 3 months related to radiation therapy (total No. of patients was 82) There was QLQ-C30 data on 89 patients at baseline and on 62 patients at 3 months. At 3 months the median score was worse for physical functioning, VAS score and pain.
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Affiliation(s)
- R Westley
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Peltenburg
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, Noord-Holl, The Netherlands
| | - K L Aitken
- Royal Marsden Hospital, London, United Kingdom
| | - M J Awan
- Case Western Reserve University, Cleveland, OH
| | - P M Braam
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Janssen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - T Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - J J Sonke
- The Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands, Amsterdam, The Netherlands
| | - M W Straza
- Department of Radiation Oncology, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M E Nowee
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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7
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Johnny C, Huang SH, Su J, Bratman S, Cho J, Hahn E, Hosni A, Hope A, Kim J, O'Sullivan B, Ringash JG, Waldron J, Spreafico A, Eng L, Goldstein D, Tong L, Xu W, McPartlin A. The Prognostic and Predictive Value of Pre-Treatment Total Lymphocyte Count in HPV+ Oropharyngeal Carcinoma Receiving Definitive (Chemo-) Radiation. Int J Radiat Oncol Biol Phys 2023; 117:e591-e592. [PMID: 37785789 DOI: 10.1016/j.ijrobp.2023.06.1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Evidence of prognostic importance of pre-radiotherapy (RT) total lymphocyte counts (TLC) and interaction with addition of cisplatin (CRT) in HPV-positive oropharyngeal carcinoma (HPV+OPC) is conflicting. Recent data suggest patients with high TLC may not benefit from the addition of chemotherapy (Price et al, JCO 2022). We assess the prognostic and predictive value of TLC in a large single center HPV+OCP cohort. MATERIALS/METHODS All HPV+OPC patients treated at a single academic center with definitive RT/CRT between 2005-2018 were included. Pre-treatment TLC up to 6 weeks prior to RT start were considered. Multivariable analysis (MVA) was applied to assess the prognostic importance of TLC (continuous variable), adjusted for age, gender, performance status, TNM-8 stage, and smoking status in the CRT and RT subgroups. The actuarial rates of locoregional control (LRC), distant control (DC), and overall survival (OS) were calculated using Kaplan-Meier and competing risk methods, stratified by low vs high TLC (determined using Contal and O'Quigley method for optimal cutoff). RESULTS Among 1153 eligible patients, 707 (61%) were treated with CRT. Median age was 59.7 (range 22.7-92.2) years. 526 patients were (46%) TNM-8 stage I, 366 (32%) stage II and 261 (23%) stage III. Median TLC was 1.6 x 109/L (range 0.1-8.5). Median follow-up was 5.5 years. On MVA, TLC was prognostic for patients receiving CRT (OS [adjusted hazard ration (aHR) 0.55 (0.38-0.79), p = 0.002], DC [aHR 0.57 (0.37-0.88), p = 0.011], LRC [aHR 0.57 (0.36-0.89), p = 0.014]) but not RT (OS [aHR 1.04 (0.82-1.31), p = 0.74], LRC [aHR 1.26 (0.86-1.85), p = 0.23], DC [aHR 0.87 (0.64-1.19), p = 0.4)]. The optimal TLC cut-off for OS with CRT was 1.9 x 109/L. Low vs high TLC patients receiving CRT had significantly inferior 5-year DC (87% vs 93%, p = 0.017) and OS (84% vs 90%, p = 0.026). The benefit of higher TLC was most evident in stage II disease (table 1). CRT vs RT improved OS for stage II/III disease at high and low TLC. CONCLUSION Pre-treatment TLC is prognostic in a large cohort of HPV+OPC patients receiving CRT but not RT alone. Further investigation of the interaction of cisplatin and immune response during RT is warranted. The omission of chemotherapy based on TLC is not supported.
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Affiliation(s)
- C Johnny
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S H Huang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Center/University of Toronto, Toronto, ON, Canada
| | - J Cho
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hope
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B O'Sullivan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - J G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Spreafico
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L Eng
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - D Goldstein
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - L Tong
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Center/University of Toronto, Toronto, ON, Canada
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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8
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Saha S, Huang SH, O'Sullivan B, Su J, Xu W, Hosni A, Waldron J, Irish J, de Almeida J, Witterick I, Monteiro E, Gilbert RW, Catton CN, Chung P, Brown D, Goldstein D, Razak AA, Gullane P, Hahn E. Outcomes of Head and Neck Cutaneous Angiosarcoma Treated in the IMRT Era. Int J Radiat Oncol Biol Phys 2023; 117:e620-e621. [PMID: 37785859 DOI: 10.1016/j.ijrobp.2023.06.2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Clinical behavior, natural history, and varied presentations of cutaneous angiosarcomas of the head and neck region (HN), in conjunction with its rarity, have rendered standardization of treatment elusive. We aimed to assess outcomes and patterns of failure for patients treated with surgery and radiation (Sx+RT), and radiation alone (RT). MATERIALS/METHODS A retrospective review of all HN angiosarcoma patients amenable for upfront Sx or RT in our institution between 2004-2018 was completed. Generally, treatment included Sx when feasible, and RT for large or extensive/ill-defined tumors. Demographic, tumor characteristics, local (LC), regional (RC), distant control (DC), and overall survival (OS), as well as patterns (in-field, marginal, out-of-field) of local failure at 5-year were estimated. Univariate analysis (UVA) was conducted to assess association with outcomes. RESULTS A total of 33 patients were eligible (14 Sx+RT and 19 RT). Tumor locations were: scalp (16, 48%). face (n = 12, 36%), and overlapping (5, 15%). Lesion types were: nodular (n = 23, 70%), flat (n = 4, 12%) and mixed (n = 6, 18%). Tumor size was larger in the RT group (median: 10.00 vs 2.85 cm, p<0.01). RT and Sx+RT patients had otherwise similar baseline characteristics: median age 74.3; male 70%; and ECOG performance status ≤1 85%. RT dose fractionations ranged from 50-70 Gy in 25-35 fractions in the RT group and 50-66 Gy in 25-33 fractions in the Sx+RT group. Four (12%) patients received neoadjuvant chemotherapy. Median follow up was 5.5 years. Five-year LC, RC, DC, and OS for RT vs Sx+RT groups were 68% vs 85% (p = 0.28); 95% vs 86% (p = 0.89); 79% vs 86% (p = 0.39); and 45% vs 55% (p = 0.71), respectively. The in-field/marginal/out-of-field local failure rate at 5 years were 16% vs 7% (p = 0.46), 26% vs 15% (p = 0.41), and 13% vs 0% (p = 0.24) for the RT vs Sx+RT groups, respectively. UVA showed that scalp location and ulceration/bleeding were strong adverse features for OS. Bone invasion was significantly associated with lower DC (Table). Lesion type (nodular/flat/mixed), tumor size, and treatment type (Sx+RT vs RT), were not significantly associated with LC or pattern of local failure. CONCLUSION Scalp tumors, as compared to face, portended poorer prognosis, and ulceration/bleeding and bone invasion were associated with increased distant metastases. Sx+RT was the preferred treatment modality when possible and typically used for smaller and better defined tumors. RT was reserved for larger and extensive/ill-defined disease; despite this, in the IMRT era, RT achieves reasonable rates of control, markedly superior to historical series.
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Affiliation(s)
- S Saha
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - S H Huang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - B O'Sullivan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - J Su
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Irish
- Department of Otolaryngology - Head & Neck Surgery, University Health Network-University of Toronto, Toronto, ON, Canada
| | - J de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - I Witterick
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - E Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - R W Gilbert
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - C N Catton
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - P Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - D Brown
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - D Goldstein
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A A Razak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - P Gullane
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Dawson L, Winter K, Knox J, Zhu A, Krishnan S, Guha C, Kachnic L, Gillin M, Hong T, Craig T, Hosni A, Chen E, Noonan A, Koay E, Sinha R, Lock M, Ohri N, Dorth J, Moughan J, Crane C. NRG/RTOG 1112: Randomized Phase III Study of Sorafenib vs. Stereotactic Body Radiation Therapy (SBRT) Followed by Sorafenib in Hepatocellular Carcinoma (HCC) (NCT01730937). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Zhao E, Bushehri A, Chan B, Wong O, Lee J, Patel T, Kim S, King I, Huang S, Cho J, Hahn E, Hosni A, Kim J, Ringash J, O'Sullivan B, Waldron J, Bissonnette J, Giuliani M, Haibe-Kains B, Malkov V, Tadic T, McNiven A, Hope A, Bratman S. Daily Assessment of On-Treatment Tumor Regression by Cone Beam CT as a Prognostic Dynamic Biomarker in Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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11
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Mohamad I, Almousa A, Abuhijlih R, Taqash A, Al-Gargaz W, Wahbeh L, Mayta E, Ababneh H, Hussein T, Ghatasheh H, Abuhijla F, Hosni A. Intensified Radiation Therapy for Laryngeal Cancer: Oncologic and Functional Outcomes. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Johnny C, Huang S, Waldron J, O'Sullivan B, Su J, Bayley A, Goldstein D, Gullane P, Ringash J, Kim J, Cho J, Hope A, Bratman S, Hosni A, Hahn E, Tong L, Xu W, Caparrotti F. Definitive Radiotherapy for Head and Neck Paragangliomas – A Single-Institution 30-Year Experience. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Zhao E, Rostami A, Zhao Z, Huang S, Malkov V, Cho J, de Almeida J, Giuliani M, Goldstein D, Hahn E, Han K, Hope A, Hosni A, Kim J, Liu F, Liu G, Ringash J, O'Sullivan B, Siu L, Spreafico A, Waldron J, Bratman S. Circulating HPV DNA Kinetics and Clinical Outcomes in a Large Cohort of Radiotherapy-Treated p16-Positive Oropharyngeal Cancers. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Mohammed HSED, Kamal MM, ElBadre HM, Hosni A, Elfadl AA, Mostafa MA, El-Mahdy RI. Lectin-Like OLR1 3'UTR Rs1050286 Gene Polymorphism and Plasma Oxidized-LDL in Coronary Artery Disease and Their Relation to Cardiovascular Risk and Outcomes. Rep Biochem Mol Biol 2022; 10:537-553. [PMID: 35291601 PMCID: PMC8903367 DOI: 10.52547/rbmb.10.4.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Oxidized low-density lipoprotein (ox-LDL) has an important role in the genesis of coronary atherosclerosis. Lectin-like ox-LDL receptor 1 (OLR1) contributes to the uptake and internalization of ox-LDL. Genetic polymorphisms have been associated with coronary artery disease (CAD). Here we explore the association of plasma levels of ox-LDL and 3' UTR OLR1 (rs1050286) SNP with CAD risk and in-hospital adverse outcomes. METHODS A case-control study enrolled 192 patients with ST-segment elevation myocardial infarction (STEMI), 100 patients with unstable angina, and 100 healthy controls. Baseline, clinical characteristics, and risk scores of the patients were determined. Plasma ox-LDL and other biochemical variables were measured. All subjects are genotyped for OLR1 (rs1050286) by RT-PCR with TaqMan SNP genotyping assay. RESULTS Plasma ox-LDL was higher with enhanced sensitivity and specificity in identifying patients with STEMI and was found as a significant independent risk factor for CAD in those two groups. Levels of ox-LDL were increased with increasing poor prognostic factors in STEMI patients that are associated with an increased incidence of some adverse events and in-hospital mortality. Elevated STEMI risk was associated with T allele of OLR1 (rs1050286) (odds ratio of 4.9, 95% CI: 2.6-9.4, p< 0.001). STEMI patients who have T allele exhibited higher risk scores, coronary multivessel narrowing, and elevated incidence of in-hospital major adverse clinical events. CONCLUSION These results suggest that plasma ox-LDL, as well as T allele of ORL-1 (rs1050286), is associated with the increased risk for developing STEMI and the associated adverse clinical outcomes.
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Affiliation(s)
| | - Manal Mohamed Kamal
- Department of Medical Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Hala Mostafa ElBadre
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Azza Abo Elfadl
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Mohamed Ahmed Mostafa
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| | - Reham Ibrahim El-Mahdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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15
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Mahmoud M, Khaleel WE, Medhat M, Hosni A, Kasem A, Ramadan HA. Can hematologic inflammatory parameters predict the severity of coronavirus disease 2019 at hospital admission? Egypt J Chest Dis Tuberc 2022. [DOI: 10.4103/ecdt.ecdt_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Mohammed HSED, Ramadan HKA, El-Mahdy RI, Ahmed EH, Hosni A, Mokhtar AA. The Prognostic Value of Different Levels of Cortisol and High-sensitivity C-reactive Protein in Early Acute Pancreatitis. Am J Med Sci 2021; 363:435-443. [PMID: 34798139 DOI: 10.1016/j.amjms.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/09/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) ranges in severity from mild to severe with high mortality. Severe AP, similar to other critical illnesses, is associated with changes in cortisol level. Early increase of high-sensitivity C-reactive protein (hs-CRP) as an inflammatory marker could be an indicator of AP progression. We aimed to assess the level of cortisol and hs-CRP on initial diagnosis of AP and identify their prognostic value. METHODS This case-control study included patients with AP and a control group of healthy subjects. Laboratory tests such as liver profile, kidney functions, blood picture, lactate dehydrogenase, blood glucose, and lipogram were evaluated, the severity of AP was determined, the duration of hospitalization, complications, and outcomes were identified, and the serum levels of cortisol and hs-CRP were assessed. RESULTS There were 90 patients with AP and 60 controls with a higher percent of females in both groups. Serum cortisol and hs-CRP were significantly higher in AP relative to controls and were higher in severe AP relative to mild AP. Significant positive correlation was present between high cortisol and severity of AP (r=0.520 and p<0.001) and negatively with pancreatic necrosis (r= - 0.303 and p= 0.007) and morality (r= - 0.432, p= 0.005) while hs-CRP did not show significant correlation. CONCLUSIONS Different levels of serum cortisol in early AP should be considered on initial diagnosis. High cortisol level was a good prognostic indicator for AP with low mortality. This could have further implications on the appropriate initiation of steroid therapy to prevent necrotizing pancreatitis and lower the mortality. Meanwhile, hs-CRP has a low prognostic value in early AP.
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Affiliation(s)
| | - Haidi Karam-Allah Ramadan
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Reham I El-Mahdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Entsar H Ahmed
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abeer A Mokhtar
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
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17
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Id Said B, Ailles L, Huang S, Xu W, Keshavarzi S, Bratman S, Cho J, Giuliani M, Hahn E, Kim J, O'Sullivan B, Ringash J, Waldron J, Spreafico A, de Almeida J, Chepeha D, Irish J, Goldstein D, Hope A, Hosni A. Patient-Derived Xenograft Engraftment Predicts Oral Cavity Cancer Outcomes. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Jacinto J, Huang S, Su J, Kim J, O'Sullivan B, Ringash J, Cho J, Hope A, Bratman S, Giuliani M, Hosni A, Hahn E, Spreafico A, Hansen A, Goldstein D, Tong L, Perez-Ordonez B, Weinreb I, Xu W, Waldron J. Clinical Behavior and Outcome of HPV-Positive Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Hahn E, Barot S, O'Sullivan B, Huang S, Gupta A, Hosni A, Razak A, Waldron J, Irish J, Gullane P, Brown D, Gilbert R, de Almeida J, Laperriere N, Hodgson D, Shultz D. Adult Head and Neck Rhabdomyosarcoma: Management, Outcomes, and the Impact of IMRT on Locoregional Control. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Chiu K, Hosni A, Huang SH, Tong L, Xu W, Lu L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, Irish J, Gilbert R, Gullane P, Goldstein D, O'Sullivan B, Hope A. The Potential Impact and Usability of the Eighth Edition TNM Staging Classification in Oral Cavity Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e442-e449. [PMID: 34261594 DOI: 10.1016/j.clon.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
AIMS In the current eighth edition head and neck TNM staging, extranodal extension (ENE) is an adverse feature in oral cavity squamous cell cancer (OSCC). The previous seventh edition N1 with ENE is now staged as N2a. Seventh edition N2+ with ENE is staged as N3b in the eighth edition. We evaluated its potential impact on patients treated with surgery and postoperative intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS OSCC patients treated with primary surgery and adjuvant (chemo)radiotherapy between January 2005 and December 2014 were reviewed. Cohorts with pathological node-negative (pN-), pathological node-positive without ENE (pN+_pENE-) and pathological node-positive with ENE (pN+_pENE+) diseases were compared for local control, regional control, distant control and overall survival. The pN+ cohorts were further stratified into seventh edition N-staging subgroups for outcomes comparison. RESULTS In total, 478 patients were evaluated: 173 pN-; 159 pN+_pENE-; 146 pN+_pENE+. Outcomes at 5 years were: local control was identical (78%) in all cohorts (P = 0.892), whereas regional control was 91%, 80% and 68%, respectively (P < 0.001). Distant control was 97%, 87%, 68% (P < 0.001) and overall survival was 75%, 53% and 39% (P < 0.001), respectively. Overall survival for N1 and N2a subgroups was not significantly different. In the seventh edition N2b subgroup of pENE- (n = 79) and pENE+ (n = 79) cohorts, overall survival was 67% and 37%, respectively. In the seventh edition N2c subgroups, overall survival for pENE- (n = 17) and pENE+ (n = 38) cohorts was 65% and 35% (P = 0.08), respectively. Overall, an additional 128 patients (42% pN+) were upstaged as N3b. CONCLUSIONS When eighth edition staging was applied, stage migration across the N2-3 categories resulted in expected larger separations of overall survival by stage. Patients treated with primary radiation without surgical staging should have outcomes carefully monitored. Strategies to predict ENE preoperatively and trials to improve the outcomes of pENE+ patients should be explored.
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Affiliation(s)
- K Chiu
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada; Department of Head and Neck Oncology, Mount Vernon Cancer Centre, Northwood, London, UK
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - S H Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - L Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - W Xu
- Division of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - L Lu
- Division of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Bayley
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - S Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - M Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Spreafico
- Department of Medical Oncology, Princess Margaret Cancer Centre/ University of Toronto, Toronto, Ontario, Canada
| | - J Irish
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - R Gilbert
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - P Gullane
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - D Goldstein
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - B O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
| | - A Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
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Elamir AM, Hutchinson S, Albaba H, Keshavarzi S, Xu W, Moulton CA, McGilvary I, Cleary S, Wei A, Dodd A, Knox J, O'Kane G, Prince RM, Kalimuthu S, Kim J, Ringash J, Dawson LA, Wong R, Barry A, Brierley J, Gallinger S, Hosni A. A Risk Score Model for Locoregional Recurrence Following Upfront Surgery for Pancreatic Adenocarcinoma: Implications for Adjuvant Therapy. Clin Oncol (R Coll Radiol) 2021; 33:527-535. [PMID: 33875360 DOI: 10.1016/j.clon.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/21/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
AIMS The aims of the study were to identify predictors of locoregional failure (LRF) following surgery for pancreatic adenocarcinoma, develop a prediction risk score model of LRF and evaluate the impact of postoperative radiation therapy (PORT) on LRF. MATERIALS AND METHODS A retrospective review was conducted on patients with stages I-III pancreatic adenocarcinoma who underwent surgery at our institution (2005-2016). Univariable and then multivariable analyses were used to evaluate clinicopathological factors associated with LRF for patients who did not receive PORT. The risk score of LRF was calculated based on the sum of coefficients of the predictors of LRF. The model was applied to the entire cohort to evaluate the impact of PORT on the high- and low-risk groups for LRF. RESULTS In total, 467 patients were identified (median follow-up 22 months). Among patients who did not receive PORT (n = 440), predictors of LRF were pN+, involved or close ≤1 mm margin(s), moderately and poorly differentiated tumour grade and lymphovascular invasion. After adding patients who received PORT, the 2-year LRF in the high-risk group was 57% for patients who did not receive PORT (n = 242) and 32% among patients who received PORT (n = 22), with an absolute benefit to LRF of 25% (95% confidence interval 5-52%, P = 0.07). The 2-year overall survival for the high-versus the low-risk group was 36% versus 67% (P < 0.001). CONCLUSION This risk group classification could be used to identify pancreatic adenocarcinoma patients with higher risk of LRF who may benefit from PORT. However, validation and prospective evaluation are warranted.
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Affiliation(s)
- A M Elamir
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - S Hutchinson
- McCain Centre for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto, Canada
| | - H Albaba
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - S Keshavarzi
- Princess Margaret Cancer Center, Department of Biostatistics, Toronto, Canada
| | - W Xu
- Princess Margaret Cancer Center, Department of Biostatistics, Toronto, Canada
| | - C-A Moulton
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - I McGilvary
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - S Cleary
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - A Wei
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - A Dodd
- McCain Centre for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto, Canada
| | - J Knox
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - G O'Kane
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - R M Prince
- Princess Margaret Cancer Center, Department of Medical Oncology, Toronto, Canada
| | - S Kalimuthu
- Princess Margaret Cancer Center, Department of Pathology, Toronto, Canada
| | - J Kim
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - J Ringash
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - L A Dawson
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - R Wong
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - A Barry
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - J Brierley
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada
| | - S Gallinger
- Princess Margaret Cancer Center, Department of Surgical Oncology, University of Toronto, Toronto, Canada
| | - A Hosni
- Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada.
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Koneru G, Batiha GES, Algammal AM, Mabrok M, Magdy S, Sayed S, AbuElmagd ME, Elnemr R, Saad MM, Abd Ellah NH, Hosni A, Muhammad K, Hetta HF. BCG Vaccine-Induced Trained Immunity and COVID-19: Protective or Bystander? Infect Drug Resist 2021; 14:1169-1184. [PMID: 33790587 PMCID: PMC8001200 DOI: 10.2147/idr.s300162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/24/2021] [Indexed: 01/08/2023] Open
Abstract
In late 2019, a new virulent coronavirus (CoV) emerged in Wuhan, China and was named as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This virus spread rapidly, causing the coronavirus disease-2019 (COVID-19) pandemic. Bacillus Calmette-Guérin (BCG) is a live attenuated tuberculosis (TB) vaccine, associated with induction of non-specific cross-protection against unrelated infections. This protection is a memory-like response in innate immune cells (trained immunity), which is caused by epigenetic reprogramming via histone modification in the regulatory elements of specific genes in monocytes. COVID-19 related epidemiological studies showed an inverse relationship between national BCG vaccination policies and COVID-19 incidence and death, suggesting that BCG may induce trained immunity that could confer some protection against SARS-CoV-2. As this pandemic has put most of Earth's population under quarantine, repurposing of the old, well-characterized BCG may ensure some protection against COVID-19. This review focuses on BCG-related cross-protection and acquisition of trained immunity, as well as the correlation between BCG vaccination and COVID-19 incidence and mortality.
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Affiliation(s)
- Gopala Koneru
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutger New Jersey Medical School, Rutgers University, New Brunswick, NJ, 07103, USA
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicines, Damanhour University, Damanhur, 22511, Egypt
| | - Abdelazeem M Algammal
- Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Mahmoud Mabrok
- Department of Fish Diseases and Management, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
- Fish Infectious Diseases Research Unit (FID RU), Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sara Magdy
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Shrouk Sayed
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Mai E AbuElmagd
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Reham Elnemr
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Mahmoud M Saad
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Noura H Abd Ellah
- Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khalid Muhammad
- Department of Biology, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
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Hosni A, Laamrani FZ, Jroundi L. [A wrong pneumoperitoneum]. Rev Med Interne 2021; 42:579-580. [PMID: 33461786 DOI: 10.1016/j.revmed.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- A Hosni
- Service de radiologie des urgences, Hôpital universitaire Ibn Sina, Rabat, Maroc.
| | - F Z Laamrani
- Service de radiologie des urgences, Hôpital universitaire Ibn Sina, Rabat, Maroc
| | - L Jroundi
- Service de radiologie des urgences, Hôpital universitaire Ibn Sina, Rabat, Maroc
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24
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Pilar A, Yu E, Su J, Bartlett E, O’Sullivan B, Waldron J, Spreafico A, de Almeida J, Bayley A, Bratman S, Cho J, Giuliani M, Hope A, Hosni A, Kim J, Ringash J, Perez-Ordonez B, Tong L, Xu W, Huang S. Validating and Refining the 8th Edition TNM N-Classification for HPV Negative Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Cozma A, Alfaraj F, Lukovic J, Su J, Xu W, Mierzwa M, Ynoe de Moraes F, Huang S, Bratman S, Giuliani M, Hope A, Kim J, Ringash J, Waldron J, de Almeida J, Goldstein D, Rosko A, Spector M, Kowalski L, Marta G, Hosni A. Development Of A Risk Group Classification To Predict Locoregional Failure And To Quantify The Effect Of Post-Operative Radiotherapy Among Patients With Major Salivary Gland Carcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Huo M, Morley L, Dawson L, Bissonnette J, Helou J, Giuliani M, Berlin A, Shultz D, Hosni A, Shessel A, Barry A. PO-1757: Peer Review in Stereotactic Body Radiotherapy: The Impact of Case Volume. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Watson E, Xu W, Giuliani M, Huang J, Huang S, O'Sullivan B, Ringash J, Hosni A, Kim J, Waldron J, Bayley A, Cho J, Bratman S, Goldstein D, Maxymiw W, Glogauer M, Hope A. PO-0805: Dental insurance status influences prophylactic dental care prior to head and neck radiation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Elamir A, Gallinger S, Moulton C, McGilvary I, Lu L, Xu W, Knox J, Prince R, O'Kane G, Kim J, Ringash J, Dawson L, Wong R, Barry A, Brierley J, Hosni A. PD-0423: Risk group classification for locoregional failure following upfront surgery for pancreatic cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Hahn E, O'Sullivan B, Waldron J, Kim J, Ringash J, Bayley A, Bratman S, Cho J, Giuliani M, Hosni A, Hope A, Irish J, Gilbert R, Goldstein D, Su J, Xu W, Tong L, Huang S. Outcomes of Salvage Radiotherapy after Laser Surgery for Early Stage Glottic Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Stanescu T, Shessel A, Carpino-Rocca C, Simeonov A, Lukovic J, Velec M, Hosni A, Dawson L. Development of an Online Adaptive Procedure for MRI-Guided Liver SBRT. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Ramadan HKA, Mahmoud MA, Aburahma MZ, Elkhawaga AA, El-Mokhtar MA, Sayed IM, Hosni A, Hassany SM, Medhat MA. Predictors of Severity and Co-Infection Resistance Profile in COVID-19 Patients: First Report from Upper Egypt. Infect Drug Resist 2020; 13:3409-3422. [PMID: 33116660 PMCID: PMC7547142 DOI: 10.2147/idr.s272605] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022] Open
Abstract
Background The emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in a worldwide devastating effect with a diagnostic challenge. Identifying risk factors of severity aids in assessment for the need of early hospitalization. We aimed to demonstrate, for the first time, the clinical, laboratory and radiological characteristics of coronavirus disease 2019 (COVID-19) patients, to identify the predictors of severity and to describe the antimicrobial resistance profile in patients from Upper Egypt. Materials and Methods Demographic characters, clinical presentations, laboratory, and radiological data were recorded and analyzed. Presence of other respiratory microorganisms and their sensitivity patterns were identified using the VITEK2 system. Resistance-associated genes were tested by PCR. Results The study included 260 COVID-19 patients. The majority were males (55.4%) aged between 51 and 70 years. Hypertension, diabetes, and ischemic heart disease were common comorbidities. Main clinical manifestations were fever (63.8%), cough (57.7%), dyspnea (40%) and fatigue (30%). According to severity, 51.5% were moderate, 25.4% mild and 23% severe/critical. Lymphopenia, elevated CRP, ferritin, and D-dimer occurred in all patients with significantly higher value in the severe group. Age >53 years and elevated ferritin ≥484 ng/mL were significant risk factors for severity. About 10.7% of the COVID-19 patients showed bacterial and/or fungal infections. Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus were the predominant isolated bacteria while Candida albicans and Candida glabrata were the predominant isolated fungi. All Staphylococci were methicillin-resistant and carried the mecA gene. Gram-negative isolates were multidrug-resistant and carried different resistance-associated genes, including NDM-1, KPC, TEM, CTX-M, and SHV. Conclusion Older age and elevated serum ferritin were significant risk factors for severe COVID-19. Bacterial co-infection and multidrug resistance among patients with COVID-19 in Upper Egypt is common. Testing for presence of other co-infecting agents should be considered, and prompt treatment should be carried out according to the antimicrobial sensitivity reports.
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Affiliation(s)
- Haidi Karam-Allah Ramadan
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Manal A Mahmoud
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Zakaria Aburahma
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal A Elkhawaga
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ibrahim M Sayed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Pathology, School of Medicine, University of California, San Diego, CA, USA
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sahar M Hassany
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed A Medhat
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
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32
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El-Mahdy RI, Ramadan HKA, Mohammed HSED, Ahmed EH, Mokhtar AA, Hosni A. Impact of the etiology and Vitamin D receptor TaqI rs731236 gene polymorphism on the severity of acute pancreatitis. J Hepatobiliary Pancreat Sci 2020; 27:896-906. [PMID: 32780933 DOI: 10.1002/jhbp.817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/07/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE This work aimed to assess the impact of different etiologies of acute pancreatitis (AP) and vitamin D receptor (VDR) TaqI rs731236 gene polymorphism on the severity of AP. METHODS This case-control study included 70 patients with AP and 40 healthy controls. Etiologies of AP were identified by imaging, ANA, cytomegalovirus (CMV) IgM, coxsackie B virus IgM, and IgG4. Genotyping of VDR TaqI rs731236 polymorphism, Laboratory tests and severity scores using Ranson, BISAP, Atlanta and APACHE II scores were determined. RESULTS The age in AP patients was 36.03 ± 10.76, and females were 85.7%. The etiologies of AP were as follows: biliary (51.4%), coxsackievirus (22.9%), autoimmune (14.3%), post-ERCP (8.6%) and 2.9% were idiopathic. The TT genotype of VDR polymorphism was significantly more common in AP than control (P = .001) and allele T dominated in AP group (OR = 2; 95% CI: 0.665-5.64). Most cases showed low severity scores with significant differences among etiologies and VDR genotypes. Biliary pancreatitis showed highest percentages of severe AP. However, etiologies and VDR polymorphism were not predictors of severity. CONCLUSION Etiology of AP could have impact on the disease severity. VDR gene polymorphism increases the risk of AP. Neither the etiology nor VDR gene polymorphism could predict AP severity.
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Affiliation(s)
- Reham I El-Mahdy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Haidi Karam-Allah Ramadan
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Entsar H Ahmed
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
| | - Abeer A Mokhtar
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
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33
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Hetta HF, Zahran AM, Shafik EA, El-Mahdy RI, Mohamed NA, Nabil EE, Esmaeel HM, Alkady OA, Elkady A, Mohareb DA, Hosni A, Mostafa MM, Elkady A. Circulating miRNA-21 and miRNA-23a Expression Signature as Potential Biomarkers for Early Detection of Non-Small-Cell Lung Cancer. Microrna 2020; 8:206-215. [PMID: 30652656 DOI: 10.2174/1573399815666190115151500] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/16/2018] [Accepted: 12/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Lung Cancer (LC) is a major cancer killer worldwide, and 5-yr survival is extremely poor (≤15%), accentuating the need for more effective diagnostic and therapeutic strategies. Studies have shown cell-free microRNAs (miRNAs) circulating in the serum and plasma with specific expression in cancer, indicating the potential of using miRNAs as biomarkers for cancer diagnosis and therapy. This study aimed to identify differentially-expressed two miRNAs in the plasma of Non-Small Cell Lung Cancer (NSCLC) patients that might be a clinically useful tool for lung cancer early detection. miRNA-21 is one of the most abundant oncomirs. miRNA-23a functions as an oncogene in several human cancers, however, its clinical value has not been investigated in NSCLC. MATERIALS AND METHODS A case-control study was conducted in Assiut University Hospital, Egypt, from 2017 to 2018. Plasma samples were obtained from 45 NSCLC patients. The expression level of miR-21 and miRNA-23a was detected by qRT-PCR and compared to 40 healthy control subjects. The relation between both miRNAs and clinicopathological parameters was evaluated. RESULTS The expression level of miR-21 and miRNA-23a was significantly up-regulated (36.9 ± 18.7 vs. 1.12 ± 0.84 and 24.7 ± 19.09 vs. 1.16 ± 0.45) in NSCLC compared to matched controls (P<0.0001each). There was a significant difference in the level of plasma miRNA-21 and miRNA- 23a expression between the different grades of the disease (P = 0.032 and P = 0.001, respectively). The plasma miRNA-21 and miRNA-23a levels in the lung cancer patients with distant metastasis (n = 20) were significantly higher than those in the patients without metastasis (n = 25) (P<0.0001 each), the expression of miR-21 and miRNA-23a was significantly associated with tumor size (P = 0.001, P = 0.0001, respectively), but not significantly related to lymph node metastasis (P = 0.687 and 0.696, respectively). A positive correlation was observed between miRNA-21 and miRNA-23a (r = 0.784, P<0.01), There was no significant difference in the plasma miRNA-21 and miRNA-23a levels in the lung cancer patients with different histopathological types. CONCLUSION miR-21 and miR-23a might play an oncogenic role in LC and is a poor prognostic factor. Switching off miRNA-21 and miRNA-23a may improve the treatment of LC. Our results must be verified by large-scale prospective studies with standardized methodology.
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Affiliation(s)
- Helal Fouad Hetta
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0595, United States.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Engy A Shafik
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut, Egypt
| | - Reham I El-Mahdy
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nahed A Mohamed
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Emad Eldin Nabil
- Department of Clinical Oncology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hend M Esmaeel
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ola A Alkady
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Dina A Mohareb
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed Mahmoud Mostafa
- Department of Cardiothoracic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Abeer Elkady
- Department of Clinical and Chemical Pathology, Faculty of Medicine, South Valley University, Qena, Egypt
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Liu T, David M, Batstone M, Clark J, Low TH, Goldstein D, Hope A, Hosni A, Chua B. The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2020; 50:143-150. [PMID: 32616305 DOI: 10.1016/j.ijom.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/13/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
The effectiveness of postoperative radiotherapy (PORT) in improving outcomes remains debatable for oral squamous cell carcinoma (OSCC) patients with pathological intermediate-risk factors (IRFs) after surgery. A retrospective analysis was conducted on 432 intermediate-risk OSCC patients defined by histological reporting of close margin (<5mm), early nodal disease (pN1), depth of invasion/tumour thickness ≥5mm, perineural invasion, and/or lymphovascular invasion. Outcomes measured were disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). PORT was associated with an improvement in 5-year DFS on univariable analysis (80% vs 71%; P=0.044), but this did not remain significant on multivariable analysis. PORT was not associated with differences in DSS or OS. The surgical salvage rate was similar in the PORT and surgery-only groups (41% vs 47%; P=0.972). Perineural invasion was found to be an independent predictor of inferior DSS (hazard ratio (HR) 2.19), DFS (HR 1.89), and OS (HR 1.97). Significantly worse outcomes were observed for patients with ≥4 concurrent IRFs. The application of PORT was associated with lower rates of recurrence, but the benefit was less apparent on mortality. Patients with perineural invasion and multiple concurrent IRFs were found to be at greatest risk, representing a subset of intermediate-risk OSCC patients who may benefit from PORT.
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Affiliation(s)
- T Liu
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - M David
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - M Batstone
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - J Clark
- Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - T-H Low
- Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - D Goldstein
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - A Hope
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A Hosni
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - B Chua
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Radiation Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Elkhawaga AA, Hetta HF, Osman NS, Hosni A, El-Mokhtar MA. Emergence of Cronobacter sakazakii in Cases of Neonatal Sepsis in Upper Egypt: First Report in North Africa. Front Microbiol 2020; 11:215. [PMID: 32210926 PMCID: PMC7075355 DOI: 10.3389/fmicb.2020.00215] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Aim Cronobacter sakazakii (C. sakazakii) has attracted considerable attention as an emerging neonatal pathogen and has been associated with outbreaks of life-threatening septicemia, necrotizing enterocolitis, and meningitis in neonates and infants globally. No data about the role of C. sakazakii as a cause of neonatal sepsis in North Africa is availale. Herein, we aimed to study the incidence of C. sakazakii in cases of neonatal sepsis, its distribution in different food samples in Egypt, antimicrobial profile, and the ability of the strains to form biofilms. Methods A total of 100 positive blood cultures from cases of neonatal sepsis admitted to the neonatal ICU at Assiut University Children's Hospital, Egypt, were analyzed. In addition, 1,100 food samples, including 400 powdered infant formula (PIF), 500 herbs, and 200 water samples were screened for the presence of C. sakazakii. We evaluated the antimicrobial profile and the ability of the strains to form biofilms. Results Cronobacter sakazakii was detected in 12 out of 100 cases of neonatal sepsis. The organism was also isolated from PIF, herbs, and water in percentages of 17.5, 9.2, and 7.5%, respectively. Regarding the antimicrobial sensitivity, all strains were resistant to ampicillin, amoxicillin, ampicillin/sulbactam, clindamycin, cephalothin, and cephalexin. In addition, C. sakazakii strains showed the ability to form biofilms, but with variable degrees of cell density. Conclusion We reported, for the first time, cases of neonatal sepsis caused by the emerging life-threatening pathogen C. sakazakii in Egypt. The organism was also detected in contaminated PIF, herbs, and water, which may be sources of infection for neonates, especially in countries where natural herbs are widely used as an alternative medicine. Finally, collective efforts by the parents, manufacturers of PIF, and healthcare personnel are essential to prevent serious infections caused by C. sakazakii, particularly in infants.
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Affiliation(s)
- Amal A Elkhawaga
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Naglaa S Osman
- Department of Pediatrics, Children's Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal Hosni
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Lukovic J, Alfaraj FA, Mierzwa ML, Marta GN, Xu W, Su J, Moraes FY, Huang SH, Bratman SV, O'Sullivan B, Kim JJ, Ringash JG, Waldron J, de Almeida JR, Goldstein DP, Casper KA, Rosko AJ, Spector ME, Kowalski LP, Hope A, Hosni A. Development and validation of a clinical prediction-score model for distant metastases in major salivary gland carcinoma. Ann Oncol 2020; 31:295-301. [PMID: 31959347 DOI: 10.1016/j.annonc.2019.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/15/2019] [Accepted: 10/25/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The most common pattern of failure in major salivary gland carcinoma (SGC) is development of distant metastases (DMs). The objective of this study was to develop and validate a prediction score for DM in SGC. PATIENTS AND METHODS Patients with SGC treated curatively at four tertiary cancer centers were divided into discovery (n = 619) and validation cohorts (n = 416). Multivariable analysis using competing risk regression was used to identify predictors of DM in the discovery cohort and create a prediction score of DM; the optimal score cut-off was determined using a minimal P value approach. The prediction score was subsequently evaluated in the validation cohort. The cumulative incidence and Kaplan-Meier methods were used to analyze DM and overall survival (OS), respectively. RESULTS In the discovery cohort, DM predictors (risk coefficient) were: positive margin (0.6), pT3-4 (0.7), pN+ (0.7), lymphovascular invasion (0.8), and high-risk histology (1.2). High DM-risk SGC was defined by sum of coefficients greater than two. In the discovery cohort, the 5-year incidence of DM for high- versus low-risk SGC was 50% versus 8% (P < 0.01); this was similar in the validation cohort (44% versus 4%; P < 0.01). In the pooled cohorts, this model performed similarly in predicting distant-only failure (40% versus 6%, P < 0.01) and late (>2 years post surgery) DM (22% versus 4%; P < 0.01). Patients with high-risk SGC had an increased incidence of DM in the subgroup receiving postoperative radiation therapy (46% versus 8%; P < 0.01). The 5-year OS for high- versus low-risk SGC was 48% versus 92% (P < 0.01). CONCLUSION This validated prediction-score model may be used to identify SGC patients at increased risk for DM and select those who may benefit from prospective evaluation of treatment intensification and/or surveillance strategies.
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Affiliation(s)
- J Lukovic
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - F A Alfaraj
- Department of Radiation Oncology, BC Cancer Agency Centre for the North, Prince George, Canada
| | - M L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - W Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | - J Su
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada
| | - F Y Moraes
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - S H Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - S V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - B O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - J J Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - J G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - J Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - J R de Almeida
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - D P Goldstein
- Department of Otolaryngology-Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - K A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA
| | - A J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA
| | - M E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA
| | - L P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - A Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada.
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Lukovic J, Hosni A, Liu Z, Chen J, Tadic T, Patel T, Brierley J, Wong R, Ringash J, Dawson L, Kim J. Evaluation of Dosimetric Predictors of Acute and Late Toxicity after IMRT with Concurrent Chemotherapy for Anal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Billfalk-Kelly A, Huang S, Xu W, Lu L, Wu R, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, O'Sullivan B, Ringash J, Hansen A, Irish J, Monteiro E, de Almeida J, Goldstein D, Waldron J, Hope A, Hosni A. Outcomes of Oral Cavity Squamous Cell Carcinoma Patients Under the Age of 40: A Propensity Score Matched Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Elkhawaga AA, Hosni A, Zaky DZ, Kamel AA, Mohamed NA, Abozaid MA, El-Masry MA. Association of Treg and TH17 Cytokines with HCV Pathogenesis and Liver Pathology. Egypt J Immunol 2019; 26:55-63. [PMID: 31926495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Chronic hepatitis C (CHC) infection is considered a high risk for development of end-stage liver diseases, particularly server hepatitis, decompensated liver cirrhosis, and hepatocellular carcinoma. Regulatory T cells (Treg) and T-helper 17 (TH17) associated cytokines presumed to play a pivotal role in the immune pathogenesis of HCV infection and stimulate autoimmune diseases. Herein, we tried to assess the association of Treg and TH 17 cytokines with HCV pathogenesis and liver pathology. Fifty CHC infected patients and twenty HCV free controls were included in this study, IL17, IL21, IL10, IL4, TGF- and IL35 serum levels were assessed in both groups using enzyme linked immunosorbent assay (ELISA). CHC infected patients had statistically significant higher values of all serum cytokine levels when compared to the control group (P < 0.0001) for each. Additionally, serum levels of IL17, IL10 and IL35 were positively correlated with viral load. Also, the serum level of IL17 IL21, IL10 and IL35 was positively correlated with ALT serum levels. Only IL21 and IL10 were positively correlated with AST levels. Serum IL17, IL10, TGF- and IL35 levels were significantly elevated in CHC patients with advanced fibrosis stages. We concluded that CHC infected patients displayed high serum levels of Treg and TH17 associated cytokines. Collectively, these results support the hypothesis that liver damage in CHC infection might be due to an immune-mediated destructive mechanism rather than to the direct cytopathic effect of the virus itself.
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Affiliation(s)
- Amal A Elkhawaga
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amal Hosni
- Department of Medical Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Doaa Z Zaky
- Department of Tropical Medicine, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Amira A Kamel
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nahed A Mohamed
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A Abozaid
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Muhammad A El-Masry
- Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
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Traverso A, Kazmierski M, Wee L, Dekker A, Welch M, Hosni A, Jaffray D, Hope A. PV-0314 Machine learning helps identifying relations and confounding factors in radiomics-based models. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lukovic J, Kim J, Liu A, Ringash J, Brierley J, Wong R, Barry A, Dawson L, Cummings B, Krzyzanowska M, Chen E, Hedley D, Prince R, Quereshy F, Easson A, Swallow C, Gryfe R, Kennedy E, Hosni A. EP-1473 Anal adenocarcinoma: a comprehensive review of management practices and clinical outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Huang S, Yu E, Billfalk-Kelly A, Su J, Waldron J, Bartlett E, Bayley A, Bratman S, Cho J, Giuliani M, Hope A, Hosni A, Kim J, Ringash J, Hansen A, De Almeida J, Tong L, Xu W, O’Sullivan B. OC-007 Radiologic extranodal extension portends worse outcome in TNM-8 cT1-T2N1 HPV + oropharyngeal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30173-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hassan K, Hosni A, Hewidy M, Abd El razik A. MICROPROPAGATION AND EVALUATION OF GENETIC STABILITY OF FOXGLOVE TREE (Paulownia tomentosa). Arab Universities Journal of Agricultural Sciences 2019; 26:2287-2296. [DOI: 10.21608/ajs.2018.35343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Hosni A, Huang S, Chiu K, Xu W, Su J, Tong L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, O’Sullivan B, Ringash J, Waldron J, De Almeida J, Chepeha D, Goldstein D, Hope A. OC-0277: Development and validation of distant metastases risk group classification in oral cavity cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berlin A, Chua M, Truong H, Hosni A, Pintilie M, Davicioni E, Dicker A, Van der Kwast T, Bristow R, Den R. OC-0633: Subpathologies and genomic classifier for individualized post-prostatectomy radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30943-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hosni A, Huang S, Chiu K, Xu W, Su J, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, O’Sullivan B, Ringash J, Hansen A, De Almeida J, Monteiro E, Chepeha D, Gilbert R, Irish J, Goldstein D, Waldron J, Hope A. PO-0709: Postoperative salvage therapy for early recurrence in oral cavity squamous cell carcinoma. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abuhijla F, Al Mousa A, Mohamad I, Al Khatib S, Alnsoor A, Asha W, Abuhijlih R, Hosni A, Khader J. Enhancing Value of Quality Assurance Rounds in Improving Radiation Therapy Management: A Retrospective Analysis. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chiu K, Huang S, Hosni A, Tong L, Xu W, Lu L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, Irish J, Gilbert R, Gullane P, Goldstein D, O'Sullivan B, Hope A. Outcomes of Oral Cavity Cancer Patients Treated with Definitive Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chiu K, Huang S, Hosni A, Tong L, Xu W, Lu L, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Spreafico A, Irish J, Gilbert R, Gullane P, Goldstein D, O'Sullivan B, Hope A. Potential Impact of the 8th edition UICC/AJCC Staging in Oral Cavity Cancer Patients Treated With Surgery and Post-Operative Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hosni A, Cummings B, Han K, Le L, Brierley J, Wong R, Dinniwell R, Brade A, Dawson L, Ringash J, Krzyzanowska M, Chen E, Hedley D, Knox J, Easson A, Craig T, Lindsay P, Kim J. Failure of Standardized High-Dose Radiation (63 Gy/7 weeks) and 2 Cycles of Concurrent 5FU and Mitomycin to Control Large Anal Cancers. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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