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Commentary of Sarcopenia and Postoperative Complications in Gastrointestinal Cancer

Commentary

The undoubted achievement of the authors of the article is the detailed literature review and scrupulous data collecting, which allowed researchers to identify multiply factors and analyze an impact of those on the outcome. The most appropriate design for this type of study is a multivariate analysis. Current study presents results of a several univariate comparisons using one-by-one comparison of separate risk factors affecting the outcome using the SPSS package. At the same time, age and gender of the patient - a major factors which could impact on the outcome - were not taken into account in the analysis. The results presented in the study lean on p-values given for factors that has categories, i.e. categorical variables - a stage or degree of severity (for example, BMI has 3 levels: Underweight, Eutrophy, Overweight, which obviously can have an opposite impact on the outcome). A question arises, which of those categories was used for the comparison giving single p-value and how this significance corresponds beside the levels of single risk factor. Also, the key question is how much the severity of Sarcopenia, which has 3 stages, affects the outcome. Authors should remember that this approach (direct comparison when combining all categories into one) the Simpson paradox could cause.

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Nanoparticulate Carriers of Anticancer Drugs and Therapeutics

Nanoscale drug delivery platforms have been developed over the past four decades that have shown promising clinical results in several types of cancer and inflammatory disorders. Nanoparticles have special characteristics of high surface to volume ratio, size controllability, and can be easily functionalized during synthesis [1]. Biodegradable polymer nanoparticles have been used as carriers for drugs, peptides, proteins, vaccines, and nucleotides [2]. Nanoparticles (NPs) can protect drug moieties from degradation and provide sustained drug release. NPs are sometimes effective in facilitating intracellular delivery of bioactive materials. Polylactideco- glycolic acid (PLGA) NPs have been used for various applications in vaccination, cancer therapy, and the treatment of cerebral disorders [3].

In particular, NPs have been widely investigated for use in cancer therapy. NPs, if given intravenously, can extravasate into and accumulate within tumor tissues that have defective blood vessels and impaired lymphatic drainage [4]. This enhanced permeability and retention (EPR) effect helps direct nanoparticles to tumor sites [5]. Even though a lot of polymer nanoparticles have emerged as a promising carrier, they have a number of intrinsic drawbacks. These nanocarriers carrying therapeutic payloads are maximizing the therapeutic outcomes while minimizing adverse effects. The functionality of bare (polymer, metal, quantum dots, silica, etc.) nanoparticles is limited to drug depot or drug solubilization in their hard cores. When these systems are administered intravenously, the nanoparticles undergo rapid clearance from systemic circulation before reaching the site of action. Recent research shows that surface functionalization of nanoparticles and development of new nanoparticulate dosage forms help overcome these delivery challenges and improve in vivo performance.

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Perspectives of Photodynamic Therapy (PDT) as a Potential Therapeutic Intervention for Câncer

Abstract

Photodynamic therapy (PDT) relies on the interaction between a photosensitizer, the appropriate wavelength, and oxygen leading to production of cytotoxic reactive oxygen species, which can damage the cellular organelles and cause cell death. Photodynamic therapy (PDT) is a tumor-ablative and function-sparing oncologic intervention. The relative simplicity of photosensitizer application followed by light activation resulting in the cytotoxic and vascular toxic photodynamic reaction has allowed PDT to reach a worldwide audience. With several commercially available photosensitizing agents now on the market, numerous well-designed clinical trials have demonstrated the efficacy of PDT on various cutaneous and deep tissue tumors. PDT has been widely used for many purposes’ great success. Although the therapeutic protocols regarding use of PDT in many diseases have not yet been standardized, and vary significantly between the different literature studies, PDT will likely continue to be explored thoroughly for use.

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Report the Effective of Integrated Palliative Care using for Advanced Cancer as Second-Line or Later Treatment by Herbal Extractive Medicine

Abstract

Background: The on-going treatments of unresectable pancreatic, hepatocellular and late-stage lung cancer (PC\HCC\LC) are less effectiveness as second-line or later treatment. However, the palliaitve care is alternative option. Here, we reported the patients who received palliative care by herbal extractive medicines (CHM).

Methods: 13 pancreatic, 31 hepatocellular and 168 lung cancer patients were enrolled. CHM (Senghuang, SH; Xianhe Baijiang, XB), which approved by the China Food and Drug Administration (CFDA), hyperthermia and arginine were initiated. Survival time, quality of life (QOL) and toxicity were evaluated.

Result: The average ECOG score improved and no severe hematology and digestion side-effects were observed. In PC group, the median and the average survival time were 5.1 and 6.5 months; The 3-, 6-, and 10-month survival rates were 92.3%, 46.2%, and 30.8%, respectively. The longest survival time was 16.7 months and patient still alive. In HCC group, the average and median survival time were 12.48 and 5.03 months; The 3-, 6-, and 12-month survival time rates were 77.42%, 38.71%, and 29.03%, respectively. The longest survival time was 84.2 months. In LC group, the 6 months, 1-, 2- and 5-year survival time rates were 33.93%, 19.05%, 14.29% and 4.17%, respectively. Meanwhile, in lung cancer group, once the survival time was over 6 months, the average and median survival time were 29.98 and 14.80 months; and the 1-, 2- and 5-year survival time rates were up to 56.14%, 42.11% and 12.28%, respectively.

Conclusion: CHM can be considered as complementary and alternative medicine that provide moderate effective and low toxicity for advanced cancer.

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Practical Use of Amino Acids in Oncology: Replacement Therapy as a Structural Components of Proteins and/or for Correction of Metabolism in Quantities Comparative with their Endogenous Concentrations?

Introduction

The aim of our research is the formulation of methodology creation for practical application of the regulatory action of endogenous (physiological) concentrations of separate amino acids or their pathogenetically justified compositions [1-4]. Changes in amino acid pool in liquids and their tissues fund of oncology patients specifically characterize development of cancer and largely induced by metabolic competition between the tumor and the tumor carrier [5-10]. Correction of the intermediate metabolic changes in cancer can be reached by the use of certain amino acids or their combinations. Based on the positions of metabolomics, the free amino acid pool in biological fluids and tissues is regarded as a single information unit which is a kind of “a chemical projection” of the genome, the proteome realized through this approach not only develops ideas about the pool of amino acids as a dynamical system-generated supply of them from outside, but also due to endogenous synthesis, transport, degradation and excretion and allows the identification of “key points” in intermediate metabolic equilibrium shift that may reflect ratios at the individual levels of endogenous amino acids and related species (metabolicallyrelated) compounds to achieve “metabolic comfort” [11-15].

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Side Effects of Chemotherapy Induces Death Triangle Machinery Activation Irreversibly, Reconsiderations on Different Cancer Treatments

Short Communication

Cancerogenous processes and treatments’ complications affect health status of many patients irreversibly and intensely increases morbidity and mortality rate of the affected cancer patients. [1- 5] Complications originating from bad treatments and unspecific diagnostics aggravate patients’ wellness continuously. One might expect a standard diagnostic and appropriate treatments after all mouthful sophisticated and developed tools, in 21th Century. Standard guidelines for cancer treatments are mainly surgery, chemotherapy, radiotherapy, and /or a combination of aforementioned therapies. A simple pubmed research reveals that there is neither standard registration and choice for the diagnostic tools nor standard treatments for the same cancer. Beside no similar complications and side effects’ registrations in hospitals after all, globally. Some percentage of patients get well and some of them because of wrong therapeutic approaches get treatment complications that cause (un-)known side effects, which aggravates health status of affected patients toward end-stage and risk of septic shock and death, eventually [4,5].

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Emerging Role of Stereotactic Body Radiotherapy

Stereotactic Body Radiation Therapy (SBRT) also known as stereotactic ablative Radiotherapy (SABR) is a newer modality of delivering radiation therapy for many primary and secondary tumors, with good results. Multiple beams are focused to deliver high dose to single target so that tumour receive very high dose and normal tissue receive very limited dose. The aim is to deliver a high dose of radiation to a small tumour to achieve radio ablation. Patient is first immobilized and then a planning CT scan is taken. This scan is corelated with diagnostic CT, MRI and PET- CT to get the exact location and extension of tumour. Planning is then done with multiple beams focusing on tumour and with high dose per fraction aim is to achieve complete ablation. Treatment is delievered by Linacs, Cyberknife, Tomotherapy etc. Liver and lung metastases from colorectal, breast and Other cancer are most common. Studies focusing on SBRT for metastases from a single primary tumor type colorectal cancer have been published. Regardless of age, patients should have good performance status (Eastern Cooperative Oncology Group 0-1 or Karnofsky >70), with absent or stable extra hepatic disease and adequate hepatic volume and function. Number of metastasis should be less than three and size less than 6 cm. Prescribed dose is generally very high in range of 30 to 60 Gy in three fractions. The toxicity profile is generally low with a G3 toxicity rate of 1-10% and the incidence of Radiation Induced Liver disease less than 1%.

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Pancreatic Cancer: Overview of Recommendations from the 2018 National Institute of Clinical Excellence (NICE) Guidelines on Providing pain relief to Patients with Endoscopic Therapies

EUS-CPN is an outpatient endoscopic procedure and is recommended within current NICE as part of the standard care for relieving abdominal pain in patients with pancreatic cancer, when pain is intractable, or morphine use is escalating. . A meta-analysis of case series report that EUS-CPN can significantly reduce pain scores (p<0.00001). In a clinical trial, compared to patients treated with morphine alone, those receiving EUS-CPN had 60.7 % less pain (P=0.01) at 3 months . Diarrhea, postural hypotension and exacerbation of pain occurs in 9-30% of patients, which resolve spontaneously. Spinal stroke has been reported twice in case reports. Overall, EUS-CPN reduces pain and morphine consumption, and should be available routinely, although further research is needed to optimize timing and patient selection. In their guidelines from 2018 on the management of patients with pancreatic cancer, NICE recommends use of endoscopic ultrasound guided coeliac plexus neurolysis (EUS-CPN) to promote relief of abdominal pain when the pain: i) is intractable, ii) is refractory to escalating doses of opioids or iii) there are adverse effects from opioids negatively affecting patient’s quality of life [1]. This paper gives an overview of EUS-CPN use, which is relevant to many health professionals who manage patients with pancreatic cancer. Currently, EUS-CPN availability may be limited due to the relative lack of doctors trained in this procedure. We review its application, efficacy and safety which clinicians need to be appreciate when referring patients for EUS-CPN.

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Prognostic Implication of Positive Area on Bone Scans (%PAB- Quantitative Parameter) in Bones of Patients with metastatic Prostate cancer

Introduction

Prostate Cancer is one of the common cancers in the world. It could primarily disseminate to the bone and can lead to death. In order to address its life-threatening distant metastasis, it is important to diagnose it earlier for timely treatment. Bone metastasis is usually diagnosed deploying bone scan imaging. However, interpretation of the bone scans is a tedious procedure for the physicians and often leads to misinterpretation either as overestimation or underestimation of the metastasis. To minimize the risk of misinterpretation, one of the accurate methods is quantitative analysis of the bone scans in order to ascertain, whether a metastatic lesion is present or not. There are several methods to-date which can be used to analyze the extent of such lesions. The aim of this study is to use % PAB (Positive Area on Bone Scan-quantitative parameter) on a baseline bone scan.

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Proposed Breast Lump (FMTVDM/BEST) Pathway Nuclear Imaging Protocol

Introduction

One of the major problems associated with the “screening” of women and men for breast cancer is the utilization of several “qualitative” imaging studies associated with sensitivity and specificity problems. According to the National Cancer Institute (NCI), 10% of all women who don’t have breast cancer are told they have breast cancer based upon the results of a “screening” mammogram. The odds of a woman being told she has breast cancer increases to 50-50 if she has a mammogram 10-years in a row. Problems with sensitivity are seen most frequently in younger women and women with “dense” breasts, which has resulted in national legislation in the USA requiring that mammography reports include a disclaimer telling women that if they have dense breast tissue, something seen in half of all women, they may have a breast cancer which was missed by mammography.

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Proposed Acute Coronary Syndrome (ACS) Chest Pain Pathway Using Quantitative FMTVDM Nuclear Imaging

Short Communication

There are an estimated 8 to 10 million emergency room visits each year for the evaluation and treatment of acute coronary syndrome; i.e. ischemic coronary artery disease; with potential consequential damage to the heart muscle itself (infarction). The standard diagnostic evaluation has routinely included a series of tests looking for evidence of concurrent tissue injury happening at the time of evaluation. This includes a standard 12-lead (perhaps more depending upon specific clinical acumen and equipment) electrocardiogram (ECG) looking for evidence of ST elevations of greater than 1 mm in two or more contiguous leads or in some instances V4 alone for distal LAD disease. Additional information is occasionally gleaned by reciprocal changes. To compare changes over time, patients routinely undergo more than one ECG. In addition to the use of ECGs (also called EKGs to prevent confusion with the term EEG), looking for membrane conduction and ion transport abnormalities caused by damaged myocyte and conduction tissue resulting from insufficient coronary blood flow for the needs of the tissue, clinicians also routinely obtain a series of blood tests looking for enzymes and proteins which have been released from the myocytes themselves. The sequence with which these “cardiac enzymes” appear in the blood are directly related to the fact that ischemic membrane damage will initially result in the leakage of smaller molecules followed by progressively larger molecules. The classic sequence of released molecules is consequently, based upon our current level of knowledge, myoglobin, creatine kinase (CK), Troponin I (TnI) and Troponin T (TnT), serum glutamicoxaloacetic transaminase (SGOT) which is also known as aspartate aminotransferase (AST) and finally lactate dehydrogenase (LDH).

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Prognostic Implication of Positive Area on Bone Scans (%PAB- Quantitative Parameter) in Bones of Patients with metastatic Prostate cancer

Abstract

Prostate Cancer is one of the common cancers in the world. It could primarily disseminate to the bone and can lead to death. In order to address its life-threatening distant metastasis, it is important to diagnose it earlier for timely treatment. Bone metastasis is usually diagnosed deploying bone scan imaging. However, interpretation of the bone scans is a tedious procedure for the physicians and often leads to misinterpretation either as overestimation or underestimation of the metastasis. To minimize the risk of misinterpretation, one of the accurate methods is quantitative analysis of the bone scans in order to ascertain, whether a metastatic lesion is present or not. There are several methods to-date which can be used to analyze the extent of such lesions. The aim of this study is to use %PAB (quantitative parameter) on a baseline bone scans. Moreover, an improved methodology is introduced by comparing the results with PSA levels. 141 patients with histopathologically proved prostate cancer were chosen to implement the % PAB on individual baseline bone scans. After which, for the calculation of risk of progression or regression of disease and survival rate, 40 patients were chosen from the same dataset. A serial follows up scan was performed to calculate 2-years survival rate. The dataset was again analyzed using the same quantitative parameter and the cut off were calculated as % PAB: 0.5. It was found out that the % PAB method is a good prognostic indicator in baseline scans. Moreover, the prostate cancer patients with the cut off % PAB > 0.5 showed increase risk of disease progression and less survival.

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Genetic Screening Offers New Hope for Prostate Cancer Patients

Mini Review

The good news for prostate cancer patients currently undergoing chemotherapy treatments is that, genetic markers which once seemed the kiss of death may now permit classification into a group of new prostate cancer treatments! Hospitals should be made aware that if their prostate cancer patients are PTEN or p53 mutant, these patients may benefit from therapy blocking interleukin-6 (IL6)[1]. With our present-day individualized approach to medicine, standard diagnostic tests can be employed, such as a cheek swab, to flag patients who are candidates for this novel treatment. This novel immunotherapy is presently in drug development and will treat metastasis in the most refractory prostate cancer patients. What does this novel IL6-based therapy mean for a prostate cancer patient who is nearing Stage T3 or T4 (TNM, Tumor/Nodes/Metastasis system [2]) or has already entered it? It means a fighting chance.

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Survival Rate Estimation of Advanced Carcinoma Prostate Patients by using Bone Scan Quantitative Parameters

Abstract

There are several methods to-date which can be used to analyze the extent of such lesions. For example, quantitation of the bone scan using quantitation methods i.e. % BSI (Bone scan index), % PAB (Positive area on bone scans), EOD (extent of disease) and BLS (Bone lesion scoring). These methods are used for prognostication of survival and response to treatment on serial scans. 40 patients with histopathologically proved prostate cancer were chosen to implement all the four quantitative parameters on individual baseline bone scans and serial follow up scan were performed to calculate 2-years survival rate. After which, survival rate was calculated. The dataset was again analyzed using the four bone scan quantitative parameters and the cut off were calculated as % BSI: 1, % PAB: 0.5, EOD: grade 0 & 1, grade2, 3 & 4 and BLS: 5. It was found out that the %PAB and % BSI methods are good prognostic indicator in baseline scans. Moreover, the prostate cancer patients with the cut off % BSI >1, %PAB > 0.5, BLS >5 and EOD with grade 2, 3 & 4 showed increase risk of disease progression and less survival.

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1p and 19q Chromosomes Loss of Heterozygosity and Genetic Deletions Role in the Chemosensitivity of Oligodendrogliomas

Oligodendroglioma as a glial tumor originating from oligodendrocytes, is identified by positive stain for myelin basic protein and characterized by ‘fried-egg’ appearance histologically. It would be a low-grade tumor with slow growing pattern, but anaplasia and aggressive behavior also can be occurred. Due to the hemorrhage in the tumor, sometimes the tumor will be symptomatic abruptly. CT and MRI scans can be used to determine the tumor as it presents as a hypointense T1-lesion on MRI scans and a nonenhanced hypodense lesion on CT scans. The presence of enhancement can be a sign of a mixed oligoastrocytoma or a more aggressive tumor.

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Advances in Cancer Research & Clinical Imaging Wishing you Happy Thanksgiving!

Wish you a very happy and blessed Thanksgiving! Wishing you the gift of faith and the blessing of hope this Thanksgiving Day! We gather on this day to be thankful for what we have, for the family we love, the friends we cherish, and for the blessings that will come. 

Happy Thanksgiving!

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Metronomic Chemotherapy in Metastatic Breast Cancer: a case report of 11 Patients

Introduction

Metronomic chemotherapy is an emergent treatment schedule in which low doses of cytotoxic agents are given orally continuously, with no or short drug-free intervals. In general, it provides better tolerance, especially in patients who have been previously exposed to other oncologic treatments. It is well known that all these lowdose schedules have a favorable safety profile and may provide an adequate tumor control in patients with metastatic breast cancer.

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