Predictors of response to radio-embolization (TheraSphere®) treatment of neuroendocrine liver metastasis

BACKGROUND

Neuroendocrine tumours (NET) frequently metastasize to the liver. NET liver metastasis has been shown to respond to Yttrium-90 microspheres therapy. The aims of the present study were to define factors that predict the response to radio-embolization in patients with NET liver metastases.

METHODS

From January 2006 until March 2009, all patients with NET liver metastasis that received radio-embolization using TheraSphere® (glass microspheres) were reviewed. The response was determined by a change in the percentage of necrosis (ΔN%) after the first radio-embolization based on the modified RECIST criteria (mRECIST) criteria. The following confounding variables were measured: age, gender, size of the lesions, liver involvement, World Health Organization (WHO) classification, the presence of extra-hepatic metastasis, octereotide treatment and previous operative [surgery and (RFA)] and non-operative treatments (chemo-embolization and bland-embolization).

RESULTS

In all, 25 patients were identified, with a median follow-up of 21.7 months. The median age was 64.6 years, 28% had extra-hepatic metastasis and 56% were WHO stage 2. Post-treatment, the mean ΔN% was 48.4%. Previous surgical therapy was a significant predictor of the response with a response rate of 66.7 ΔN% vs. 31.5 ΔN% (P= 0.02). Bilateral liver disease, a high percentage of liver involvement and large metastatic lesions were inversely related to the degree of tumour response although did not reach statistical significance.

CONCLUSION

Radio-embolization increased the necrosis of NET liver metastasis mainly in patients with less bulky disease. This may imply that surgical therapy before radio-embolization would increase the response rates.

Experimental studies on the determination of the dipole moments of some different laser dyes

In this paper we used the Stokes shift phenomena to determine the difference in the dipole moments of the excited state micro(e) and ground state micro(g) to be (micro(e)-micro(g)), and the polarizability alpha. In this paper, we studied six different laser dyes belonging to four different classes of laser dyes which are diolefin 2,5-Distyryl pyrazine (DSB); 1,4-Bis (-pyridyl-2-vinyl) benzene (P2VB) and p-Bis-(o-methylstyryl)-benzene (Bis-MSB) with (micro(e)-micro(g)) equal to 6.40, 6.70 and 2.98 Debye, respectively; anthracene class includes 10(4-acetoxyphenyl)-2-methyl-9-acetoxy anthracene (APMAA) with (micro(e)-micro(g)) value of 7.25 Debye; Rhodamine B (RB) with (micro(e)-micro(g)) value of 5.33 Debye; and Coumarin 120 (C120) with the value 3.97 Debye for (micro(e)-micro(g)). In addition the value of both polarizability alpha and the radius r of each investigated laser dye molecule are determined. Therefore, the ratio alpha/r(3) for each dye is calculated to be 0.93, 0.79, 0.39, 0.37, 0.67 and 0.76 for DSP, P2VB, Bis-MSB, APMAA, RB and C120, respectively. The values of r are 4.83, 4.83, 4.90, 5.34, 5.75 and 4.11 A for the above consequence laser dyes. These dyes are studied in a large number of different solvents. The values obtained of (micro(e)-micro(g)) for these selected dyes are positive, which means that the excited state is more polar than the ground state.

Structure activity analysis of the pro-apoptotic, antitumor effect of nitrostyrene adducts and related compounds

In the present study, we outlined the part of the molecule mediating the prominent pro-apoptotic effect of the Michael adduct of ascorbic acid with p-chloro-nitrostyrene, a new synthetic phosphatase inhibitor. The nitrostyrene (NS) moiety was identified as the structure essential for apoptosis induction. NS and its ascorbic acid adducts displayed LC(50) values of 10-25 microM with no significant reduction of potency in okadaic acid resistant cells overexpressing the MDR1 P-glycoprotein. Induction of apoptosis by NS derivatives and the protein phosphatase 2A inhibitor cantharidic acid was proven by the analysis of caspase-3 activation and subsequent fragmentation of DNA. Further structure activity analysis revealed the necessity of the nitro group at the beta-position of the side chain. The pro-apoptotic potential of adducts of NS with pyrimidine- or pyridine-derivatives varied between NS and a progressive reduction in potency up to a nearly complete loss of cytotoxicity. Substitutions at the benzene core of NS suggested a prominent enhancement of toxicity only by substitutions at the 2- or 3-position. Heterocyclic aromatics can substitute for the benzene ring of NS albeit with a 2-3-fold reduced potency. In conclusion, nitrostyrene was identified as the core structure mediating the pro-apoptotic effect of a new synthetic phosphatase inhibitor. Further studies defined a nitrovinyl side chain attached to an aromatic ring as the pharmacophore structure of a new group of pro-apoptotic agents. These observations present the basis for the development of a new group of anticancer drugs.

Hepatitis C virus genotypes in patients with chronic liver disease and haemodialysis patients from Saudi Arabia

The genotypes of hepatitis C virus (HCV) were investigated in 28 Saudi patients (21 males, seven females; age range 23-68 years; mean 45.0 years) with histologically proven chronic hepatitis (13 chronic active hepatitis and 15 liver cirrhosis) and in 32 Saudi patients with chronic renal failure maintained on haemodialysis (22 males, 10 females; age range 18-60 years; mean 40.0 years) who also had liver disease due to HCV. Among the 28 patients with chronic liver disease genotype 4 was the predominant one (60.7%), followed by types 1b (21.4%), 1a (14.3%) and 2a (3.6%). The distribution of genotypes was similar in patients with chronic active hepatitis to those with liver cirrhosis. Among the 32 patients with chronic renal failure and maintained on haemodialysis, genotype 4 was also the dominant type (55.0%), followed by 1a (25.0%), 1b (21.9%) and 2a (3.1%). In all categories studied the prevalence of genotypes between males and females was the same. As our patients were selected from various regions of Saudi Arabia, we believe that genotype 4 is the predominant one throughout the whole kingdom.