Grape Seed Extract Alleviates Dexamethasone-Induced Hyperlipidemia, Lipid Peroxidation, and Hematological Alteration in Rats

The ameliorative effects of dietary natural compounds have drawn increasing attention. Dietary antioxidant is considered a common practice adopted in traditional and alternative medicine. The current study was considered to assess the ameliorative effect of grape seed extract on dexamethasone-induced hepatotoxicity in rats. Rats were injected with dexamethasone, (0.1 mg/kg; i.m.), three times per week, for 30 days. The other groups; dexamethasone (0.1 mg/kg) and grape seed extract at a dose of 200 and 400 mg/kg were given orally to rats, respectively. Dexamethasone treatment resulted in a significant elevation in liver function markers activities, lipid profile, and hematological alterations; also, a remarkable increase in hepatic lipid peroxidation marker whereas decreased antioxidant activities in rats. However, administration of grape seed extract resulted in a reversal of dexamethasone-induced lipid peroxidation, antioxidant enzyme activities, liver function markers and lipid profile, and hematological alterations. Moreover, grape seed extract demonstrated preventive action against dexamethasone-induced histopathological changes in rat liver tissues. In conclusion, grape seed extract exhibited a protective effect in rats against oxidative stress, hyperlipidemia and hematological alterations induced by dexamethasone.

Abstract P3-13-25: Oncoplastic breast surgery is oncologically safe in locally advanced breast cancer after neoadjuvant chemotherapy, an Egyptian experience

Background:

Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing mastectomy and re-excision rates, while avoiding breast deformities. OPS integrates plastic surgery techniques for immediate reshaping after wide excision for breast cancer. This techniques is emerging and our experience in Egypt has been gradually increasing. Our aim was to extend the applicability of OPS into more advanced tumours following neoadjuvant chemotherapy.

Method:

A prospective feasibility cohort study of OPS after neoadjuvant chemotherapy was carried at the national Cancer institute – Cairo University and included 40 patients. We aimed to look at long term oncologic safety and cosmetic outcomes.

The primary outcome was the local recurrence rate. Secondary outcomes included survival and margins obtained as well as cosmetic outcomes. Survival analysis was performed with Kaplan-Meir curves. Cosmetic outcomes were assessed using a modified Breast Q questionnaire (EORTC 10801).

Results:

40 patients were included in this study. All were diagnosed with locally advanced breast cancer between September 2012 and January 2015 at the National Cancer Institute – Cairo University. All were treated primarily with neoadjuvant chemotherapy (Anthracycline-based). The median age was 44.45 (Range 22- 65) years with median follow-up period of 42 (Range 24 – 60) months.

27.5% showed complete pathological response. 62.5% of patients had a level I OPS procedure, 10% had a level II procedure, and 27.5% had a volume replacement procedure with a Latissimus Dorsi flap.

The median resection margins with level I, level II, and volume replacement were 10 mm,25 mm and 15 mm respectively. The difference in margins between level I and II was statistically significant (p = 0.028), so was the difference between the 3 types of procedures (p = 0.035).

Three patients (7.5%) had local recurrence and required mastectomy; at 11, 13 and 16 months respectively. One of those (2.5%) developed distant bone metastasis.

Cumulative disease-free survival (DFS) for the whole cohort was 90.2%. Overall survival (OS) was 100% as there was no mortality reported during the follow-up period. Cumulative disease-free survival for patients with level I surgery was 85.4% while for those with level II and volume replacement it was 100% with no statistically significant difference (p = 0.2) because of small number of events.

The cumulative disease-free survival when the median resection margin obtained was less than 20 mm was 86.3%, whereas when the median margin was equal or more than 20 mm, it was 100%. This difference was not statistically significant (p = 0.2).

The cosmetic outcomes ranged between excellent result (70%), very good (15%), good (10%) and poor results (5%) on a very simplified scale that was used for the purpose of the study.

Discussion:

Oncoplastic breast surgery didn't compromise oncologic safety in the patients included in the study. The local recurrence rate, the DFS and OS were all within acceptable ranges .It even allowed wider margins of resection which could be associated with better oncologic outcomes. At the same time, it gave a better cosmetic outcome and therefore higher patient satisfaction.

Citation Format: Youssef M, Namour A, Youssef O, Morsi A. Oncoplastic breast surgery is oncologically safe in locally advanced breast cancer after neoadjuvant chemotherapy, an Egyptian experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-25.

Outcomes of Stereotactic Radiosurgery in the Management of Brain Metastasis in Patients with HER2 Positive Metastatic Breast Cancer

Background:We present single institution experience on the effect of Her 2 status on results of Gamma knife radiosurgery (SRS) for brain metastases (BM) as to local control, pattern of relapse and survival.Material and Methods:From 2004 to 2008, 65 patients with metastatic breast cancer (MBC) were treated with GK-SRS at our center, 52 had documented Her 2 status. We performed analysis based on Her 2 status of the original tumor defined as positive by 3+ DAKO or FISH. SRS was delivered using cobalt leksell GKS to a median dose of 20Gy (range 16-20 Gy) at 50% isodose line. Responses were evaluated by gadolinium enhanced MRI. We analyzed the data as to: objective response (OR) defined as radiologic response or stable disease, and local progression –free survival (PFS) defined as freedom from progression of treated BM, appearance of new brain metastases and/or leptomeningeal progression, as well as overall survival (OS) measured from the time of SRS .ResultsTwenty-eight patients were identified as HER2 positive (Group A) and 24 patients were HER2 negative (Group B). Median time to develop BM in group A was 60 months (4 -240 months) versus 48 months (4-156) in group B. Median follow-up was 12 months (1-48) from the time of onset of BM. 66% patients in group A and 82% patients in group B have no more than 2 BM at the time of SRS.In group A, OR was 78.6% (22 pts)and 21.4%(6 pts) had progressive disease (PD) where as in group B the OR was 83% (20 pts) and 17%(4 pts) had PD. Median time to local recurrence of the treated lesion in group A was 13 months (95% CI 5.84 to 20.15) compared to 8 months (95%CI 6.75 to 9.25) in group B. Local PFS at 1 year for Group A vs. B was: control of the treated lesions 69% versus 41.2% respectively, p= 0.97 by log rank test; and development of new BM 67% compared to 86% (p=0.2).Out of all CNS relapses, almost a quarter of patients in both groups received second SRS whereas 25% patients in group A and 31% patients in group B received whole brain irradiation respectively. Interestingly, 28% (9 pts) failed as leptomeningeal disease following SRS, 7 of them with Her 2 positive tumors. Leptomeningeal relapses were seen both as only pattern of recurrence (4 pts) or associated with other types of CNS progression: local re-growth or new BM (5pts).ConclusionsSRS provides high rate of objective response and local control for BM from both Her 2 positive and Her 2 negative breast cancer. No statistically significant difference in local PFS was seen. More frequent pattern of relapse as leptomeningeal disease was seen in Her 2 positive after SRS. Evaluation of novel systemic targeted therapies in conjunction with local therapies is needed for effective management of BM from breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6152.

Evaluation of the BTA tests for the detection of bilharzial related bladder cancer: the Cairo experience

OBJECTIVE

To evaluate the clinical performance of the BTA stat test and the BTA TRAK assay in the diagnosis of bilharzia-related bladder cancer and to calculate a new 'Egyptian' cut-off value for the BTA TRAK (quantitative) assay.

METHODS

Urine samples of 149 individuals were tested for the presence of the human complement factor H-related protein, the antigen detected by the BTA stat and BTA TRAK tests. The group consisted of 53 healthy volunteers, 20 patients with active bilharziasis, 11 patients with other urologic disorders including prostate cancer, and 65 patients with histologically proven bladder cancer. All samples were obtained prior to surgery or therapy.

RESULTS

The BTA stat test was positive in 64 of 65 samples from patients with bladder cancer, for an overall sensitivity of 99%. With a BTA TRAK assay cut-off of 60 U/ml (set at 97% specificity in the healthy population), the sensitivity of the TRAK assay was 94%. There was no statistically significant difference between the sensitivities of the two BTA tests in patients diagnosed with squamous cell carcinoma and those with transitional cell carcinoma. The overall specificity of the BTA stat test was 67% ranging from 15% in patients with bilharziasis to 94% in healthy volunteers. The overall specificity of the TRAK assay was 66%, again with negative results in 15% of the patients with bilharziasis.

CONCLUSIONS

The BTA stat test and TRAK tests are extremely sensitive in the detection of bladder cancer in the Egyptian population. Positive results (85%) are also observed in patients with active bilharziasis, which often leads to bladder cancer. Longitudinal follow-up of these positive cases is needed to determine whether these positive results are false or predictive of bladder cancer.

The development of sinoatrial dysfunction in pacemaker patients with isolated atrioventricular block

The purpose of this paper is the assessment of sinus node competence over time in patients with isolated atrioventricular block (AV block). Patients implanted with AV synchronous pacemakers for isolated AV block between December 1993 and June 1995 were prospectively evaluated at predischarge, 6 weeks, and subsequent 6 months follow-up with respect to atrial rate monitors/24-hour Holter and modified exercise test. Patients unable to maintain AV synchronous pacing or complete a modified exercise test were excluded. Sinus node competency is interpreted as: (1) absence of atrial brady- or tachyarrhythmia, (2) ability to achieve a minimum heart rate of 100 beats/min with modified exercise test or during daily activities. There were 58 patients (22 women), mean age 71.0 +/- 13.8 with an average follow-up of 30.4 months (11-40). Three patients did not complete a modified exercise test, 4 patients were lost to follow-up, and 2 patients were unable to maintain AV synchronous pacing. Of the remaining 49 patients, 3 developed chronic or paroxysmal atrial fibrillation. No patient developed significant bradyarrhythmias. All patients achieved a heart rate of > or = 100 beats/min modified exercise test. In our group of patients with isolated AV block within a moderate follow-up period, development of sinoatrial dysfunction was rare (6%). A longer follow-up is required to delineate the natural history of sinoatrial dysfunction in patients with isolated AV block.

Pituitary apoplexy after leuprolide administration for carcinoma of the prostate

The syndrome of pituitary apoplexy has been reported to occur after the administration of several different medications. We report a case in which pituitary apoplexy developed shortly after the administration of leuprolide in a patient with prostate cancer. Leuprolide is a potent gonadotrophin releasing hormone (GnRH) analogue used to suppress leuteotrophic hormone (LH) and testosterone levels in patients with metastatic prostate cancer. LH and testosterone levels actually rise in the first week after its administration before becoming suppressed. We suspect that this acute stimulating effect of leuprolide is linked to the acute onset of pituitary apoplexy in a patient with a possible gonadotrophoma.