Journal Issue: Vol.12, No.3 - July 2013

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Report on the Current Nuclear Medicine Status of the Asian Member States from the Initial Cooperative Project Meeting (RAS6061/9001/01) of International Atomic Energy Agency/ Regional Cooperative Agre

Dr Shigeru Kosuda

  1. Dr Shigeru Kosuda
    Department of Radiology, National Defense Medical College

Purpose: The objective of this study is to report a brief summary of the nuclear medicine status reports presented by the 13 delegates of the National Project Coordinators (NPC) of the Asian Member States in the International Atomic Energy Agency (IAEA). Methods: The initial cooperative meeting (RAS6061/9001/01) of the International Atomic Energy Agency/Regional Cooperative Agreement (IAEA/RCA ) was held on March 19-23, 2012 in Chiang Mai, Thailand. The brief reports presented at the meeting were assembled here with the delegates’ approval. Results: The Republic of Korea leads in the number of PET/CT apparatuses, followed by China. In contrast, China leads country in the numbers of SPECT/CT apparatuses and cyclotrons, followed by the Republic of Korea. These two countries own far more hybrid modalities than other Asian countries. However, in devices per capita, the Republic of Korea leads with one PET/CT for 0.32 million, followed, in order, by Singapore with one PET/CT for 0.57 million people and Malaysia with one PET/CT for 2.5 million people. In addition to heterogeneity of instrumentation, radiopharmaceuticals, and human resources, the reports indicated that there are also regional differences in content, structure, and length of training and education programs in nuclear medicine. Conclusion: We are convinced that this summary report will contribute to the future planning of IAEA/RCA training programs, including both fundamental and advanced courses, worldwide. There is the need to hold continuing educational meetings among Member States to decrease the disparity of the knowledge, and to transfer the knowledge from developed countries to developing countries.

Screening of Antiproliferative Effect of Chitosan on Tumor Growth and Metastasis in T24 Urinary Bladder Cancer Cell Line

Senthilkumar Kuppusamy, Jeyaprakash Karuppaiah

  1. Senthilkumar Kuppusamy
    R&D Department, Apex Laboratories Private Limited
  2. Jeyaprakash Karuppaiah
    PG and Research Department of Biochemistry, Rajah Serfoji Govt College

Cancer is the second largest non-communicable disease and it has a sizable contribution in the total number of deaths. Cancer of the urinary bladder ranks fourth in men and eighth in women with an alarming increase in cancer patients of this type every year. Tobacco smoking is considered to be one of the causes of bladder cancer and a number of organic chemicals used in the industry are known to be carcinogenic to the bladder. Chemical and dyestuff manufacturers are at particularly high risk of bladder cancer. Chitosan used as potential therapeutic agents for the treatment of cancers. This study was employed to find out the therapeutic potential of chitosan against T24 urinary bladder cancer cell lines. The therapeutic potential of the chitosan against T24 urinary bladder cancer cell lines were determined by the Apoptosis by Fluorescent activated cell sorbent assay (FACS) and DNA fragmentation assay. The results obtained from the FACS assay and DNA fragmentation assay in this study showed the anti-tumour potential of chitosan against T24 bladder cancer cell lines. Thus, the chitosan can be employed as potential anticancer drugs against bladder carcinoma.

Target Delineating or Hepatic Cancer Based on an Animal Study

Dr Gong Li, Dr Guangxin Li, Dr W. Ken Zhen, Dr Jingchen Zheng, Dr Daobin Ye, Dr Shuai Jin, Dr Yajing Qu, Dr Xiaolong Ji

  1. Dr Gong Li
    Cancer Center, The General Hospital of Chinese People’s Armed Police Forces
  2. Dr Guangxin Li
    Cancer Center, The General Hospital of Chinese People’s Armed Police Forces
  3. Dr W. Ken Zhen
    Department of Radiation Oncology, Department of Otolaryngology - Head and Neck Surgery,rnUniversity of Nebraska Medical Center, 68198 Nebraska Medical Center
  4. Dr Jingchen Zheng
    Cancer Center, The General Hospital of Chinese People’s Armed Police Forces
  5. Dr Daobin Ye
    Department of CT, The General Hospital of Chinese People’s Armed Police Forces
  6. Dr Shuai Jin
    Cancer Center, The General Hospital of Chinese People’s Armed Police Forces
  7. Dr Yajing Qu
    Cancer Center, The General Hospital of Chinese People’s Armed Police Forces
  8. Dr Xiaolong Ji
    Department of Pathology, The General Hospital of Chinese People’s Armed Police Forces

Purpose: To correlate the tumor volume defined by CT imaging and pathologic specimen using rabbit VX2 liver tumor model. Methods and Materials: Fifteen New Zealand rabbits carrying implanted VX2 liver tumors were used in this study. The radiographic tumor measurements were obtained from the both arterial phase and venous phase of CT scanning. The identical pathological slices corresponding to the CT slices were analyzed for the measurement of tumor dimensions and the extent of microscopic disease to obtain precise GTV and CTV. Results: The mean tumor diameters identified by the arterial phase, venous phase CT scan and pathologic specimen were 14.59±3.14 mm, 12.93±3.18 mm, and 16.21±3.78 mm, respectively. There was no statistical difference in tumor measurements between the arterial phase CT and pathological specimen. However, there was a significant difference between the venous phase and pathological specimen (p<0.05). The furthest tumor infiltration from the fibrous membrane was 8.1 mm with a mean distance of 2.8 mm, and a range of 7.75 mm (95% confidence). Conclusions: The GTV is better defined by the arterial phase CT scan than the venous phase for the liver tumor. A GTV with 7.75 mm margins should adequately cover 95% of subclinical disease.

Rituximab Maintenance for Two Years in Patients with Follicular Lymphoma; Dubai Hospital Experience

Dr Dalia M. El-Shourbagy, Dr Emad Anwar

  1. Dr Dalia M. El-Shourbagy
    MD., PhD.
    Lecturer of Clinical Oncology, Faculty of Medicine, Tanta University, Egypt.rnDubai Hospital, Dubai, UAE.
  2. Dr Emad Anwar
    MD., PhD.
    Dubai Hospital, Dubai, UAE.

Purpose: Although follicular lymphoma is considered incurable, patient outcomes have improved over the last decade with the use of anti-CD20 monoclonal antibodies. A longstanding concept in follicular lymphoma (FL) is that although most patients have an indolent initial phase of disease, this is typically followed by sequentially shorter remission durations and justifies the continued intense search for rationally designed management. Maintaining and prolonging progression free survival is one conceptual approach challenges the notion of inevitable shorter response duration. We assessed the potential benefit of two years of Rituximab maintenance after induction Rituximab-chemotherapy in patient with follicular lymphoma. Method: The current study is a retrospective analysis of patients with follicular lymphoma who attended oncology department dubai hospital between 2005- 2010. The data collected from patients medical records. We selected patients who received one of immunochemotherapy induction regimens used in routine practice; R-CHOP or R-CVP and followed by maintenance Rituximab or observation. A total 41 patient with follicular lymphoma who received induction immunochemotherapy and complete or partial response achieved were included in the current retrospective analysis. The primary end point was progression free survival (PFS). Results: 41 patients with follicular lymphoma who responded to induction immunochemotherapy; 22/41 patients received maintenance Rituximab and 19 patients were on observation. With a median follow up of 46 months, PFS was 55.4% (95% CI 47.3 – 63.5) in the Rituximab maintenance arm and 35.7% (26.8 – 44.7) in the observation arm (p = 0.01). Overall survival did not differ significantly between the study arms. Infections were the most common grade 3-4 adverse events, occurring in 22.2% and 5.5% respectively. Conclusions: Two years of rituximab maintenance therapy after induction R-chemotherapy for follicular lymphoma significantly improves progression free survival.

Radiation Induced Bullous Pemphigoid: Case Report and Review of the Literature

Dr Christopher Heyes, Dr David Lau, Dr Anousha Yazdabadi, Dr Chris Hamilton, Dr Eric Poon

  1. Dr Christopher Heyes
    Skin and Cancer Foundation
  2. Dr David Lau
    Department of Oncology, Austin Hospital
  3. Dr Anousha Yazdabadi
    Skin and Cancer Foundation
  4. Dr Chris Hamilton
    Department of Radiation Oncology, Austin Hospital
  5. Dr Eric Poon
    Department of Dermatology, Austin Hospital

An 81 year old woman presented with a blistering skin eruption that had developed during radiation therapy for breast cancer. This was subsequently diagnosed as radiation-induced bullous pemphigoid, a rare adverse effect of radiotherapy. This case highlights the rare phenomena of bullous eruptions following radiotherapy and the pathogenesis and management of such conditions.

Pro-inflammatory Cytokines for Evaluation of the Diagnostic Performance for the Urinary Bladder Cancer

Prof Nadham K. Mahdi, Abbas Fadhel Ghdbhan, Murtadh Mohammad Saleh

  1. Prof Nadham K. Mahdi
    M.Sc., Ph.D. (England)
    Department of Microbiology & Surgery, College of Medicine, University of Basrah
  2. Abbas Fadhel Ghdbhan
    Department of Microbiology & Surgery, College of Medicine, University of Basrah
  3. Murtadh Mohammad Saleh
    Department of Microbiology & Surgery, College of Medicine, University of Basrah

Objective: This study designed to evaluate the role of serum cytokines marker in the diagnosis and prognosis of urinary bladder cancer. Patients and Methods: The study was conducted in Basrah Hospitals, Iraq between September 2011 till July 2012. Blood samples were collected from 45 patients (mean age 63.52 ± 10.96 years) with urinary bladder cancer and from 45 apparently healthy control groups with (mean 46.41 ± 8.23 years). ELISA test was used for detection of serum TNF-α, IFN-ϒ, IL-8 and IL-12. TNF-α revealed higher serum level in patients (20.8 ± 27.22) pg/ml in comparison with control group (1.189 ±26.51) pg/ml (p<0.5). A significantly higher serum INF-ϒ of patients (5.272.41)pg/ml in comparison with control group (4.01±1.1) pg/ml (p<0.5). Similar a significantly increase serum level of IL-8 in patients (51.4938.43) pg/ml in comparison with control group (36.55 ± 15.28 ) pg/ml(p<0.5). IL-12 revealed a significantly higher serum level in patients (4.29 3.95) ng/L than that of the control control group (1.09±2.14) ng/L (p<0.5). Conclusion: Serum cytokines are important diagnostic and prognostic tools for urinary bladder cancer and good predictor for disease.

Solitary Splenic Metastasis from Ovarian Serous Adenocarcinoma: A Case Report.

Dr Emad Dawoud, Dr Michael Jansen, Dr Dalia Al Shurbagy

  1. Dr Emad Dawoud
    MD, PhD.
    Medical Oncology Department, Dubai Hospital
  2. Dr Michael Jansen
    MD, FRCPath
    Pathology Department, Dubai Hospital
  3. Dr Dalia Al Shurbagy
    MD, PhD.
    Medical Oncology Department, Dubai Hospital

Introduction Metastatic tumors to the spleen are rare but are usually found in conjunction with metastasis to other organs. The most common sources of splenic metastasis are breast, lung and colorectal cancers as well as melanoma. A solitary serous adenocarcinoma metastasis to the spleen of any origin is very rare. To the best of our knowledge, there are fewer than 30 reported cases of ovarian primary tumors with solitary metastasis to the spleen. We present what is, to the best of our knowledge, a rare case of a solitary metastatic serous adenocarcinoa to the spleen arising from a primary ovarian carcinoma.. Case presentation We reported a 56-year-old Asian woman, status post-total abdominal hysterectomy for ovarian serous adenocarcinoma and 6 cycles of chemotherapy (Taxol and carboplatin) since 2004. on September 2012 she presented with complaints of Lt. hypochondrial pain of two months duration with a rising of tumor marker CA 125. An initial computed tomographic scan of her abdomen and pelvis revealed 2 splenic focal lesions. The patient was found to have metastatic serous adenocarcinoma of ovarian origin to the spleen. Conclusion Serous adenocarcinoma of the spleen is a rare tumor. Metastatic ovarian adenocarcinoma to the parenchyma of abdominal organs is a rare presentation of ovarian metastasis especially after the patient had been treated with surgery and chemotherapy with 8 years disease free survival. . Even though it is rare, serous adenocarcinoma of the ovary can metastasize to the spleen. This unique case of a solitary splenic metastasis from ovarian serous adenocarcinoma has particular interest in medicine, especially for the specialties of surgical oncology, pathology and medical oncology.

Bevacizumab Beyond Progression in Metastatic NSCLC

Dr Adel Aref, Dr Dina Hamza

  1. Dr Adel Aref
    MBBCH, MSc. Clinical oncology
    Dubai Hospital
  2. Dr Dina Hamza
    MBBCH, MSc. Clinical oncology
    Dubai Hospital

Background: Progression on first line chemotherapy with Bevacizumab may be due to resistance developed to the chemotherapy agents used and/or bevacizumab. The objective of our single institution retrospective study was to evaluate clinical benefit, and incidence of adverse effects among patients with stage IV NSCLC receiving Bevacizumab beyond progression. Patients and Methods: Using a data base maintained in the medical oncology department of Dubai Hospital we retrospectively identified patients with stage IV NSCLC who had received Bevacizumab as part of the first line treatment protocol. Patients included in the study were those who received Bevacizumab beyond progression. Clinical benefit was defined as complete response, partial response as well as stable disease. Median duration of response and the occurrence of adverse events were documented. Median survival of the whole cohort (from the date of diagnosis to the date of last follow up or death) and following second line treatment (from the date of starting second line treatment to the date of last follow up or death) were computed. Results: Eleven patients, diagnosed between January 2008 and January 2011, who met eligibility criteria, were identified. Median age of the cohort was 55 years. Performance status range was between 0 to 2. Median number of cycles of Bevacizumab received both in the first and second line was 24. Median number of cycles of Bevacizumab received in the second line setting was six. Median duration of response was six months. Six patients (54.5 %) completed > six treatment cycles, and 3 patients (27.3 %) completed > 12 treatment cycles. One patient achieved a partial response (9.1 %), 3 patients achieved stable disease, (27.3 %), 7 patients had radiological evidence of progression (63.6 %) The clinical benefit achieved (CR+PR+SD) was 36.4 %. Grade 3/4 proteinuria occurred in 2 patients (18.2 %). Other adverse events including grade 3/4 hypertension, thromboembolic events, hematological toxicity were not observed. Median survival for the whole cohort was 23 months. Median survival after starting second line treatment was 6 months. Conclusion: In our study continuing Bevacizumab beyond progression resulted in a median duration of response and median survival similar to that reported in the literature when chemotherapy is given alone. It was not accompanied by an increase in grade 3 or 4 toxicity. Although our cohort is small the benefit of continuing Bevacizumab beyond progression is questionable. Further studies are required to confirm its clinical benefit.

Occupational Sunlight Exposure and Risk of Renal Cell Carcinoma

Sara Karami

  1. Sara Karami
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, rnDepartment of Health and Human Services

Background: Recent findings indicate that vitamin D obtained from ultraviolet (UV) exposure may reduce the risk of several different cancers. Vitamin D is metabolized to its active form within the kidney, which is the major organ for vitamin D metabolism and activity. Because both the incidence of renal cell carcinoma (RCC) and the prevalence of vitamin D deficiency have increased over the past few decades, in the current study, the authors explored whether occupational UV exposure was associated with RCC risk. Methods: A hospital-based, case-control study of 1097 patients with RCC (cases) and 1476 controls was conducted in 4 Central and Eastern European countries. Demographic and occupational information was collected to examine the association between occupational UV exposure and RCC risk. Results: A significant reduction (24%-38%) in the risk of RCC was observed with increasing occupational UV exposure among men who participated in the study. No association between UV exposure and RCC risk was observed among women who participated. When the analyses were stratified by latitude as another estimate of sunlight intensity, a stronger reduction (71%-73%) in the risk of RCC was observed between UV exposure and cancer risk among men who resided at the highest latitudes. Conclusions: The current results suggested that, among men, there is an inverse association between occupational UV exposure and the risk of RCC. Replication studies are warranted to confirm these results.

Isolation of Solasodine from the Unripe Fruits of Solanum xanthocarpum Schrad and Wendl. (Solanaceae) and it’s Anti Cancer Activity against HeLa and U937 Cell Lines

Sarthak Bhattacharya, Seema Kohli, Amar Singh Chaudhary

  1. Sarthak Bhattacharya
    PhD Research Scholar (Pharmacy)
    Guru Ramdas Khalsa Institute of Science & Technology (Pharmacy)
  2. Seema Kohli
    Department of Pharmacy, Kalaniketan Polytechnic College
  3. Amar Singh Chaudhary
    College of Pharmacy, Bramhanand Group of Institutions

Recent advancements have shown that solasodine, a nitrogen containing steroidal glycoalkaloid (aglycone) obtained from different parts of the genus Solanum (Solanaceae). Solanum xanthocarpum, Solanum khasianum are the main plant sources for solasodine. Solasodine has various therapeutic effects on different body systems. Earlier solasodine was used in the drug industries for the synthesis 16-DPA, a novel precursor for anti-fertility and anti-inflammatory agents. Several studies and articles recently published clearly indicate that therapeutic potential of solasodine should be explored to see more multiple effects on different types of ailments. Solasodine, the principal aglycone is being isolated by different techniques. In the present study, it is done by two phase system containing aqueous (aq.) mineral acid- organic aq. immiscible solvent mixture less than 100°C using single step in which direct acid hydrolysis-extraction of the glycosides of the plant material is being carried out and aglycone solasodine is obtained by alkali treatment after the hydrolysis of the glycoside. The present process can be applied to obtain solasodine from various solasodine bearing plants of Solanaceae family. It is a suitable method for continuous production of solasodine which serves as a precursor for synthesis of steroidal drugs. Solasodine showed selective cytotoxicity against cervical cancer cell line (HeLa) and human myeloid leukemia cell line (U937). This compound has been isolated from the Solanaceae family by different techniques but has never previously been isolated by this technique. More over this compound is shown to be a cytotoxic drug.

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