Yongjie Shui

EGFR and HER2 expression in primary cervical cancers and corresponding lymph node metastases: Implications for targeted radiotherapy

BackgroundProteins overexpressed on the surface of tumor cells can be selectively targeted. Epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) are among the most often targeted proteins. The level and stability of expression in both primary tumors and corresponding metastases is crucial in the assessment of a receptor as target for imaging in nuclear medicine and for various forms of therapy. So far, the expression of EGFR and HER2 has only been determined in primary cervical cancers, and we have not found published data regarding the receptor status in corresponding metastatic lesions. The goal of this study was to evaluate whether any of these receptors are suitable as target for clinical diagnosis and therapy.MethodsExpression of EGFR and HER2 was investigated immunohistochemically in both lymph node metastases and corresponding primary cervical cancers (n = 53). HER2 and EGFR expression was scored using HercepTest criteria (0, 1+, 2+ or 3+).ResultsEGFR overexpression (2+ or 3+) was found in 64% (35/53) of the primary cervical tumors and 60% (32/53) of the corresponding lymph node metastases. There was a good concordance between the primary tumors and the paired metastases regarding EGFR expression. Only four patients who had 2+ or 3+ in the primary tumors changed to 0 or 1+ in lymph node metastases, and another two cases changed the other way around. None of the primary tumors or the lymph node metastases expressed HER2 protein.ConclusionThe EGFR expression seems to be common and stable during cervical cancer metastasis, which is encouraging for testing of EGFR targeted radiotherapy. HER2 appears to be of poor interest as a potential target in the treatment of cervical cancer.

Effect of patient-related delay in diagnosis on the extent of disease and prognosis in nasopharyngeal carcinoma.

Background The reasons causing the patient-related delay in diagnosis (PRDD) and the effects of PRDD on the extent of disease and prognosis in the nasopharyngeal carcinoma (NPC) remain uncertain. The aim of this study was to investigate the status of PRDD and evaluate the relationship between PRDD and prognostic factors of NPC. Methods The data of 216 patients with NPC, from 2002 to 2006, were analyzed retrospectively with respect to patient age, gender, smoking status, education experience, living area, and symptoms. PRDD was recorded as the time from initial symptoms to the first visit to a medical doctor. The extent of disease was determined by TNM staging according to the International Union Against Cancer classification in 1997. Results PRDD of the analyzed cases ranged from half a month to 24 months, with a mean delay in diagnosis of 5.6 months. Senior residents and low education population tended to have longer PRDD (p < 0.05). There was a significant correlation between PRDD and the degree of invasion, clinical stage of NPC (p < 0.05). Conclusion Senior residents and low education population tend to have longer PRDD. Delay in diagnosis correlates with the degree of invasion and stage of NPC.

Recurrence patterns in patients with high-grade glioma following temozolomide-based chemoradiotherapy

There is currently no consensus regarding the optimal radiation volume for high-grade glioma (HGG). The brain volume irradiated is associated with the extent of radiation neurotoxicity. When reducing the treatment volume, the risk of geographic tumor miss should be considered. In such cases, the recurrence patterns and, particularly, the rate of marginal tumor recurrence, are important indices for determining the optimal radiation volume. In the present study, a smaller-target delineation protocol with limited margins was adopted. The postoperative enhancing tumor and resection cavity were defined as gross tumor volume (GTV); 1 and 2 cm were added to the GTV to create clinical target volume (CTV1 and CTV2), which received 60 and 54 Gy, respectively. At a median follow-up of 14 months, 54 HGG patients developed tumor recurrence. The median overall and progression-free survival were 14 and 10.5 months, respectively. A total of 34 patients developed central recurrence, 8 presented with in-field recurrence, 2 developed marginal recurrence, 2 had distant recurrence and 11 patients developed cerebrospinal fluid dissemination, 2 of whom developed central recurrence, with 1 patient simultaneously developing marginal recurrence. Local recurrence (central and in-field) was found to be the main recurrence pattern. As the rate of marginal recurrence was low (<5%), it appears that the smaller irradiated volume in the present study was appropriate. However, clinical trials investigating limited irradiation volume are required to validate our findings.

Long-Term Relief of Cerebral Radiation Necrosis Treated with Low-Dose Bevacizumab - a Report of 2 Cases

Background: Radiation necrosis is 1 of the most significant complications of brain tumor irradiation. The standard treatment for patients with radiation necrosis consists of corticosteroids to reduce the amount of cerebral edema and, if required, cyst drainage. Case Reports: 2 patients with symptomatic radiation necrosis initially unresponsive to steroid treatment were treated with repeated low-dose bevacizumab at 5 mg/kg body weight. Rapid and lasting symptom relief, as well as neuroradiological improvement was seen in both cases. A dramatic rapid magnetic resonance imaging response with decrease in contrast enhancement was found shortly after administering the first dose of bevacizumab. The improvement of perifocal edema was relatively slower than of the reduction of enhancement. Only a slight reduction in size of the involved area could be expected after the first dose of bevacizumab. Further shrinkage was seen after the second and third doses. The individuals reported have been doing well for more than 45 and 22 months, respectively, after the initiation of bevacizumab treatment. Conclusion: Our data add to the literature supporting of the use of bevacizumab as an effective therapeutic agent for radiation necrosis, particularly in cases unresponsive to steroid treatment.