Yuk-Wah Tsang

ANGIOGENIC BLOCKADE AND RADIOTHERAPY IN HEPATOCELLULAR CARCINOMA

PURPOSE We report our preliminary experience of combining sunitinib and helical tomotherapy in patients with advanced HCC. METHODS AND MATERIALS Records of patients with advanced hepatocellular carcinoma (HCC) treated with helical tomotherapy and sunitinib after radiation therapy (RT) from March 2007 to August 2008 were retrospectively reviewed. We report acute toxicities, radiologic response, serial alpha-fetoprotein (AFP) kinetics, and survival. RESULTS Of 23 evaluable patients, 60% had >or=2 hepatic lesions, extrahepatic disease was present in 5 (21.7%), and all received 2 tablets (25 mg) of sunitinib at least 1 week before, during, and 2 weeks after RT. Thirteen patients continued maintenance sunitinib after RT until disease progression. Hypofractionated RT with a median target dose of 52.5 Gy/15 fractions was delivered. An objective response was achieved in 74% of patients. The 1-year survival rate was 70%, with median survival of 16 months. Multivariate analysis showed that maintenance sunitinib was the most significant factor for survival. The time to progression was 10 months in the maintenance group compared with 4 months in the control group. Eighteen out of 21 patients with elevated AFP (85.7%) had >or=50% decline of AFP within 2 months after RT. There were three episodes of upper gastrointestinal bleeding and one episode of pancreatitis; 10 patients had >or=Grade 2 elevation of liver enzymes, and 15 had >or=Grade 2 thrombocytopenia. CONCLUSIONS These preliminary results suggest that sunitinib and helical tomotherapy yield high Response Evaluation Criteria in Solid Tumors (RECIST) and AFP response rates in advanced HCC with an acceptable safety profile. Maintenance sunitinib after RT potentially prolongs survival. A randomized trial is warranted.

Synergistic anti-tumor effect of combination radio- and immunotherapy by electro-gene therapy plus intra-tumor injection of dendritic cells

Interleukin-2 (IL-2) and granulocyte-macrophage colony stimulating factor (GM-CSF) facilitate the maturation and functioning of injected DC. We developed a method of in situ electroporation using IL-2 and GM-CSF genes (EGT/cytokines), followed by intra-tumoral (i.t.) immature DC to determine the immune response at the tumor site using prostate-specific antigen-transfected CT26 cells. Three cycles of EGT/cytokines and i.t. DC inhibited tumor growth most effectively, but not superior to EGT/cytokines alone. However, the role of i.t. DC became significant when radiation was given after immunotherapy, which may have clinical implications on achieving better local control and prevention of systemic relapse.

Improving Detection Accuracy of Lung Cancer Serum Proteomic Profiling via Two-Stage Training Process

BackgroundSurface-Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-TOF-MS) is a frequently used technique for cancer biomarker research. The specificity of biomarkers detected by SELDI can be influenced by concomitant inflammation. This study aimed to increase detection accuracy using a two-stage analysis process.MethodsSera from 118 lung cancer patients, 72 healthy individuals, and 31 patients with inflammatory disease were randomly divided into training and testing groups by 3:2 ratio. In the training group, the traditional method of using SELDI profile analysis to directly distinguish lung cancer patients from sera was used. The two-stage analysis of distinguishing the healthy people and non-healthy patients (1st-stage) and then differentiating cancer patients from inflammatory disease patients (2nd-stage) to minimize the influence of inflammation was validated in the test group.ResultsIn the test group, the one-stage method had 87.2% sensitivity, 37.5% specificity, and 64.4% accuracy. The two-stage method had lower sensitivity (> 70.1%) but statistically higher specificity (80%) and accuracy (74.7%). The predominantly expressed protein peak at 11480 Da was the primary splitter regardless of one- or two-stage analysis. This peak was suspected to be SAA (Serum Amyloid A) due to the similar m/z countered around this area. This hypothesis was further tested using an SAA ELISA assay.ConclusionsInflammatory disease can severely interfere with the detection accuracy of SELDI profiles for lung cancer. Using a two-stage training process will improve the specificity and accuracy of detecting lung cancer.

Cutaneous Metastases from Squamous Cell Carcinoma of the Ureter

Objective: To present an extremely rare case of squamous cell carcinoma of the ureter with cutaneous metastases. Clinical Presentation and Intervention: A case is presented involving a 67-year-old woman presenting with a clinical history of squamous cell carcinoma of the ureter and who had undergone a nephro-ureterectomy with a bladder cuff excision in May 2004. The pathologic report showed squamous differentiation, as well as keratin pearl formation. A large regional cutaneous lesion on the chest wall was found in January 2006, and a biopsy showed metastatic malignant urothelial tumors consisting of squamous cell carcinomas. Conclusion: This report describes a case of cutaneous metastasis from a squamous cell carcinoma of the ureter that is extremely rare with a generally dismal prognosis.

Physiological Uptake of Soft Tissue in Positron Emission Tomography May Mimic Local Recurrelce of Nasopharyn-Geal Carcinoma: A Case Report

This paper reported a case of post-radiation nasopharyngeal carcinoma whose follow-op positive emission tomography/computed tomography (PET/CT) scan showed physiological uptake in bilateral neck soft tissue. This image pattern mimicked local recurrence. Biopsy revealed no malignant cells. One-year follow-op showed free of recurrence. PET/CT scan has been increasingly used in oncology. Physiological uptake may happen n soft tissues of neck such as muscles, fat, tonsils, lateral pharyngeal recess and salivary glands. Physiological uptake may mimic local recurrence and cause false-positive reading. Standard uptake value (SUV), image pattern and morphology change may help in differential diagnosis.

Bone and CT Scans Are Complementary for Diagnoses of Bone Metastases in Breast Cancer When PET Scans Findings Are Equivocal: A Case Report

Bone is one of the most common metastatic sites of breast cancer. We present a case of breast cancer with bone metastases and the patient was evaluated by FDG-PET/CT and a bone scan. The PET scan had a negative finding, but both bone and CT scans detected bone metastases. In general, FDG-PET has greater specificity and good sensitivity for detecting bone metastases. However, when FDG-PET scan findings are equivocal, additional findings from a bone or CT scan can be helpful in diagnosis of bone metastases.