5^th World Congress on Medical Imaging & Clinical Research June 17-18, 2019 | Holiday Inn Rome Aurelia Via Aurelia km 8,400 00165 ROMA

Biography:

Abstract:

Introduction: Malignant Pleural Mesothelioma (MPM) is an aggressive tumor. Most of MPM cases present at advanced stage and treatment options are mainly palliative chemotherapy and best supportive care. The current lines of chemotherapy are limited and ineffective. Hence, there is an urgent need to improve patient outcomes. This requires better understanding of genetic alterations and biomarkers driving MPM to improve diagnostic, prognostic and therapeutic strategies. Top2A and Her2neu were thoroughly investigated and proved to be predictive factors in breast cancer and other solid tumors.

Aim: The study aimed at investigation of TOP2A and HER-2 expression in malignant pleural mesothelioma for better understanding and the involvement of different biomarkers in this aggressive type of cancer and also the possibility for introducing new treatment strategies accordingly.

Materials & Methods: Thirty four cases of MPM with full data who were referred to NCI, Cairo University, Egypt from 2011 to 2015 were enrolled in the study. We investigated protein over expression of TOP2A using immunohistochemistry as well as gene amplification of TOP2A and HER-2 genes using FISH technique and correlated the results with different clinical pathological data and survival using ROC curve, Chi-Square and Kaplan-Meier tests.

Results: Our study included 34 cases of MPM; median age was 51 years and 16 (47%) cases were females; 19 (55%) cases were stage 1 & 2; 12 (35%) cases underwent major operations, extrapleural pneumonectomy (EPP) or decortication (P/D). 30 (88%) cases received chemotherapy, mainly platinum based chemotherapy combined with Alimta (if avilable) or Gemcitabine. 8 (23%) cases received radiotherapy either adjuvant in multimodality treatment or palliative for pain and bone metastasis. All cases were evaluated for TOP2A by immunohistochemistry with cutoff value of 0.825. 21 (64%) cases were TOP2A positive. All patients with progressive disease were TOP2A negative (p= 0.012). 13 (72%) out of 18 male cases were TOP2A negative. 11 (73%) out of 15 stage 3 and 4 cases were TOP2A negative. 8 (88%) out of 9 biphasic cases were TOP2A negative. 9 (81%) out of 11 TOP2A positive cases were epithelioid (p=0.08). There was a statistical significant correlation between time to progression (TTP) and TOP2A expression (p=0.012). There was a difference between over-expression of TOP2A immuno-histochemistry and amplification by FISH technique, as only 5 (14%) out of the 34 evaluated cases showed TOP2A amplification. There was a statistical significant correlation between better PFS (p= 0.005), OS (p= 0.024) and TOP2A amplification by FISH. However, these significant correlations were not proved using multivariate analysis. As regard HER2neu, 3 (0.08%) out of the 34 evaluated cases were HER2neu positive. There was a trend between HER2neu non- amplified cases and at earlier stage (p=185) most of the HER2neu amplified cases were males.

Conclusion: Our preliminary studies revealed favorable prognosis of MPM cases with TOP2A expression. TOP2A should be evaluated by immunohistochemistry and not only by FISH technique as there is obvious dis-concordance between the two techniques, the former succeeded in identification of more cases with TOP2A overexpression. We recommend performance of a pilot study using Anthracyclins in addition to standard chemotherapy regimen in MPM cases to evaluate the benefit of these types of drugs.

Biography:

Abstract:

The superiority of mammography (MMG) screening has been demonstrated in studies made to date. However, recent studies have begun to debate this survival advantage with the increasing efficiency of chemotherapy (CT) regimens.

Methods

Between May 2000 and June 2016, three different tertiary care centres were retrospectively screened from the files and the data from electronic registry systems of 1488 patients who were diagnosed with breast cancer. Nine hundred and fourteen patients were included in the study. Patients were divided into two groups as patients diagnosed with MMG screening (M-SCR) and diagnosed after symptomatic admission (SYM). Overall Survival (OS) was defined as the time from the date of diagnosis to the date of death due to the disease.

Results

The median age of the patients was 51 (22‑88); median follow‑up time was 46±37.9 months, median disease‑free survival was 43±36.2 months, median OS was 46±38.27 months. The 5‑year disease‑free survival rate of the entire population was 81.6% while the 5‑year OS (5y‑OS) rate was 86.6%. Of the patients, 43.4% were premenopausal, while 56.5% were postmenopausal. The histological subtype was invasive ductal carcinoma in 90%. Of the patients, 57.8% were operated with Modified Radical Mastectomy (MRM) and 23.5% were operated with Breast‑Conserving Surgery (BCS). In 233 (25.4%) patients stage‑I disease, in 338 (36.9%) patients stage‑II disease and in 343 (37.5%) patients stage III disease were detected. 765 (83.6%) patients were hormone‑receptor (HR) positive, 239 (26.1%) patients were HER‑2 positive, 73 (7.9%) patients were triple‑negative (TN), 580 (63.5%) patients were Luminal‑A, 167 (18,3%) patients were Luminal‑B, and 72 (7.8%) patients were HER‑2 breast cancer (ER and PR negative and HER‑2 positive).

Breast cancer was diagnosed after MMG screening in 302 patients (33%), whereas 612 patients (66.9%) were diagnosed after symptomatic admission. There was no significant difference between median ages of two groups (p = 0.619). Clinical and histopathologic features of these two groups are summarized in Table‑1. There was no significant difference between symptomatic group and MMG screening groups in terms of recurrence rates (18.8% vs 17.6%, p = 0.56). There was no statistically significant difference between the two groups in terms of time to recurrence (41±34.4

vs 46±39.2 months, p = 0.055). However, the mortality rate was higher in the symptomatic group than in the symptomatic group (13.9% vs 8.6%, p = 0.02), and time to death was also shorter in symptomatic group (43.5±36.7 vs 49±40.8 months).

In patients with MMG, 5y‑OS was 91.6%, while it was 83.7% in symptomatic patients (p = 0.003). However, this relationship was not detected in multivariate analysis (p = 0.145, HR = 0.68 [95% CI: 0.42‑1.11]).

Conclusion

Patients in the screening group with MMG were at an earlier stage, with a lower grade and more often HR‑positive than symptomatic patients. Patients who have diagnosed during screening were less exposed to chemotherapy and required less adjuvant radiotherapy. At the same time, breast‑conserving treatment rates were higher in these patients. However, despite all these facts, mammography is not an independent parameter that affects survival.

Biography:

Dr. Tarang Krishna is a distinguished and acclaimed physician who has made immense contribution in the field of cancer treatment. A well known and a fabled personality in healthcare, Dr. Tarang Krishna has successfully treated thousands of patients over a span of 18 years. Dr. Krishna completed his MD and thereafter went on to do his PhD from University of London. His aim is to promote and spread the awareness of the benefits of immunotherapy to maximum number of people. He has been appreciated and awarded several times by the Government of India as well as by International Organizations.

Abstract:

Breast cancer is one of the most common cancers in women. World Health Organization estimated the number of diagnosed breast cancer cases at approximately 2.1 million in 2018. This equals to about 11.6% of the total cancer incidence burden. Globally, the incidence rates of breast cancer are much higher as compared to other cancers. Such high prevalence of breast cancer calls for an effective treatment that is able to resolve the condition permanently.

Although the best form of resolution is early diagnosis but an assured treatment should be sought as most of the cases get detected in advanced stages. Most of the patients undergo surgery which is coupled with either adjuvant or neoadjuvant chemotherapy and in some cases radiotherapy. The potential side effects of chemotherapy and radiotherapy make them a non viable option. The treatments of hormone therapy and targeted therapy are also not devoid of side effects. The treatment should be such, which relieves the ailment of the patient rather than augmenting it.

Another form of treatment that has emerged to treat various forms of cancer including breast cancer is immunotherapy and it is still in the stage of clinical trials. Many studies have been conducted in relation to the treatment of metastatic breast cancer with immunotherapy but the possibility of emergence of alternate effects has also not been entirely ruled out. This case report aims to establish the efficacy of oral immunotherapy treatment in a patient of metastatic breast cancer in terms of the following: 1) Relieving the patient of her presenting complaints. 2) Removing the evidence of the disease completely from the body without any side effects. 3) Ruling out relapse of the disease. 4) Ensuring a normal life to the patient.

Biography:

Abstract:

Background: The incidence of breast cancer worldwide is still high. Surgery remains the top choice with other modalities of chemotherapy, radiation and suplementation such as Artemisia vulgaris (AV).

Aim: The study was aimed to demonstrate that administration of AV extract decreased the expression of Cyclin-D1 and the expression of Ki-67 in adenocarcinoma mammae.

Method: This study used "Post test only control group design" on 24 females C3H mice that were randomly selected and divided into four groups: group K (control), P1 (chemotherapy), P2 (extract) and P3 (combination). Adenocarcinoma mammae comes from the inoculation of donor mice. Chemotherapy of Adriamycin 60 mg/m2 and Cyclophosphamide 600 mg/m2 were given in 2 cycles. AV 13 mg (0.2 ml) was given once daily orally. Cyclin-D1expression and Ki-67 expression were evaluated by imunohistochemical staining.

Result: Mean of Cyclin-D1expression and Ki-67 expression were found in groups K, P1, P2, P3 were 35.30+0.72; 20.38+0.67; 33.50+0.71; 17.36+0.66; and 66.44+0.65; 35.40+0.65; 64.12+0.85; 32.32+0.61. The statistical analysis showed that there were significant differences in the expression of Cyclin-D1 between groups of K vs P1, P3 (p=0.001), P1 vs P2 (p=0.001), P1 vs P3 (p=0.045), P2 vs P3 (p=0.001), and in Ki-67 expression between groups of K vs P1, P3 (p=0.001), P1 vs P2 (p=0.001), P1 vs P3 (p=0.041), P2 vs P3 (p=0.001). Correlation analysis between cyclin-D1 expression and Ki-67 expression showed significant correlation (p=0.030 dan r=0.914).

Conclusion : Artemisia vulgaris is potential as supplementation that can improve the effectivity of Adriamycin-Cyclophosphamide chemotherapy in terms of decreased expression of Cyclin-D1 and expression of Ki-67 adenocarcinoma mammae of C3H mice.

Biography:

Young-Chul Kim has his expertise in treatment and research in lung cancer. He has completed his Graduation from Chonnam National University Medical School, South Korea in 1987 after his Residency and fellowship training in internal medicine and pulmonology in Chonnam National University Hospital. He has been working as a Professor of Pulmonology and Lung Cancer Clinic of Chonnam National University Medical School and CNU Hwasun Hospital. He has been an active member of International Association for the Study of Lung Cancer since 1997, and working as a Director of Research and Planning of Korean Association for Lung Cancer since 2000.

Abstract:

Background: Afatinib is one of the second generation epidermal growth factor receptor (EGFR), tyrosine kinase inhibitors that can be used as a first line treatment of non-small cell lung cancer (NSCLC) with activating EGFR mutations.

Methods: We have surveyed on85 cases retrospectively who are treated with afatinib as first line treatment for NSCLC. Afatinib was started from daily dose of 40 or 30 mg, and response, progression survival, overall survival and toxicity were reviewed. Fifty-four male (64%) and 31 female (36%) patients with mean age of 67 years were recruited to this analysis. Patients with brain metastases were 61% (52 cases).

Results: Response rate was 48.2% and 53.9%, when we exclude cases, whose response was not evaluable. Median progression free survival (PFS) was 13.2 months (95% confidence interval, CI 8.8 ~ 17.6). Median overall survival (OS) was 20.5 months (95% CI 15.6~25.4). Afatinib was started from 40 mg daily dose in 69 patients (81%), and started from 30 mg daily dose in 16 patients. However, only 26 cases maintained 40 mg starting dose (30.6%), and dose reductions were made in 59 cases (69.4%). Diarrhea (76.5%) and skin rash (65.9%) followed by paronychia (49.4%) were most frequently observed adverse events in any grades. 

Conclusions: Afatinib showed good response in patients with high proportion of male and brain metastases. As dosage reduction was made in 70% without difference in efficacy, PFS and OS between the dosage groups, active dose adjustment are warranted.

Biography:

Abstract:

Aim: To evaluate the role of DW-MRI and ADC value in monitoring therapy of head and neck squamous cell carcinoma.

Patients & Methods: 40 patients with head and neck squamous cell carcinoma, age ranged from 40 to 68 years, 30 patients were male while 10 were female. Pre-treatment examinations included contrast-enhanced CT, endoscopic biopsy and Conventional MRI. Pre-treatment includes 1^st DW-MRI imaging within 10 days before treatment (ADC1), 2^nd imaging 3 weeks after start of treatment (ADC2) and 3^rd after 6 to 8 weeks from end of treatment.

Results: Significant changes between mean ADC value of 40 primary lesions and 22 metastatic LNs, noted at ADC1 and ADC2, indicating high ability of DW-MRI to detect early changes occurs after beginning of treatment. Relationship between pretreatment ADC value and prediction of early treatment response revealed 76.9% sensitivity, 71.4% specificity, 83.3% PPV and 62.5% NPV. ROC curve for fractional ADC value change (ADC2-ADC1) from 40 lesions primary tumors provided best discriminatory accuracy (AUC=0.85±0.09) in distinguishing between responders and non-responders with 92.3% sensitivity, 85.7% specificity, 92.9% PPV and 85.7% NPV.

Conclusion: Intra treatment ADC value can be used as a marker for prediction and monitoring therapy response for HNSCC.

Biography:

Pamela Bertolazzi is a Biomedical Scientist. She has completed her Graduation in 2011 and has worked with diagnostic imaging at Sirio Libanes Hospital for seven years. Currently, she is working as a Sr. Clinical Application Specialist at Siemens Healthineers. During her time at Hospital, she was invited to teach in the first Biomedical Residence Program in Brazil. She is a PhD student with a project focused on cerebral changes of obese children in University of Sao Paulo. Her work has a great repercussion around the world and she hopes that her work will help people in the near future.

Abstract:

Background: Previous studies have shown atrophy in gray matter and decrease of white matter (WM) connectivity in several brain regions of obese adults. However, there are controversial results about WM integrity of obese children and adolescents.

Aim: Childhood obesity is an important healthy concern around the world, therefore, the aim of this study is to investigate the influence of childhood obesity on change in cerebral connectivity, using Diffusion Tensor Imaging (DTI) by Magnetic Resonance (MRI).

Methods: The images were obtained on 3T MRI scanner, and the sample consisted of 117 subjects, of which, 57 obese and 60 normal weight adolescents. The average of age was 13 years old and there were no significant statistical differences (p>0.05) between the groups in reference of gender, education, socioeconomical classification and sexual development, except for Body Mass Index (BMI, Z-score, p<0.001) as expected. The images process was performed using FSL and the fractional anisotropy (FA) values were compared between the above groups using Statistical Parametric Mapping from MATLAB.

Results: The analysis revealed that obese group had decrease of FA in WM regions, when compared to the control group, including the corpus callosum (splenium and body) and medium orbital gyrus. There were no higher FA values in obese group.

Conclusions: These findings suggest that obese adolescents may have demyelination in regions of the brain related to impulse control and cognitive functions.