Interaction between Immunotherapy and Radiotherapy

In recent years, treatment methods on immune checkpoints have emerged as promising novel therapeutic modalities against cancer as a result of studies focusing on elucidation of immune micro-environment. Immunotherapy has now become an established treatment in some cancers. [1-2] This has led the need for investigation of biomarkers which allow determining effectiveness of immunotherapies and patient groups which will most benefit from these therapies. In previous studies, it was suggested that programmed death receptor-1 (PD-1) and programmed death ligand-1 (PD-L1) expressions could be predictive biomarkers in cancers. PD-1 is a transmembrane protein present in macrophages, myeloid dendritic cells, B cells, epithelial cells and vascular endothelial cells, which limits and inhibits immunological activation in activated T cells. Blocking PD-1/PD-L1 interaction promises hope in the cancer treatment.  In clinical studies, it was shown that targeted PD-1/PD-L1 therapy alone or in combination with other modalities is beneficial in advanced cancers with aggressive behavior. It was shown that overexpression of PD-1 present in tumoral micro-environment is associated to poor prognosis in gastric cancer, breast cancer, ovarian cancer, kidney, pancreas and lung cancers and in melanoma. [1-5

Effects of Se, Zn and Cu levels on chemoradiotherapy related toxicity in patients with locally advanced lung cancer

315-321Lung cancer, with 12% of overall new cancer cases globally, has considerable mortality rate. Chemotherapy and radiotherapy are the most common treatment modalities apart from surgery. Both, chemo- and radio- therapies, are known to have side affects. Trace elements are reported to influence the radiotherapy related adverse effects in the body. In this context, here, we investigated whether there is a difference in serum Se, Zn and Cu levels in patients receiving chemoradiotherapy (CRT) due to lung cancer when compared to healthy individuals and to evaluate effects of serum trace element levels measured before and after therapy on CRT related toxicity. This prospective study included 50 patients received CRT due to lung cancer and 50 healthy individuals. Serum selenium (Se), zinc (Zn), and copper (Cu) levels were measured before and after radiotherapy in patients with cancer, while a single measurement was performed in controls. When serum trace element levels were compared between patients with lung cancer and healthy controls, a significant difference was found in Zn level. A significant difference was detected between serum Cu and Se levels measured before and after CRT in patients with lung cancer (P <0.001 and P =0.019). In the assessment of acute toxicity during, a significant difference was detected when Cu and Zn levels measured before and after treatment were compared. Our study indicates significant decreases in plasma Zn and Cu levels after radiotherapy, suggesting paying attention to nutritional status regarding these micronutrients and other antioxidant agents. Thus, Zn and Cu supplementation may reduce adverse effects in patients receiving CRT

Nurses’ awareness as a result of short term stoma bag life experienceStoma torbası deneyiminin hemşirelerin farkındalıkları üzerine etkisi

This is an experimental study conducted for raising awareness about being a patient with stoma in nurses working in surgical services where intestinal stoma is opened in Balcalı Hospital, Çukurova University.The stoma bag was inserted after applying “Introduction and Evaluation Form” which involved 11 questions was developed by the researcher via face-to-face interview technique with the nurses participating in the study and administering “Pre-Application Data Form” consisting after studying with stoma bag, whose 1/3 was filled with water, for 6 hours; “Post-Application Data Form” was administered.In nurses’ evaluation of first three feelings that the patients were experiencing before and after the life experience of using stoma bag for a short time; the difference between the exclusion feeling scores was found to be highly significant (z=-3.411; p=0.001). In the evaluation of the nurses for the question “will you share the information that you have stoma with your friend if you were a person with a stoma” before and after the stoma bag life experiment, the difference was determined to be statistically significant (z=-2.000; p=0.001). The difference between the evaluation scores for the patients to cope with their stomas before and after the application was observed to be highly significant (z=-4.724; p=0.000).Extended English abstract is in the end of PDF (TURKISH) file.  ÖzetAraştırma, Çukurova Üniversitesi Balcalı Hastanesi’nde bağırsak stoması açılan cerrahi servislerde çalışan hemşirelerde stomalı hastalarla ilgili farkındalık yaratmak amacıyla yarıdeneysel tipte yapılmıştır.Veriler araştırmacılar tarafından literatür taraması yapılarak hazırlanmış kişisel bilgi formu ve öntest/sontest veri formları ile yüz yüze görüşme tekniği ile toplanmış, sonrasında katılımcı hemşirelere stoma torbası takılmıştır. 1/3’üne kadar su ile doldurulan stoma torbası ile 6 saat çalıştıktan sonra tekrar anket formu uygulanmıştır.Hemşirelerin stoma torbası deneyimi öncesi ve sonrası hastaların en sık yaşadığı ilk üç duyguyu değerlendirmeleri incelendiğinde, dışlanma duygusu puan ortalamalarını diğer ortalamalara göre yüksek olduğu ve aradaki farkın istatistiksel olarak ileri derece anlamlı olduğu saptandı (z=-3.411; p=0.001). Hemşirelerin stoma torbası deneyimi öncesi ve sonrası “stomalı bir birey olsaydınız stomanız olduğunu iş arkadaşlarınız ile paylaşır mıydınız?” sorusunu değerlendirmelerinde farkın istatistiksel olarak anlamlı olduğu belirlendi (z=-2.000; p=0.001).Uygulama öncesi ve sonrası hastaların stomaları ile baş etmelerini değerlendirme puanortalamaları  arasındaki farkın ileri derecece anlamlı olduğu görüldü (z=-4.724; p=0.000)

Metachronous Bilateral Adenoid Cystic Carcinoma of the Lacrimal Gland

Background: To report an aggressive and treatment-resistant adenoid cystic carcinoma (ACC) of the lacrimal gland (LG).Case report: A 29-year-old woman with diagnosis of LG-ACC had operations 7 times, radiotherapy 3 times and systemic chemotherapy 2 times. Although she generally responded therapies, the duration of remissions was short lived and the tumor progressed locally and did hematogen metastases.Conclusion: LG-ACC presents a therapeutic challenge despite its slow growth rate and lower likelihood of lymph-node metastasis. Postoperative radiotherapy with wide margins should be utilized —even after a complete resection— because of persistent recurrences, perineural invasion and hematogenous spread.

A Primary Leiomyosarcoma of the Thyroid Gland: A Case and Literature Review

Introduction: We want to present a rare case of Primary leiomyosarcoma of the thyroid (PLT) gland and review the literature on PLT including the differential diagnoses, pathology, and alternative treatment strategies.Presentation of Case: A 56-year-old man who underwent left side total thyroidectomy with diagnosis of substernal goiter. On pathologic examination, three different pathology clinics had a common opinion that this was a grade 3 pleomorphic sarcoma of thyroid itself. Positron Emission Tomography (PET/CT) obtained one month after surgery displayed no distant metastases. Loco regional radiotherapy (RT) to the thyroid bed was delivered up to a dose of 59.4 Gray (Gy) in 1.8 Gy daily fractions. PET/CT obtained three months after RT showed bilateral multiple lung metastases without loco regional recurrence. The patient received 6 courses of doxorubicin and cyclophosphamide based chemotherapy. A new PET/CT scan showed only two metabolically active metastases on both lungs. Because of disappearance of small metastases, the patient underwent sequential bilateral metastasectomy in one month interval. Pathology results verified the metastases of PLT. The patient is still alive without any signs of disease 6 years after RT and he is the only long surviving case reported up to now.Conclusion: The treatment protocols for PLT have not been well established yet, because of their rareness and poor prognosis. We believe that our case may be directive for PLT treatment

Discovery of a small molecule that selectively destabilizes Cryptochrome 1 and enhances life span in p53 knockout mice

Cryptochromes are negative transcriptional regulators of the circadian clock in mammals. It is not clear how reducing the level of endogenous CRY1 in mammals will affect circadian rhythm and the relation of such a decrease with apoptosis. Here, we discovered a molecule (M47) that destabilizes Cryptochrome 1 (CRY1) both in vitro and in vivo. The M47 selectively enhanced the degradation rate of CRY1 by increasing its ubiquitination and resulted in increasing the circadian period length of U2OS Bmal1-dLuc cells. In addition, subcellular fractionation studies from mice liver indicated that M47 increased degradation of the CRY1 in the nucleus. Furthermore, M47-mediated CRY1 reduction enhanced oxaliplatin-induced apoptosis in Ras-transformed p53 null fibroblast cells. Systemic repetitive administration of M47 increased the median lifespan of p53−/− mice by ~25%. Collectively our data suggest that M47 is a promising molecule to treat forms of cancer depending on the p53 mutation

The Effects of Royal Jelly Against Radiation-Induced Acute Oral Mucositis.

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