11 research outputs found
Epigenetic markers for early detection of nasopharyngeal carcinoma in a high risk population
<p>Abstract</p> <p>Background</p> <p>Undifferentiated nasopharyngeal carcinoma (NPC) is strongly related to Epstein-Barr virus (EBV) infection, allowing aberrant antibodies against EBV and viral DNA load as screening tools in high risk populations. Methylation analysis in the promoter of tumor suppressor genes (TSGs) may serve as a complementary marker for identifying early cases. This study determined methylation status of multiple TSGs and evaluated whether it may improve early detection.</p> <p>Methods</p> <p>Nasopharyngeal brushings were taken from 53 NPC patients, 22 high risk subjects and 25 healthy EBV carriers. Corresponding NPC paraffin tissue was included. DNA was bisulfite-modified preceding analysis by methylation-specific PCR (MSP). Ten TSGs were studied.</p> <p>Results</p> <p>NPC paraffin and brushing DNA revealed an 81.8% concordance so that MSP analysis was done using either one of both specimens. NPC samples showed methylation for individual TSGs (DAPK1 79.2%, CDH13 77.4%, DLC1 76.9%, RASSF1A 75.5%, CADM1 69.8%, p16 66.0%, WIF1 61.2%, CHFR 58.5%, RIZ1 56.6% and RASSF2A 29.2%). High risk individuals, having elevated EBV IgA and viral load, showed high frequency of methylation of CDH13, DAPK1, DLC1 and CADM1, but low frequency of methylation of p16 and WIF1 and undetectable methylation of RASSF1A, CHFR, RIZ1 and RASSF2A. Healthy subjects showed similar patterns as high risk individuals. A combination of RASSF1A and p16 gave good discrimination between NPC and non-NPC, but best results were combined analysis of five methylation markers (RASSF1A, p16, WIF1, CHFR and RIZ1) with detection rate of 98%.</p> <p>Conclusion</p> <p>Multiple marker MSP is proposed as a complementary test for NPC risk assessment in combination with EBV-based markers.</p
Effectiveness of a multicentre nasopharyngeal carcinoma awareness programme in Indonesia
Objective: To evaluate the effectiveness of a
nasopharyngeal carcinoma (NPC) awareness
programme on the short-term and long-term
improvement of knowledge and referral of patients with
NPC by primary healthcare centres (PHCCs) staff in
Indonesia.
Design: The NPC awareness programme consisted of
12 symposia including a Train-The-Trainer component,
containing lectures about early symptoms and risk
factors of NPC, practical examination and the referral
system for NPC suspects. Before and after training
participants completed a questionnaire. The Indonesian
Doctors Association accredited all activities.
Participants: 1 representative general practitioner
(GP) from each PHCC attended an NPC awareness
symposium. On the basis of the Train-The-Trainer
principle, GPs received training material and were
obligated to train their colleagues in the PHCC.
Results: 703 GPs attended the symposia and trained
1349 staff members: 314 other GPs, 685 nurses and
350 midwives. After the training, respondents’ average
score regarding the knowledge of NPC symptoms
increased from 47 points (of the 100) to 74 points
(p<0.001); this increase was similar between
symposium and Train-The-Trainer component
(p=0.88). At 1½ years after the training, this
knowledge remained significantly increased at 59
points (p<0.001).
Conclusions: The initial results of this NPC
awareness programme indicate that the programme
effectively increases NPC knowledge in the short and
long term and therefore should be continued. Effects
of the improved knowledge on the stage at diagnoses
of the patients with NPC will still need to be
scrutinised. This awareness programme can serve as a
blueprint for other cancer types in Indonesia and for
other developing countries
A prospective study: current problems in radiotherapy for nasopharyngeal carcinoma in yogyakarta, indonesia
Nasopharyngeal carcinoma (NPC) has a high incidence in Indonesia. Previous study in Yogyakarta revealed a complete response of 29% and a median overall survival of less than 2 years. These poor treatment outcome are influenced by the long diagnose-to-treatment interval to radiotherapy (DTI) and the extended overall treatment time of radiotherapy (OTT). This study reveals insight why the OTT and DTI are prolonged. All patients treated with curative intent radiotherapy for NPC between July 2011 until October 2012 were included. During radiotherapy a daily diary was kept, containing information on DTI, missed radiotherapy days, the reason for missing and length of OTT. Sixty-eight patients were included. The median DTI was 106 days (95% CI: 98-170). Fifty-nine patients (87%) finished the treatment. The median OTT for radiotherapy was 57 days (95% CI: 57-65). The main reason for missing days was an inoperative radiotherapy machine (36%). Other reasons were patient's poor condition (21%), public holidays (14%), adjustment of the radiation field (7%), power blackout (3%), inoperative treatment planning system (2%) and patient related reasons (9%). Patient's insurance type was correlated to DTI in disadvantage for poor people. Yogyakarta has a lack of sufficient radiotherapy units which causes a delay of 3-4 months, besides the OTT is extended by 10-12 days. This influences treatment outcome to a great extend. The best solution would be creating sufficient radiotherapy units and better management in health care for poor patients. The growing economy in Indonesia will expectantly in time enable these solutions, but in the meantime solutions are needed. Solutions can consist of radiation outside office hours, better maintenance of the facilities and more effort from patient, doctor and nurse to finish treatment in time. These results are valuable when improving cancer care in low and middle income countrie
Overall treatment time and missed days.
<p>OTT =  overall treatment time, IQR =  inter quartile range, CI =  confidence interval.</p
Distribution of overall treatment time and insurance type.
<p>The dark line in the middle of the boxes is the median. The bottom and top of the boxes indicate the 25th and the 75th percentile. The T-bars are the inner fences of all subjects and extend to a maximum of 1.5 times the inter quartile range. * are outliers until 3 times the inter quartile range. <sup>0</sup> are outliers exceeding 3 times the quartile range.</p