Background and objective Paclitaxel and doxorubicin are associated with neurotoxicity and cardiotoxicity respectively. This study aimed at investigating the role of alpha-lipoic acid (ALA) in counteracting paclitaxel-induced neuropathy and doxorubicin-associated cardiotoxicity in women with breast cancer. Patients and methods This randomized double-blind placebo-controlled prospective study included 64 patients with breast cancer who were randomized into control group (n = 32) which received 4 cycles of doxorubicin plus cyclophosphamide (every 21 days) followed by weekly doses of paclitaxel for 12 weeks plus placebo tablets once daily and ALA group (n = 32) which received the same chemotherapeutic regimen plus ALA 600 once daily for 6 months. Patients were assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE version 4.0) for grading of neuropathy and by 12-item neurotoxicity questionnaire (Ntx-12). The assessment included also echocardiography and evaluation of serum levels of brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), and neurotensin (NT). Data were analyzed by paired and unpaired t-test, Mann–Whitney U test, and chi-square test. Results As compared to placebo, ALA provoked significant improvement in NCI-CTCAE neuropathy grading and Ntx-12 score after the end of 9th and 12th weeks of paclitaxel intake (p = 0.039, p = 0.039, p = 0.03, p = 0.004, respectively). At the end of the chemotherapy cycles, ALA resulted in significant decline in serum levels of BNP, TNF-α, MDA, and neurotensin (p < 0.05) as compared to baseline data and placebo. Conclusion Alpha-lipoic acid may represent a promising adjuvant therapy to attenuate paclitaxel-associated neuropathy and doxorubicin-induced cardiotoxicity in women with breast cancer. Trial registration ClinicalTrials.gov: NCT03908528.

Hypoxia is a prevalent hallmark of many malignant neoplasms. The aim was to assess the serum hypoxia biomarkers HIF-1α, VEGF, osteopontin, erythropoietin, caveolin-1, GLUT-1, and LDH pre- and post-radiotherapy in patients with brain tumors. The study was conducted on 120 subjects were divided into two groups: group I: 40 healthy volunteers as control group. Group II: 80 brain tumor patients were subdivided into glioblastoma subgroup: 40 glioblastoma patients, meningioma subgroup: 40 malignant meningioma patients. Two venous blood samples were collected from every patient prior to and following RT and one sample from controls. Biomarkers were assayed by ELISA. In glioblastoma subgroup, HIF-1α, VEGF, and LDH were significantly increased after RT. On the contrary, these biomarkers were significantly decreased after RT in malignant meningioma subgroup. Osteopontin was significantly increased after RT in both subgroups. Regarding erythropoietin, it was significantly decreased in both subgroups when compared to before RT. Caveolin-1 showed a significant increase in glioblastoma subgroup after RT comparing to before RT. GLUT-1 was significantly increased after RT in both subgroups comparing to before RT. Association of significant elevation of hypoxia biomarkers either pre- or post-RT with aggressive tumor such as glioblastoma indicates that, they are markers of malignancy and may have a role in tumor development and progression.

Purpose: The present study is aiming to correlate between different radiotherapy techniques, fractionations and doses received by each axillary LN level and axillary vessels with the development of breast cancer related lymphedema (BCRL). Methods and materials: We retrospectively studied 181 female breast cancer patients who were diagnosed and treated by radiation therapy during the period from January 2012- December 2017. The radiotherapy treatment plans were recalled from the archives. The axillary LN levels I, II, III, supraclavicular LN were contoured as well as axillary vessels. New dose volume histograms (DVHs) were generated to correlate between the radiotherapy dose t and the development of BCRL. Results: The study included 162 patients treated with 3D radiotherapy technique and 19 treated with 2D technique radiotherapy. 124 patients underwent MRM while 57 patients underwent BCS. 117 patients treated with hypofractionated technique while 64 patients treated with conventional radiotherapy technique . The cumulative incidence of BCRL after radiotherapy was 20.4%. There was a statistically significant relation between 2D radiotherapy technique compared with 3DCRT and development of lymphedema 55% vs 16.6% respectively(p<0.001). Patients who were treated with conventional radiotherapy had significantly higher rates of lymphedema (42.2%) compared with hypofractionated radiotherapy (8.5%) (p<0.001). There was non-significant relation between mean radiotherapy dose to axillary levels or the axillary vessels and development of lymphedema. Conclusion Breast cancer radiotherapy with 2D technique and conventional fractionation protocol might increase the risk of BCRL. No correlation was observed between radiotherapy dose to each axillary LN level, axillary vessels and BCRL.

Background: Whole brain radiotherapy is the treatment of choice for patients with brain metastases. However, neurocognitive functions decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT might provide meaningful neurocognitive functions preservation. Our study aims to demonstrate the impact of delivering HA‑WBRT on NCF changes in patients receiving WBRT. Methods: fifty patients who were referred for cranial irradiation were enrolled in the study. Before the HA‑WBRT course and randomly assigned to two equal groups, the first group will receive conventional whole brain palliative radiotherapy and the second group will receive hippocampal sparing whole brain radiotherapy, assigned to 30 Gy over 10 fractions over two weeks, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed,the primary endpoint was delayed recall, as determined by the change/decline in Hopkins Verbal Learning Test (HVLT-R) and The One Card Learning Test (OCLT) from the baseline assessment to 4 months after the start of HA‑WBRT. Results: Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post‑radiotherapy intervals, in immediate verbal memory and non‑verbal memory, except for delayed recall memory on HVLT-R Hopkins Verbal Learning Test -Revised for delayed recall Learning, p =0.008. Conclusions: Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA‑WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control.

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