Background:Adaptive radiotherapy is being used in few institutions in patients with head and neck cancer having bulky disease using periodic computed tomography imaging accounting for volumetric changes in tumor volume and/or weight loss. Limited data are available on ART in the postoperative setting. We aim to identify parameters that would predict the need for ART in patients with head and neck cancer and whether ART should be applied in postoperative setting.Materials and Methods:Twenty patients with stage III–IV head and neck cancer were prospectively accrued. A computed tomography simulation was done prior to treatment and repeated at weeks 3 and 6 of concurrent intensity-modulated radiotherapy and chemotherapy. The final plan was coregistered with the subsequent computed tomography images, and dosimetric/volumetric changes at weeks 1 (baseline), 3, and 6 were quantified in high-risk clinical target volumes, low-risk clinical target volumes , right parotid , left parotid , and spinal cord . An event to trigger ART was defined as spinal cord maximum dose >45 Gy, parotid mean dose >26 Gy, and clinical target volume coverage <95%.Results:Comparing the 2 groups, the proportion of patients with at least 1 event triggering ART was higher in bulky disease than in postoperative group: 72.7% versus 18.2% (P = .03) overall; 54.6% versus 1.8% (P = .064) at week 3; and 63.6% versus 18.2% (P = .081) at week 6. In the bulky disease group, 8 of 11 patients had events at week 3 and/or 6 as follows: overdose in spinal cord (n = 2), right parotid (n = 3), left parotid (n = 5), coverage < 95% seen in low-risk clinical target volumes (n = 3), and high-risk clinical target volumes (n = 5). In the postoperative group, 2 of 11 patients had events: spinal cord (n = 1) and low-risk clinical target volume (n = 1).Conclusion:Our study confirmed the need for ART in patients with head and neck cancer having bulky disease due to target under dosing and/or spinal cord/parotids overdosing in weeks 3 and 6. In contrast, the benefit of ART in postoperative patients is less clear.

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Background: P53 antibodies (p53 Abs) have been detected in the serum of a proportion of colorectal cancer (CRC) patients. The development of these antibodies is associated with the presence of mutant oncoprotein p53. However, it is not yet known at which stage during CRC progression p53Abs appear in serum. Aim of the Work: To identify the prevalence of p53 Abs in CRC and their association with clinicopathological features of the tumor. Patients and Methods: The study included 30 CRC patients (16 males and 14 females) their age ranged between 20-73 years. All patients were subjected to full clinical examination and laboratory studies including tumor markers (CEA, CA 19.9). Colonoscopy was done for pathological grading and staging of the tumor according to TNM and Dukes' staging system. P53 antibodies in patients' sera were detected using ELISA technique. Results: We found that 16.6 % of our CRC patients had positive anti-p53 Abs. No association was observed between the presence of these Abs and clinicopathological features including age, tumor location, tumor size, T-stage, Dukes' staging or even distant metastasis. A statistically significant association was found between the presence of p53 Abs and lymph node status (p < 0.001) and with histological grading (p=0.031). Conclusion: The presence of p53 Abs in sera of patients with CRC indicates a more advanced tumor histopathological stage and could be utilized as a complementary prognostic tool to colonoscopy in high risk patients.

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