Our findings suggest an association between BDNF and stimulation induced swallowing recovery. Further work will be required to validate these observations and demonstrate clinical utility in patients.

Purpose: To compare the outcome among patients with invasive bladder cancer treated with cystectomy alone with outcome among those treated with combined-modality treatment in a randomised phase III trial.Patients and methods: Patients with histologically confirmed invasive non-metastatic bladder cancer T2-3, N0 and M0 were randomly assigned to two arms: Arm 1: of which all patients underwent radical cystectomy (RC) alone; and Arm 2, of which all patients were subjected to maximal transurethral resection of bladder tumour, followed 2 weeks later by combined chemoradiotherapy. The whole pelvis received 46 Gy in 23 fractions over 4?5 weeks. Chemotherapy was administered concomitantly with radiotherapy with: cisplatin 70 mg/m 2 q. 3 weeks and Gemcitabine 300 mg/m 2 D 1, 8 and 15 q. 3 weeks for two cycles. Patients who had complete response were shifted to phase II treatment: 20 Gy/10 fractions/2 weeks to the bladder. Patients with residual tumour underwent RC.Results: Of the 80 patients assigned Arm 2, a visibly completed transurethral resection of the bladder tumour was possible in 48 patients (60%). Phase I of combined chemoradiotherapy (CCRT) was accomplished in 74 patients. Post-induction urologic evaluation revealed no evidence of disease in 62 patients (83?8%) and residual disease in 12 patients (16?2%). Phase II of CCRT was completed in 58 of the 62 patients. The median follow-up for all patients is 27 months (range: 4-49). The 3-year overall survival (OS) for the combined-modality group and for the surgery group were 61 and 63%, respectively (p 5 0?425), whereas the disease-specific survival (DSS) for each group was 69 and 73%, respectively (p 5 0?714). The 3-year OS with bladder preservation for Arm 2 patients was 50%. Multivariate analysis for the whole series showed that tumour stage and performance status (PS) were the only factors independently associated with DSS, although PS was the only factor independently associated with OS. In addition, residual disease after transurethral resection of the bladder tumour in Arm 2 patients was independently associated with both DSS and OS. Acute toxicity was moderate and most of the late toxicities were grade 2 with no grade 4 toxicity and no treatment-related deaths, none required cystectomy for bladder contraction. 428Conclusion: This study demonstrates that trimodality bladder-preserving approach represents a valid alternative for suitable patients. The OS and DSS rates of patients treated with trimodality bladder-preserving protocol are comparable to the results reported on patients treated with immediate radical cystectomy.

BackgroundThe Child-Turcotte-Pugh score (CTP) is the standard tool for hepatic reserve assessment in hepatocellular carcinoma (HCC). Recently, we reported that integrating plasma insulin-like growth factor-1 (IGF-1) level into the CTP score was associated with better patient risk stratification in two U.S. independent cohorts. Our current study aimed to validate the IGF-CTP score in patients who have different demographics and risk factors.Patients and MethodsWe prospectively recruited 100 Egyptian patients and calculated their IGF-CTP score compared to CTP score. C-index was used to compare the prognostic significance of the two scoring systems. Finally, we compared our results with our U.S. cohorts published data.ResultsIGF-CTP score showed significant better patient stratification compared to CTP score in the international validation cohort. Among CTP class A patients, who usually considered for active treatment and clinical trial enrollment, 32.5% were reclassified as IGF-CTP class B with significantly shorter OS than patients reclassified as class A with hazard ratio [HR] = 6.15, 95% confidence interval [CI] = 2.18-17.37.ConclusionIGF-CTP score showed significantly better patient stratification and survival prediction not only in the U.S. population but also in international validation population, who had different demographics and HCC risk factors.

Purpose. The purpose of this prospective pilot study was to determine the efficacy of preoperative chemotherapy with six cycles of FOLFOX 6 (without radiation therapy) followed by radical surgery followed by six additional cycles of FOLFOX 6 for patients with stage II/III rectal cancer. Patients and Methods. From January 2010 to January 2014, patients with locally advanced rectal cancer who met the eligibility criteria were enrolled in this study. Patients received FOLFOX 6 chemotherapy comprising oxaliplatin and leucovorin calcium i.v. over 2 hours on day 1, then bolus, and then continuous fluorouracil i.v. over 46 hours on days 1 and 2. Treatment was repeated every 14 days for 6 courses followed by radical surgery followed by additional 6 cycles of FOLFOX 6. Results. In total, 45 patients were enrolled in this study. In the preoperative re-evaluation, the overall response rate was 68.8% (clinical complete response was 4.4%, and the partial response was 64.4%). There were 14 cases (31.2%) of stable disease. No patients had progressive disease. Postoperatively, the pathologic complete response rate was 8 of 45 (17.8%; 95% confidence interval [CI]: 8.9%-28.9%). The median follow-up was 29 months (range 9-54 months). The actuarial 3-year overall survival and disease-free survival rates for all patients were 80.8% (standard error, 1.877; 95% CI: 69.3%-92.3%) and 67.9% (standard error, 2.319; 95% CI: 54.3%-81.5%), respectively. Conclusion. Neoadjuvant chemotherapy (FOLFOX) without radiotherapy is active and safe but cannot be considered a standard of care until the results of prospective randomized phase III trials are available. The Oncologist 2015; 20:752-757 Implications for Practice: Neoadjuvant radiotherapy of rectal cancer represents the current standard of care. However, its use is also associated with short-term toxicity and long-term morbidity.With the increasing use of total mesorectal resection resulting in better local control and advances in systemic therapy for colorectal cancer, this study highlights the question of whether radiation is a necessary component of neoadjuvant therapy for all patients with rectal cancer or whether select patients could be spared the additional toxicities and inconvenience of radiotherapy. This study suggests that neoadjuvant FOLFOX without radiotherapy is active and safe, but it could not be considered a standard of care till now.

Purpose: To update long-term results with selective organ preservation in invasive bladder cancer using aggressive transurethral resection of bladder tumor (TURBT) and radiochemotherapy (RCT) and to identify prognostic and predictive value of the biomarkers ;p53, pRB, BCL2 and EGFR. Patients and Methods: Between 2000 and 2006, a total of 55 patients with T2-T3 bladder cancer were enrolled in 2 sequential bladder-sparing protocols including aggressive TURB and RCT. From September 2000 to May 2003, 25 patients (in protocol no. 1) were treated by TURBT followed by radiotherapy 46 Gy with concurrent cisplatin 20 mg/m² day1-5, followed for complete and partial responders by radiotherapy 20 Gy with concurrent cisplatin (same dose) on the last five days. From December 2004 to April 2006, thirty patients were entered in protocol no. 2 that consisted of radiotherapy 60 Gy with concurrent Cisplatin 75 mg/ m2 q. 3 ws and Gemcitabine 300 mg / m2 D 1, 8 and 15 q. 3 ws for 2 cycles. In case of invasive residual tumor or recurrence, salvage cystectomy was recommended. All specimens were examined for expression of the biomarkers (p53, bcl2, Rb and EGFR) using immunohistochemical staining. results: The median follow-up for all patients is 30 months (range 4-84), 38 months (range 9-84) for patients in P1 and 22 months (4-54) for patients in P2. The actuarial 5-year OS were 58 % (SE 5), 52% (SE 7) and 61% (SE 6),for the whole series, P1 and P2 protocols respectively, (P =0.270). The corresponding figures for cancer specific survival (CSS) were 60%, 55% (SE 7) and 63% (SE 4), (P = 0.452). The 5-year actuarial OSB for all series, P1 and P2 protocols were 51% (SE 6), 46% (SE 7) and 55% (SE 9), respectively, (P = 0.323). For all patients, altered expression of p53, bcl2, pRb and EGFR were detected in (47.3%, 56.4%, 52.7% and 40% respectively The results of UVA showed that tumor stage and altered expression of pRB, BCL2 and EGFR were significantly associated with CSS and OS (P<0.05). There were no grade 4 toxicity and no treatmentrelated deaths. conclusion: Trimodality therapy to preserve the bladder is a therapeutic option that results in a high rate of long-term survivors retaining functional bladders in carefully selected patients. Patients with higher tumour stage and altered biomarkers; pRB, BCL2 and EGFR might not be candidate for bladder preserving approach.