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Introduction: Sulfiredoxin (Srx), which is an endogenous antioxidant substance which could, regulate the signaling pathways of reactive oxygen species. Nuclear factor erythroid 2-related factor 2 (Nrf2) is Cap-N-collar (CNC) transcription factors family member that have essential roles in regulation of antioxidant response. The transcription factor PROX1 is a transcription factor and a key regulatory protein in cancer development. Aim of the study: To analyze levels of tissue expression of Srx, Nrf2, and PROX1 in gastric cancer and adjacent non-neoplastic gastric mucosa to clarify the relationship between their expression levels, clinical, pathological parameters and patients' outcome. The results might lead to discovering novel targeted therapies to gastric cancers. Material and methods: We included 70 paraffin-embedded samples: 50 specimens from gastric carcinomas and 20 specimens from adjacent non-neoplastic gastric mucosa. All samples are stained with Srx, Nrf2, and PROX1 using immunohistochemistry, correlated their expression with clinicopathological and prognostic parameters of patients. Results: High levels of Srx and Nrf2 expression were positively associated with higher cancer grade (p = 0.006, 0.031 respectively), advanced stage (p < 0.001, 0.02 respectively), higher incidence of distant metastases (p = 0.029, 0.03 respectively) and dismal outcome (p < 0.001). High levels of PROX1 expression were associated with lower cancer grade (p = 0.005), absence of lymph nodes metastases (p = 0.023), early stage (p = 0.003), absence of relapse (p = 0.004), and favorable outcome (p < 0.001). Conclusions: Srx and Nrf2 expression increase gastric cancer invasiveness, suggesting their utility as poor prognostic markers, but PROX1 serves as a favorable prognostic marker of gastric cancer patients.

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Background: Radiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The aim of the study: To evaluate the dose received by the left anterior descending coronary artery (LAD), correlate it with cardiac dose & acute cardiac toxicity in relation to the dose received by LAD within first 2 months following RT to left sided breast cancer. Patients and Methods: This prospective study included 26 left-sided breast cancer patients who operated with breast conservative surgery and all of them had to have the inclusion criteria. Patients evaluated pretreatment by medical history, complete physical examination &Cardiologic consultation., Laboratory evaluation: Complete blood count , Liver, kidney functions tests and serum CA 15-3. Radiological evaluation: Chest x-ray,Pelvi-abdominal ultrasound. Bone scan., Evaluation of cardiac status e.g. ECG, ECHO. Treatment protocol: Patients were simulated using a CT-planning system, target volumes and organ at risk were contoured .The detailed dosimetry of target volumes and organ at risk were obtained and analyzed.Treatment evaluation and follow-up:Patients were evaluated weekly during treatment for cardiac, hematological, skin, lung toxicities and after completing RT by 2,6 months,and 0ne year according to WHO grading system.Results: The mean age was 47.80 ± 10.17., 42.3% of patients were premenopausal ,while postmenopausal women represented 38.5%, The perimenopausal women were represented by 19.2%. A significant direct correlation was found between mean LAD dose and mean heart dose with Regression line equation: Mean LAD Dose (cGy) = 4.24 x Mean Heart Dose (cGy).and we couldn't identify acute heart toxicity.Mean LAD dose was 15.8 Gy.Mean heart dose was 3.5 Gy and median V25 was 2.7%., for every 1 Gy increase in mean heart dose, mean LAD dose increased by 4.24 Gy. For every percent increase in the heart V10 and V25, there was a 2.24 Gy and 3.74 Gy increase in mean LAD dose, respectively. For every percent increase in the heart V40 a 5.06 Gy increase in mean LAD dose was noted and for every percent increase in heart V25 a 5.16% increase in the LAD V20 was demonstrated. There was no significant association between central lung distance(CLD) ,minimal, and mean LAD dose while there is a direct correlation between CLD and Max LAD dose. There was no significant association between heart volume,mean and max., LAD dose while there is a direct correlation between heart volume and mean LAD dose.Conclusion: Clear excellent correlation between the dose to the heart and LAD artery was discovered., So, LAD artery does not need to be contoured separately when standard tangential borders are used.

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