Lung cancer is the most common cancer worldwide and is the fourth leading cause of death in South Africa. Lung cancer is categorised into two types; non-small cell lung cancer and small cell lung cancer (SCLC). SCLC constitutes 20% of all lung cancers and is considered to be an aggressive tumour as it gains chemo-resistance and exhibits early metastasis in diagnosed patients. SCLC cells originate from the neuroendocrine cells of the bronchoepithelium and are known to secrete the neuropeptide, proopiomelanocortin (POMC). POMC undergoes proteolytic cleavage to produce the adrenocorticotropin hormone (ACTH). ACTH stimulates the production of the steroid hormone, glucocorticoid hormone (GC), through the hypothalamus-pituitary-adrenal (HPA) axis. The produced GCs mediate a negative feedback system of the HPA axis to sequester ACTH production. SCLC cells are insensitive to this negative feedback stimulus. GCs elicit their actions through the glucocorticoid receptor (GR). Studies have shown that SCLC cells have a reduced expression of GR which perpetuates the GC-insensitivity. Importantly, over-expression of exogenous GR in SCLC cells leads to cell death by apoptosis. It was postulated that SCLC cells select against GR expression for longevity. Cancer cells are known to alter/silence the expression of tumour suppressor genes by a mechanism known as methylation. Methylation occurs when the enzyme, DNA methyltransferase 1, adds a methyl group to a cytosine present in a guanine-cytosine rich region of the gene (CpG island). The GR gene has a 5’-untranslated exon 1 region that consists of eight promoter regions (1A-1J), in these promoter regions are many CpG islands that have the potential to be methylated. The first aim of this study was to determine the promoter/s utilised by SCLC cells to express the GR protein. Conventional PCR revealed that all three cell lines predominantly utilise promoters 1B and 1C for GR expression. Bioinformatic analysis revealed that these promoters contain putative CpG islands and new data suggests that the GR is silenced by methylation and that treatment with a de-methylating agent results in GR re-expression. To determine which promoter is responsible for GR re-expression after de-methylation, the SCLC cell line, DMS79, as well as two control cell lines, A549 and HEK cells, were treated with the de-methylating agent, 5-aza-2’-deoxycytidine, for 72 hours. qPCR analyses revealed that all three cell lines expressed promoters 1B and 1C with A549 cells showing no evidence of methylation. The HEK cells showed methylation in promoter 1C and not promoter 1B. The SCLC cells showed methylation in both promoter 1B and 1C, however, only promoter 1B showed a significantincrease in transcript levels. SCLC cells are induced to undergo GC-mediated apoptosis when GR expression is restored however the mechanism utilised by the GR to induce the apoptotic cascade is unknown. The GR structure is divided into three domains; ligand binding domain (LBD), DNA binding domain (DBD) and amino terminal domain (NTD). The second aim of this study was to determine the component of the GR that induces apoptosis of SCLC cells. HEK and SCLC cells were infected with empty virus and various GR construct viruses; containing either a wild-type GR, ligand binding mutant, DNA binding mutant or a transactivation mutant (NTD); for 72 hours. Both cell lines were quantified for apoptosis and cell death using microscopic analyses. In HEK cells, it was shown that apoptosis occurred in cells expressing the wild-type GR, the DNA binding mutant and transactivation mutant constructs but apoptosis was reduced in cells expressing the ligand binding viruses. This indicates that the LBD may be necessary for inducing apoptosis in HEK cells. In DMS79 cells, apoptosis occurred in cells expressing the wild-type GR, ligand binding mutant and the DNA binding mutant constructs. There was less apoptotic activity exhibited in the transactivation constructs which indicates the NTD may be necessary for apoptosis induction in these cells. The NTD of the GR is responsible for interaction with other transcription factors to mediate GR transcriptional activity and this study has shown that the transactivation domain plays a necessary role in apoptosis induction. An analysis of the various pathways the GR interacts with through the NTD domain could lead to the identification of the pathway which triggers apoptosis in SCLC cells. This discovery, together with knowledge of promoter methylation and expression may contribute to the development of new, more effective therapies for SCLC. / Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2013.

Lung cancer is the leading cause of cancer-related deaths among men and women. Non-Small Cell Lung Cancer (NSCLC) constitutes the most common type of lung cancer and is frequently diagnosed at advanced stages. In the past decade, discovery of Epidermal Growth Factor Receptor (EGFR) mutations have heralded a new paradigm of personalized treatment for NSCLC. Clinical studies have shown that molecular targeted therapies increase survival and improve quality of life in patients. Despite these advances, the realization of personalized therapies for NSCLC faces a number of challenges including the integration of clinical and genetic data and a lack of clinical decision support tools to assist physicians with patient selection. This thesis demonstrates the development of a predictive computational model for personalized therapeutic interventions in advanced NSCLC. The findings suggest that the combination of clinical and genetic data significantly improves the model’s predictive performance for tumor response than clinical data alone.

In a case-control study comprising 589 cases of male lung cancer in northern Sweden longitudinal data concerning occupations, employments and smoking habits were collected by questionnaires. Pipe smoking was as common as cigarette smoking and gave very similar relative risk. The pipe smoking cases, however, had significantly higher mean age and mean smoking years at the time of diagnosis than the cigarette smoking cases. In ex- smokers, the relative risk gradually decreased from 5 years after smoking cessation but this decrease was much less pronounced in ex-pipe smokers than in ex-cigarette smokers. High relative risks were obtained for small cell and squamous cell carcinomas. For adenocarcinoma the relative risk was considerably lower but still significantly increased. The population etiologic fraction attributable to smoking was about 80% in this series. Some occupational groups (underground miners, copper smelter workers, electricians and plumbers) exposed to previously known lung carcinogenic agents had considerably increased odds ratios, which persisted after adjustment for smoking. A slightly elevated odds ratio was observed in a group of blue collar workers potentially exposed to lung carcinogenic agents but this elevation generally disappeared after adjustment for smoking. For two specific subgroups, asphalt and concrete workers and pulp workers, the overrisk persisted after adjustment for smoking. Farmers and foresters had strikingly low odds ratios, which could only partly be explained by their more moderate smoking habits. The population etiologic fraction attributable to occupation was in the reported material assessed to 9 per cent. Professional drivers had higher average tobacco consumption than non-drivers, which explained the slightly increased crude odds ratio found for the occupational group as a whole. Smoking drivers in an upper age group (70 and over), however, had a high relative risk of lung cancer, while in a lower age group (under 70) no significant increase was found. The results in the older age group suggested a multiplicative effect between smoking and the occupational exposure. The study clearly verified the increased lung cancer risk in underground miners. An obvious dose-response relation was found with high risk after long time exposure. All analyses concerning underground miners suggested an interaction of a multiplicative type between underground mining and smoking in the causation of lung cancer. The cases of small cell carcinoma among the underground miners had shorter average latency time and in contrast to the other part of the material, shorter average age than the cases with epidermoid cancer. / <p>S. 1-40: sammanfattning, s. 41-136: 6 uppsatser</p> / digitalisering@umu

Multidrug resistance (MDR) in small cell lung cancer is one of the major causes of failures of chemotherapy. MDR is a means of protection of tumor cells against chemotherapeutic drugs. Although the molecular basis of MDR is not fully understood, genes involved in apoptosis may be mutated. Recent finding of a link between over-expression of an apoptotic gene, cyclooxygenase 1 (cox 1), and MDR suggests that cox 1 is involved in the development of MDR phenotype. This research was an attempt to observe whether up-regulation of cox 1 contributes to the MDR phenotype in small cell lung cancer cells. This research ultimately may provide a mechanism to reverse the abberant up-regulation of apoptosis genes associated with multidrug resistance to either eliminate or control reproduction of cancer cells. Real time RT PCR was used to confirm the up-regulation of cox 1 in cultured MDR resistant small cell lung cancer cells (GLC4). The up-regulated cox 1 expression was down-regulated using RNA interference technology (RNAi) by transfection with an anti-cox 1 siRNA. More than 90% transfection of cells was confirmed using confocal microscopy. Down-regulation of cox 1 was validated as the protein expression significantly decreased (P=0.004) from multidrug resistant small cell lung cancer transfected cells compared to multidrug resistant nontransfected cells. There was decrease level of expression of cox 1 in multidrug resistant cells after the knockdown with siRNA specific to cox 1. The decreased level of cox 1 expression and, therefore, Cox 1 production increased the rate of apoptosis in small cell lung cancer cells as indicated by its sensitivity to the doxorubicin. / Department of Biology

The gene, cox-1, is over-expressed in cultured GLC4 small cell lung cancer cells concurrent with the development of multi-drug resistance (MDR) as a result of the use of the chemotherapeutic agent used to combat the cancer, doxorubicin. Prevention of MDR has been a tremendous challenge in cancer research and this research is concerned with abolishment of MDR as a cancer survival strategy. RNA-mediated interference technology (RNAi) was employed using siRNA to decrease cox-1 expression and temporarily restore the susceptibility of the cells to doxorubicin. GLC4 cells are of three types: S (sensitive cells never exposed to doxorubicin); ADR (MDR cells cultured in doxorubicin), and; REV (revertant cells previously cultured in presence of doxorubicin but no longer). REV and ADR cells were transfected with cox-1 siRNA. After 24 h, 1x106cells were used for RNA isolation and 1 μg of RNA was used for RT-PCR to assess down-regulation of cox-1 RNA. RT-PCR results indicated that cox-1 RNA was down-regulated to basal levels seen before exposure to doxorubicin. Ct values for GLC4/ADR and cox-1 down-regulated GLC4/ADR cells were 23 and 34, respectively. The result indicated abundant levels and moderate levels of cox-1 mRNA in the ADR cells and the transfected ADR cells respectively. The relative expression level of cox-1 mRNA was 33% higher in the non-transfected GLCR/ADR cells as compared to the transfected GLCR/ADR cells as shown by the curve. Two hundred thousand cells were used for hemacytometer cell counts in the presence of trypan blue to assess cell viability. cox-1 down-regulation in ADR cells resulted in a significantly higher percentage of non-viable cells (25.4%) as compared to its non-transfected control (20.5%) using a Student’s t-test (*P <0.05). Similarly, fluorescence microscopy confirmed that apoptosis was significantly increased in the ADR cells treated with doxorubicin and cox-1 siRNA simultaneously (69.4%) as compared to its non-transfected control (56.7%) (*= P <0.01). A Western blot analysis performed by Fernando Cuadrado indicated that siRNA transfection decreased the expression of COX-1 by 66% in GLC4/ ADR cells as compared to the non-transfected control using densitometry. However, no conclusive results were obtained using flow cytometry as the flow cytometer was incapable of analyzing the mixed cell population (adherent and suspension) which is a characteristic of this cell line, GLC4. Thus, we have clearly demonstrated that MDR cancer cells can be altered temporarily to become susceptible to doxorubicin, a potentially important finding for the treatment of cancer patients. / Department of Biology

Angesichts der nach wie vor hohen Mortalität und Morbidität des Bronchialkarzinoms ist die Entwicklung geeigneter Methoden zur früheren Diagnostik eine wichtige Notwendigkeit, um die geringe durchschnittliche 5-Jahres-Überlebensrate von 15% – 18% zu steigern. Unter diesem Gesichtspunkt wurde in der vorliegenden Arbeit das Atemkondensat von Patienten mit Bronchialkarzinom als nicht-invasiv und kostengünstig zu gewinnendes Medium auf das Vorliegen eines potentiellen Screeningmarkers – dem methylierten Tumorsuppressor-Gen p16 – untersucht. Dazu wurde ein Versuchsablauf entwickelt, bei dem trotz des geringen DNA-Gehaltes im Atemkondensat p16-Methylierungen nachgewiesen werden konnten. Die letztendlich etablierte Methode war eine methylierungsspezifische nested-PCR mit anschließendem Restriktionsverdau durch das Restriktionsenzym BstUI. Des Weiteren erfolgte die Untersuchung von in Paraffin eingebetteten Tumorpräparaten der Patienten. In der anschließenden statistischen Auswertung wurde der Einfluss von verschiedenen Faktoren wie COPD-Grad, Tumorlage, Tumorart, Nikotinabusus und stattgehabte Chemo- oder Strahlentherapie auf den Methylierungsstatus des p16-Gens analysiert.

Bakgrund: Lungcancer är en sjukdom med dålig prognos och hög dödlighet. Många patienter behandlas därför med palliativ vård. Att ha lungcancer påverkar patientens livskvalitet, och sjuksköterskan har ett stort ansvar i att främja patientens livkvalitet. Syfte: Att beskriva vad som innefattades i begreppet livskvalitet utifrån lungcancersjuka patienter i palliativ fas, vilka faktorer som påverkade känslan av den och hur sjuksköterskan kunde främja livskvalitet utifrån sin yrkesroll. Metod: Studien genomfördes som en litteraturöversikt. Totalt användes 25 artiklar av både kvalitativ och kvantitativ ansats. Artiklar till studien söktes i databaserna CINHAL och PubMed. Resultat: Livskvalitet är ett multidimensionellt begrepp och det kan ses som någonting individuellt och unikt för varje enskild lungcancersjuk patient, och innebörden av begreppet hade olika betydelse för alla. Livskvalitet kunde påverkas utifrån både fysiska, psykiska, sociala och existentiella aspekter. Sjuksköterskan hade därför en viktig roll i att ha en helhetssyn på patienten och se denne som en enskild individ i situationen, för att livskvalitet ska kunna främjas optimalt hos patienten. Slutsats: Livskvalitet är ett oändligt begrepp, som har en unik betydelse för varje patient. Som sjuksköterska fanns inget facit på vilka åtgärder som bäst kan främja patientens livskvalitet. Dock handlar det om till stor del för sjuksköterskan att våga möta patienten i denna svåra situation och att våga lyssna på patienten.

No description available.

In order to study the incidence of Estrogen Receptors (ER) in breast carcinoma, lung carcinoma and melanoma, an in situ hybridisation technique for ER mRNA (ER mRNA-ISH) was developed. Various technical aspects of the procedure including tissue fixation, hybridisation conditions, and demonstration technique were investigated in order to obtain an optimum technique for routine use. ISH results were compared with ER immunohistochemistry using the monoclonal antibodies ER1D5 and D5. Commercially available biotin labelled antisense oligonucleotides to ER, Poly A (total mRNA), and sense chromogranin (negative control) were applied to frozen and formalin-fixed paraffin sections of breast carcinomas. For frozen sections, various fixatives including formalin, alcohol, Schoobridge, Zamboni's and acetic- alcohol were compared. A direct streptavidin- eroxidase and an indirect demonstration method using anti-biotin were also compared. The effect of differing formamide concentrations and post hybridisation stringency washings were analysed. An optimised ISH technique was then applied to frozen sections of 21 cases of breast carcinoma and 11 cases of lung carcinoma. Results were compared to H222 staining on adjacent sections. The ISH technique was also optimised for use on formalin-fixed, paraffin-embedded sections of 28 breast carcinomas and 17 melanomas. The results were compared with ER1D5 and D5 immunohistochemistry done on adjacent sections. The occurrence of endogenous biotin was also studied on a range of normal tissues. Consistent ISH results were obtained when formamide was omitted from the hybridisation cocktail, high stringency post hybridisation washes were discarded, room temperature hybridisations and an indirect demonstration method were used. Fixation of frozen sections in acetic/ethanol gave more consistent results with good morphology and resulted in positive nucleolar staining in 90% of breast and 45% of lung carcinomas. Positive nucleolar staining was also present in frozen sections of one metastatic melanoma. In formalin fixed paraffin sections, acid hydrolysis and pronase treatment were required prior to ISH. Cytoplasmic and/or nucleolar ER mRNA-ISH staining was seen in 87% of breast carcinoma and 97% of melanoma studied. ER1D5 was present in 54% of breast carcinomas but was absent in all melanomas. D5, on the other hand, was found in 88% of the melanomas. In conclusion, ER mRNA-ISH can be successfully done on acetic/alcohol fixed frozen sections and formalin fixed paraffin sections. Formamide, high stringency washes and elevated hybridisation temperatures are detrimental to a successful ISH reaction and an indirect demonstration method (using anti-biotin) is preferred. Unfortunately, endogenous biotin can cause false positive ISH reactions and needs to be considered during interpretation. Results show that the localisation of ER mRNA in the nucleolus is specific. Both ER mRNA-ISH and ER immunohistochemistry indicate that melanomas and some lung carcinomas contain a receptor possibly similar to that in breast carcinomas. / Thesis (M.Sc.)--Department of Anatomical Sciences, 2004.

Recent studies have suggested significant variation in radiotherapy schedules used to treat advanced NSCLC, both between different centres as well as between countries. In this study, treatment methodologies have been explored using management plans proposed by radiation oncologists when given general questions and theoretical case histories for patients with advanced NSCLC. Methods and Materials The survey was conducted by sending a questionnaire to twenty four radiotherapy centres in Europe. The questionnaire was composed of two sections. The first section concerned reasons for starting radiotherapy, parameters that influence the choice of total dose and fractionation for radiotherapy and the kind of equipment that is used. The second section examines five case histories and asked the responders about the management of these five theoretical patients also regarding the radiotherapy techniques proposed and the aim of treatment (radical or palliative). Furthermore, trials comparing different regimens of palliative radiotherapy in patients with NSCLC were compared. Nineteen trials were reviewed. There were important differences in the doses of radiotherapy investigated, the patient characteristics and the outcome measures. Results In the first part responders (70% of the centres) suggested as the most important factors that influence the choice of total dose and fractionation for radiotherapy, distant metastases, performance status of the patient, lung function and size of the primary tumour. The most common reasons for starting the treatment is not only symptom relief, but also cure and prolongation of life. In the second part, more than 95% of the responders replied that they would give radiotherapy in each of these cases. The median total doses proposed where 20Gy/5fractions/1week or 30Gy/10fractions/2weeks for cases A and D (equivalent dose for fractionation 2Gy per fraction=23 and 33Gy) and 60-68Gy/30fractions/6weeks or 68Gy/34fractions/7weeks for cases B, C and E. For case E, 20% of the responders suggested Stereotactic Body Radiotherapy with 63Gy in 3 Fractions. The total dose and number of fractions of radiotherapy could be related to the perceived aims and expectations of treatment e.g. those aiming to extent life would give significantly higher total doses in a larger number of fractions, whereas those aiming to relieve symptoms would give significantly lower total doses. For the review to the literature there is no strong evidence that any regimen gives greater palliation. Higher dose regimens give more acute toxicity, especially oesophagitis. There is evidence for a modest increase in survival (5% at 1 year and 3% at 2 years) in patients with better performance status (PS) given higher dose radiotherapy. Some regimens are associated with an increased risk of radiation myelitis. Conclusions This survey demonstrates a range of treatment strategies for advanced and inoperable NSCLC within Europe. There are a number of factors that influence the perceived aims of treatment and treatment planning. These factors should be taken into account when evaluating the effectiveness of different irradiation techniques, especially in the determination of radiobiological parameters and dose-response relations. The majority of patients should be treated with short courses of palliative radiotherapy, of 1 or 2 fractions. Care should be taken with the dose to the spinal cord. The use of high dose palliative regimens should be considered for and discussed with selected patients with good performance status. More research is needed into reducing the acute toxicity of large fraction regimens and into the role of radical compared to high dose palliative radiotherapy. In the future, large trials comparing different RT regimens may be difficult to set up because of the increasing use of systemic chemotherapy. Trials looking at how best to integrate these two modalities, particularly in good PS patients need to be carried out. / Πρόσφατες μελέτες έχουν αναδείξει σημαντική ποικιλία στα ακτινοθεραπευτικά σχήματα που χρησιμοποιούνται στην ακτινοθεραπεία του μη μικροκυτταρικού καρκίνου του πνεύμονα προχωρημένου σταδίου. Στη συγκεκριμένη μελέτη θεραπευτικές μεθοδολογίες έχουν διερευνηθεί χρησιμοποιώντας τεχνικές που προτείνονται από ογκολόγους ακτινοθεραπευτές . Υλικά και Μέθοδοι: Η μελέτη αποτελείται από δυο μέρη. Στο πρώτο ένα ερωτηματολόγιο εστάλη σε είκοσι τέσσερα ακτινοθεραπευτικά κέντρα στην Ευρώπη .Το ερωτηματολόγιο αποτελούνταν από δυο τμήματα. Στο πρώτο ζητούνταν οι λόγοι για τους οποίους γίνεται έναρξη της ακτινοθεραπείας, οι παράμετροι που επηρεάζουν την επιλογή για τη συνολική δόση και τις συνεδρίες για την θεραπεία και τον εξοπλισμό που χρησιμοποιούν. Στο δεύτερο τμήμα παρουσιαστήκαν πέντε θεωρητικά κλινικά περιστατικά και ζητήθηκε η αντιμετώπιση αυτών των θεωρητικών ασθενών. Στο δεύτερο μέρος της μελέτης πραγματοποιήθηκε ανασκόπηση στη βιβλιογραφία και σύγκριση των αποτελεσμάτων κλινικών δοκιμών που έχουν πραγματοποιηθεί στο παρελθόν. Αποτελέσματα: Στο ερωτηματολόγιο απάντησαν το εβδομήντα τοις εκατό των κέντρων στα όποια εστάλη. Στο πρώτο μέρος ως οι πιο σημαντικοί παρόντες που επηρεάζουν την επιλογή της τελικής δόσης και τις συνεδρίες οριστήκαν οι παρουσία απομακρυσμένων μεταστάσεων, η κλινική εικόνα του ασθενούς, η πνευμονική λειτουργία και το μέγεθος του πρωτογενούς όγκου. Οι σημαντικότεροι λόγοι για έναρξη θεραπείας είναι ανακούφιση από τα συμπτώματα καθώς και επιμήκυνση της ζωής. Στο δεύτερο μέρος ενενήντα πέντε τοις εκατό των κέντρων απάντησαν ότι θα πραγματοποιούσαν ακτινοθεραπεία και στους πέντε αυτούς ασθενείς. Η επιλογή της συνολικής δόσης και συνεδρίων επηρεάζεται από την θεώρηση της θεραπείας ως παρηγορική ή θεραπευτική. Τα κέντρα που είχαν στόχο την επιμήκυνση της ζωής έδιναν μεγαλύτερες δόσεις και περισσότερες συνεδρίες εν αντιθέσει με τα κέντρα που είχαν στόχο την υποχώρηση των συμπτωμάτων που έδιναν μικρότερης δόσεις σε λιγότερες συνεδρίες. Στο δεύτερο μέρος υπολογιστήκαν οι σχετικές βιολογικές δραστικότητες από τα δεδομένα της βιβλιογραφίας καθώς και ο παράγοντας πολλαπλασιασμού του όγκου και κατασκευάστηκαν καμπύλες δόσης απόκρισης. Συμπεράσματα: Η μελέτη αποδεικνύει την ύπαρξη ποικιλίας στις τεχνικές που χρησιμοποιούνται στη θεραπεία προχωρημένου και ανεγχείρητου μη μικροκυτταρικού καρκίνου του πνεύμονα. Αυτοί οι παράγοντες πρέπει να συνυπολογίζονται όταν εκτιμάται η αποτελεσματικότητα διαφορετικών ακτινοθεραπευτικών τεχνικών, κυρίως στο προσδιορισμό ακτινολογικών παραμέτρων και σχέσεων δόσης –απόκρισης.