Histologic response after neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma: experience from Sudan.

Background: Locally advanced rectal cancer can be down staged by neoadjuvant therapy and the resultant tumor response can be quantified histologically. This study aimed to assess pathological response of neoadjuvant chemoradiation in patients with locally advanced rectal cancers treated in Wad Medani Teaching Hospital (WMTH) and National Cancer Institute (NCI), Wad Medani, Sudan. Patients and Methods: A total of 36 consecutive patients with locally advanced rectal cancer that were managed in WMTH and NCI during the period from 2006-2011 were reviewed. Preoperative pelvic radiotherapy was delivered. Total of 46 Gray were delivered concurrently with 5- fluorouracil (5-FU) on the first and last week of radiation. Total mesorectal excision of the rectal tumour either by anterior or abdominoperineal resections was planned at 6-8 weeks from completion of preoperative treatment. The pathological response to therapy was assessed by histopathology examination of the surgical specimen. Results: Initial clinical staging of patients revealed 58.3% of them were stage T3/T4N2M0 and 41.7% were stage T3N0M0. Down-staging to stage T1/T2N0M0 was found in 36.1% and stage T3N0M0 in 30.6%. No response was seen in 8.3% of cases with stage T3/T4N2M0 while complete clinical response (no residual) was seen in 25.0%. Complete histological response was observed in 13.8%. Positive lymph-nodes metastasis was confirmed in 8.3% of cases. Conclusion: Neoadjuvant chemoradiation is a reasonable option for cases of rectal cancer and deserves further evaluation.

NUTRITIONAL COMPOSITION AND ANTIOXIDANT PROPERTIES OF RAPHIONACME SPLENDENS (SCHL.) TUBERS

People of Western Kordofan (Sudan) are endowed with a deep knowledge concerning the use of wild plants. Tubers of Raphionacme splendens Schl. subspecies splendens Flickr (family Apocynaceae), locally known as Elfayo, are used as a food reserve during times of famine or poor harvest. The aim of this study was to analyze the nutritional composition and antioxidant capacity of root tubers of R. splendens. Samples were collected from South-West Kordofan. Analyses included determination of moisture, carbohydrate, crude protein, fat, fibre, ash, minerals, vitamin C, amino acids and fatty acids composition. Antioxidant activity was determined by the DPPH (1,1-diphenyl-2-picrylhydrazyl) and ABTS (2.2’-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) assays. The total phenolic content was also assessed. The results, which are referred to as (%) dry weight, showed that the tubers contained 3.2% protein, 18% carbohydrate, 0.5% lipid, 2.4% crude fibre, 3.5% ash, 79.2% moisture and gross energy 101.7 kJ/g. The total amino acids were 10776 mg/100g where the essential amino acids represented 28.2%. The more abundant essential amino acids were leucine (792mg/100g), isoleucine (712mg/100g) and threonine (536mg/100g). Methionine and lysine were the limiting amino acids. Minerals were potassium (259mg/100g), calcium (183mg/100g), magnesium (64mg/100g), phosphorus (37mg/100g), copper (3.6mg/100g), manganese (2.4mg/100g), zinc (1.8mg/100g) and iron (1.2mg/100g). Total saturated fatty acids were 45.6% whereas total unsaturated fatty acids were 54.4%. Oleic acid (32.56%) and palmitic acid (30.23%) were the most abundant fatty acids. Tubers displayed good antioxidant activity with IC50 values 0.987 and 1.559mg/mL against DPPH and ABTS radicals respectively. Vitamin C was 31.5mg/100g and total phenolic content was 60mg gallic acid equivalent (GAE) per 100g dry sample and they could be the main contributor to the antioxidant capacity of the tubers. In conclusion, the results of this study suggested that tubers of R. splendens could have beneficial effect for food and/or nutraceutical application for normal growth and adequate protection against diseases associated with reactions of free radicals.