CURRENT ISSUE

ABSTRACT: Surgery in metastatic cancer has been considered to have a limited role in the treatment of metastatic disease and has generally been reserved for palliative intent. However, as imaging, systemic therapy, surgical techniques, and understanding of the biology of cancer has improved, the role of surgery in the treatment of metastatic disease has evolved. This narrative review will discuss the current state of surgical therapy in metastatic cancer and the indications for such an approach. A discussion of the impact of reducing tumor burden, the concept of oligometastatic disease, and the role of host–tumor interactions will provide a basis for the discussion. The objectives of surgery have evolved from palliation to include longer survival and even potentially curative intent. The primary consideration in the decision to pursue surgical therapy for metastatic disease is proper patient selection, and this requires a thorough evaluation of disease and patient factors, as well as the integration of systemic therapy and other local therapies. While evidence is strongest for metastasectomy in colorectal cancer, there is growing evidence in breast cancer, renal cell carcinoma, lung cancer, and neuroendocrine tumors. As a general rule, the optimal management of metastatic cancer includes a combination of systemic and surgical therapies to maximize benefit for the patient. While there are limitations to the current role of surgical therapy in metastatic cancer, challenges including surgical morbidity, delays in initiation of necessary systemic therapy, and a paucity of high-quality evidence, proper patient selection remains the cornerstone to providing meaningful clinical benefit.

ABSTRACT: ABSTRACT
Background: Diethylnitrosamine (DEN) is a nitrosamine derivative with alkylating, carcinogenic, and mutagenic properties that causes major liver damage and acts as a hepatocarcinogen in rodents. Acacia nilotica and Kigelia africana are plants used in local communities to treat wounds and ulcers.
Objective: This study investigated the effect of aqueous extracts of Kigelia africana and Acacia nilotica on alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and cancer antigen 125 (CA-125) levels in DEN-induced liver cell dysplasia in Wistar rats.
Methods: Forty (40) male Wistar rats, aged 6–8 weeks, were divided into eight (8) groups of five (5) animals each. Liver cell dysplasia was induced with a single intraperitoneal dose of DEN (100 mg/kg) and promoted with oral phenobarbitone (0.25 mg/kg) twice weekly, beginning one week after induction. Group I received clean drinking water; group II received DEN only; group III received DEN + phenobarbitone; groups IV and V received DEN + phenobarbitone + 250 mg/kg and 500 mg/kg of Acacia nilotica respectively; groups VI and VII received DEN + phenobarbitone + 250 mg/kg and 500 mg/kg of Kigelia africana respectively; and group VIII received DEN + phenobarbitone + 10 mg/kg of sorafenib. Blood samples were collected on day 120 for biomarker evaluation, and liver tissue was processed for histopathology.
Results: CEA and CA-125 differed significantly among groups (p < 0.001), although group means largely remained within the physiological reference range; AFP showed no significant difference (p = 0.580). The highest CEA values occurred in the DEN-only and DEN + phenobarbitone groups, while CA-125 was highest in the DEN-only and sorafenib-treated groups. Animals treated with the plant extracts, particularly at the higher dose (500 mg/kg), maintained CEA and CA-125 values close to those of the negative control. Histopathology showed dose-dependent attenuation of DEN-induced changes by both extracts, with the higher dose of Kigelia africana producing near-normal liver architecture.
Conclusion: Both extracts, especially at higher doses, appeared chemoprotective against DEN-induced hepatic changes, supporting further investigation of their underlying mechanisms.