الفهرس 
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Abstract
Among women, BC is the most common type of cancer. In addition to this, it is the second most significant cause of death from cancer in the entire world. As per the malignancy statistics for the year 2020, breast cancer is responsible for thirty percent of all female malignancies. In the year 2020, it is anticipated that there will be 276,480 new cases of breast cancer and over 42,000 deaths. BC is responsible for 33 percent of all cases of cancer that occur in females in Egypt, and each year, more than 22,000 new cases are found. When advanced breast cancer metastatic spread occurs, bone tissue is the most common site of dissemination.
The interaction between specific cells in the bone microenvironment and metastatic bone cancer cells results in the development of metastatic bone disease. This disease is indicative of a bad prognosis and has a severe influence on the quality of life for people who have this condition. Treatment for breast cancer that has spread to bone cancer cells from the breast: This entails either destroying cancer cells or inhibiting the development of tumor cells to lengthen the amount of time that the patient is able to survive.
It is possible to accomplish this through the utilization of cytotoxic medications, the deprivation of hormones, or the blockage of particular signaling pathways by a targeted agent. This study aimed to investigate the function that CD44, CD133, EpCAM, and Ca15.3 play in bone metastases breast cancer, in comparison to primary breast cancer patients. as well as the response to radiotherapy treatment.
This study consisted of group I, which comprised 40 apparently normal healthy controls. group II consisted of 40 patients diagnosed with breast cancer with bone metastases. These patients received treatment with fractionated radiation. group III consisted of 40 primary breast cancer patients. The gene expressions of CD44, CD133, and EpCAM were analyzed in patients with bone metastatic breast cancer (BMBC) and primary breast cancer using reverse transcription polymerase chain reaction (RT-PCR). The serum levels of Ca 15.3 were measured using an ELISA technique in patients with BMBC.
Our main results showed that:
• In BMBC patients, CD44, CD133, and EpCAM gene expression and Ca15.3 serum levels, either before or after radiotherapy, are statistically significantly higher than those in the control group.
• In BMBC patients, the investigated biomarkers’ gene expressions are significantly deceased after RT treatment, which illustrates the potential role of these biomarkers for predicting the response to radiotherapy and directing treatment decisions in cases of bone metastases and breast cancer.
• In BMBC patients, the CD44, CD133, and EpCAM gene expression and Ca15.3 serum levels are statistically significantly higher compared to primary breast cancer patients.
• In primary BC tissues, CD44, CD133, and EpCAM gene expression are statistically significantly higher than that in normal adjacent breast tissues.
6.2 Conclusion
• Positive CD44, CD133, and EpCAM gene expressions and Ca 15.3 serum levels emerge as valuable biomarkers for BMBC patients; moreover, these biomarkers’ overexpression is markedly correlated with aggressive tumor behavior, suggesting their role as a prognostic marker and therapeutic target.
• CD44, CD133, and EpCAM gene expressions are employed as oncogenic functions in breast cancer patients.
• The down expression of these biomarkers after RT treatment is utilized as potential biomarkers for predicting RT response in breast cancer bone metastasis.