Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and rapidly fatal tumor.Therapeutic options have traditionally been limited and ineffective.The biologic and molecular events correlated with poor respon...Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and rapidly fatal tumor.Therapeutic options have traditionally been limited and ineffective.The biologic and molecular events correlated with poor responsiveness to therapy are still poorly understood.In recent years,an innovative treatment approach involving aggressive cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy has reportedly resulted in improved outcome,as compared to historical controls.Since 1995,at the National Cancer Institute (NCI) of Milan (Italy),patients with DMPM have been treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC).In the present paper,clinical experiences and basic science investigations on DMPM at Milan NCI are reviewed.Perioperative and long-term outcome results with CRS and HIPEC are presented.Clinico-pathological prognostic factors were investigated by multivariate analysis.The pathologic features and immunohistochemical markers related to DMPM biologic behavior were assessed in a large case-series uniformly treated at our institution.The prevalence and prognostic role of telomere maintenance mechanisms,which account for the limitless cell replicative potential of many malignancies,were studied.The dysregulation of the apoptotic pathways may play a role in the relative chemo-resistance of DMPM and a better understanding of apoptosis-related mechanisms could result in novel targeted therapeutic strategies.On this basis,the expression of survivin and other IAP family members (IAP-1,IAP-2,and X-IAP),the pro-apoptotic protein Smac/DIABLO,and antigens associated with cell proliferation (Ki-67) and apoptosis (caspase-cleaved cytokeratin-18) were analyzed.Finally,analyses of EGFR,PDGFRA and PDGFRB were performed to ascertain if deregulation of RTK could offer useful alternative therapeutic targets.展开更多
Background: Worldwide, lung cancer is the most commonly diagnosed cancer and causes more deaths than any other cancer. In Egypt;it accounts for 7% of male cancer & 3% in females. It is considered to be 3rd most co...Background: Worldwide, lung cancer is the most commonly diagnosed cancer and causes more deaths than any other cancer. In Egypt;it accounts for 7% of male cancer & 3% in females. It is considered to be 3rd most common cancer in Egyptian males & 6th most common of both sexes. Materials and Methods: A total of 99 advanced non-small cell lung cancer patients who underwent first line platinum containing chemotherapy in our institute were included in this study. All clinical and pathological data were collected from patient’s files retrospectively between 2012-2014. Results: All 99 cases were diagnosed at late stage IIIB-IV (59 cases were IIIB).The median age was 54 years (range: 30 - 70) with 53% of cases are ≥ 54 years. 71% were males with male: female ratio of 2.4:1. All male patients were chronic smokers. The most frequent symptom was coughing (68%). Most of the patients had primary lung cancer in the right lung (77%). The most common histological subtype was squamous cell carcinoma (35.4%) with 54 cases present with PS-I, the remain was PS-II. All cases received platinum containing chemotherapy. The majority of cases experienced a progressive disease 60.6%. The median progression free survival (PFS) was 6 months & median overall survival (OS) was 18 months. We found that PS, disease stage, pathological subtypes and response to treatment statistically affect both median OS & PFS. Age affects only OS. Conclusions: Our analysis suggests that some of clinico-pathological factors & response to first line platinum containing regimens affect both OS & PFS of advanced NSCLC. This may be beneficial as prognostic markers and further studies were needed to aid in identification and treatment of these patients.展开更多
Background: Gastric cancer is the third most incident malignancy and the fifth leading cause of death in the world. In Brazil, it is the fourth most common tumour in men and the fifth in women. Familial aggregation of...Background: Gastric cancer is the third most incident malignancy and the fifth leading cause of death in the world. In Brazil, it is the fourth most common tumour in men and the fifth in women. Familial aggregation of this tumour is being studied and discussed by experts. Aim: Determine the frequency of family history of cancer in patients with gastric cancer, suggesting familial aggregation or increased risk for hereditary cancer syndromes. Methods: This is a retrospective cross-sectional study carried out from January 2011 to March 2015 at the Department of Abdominal and Pelvic Surgery of the Brazilian National Cancer Institute (INCA). Data were collected from electronic medical records and analyzed using SPSS Statistics? version 20. Results: 873 patients with gastric adenocarcinoma were analyzed. A family history of cancer was reported by 451 patients (51.6%), which reported cancer in 878 relatives, of which 110 (12.6%), reported having more than three relatives with any type of cancer. The most prevalent malignancies among these relatives were gastric cancer (21.3%) and breast cancer (9.5%). Conclusion: Most of the patients had cancer family history, being gastric cancer the most common. The high percentage of cancer family history confirms the importance of collecting this information, whose lack reflects professional negligence, as family history study can serve as a low-cost tool, favoring prevention and early diagnosis, situations where morbidity and mortality are smaller, thus reducing health costs and assistance and preserving lives.展开更多
Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. The potential to prevent needless laparotomy by means of precis...Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. The potential to prevent needless laparotomy by means of precise staging is the pouring force behind the use of diagnostic laparoscopy (DL). Objective: To assess the role of laparoscopy and laparoscopic ultrasound (LUS) in proper staging of upper gastro intestinal malignancies, and in potential palliation in advanced cases for pain (by neurolytic celiac plexus block) or gastric outlet obstruction (by laparoscopic bypass surgery). Study design: In this prospective study, 62 patients with lower esophageal, gastric and peri-pancreatic carcinomas were joined after written informed consent. All patients were examined with laparoscopy and LUS with the help of frozen section analysis to any doubtful metastatic site, peritoneal fluid and ascitic fluid analysis. Results: DL helped us to avoid needless laparotomy in 22.5% of patients, reducing its post-operative complications, hospital stay and cost. DL also helped us to do palliative management either in the form of gastric bypass or laparoscopic celiac plexus block. Conclusion: we praise the use of DL as a safe, effective and complimentary method to the other routine imaging modalities, in proper staging and palliation for upper gastrointestinal malignancies.展开更多
Background: Reviewing and analyzing the Clinico-pathologic aspects of non-melanoma skin cancer of the head and neck (NMSCHN), type of management, prognostic factors, and disease-free survival (DFS) in a period of 5 ye...Background: Reviewing and analyzing the Clinico-pathologic aspects of non-melanoma skin cancer of the head and neck (NMSCHN), type of management, prognostic factors, and disease-free survival (DFS) in a period of 5 years at the National Cancer Institute—Cairo University—Egypt. Materials and Methods: A retrospective study of two hundred patients with NMSCHN was treated at the National Cancer Institute—Cairo University—Egypt from January 2008 to December 2012. The mean follow-up was 6 months (1 - 84 months). Results: 117 males and 83 females with 90% ≥ 50 years old. The scalp (27.5%), the periorbital region (13%), the cheek (12.5%) and the nose (12.5%) are the main anatomical sites affected. BCC represented 71.5% with nodular type (79%) predominance;SCC represented 21% with GII (61.1%) the commonest grade. Surgery was the main modality of treatment (93%) with local flaps only (63.9%) and primary closure (14.7%) were the main surgical options following wide local excision. Positive and close margins were detected in 23.5% of excised specimens. No significant association was found between disease-free survival (DFS) and pathology, treatment modality, the occurrence of complications or safety margin status. Conclusion: NMSCHN lesions should be surgically excised in specialized high volume centers with readily available peripheral margin control and should be operated by senior experienced surgeons.展开更多
Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides ...Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.展开更多
Purpose: To evaluate treatment outcomes and prognostic factors of pediatric Medulloblastoma (MB) patients treated by adjuvant post-operative riskadapted radiotherapy (RT) and chemotherapy (CT). Patients and Methods: A...Purpose: To evaluate treatment outcomes and prognostic factors of pediatric Medulloblastoma (MB) patients treated by adjuvant post-operative riskadapted radiotherapy (RT) and chemotherapy (CT). Patients and Methods: A retrospective analysis was conducted based on medical records of pediatric patients with pathologically confirmed MB treated between 2006 and 2013 at the National cancer Institute (NCI), Egypt. Various patients’ and disease characteristics, treatment details and outcome data were reviewed. Results: Fifty patients’ records were included in the analysis with a median age of 6 years at diagnosis (range 3 - 18). According to the Chang staging system;38%, 44%, 4%, and 14% were M0, M1, M2, and M3, respectively. All patients underwent primary surgery;gross total resection (with no residual) in 38%, near total resection (with residual ≤1.5 cm2) in 8%, subtotal resection (with residual > 1.5 cm2) in 34%, and 20% had only biopsy. All patients were treated by riskadapted craniospinal irradiation (CSI);high-risk patients were treated by CSI 36 Gy/20 fractions over 4 weeks followed by posterior fossa (PF) boost 18 Gy/10 fractions over 2 weeks (180 cGy per fraction), while standard-risk patients were treated by CSI 23.4 Gy/13 fractions over 2 and half weeks followed by PF boost 30.6 Gy/17 fractions over 3 and half weeks. Median overall treatment time (OTT) was 52 days. All patients received adjuvant CT;47 patients (94%) received concomitant chemo radiotherapy (CCRT), while 4 patients (8%) only received neoadjuvant CT (NB: only one patient received all neoadjuvant, concomitant and adjuvant CT). With a median follow up time of 32.5 months, ranging from 6 to 104 months, the whole group estimates of the overall survival (OS) at 1, 3, and 5 years were 83%, 70%, and 64%, respectively, while, the progression-free survival (PFS) rates at 1, 3, and 5 years were 79%, 62%, and 57% respectively. Four patients relapsed. Neural-axis was the commonest site of relapse (3 patients). Both risk groups were equally represented in relapsed patients (2 standard risk & 2 high risk patients) and relapse took place within 2 years. In univariate analysis, performance status,extent of surgery, and post-operative residual tumor size were significant prognostic factors for OS. On the other hand, factors which affected the PFS included gender, extent of surgery, and post-operative residual tumor. Conclusion: Neural-axis relapse was the commonest site of relapse for pediatric MB patients. Extent of surgical resection, post-operative residual tumor, and gender are powerful prognostic factors. Maximal safe resection is the standard surgical approach for MB patients to achieve cure.展开更多
Background: Ureterosigmoidostomy was the first form of continent urinary diversion and had broad popularity during the first half of the 20th century. Primary enthusiasm was followed by disappointment when serious pro...Background: Ureterosigmoidostomy was the first form of continent urinary diversion and had broad popularity during the first half of the 20th century. Primary enthusiasm was followed by disappointment when serious problems such as pyelonephritis, electrolyte imbalance, renal calculi and renal function deterioration become evident. In the 1950s these life threatening complications led to avoid this urinary diversion in favor of uretro-intestinal conduits. Objectives: Our aim was to evaluate our experience in ureterocolic shunt after radical cystectomy for bladder cancer. Methodology: This study was conducted in surgical oncology department, South Egypt cancer institute, Assiut university;in the period from January 2012 to January 2017 and including 115 patients (75 males & 40 females). Results: This is retrospective study including 115 patients (75 males & 40 females). Operative time was 130 minutes ranging between 2 to 2.5 hours. Average blood loss was 450 ml. After removal of rectal tube all patients were continent except 15 patients who were improved after 1 - 3 days. Within a month 12 patients had night incontinence and 5 patients had day time incontinence. After that day and night continence gradually improved in all patients except two females who had persistent night soiling and was in need for night time rectal tube. Conclusion: Ureterosigmoidostomy regains the interest of surgical oncology and urologist because of its simplicity and absence of appliance as many patients refusing cutaneous stoma and others are not suitable for orthotopic substitutes.展开更多
Objective The purposes of this study were to(1) assess the clinicoepidemiological characteristics of esophageal cancer patients,(2) analyze the prognostic factors determining treatment failure and survival, and(3) eva...Objective The purposes of this study were to(1) assess the clinicoepidemiological characteristics of esophageal cancer patients,(2) analyze the prognostic factors determining treatment failure and survival, and(3) evaluate the results of various treatment modalities for locoregional and disseminated disease and their effect on disease-free survival and overall survival(OS).Methods Clinicoepidemiological retrospective data from 81 esophageal cancer patients treated at the National Cancer Institute of Cairo between 2007 and 2011 were evaluated. Results The study showed that patients with esophageal cancer commonly present with locally advanced disease(87.7% had T-stage 3 and 12.3% had T-stage 4). There was a significant correlation between surgery and survival; patients who received radical surgery and postoperative radiation had a better median survival than patients who received radical radiotherapy(20 months vs. 16 months, respectively; P = 0.04). There was also a significant statistical correlation between radical concomitant chemoradiotherapy(NCRT) and palliative treatment. Patients who received radical NCRT had a better median survival than patients who received palliative radiotherapy(16 months vs. 10 months, respectively; P = 0.001). The median follow-up period for all patients was 7 months. The median OS of the whole group was 12 months. The OS after 1 and 2 years was 57.8% and 15%, respectively.Conclusion High-dose NCRT is an acceptable alternative for patients unfit for surgery or with inoperable disease. High-dose radiation is more effective than low-dose radiation in terms of local control, time to relapse, and OS. Further study using a larger series of patients and introducing new treatment protocols is necessary for a final evaluation.展开更多
Background: Hepatocellular carcinoma is a great problem that poses a huge burden upon any healthcare system. In Egypt it has shown a doubling in its incidence rate. This study intended to assess the different prognost...Background: Hepatocellular carcinoma is a great problem that poses a huge burden upon any healthcare system. In Egypt it has shown a doubling in its incidence rate. This study intended to assess the different prognostic factors for the overall survival of HCC patients in Egypt. Study Design: This is a retrospective patients’ charts review of all patients (561) admitted to the National Cancer Institute (NCI), Cairo University with HCC from January 2007 to December 2011. The main outcome measures were the median overall survival. Also, all demographics, clinicopathological variables, laboratory data were tested as prognostic factors for the overall survival. Results: The median overall survival of our patients was seven months. The overall actuarial probability of survival during the follow-up period was 65% of patients at six months, 25% of patients at 12 months, 11% of patients at 18 months, and only 3% of patients at 24 months. In our study, a broad range of clinical, laboratory, tumor parameters, and demographic data of patients had shown statistical significance in univariate analysis. However, when all these significant factors in the univariate analysis were further analyzed by stepwise multivariate regression analysis which revealed that only age less than 60, non-symptomatic cases, AFP less than 400, no PV thrombosis, no portal HTN, no ascites, no metastasis and potentially curative therapy were prognostic factors for the overall survival. Conclusion: Among all detected prognostic factors, only, management therapy is modifiable, other factors are non-modifiable. Thus, for HCC, the earlier the diagnosis and intervention, the better is the prognosis and outcome. Therefore, US screening and follow-up of high-risk groups are a must for early diagnose and better outcome.展开更多
Background: The current treatment for pseudomyxoma peritonei (PMP) consists of radical cytoreductive surgery (CRS) followed by hyperthermic intra-peritoneal chemotherapy (HIPEC). Aim: To assess PMP patients regarding ...Background: The current treatment for pseudomyxoma peritonei (PMP) consists of radical cytoreductive surgery (CRS) followed by hyperthermic intra-peritoneal chemotherapy (HIPEC). Aim: To assess PMP patients regarding the clinical and pathological characteristics, the treatment including surgery (CRS) and chemotherapy either HIPEC type or post-operative systemic chemotherapy aiming to evaluate end results regarding recurrence and survival. Patients and Methods: This retrospective study included 39 patients with PMP who were diagnosed, treated and followed-up from 2009-2014 at National Cancer Institute, Cairo, Egypt. Results: High grade mucinous adenocarcinoma was found in 23.1% of patients. Patients with low grade tumor showed higher survival rate compared with patients with high grade disease. The mean operative PCI score (peritoneal cancer index) that was done to all patients who were explored was 15.81. Our study reported success to achieve complete cytoreduction that was combined with HIPEC in 44% of patients who were planned for this modality. Treatment related postoperative grade (3 - 5) complications mainly surgery related developed in 17.3 of patients. Operative mortality was 22.2%. The follow up period in our study was quite short (mean 22.9). However the overall survival at the end of the follow up in our study was 48.7%, 1 year survival was 82%, and 2 year survival was 41%. The overall survival in patients treated with CRS and HIPEC was 66.6%, with 1 year and 2 year survival of 91% and 66.6% respectively. Only 2 patients developed recurrent disease during the follow up period. Conclusions: The outcome of PMP treatment process is extremely variable. Combined CRS and HIPEC is considered the best therapeutic approach for patients with PMP. Surgical experience combined with proper patient selection have to be built up together to improve the outcome. That could only be achieved through more centralization of patients’ treatment in specialized units or center.展开更多
Risk stratification allows tailoring of treatment protocol using, for selected patients, reduced total chemotherapy exposure, including decreases in alkylator therapy and avoidance of agents with recognized risk of la...Risk stratification allows tailoring of treatment protocol using, for selected patients, reduced total chemotherapy exposure, including decreases in alkylator therapy and avoidance of agents with recognized risk of late complications (anthracyclines), elimination of irradiation and reduction of radiotherapy dose. Patients and Methods: Twenty-nine newly diagnosed pediatric rhabdomyosarcoma patients attended the pediatric oncology department between January 2008 and May 2011. Patients were divided into 3 groups according to age, stage, group, pathology and site of the tumor. Treatment protocol tailored according to risk group. Results: Twenty-nine newly diagnosed pediatric rhabdomyosarcoma patients were evaluated. Seven patients had low risk, Intermediate risk included 12 patients, and 10 patients had high risk. After three years median follow up, event free survival was 51.7% for all patients however it was 86%, 67% and 10% for low, intermediate and high risk respectively (P = 0.0002). There was statistical difference for survival among different sites, histology, clinical group and stage as risk factors within each risk group, no statistically survival significance of any of these factors within the same risk group. Conclusion: Risk stratification is the best single predictor factor for pediatric rhabdomyosarcoma and allows tailoring of the treatment protocol. For selected patients, reductions in total chemotherapy exposure, elimination of irradiation in selected low risk patients and reduction of radiotherapy dose according to postoperative margin and nodal status is safe.展开更多
Purpose: Adjuvant radiation therapy could reduce loco regional failure, but currently has no defined role because of previously reported morbidity. NCI-Cairo routine work is to give adjuvant PORT for locally advanced ...Purpose: Adjuvant radiation therapy could reduce loco regional failure, but currently has no defined role because of previously reported morbidity. NCI-Cairo routine work is to give adjuvant PORT for locally advanced bladder carcinoma patients. The aim of this work is to re-evaluate this protocol regarding its effect on prognosis and complications. Patients and Method: A retrospective study included 208 patients with pathologically proven bladder cancer who presented to the NCI, Cairo University from 2007-2011. All of them underwent RC with bilateral PLND followed by conventional post-operative radiotherapy in 2 - 6 weeks after surgery for 5000 cGy in 25 fractions, over 5 weeks using 2D technique. Analysis of data from their files was done for the treatment results, prognostic factors and complications. Results: Three years overall survival (OS) and disease free survival (DFS) for the whole group was ~60%, and 54% respectively in favour of the female gender, non-smokers, Squamous cell carcinoma patients, low grade tumours (grade 1 and 2) negative margins, N0, pT2b and early stage group showed the best prognoses. The 3 years metastases free survival (MFS) was ~71%. Only four factors showed a significant relation with the MFS which were the grade, LN status, T-stage and group staging. The local recurrence rate (LRC) at 2 years for the whole group was ~95% and 94% at 3 years. Only surgical margin status and extent of LN dissection had a significant impact on the LRC. Conclusions: Adjuvant radiotherapy shows sustained improvement in the loco regional control, and should be recommended for patients with locally advanced disease especially those with less than 10 dissected lymph nodes and those with positive margins.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Colon cancer (CC) ranks...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Colon cancer (CC) ranks as the third most common cancer worldwide and is considered the second leading cause of cancer death. Recently, many international studies have made the observation that right and left colon cancer have many significant differences regarding clinico-pathological </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">characteristics and primary tumor location has a crucial impact on treatment outcomes and overall survival. Our study was conducted to verify the presence of significant differences between right and left colon cancer. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">This study is a retrospective cohort study which aimed at comparing right and left colon cancer as regards clinico-pathological data and treatment results among patients with colon cancer receiving treatment at South Egypt Cancer Institute (SECI) during the period from 1/2008 to 12/2018. A sample size of 160 cases of colon cancer patients (80 diagnosed as right colon cancer and 80 diagnosed as left colon cancer) was randomly selected from our South Egypt Cancer Institute (SECI)’s tumor registry. Statistical analysis was done using SPSS program version 20. Difference was considered statistically significant at P-value < 0.05. Survival curves were conducted using the Kaplan-Meier methods and were compared with the log-rank test. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Right colon cancer occurred at an older age and was more commonly presented with abdominal pain while left colon cancer was more commonly presented with bleeding manifestations. More cases of the right side underwent curative surgeries whereas more palliative surgeries were performed to left-sided cases. Left sided cases were associated with a more advanced stage at diagnosis while right-sided cases were associated with a better response to first-line chemotherapy. More cases of the left side died due to metastatic disease. On the other hand, our findings demonstrated no differences between both sides regarding gender predilection, risk factors, sites of metastases, number of metastatic organs, histo-pathological examination and grading, response to second- or third-line chemotherapy, chemotherapy toxicity (hematological or non-hematological), overall survival, progression-free survival, or disease-free survival. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Primary tumor location of colon cancer has a significant effect on clinico-pathological characteristics and treatment outcomes.</span></span></span></span>展开更多
Background: Colorectal carcinoma usually arises from an adenomatous polyp and observational studies suggest that the adenoma-to-carcinoma sequence takes approximately 10 to 15 years. Risk factors are adoption of weste...Background: Colorectal carcinoma usually arises from an adenomatous polyp and observational studies suggest that the adenoma-to-carcinoma sequence takes approximately 10 to 15 years. Risk factors are adoption of westernized diets, obesity, cigarette smoking, and alcohol and reduced physical activity. Clinical Presentations are blood per rectum, abdominal pain, Anemia, change in bowel habits and bowel obstructive symptoms. The treatment of colorectal cancer is a dependent stage which includes chemotherapy, radiotherapy, surgery or both. Objective: This study aims at describing the clinical pathological characteristics of colorectal carcinoma and factors influencing survival among patients treated at Ocean Road Cancer Institute. Methods: This was a cross sectional study that involved histological confirmed colorectal carcinoma treated at Ocean Road Cancer Institute from 2010-2015. Results: Among 100 files extracted, 63% were males and 37% females. 21% were below 40 years of age. Left-sided tumor accounted for 46%. Abdominal pain, rectal bleeding and constipation were 72%, 68% and 55% respectively. Moderately differentiated adenocarcinoma accounted for 80%. Patients presented at stage III and IV were 37% and 56% respectively. Colostomy was the most surgical procedures performed. Folinic acid, Fluorouracil and Oxaliplatin were the most common chemotherapies used. Median overall survival was estimated to be 9.4 months. Conclusion: A significant proportion of patients in this study population are young. Survival from colorectal cancer is poor owing largely to the late presentation seen in this study group.展开更多
Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural ...Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural injury. No other effective therapeutic alternative to surgery exists. Cervicotomy is still the surgical approach of choice, although a form of sternotomy may always be necessary for field extension and safe gland delivery. Materials and Methods: This is a single institution combined retrospective & prospective study including retrospective analysis of all cases presenting to the NCI, Cairo University with RG candidate for surgery between Jan. 2008 until the end of Dec. 2012, and a prospective study of all cases with the same presentation presenting to the NCI between Jan. 2013 until the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the clinico-pathological characteristics, the presentation, work-up, surgical approaches and postoperative complications of RG. Results: 42 patients were included & were divided into benign (34 patients, 80.9%) and malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19 to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration of symptomatology was 23 months ranging (6 - 53 months). 23 patients (54.7%) were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients (73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy & 4 cases (9.5%) received postoperative radioactive iodine. No perioperative mortality occurred & the overall morbidity was 6 cases (14.2%) in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The median follow up period was 17.5 months. The median overall survival (OS) was 39.4 months and the median disease free survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy is a safe favorable approach to remove a RG. Intraoperative field extension up to a form of sternotomy may be necessary for gland delivery with increasing operating time, hospital stay and morbidity. Postoperative morbidity is mainly due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism which is mainly increased when sternotomy is performed.展开更多
Background: Carcinoma of the male breast is relatively a rare disease accounting for about 1% of all cancer in men. Its treatments are based mainly on those of Female Breast Cancer (BCF). Materials and Methods: This i...Background: Carcinoma of the male breast is relatively a rare disease accounting for about 1% of all cancer in men. Its treatments are based mainly on those of Female Breast Cancer (BCF). Materials and Methods: This is a single institution retrospective study including all presenting to the NCI, Cairo University with Breast Cancer in a Male (BCM) in the last 11 years between Jan. 2005 until Jan. 2016. Data were collected from patient’s files from the statistical department then analyzed. Aims: To study the clinico-pathological characteristics, the presentation, workup, surgical approaches and postoperative complications and outcome of management, with addressing similarities and difference from BCF. Results: 64 patients were included in this cohort. The mean age was 58.6 & the median age was 59 years (range: 31 - 87 years). The main presenting symptomatology was retroareolar breast lump (50 cases, 78.1%). Most of our cases were advanced;22 cases (34.3%) were stage III & 16 cases (25%) were stage IV. Surgery was performed for 50 patients;MRM for 26 cases (40.6%), RM for 18 cases (28.1%) & toilet mastectomy for 6 cases (9.3%). Primary closure was feasible in 34 patients (68%) while 16 cases (32%) required reconstruction by local or pedicled flaps. Tamoxifen is the most important non-surgical treatment. It was given to all our cases (64 cases, 100%) either postoperatively as adjuvant management (36 cases, 56.2%) or as palliation for metastatic disease (28 cases, 43.8%). Chemotherapy was given to 32 patients (100%) as an adjuvant for 24 cases (75%) and as a palliation for 8 cases (25%). Radiotherapy was given to 26 patients (100%) as adjuvant therapy for 20 cases (76.9%) and as a palliation for 6 cases (23.1%). The only significant factor determining the overall 5 years survival was the stage of the disease. LN status & surgery type were of border line significance (better survival with negative LN & with MRM). The 5-year Overall Survival (OS) & Disease Free Survival (DFS) for the whole group were 66% & 52% respectively. Within the DFS there was no significant variable;however, the stage and type of surgery were of borderline significance, with better survival with early stage disease (I & II) and with MRM (both were 61%). Conclusion: BCM has many similarities to BCF, but it harbours many different genetic and pathologic features. They obtain similar prognostic factors and similar stage-for-stage survival. They are always advanced to T4 stage rapidly due to the lack of breast parenchyma with higher ER expression in BCM than BCF patients.展开更多
Background: Askin tumor is a primitive neuroectodermal tumor of the Ewing sarcoma family arising from soft tissues of the chest wall. It is the commonest chest wall malignancy in children and adolescents. Its diagnosi...Background: Askin tumor is a primitive neuroectodermal tumor of the Ewing sarcoma family arising from soft tissues of the chest wall. It is the commonest chest wall malignancy in children and adolescents. Its diagnosis is complex and management requires a multidisciplinary work including chemotherapy for systemic disease and radiation therapy to assist local control which is achieved through surgery with or without reconstruction. Objective: To analyze report and understand the clinicopathological features, results and outcome of this tumor with assessment of early and late postoperative complications following resection and chest wall reconstruction. Materials and Methods: This is a retrospective analysis of 30 cases with chest wall ES/PNET presented to the National Cancer Institute;Cairo University between January 2011 and December 2015. All patients’ records were revised for age, sex, clinical presentation, imaging, pathology, operative notes, different treatment modalities given, early and late postoperative complications following surgical resection or reconstruction, and outcome including overall survival (OS) and disease free survival (DFS). Results: Our cohort included 30 patients with chest wall ES. The median follow up period (n = 30) was 33.7 months (ranging from 3.7 to 69.3 months). The median OS was 54.2 months with cumulative OS at 60 months which was 45.6%. The median DFS was 27.9 months with cumulative DFS at 60 months which was 40.6%. All cases were below 18 years with a male predominance (n = 19). The commonest affected sites were ribs (n = 22, 73.3%), the scapula (n = 5, 16.6%), the clavicle (n = 2, 6.66%) and the sternum (n = 1, 3.33%). 23 patients (76.6%) were presented with localized disease, and 7 patients (23.4%) were metastatic from the start. All patients received neoadjuvant chemotherapy (4 cycles of VAC/IE) followed by local control: either surgery (26 cases, 86.6%) or radical radiotherapy (3 cases, 10%). A single case of a rib ES with initial bilateral lung deposited where no local control was done. After chest wall resection, closure of the defect was done by 1 ry closure with no reconstruction or double layer prolene mesh and bone cement that was covered by pedicled flap (latissimus dorsi, serratus anterior or pectoralis major muscle flap). Postoperative radiation therapy was given to 9 patients: 4 (13.3%) had postoperative poor chemotherapy effect (<90% tumor necrosis), 3 (10%) had +ve microscopic safety margin and 2 (6.6%) had pleural based nodules with malignant pleural effusion at initial presentation. Conclusion: Askin’s tumor shows a dramatic response to polychemotherapy. Treatment of such tumor should include multidisciplinary working groups for optimum results and better survival.展开更多
This study aimed at investigating the relationship between coping and caregiving satisfaction among informal cancer caregivers in Ugandan referral hospitals. A convenient sample of 436 consenting informal care givers ...This study aimed at investigating the relationship between coping and caregiving satisfaction among informal cancer caregivers in Ugandan referral hospitals. A convenient sample of 436 consenting informal care givers aged 18 years and above were interviewed;a cross-sectional design was used. Because of the difficulty in defining a fixed population for this category of care givers, whoever was found at the bed side meeting the inclusion and exclusion criteria were recruited into the study. A tri-dimensional coping scale (namely;problem solving, denial and venting) was used to measure coping. After controlling for all the relevant covariates (Patient’s age, sex of care giver, education of caregiver, respondent’s age, respondent’s education level, respondent’s education, respondent’s country of origin, respondent’s religion, stage of cancer, score on burnout scale), the venting aspect of coping had a significant effect on caregiving satisfaction (F = 1.83, P-value = 0.03). The above covariates accounted for 41.3% of the variability in care giving satisfaction scores (R<sup>2</sup> = 0.413). Venting as a coping mechanism had a significant effect on caregiving satisfaction. There is need to pay attention to the coping strategies of informal cancer caregivers to enhance their care giving experience. There is need to help caregivers develop healthy coping methods as they participate in cancer care.展开更多
One of the quintessential challenges in cancer treatment is drug resistance.Several mechanisms of drug resistance have been described to date,and new modes of drug resistance continue to be discovered.The phenomenon o...One of the quintessential challenges in cancer treatment is drug resistance.Several mechanisms of drug resistance have been described to date,and new modes of drug resistance continue to be discovered.The phenomenon of cancer drug resistance is now widespread,with approximately 90% of cancer-related deaths associated with drug resistance.Despite significant advances in the drug discovery process,the emergence of innate and acquired mechanisms of drug resistance has impeded the progress in cancer therapy.Therefore,understanding the mechanisms of drug resistance and the various pathways involved is integral to treatment modalities.In the present review,I discuss the different mechanisms of drug resistance in cancer cells,including DNA damage repair,epithelial to mesenchymal transition,inhibition of cell death,alteration of drug targets,inactivation of drugs,deregulation of cellular energetics,immune evasion,tumor-promoting inflammation,genome instability,and other contributing epigenetic factors.Furthermore,I highlight available treatment options and conclude with future directions.展开更多
文摘Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and rapidly fatal tumor.Therapeutic options have traditionally been limited and ineffective.The biologic and molecular events correlated with poor responsiveness to therapy are still poorly understood.In recent years,an innovative treatment approach involving aggressive cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy has reportedly resulted in improved outcome,as compared to historical controls.Since 1995,at the National Cancer Institute (NCI) of Milan (Italy),patients with DMPM have been treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC).In the present paper,clinical experiences and basic science investigations on DMPM at Milan NCI are reviewed.Perioperative and long-term outcome results with CRS and HIPEC are presented.Clinico-pathological prognostic factors were investigated by multivariate analysis.The pathologic features and immunohistochemical markers related to DMPM biologic behavior were assessed in a large case-series uniformly treated at our institution.The prevalence and prognostic role of telomere maintenance mechanisms,which account for the limitless cell replicative potential of many malignancies,were studied.The dysregulation of the apoptotic pathways may play a role in the relative chemo-resistance of DMPM and a better understanding of apoptosis-related mechanisms could result in novel targeted therapeutic strategies.On this basis,the expression of survivin and other IAP family members (IAP-1,IAP-2,and X-IAP),the pro-apoptotic protein Smac/DIABLO,and antigens associated with cell proliferation (Ki-67) and apoptosis (caspase-cleaved cytokeratin-18) were analyzed.Finally,analyses of EGFR,PDGFRA and PDGFRB were performed to ascertain if deregulation of RTK could offer useful alternative therapeutic targets.
文摘Background: Worldwide, lung cancer is the most commonly diagnosed cancer and causes more deaths than any other cancer. In Egypt;it accounts for 7% of male cancer & 3% in females. It is considered to be 3rd most common cancer in Egyptian males & 6th most common of both sexes. Materials and Methods: A total of 99 advanced non-small cell lung cancer patients who underwent first line platinum containing chemotherapy in our institute were included in this study. All clinical and pathological data were collected from patient’s files retrospectively between 2012-2014. Results: All 99 cases were diagnosed at late stage IIIB-IV (59 cases were IIIB).The median age was 54 years (range: 30 - 70) with 53% of cases are ≥ 54 years. 71% were males with male: female ratio of 2.4:1. All male patients were chronic smokers. The most frequent symptom was coughing (68%). Most of the patients had primary lung cancer in the right lung (77%). The most common histological subtype was squamous cell carcinoma (35.4%) with 54 cases present with PS-I, the remain was PS-II. All cases received platinum containing chemotherapy. The majority of cases experienced a progressive disease 60.6%. The median progression free survival (PFS) was 6 months & median overall survival (OS) was 18 months. We found that PS, disease stage, pathological subtypes and response to treatment statistically affect both median OS & PFS. Age affects only OS. Conclusions: Our analysis suggests that some of clinico-pathological factors & response to first line platinum containing regimens affect both OS & PFS of advanced NSCLC. This may be beneficial as prognostic markers and further studies were needed to aid in identification and treatment of these patients.
文摘Background: Gastric cancer is the third most incident malignancy and the fifth leading cause of death in the world. In Brazil, it is the fourth most common tumour in men and the fifth in women. Familial aggregation of this tumour is being studied and discussed by experts. Aim: Determine the frequency of family history of cancer in patients with gastric cancer, suggesting familial aggregation or increased risk for hereditary cancer syndromes. Methods: This is a retrospective cross-sectional study carried out from January 2011 to March 2015 at the Department of Abdominal and Pelvic Surgery of the Brazilian National Cancer Institute (INCA). Data were collected from electronic medical records and analyzed using SPSS Statistics? version 20. Results: 873 patients with gastric adenocarcinoma were analyzed. A family history of cancer was reported by 451 patients (51.6%), which reported cancer in 878 relatives, of which 110 (12.6%), reported having more than three relatives with any type of cancer. The most prevalent malignancies among these relatives were gastric cancer (21.3%) and breast cancer (9.5%). Conclusion: Most of the patients had cancer family history, being gastric cancer the most common. The high percentage of cancer family history confirms the importance of collecting this information, whose lack reflects professional negligence, as family history study can serve as a low-cost tool, favoring prevention and early diagnosis, situations where morbidity and mortality are smaller, thus reducing health costs and assistance and preserving lives.
文摘Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. The potential to prevent needless laparotomy by means of precise staging is the pouring force behind the use of diagnostic laparoscopy (DL). Objective: To assess the role of laparoscopy and laparoscopic ultrasound (LUS) in proper staging of upper gastro intestinal malignancies, and in potential palliation in advanced cases for pain (by neurolytic celiac plexus block) or gastric outlet obstruction (by laparoscopic bypass surgery). Study design: In this prospective study, 62 patients with lower esophageal, gastric and peri-pancreatic carcinomas were joined after written informed consent. All patients were examined with laparoscopy and LUS with the help of frozen section analysis to any doubtful metastatic site, peritoneal fluid and ascitic fluid analysis. Results: DL helped us to avoid needless laparotomy in 22.5% of patients, reducing its post-operative complications, hospital stay and cost. DL also helped us to do palliative management either in the form of gastric bypass or laparoscopic celiac plexus block. Conclusion: we praise the use of DL as a safe, effective and complimentary method to the other routine imaging modalities, in proper staging and palliation for upper gastrointestinal malignancies.
文摘Background: Reviewing and analyzing the Clinico-pathologic aspects of non-melanoma skin cancer of the head and neck (NMSCHN), type of management, prognostic factors, and disease-free survival (DFS) in a period of 5 years at the National Cancer Institute—Cairo University—Egypt. Materials and Methods: A retrospective study of two hundred patients with NMSCHN was treated at the National Cancer Institute—Cairo University—Egypt from January 2008 to December 2012. The mean follow-up was 6 months (1 - 84 months). Results: 117 males and 83 females with 90% ≥ 50 years old. The scalp (27.5%), the periorbital region (13%), the cheek (12.5%) and the nose (12.5%) are the main anatomical sites affected. BCC represented 71.5% with nodular type (79%) predominance;SCC represented 21% with GII (61.1%) the commonest grade. Surgery was the main modality of treatment (93%) with local flaps only (63.9%) and primary closure (14.7%) were the main surgical options following wide local excision. Positive and close margins were detected in 23.5% of excised specimens. No significant association was found between disease-free survival (DFS) and pathology, treatment modality, the occurrence of complications or safety margin status. Conclusion: NMSCHN lesions should be surgically excised in specialized high volume centers with readily available peripheral margin control and should be operated by senior experienced surgeons.
文摘Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.
文摘Purpose: To evaluate treatment outcomes and prognostic factors of pediatric Medulloblastoma (MB) patients treated by adjuvant post-operative riskadapted radiotherapy (RT) and chemotherapy (CT). Patients and Methods: A retrospective analysis was conducted based on medical records of pediatric patients with pathologically confirmed MB treated between 2006 and 2013 at the National cancer Institute (NCI), Egypt. Various patients’ and disease characteristics, treatment details and outcome data were reviewed. Results: Fifty patients’ records were included in the analysis with a median age of 6 years at diagnosis (range 3 - 18). According to the Chang staging system;38%, 44%, 4%, and 14% were M0, M1, M2, and M3, respectively. All patients underwent primary surgery;gross total resection (with no residual) in 38%, near total resection (with residual ≤1.5 cm2) in 8%, subtotal resection (with residual > 1.5 cm2) in 34%, and 20% had only biopsy. All patients were treated by riskadapted craniospinal irradiation (CSI);high-risk patients were treated by CSI 36 Gy/20 fractions over 4 weeks followed by posterior fossa (PF) boost 18 Gy/10 fractions over 2 weeks (180 cGy per fraction), while standard-risk patients were treated by CSI 23.4 Gy/13 fractions over 2 and half weeks followed by PF boost 30.6 Gy/17 fractions over 3 and half weeks. Median overall treatment time (OTT) was 52 days. All patients received adjuvant CT;47 patients (94%) received concomitant chemo radiotherapy (CCRT), while 4 patients (8%) only received neoadjuvant CT (NB: only one patient received all neoadjuvant, concomitant and adjuvant CT). With a median follow up time of 32.5 months, ranging from 6 to 104 months, the whole group estimates of the overall survival (OS) at 1, 3, and 5 years were 83%, 70%, and 64%, respectively, while, the progression-free survival (PFS) rates at 1, 3, and 5 years were 79%, 62%, and 57% respectively. Four patients relapsed. Neural-axis was the commonest site of relapse (3 patients). Both risk groups were equally represented in relapsed patients (2 standard risk & 2 high risk patients) and relapse took place within 2 years. In univariate analysis, performance status,extent of surgery, and post-operative residual tumor size were significant prognostic factors for OS. On the other hand, factors which affected the PFS included gender, extent of surgery, and post-operative residual tumor. Conclusion: Neural-axis relapse was the commonest site of relapse for pediatric MB patients. Extent of surgical resection, post-operative residual tumor, and gender are powerful prognostic factors. Maximal safe resection is the standard surgical approach for MB patients to achieve cure.
文摘Background: Ureterosigmoidostomy was the first form of continent urinary diversion and had broad popularity during the first half of the 20th century. Primary enthusiasm was followed by disappointment when serious problems such as pyelonephritis, electrolyte imbalance, renal calculi and renal function deterioration become evident. In the 1950s these life threatening complications led to avoid this urinary diversion in favor of uretro-intestinal conduits. Objectives: Our aim was to evaluate our experience in ureterocolic shunt after radical cystectomy for bladder cancer. Methodology: This study was conducted in surgical oncology department, South Egypt cancer institute, Assiut university;in the period from January 2012 to January 2017 and including 115 patients (75 males & 40 females). Results: This is retrospective study including 115 patients (75 males & 40 females). Operative time was 130 minutes ranging between 2 to 2.5 hours. Average blood loss was 450 ml. After removal of rectal tube all patients were continent except 15 patients who were improved after 1 - 3 days. Within a month 12 patients had night incontinence and 5 patients had day time incontinence. After that day and night continence gradually improved in all patients except two females who had persistent night soiling and was in need for night time rectal tube. Conclusion: Ureterosigmoidostomy regains the interest of surgical oncology and urologist because of its simplicity and absence of appliance as many patients refusing cutaneous stoma and others are not suitable for orthotopic substitutes.
文摘Objective The purposes of this study were to(1) assess the clinicoepidemiological characteristics of esophageal cancer patients,(2) analyze the prognostic factors determining treatment failure and survival, and(3) evaluate the results of various treatment modalities for locoregional and disseminated disease and their effect on disease-free survival and overall survival(OS).Methods Clinicoepidemiological retrospective data from 81 esophageal cancer patients treated at the National Cancer Institute of Cairo between 2007 and 2011 were evaluated. Results The study showed that patients with esophageal cancer commonly present with locally advanced disease(87.7% had T-stage 3 and 12.3% had T-stage 4). There was a significant correlation between surgery and survival; patients who received radical surgery and postoperative radiation had a better median survival than patients who received radical radiotherapy(20 months vs. 16 months, respectively; P = 0.04). There was also a significant statistical correlation between radical concomitant chemoradiotherapy(NCRT) and palliative treatment. Patients who received radical NCRT had a better median survival than patients who received palliative radiotherapy(16 months vs. 10 months, respectively; P = 0.001). The median follow-up period for all patients was 7 months. The median OS of the whole group was 12 months. The OS after 1 and 2 years was 57.8% and 15%, respectively.Conclusion High-dose NCRT is an acceptable alternative for patients unfit for surgery or with inoperable disease. High-dose radiation is more effective than low-dose radiation in terms of local control, time to relapse, and OS. Further study using a larger series of patients and introducing new treatment protocols is necessary for a final evaluation.
文摘Background: Hepatocellular carcinoma is a great problem that poses a huge burden upon any healthcare system. In Egypt it has shown a doubling in its incidence rate. This study intended to assess the different prognostic factors for the overall survival of HCC patients in Egypt. Study Design: This is a retrospective patients’ charts review of all patients (561) admitted to the National Cancer Institute (NCI), Cairo University with HCC from January 2007 to December 2011. The main outcome measures were the median overall survival. Also, all demographics, clinicopathological variables, laboratory data were tested as prognostic factors for the overall survival. Results: The median overall survival of our patients was seven months. The overall actuarial probability of survival during the follow-up period was 65% of patients at six months, 25% of patients at 12 months, 11% of patients at 18 months, and only 3% of patients at 24 months. In our study, a broad range of clinical, laboratory, tumor parameters, and demographic data of patients had shown statistical significance in univariate analysis. However, when all these significant factors in the univariate analysis were further analyzed by stepwise multivariate regression analysis which revealed that only age less than 60, non-symptomatic cases, AFP less than 400, no PV thrombosis, no portal HTN, no ascites, no metastasis and potentially curative therapy were prognostic factors for the overall survival. Conclusion: Among all detected prognostic factors, only, management therapy is modifiable, other factors are non-modifiable. Thus, for HCC, the earlier the diagnosis and intervention, the better is the prognosis and outcome. Therefore, US screening and follow-up of high-risk groups are a must for early diagnose and better outcome.
文摘Background: The current treatment for pseudomyxoma peritonei (PMP) consists of radical cytoreductive surgery (CRS) followed by hyperthermic intra-peritoneal chemotherapy (HIPEC). Aim: To assess PMP patients regarding the clinical and pathological characteristics, the treatment including surgery (CRS) and chemotherapy either HIPEC type or post-operative systemic chemotherapy aiming to evaluate end results regarding recurrence and survival. Patients and Methods: This retrospective study included 39 patients with PMP who were diagnosed, treated and followed-up from 2009-2014 at National Cancer Institute, Cairo, Egypt. Results: High grade mucinous adenocarcinoma was found in 23.1% of patients. Patients with low grade tumor showed higher survival rate compared with patients with high grade disease. The mean operative PCI score (peritoneal cancer index) that was done to all patients who were explored was 15.81. Our study reported success to achieve complete cytoreduction that was combined with HIPEC in 44% of patients who were planned for this modality. Treatment related postoperative grade (3 - 5) complications mainly surgery related developed in 17.3 of patients. Operative mortality was 22.2%. The follow up period in our study was quite short (mean 22.9). However the overall survival at the end of the follow up in our study was 48.7%, 1 year survival was 82%, and 2 year survival was 41%. The overall survival in patients treated with CRS and HIPEC was 66.6%, with 1 year and 2 year survival of 91% and 66.6% respectively. Only 2 patients developed recurrent disease during the follow up period. Conclusions: The outcome of PMP treatment process is extremely variable. Combined CRS and HIPEC is considered the best therapeutic approach for patients with PMP. Surgical experience combined with proper patient selection have to be built up together to improve the outcome. That could only be achieved through more centralization of patients’ treatment in specialized units or center.
文摘Risk stratification allows tailoring of treatment protocol using, for selected patients, reduced total chemotherapy exposure, including decreases in alkylator therapy and avoidance of agents with recognized risk of late complications (anthracyclines), elimination of irradiation and reduction of radiotherapy dose. Patients and Methods: Twenty-nine newly diagnosed pediatric rhabdomyosarcoma patients attended the pediatric oncology department between January 2008 and May 2011. Patients were divided into 3 groups according to age, stage, group, pathology and site of the tumor. Treatment protocol tailored according to risk group. Results: Twenty-nine newly diagnosed pediatric rhabdomyosarcoma patients were evaluated. Seven patients had low risk, Intermediate risk included 12 patients, and 10 patients had high risk. After three years median follow up, event free survival was 51.7% for all patients however it was 86%, 67% and 10% for low, intermediate and high risk respectively (P = 0.0002). There was statistical difference for survival among different sites, histology, clinical group and stage as risk factors within each risk group, no statistically survival significance of any of these factors within the same risk group. Conclusion: Risk stratification is the best single predictor factor for pediatric rhabdomyosarcoma and allows tailoring of the treatment protocol. For selected patients, reductions in total chemotherapy exposure, elimination of irradiation in selected low risk patients and reduction of radiotherapy dose according to postoperative margin and nodal status is safe.
文摘Purpose: Adjuvant radiation therapy could reduce loco regional failure, but currently has no defined role because of previously reported morbidity. NCI-Cairo routine work is to give adjuvant PORT for locally advanced bladder carcinoma patients. The aim of this work is to re-evaluate this protocol regarding its effect on prognosis and complications. Patients and Method: A retrospective study included 208 patients with pathologically proven bladder cancer who presented to the NCI, Cairo University from 2007-2011. All of them underwent RC with bilateral PLND followed by conventional post-operative radiotherapy in 2 - 6 weeks after surgery for 5000 cGy in 25 fractions, over 5 weeks using 2D technique. Analysis of data from their files was done for the treatment results, prognostic factors and complications. Results: Three years overall survival (OS) and disease free survival (DFS) for the whole group was ~60%, and 54% respectively in favour of the female gender, non-smokers, Squamous cell carcinoma patients, low grade tumours (grade 1 and 2) negative margins, N0, pT2b and early stage group showed the best prognoses. The 3 years metastases free survival (MFS) was ~71%. Only four factors showed a significant relation with the MFS which were the grade, LN status, T-stage and group staging. The local recurrence rate (LRC) at 2 years for the whole group was ~95% and 94% at 3 years. Only surgical margin status and extent of LN dissection had a significant impact on the LRC. Conclusions: Adjuvant radiotherapy shows sustained improvement in the loco regional control, and should be recommended for patients with locally advanced disease especially those with less than 10 dissected lymph nodes and those with positive margins.
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Colon cancer (CC) ranks as the third most common cancer worldwide and is considered the second leading cause of cancer death. Recently, many international studies have made the observation that right and left colon cancer have many significant differences regarding clinico-pathological </span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">characteristics and primary tumor location has a crucial impact on treatment outcomes and overall survival. Our study was conducted to verify the presence of significant differences between right and left colon cancer. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">This study is a retrospective cohort study which aimed at comparing right and left colon cancer as regards clinico-pathological data and treatment results among patients with colon cancer receiving treatment at South Egypt Cancer Institute (SECI) during the period from 1/2008 to 12/2018. A sample size of 160 cases of colon cancer patients (80 diagnosed as right colon cancer and 80 diagnosed as left colon cancer) was randomly selected from our South Egypt Cancer Institute (SECI)’s tumor registry. Statistical analysis was done using SPSS program version 20. Difference was considered statistically significant at P-value < 0.05. Survival curves were conducted using the Kaplan-Meier methods and were compared with the log-rank test. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Right colon cancer occurred at an older age and was more commonly presented with abdominal pain while left colon cancer was more commonly presented with bleeding manifestations. More cases of the right side underwent curative surgeries whereas more palliative surgeries were performed to left-sided cases. Left sided cases were associated with a more advanced stage at diagnosis while right-sided cases were associated with a better response to first-line chemotherapy. More cases of the left side died due to metastatic disease. On the other hand, our findings demonstrated no differences between both sides regarding gender predilection, risk factors, sites of metastases, number of metastatic organs, histo-pathological examination and grading, response to second- or third-line chemotherapy, chemotherapy toxicity (hematological or non-hematological), overall survival, progression-free survival, or disease-free survival. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Primary tumor location of colon cancer has a significant effect on clinico-pathological characteristics and treatment outcomes.</span></span></span></span>
文摘Background: Colorectal carcinoma usually arises from an adenomatous polyp and observational studies suggest that the adenoma-to-carcinoma sequence takes approximately 10 to 15 years. Risk factors are adoption of westernized diets, obesity, cigarette smoking, and alcohol and reduced physical activity. Clinical Presentations are blood per rectum, abdominal pain, Anemia, change in bowel habits and bowel obstructive symptoms. The treatment of colorectal cancer is a dependent stage which includes chemotherapy, radiotherapy, surgery or both. Objective: This study aims at describing the clinical pathological characteristics of colorectal carcinoma and factors influencing survival among patients treated at Ocean Road Cancer Institute. Methods: This was a cross sectional study that involved histological confirmed colorectal carcinoma treated at Ocean Road Cancer Institute from 2010-2015. Results: Among 100 files extracted, 63% were males and 37% females. 21% were below 40 years of age. Left-sided tumor accounted for 46%. Abdominal pain, rectal bleeding and constipation were 72%, 68% and 55% respectively. Moderately differentiated adenocarcinoma accounted for 80%. Patients presented at stage III and IV were 37% and 56% respectively. Colostomy was the most surgical procedures performed. Folinic acid, Fluorouracil and Oxaliplatin were the most common chemotherapies used. Median overall survival was estimated to be 9.4 months. Conclusion: A significant proportion of patients in this study population are young. Survival from colorectal cancer is poor owing largely to the late presentation seen in this study group.
文摘Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural injury. No other effective therapeutic alternative to surgery exists. Cervicotomy is still the surgical approach of choice, although a form of sternotomy may always be necessary for field extension and safe gland delivery. Materials and Methods: This is a single institution combined retrospective & prospective study including retrospective analysis of all cases presenting to the NCI, Cairo University with RG candidate for surgery between Jan. 2008 until the end of Dec. 2012, and a prospective study of all cases with the same presentation presenting to the NCI between Jan. 2013 until the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the clinico-pathological characteristics, the presentation, work-up, surgical approaches and postoperative complications of RG. Results: 42 patients were included & were divided into benign (34 patients, 80.9%) and malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19 to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration of symptomatology was 23 months ranging (6 - 53 months). 23 patients (54.7%) were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients (73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy & 4 cases (9.5%) received postoperative radioactive iodine. No perioperative mortality occurred & the overall morbidity was 6 cases (14.2%) in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The median follow up period was 17.5 months. The median overall survival (OS) was 39.4 months and the median disease free survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy is a safe favorable approach to remove a RG. Intraoperative field extension up to a form of sternotomy may be necessary for gland delivery with increasing operating time, hospital stay and morbidity. Postoperative morbidity is mainly due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism which is mainly increased when sternotomy is performed.
文摘Background: Carcinoma of the male breast is relatively a rare disease accounting for about 1% of all cancer in men. Its treatments are based mainly on those of Female Breast Cancer (BCF). Materials and Methods: This is a single institution retrospective study including all presenting to the NCI, Cairo University with Breast Cancer in a Male (BCM) in the last 11 years between Jan. 2005 until Jan. 2016. Data were collected from patient’s files from the statistical department then analyzed. Aims: To study the clinico-pathological characteristics, the presentation, workup, surgical approaches and postoperative complications and outcome of management, with addressing similarities and difference from BCF. Results: 64 patients were included in this cohort. The mean age was 58.6 & the median age was 59 years (range: 31 - 87 years). The main presenting symptomatology was retroareolar breast lump (50 cases, 78.1%). Most of our cases were advanced;22 cases (34.3%) were stage III & 16 cases (25%) were stage IV. Surgery was performed for 50 patients;MRM for 26 cases (40.6%), RM for 18 cases (28.1%) & toilet mastectomy for 6 cases (9.3%). Primary closure was feasible in 34 patients (68%) while 16 cases (32%) required reconstruction by local or pedicled flaps. Tamoxifen is the most important non-surgical treatment. It was given to all our cases (64 cases, 100%) either postoperatively as adjuvant management (36 cases, 56.2%) or as palliation for metastatic disease (28 cases, 43.8%). Chemotherapy was given to 32 patients (100%) as an adjuvant for 24 cases (75%) and as a palliation for 8 cases (25%). Radiotherapy was given to 26 patients (100%) as adjuvant therapy for 20 cases (76.9%) and as a palliation for 6 cases (23.1%). The only significant factor determining the overall 5 years survival was the stage of the disease. LN status & surgery type were of border line significance (better survival with negative LN & with MRM). The 5-year Overall Survival (OS) & Disease Free Survival (DFS) for the whole group were 66% & 52% respectively. Within the DFS there was no significant variable;however, the stage and type of surgery were of borderline significance, with better survival with early stage disease (I & II) and with MRM (both were 61%). Conclusion: BCM has many similarities to BCF, but it harbours many different genetic and pathologic features. They obtain similar prognostic factors and similar stage-for-stage survival. They are always advanced to T4 stage rapidly due to the lack of breast parenchyma with higher ER expression in BCM than BCF patients.
文摘Background: Askin tumor is a primitive neuroectodermal tumor of the Ewing sarcoma family arising from soft tissues of the chest wall. It is the commonest chest wall malignancy in children and adolescents. Its diagnosis is complex and management requires a multidisciplinary work including chemotherapy for systemic disease and radiation therapy to assist local control which is achieved through surgery with or without reconstruction. Objective: To analyze report and understand the clinicopathological features, results and outcome of this tumor with assessment of early and late postoperative complications following resection and chest wall reconstruction. Materials and Methods: This is a retrospective analysis of 30 cases with chest wall ES/PNET presented to the National Cancer Institute;Cairo University between January 2011 and December 2015. All patients’ records were revised for age, sex, clinical presentation, imaging, pathology, operative notes, different treatment modalities given, early and late postoperative complications following surgical resection or reconstruction, and outcome including overall survival (OS) and disease free survival (DFS). Results: Our cohort included 30 patients with chest wall ES. The median follow up period (n = 30) was 33.7 months (ranging from 3.7 to 69.3 months). The median OS was 54.2 months with cumulative OS at 60 months which was 45.6%. The median DFS was 27.9 months with cumulative DFS at 60 months which was 40.6%. All cases were below 18 years with a male predominance (n = 19). The commonest affected sites were ribs (n = 22, 73.3%), the scapula (n = 5, 16.6%), the clavicle (n = 2, 6.66%) and the sternum (n = 1, 3.33%). 23 patients (76.6%) were presented with localized disease, and 7 patients (23.4%) were metastatic from the start. All patients received neoadjuvant chemotherapy (4 cycles of VAC/IE) followed by local control: either surgery (26 cases, 86.6%) or radical radiotherapy (3 cases, 10%). A single case of a rib ES with initial bilateral lung deposited where no local control was done. After chest wall resection, closure of the defect was done by 1 ry closure with no reconstruction or double layer prolene mesh and bone cement that was covered by pedicled flap (latissimus dorsi, serratus anterior or pectoralis major muscle flap). Postoperative radiation therapy was given to 9 patients: 4 (13.3%) had postoperative poor chemotherapy effect (<90% tumor necrosis), 3 (10%) had +ve microscopic safety margin and 2 (6.6%) had pleural based nodules with malignant pleural effusion at initial presentation. Conclusion: Askin’s tumor shows a dramatic response to polychemotherapy. Treatment of such tumor should include multidisciplinary working groups for optimum results and better survival.
文摘This study aimed at investigating the relationship between coping and caregiving satisfaction among informal cancer caregivers in Ugandan referral hospitals. A convenient sample of 436 consenting informal care givers aged 18 years and above were interviewed;a cross-sectional design was used. Because of the difficulty in defining a fixed population for this category of care givers, whoever was found at the bed side meeting the inclusion and exclusion criteria were recruited into the study. A tri-dimensional coping scale (namely;problem solving, denial and venting) was used to measure coping. After controlling for all the relevant covariates (Patient’s age, sex of care giver, education of caregiver, respondent’s age, respondent’s education level, respondent’s education, respondent’s country of origin, respondent’s religion, stage of cancer, score on burnout scale), the venting aspect of coping had a significant effect on caregiving satisfaction (F = 1.83, P-value = 0.03). The above covariates accounted for 41.3% of the variability in care giving satisfaction scores (R<sup>2</sup> = 0.413). Venting as a coping mechanism had a significant effect on caregiving satisfaction. There is need to pay attention to the coping strategies of informal cancer caregivers to enhance their care giving experience. There is need to help caregivers develop healthy coping methods as they participate in cancer care.
文摘One of the quintessential challenges in cancer treatment is drug resistance.Several mechanisms of drug resistance have been described to date,and new modes of drug resistance continue to be discovered.The phenomenon of cancer drug resistance is now widespread,with approximately 90% of cancer-related deaths associated with drug resistance.Despite significant advances in the drug discovery process,the emergence of innate and acquired mechanisms of drug resistance has impeded the progress in cancer therapy.Therefore,understanding the mechanisms of drug resistance and the various pathways involved is integral to treatment modalities.In the present review,I discuss the different mechanisms of drug resistance in cancer cells,including DNA damage repair,epithelial to mesenchymal transition,inhibition of cell death,alteration of drug targets,inactivation of drugs,deregulation of cellular energetics,immune evasion,tumor-promoting inflammation,genome instability,and other contributing epigenetic factors.Furthermore,I highlight available treatment options and conclude with future directions.
