Purpose: To study the dosimetric characteristics of amorphous silicon Electronic Portal Imaging Device EPID and 2D array detector for dose verification of radiotherapy treatment plans, and the quality assurance QA tes...Purpose: To study the dosimetric characteristics of amorphous silicon Electronic Portal Imaging Device EPID and 2D array detector for dose verification of radiotherapy treatment plans, and the quality assurance QA testing of IMRT was investigated. Materials and methods: All measurements were done with Varian IX linear accelerator, aSi-1000 EPID and 2D array detector. The dose linearity, reproducibility, output factors, dose rate, SDD and response with slap phantom thickness have been measured and compared against those measured by ion chamber. Results: The characteristics of EPID and 2D array: the response of EPID agreed with 2D array and ion chamber 0.6cc. EPID and 2D array showed short-term output reproducibility with SD = 0.1%. The dose rates of 2D array SD = ±0.7%, EPID = ±0.4% compared with a 0.6 cc SD = ±0.5%. Output factor measurements for the central chamber of the EPID and 2D array showed no considerable deviation from ion chamber measurements. Measurement of beam profiles with the EPID and 2D array matched very well with the ion chamber measurements in the water phantom. The EPID is more sensitive to lower energy photons by increasing solid water phantom thickness. The mean and standard deviation passing rates (γ%≤1) for film, 2D array and EPID for 30 IMRT fields of five patients were 95.93 ± 0.96%, 99.05 ± 0.24%, and 99.37 ± 0.12%, respectively. Conclusion: The study shows that EPID and 2D array are a reliable and accurate dosimeter and a useful tool for quality assurance. We found that the EPID was more accurate compared with both 2D array and ion chamber. The gamma criterion of 3%/3 mm is the most suitable criteria for IMRT plans of QA.展开更多
Objective： Gene expression profiling of breast cancer has identified five molecularly distinct subtypes of breast cancer that have different biological behavior and clinical outcomes. These subtypes are termed lumina...Objective： Gene expression profiling of breast cancer has identified five molecularly distinct subtypes of breast cancer that have different biological behavior and clinical outcomes. These subtypes are termed luminal A, luminal B, luminal HER2, HER2-enriched and triple negative breast cancers （TNBC）. We aimed at identification of breast cancer subtypes among Egyptian population and their clinicopathologic features using ER, PR and HER2, KJ-67 and CK5/6. Methods： Tumors from 100 patients with invasive duct carcinoma were subtyped by immunohistochemistry using ER, PR, HER2, Ki-67 and CK5/6. The prognostic value of the immunohistochemical assignment for breast cancer disease-specific survival was inves- tigated by using Kaplan-Meier curves. Results： Immunohistochemical profiling classified 22 cases as luminal A, 33 cases as luminal B, 9 cases as luminal HER2, 26 cases as HER2-enriched and 10 cases as TNBC. Tumors that measured more than 3.5 cm, showed predominance of HER2-enriched subtype. HER2-enriched and luminal B subtypes dominated the node positive cases （35.4% and 33.8%; respectively）. Large tumor size （〉 3.5 cm）, hormone receptor negative state and HER2 positive state were associated with poor prognosis. Disease free survivals （DFSs） were significantly different （P 〈 0.0001） among different breast subtypes with worst 2-year DFS for HER2-enriched subtype （40.77%） followed by luminal A （63.56%）. DFS was almost similar in the remaining other subtypes, and luminal B, luminal HER2 and TNBC which were 86.85%, 87.5% and 88.89%; respectively. Conclusion： ER, PR, HER2 and Ki-67 constituted a strong surrogate for molecular breast cancer subtypes and can be easily applied. HER2-enriched subtype carries worse features being associated with large tumor size, nodal metastasis and is associated with poor outcome. Luminal A is a heterogeneous subtype with underlying several factors that can turn its prognosis adversely. TNBC subtype may behave unexpected in a favorable way.展开更多
Objective： Postmenopausal women with breast cancer are at increased risk of bone loss because of age related estrogen deficiency face which accelerated with the use of aromatase inhibitors （AIs）. We aimed to study ...Objective： Postmenopausal women with breast cancer are at increased risk of bone loss because of age related estrogen deficiency face which accelerated with the use of aromatase inhibitors （AIs）. We aimed to study the effect on bone mineral density （BMD） and bone formation biomarker osteocalcin level in postmenopausal breast cancer patients, for the first three years of adjuvant hormonal treatment of both groups Tamoxifen versus Anastrozol. Methods： One-hundered postmenopausal breast cancers were prospectively randomized to receive either Tamoxifen 20 rag/day （n = 50） or Anastrozole 10 mg （n = 50）. Both BMD and osteocalcin were assessed initially before treatment and then at regular intervals for both groups. Results： Use of Tamoxifen was associated with significant annual decrease in osteocalcin （P = 0.001）, whereas Anastrozole group had gradual increase of the annual levels （P 〈 0.01）. BMD decreased significantly in Anastrozole versus Tamoxifen groups （2.6% vs. 0.4%, P 〈 0.001）. Osteoporosis T 〈 -2.5 was reported significantly higher in Anastrozole group （P 〈 0.01）. Women with initial osteopenia in Anastrozole group showed significant decrease in BMD （P 〈 0.05）. The addition of bisphosphonate for patients with early osteoporosis markedly improved both osteocalcin level and BMD. Conclusion： Tamoxifen preserves BMD in postmenopausal breast cancer patients, whereas Anastrozole accelerates age associated fall in BMD especially in the first year of therapy, moreover, the addition of bisphosphonate can help to decrease the skeletal related events associated with treatment to ensure better quality of life with treatment.展开更多
Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidit...Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was34 mm. The surgical procedure through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy 70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%, anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection 95.1%. Pathologic complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal margin20 mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal cancer. Oncologic and functional, outcomes after are acceptable.展开更多
文摘Purpose: To study the dosimetric characteristics of amorphous silicon Electronic Portal Imaging Device EPID and 2D array detector for dose verification of radiotherapy treatment plans, and the quality assurance QA testing of IMRT was investigated. Materials and methods: All measurements were done with Varian IX linear accelerator, aSi-1000 EPID and 2D array detector. The dose linearity, reproducibility, output factors, dose rate, SDD and response with slap phantom thickness have been measured and compared against those measured by ion chamber. Results: The characteristics of EPID and 2D array: the response of EPID agreed with 2D array and ion chamber 0.6cc. EPID and 2D array showed short-term output reproducibility with SD = 0.1%. The dose rates of 2D array SD = ±0.7%, EPID = ±0.4% compared with a 0.6 cc SD = ±0.5%. Output factor measurements for the central chamber of the EPID and 2D array showed no considerable deviation from ion chamber measurements. Measurement of beam profiles with the EPID and 2D array matched very well with the ion chamber measurements in the water phantom. The EPID is more sensitive to lower energy photons by increasing solid water phantom thickness. The mean and standard deviation passing rates (γ%≤1) for film, 2D array and EPID for 30 IMRT fields of five patients were 95.93 ± 0.96%, 99.05 ± 0.24%, and 99.37 ± 0.12%, respectively. Conclusion: The study shows that EPID and 2D array are a reliable and accurate dosimeter and a useful tool for quality assurance. We found that the EPID was more accurate compared with both 2D array and ion chamber. The gamma criterion of 3%/3 mm is the most suitable criteria for IMRT plans of QA.
文摘Objective： Gene expression profiling of breast cancer has identified five molecularly distinct subtypes of breast cancer that have different biological behavior and clinical outcomes. These subtypes are termed luminal A, luminal B, luminal HER2, HER2-enriched and triple negative breast cancers （TNBC）. We aimed at identification of breast cancer subtypes among Egyptian population and their clinicopathologic features using ER, PR and HER2, KJ-67 and CK5/6. Methods： Tumors from 100 patients with invasive duct carcinoma were subtyped by immunohistochemistry using ER, PR, HER2, Ki-67 and CK5/6. The prognostic value of the immunohistochemical assignment for breast cancer disease-specific survival was inves- tigated by using Kaplan-Meier curves. Results： Immunohistochemical profiling classified 22 cases as luminal A, 33 cases as luminal B, 9 cases as luminal HER2, 26 cases as HER2-enriched and 10 cases as TNBC. Tumors that measured more than 3.5 cm, showed predominance of HER2-enriched subtype. HER2-enriched and luminal B subtypes dominated the node positive cases （35.4% and 33.8%; respectively）. Large tumor size （〉 3.5 cm）, hormone receptor negative state and HER2 positive state were associated with poor prognosis. Disease free survivals （DFSs） were significantly different （P 〈 0.0001） among different breast subtypes with worst 2-year DFS for HER2-enriched subtype （40.77%） followed by luminal A （63.56%）. DFS was almost similar in the remaining other subtypes, and luminal B, luminal HER2 and TNBC which were 86.85%, 87.5% and 88.89%; respectively. Conclusion： ER, PR, HER2 and Ki-67 constituted a strong surrogate for molecular breast cancer subtypes and can be easily applied. HER2-enriched subtype carries worse features being associated with large tumor size, nodal metastasis and is associated with poor outcome. Luminal A is a heterogeneous subtype with underlying several factors that can turn its prognosis adversely. TNBC subtype may behave unexpected in a favorable way.
文摘Objective： Postmenopausal women with breast cancer are at increased risk of bone loss because of age related estrogen deficiency face which accelerated with the use of aromatase inhibitors （AIs）. We aimed to study the effect on bone mineral density （BMD） and bone formation biomarker osteocalcin level in postmenopausal breast cancer patients, for the first three years of adjuvant hormonal treatment of both groups Tamoxifen versus Anastrozol. Methods： One-hundered postmenopausal breast cancers were prospectively randomized to receive either Tamoxifen 20 rag/day （n = 50） or Anastrozole 10 mg （n = 50）. Both BMD and osteocalcin were assessed initially before treatment and then at regular intervals for both groups. Results： Use of Tamoxifen was associated with significant annual decrease in osteocalcin （P = 0.001）, whereas Anastrozole group had gradual increase of the annual levels （P 〈 0.01）. BMD decreased significantly in Anastrozole versus Tamoxifen groups （2.6% vs. 0.4%, P 〈 0.001）. Osteoporosis T 〈 -2.5 was reported significantly higher in Anastrozole group （P 〈 0.01）. Women with initial osteopenia in Anastrozole group showed significant decrease in BMD （P 〈 0.05）. The addition of bisphosphonate for patients with early osteoporosis markedly improved both osteocalcin level and BMD. Conclusion： Tamoxifen preserves BMD in postmenopausal breast cancer patients, whereas Anastrozole accelerates age associated fall in BMD especially in the first year of therapy, moreover, the addition of bisphosphonate can help to decrease the skeletal related events associated with treatment to ensure better quality of life with treatment.
文摘Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was34 mm. The surgical procedure through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy 70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%, anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection 95.1%. Pathologic complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal margin20 mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal cancer. Oncologic and functional, outcomes after are acceptable.
