Journal Issue: Vol.11, No.3 - July 2012

Displaying 1 - 10 of 10

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Prognostic Factors and a Survival Score for Patients with Metastatic Spinal Cord Compression (MSCC) from Renal Cell Carcinoma (RCC)

Dirk Rades

  1. Dirk Rades
    MD, PhD
    Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Lubeck, Germany.rn

This study aimed to identify prognostic factors and create a survival score in 142 patients with MSCC from RCC. On multivariate analysis, functional outcome was associated with visceral metastases (p=0.011), interval from cancer diagnosis to MSCC (p<0.001), and time developing motor deficits (p<0.001). Survival was associated with ambulatory status (p=0.004), visceral metastases (p<0.001), interval from cancer diagnosis to MSCC (p=0.002), and time developing motor deficits (p=0.002). Based on these prognostic factors, a survival score was developed. 6-months survival rates of four prognostic groups were 5%, 20%, 72% and 97% (p<0.001). The prognostic factors and the survival score help personalize treatment.

Capecetabine Plus Oxaliplatin as Adjuvant Therapy for Colon Cancer

Wael Makar

  1. Wael Makar
    MD Clinical Oncology
    Kasr EL Aini Centre of Clinical Oncology (NEMROCK) - Cairo University,rn38 Abou Bakr El Sedik St., Dokki, Giza 12411, Egypt.

Background: Adjuvant chemotherapy improves overall survival (OS) in patients with locally advanced, node-positive (stage III) colon cancer. Methods: This study was designed to compare capecitabine/ oxaliplatin (XELOX) with FU/LV/oxaliplatin (FOLFOX4) as adjuvant treatment for patients with high risk stage II and stage III colon carcinoma in terms of toxicity, patient convenience, event-free survival (EFS) and overall survival. Patients were followed up for a median period of 39 months ranging from 30 to 48 months. Results: Sixty four patients were enrolled in each arm. The overall survival at 36 and 48 months for the XELOX group was 73.8% and 62% respectively. While the overall survival for FOLFOX group was 72% and 58% respectively (HR 0.8338, 95%CI= 0.2557-2.719). The difference was not statistically significant. Grade 3/4 neutropenia was more significant with FOLFOX 22% versus 9.4% (p=0.01). XELOX was associated with more G3/4 diarrhea 17.2% versus 11% (p=0.25), and hand and foot syndrome 9.4% versus 1% (p=0.04). Conclusion: This study reveals that XELOX is as effective and safe as FOLFOX and has a manageable tolerability profile in the adjuvant setting with more convenience to the patients.

Advanced Pleomorphic Liposarcomas: Clinical Outcome and Impact of Chemotherapy

Dr. Antoine Italiano

  1. Dr. Antoine Italiano
    Institut Bergonié, 229 Cours de l’Argonne, 33076 Bordeaux cedex, France.

Background: Data regarding the role of systemic therapy in patients with advanced pleomorphic liposarcomas (PLPS) are very limited. Patients and Methods: From 1991 to 2011, 33 patients with advanced PLPS received chemotherapy in two participating institutions. Clinical and pathologic data were collected by reviewing medical records. Results: Median age was 62 years (range 32-84). Combination chemotherapy was delivered in 19 cases (41%) and single agent in 14 cases (59%), respectively. Twentyone patients (64%) received an anthracycline-containing regimen. Using RECIST, the objective response rate was 24%. Median progression-free survival (PFS) and overall survival (OS) were 4 months (95% CI: 3.4-4.7) and 14 months (95% CI: 0-28), respectively. On univariate analysis, performance status > 1 was the sole factor associated with outcome (PFS, OS). Conclusion: Overall survival of patients with advanced PLPS is poor even though this disease appears more chemosensitive than well-differentiated/dedifferentiated liposarcomas which are far more frequent.

Impact of Nodal Status and Tumor Burden in Sentinel Lymph Nodes on the Clinical Outcomes of Cancer Patients

Stanley P.L. Leong

  1. Stanley P.L. Leong
    MD, FACS
    Chief of Cutaneous Oncology, Associate Director of the Melanoma Program California PacificrnMedical Center, Member California Pacific Medical Center Research Institute, 2340 Clay Street, 2nd Floor San Francisco, CA 94115rn

The validation of sentinel lymph node (SLN) concept in melanoma and breast cancer has established a new paradigm in cancer metastasis that, in general, cancer cells spread in a orderly fashion from the primary site to the SLNs in the regional nodal basin and then to the distant sites. In this review article, we examine the development of SLN concept in penile carcinoma, melanoma and breast carcinoma and its application to other solid cancers with emphasis of the relationship between micrometastasis in SLNs and clinical outcomes.

Cancer Treatment in Nepal: A Historical Background, Development of Treatment Facilities, Epidemiology and Challenges for Prevention and Control of Cancer.

Dr. Kalloo Sharma Subedi

  1. Dr. Kalloo Sharma Subedi
    Department of Radiation Oncology, Graduate School of Medicine, Gunma University, 3-39-22,rnShowa-machi, Maebashi, Gunma-371-8511, Japan.

Cancer incidence is increasing and becoming a leading cause of death worldwide. Deaths from cancers continue to increase worldwide, particularly in countries with low and middle income leading to a global burden. The burden of cancer is not less for Nepal. Cancers of lung, uterine cervix, head & neck, breast and stomach are the most common types in Nepal. Due to the high prevalence of tobacco smoking, lung cancer is the commonest in both genders in Nepal and is usually treated palliatively. The majority of cancer patients still attend only 7 major hospitals of the country at an advance stage. Head & neck cancers in both genders and cancer of uterine cervix in females are the most common cancers treated with curative intentions. Elderly patients are more likely to receive palliative treatment rather than curative radiotherapy. Major group of cases have been found between 4th to 7th decades of life in both genders. The cancer registry system of Nepal is very poor. A population-based national cancer registry system does not exist. However, a new cancer registry system supported by WHO was established only in 2005 to collect cancer data from 7 major hospitals. It was a helpful step to gather at least basic data to publish hospital-based reports. Though, there has been recent advancements in cancer treatment, Nepal is still struggling to improve and manage even conventional modalities for cancer treatment despite many socio-economic and political conditions. Due to the poor infrastructure of the health care system, the Nepalese government can hardly support the expensive cancer treatment expenditures. The Government has been conducting major public awareness and screening programs for prevention and control of cancer. Various organizations are co-operating with the Government in this regard.

Mammography Screening Efficacy for Breast- Cancer Detection in Saudi Arabia

Dr. Alice Franklin

  1. Dr. Alice Franklin
    Mouwasat Hospital ,PO Box - 1444, Qatif -31911, Kingdom of Saudi Arabia.

To assess the effectiveness of screening for breast cancer with mammography on mortality and morbidity. This study was carried out in Mouwasat Hospital, Qatif, Saudi Arabia where we screened 1,590 women over a period of two years (February ’10 – February ’12) and mainly took into consideration BI-RADS categories 3-5. Twenty-five suspected cases where then subjected to FNAC of which eleven proved cancerous. We conclude that the availability of screening mammography was associated with a reduction in the rate of death from breast cancer.

Post Surgical Diagnosis of Primary Diffuse Large B Cell Lymphoma Presenting as Splenic Abscess – A Case Report

Dr. Sunil C. Agrawal

  1. Dr. Sunil C. Agrawal
    Sanjeevani Surgical and General Hospital, Bhavani Chambers, Kedarmal Road,rnOff Rani Sati Marg, Malad East, Mumbai-400097

Primary Splenic Lymphoma is very rare, with a reported incidence of less than 1% of all malignant lymphomas. Still rarer is presentation of primary Diffuse Large B Cell Lymphoma mimicking an abscess. A 53 year-old woman presented with left upper quadrant pain and fever for a month. Investigations revealed a splenic abscess with well-defined thick walls. The left kidney was displaced by the lesion. Percutaneous drainage of the abscess first drained purulent material and then only serous fluid. In spite of drainage and appropriate antibiotic therapy, the abscess cavity persisted with only marginal reduction in size. Lower limb venous Doppler study performed three weeks following drainage revealed a new extensive thrombotic lesion in the Right Common Iliac and distal Inferior Vena Cava. The Inferior Vena Cava thrombosis was clinically presumed to be due to sepsis. An Inferior Vena Cava umbrella filter was placed above the thrombus to prevent pulmonary embolism and antithrombotic treatment was initiated. The patient underwent splenectomy for definitive diagnosis and treatment. At surgery, a thick-walled cavity was evident in the lower half of the spleen. There were no peri-splenic/para aortic lymph nodes. Histopathology revealed the lesion to be a Diffuse Large B Cell Lymphoma of the spleen.

Dosimetric Characteristics of IMRT versus 3DCRT for Intact Breast Irradiation with Simultaneous Integrated Boost

Suresh Moorthy

  1. Suresh Moorthy
    Division of Radiation Oncology, Department of Oncology & Hematology, Salmaniya MedicalrnComplex, MOH, Manama, Kingdom of Bahrain.

Background and Purpose: Whole breast irradiation is part of breast conservative management for early breast cancer. Simultaneous Integrated Boost methods are used for head & Neck and Prostate cancers. Most recently SIB for intact breast is gaining interest. In this study we attempt to compare and analyze the dosimetric aspects of Simultaneous Integrated Boost technique (SIB) of IMRT over 3DCRT. Methods: We took the CT simulation data of 27 consecutive patients for our retrospective study to compare the SIB-IMRT and SIB-3DCRT. Dose prescribed was 45 Gy/25 fractions to whole breast (1.8 Gy/Fraction) and 60 Gy/25fractions to Lumpectomy cavity (2.4Gy/Fraction) .The prescribed dose delivered in a 5 fraction per week schedule. Treatment Plans were compared for Target Minimum, Maximum, Mean, Conformity Index, Homogeneity Index and Organs at Risk doses were compared and analysed. Results: The Target coverage was achieved with 95% of prescription to the 95% of the lumpectomy cavity as well as whole breast for all the plans. Dose conformity to the boost volume was significantly higher with IMRT technique; 3DCRT technique showed more dose spillage outside the boost volume. SIB-IMRT better in sparing critical organs parameters like Lung V20 &Mean, Heart V30&Mean, and LAD maximum dose. Conclusion: We infer from our study that both methods achieved adequate target coverage, IMRT reduces maximum doses and improves Conformity and Homogeneity indices of target volumes, also reduces dose to OAR.

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