The gulf journal of oncology最新文献

Cancer is the second leading cause of death in Iraq following heart and cerebrovascular diseases. Assessment of incidence and mortality trends is essential for prioritizing cancer control in the national health policies and plans.

Aim: To determine the patterns and trends in the incidence and mortality of the leading types of cancers affecting the Iraqi population during the last two decades.

Material and methods: This is a descriptive retrospective study based on the available data of the Iraqi Cancer Registry for the years (1999 - 2019). The analyzed information included the annual total number of new cancer cases and cancer deaths during the assigned period categorized by site, age, gender and morphology of each cancer. The data was coded according to Cancer Registry Program 4 (Can Reg4) and the International Classification of Diseases for Oncology (ICD-O). The estimated total annual number of Iraqi populations for the same period was retrieved from the Iraqi Ministry of Planning. The incidence and mortality rates were calculated per 100,000 Iraqi population and classified by ICD-O, site of the tumor, gender and age group.

Results: The overall cancer incidence rate (IR) in 2019 was 91.66/100,000 population (78.14 and 105.46/100,000 in males and females, respectively). The age standardized rate (ASR) was 155.60/100,000. The top five cancers in terms of IR were those of the breast (18.17/100,000; ASR:29.93/100,000), lung (7.24/100,000; ASR:14.81 /100,000), colorectum (5.95/100,000; ASR:10.77 /100,000), brain/CNS (5.83/100,000, ASR:8.39/100,000) and leukemia (5.05/100,000; ASR:6.83/100,000). The peak IR was observed among patients of both genders in the eighth decade of life (1127.37/100,000). The trend of IR for all cancers has significantly increased from 43.95/100,000 in 1999 to 91.66/100,000 in 2019 (more than 100%, p < 0.0001). The highest increase was demonstrated in cancers of the colorectum (from 1.2 to 5.90, p< 0.001), breast (from 6.6 to 18.2, p< 0.001) and brain (from 2.0 to 5.80, p=0.032). On the other hand, the mortality rate (MR) was 28/100,000 population in 2019 (28.45 and 27.55/100,000 in males and females, respectively). The highest MR was observed in cancers of the lung (4.48/100,000), breast (3.16/100,000) and leukemia (2.42/100,000). Whereas a non-significant increase in the mortality trends of leukemia, colorectum, breast and lung cancers were noted, our data revealed a decline in the trend of brain/CNS cancer mortality (from 3.2 to 2.3/100,000).

Conclusions: The top leading cancers in Iraq are steadily increasing in upward trends though they remain lower than the global rates. The underestimated IRs and MRs are possibly attributed to suboptimum registration and missing data due to the lack of a national surveillance system. Efforts should be directed to prioritize the adoption of the national cancer control plan focusing on stre

Purpose: This systematic review aimed to identify the role of Ki-67 as a prognostic factor in estimating tumor grade and the radiation response in meningiomas.

Methods: A systematic search of the literature on meningiomas was carried out through the PubMed, Scopus, and EBSCOhost databases according to the PRISMA guidelines.

Results: Our search resulted in 465 collected articles, 15 of which satisfied the eligibility criteria. Twelve studies reported the correlation between Ki-67 and meningioma grade. Two other investigations reported the relationship between Ki-67 and the radiation response in meningioma, and one failed to capture the association between Ki-67 and the radiation response in meningioma.

Conclusion: The Ki-67 proliferation index has a uniform correlation with meningioma grade. Two of the 3 studies on the correlation of Ki-67 with the radiation response in meningioma patients reported that patients with a higher Ki-67 responded better to radiation therapy.

Persistent Mullerian duct syndrome (PMDS) is a congenital disorder related to male sexual development. PMDS is usually diagnosed during an inguinal hernia cure. The diagnosis of PMDS following a testicular germ cell tumor is less common. We report the cases of three infertile male patients who were diagnosed with PMDS after surgery for germ cell tumors. They were 39, 27, and 37 years old men with a medical history of neglected cryptorchidism. All patients had a male karyotype and the ELISA test for the anti-Mullerian hormone was undetectable. Patients underwent chemotherapy followed by resection of residual mass in one patient. One patient is currently alive and disease-free. The two other patients died of systemic relapse. These cases highlight how early recognition and treatment of PMDS can prevent malignant germ cell tumors. The diagnosis of PMDS relies on a systemic assessment and analysis of mutations in the gene coding for AMH and AMHR-II. Key words: Persistent Müllerian duct syndrome (PMDS), anti mullerian hormone, germ cell neoplasm.

Introduction: The study aim is to determine the association of post-menopausal status with abnormal Pap smear cytology and cervical dysplasia detected by colposcopically-directed biopsy. We also study the association of biopsy-confirmed dysplasia with Pap smear results.

Patients and methods: This retrospective study included 480 women with abnormal Pap smear results who were referred for colposcopy. Covariates considered included demographic (age, race/ethnicity, smoking status), sexual activity (age first sexual intercourse, number lifetime partners, duration current partner), and disease (HIV, high-risk HPV, immunosuppression).

Results: Post-menopausal status was not significantly associated with abnormal Pap smear cytology or cervical dysplasia. We found a statistically significant association of high-grade dysplasia with high-grade Pap smear results: ASC-H (B=3.43, SE=0.84, p< 0.001); HSIL (B=3.50, SE=0.84, p< 0.001) and AGC (B=3.47, SE=1.02, p< 0.01).

Discussion and conclusion: Although clinicians may want to consider not requiring colposcopically-directed biopsy for certain post-menopausal patients, we recommend continuing with current cervical cancer guidelines of screening for all women regardless of menopausal status.

Introduction: Combination of external beam radiotherapy (EBRT) and High Dose Rate (HDR) brachytherapy (BT) with concurrent chemotherapy (Cisplatin 40mg/m2/weekly) is the standard treatment of approach for the carcinoma of uterine cervix. In this study for image based HDR brachytherapy of intracavitary both 192Ir and 60Co sources were used for dosimetry and the dose distribution compared between point doses and volume doses as per the recommendation of ICRU89 and GEC-ESTRO on 3D image based planning. The dosimetry and clinical outcome will decide decisionmaking on choice of radionuclide for HDR brachytherapy of cervix in addition to economic reason.

Materials and methods: The Study conducted for 27 patients of cancer cervix stage IIB or IIIB with vaginal involvement limited to the upper third of vagina. All patients underwent concurrent chemoradiation Cisplatin 40mg/m2 weekly throughout EBRT by 3D conformal therapy 46Gy in 23# followed by two fractions of HDR brachytherapy with 9Gy/1Fr. Post implants 3mm slice selection of pelvic CT scans performed with ring applicator in place followed by T2 weighted paracorpal or paracoronal section of MRI imaging. The solid ring applicator (AL13017000) from library used for applicator reconstruction. Initially all plan calculated with TG-43 formalism using 192Ir radionuclide (Varian, GammaMed HDR Plus source) and then modelled 60Co radionuclide (Eckert < Ziegler BEBIG GmbH, Co0. A86) used for dose computation. ICRU89 recommended points and volumes of targets and OARs evaluated and compared.

Results: The study concludes that 60Co based point-A, BICRU and RICRU doses showed a comparable result with that of 192Ir HDR source based dosimetry. The volume based criterion for the target such as GTV, CTVHR, CTVIR for D90, D98, V150%and V200% are all within 5% dose level comparing two sources.

Conclusion: 60Co a viable alternate to 192Ir by taking into consideration frequency of source exchange and cost reserve with comparable dosimetry.

Introduction: Head and neck cancer and its treatment play a significant role in a patient's quality of life. The evaluation of the quality of life is important for the better survival of the patients. The study aims to determine how the different treatment modalities impact the quality of life in head and neck cancer patients.

Methods: A prospective cross-sectional study was conducted among the 400 HNC patients. Patients who were newly diagnosed with cancer (treatment not yet started) and those who received cancer-directed treatment were enrolled. The quality of life was assessed by using European Organization for Research and Treatment of Cancer: Core (QLQ-C30) and Head and Neck specific module (QLQ-H&N35).

Results: Tumor involving pharynx and larynx had significantly worst score as compared to cancer of oral cavity. The quality of life deteriorated in the advanced stage of cancer as compared to the initial stage. Problems related to social contact were significantly more in patients treated with surgical treatment. The symptoms scores were high in patients receiving chemoradiation therapy. Patients treated with single treatment had a significantly better score on most scales than patients receiving combined treatment modality. Performance status was a strong predictor of quality of life.

Conclusion: The result of the study concludes that the many domains of quality of life were significantly affected in patients receiving cancer-directed treatment. Assessment of quality of life will help reduce the impact of therapeutic complications and thus improve patients' quality of life.

Introduction: Breast cancer (BC) is the leading malignancy globally with consequent morbidity, mortality and burden on health care resources when diagnosed at an advance stage. Early-stage diagnosis is crucial to the better outcome. Screening is pivotal to early detection at an early stage. It is understood to reduce mortality, improve outcome, and is cost effective.

Objective: The objective of the study was to see the impact of screening program on Breast cancer stage in Oman. In this study we looked into the trends in stagespecific breast cancer incidence during two pre-specified time periods 2006-2010 and 2015-2017, before and after the introduction of a national screening programme in Oman.

Patients and methods: It is a retrospective analysis, where breast cancer patient's data was retrieved from Oman national cancer Registry ministry of health Sultanate of Oman, for two pre-specified time periods 2006-2010 before the introduction of cancer screening programs and 2015-2017. The cases included were those who had confirmed histopathology diagnosis and where a composite stage, based on TNM stage, was available to be analysed and compared in these two pre-specified time periods to find out the difference between these two time periods. The statistical analysis was carried out and p values were determined. Ethical approval obtained from Royal Hospital medical ethics and scientific research committee.

Results: There was a 41% reduction in stage IV breast cancer from 23.01% to 13.58 %, and 86.15% increase in stage 0-1 from 6.86 % to 16.98%. (p Value<001). The stage 0 cases increased from 0% to 4.26 %. With regard to tumour size, T0-1 tumours increased from 14.16% to 26.03%, while T4 tumours decreased from 16.59% to 7.69%. There was increase in node negative breast cancer cases in Oman. The N0 increased from 28.43% to 37.64%. The diagnosis as Non-metastatic M0 disease increased from 39.77% to 60.23%, while diagnosis as metastatic M1 disease decreased from 55.32% to 44.68%.

Discussion and conclusions: The introduction of national screening programme in Oman resulted in a continued increase in localized cancers and a decline in advanced disease. Screening programmes should be evaluated continuously and systematically to ensure their targeted objectives. The causal link between stage distribution and mortality needs to be investigated further in the context of screening. Health planners, policymakers, and other stakeholders; including clinicians, educators, community members, and advocates, should be aware of the health system requirements, as well as overall costs of these approaches to breast cancer early detection, to make effective investments, plans, and policies. Key Words: Breast Cancer; Screening; Oman; Royal hospital; early detection; early stage; OCA.

Objectives: Background: Tumor-infiltrating lymphocytes (TILs) reflect the antitumor response of the host. This study aimed to assess the value of TILs in predicting pathological response after neoadjuvant chemotherapy (NAC) and survival outcomes in patients with triple-negative breast cancer (TNBC).

Methods: A retrospective analysis conducted between February 2012 and December 2015. Patients with stage I, II, and III TNBC patients were enrolled. TILs were assessed in haematoxylin and eosin-stained sections from true cut needle biopsies before NAC. According to international TILs working group, we had three groups; low (0-10%), intermediate (11-59%), and high TILs (= 60%).

Results: A total of 159 patients was included, 56% were premenopausal and 76.1% were less than 60 years. The main bulk of patients had histological grade III, high Ki 67, and high TILs (74.2%, 84.3%, and 72.3%), respectively. The pre-treatment high TILs was significantly correlated with high Ki-67 (p = 0.001), pCR (p<0.001), and late relapse (p<0.001). Other clinico-pathological features such as age, menopausal status, tumor size, histological grade, lymph node involvement and lympho-vascular invasion weren't significantly correlated with TILs levels. 71.3% of enrolled patients having high TILs achieved pCR, vs 27.8% in the intermediate group and 30.8% in low group. After a median follow-up of 45.3 months, patients with high TILs were significantly associated with longer DFS and OS as compared to intermediate and low TILs (27.2 vs 15.9 vs11.4 months for DFS and 70.2 vs 34.3 vs 27.6 months for OS)p<0.001).

Conclusions: Pre-treatment level of TILs had a predictive and prognostic value in TNBC patients receiving NAC. TILs may be integrated into the basic laboratory for TNBC prognostication as a credible biomarker.

Health systems provides care only to those people who spontaneous demand for attention; excluding those who dont perceive illness or are not aware enough to consult. Alternative healthcare models based on the nominal-personalized care like "University Center for Integrated Care of Referred Health Care" (CUIDARAS) may have better results. In order to demonstrate benefits of this model, it was performed an experience based in colorectal cancer (CRC) detection and care that focused the entire population of the town.

Methods: It is an intervention study for early detection of CRC. A survey and a physical examination were performed in each adult from "CH" town. Two visits were made. Blood in stool test (BIST) was self-collected, analyzed and results delivered with appointment for a programmed video-colonoscopy (VCC) when test was positive.

Results: people enrolled (n546) had 59.9+/-6.4 yrs. Adherence was 93.8% of the target population; 99.2% performed BIST; while 95.3% a positive BIST had access to VCC and treatment. Overall cost of the experience (stool test, VCC, biopsy, local treatment) was 7685 USD, while costs associated to an advanced CRC classic treatment was USD 9577/patient (USD 26098 if treatment included bevacizumab).

Conclusion: The present study based on preventive actions like blood in stool test, applied as a screening to all inhabitants in town, had 93.8% of adherence and high level of CRC early detection. A health model based on personalized care (CUIDARAS), achieved more effective results in terms health care and disease prevention, with a favorable benefit/cost ratio compared with classical health care provide by current system. Key words: Model of care; colorectal cancer; CUIDARAS; personalized care.

Objectives: To evaluate the role of alkaline phosphatase (ALP) as marker of bone metastases in patients of genitourinary cancers compared to bone scan, and to correlate with NCCN guidelines.

Methods: This retro-prospective, observational study included all newly diagnosed patients of renal, bladder (muscle invasive) and prostate cancers who presented from July 2014 to March 2017. For diagnosis of bone metastases, ALP groups (raised/normal) were compared with bone scan (positive/negative). Sub-group analysis was done on patients with normal ALP levels and positive bone scan.

Results: 150 patients were included and stratified depending on bone scan findings. Hemoglobin values were significantly different between two groups in renal and prostate cancers (p=0.015 and 0.002 respectively). AL values were significantly different between two groups in prostate cancers (p=0.0008), but not for others. Three out of seven patients with bone metastases for renal cancers (42.9%) and all three for bladder cancers had normal ALP values, no bone symptoms, and would have been missed. For prostate cancers, out of 23 who had bone metastases, ALP was normal in ten. All these ten had Gleason score of > 8 and all except one had S. PSA > 20ng/ml. All cases would have been detected irrespective of ALP values.

Conclusions: ALP has limited sensitivity but reasonable negative predictive value for bone metastases in genitourinary cancers. Current guidelines may miss significant number of cases with bone metastases for renal and bladder cancers. Current guidelines have good accuracy for prostate cancers, since PSA and Gleason score are independent predictors of bone metastases.