The gulf journal of oncology最新文献

Introduction: Technical innovations in radiation therapy treatment planning and delivery over the last two decades have changed the practice of radiation therapy dramatically. The benefit of improved dose homogeneity and better sparing of critical structures in helical tomotherapy compared with conventional linac-based IMRT has been reported. This study was conducted to compare acute toxicities (skin, mucous membrane, salivary gland and hematological) during treatment and overall treatment time in Head and Neck Cancer patients treated with IMRT and Helical Tomotherapy and to assess the quality of life of patients during treatment between two groups.

Materials and methods: The study involved thirty patients with histologically proven Squamous cell carcinomas of Head and Neck. They were treated with concurrent chemoradiotherapy, to a dose of 60-70 Gray in 30-35 fractions. The study consists of 2 arms which are standard IMRT and Tomotherapy arm. Fifteen consecutive patients were treated under IMRT and 15 patients were treated under Helical tomotherapy, along with concurrent chemotherapy. After completion of planning, plans were evaluated and dose to the targets, organs at risk were tabulated. Patients were assessed weekly for acute toxicities (skin reactions, mucositis, xerostomia, haematological toxicities) during the course of the treatment as per RTOG criteria. Quality of life of patients were assessed using FACT/ NCCN HNSI questionnaire in local language at day 1, day 21 and at completion of radiotherapy.

Results: Grade 2-3 skin reactions, mucositis, anemia, leukopenia and thrombocytopenia were predominant in both arms. Treatment time from start of radiotherapy to completion of radiotherapy varied from 39 days to 68 days. Majority of patients completed radiotherapy within 50-56 days. Mean quality of life score did not show much difference between IMRT and tomotherapy arms.

Conclusion: The study did not show any statistically significant difference in overall treatment time, acute toxicities- skin reactions, xerostomia, mucositis& hematological toxicities and quality of life of patients during radiotherapy between IMRT and Helical Tomotherapy. Dosimetric benefits of Tomotherapy over IMRT do not translate into clinical benefit in terms of reduced acute toxicities, lesser overall treatment time and better quality of life of patients.

Key words: Head and Neck Carcinoma, IMRT, Tomotherapy, RTOG, toxicity, FACT/ NCCN HNSI, quality of life.

Breast cancer (BC) is the most common cancer among women worldwide and also in Algeria. Despite therapeutic progress, it remains a cancer with serious physical and psychological consequences.

Materials and methods: The objective of this study was to perform a histological analysis on 244 patients from the western Algerian population who were receiving treatment at the Oran University Hospital.

Results and discussion: The findings of our study indicates that women are more likely to be affected, with a predominance of tumors in the right breast (77%), we also found that (72%) of patients had a personal history risk of developing breast cancer. The majority of the cases that were examined were in the age range of 40 to 50. In addition, we noticed that unemployed and married women were the most affected, with (86% and 95%, respectively). Total of (63%) patients used contraceptives known to be endocrine disruptors and (68%) of cases were breast-feeding.Our results revealed that the most frequent histological type is the infiltrative ductal carcinoma (77%) followed by the ductal carcinoma in situ which is (13%), on the other hand the infiltrative lobular carcinoma presents a very low percentage (9%). The SBR II grade is the most dominant with (81%) followed by the SBRIII grade (18%) and no cases of SBR I grade were observed.

Conclusion: Breast cancer is one of the most complex and difficult to control diseases, especially in developing countries. Breast cancer screening remains a powerful way of improving early detection and survival rate. The Findings of our study demonstrate that histopathological analysis provides an important prognostic information and, if the grading protocol is followed consistently, reproducible results can be obtained for a favorable prognosis and management of breast cancer to reduce the burden of the disease.

Key words: Breast cancer, risk factor, histopathology, chemotherapy and radiotherapy.

Introduction: rhTSH-assisted radioiodine therapy of multinodular goiter is not fully known and only a few studies, with a limited number of patients have evaluated the effect of rhTSH assisted radioiodine therapy beyond 1 year. Though there is an effective and safe management of benign non-toxic MNG available, it is not applicable to all patient categories in Kuwait covering the impact of the past environmental events (Gulf War) and the genetic relation. The proposed project aims to address those points raised, that is exclusive to the Kuwait population.

Materials and methods: In this cohort study, 2 groups of patients, group one (G1) and group two (G2) patients (N=50, ≥18 years old) went undergo evaluated according to a proposed criteria followed by FNA to exclude cancer, toxicity and those who have refused surgery. All patients had a CT scan, TSH, T3, T4 and CBC and complete biomedical tests at a 6-months interval during the treatment period and the follow up. The Volumetric application of GE 670 SPECT/CT (i.e. Xeleris) and in-house developed MATLAB used for quantitative measurement. All patients had a 131-I uptake at baseline and 24 intervals post intramuscular a single dose of 0.3mg or 0.1mg (group 1, group 2) of rhTSH.

Results: There was no significant difference in TSH levels at 24-month follow-up between the two groups (p=0.327), whereas there was a statistically significant difference at the baseline and at the 6-months interval between the 2 groups for T4. Post treatment follow up at the 24-hour time point, Group 1 displayed significantly higher uptake than Group 2 (G1:41.74 ± 6.27 vs. G2:34.80 ± 3.84, p < 0.001). The change in I131 uptake from baseline to 24 hours was significantly greater in Group 1compared to Group 2 (p < 0.001). The ROC analysis (AUC) post treatment indicated an excellent discriminatory power for AUC (0.960) and (p < 0.001). There was a much better correlation posttreatment between BMI and thyroid volume for group 1 (R2=0.661) than for group 2 (R2=0.008). Our results suggest 42.1% thyroid volume reduction for group 1 and 20% for group 2.

Conclusion: The study underscores the potential benefits of the higher rhTSH dose (0.3mg) in managing multinodular non-toxic goiter for the Kuwaiti population and the region considering the impact of dietary, and experience to the drastic environmental exposure.

Background: Prostate cancer (PC) is the second most common cancer in men worldwide. It's the second leading cause cancer men in death. Prognostic tests based on molecular and biomarker analysis of tumor tissue may improve risk stratification of prostate cancer 2.

Materials and methods: After a search on Pubmed for PC biomarkers, 72 papers responded to the objectives and will be included in the review.

Results: A plethora of biomarkers are predictive for the prognosis of PC and its response to certain therapies, while others, once thought to be indicative of prognosis in PC, were not.

Conclusions: This study can help in the development of diagnostic and prognostic tests of PC and contribute to the ongoing research into already existing tests.

Introduction: Papillary squamotransitional cell carcinoma (PSTCC) arising from the uterine cervix is a distinctive histomorphological subtype of squamous cell carcinoma (SCC) not otherwise specified (NOS) of cervical epithelial tumors.

Aim: The present study was undertaken to study the histopathological features and immunoexpression of CK7, CK20, p53 and Ki-67 in PSTCC of the cervix.

Materials and methods: This study included 43 cases of PSTCC of cervix. A technique of manual tissue array was employed along with IHC staining of entire section in some cases. The expression pattern of CK7, CK 20, p53 and Ki67 in PSTCC was studied and clinico-pathological correlation of various parameters with IHC expression of CK7 and CK20 was observed. Results were subjected to statistical analysis and were considered significant when the p-value was less than 0.05.

Results: Out of 43 PSTCC cases, there were 38 squamotransitional type and 5 papillary type. Histomorphologically, all the cases studied were having fused papillae with rounded contours and fibrovascular cores with highest number of cases having intermediate cell type morphology (86%). Stromal invasion was seen in 74.4% of cases. Koilocytosis were seen in 39.3% of cases. Thirty-two cases showed CK7 immunopositivity (+) and CK20 immunonegativity (-), nine cases were both CK7 and CK20 - and two cases were CK7- and CK20+. Among them 90.7% cases were p53 positive and all cases were positive for Ki67 immunostaining with highest number of cases showing moderate proliferative activity (74.4%); followed by nine cases showing high (20.93%) and two cases showing low proliferative activity (4.65%).

Conclusion: The distinct histomorphology and CK7/CK20 immnunoprofile of PSTCC along with Ki67 and p53 could help in arriving at an accurate diagnosis as well predicting its biological behavior.

Introduction: Several studies evaluated the outcomes of cancer patients treated with septic shock in intensive care units (ICUs), but limited data is available on the long-term outcomes of this patient population. In this report, we aimed to evaluate the one-year mortality in cancer patients who were discharged alive following their intensive care unit (ICU) admission for septic shock.

Patients and methods: A retrospective study that was conducted at an oncologic ICU of a comprehensive cancer center. The study included all adult cancer patients who were admitted to the ICU with septic shock between 2008 and 2019. Septic shock was defined as the need to start vasopressors within the first 24 hours of ICU admission with sepsis. Patient baseline characteristics and longterm outcomes were evaluated. Descriptive analysis was used to report the data.

Results: Of the 1408 cancer patients who were admitted to the ICU with septic shock, 494 patients (35%) were discharged alive from the hospital. Their mean age was 56.3±16.5 (SD) years, 321 (65%) were males, and 326 (66%) had solid tumors. At 1-year, 258 patients died as follows: 129 (50%) died during the first 3-months, 69 (27%) patients died between 3 and 6-months, and 60 (23%) patients died between 6 and 12-months, resulting in a mortality rate of 74%, 78.9% and 83.2%, at the 3-months, 6-months and 1-year, respectively.

Discussion and conclusion: In this cohort of cancer patients, we described the long-term outcomes of patients treated in the ICU with septic shock. The majority of the included patients died during the first year following their ICU admission. Future studies should identify measures to improve the outcomes of this patient population.

Background: Cancer is a medical condition where some cells of the body reproduce uncontrollably and metastasize to other parts of the body. This study attempts to review the effect of physiotherapy application on head and neck, lung and breast cancer survivors on important clinical outcomes such as pain, strength, fatigability, coordination, balance, activities of daily living (ADLs), psychosocial aspects, cognitive aspects, and quality of life (QoL) Methods: A systematic review was conducted following PRISMA guidelines. Scientific articles were retrieved from electronic databases including Cochrane, Medline, EBSCO, Science Direct, Springer and Web of Science. Studies using only experimental design measuring the effectiveness of physiotherapy methods in head and neck, lung and breast cancer patients were selected for the review. Articles from 2012 till date were selected to find a piece of evidence for the latest physiotherapy practice in the last decade.

Results: 19 articles out of 9343 records were selected (Head & Neck HN = 3, Lung LU = 5, Breast BR = 11) which demonstrated that there was a significant effect of various physiotherapeutic techniques on the selected outcomes among patients with head and neck, lung and breast cancer.

Conclusion: In this review study, we conclude that head and neck cancer patients can benefit from physiotherapy exercises and muscle awareness. However, more evidence is needed to prescribe a specific exercise regimen. It was found that a combination of fitness training along with aerobic training has the maximum gain in advanced lung cancer patients. For breast cancer patients, combined aerobic and resistance training along with stretching and relaxation is the current suggested treatment.

Key words: "Upper Body Cancer", "Physiotherapy", "head and neck cancer", "lung cancer", and "breast cancer".

Artificial intelligence (AI) has truly revolutionized many fields, including healthcare. In radiation oncology, AI has emerged as a powerful tool for improving the speed, accuracy and overall quality of radiotherapy treatments. The radiotherapy workflow involves complex processes that require coordination between healthcare professionals with diverse skills. AI and deep learning methods offer unprecedented potential to transform this workflow by leveraging imaging modalities, digital data processing and advanced software algorithms. Despite the revolutionary potential, challenges remain in seamlessly integrating AI into clinical workflows. Ethical considerations, data privacy, and algorithm interpretability necessitate cautious implementation. Additionally, fostering interdisciplinary collaboration between AI experts and radiation oncologists is imperative to harness the technology's full potential. This paper explores the impact of AI in four key areas of radiotherapy: automated segmentation, dosimetric and machine quality assurance, adaptive radiation therapy, and clinical outcome prediction. Key words: Artificial intelligence, Radiotherapy, Workflow, Accuracy, cancer ,machine-learning.

Introduction: CT information of the target undergoing motion/movement during its scanning has been questioned by many researchers for its preciseness as well as accuracy. The present study was taken with aim to validate the racimosa wood as lung equivalent and to assess the uncertainty in volume estimation during virtual simulation of non-static target of known dimension such as in lung cancer radiotherapy.

Materials and methods: The racemosa wood was validated as lung equivalent material with the help of two methods. Wood insert with tumor model was put into the hollow cylinder space of dimension 6.4 cm in diameter provided in CIRS phantom. First CT image of rest position was taken and given name "No Movement". Subsequently the tumor was shifted +/-5mm, +/-15mm and +/-25 mm with respect to "Rest Position". CT images of the CIRS phantom containing tumor in wood cylinder were acquired after each movement given to wood cylinder.

Results: The relative electron density of racemosa wood corresponding to HU value -724 was found to be 0.275 gm/cm3. The true volume of the target was 7.8.cm3 however variation up to 9.5 cm3 was observed in CT produced volume of the target over the range of different movements.

Discussion: The racemosa wood was found to be having range of density (- 850 HU to - 400 HU) similar to real human lung density variation. Various studies have been performed using uniform density lung structures in their experimental setups to assess the accuracy in lung cancer radiation delivery. However, in the present work approximately real clinical setting was reproduced by putting the wood cylinder with density variation from 0.2 gm/cm3- 4.5 gm/cm3in hollow space provided in one lung structure the phantom used in this study.

Conclusions: The racemosa wood was found to be lung equivalent which is available locally and cost-effective as well. Overestimation in the target volume (by CT imaging) showed a trend of increase with 3 directional movement amplitudes. The results of this study can be utilised in lung cancer radiotherapy as the same were derived from setup having clinical settings in terms of lung density variation, shape, compositions of the phantom maximally as found during the real patient radiotherapy.

Background: Dentists play a key role in and the management of oral cancer treatment complications. This study aimed to evaluate the general and specialist dentists' knowledge and practice regarding the dental management of such patients.

Methods: This cross-sectional analytic study was conducted among 370 general and specialist dentists in Isfahan, Iran 2020. A self-administrative questionnaire was designed and validated. The questionnaire had 18 questions in Knowledge section, 10 questions to measure performance, and 3 questions to evaluate dentist's opinion toward their management ability. The collected data were analyzed by descriptive and analytic tests such as T-Test, Kruskal-Wallis, Mann-Whitney, Chi-square, and Fisher's Exact statistics (P ≤ 0.05).

Results: The mean knowledge score was 9.96±2.87 in specialists and 7.59±2.36 in general dentists (out of 18, P < 0.001). There was no statistically significant difference between the mean knowledge based on gender, employment type, work experience of general and specialist, or the number of working days in a week. In addition, there was a significant relationship between the mean knowledge and having patients with oral cancer undergoing radiotherapy or chemotherapy (P = 0.012).

Conclusion: This study indicated that specialists'knowledge level is higher than general dentists. It was also shown that knowledge directly relates to practice and attitude. Besides, regarding insufficient knowledge of dentists in this field, it is necessary to hold training programs and retraining sessions.