National Cancer Institute (some times Apeksha Hospital), widely known as the "Maharagama Cancer Hospital" is a government hospital in Maharagama, Sri Lanka. Is the main hospital which is dedicated for treating cancer .Which is under the control of Department of Health, provides all its services free of charge. In 2016 hospital open Haematopoietic Stem Cell Transplant (HSCT) unit. Its valued Rs. 1.2 billion. Present day Sri Lanka has more than 50,000 cancer patients. Annually died 14,000 patient.
Background: Though the outcome of patients with stage I/II HL is excellent with standard combined chemo- and radiotherapy, the H10 trial assessed the possibility of improving tumor control by treatment intensification in early (i.e., after two cycles of ABVD) PET-positive patients and of reducing treatment related toxicity by omission of involved-node radiotherapy (INRT) in early PET-negative patients. Here, we present the results of 10y long term follow-up analysis, focused on progression-free survival (PFS), and overall survival (OS). Methods: H10 was a randomized trial to evaluate treatment adaptation on the basis of early PET (ePET) after two cycles of ABVD in previously untreated stage I and II HL—according to European Organisation for Research and Treatment of Cancer criteria favorable (F) and unfavorable (U). The standard arm consisted of ABVD followed by involved-node radiotherapy (INRT), regardless of ePET result. In the experimental arm, ePET-negative patients received ABVD only (noninferiority design), whereas ePET-positive patients switched to two cycles of BEACOPPesc and INRT (superiority design). Primary end point was progression-free survival (PFS). In January 2019, a preplanned analysis on 10y follow-up was launched. So far, out of 1925 patients constituting the original study population, 1419 cases have been updated, and are included in the present analysis; 506 cases showing similar baseline characteristics and 5y OS and PFS than updated patients were excluded so far. Results: After a median follow-up of 9.5 yrs, a total of 57 deaths and 136 events for PFS were reported in the analyzed population, leading to an overall 10-year OS and PFS rates of 96% and 90% respectively. In ePET-positive patients, 10y PFS increased from 79% for standard ABVD + INRT to 85% for intensification to BEACOPPesc + INRT (hazard ratio [HR] = 0.67; 95% CI, 0.37 to 1.20), although the difference was not statistically significant. The 10y OS rates were 90% and 92%, respectively (hazard ratio [HR] = 0.92; 95% CI, 0.43–1.97). In the F ePET negative group the 10y PFS rates were 99% versus 85% (HR = 13.2; 95% CI, 3.1–55.8) in favor of ABVD + INRT, and the difference was statistically significant. The 10y OS rates were 100% versus 98% for ABVD + INRT and ABVD only arms, respectively (hazard ratio [HR] = 2.80; 95% CI, 0.3–26.9). Finally, in the U ePET negative group 10y PFS rates were 91% and 87% (HR = 1.52; 95% CI, 0.8–2.8) for standard and experimental arm, respectively. The 10y OS rates were 94% versus 95% for ABVD + INRT and ABVD only arms, respectively (hazard ratio [HR] = 0.84; 95% CI, 0.4–2.0). Conclusion: The present long-term analysis confirms that in F ePET-negative patients, the omission of INRT is associated with lower 10y PFS, although no differences in terms of OS emerged. Moreover, in the U ePET negative and in the ePET positive patients, no significant differences between standard and experimental arms emerged in terms of 10y PFS and OS. Keyword: Hodgkin lymphoma No conflicts of interests pertinent to the abstract.
Introduction Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). Methods Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. Results A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. Conclusions Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.
A combination of cytoreductive intervention with the intrahepatic hyperthermic chemotherapy is a well-established treatment of peritoneal carcinomatosis. There are many challenges in establishing a new peritoneal surface malignancy program in a low-income country regarding perioperative safety and resource allocation. We analyzed the retrospective database to determine the immediate surgical outcomes of the first 28 patients with peritoneal carcinomatosis and the impact of the program on allocation of general hospital and human resources. During the preparatory stage, web conferences with international experts established the goals and general requirements of the program, formalized in a written document; and a peritoneal surface malignancy multidisciplinary team was established. The team created the patient selection criteria, perioperative management checklists, and suggested material and staff requirements for surgical and anesthesia services. Twenty-nine cytoreduction were carried out, of which 18 were followed by HIPEC. The average operative time was 6.2 h. The median blood loss was 350 mL, which did not result in additional blood transfusion requirements for the blood bank. No additional nursing and supportive staff were provided for the ICU and the surgical unit. The average postoperative stay was 8.7 days. One patient died with 30-day mortality rate of 3%. Ten patients (34.5%) developed postoperative complications, of which 6 (20.6%) had grade III and higher Clavien-Dindo complications. Establishing a peritoneal surface malignancy program is possible via staged planning, liberal use of international mentors, and thoughtful resource allocation. This new program did not result in a significant redistribution of resources among other service lines of cancer care within the same institution.
Superparamagnetic Iron(II, III) oxide Fe3O4 nanoparticles (NP) in magnetic nanocomplex (MNC2) with antitumor drug doxorubicin (DOXO) induced a greater antitumor and antimetastatic effect compared to the magnetic nanocomplex (MNC1) composed of ferromagnetic nanoparticles with DOXO and conventional DOXO during magnetic nanotherapy of animals with Lewis lung carcinoma. The intratumor temperature did not exceed 39 degrees C. MNC2 had g-factors of 2.00, 2.30 and 4.00. MNC1 had the g-factor of 2.50. The MNC2 increased the content of Nitric oxide - Iron(II) sulfide protein N complex and NADH-ubiquinone in tumor as compared to MNC1 or conventional DOXO. The results have been analyzed in terms of increased level of reactive oxygen species which could induce death of tumor cells.
