OBJECTIVE:This study aimed to evaluate the prognostic significance of baseline 18F-fluorodeoxyglucose PET/computed tomography-derived metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) for treatment outcome in pediatric Hodgkin lymphoma. METHODS:We retrospectively analyzed 48 patients aged less than or equal to 18 years with newly diagnosed intermediate-risk Hodgkin lymphoma who underwent baseline 18F-fluorodeoxyglucose PET/computed tomography between January 2020 and December 2025 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Baseline MTV and SUVmax were quantified and assessed for association with treatment outcomes. The primary endpoint was event-free survival (EFS). RESULTS:Median baseline MTV was 263.5 ml (range: 22-781) and median SUVmax was 9.2 (range: 3.2-31.8). After a median follow-up of 48.8 months, 14 (29.2%) patients experienced an EFS event. MTV was higher in patients with events than in those without (303.0 vs. 254.5 ml), but the difference was not significant (P = 0.212). SUVmax was also nonpredictive (P = 0.834). EFS was 63.6% in the high-MTV group versus 86.7% in the low-MTV group (Fisher's exact P = 0.171; log-rank P = 0.194). MTV and SUVmax showed a weak, nonsignificant correlation (ρ = 0.173, P = 0.244). Disease stage was the only significant prognostic factor (P = 0.010). Receiver operating characteristics analysis demonstrated modest discriminatory ability for MTV [area under the curve (AUC) = 0.617], whereas SUVmax showed none (AUC = 0.479). CONCLUSION:In this single-center cohort, baseline MTV and SUVmax were not significantly predictive of EFS, with disease stage remained the only significant prognostic determinant. However, given the limited statistical power inherent to this sample size, a clinically meaningful association cannot be excluded and warrants evaluation in larger prospective studies.
Introduction:Cranio-spinal irradiation (CSI) is essential in treating central nervous system malignancies such as medulloblastoma, but conventional 3D-conformal radiotherapy poses challenges in dose uniformity and toxicity. Advanced techniques like Volumetric Modulated Arc Therapy (VMAT) offer improved target coverage and organ sparing, yet data on its use in resource-limited settings remain scarce. This study aimed to evaluate the clinical feasibility, dosimetric performance, toxicity profile, and early outcomes of CSI delivered via VMAT in medulloblastoma patients treated at a tertiary care center in Pakistan. Materials and Methods:This retrospective study included 113 patients (median age 12 years, range 4-37) diagnosed with medulloblastoma and treated between 2018 and 2024. Patients underwent surgical resection followed by VMAT-based CSI, with doses ranging from 23.4 to 36 Gy and tumor boosts of 54-55.4 Gy. Dosimetric parameters including planning target volume (PTV) coverage, conformity index (CI), homogeneity index (HI), and organ-at-risk (OAR) doses were analyzed. Acute toxicities were graded, and disease-free survival (DFS) was assessed over a median follow-up of 15 months. Results:Gross total or near-total resection was achieved in 38.1% of patients. Mean PTV coverage was 94%, with median CI and HI values of 1.02 and 0.10, respectively, indicating excellent dose conformity and homogeneity. The majority of patients required multiple isocenters for complete cranio-spinal coverage. Acute toxicities were predominantly mild to moderate, with esophagitis (11%), bone marrow suppression (12%), and nausea/vomiting (10%) most commonly observed. Organ doses remained within acceptable limits. The two-year DFS rate was 76%. Conclusion:VMAT-based CSI is a feasible and effective treatment modality for medulloblastoma in a resource-constrained setting, providing superior dosimetric outcomes with manageable toxicity. These findings support the broader adoption of advanced radio-therapy techniques like VMAT in similar clinical environments.
Huntington’s disease (HD) is a progressive inherited neurodegenerative disorder characterized by motor, cognitive, and psychiatric symptoms. It is caused by an expanded CAG trinucleotide repeat in HTT, which leads to the production of a mutant huntingtin protein (mHTT) with an abnormally long polyglutamine tract. This mutation results in protein misfolding, aggregation, and neuronal toxicity, particularly in the basal ganglia. Symptomatic treatments, such as tetrabenazine for chorea and antipsychotics for psychiatric symptoms, offer some relief, but do not alter the underlying disease progression. Recent studies have focused on understanding the molecular pathology of HD and developing gene therapies that target its genetic cause. Advanced techniques, such as CRISPR-Cas9 and RNA interference (RNAi), aim to reduce or correct mHTT expression, and preclinical studies have demonstrated improvements in motor and cognitive functions in animal models. Gene replacement therapy using viral vectors and lipid nanoparticles is also under investigation, along with potential cell-based therapies to replace lost neurons. Despite promising advances, challenges in delivering therapies across the blood-brain barrier, ensuring long-term safety, and addressing ethical concerns remain significant. Future strategies, such as personalized medicine and targeted gene-editing technologies, are being actively explored as potential disease-modifying approaches capable of altering the progression of HD. Ongoing research is critical for transforming these innovative strategies into clinical treatments, providing new hope for improved outcomes and quality of life in HD patients.
Introduction:Tapentadol, a centrally acting μ-opioid receptor agonist and noradrenaline reuptake inhibitor, has shown promise in providing potent analgesia with fewer opioid-related side effects. This study evaluated its role as a pre-emptive analgesic in cancer patients undergoing breast conservation surgery. Materials and Methods:A prospective, double-blinded, randomized controlled trial was conducted on 70 American Society of Anesthesiologists class II adult females, scheduled for conservative breast surgery, randomized into two groups after informed consent. Group A received 75 mg oral tapentadol, and Group B an oral placebo, one hour before induction. Intraoperatively, more than 20% increase in mean arterial pressure from baseline, and postoperatively, pain score (at 1, 2, 3, and 4 hours) greater than 3 was treated with intravenous morphine (up to 0.1 mg/kg). Data regarding total morphine used (dose and number of patients) intra-operatively and postoperatively, time to first rescue dose, and pain scores postoperatively, and side effects were documented. Results:Mean intraoperative morphine requirement was significantly lower in the tapentadol group (1.11 ± 1.53 mg) compared with the placebo group (3.36 ± 1.60 mg; p < 0.001). Only 13 (37.1%) patients in the tapentadol group required intraoperative morphine compared to 31 (88.6%) in the placebo group (p < 0.001). Postoperative pain scores were lower in the tapentadol group at 1 hour (1.89 ± 0.83 vs 2.46 ± 1.15, p = 0.020) and 3 hours (1.06 ± 0.24 vs 1.23 ± 0.43, p = 0.042). Rescue morphine use post op was lower in the tapentadol group [5 (14.3%) vs.10 (28.6%), p = 0.145] with a longer time to first rescue dose (58.0 ± 21.7 vs. 43.5 ± 27.3 minutes, p = 0.290). Conclusion:Pre-emptive tapentadol administration significantly reduced perioperative morphine use and improved postoperative pain scores at certain time points. However, the increase in time to first rescue analgesia was not statistically significant.
Introduction:Perineal wound infection remains a significant complication following abdominoperineal resection (APR), and its associated clinical and financial burden necessitates continued evaluation of modifiable risk factors. This study evaluated surgical and patient-related predictors to inform prevention strategies and postoperative management. Methodology:We conducted a retrospective analysis of 233 consecutive laparoscopic APR procedures performed at a tertiary cancer center between January 2018 and December 2022, examining demographic characteristics, comorbidities, treatment parameters, and operative details. The data were analyzed using SPSS version 26 for descriptive statistics and univariate analysis. Results:The overall infection rate was 21% (49/233). On univariate analysis, significantly higher rates were observed in males (27.7% vs 7.7% in females, P < 0.001), extralevator APR (27.9% vs 15.5%, P = 0.021), and longer operations (mean 325.1 vs 303.9 minutes). On multivariate analysis, only male gender remained an independent predictor of perineal wound infection (P = 0.003). Conclusion:These findings demonstrate that technical factors (surgical approach, operative duration) and biological variables (gender) substantially influence infection risk. Given the significant healthcare burden of these infections, enhanced perioperative strategies and improved understanding of risk profiles are essential to optimize outcomes.
