Introduction:Precursor B-cell acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. While cure rates in high-income countries (HICs) exceed 90%, outcomes in low- and middle-income countries (LMICs) remain suboptimal. This study evaluated treatment outcomes for pediatric pre-B cell ALL patients at a tertiary cancer hospital in an LMIC. Materials and Methods:Pediatric precursor B-cell ALL patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan between September 2017 and September 2022 were included. Results:A total of 436 pediatric patients were analyzed, with a median age of 3 years and a male predominance (61.5%). Most patients (96.3%) were classified as standard risk, while CNS and testicular involvement were rare. Among standard-risk patients, 81.8% achieved complete remission, and 17.4% remained minimal residual disease (MRD)-positive after induction. For high-risk patients, 75% achieved complete remission, and 25% remained MRD-positive at the end of induction. In total, 374 patients achieved remission, but 56 (14.9%) relapsed, most often as isolated bone marrow relapse (53.6%). Early relapse was most common. Overall mortality was 26.1%, with induction mortality at 11.7%. Sepsis was the leading cause of death (59.7%), followed by relapse (29%). Five-year overall survival (OS) and event-free survival (EFS) were 75.8% and 66.4%, respectively. Conclusion:Our study demonstrates good outcomes for pediatric precursor B-cell ALL in a resource-limited LMIC setting. Sepsis and relapse were the main causes of mortality.
Introduction:Endometrial carcinoma (EC) is a common gynecologic malignancy with rising incidence globally, including in low- and middle-income countries. Local data on clinicopathological characteristics, treatment patterns, and survival outcomes remain limited in Pakistan. Materials and Methods:This retrospective cohort study included 622 women aged ≥18 years with histologically confirmed EC treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre between 2010 and 2020. Clinical, pathological, treatment, and outcome data were extracted from the institutional electronic medical records. Survival outcomes were estimated using Kaplan-Meier analysis, and prognostic factors were evaluated using Cox proportional hazards regression. Statistical analyses were conducted using IBM SPSS Statistics 27.0. The study was approved by the Institutional Review Board of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan (IRB exemption number EX-17-12-25-01). Results:The median age was 56 years (range 24-87), and 36.3% were aged ≥60 years. Mean BMI was 32.8 kg/m2, reflecting a high prevalence of obesity. Most patients presented with FIGO stage I disease (71.4%), and deep myometrial invasion (≥50%) was present in 47.7%. Nodal metastasis was identified in 5.8%. Primary surgical treatment was performed in 94.4% of patients, with frequent use of adjuvant radiotherapy (57.2%), brachytherapy (60.6%), and chemotherapy (83.6%). The 5-year overall survival (OS) was 88.6% (95% CI: 85.6-91.7). On multivariate analysis, FIGO stage, nodal status, age and BMI were independent predictors of Overall Survival (OS). Conclusion:Key prognostic factors in EC, including age, stage, nodal involvement, histology, and performance status, are consistent with international and Asian data. Regional differences in age at diagnosis, obesity prevalence, and histologic distribution highlight the need for context-specific management strategies in LMICs. Prospective studies incorporating molecular profiling may further refine risk stratification and improve outcomes.
Introduction:Cancers of the pancreato-duodenal region carry a poor prognosis and are resource-intensive to manage. Long-term data from specialized cancer centers in Pakistan are limited. We aimed to determine the long-term outcomes of patients with duodenal, peri-ampullary, distal bile duct, and pancreatic cancers treated at a tertiary cancer center in Pakistan. Material and methods:We retrospectively evaluated data from all patients with pancreaticoduodenal cancer registered at our institute between January 2000 and December 2020. The Kaplan-Meier method was used to examine significant differences in survival distributions across subcategories, with results considered significant at an alpha level of 0.05. SPSS 27 was used for descriptive and comparative data analysis. Results:The mean age at presentation was 53 years, with peri-ampullary cancers being the most common histology. Pancreatic cancers were associated with poor prognosis as compared to duodenal cancers and pancreatic Neuro-Endocrine Tumors (pNET). For patients with pNET undergoing resection, the 5-year overall and disease-free survival was 90% and 75%, respectively. Patients who achieved textbook outcomes after surgery had better OS and DFS. Discussion:The current study showed that in our part of the world, patients are younger and have advanced stages at the time of diagnosis of pancreato-duodenal cancers. We also found that the long-term survival is associated with an early stage at diagnosis.
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.
