INTRODUCTION:Breast cancer (BC) is the most common cancer and foremost cause of death in women. AIM:This study was conducted to study the BCL2 expression in BC and its correlation with other clinicopathological parameters such as histological grade, tumor size, lymph node status, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2/neu), Ki67 status and molecular subtypes in Indian setting. MATERIALS AND METHODS:Fifty cases of BC diagnosed between 2015 and 2020 were included in the study. A technique of manual tissue microarray was employed for the analysis of expression of IHC markers such as BCL2, ER, PR, Her2/neu, Ki67, CK5/6 and EGFR in all cases. Results were subjected to statistical analysis. RESULTS:BCL2 positivity was seen in 36% cases of BC of which 22.22% were HER2 enriched, 33.33% were hormone receptor positive, 38.89% were triple negative (TNBC) non-classifiable, and 5.56% were of basal like BC (BLBC) molecular subtype. Maximum cases of BC showing loss of BCL2 expression showed a statistically insignificant association with higher tumor grade and stage, lymph node positivity, presence of lymphovascular invasion, absence of ER/PR and HER2/neu expression, and Ki67 positivity. 34% cases were of hormone receptor positive BC cases. BCL2 was found positive in 35.29% of hormone receptor positive BC cases. 44% cases were TNBC. BCL2 was found positive in 36.36% of TNBC cases. 20% cases were BLBC. BCL2 was found positive in 10% of BLBC cases. Maximum cases of hormone receptor positive BC, TNBC and BLBC showing loss of BCL2 expression showed a statistically insignificant association with higher grade and stage, lymph node positivity, lymphovascular invasion, and Ki67 expression. CONCLUSION:BCL2 can serve as a useful prognostic marker and merits inclusion in the routine IHC panel for breast cancer, as it may contribute to the development of individualized, tailored therapeutic strategies.
Lung cancer is the leading cause of cancer deaths worldwide, with most cases found late. This review summarizes evidence on lung cancer diagnostics, highlights findings from important screening trials, and discusses new technologies shaping future approaches. It describes recent advances like artificial intelligence, radiomics, and molecular biomarkers for early detection. The review compares diagnostic tools, addresses barriers to their use, and presents new results from recent trials and technologies. By highlighting innovations and contrasting them with current practices, it clarifies the evolving landscape and offers strategies to improve early diagnosis. The review used a comprehensive PubMed search with the terms: "lung cancer AND (screening OR early detection OR diagnosis OR biomarkers OR artificial intelligence OR radiomics)." It included articles from 2010 to April 2024. Only English articles focused on adult human studies were included. The review analyzed original research, systematic reviews, meta-analyses, and major screening trials. Twenty-eight articles met these criteria, including five major screening trials. Five themes are identified: Enhanced Endoscopic Diagnostics, Liquid Biopsy and Molecular Biomarkers, Artificial Intelligence and Radiomics, Novel Biomarkers, and Integrated Screening Approaches. Low-dose computed tomography (LDCT) trials such as National Lung Screening Trial (NLST), Dutch Belgian lung cancer screening trial (NELSON), UK Lung Cancer Screening Trial (UKLS), and Multicentric Italian Lung Detection (MILD) show mortality benefit, but barriers remain. New diagnostic approaches, including liquid biopsy, AI with radiomics, and volatile organic compound profiling, may help overcome these barriers and support current strategies. Keywords: lung cancer, early detection, screening, low-dose CT, liquid biopsy, artificial intelligence, radiomics, biomarkers.
Breast cancer poses a significant public health concern in Kuwait, accounting for 37.4% of all newly diagnosed female cancer cases as reported by the Kuwait National Cancer Registry. The rising incidence, coupled with variability in imaging expertise, contributes to diagnostic delays and disparities in patient care. Artificial intelligence (AI) has rapidly become a transformative tool supporting breast ultrasound, enhancing diagnostic accuracy, standardization, and assistance for non-specialist providers. This editorial evaluates the potential of AI-enabled ultrasound to improve diagnostic performance by increasing sensitivity, decreasing false positive rates, and reducing inter-observer variability, while also addressing structural inequities that affect cancer outcomes within the region. Recent advancements in deep learning and radiomics-based tools are reviewed, alongside considerations related to governance and ethics, and recommendations for practical integration of AI solutions into national breast cancer management pathways are provided. The adoption of AI-augmented ultrasound holds considerable promise for strengthening Kuwait's capacity for early detection and advancing equitable, high-quality cancer care. Keywords: Artificial intelligence, breast ultrasound, diagnostic precision, cancer care, Kuwait, equity.
BACKGROUND:Head and neck squamous cell carcinoma (HNSCC) incidence in Yemen shows distinct patterns, influenced by unique risk factors like qat chewing alongside tobacco, smoking, and viral infections. Epstein-Barr virus (EBV) is an established oncogenic virus, particularly for nasopharyngeal carcinoma (NPC). This study investigated EBV seroprevalence, infection status, and associations with demographic and risk factors in Yemeni HNSCC patients. METHODS:A cross-sectional study was conducted at the National Oncology Center, Aden, Yemen (Jan-Dec 2023). One hundred histologically confirmed HNSCC patients provided informed consent. Data on demographics, tumor characteristics (site, stage, histology), risk factors (tobacco, smoking, qat chewing, family history), and blood group were collected via records and questionnaires. EBV infection status (primary, past, reactivation) was determined using Chemiluminescent Immunoassay (CLIA) for EA IgG, NA IgG, VCA IgG, and VCA IgM. RESULTS:Patients had a mean age of 53.2 ± 14.7 years, with peaks in 36-54 (41%) and 55-73 (40%) years. Males predominated (M:F = 2.45:1). The nasopharynx was the most common site (48%). Most patients presented with advanced disease (Stage III: 57%, Stage IV: 29%). Qat chewing was the leading risk factor (74%), followed by tobacco use (68%) and cigarette smoking (50%), showing significant associations (p<0.05). EBV infection was highly prevalent: 8% primary, 39% past, 53% reactivation (p<0.001). CLIA positivity was high for VCA IgG (99%), NA IgG (88%), and EA IgG (61%). EA IgG positivity was significantly associated with infection status (p<0.001). Reactivation infection was strongly linked to NPC (66%). Blood group A was associated with increased NPC risk (52.0% of NPC patients). CONCLUSION:This study highlights a high burden of EBV infection, particularly reactivation, among Yemeni HNSCC patients, with a striking predominance of NPC. Qat chewing emerges as a major local risk factor alongside tobacco and smoking. The association of EBV reactivation and blood group A with NPC underscores the virus's significant role in HNSCC pathogenesis within this population. These findings emphasize the need for EBV screening in HNSCC management and targeted public health interventions against modifiable risks like qat and tobacco in Yemen.
INTRODUCTION:Anorectal melanomas are rare and agressive malignant tumors of the anorectal region of the digestive tract. Due to their rarity and similarity to other more benign and common conditions, such as hemorrhoids, their diagnosis is often delayed, which worsens the prognosis of this aggressive disease. Histological evaluation with special immunohistochemical (IHC) staining is often essentiel to establish a confirmed diagnosis. In the localized stage, the primary treatment for this condition consists primarily of surgical resection combined with adjuvant immunotherapy. CASE PRESENTATION:We report the case of a 62-year-old women who presented for an etiological evaluation of mild rectal bleeding without other associated signs. Proctological examination revealed the presence of a flashy mass occupying almost the entire anal lumen, with irregular thickening of the anterior anorectal wall during rectal examination. The colonoscopy revealed a friable and ulcerated process in the lower and middle rectum, and several biopsies were performed, confirming the diagnosis of rectal melanoma. The patient was successfully treated with surgery and adjuvant immunotherapy. Discussion/ conclusion: Our case demonstrates the importance of rapid diagnosis and a multidisciplinary therapeutic approach for a better prognosis of malignant rectal melanoma.
INTRODUCTION:Artificial intelligence (AI) is the general term that contains Machine Learning (ML), and Deep Learning (DL). Utilization of these technologies in brain tumor treatment and prognosis is promising. AIM:This article aims to review recent applications of AI in neuro-oncology treatment and prognosis. Furthermore, it elucidates the challenges and future directions. METHOD:A comprehensive literature review in four databases (Wiley, Scopus, PubMed, and Google Scholar) gave a total of 21 articles using AI in neuro-oncology treatment and disease prognosis. papers were grouped and reviewed. The data was summarized and presented in tables and graphs. This is the first article to review these two areas of AI in neuro-oncology in a single paper and provide insight into knowledge gaps and future directions. RESULTS:Most of the reviewed articles are about prognosis (14 articles). The largest article in sample size (41222) is about the prediction of inpatient Length of Stay (LOS) after brain tumor surgery. They used twenty-nine machine learning algorithms. In articles about the treatment of neuro-oncology, the highest sample size is (1585) in assessment of treatment response using AI algorithms. CONCLUSION:AI technologies implementation in neuro-oncology is crucial. More research and validation of current applications is needed. And careful integration of these technologies is important.
BACKGROUND:Globally, breast cancer (BC) stands as the most common malignancy, predominantly affecting women, with observed trends of increasing incidence and mortality. Data concerning the survival of BC patients in Saudi Arabia (SA) is notably scarce. This study aims to pinpoint the specific factors that impact the survival rate (SR) among breast cancer patients in Saudi Arabia's central region. METHODS:This retrospective study analyzed data from 1405 breast cancer patients documented in the King Abdulaziz Medical City Cancer Registry from 2009 to 2018. The collected patient information included sociodemographic details and comprehensive tumor characteristics such as its location, histopathology, molecular subtypes, disease stage, and ultimate survival outcomes. To assess the relationship between these factors and patient survival, survival analyses were performed, incorporating Kaplan-Meier curves and Cox regression models, which were adjusted for potential confounding variables. RESULTS:Patients of older age (over 60 years) demonstrated a higher mortality risk from breast cancer. Invasive ductal carcinoma was the most frequently observed histopathologic subtype; however, invasive lobular carcinoma was linked to an elevated death risk. Adjusted Hazard Ratios from Cox regression indicated that BC patients with metastasis were six times (AHR=6.3; 95%CI=4.6-8.7, p<0.001) more likely to face a higher death risk compared to those with localized or regional tumors. Furthermore, patients diagnosed with triple-negative tumors were associated with twice the risk of death compared to other subtypes (AHR=2.1; 95%CI=1.4-2.9, p<0.001). CONCLUSION:Both patient age and the presence of distant cancer spread are critical predictors of survival for breast cancer patients residing in central Saudi Arabia. Emphasizing early diagnosis, timely treatment, and consistent follow-up is essential for enhancing patient outcomes.
INTRODUCTION:Development of spontaneous subcutaneous emphysema is a rare and benign entity and in some cases it could be symptomatic. Subcutaneous emphysema is commonly seen in neck and chest wall which gradually extend to other body organs. It is characterised by development of neck swelling and chest pain with the involvement of deeper tissues of thoracic outlet chest and abdominal wall may predispose in life-threatening conditions. CASE PRESENTATION:We report a rare case report of a patient with advanced cancer of right lung who developed extensive subcutaneous emphysema during the course of treatment. DISCUSSION/CONCLUSION:This case report highlights the possible etiology, treatment and outcomes of the same.
BACKGROUND:Classical Hodgkin lymphoma (cHL) is a malignancy that is readily amenable to treatment, but still advanced-stage disease (stage III/IV) carries a significant therapeutic challenge. While ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) is a standard frontline regimen, its efficacy is limited by toxicity and relapse rates. Brentuximab Vedotin (BV), an anti-CD30 antibody-drug conjugate, concurrent with AVD (BV+AVD) has emerged as a promising alternative. This study compares the effectiveness and tolerability of BV+AVD versus ABVD in Egyptian patients with advanced cHL. METHODOLOGY:A prospective, randomized, open-label study was conducted at Helwan University Hospitals (March 2023-February 2025). A total of sixty patients with newly diagnosed stage III/IV cHL were randomized to receive either BV combined with AVD (BV+AVD; n = 30) or standard ABVD (n = 30). The primary endpoint was PFS, while secondary endpoints included PET negativity after two cycles, overall response rate (ORR), overall survival (OS), and treatment-related toxicity. RESULTS:Interim analysis demonstrated superior 2-year PFS for BV+AVD (80.0%) versus ABVD (53.3%). BV+AVD showed higher PET negativity rates post-cycle 2 (83.3% vs. 76.6%) and reduced pulmonary toxicity (6.7% vs. 23.3%). Hematologic toxicity (neutropenia: 60% vs. 40%) and neuropathy (43.3% vs. 16.7%) were more frequent with BV+AVD but mainly low grade and manageable. DISCUSSION:Limitations of this study encompass that it is a single-center study with a relatively small sample size that reduces the statistical power and makes it challenging to detect rare side effects. The population of the study represents the young and middle age group of patients with cHL so the treatment effect on older population was not studied. The limited follow-up duration restricts further knowledge about late relapses or delayed toxicities. CONCLUSION:BV+AVD significantly improves PFS and reduces bleomycin-associated toxicity, supporting its adoption as a frontline regimen for advanced cHL. Extended follow-up is required to validate the observed survival benefits.
BACKGROUND:Oral cavity cancers often require radiotherapy (RT), leading to toxicities such as xerostomia, skin reactions, and mucositis. This study aims to compare these toxicities between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques. METHODS:This prospective observational study included 60 patients with primary oral cavity squamous cell carcinoma. Patients were divided into two groups: 30 underwent 3D-CRT, and 30 underwent IMRT. Toxicities were assessed weekly during RT and bi-monthly up to one year post-RT using Radiotherapy Oncology Group (RTOG) criteria. RESULTS:The mean age was 46.60 ± 11.58 years for 3D-CRT and 48.0 ± 11.38 years for IMRT patients. Both groups had a majority of male patients. No significant difference was observed in mucositis and skin reactions. However, xerostomia was significantly higher in the 3D-CRT group from 6 to 10 months post-RT. CONCLUSION:IMRT is preferable for treating oral cavity cancer to reduce long-term xerostomia compared to 3D-CRT, despite similar rates of acute mucositis and skin reactions.
BACKGROUND:Brain tumours are a significant economic burden on patients and health systems. OBJECTIVES:This research aims to study the cost associated with management of brain tumour and its impact on healthcare. METHODS AND MATERIAL:This is a retrospective observational study involving 280 patients with brain tumours at the Neurosurgery Department at Khoula Hospital in Oman. Data on patient demographics, type of brain tumour, diagnosis, treatment, cost of imaging and laboratory investigations, and length of hospital stay were collected from medical records. RESULTS:The average cost of imaging and laboratory investigations was $276,293.33, with imaging accounting for $208,168.7 and laboratory tests accounting for $68,124.63. CT scan was the most expensive imaging investigation, followed by MRI and X-ray. RFT, MDR, and MRSA screening were the most expensive laboratory tests. The most common diagnosis was meningioma (18% of cases). The average length of hospital stay was 16 days. CONCLUSION:The cost of brain tumour management in Oman is significant. Further research is needed to understand the full economic burden of brain tumour management in Oman, including the costs of surgical and non-surgical interventions.
INTRODUCTION:Colorectal cancer is one of the most common digestive cancers worldwide and constitutes a major public health problem in Morocco, a country where its incidence is increasing. The majority of patients are often diagnosed at an advanced stage, which sometimes compromises the prognosis. This study aims to describe the epidemiological, clinical, and histopathological profile of colorectal adenocarcinomas in Morocco and to identify prognostic factors influencing survival. MATERIALS AND METHODS:We conducted a prospective, descriptive, and analytical multicenter study between February 2015 and February 2021, including 214 patients with histologically confirmed colorectal adenocarcinoma, followed up in three Moroccan university hospitals (Fez, Oujda, and Rabat). Clinical, pathological, and therapeutic data were collected from medical records. Overall survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated using multivariate analysis. RESULTS:The mean age of patients was 57 years (22-86 years), with a sex ratio of 1.02. Colonic forms accounted for 45.8% of cases, mostly located in the left colon, and rectal forms 33.2%, predominantly in the lower rectum. Significant complications were present in 21.5% of cases, primarily obstructions. Histologically, 52.3% of tumors were well differentiated, and 10.3% had a mucinous component. Curative resection was possible in 60.3% of cases. Overall survival was 82% at 1 year, 70.5% at 2 years, and 48.9% at 5 years. Factors associated with a poor prognosis were male gender, age <50 years, advanced tumor stage, the presence of a mucinous component, and the need for palliative treatment. DISCUSSION:Consistent with global research, our results emphasize the prevalence of late-stage diagnoses and the detrimental effect of tumor complications on survival. Due to delayed presentation and limited early detection, the five-year survival rate is still lower than in Western nations. Poorer outcomes are linked to a mucinous component and a younger age at diagnosis, highlighting the importance of early intervention and focused screening. CONCLUSION:Colorectal cancer in Morocco is diagnosed late in nearly one-third of cases, with a major impact on survival. Management is based on a multidisciplinary approach integrating surgery, chemotherapy, and radiotherapy. The prognosis is significantly better for early-diagnosed forms undergoing surgery with R0 resection. Strengthening screening and improving access to care are essential to reduce CRC-related mortality in Morocco.
PURPOSE:This study aims to investigate the effects of a mental toughness education program on the psychological well-being and resilience of cancer patients. METHOD:This randomized clinical trial recruited 32 adults with cancer from Baqayi Hospital 2 in Ahvaz. The participants were divided into two groups: an intervention group and a control group. The intervention group received the psychological resilience-based educational intervention. Data were collected using four questionnaires, including the Ryff Psychological Well- Being Scale, the Connor-Davidson Resilience Scale, and the Clough Mental Toughness Scale. Data analysis was performed using SPSS software version 25. RESULTS:The average age of the participants in this study was 46.47 ± 10.21 years. The mean mental toughness scores before the intervention were 120.5 and 110.81 in the intervention and control groups, respectively. After the intervention, the mean scores increased to 164 and 111.88, respectively, and this difference was statistically significant (P<0.001). The overall mean resilience scores before and after the intervention in the intervention group were 49.56 and 108.63, respectively, with a statistically significant difference (P<0.001). The overall psychological well-being score decreased immediately after the intervention but increased one month later. However, this change was not statistically significant. CONCLUSION:Based on the results of this study, psychological resilience education has a positive impact on resilience, psychological well-being, and certain dimensions of social well-being in patients with cancer. Therefore, interventions focused on developing psychological resilience, with an emphasis on increasing resilience and psychological well-being, can lead to positive outcomes in patients with cancer.
BACKGROUND:Immunotherapy is an effective cancer treatment strategy. Immune checkpoint inhibitors (ICIs), such as anti-PD-1/PD-L1, have demonstrated promising clinical outcomes. In Lebanon, a lower-middle-income country with a history of economic collapse, oncologists began prescribing ICI therapy despite its high cost and the lack of clear evidence regarding the pattern of ICI clinical outcomes in Lebanese patients. The current status of ICIs use in Lebanon remains unclear. METHODS:This retrospective study involved cancer patients treated with programmed cell death-1 (PD-1/PD-L1) inhibitors at the Central Military Hospital in Beirut, Lebanon. Demographic and clinical data were collected from patients' records from 2016 to 2024. RESULTS:The study included 118 patients. The hospital covered the patient's treatment. Of those, 59.3% (n = 70) had received ICIs. They were distributed as follows: 58.6% received pembrolizumab; 24.3%, nivolumab; and 17.2%, atezolizumab. Of the patients, approximately 35.7% (n = 25) had undergone a PD-L1 immunohistochemistry (IHC) test prior to receiving the ICI. All PD-L1-positive patients responded to ICI treatment: three showed no tumor progression and 11 showed tumor size regression. CONCLUSION:The study provided an overview of the use of ICIs at a single center in Lebanon. It revealed that ICI prescriptions were not consistently preceded by a PDL1 positivity test. A significant proportion of patients responded to ICIs, and no association was found between demographics, clinical variables, and clinical outcomes to ICIs.
BACKGROUND:Multiple endocrine neoplasia type 2A (MEN2A) is a rare autosomal dominant disorder associated with RET proto-oncogene mutations. Early diagnosis is absolutely critical for managing and preventing aggressive forms of medullary thyroid carcinoma (MTC) and associated tumours. Our aims are to confirm the clinical diagnosis and to detect, in relatives, those who bear the familial mutation in order to benefit from medical management before the first symptoms appear. CASE PRESENTATION:We report a sporadic case of MEN2A in a 34-year-old woman from western Algeria. She presented with bilateral medullary thyroid carcinoma and a left pheochromocytoma. RESULTS:Genetic analysis by nextgeneration sequencing revealed a de novo heterozygous c.1901G>C (p.Cys634Ser) mutation in exon 11 of the RET gene. This is a well-known pathogenic variant associated with MEN2A. DISCUSSION:This case proves that RET genetic testing is vital in all cases of MTC, even in those without a family history, as de novo mutations can occur. The absence of this variant in the patient's first-degree relatives confirms the de novo origin, possibly linked to advanced paternal age. CONCLUSION:Systematic genetic screening and counselling are essential for the early diagnosis and appropriate management of MEN2A, particularly in sporadic cases. Broader implementation of molecular testing and genetic counselling in Algeria is recommended to improve patient outcomes and prevent transmission to future generations.
BACKGROUND:Intracavitary Brachytherapy(ICBT) applications alone offer suboptimal coverage in some patients with medial parametrial(<2cms) residual disease after optimization. This retrospective study aims to identify the commonly accommodated size of ovoids in ICBT to identify the dose delivered to the parametrial disease and organs at risk (OARs). METHODS:Cancer cervix Patients treated with concurrent chemoradiotherapy and High Dose Rate(HDR) BT of 6-7 Gy in 3-4 fractions prescribed to point A were identified. Dosimetric details were documented from BT plans. RESULTS:219 ICBT applications were performed for 142 patients. 115 (52%) with semi-small (20mm), 69 (32%) small (25mm) and 35 (16%) medium (30mm) ovoids. Mean distance of 100% isodose curve obtained by above ovoids were 3.48 ± 0.53cm, 3.57 ± 0.45cm and 3.80 ± 0.44cm respectively (p = 0.005). Point A doses for respective ovoids were 5.40 ± 0.71 Gy, 5.59 ± 0.75 Gy and 5.79 ± 0.70 Gy (p=0.016) and Total Reference Air Kerma(TRAK) was 4137.35 ± 509.35, 4433.60 ± 554.80 and 4604.72 ± 381.45 mGy m2 h-1 (p < 0.001). No significant impact was observed in the OAR doses. CONCLUSION:Majority of our patients could accommodate semi-small ovoids. This compromises the distance covered by 100% isodose curve at the level of Point A and the dose to medial parametrial disease (<2cms) as well. Such patients may be receive higher dose within medial parametrium by use of Intracavitary + Interstitial Brachytherapy (IC + ISBT) Keywords: Intra-cavitary Brachytherapy, Size of Ovoids.
INTRODUCTION:Quality of life (QoL) encompasses the awareness of individuals' well-being in various aspects of their lives, including physical, personal, mental, and social domains. It is imperative to address QoL concerns in patients with brain tumors. The objective of this study is to assess the QoL among brain tumor patients treated a tertiary hospital in Saudi Arabia. METHODS:A retrospective study conducted at a single academic institution in 2017 analyzed data from adult patients diagnosed with brain tumors who underwent craniotomy and resection procedures over a 10-year period (2007-2017). The assessment of QoL was conducted employing a translated Arabic questionnaire derived from the European Organization for Research and Treatment of Cancer (EORTC) standardized model (QLQ-C30). This model evaluates various domains, including global health, physical function, role functioning, emotional functioning, cognitive functioning, social functioning, and symptoms domain. Furthermore, the brain cancer model (BN20) was utilized to assess symptoms and evaluate all aspects of well-being. RESULTS:In this study, a total of 76 patients were included, with a median age of 46 years. No gender bias was observed. Meningioma was the most prevalent brain tumor in our study, comprising 40% of the cases, followed by glioma and other types. It is noteworthy that more than half (65%) of the brain tumor patients had a World Health Organization (WHO) grade I brain tumor, while 15% had grade II, and 20% had grades III or IV. Supratentorial was the most common location for brain tumors. In all types of brain tumors, particularly in patients who underwent resection of meningioma and glioma, the QoL scales and measurements of daily functioning consistently exhibited low scores. Better QoL scores were correlated with male gender, the location of the brain tumor, and the WHO tumor grade. Conversely, perioperative headache, drowsiness, neurological deficits, and low socioeconomic status were associated with poor QoL. CONCLUSION:Our study is the first study reported in Saudi Arabia to evaluate the quality of life of patients undergoing surgical procedures for brain tumors. We demonstrated that the QoL experienced by brain tumor patients consistently appeared to be poor, irrespective of the specific type of tumor. We underscore the paramount significance of evaluating the QoL of brain tumors within the Gulf and Middle East regions. To comprehensively evaluate the QoL of brain tumor patients globally, a substantial sample size and longitudinal or prospective studies are indispensable.
INTRODUCTION:The optimal cut-off of ER-positivity is still debatable; however, adjuvant hormonal therapy is usually given if ER expression = 1%. The present study aims to assess clinicopathological features and survival outcome of patients with low compared to higher ER expression level. METHODS:In this retrospective, we checked nonmetastatic hormonal receptors-positive, HER2 negative breast cancer patients who presented to three Hospitals in Egypt and Saudi Arabia between 2020-2022. Different clinicopathological factors and data of relapse were checked in patients' medical records. These data were compared in patients with ER-Low (1-10%) Vs. ER-High (>10%) expression level. RESULTS:We included 419 patients who met the eligibility criteria of the study. Only 3.3% of patients had ER-Low. Compared to ER-High group, the ER-Low expression were more likely to have grade 3 tumours (64.3% vs. 21.0%, p=<0.0001), PR-negative (64.3% vs. 16.3%, p= <0.0001). Furthermore, younger age (= 50 years) was more frequent in ER-Low group compared to ERHigh patients (71.4% vs. 42.5%, respectively, p=0.032). Likewise, ER-High patients were more likely to have high ER-staining intensity (74.1% vs. 0.0%, p<0.0001). Disease free survival (DFS) was numerically improved in patients with ER-High, but without statistical significance. After adjustment of different clinicopathological prognostic factors, DFS benefit in ER-High group was more definite (HR=3.59, 95% CI 1.11-11.55, p=0.032). CONCLUSION:ER-low (1-10 %) expression was rare in the study group. Low ER expression was linked with more aggressive features at diagnosis and seems to have worse DFS which was more pronounced after adjustment for different clinic-pathological factors.
INTRODUCTION:Historically, the management of inguinal nodes in node-negative carcinoma penis has been a topic of debate. The chance of harboring micrometastasis in inguinal nodes in clinically node-negative patients is up to 25%. Dynamic sentinel node biopsy and elective inguinal lymph node dissection have flaws of false negativity and morbidity. METHODOLOGY:This is a retrospective study on patients with carcinoma penis treated between January 2010 and August 2019 who underwent upfront surgery for the disease. Patients who were clinically and radiologically node-negative underwent surgery for the primary disease only, and were kept under follow-up for nodal recurrence, while those with suspicious nodes clinically or radiologically underwent inguinal node dissection. RESULTS:77 patients were included in the study. Of the 50 patients who were clinically and radiologically nodenegative and did not undergo nodal dissection or invasive nodal staging, 21 had recurrence. Of the 27 patients who had node dissection, 16 were pathologically negative. Nine out of 16 patients with pathologically node-negative and seven out of 11 patients with pathologically node positive disease had recurrence. The median Overall survival (OS) and the median Recurrence free survival (RFS) were 77 and 75 months, respectively. The median OS in nodal observation and pathologically nodenegative group were 92 and 79 months, respectively (p- 0.266). The median RFS in nodal observation and pathologically node-negative group were 90 and 74 months, respectively (p- 0.182). CONCLUSIONS:Our series shows that in properly evaluated clinically and radiologically node negative patients kept under observation, OS and RFS are comparable with pathologically node-negative patients, opening a window for nodal observation, thus avoiding morbidities of ilioinguinal block dissection or invasive nodal staging.
BACKGROUND:Breast cancer (BC) remains the most common malignancy among Indian women, with Stage III being the most frequent at diagnosis. While radiation therapy (RT) plays a pivotal role in the adjuvant treatment of breast cancer, the inclusion of internal mammary lymph nodes (IMLNs) in the radiation field remains controversial due to potential cardiopulmonary toxicity. However, the extent of incidental radiation to the IMLNs, especially with forward planning intensity-modulated radiation therapy (IMRT), remains under-explored. OBJECTIVE:This study aimed to evaluate the incidental radiation dose received by the IMLNs in patients with leftsided breast cancer treated with forward planning IMRT. MATERIALS AND METHODS:A total of 36 left-sided breast cancer patients, aged 35-60 years, who underwent modified radical mastectomy followed by adjuvant RT using IMRT, were retrospectively analyzed. CT-based planning and contouring were performed according to RTOG guidelines, with IMLNs contoured retrospectively using Jetwa et al.'s method. Dosimetric parameters for the planning target volume (PTV) and IMLNs were extracted and analyzed using dose-volume histograms. Statistical comparisons were made using the dependent Student's t-test. RESULTS:The PTV received effective radiation coverage with a mean D95 of 38.47 Gy and a mean Dmean of 40.10 Gy. The IMLNs, although not directly targeted, received significant incidental radiation, with a mean D95 of 8.49 Gy, D50 of 21.59 Gy, and Dmean of 21.40 Gy. The maximum dose to the IMLNs (Dmax) reached 38.14 Gy. Comparative analysis revealed statistically significant differences in both Dmax and Dmean between PTV and IMLNs (p = 0.004 and p < 0.001, respectively). CONCLUSION:Forward planning IMRT provides substantial incidental radiation exposure to the IMLNs, which may have therapeutic implications in reducing recurrence risk. However, this exposure also necessitates careful consideration of potential long-term toxicities to adjacent organs. Further prospective studies are warranted to evaluate the clinical outcomes associated with incidental IMLN irradiation.
