Clinical Oncology Department Research Articles

A population-based survey of patients’ experiences with teleconsultations in cancer care in Denmark during the COVID-19 pandemic

Background During the COVID-19 pandemic, teleconsultations (TC) have been increasingly used in cancer care as an alternative to outpatient visits. We aimed to examine patient-related and cancer-specific characteristics associated with experiences with TC among patients with cancer during the COVID-19 pandemic. Material and methods This population-based survey included patients with breast, lung, gastrointestinal, urological, and gynaecological cancers with appointments in the outpatient clinics, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in March and April 2020. Age- and sex-adjusted logistic regression analyses were used to study associations of sociodemographics, cancer and general health, anxiety, and health literacy with patients’ experiences of TC in regards to being comfortable with TC, confident that the doctor could provide information or assess symptoms/side effects and the perceived outcome of TC. Results Of the 2119 patients with cancer receiving the electronic survey, 1160 (55%) participated. Two thirds of patients (68%) had consultations with a doctor changed to TC. Being male, aged 65–79 years, and having TC for test results were statistically significantly associated with more comfort, confidence, and perceived better outcome of TC. Having breast cancer, anxiety, low health literacy, or TC for a follow-up consultation were statistically significantly associated with less positive experiences with TC. Living alone, short education, disability pension, and comorbidity were statistically significantly associated with anxiety and low health literacy. Conclusions Most patients reported positive experiences with TC, but in particular patients with anxiety and low health literacy, who were also the patients with fewest socioeconomic and health resources, felt less comfortable and confident with and were more likely to perceive the outcome negatively from this form of consultation. TC may be suitable for increasing integration into standard cancer care but it should be carefully planned to meet patients’ different information needs in order not to increase social inequality in cancer.

Patterns of Care and Treatment Pathways for Non-Surgically Managed Early and Locally Advanced Non-Small Cell Lung Cancer Patients at Ain Shams University Clinical Oncology Department: A Retrospective and Descriptive Analysis

Patterns of Care and Treatment Pathways for Non-Surgically Managed Early and Locally Advanced Non-Small Cell Lung Cancer Patients at Ain Shams University Clinical Oncology Department: A Retrospective and Descriptive Analysis

Prophylactic Effect of Liaison Treatment on the Occurrence of Skeletal-Related Events in Patients with Metastatic Spinal Tumours: An Exploratory Interrupted Time Series Study.

Introduction There is a growing momentum for the collaboration between multiple disciplines for the prevention and treatment of skeletal-related events (SREs) in patients with metastatic spinal tumors. However, the effectiveness of multidisciplinary approaches remains unclear. Hence, we conducted an exploratory study to examine the impact of liaison treatment for metastatic spinal tumor (LMST) on the prevention of SREs among patients with a metastatic spinal tumor. Methods This study was an exploratory interrupted time series conducted in a single medical center. Overall, 1,043 patients with a metastatic spinal tumor diagnosed between January 2011 and December 2020 were included. The LMST was implemented in January 2014. The LMST team consisted of the orthopedic surgery, thoracic surgery, breast and thyroid surgery, clinical oncology, urology, and radiology departments. Monthly joint conferences were held for patients with spinal instability, and the incidence of SRE was measured at 6-month intervals. Results Throughout the study period, we identified 66 SRE incidences. After the implementation of the LMST, a level change of −5.2% (95% confidence interval [CI]: −11.7 to 1.3, p = 0.11) was observed. Subsequently, a post-implementation trend change of −0.3% (95% CI: −2.0 to 1.5, p = 0.75) beyond the baseline was noted. Conclusions We suggest both immediate and gradual effects of the introduction of the LMST on deterring the development of SREs. Our results support the global trend of introducing a multidisciplinary approach for the treatment of metastatic spinal tumors.

The effect of a Clinical Decision Support System on the frequency of dose adjustments of anticancer drugs in case of renal or hepatic dysfunction.

Dose adjustments in patients with renal or hepatic dysfunction using anticancer drugs are indicated according to guidelines. However, implementation depends on awareness of prescribing physicians. We implemented a Clinical Decision Support System (CDSS), recommending dose adjustments upon electronic prescriptions based on renal and hepatic function. The alert provides a dose adjustment proposal and recent laboratory results. Our objective was to determine the frequency of dose adjustments before and after implementation of this CDSS. We included all first orders for patients ≥18 years treated with parenteral antineoplastic agents, for whom dosage adjustment is necessary based on renal or hepatic function between February 2018 and January 2019. This study was performed at the department of Clinical Oncology and Hematology of the Amsterdam University Medical Center. We implemented the CDSS August first. All prescriptions were prescribed according to common practice. We analyzed the orders where a dose reduction based on renal or hepatic function was indicated. We included 73 orders before implementation and 99 orders after implementation. Before implementation 21% of doses were reduced in line with the guidelines versus 34% after implementation (p = 0.048). For hepatic dysfunction the proportion changed from 11% to 46% p = 0.011, while there was no effect for renal dysfunction (24% vs. 26% p = 0.75). Dosages are more frequently adjusted in concordance with guidelines in patients with hepatic dysfunction who are treated with parenteral antineoplastic agents after implementation of a CDSS. The change was not seen in patients with renal dysfunction.

Endocrine Therapy Versus Chemotherapy as First Line Treatment in Metastatic Hormone Receptor Positive Breast Cancer

Introduction: The standard treatment of hormone receptor positive Her2 negative metastatic breast cancer is endocrine therapy with or without targeted therapy (e.g.CDK4/6inhibitors and mTOR inhibitors). Chemotherapy is indicated only in visceral crisis and the presence of visceral metastases is not indication for chemotherapy Aim of study The retrospective study aimed to characterize treatment and outcomes for patients with hormone receptor positive metastatic breast cancer in Alexandria clinical oncology department to review change in treatment trend during the last 10 years. Physician questionnaire to determine their preferences in choosing treatment. Methods Retrospective study using patient files of adult female diagnosed and treated at Clinical Oncology and Nuclear Medicine Department, Alexandria Main University Hospitals during the period from January 2010 to December 2019. Physician questionnaire was done by physician recruitment via online survey & scientific meetings. Results: The study identified 611 women with hormone receptor positive metastatic breast cancer, median age was 50years, 48.9% were postmenopausal, 56.7% of hormone receptor positive, Her2 negative patients received chemotherapy as first line systemic treatment, 69.5% of these patients received chemotherapy as first line treatment in the first 5years. But, 48.8% of these patients received chemotherapy as first line in the last 5years and the study showed that median overall survival for all studied patients was 34 months. In contrast, the physician questionnaire showed that 75% of physicians prefer endocrinal therapy as first line treatment for hormone receptor positive, Her2 negative metastatic breast cancer. Conclusion: There is significant change in practice pattern in choosing the first line treatment between the first and last 5 years. Also, there is a discrepancy between practice pattern and physician preferences in choosing the first line systemic treatment for hormone receptor positive, Her2 negative metastatic breast cancer. The reason is the unavailability of most targeted agents (e.g; CDK4/6 inhibitors and mTOR inhibitors) and some hormonal agents such as fulvestrant.

Evaluation of the Prognostic Value of Ki-67 in Early Stage Breast Cancer

Background: Breast cancer is a disease which have a variety of important features whose different phenotype only partially summarize the underlying biological complexity. Treatment choices in routine management principally rely on the clinical and pathological characteristics of the disease, although molecular classification currently offers information alongside that provided by clinical and pathological examination. The decision to offer adjuvant chemotherapy to patients is not easy and the knowledge of prognostic factors is mandatory. Ki 67 plays an important role in this context, especially in patients who do not have access to genetic signatures. Aim of the work: This study aims to evaluate the value of Ki67 as a prognostic factor in relation to disease free survival and other clinico-pathological factors in Egyptian females with early stage breast cancer. Patients and Methods: Type of study: This is a retrospective cohort study. Study population: It consisted of 124 patients diagnosed with early stage breast cancer. Study Period: They were diagnosed between January 2011 and December 2015. Study setting: The patients were following up in Ain Shams University Hospital clinical oncology department. Information were manually retrieved from the records of the clinical oncology department at Ain Shams university hospitals. Clinical and pathological tumor characteristics were collected using patient charts and pathology reports. Results: Our study showed a significant relation between Ki67 index and estrogen receptors, progesterone receptors and Her2 neu status. Ki67 was found to be statistically significantly correlated to intrinsic subtypes. Our study was unable to find out the effect of Ki67 on disease free survival. Cox regression analysis revealed a statistical significant influence of estrogen receptors status on disease free survival. It also revealed statistical prognostic effect of progesterone receptors and Her2 status on disease free survival. Covariate analysis of results in our study showed that tumor with T4 stage has a significant prognostic effect on disease free survival. Conclusion: ki67 index may have a prognostic role in management of early stage breast cancer in relation to other prognostic markers like hormone receptor status and HER2neu expression. Moreover, immunohisto-chemistry-based subtyping is extremely important to classify breast carcinoma into molecular subtypes that vary in clinic-pathological features and would lead to different prognosis. Thus, molecular subtyping is essential for breast carcinoma management.

EVALUATION OF CHEMOTHERAPY SERVICE AT THE ALEXANDRIA UNIVERSITY CLINICAL ONCOLOGY DEPARTMENT IN VIEW OF INTERNATIONAL RECOMMENDATIONS

Chemotherapy is considered the most extensively used modality in the current management of adult oncology patients. In some cases it is given in combination with other treatment modalities such as radiotherapy, surgery, hormonal and targeted therapy. The purpose of this study was to assess the aspects of chemotherapy service in the clinical oncology department Alexandria university hospital, to come up with recommendations and a chemotherapy checklist to facilitate the chemotherapy process.Patients and methodsThis was a prospective observational study conducted on 300 adult patients seen from August 2019 to February 2020.The patients’ demographic data, clinical details and chemotherapy data were collected and analyzed using SPSS version 2.ResultsThe median age was 54 years old with a range of 17-83 years. 71.3% of the patients were overweight& obese. Breast cancer accounted for 24.3% of the cases, ovarian(6.7%) and colon/lung cancer (5.7%) each. Adriamycin /cyclophosphamide followed by Taxol was the most commonly used regimen (17.3%), followed by Paclitaxel/Carboplatin (13%) and Gemcitabine/Cisplatin(7%). Majority of the patients were on outpatient chemotherapy (77%) and 23% were inpatients. A small percentage of patients (5.7%) received target therapy. 82% of patients were on intravenous chemotherapy and 6.3% on oral chemotherapy. 100% of the patients gave verbal consent before the start of treatment.21% of the patients had dose modifications during their treatment cycle due to hematological toxicity (17.3%), neurological toxicity (3%) and renal impairment (1%).

Abiraterone prescribed by medical oncologist versus urologist in patients with metastatic castration-resistant prostate cancer: Real-world data from a public institution in Peru.

Retraction The abstract by Motta et al entitled, “Abiraterone prescribed by medical oncologist versus urologist in patients with metastatic castration-resistant prostate cancer: Real-world data from a public institution in Peru,” published in the Journal of Clinical Oncology 39, no. 15 suppl (May 20, 2021) e18793-e18793, was retracted by the authors due to a data management error that may significantly change final results. This abstract was retracted on June 29, 2021. e18793 Background: Abiraterone, an androgen synthesis inhibitor, is used in the treatment of metastatic castration resistant prostate cancer (mCRPC) worldwide. Today, in some centers systemic treatment is indicated by both clinical and surgery oncologist, we aimed to evaluate if benefit with abiraterone differs between medical oncologist and urologist in a national cancer center. Methods: A single institution retrospective cohort was carried out. The medical records was queried for mCRPC population from 2019 to 2020 were reviewed. The main endpoint was progression-free survival (PFS). Descriptive statistics was used to summarize data. Chi2 test, estimating p-values, was used to compare the different variables with the type of service. Cox regression was performed for time to progression (months) with type of service, Hazard estimates and a 95% confidence interval (95% CI). Results: : Sixty-seven patients were included, 26 from clinical oncology and 41 from urology department. Mean age was 69 years in both groups. All patients received abiraterone. Forty-three patients (64.2%) had ECOG 0-1. Eighteen (69.2%) patients from clinical oncology and twenty five (60.9%) from urology departments had regular follow-up (every 3 months) with CT scans. Patients from clinical oncology and urology departments received abiraterone from second line in 65.3% and 17%, respectively. Sixteen patients had adverse events (23.1% in clinical oncology group and 24.4% in urology group). Six patients had grade 3-4 adverse events [3 (11.5%) belonged to clinical oncology and 3 (7.3%) to urology (HR 0.46, IC 95% 0.07-2.87; p=0.405)]. Seventeen (41.5%) patients from urology department lost sight during treatment meanwhile seven (26.9%) of patients from clinical oncology lost sight, mainly due to coronavirus pandemic. Fifty-one patients (76.1%) progressed in both groups, 80.8% belonged to clinical oncology and 73.2% to urology department. Mean time of progression was 5.1 months in patients from clinical oncology and 4.3 months from urology department (HR = 0.85; IC: 0.48 a 1.51; p=0.578). Conclusions: Although there is a slight difference in the patients who were lost from sight, the differences were not statistically significant between the groups. However, we highlight that patients with mCRPC had a worse progression-free time in both groups than in other international reports and it is necessary to explore the factors involved.[Table: see text]

Impact of the COVID-19 pandemic on health care activities at a Uruguayan mastology teaching unit: Preliminary results.

e12502 Background: After the government declared a health emergency due to COVID-19 on March, 2020, the Mastology Teaching Unit (UDAM) providing care to breast cancer patients tried to ensure adequate oncological care, and to protect patients from the virus infection and serious complications due to a possible state of immunosuppression. Towards this objective, the Department of Clinical Oncology developed guidelines with some treatment modifications. Objective: To assess the health care activities of the UDAM during the period considered as the “peak” of the pandemic, since its beginning to June 30, 2020. Methods: This is an observational study that collected data from the electronic clinical record system called Oncology Electronic Health Record (HCEO) during the aforementioned period. Results: There werea total of 293 medical appointments (221 in person), through which 131 patients were attended to. The number of medical appointments decreased by 16.7% compared to the same period in 2019 (352 appointments). Of the patients who were attended to during the “peak” period, 109 (83.2%) were on systemic onco-specific treatment and 22 (16.8%) were attended to for disease control. The medical appointments were scheduled to evaluate the continuity of treatment and treatment modifications if necessary (95 patients; 72.5%), for disease control (17; 12.9%), for first-time consultation (12; 9.1%) and to assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (HT) (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). A total of 20 treatments were initiated, 14 with HT and 6 with CT. Of the 21 patients on CT, 14 (66.6%) were on adjuvant/neoadjuvant therapy. Of these, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte colony stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. The remaining 7 of 21 patients (33.3%) were on palliative CT. Of these, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one of them and this decision was due to the progression of the disease in the other patient). The 90 patients who were receiving adjuvant, neoadjuvant, or palliative criteria HT and/or anti-HER2 therapies, continued the treatment with no changes Conclusions: Although these are preliminary results, the available evidence suggests that, although medical appointments decreased by approximately 17%, the UDAM was able to maintain its healthcare activities and continued most of the treatments. The most modified treatment was CT, with the addition of prophylactic G-CSF, to avoid myelosuppression and potential complications from COVID-19 infection.

Retrospective study to assess the impact of hepatitis C virus infection on the prognosis and management of multiple myeloma.

e20001 Background: Multiple Myeloma (MM) is a neoplasm of the post-germinal center, terminally differentiated B-cells. MM accounts for 1% of all types of cancer and 10% for all hematologic malignancies. Chronic hepatitis C virus (HCV) is an infection that affects over 71 million patients worldwide. Cytotoxic agents and immunosuppressive therapy as steroids are the main line of therapy in lymphoid malignancies, but these drugs may exacerbate chronic viral hepatitis and cause uncontrolled replication of hepatitis viruses. The impact of HCV infection on MM patients remains unclear. Objective: To assess the impact of HCV infection on the prognosis and management of MM patients. Methods: A 10-year retrospective study of MM patients was conducted at Cairo University Clinical Oncology Department from January 2009 to April 2019. Results: During this time, 150 patients were diagnosed with MM, 109 (72.7%) were HCV negative, 24 (16%) were HCV positive, and 17 (11.3%) with unknown HCV status. The median age was 51 and 54 years for HCV negative and positive groups respectively, with a statistically insignificant difference (p-value > 0.2). In the multivariate analysis, HCV infection was not an independent factor related to overall survival (OS), however age, creatinine and hemoglobin levels correlated significantly with OS (p < 0.009, 0.008, 0.031 respectively). The median OS for the HCV negative group was 31.11 months (95% CI: 22.62 - 39.61) compared to 37.66 months (95% CI: 7.19 - 68.13) for the HCV positive group. The median progression-free survival (PFS) for all patients was 18.9 months, for HCV positive patients was 15.36 months (95% CI: 13.18 – 17.54), and for HCV negative patients was 20.49 months (95% CI: 14.13 – 26.85). Age below 60 years and creatinine level less than 2 mg/dL were statistically significant for favorable disease-free survival (DFS) (p < 0.030, 0.034 respectively). Conclusions: Age, creatinine and hemoglobin levels are significant prognostic factors in MM but HCV status doesn’t affect the overall survival or progression-free survival. HCV infection should not contraindicate MM therapy.

Pattern of Failure in Patients with Non-Metastatic Renal Pelvis Transitional Cell Carcinoma: A Single Center Experience in Alexandria, Egypt Shaaban Elassal,Maher Soliman, Naomi Nyambura Clinical Oncology Department,Alexandria University, Egypt.

PURPOSE:Globally, renal pelvis transitional cell carcinoma (RPTCC) is rare. There is a scarcity of information on the pattern of failure from the low and middle-income countries' patients, posing an unmet need. The aim of this study was to identify the patterns of failure and prognostic factors of survival outcomes in non-metastatic RPTCC.PATIENTS AND METHODS:The medical files of all patients with non-metastatic RPTCC who were treated in Alexandria Main University Hospital between January 2007 and December 2017 were reviewed. The clinicopathologic characteristics and treatment outcome data was collected and analyzed using univariate and multivariate analyses. RESULTS:Thirty-six patients were included. The mean age at diagnosis was 60 years (SD ± 9.79). The median tumor size was 7cm (6.0-8.75 cm). High tumor grade and lymphovascular invasion (LVI) were observed in 63.9% and 61.1% of tumors, respectively. About half of patients (47.2%) of the patients developed treatment failures including (13.9%) local recurrence and (33.3%) distant recurrence. Lungs (22.2%) was the most common site of distant failure.The 5-year local failure-free survival (LFFS) was 71%, while the distant failure-free survival (DFFS) was 60.3%. The 5-years overall survival (OS) was 82.5%. In multivariate analysis, the tumor size was an independent predictive factor for LFFS, DFFS and OS. The tumor size (p = 0.03) and LVI (p= 0.01) were significant prognostic factors for DFFS in multivariate analysis. CONCLUSION:RPTCC is very aggressive rare tumor which should be further explored in future research. The tumor size and grade are independent factors for survival outcomes.

PRE-OPERATIVE HISTOLOGICAL PARAMETERS AS A PREDICTOR OF CHEMOTHERAPY RESPONSE IN ADVANCED OVARIAN CANCER

Ovarian cancer is the second deadliest gynecological worldwide as most women present with advanced-stage disease. There is also no strong consensus as to which women will benefit most from neoadjuvant chemotherapy, but it is usually preserved for the poor candidates for primary surgery due to either the location or severity of the disease or medical comorbidity. In our study, we aimed to evaluate the parameters that predict the response to neoadjuvant chemotherapy. We also aimed to evaluate the prognostic and clinical value of pre-surgical assessment of KI-67 protein, Tumor infiltrating lymphocytes and histological type and grade in drawing a set of characteristics of patients who will have the best response to neoadjuvant chemotherapy. The methodology was retrospective review of patients who were diagnosed with locally advanced ovarian cancer using the cancer registration database in Alshatby University Maternity Hospital and Alexandria University Clinical Oncology department. The patients had NACT followed by staging laparotomy and they were followed up for two years afterwards. The results showed significant association between good response to chemotherapy and younger age, lower FIGO Stage, Higher Ca-125, Higher Grade Serous carcinomas, Higher Ki 67 and the presence tumor infiltrating lymphocytes. We also validated and refined the Chemotherapy Response Score CRS and found it significantly associated with progression free survival and Overall survival. Our conclusion was: CRS was a valid tool to evaluate response to NACT. There are some characteristics that can predict response to NACT. However, larger multicenter and prospective studies are required to confirm these associations.

Metastatic Esophageal Carcinoma: Prognostic Factors and Survival.

Worldwide, esophageal cancer is the eighth most common cancer and the sixth leading cause of cancer-related death. At initial diagnosis, about 50% of esophageal cancer patients present with metastasis. The prognosis of metastatic esophageal cancer is poor with 5-year survival rate of less than 5%. This is a retrospective study of stage IV esophageal cancer patients registered at Clinical Oncology and Nuclear Medicine department and Oncology Center Mansoura University in the period from 2009 to 2018 inclusive. Eligibility criteria were all pathologically proven stage IV esophageal cancer patients. The medical files of patients were reviewed. Most patients were ≥ 50years (67.8%) with male predominance (76.7%). Middle third was the most common site of primary tumor (38.9%). Squamous cell carcinoma was more common with incidence of grade 3 (40%). T3-4 lesion was recorded in 61.1% and node positive in 66.7%. As regards metastasis; liver was the most common one (45.5%) followed by lung (30%). One-year survival rate was 25.6% with median survival time of 8months. Multivariate analysis indicated that age (p = 0.03), site (p = 0.04), grade of primary tumor (p = 0.049), T classification (p = 0.0038), ECOG PS (p = 0.046), site (p = 0.026), and number of metastasis (p = 0.04) significantly affect prognosis while sex (p = 0.74) and histologic type (p = 0.94) do not. Metastatic esophageal carcinoma is a disease of poor prognosis especially in patients with the following criteria: old age, lower third location, high grade and large tumors, poor performance status, multiple sites of metastasis and presence of bone secondaries.

Impact of anti-cancer drugs shortages in oncology and hematology departments in a Moroccan hospital

Drug shortages have been a growing global problem in recent years. Some of them are of vital necessity and importance for the patient, such as those used to treat pathologies in clinical hematology and oncology departments. The objectives of this study are to determine the impact of anti-cancer drugs shortages on both: treatment and patient in the hematology and oncology departments, to describe the actions that have been put in place to manage the shortages and to survey patients about their perspectives and experiences. It was a prospective, observational study, it took place in the oncology and hematology departments. It was carried out with the help of an operating sheet, which contained two parts: patient and treatment data. This sheet was filled out after the interview with the patient and on the basis of the medical file. Of the 101 patients interviewed, 67.3% were impacted by the shortage of drugs. The treated pathology that was most impacted by the rupture was Non-Hodgkin lymphoma (55.8%), vincristine was the drug most responsible for the shortages (34%). Most patients (51.4%) went to a non-local pharmacy to buy the medicine that was in short supply in the hospital. Delayed care was the main impact of the drug shortage (42.6%). As a result of these shortages, the majority of patients (45.6%) were frustrated and anxious about the situation. Drug shortages have a profound impact on patient safety, clinical outcomes, quality of treatment, hospital management and other important factors. In-depth collaboration between different health actors and timely communication strategies are essential elements of an effective drug shortage management plan.

Frequency of different histopathological types of esophageal cancer patients at oncology department of a tertiary care hospital in Karachi

Background: Around the globe, carcinoma of the esophagus is the eighth most prevalent cancer with an incidence of 456,000 cases per year and is the sixth cause of cancer mortality. There are two major histological subtypes of carcinoma of the esophagus, esophageal squamous cell carcinoma and adenocarcinoma. The aim of the current study is to evaluate the frequency of different histopathological types of esophageal cancer in patients presenting at the tertiary care hospital of Karachi.
 Patients and methods: It was a cross-sectional study conducted at the Department of Clinical Oncology, Jinnah Postgraduate Medical Center, Karachi from March 2017 till March 2019. Two hundred and one histologically proven cases of esophageal cancer of in patients of either gender and between 15-80 years of age were included. Patients were interviewed and data regarding age, gender, education, marital status, employment status, addictions like cigarette or huqqa smoking, consumption of pan, betel nut, naswar, or gutka were recorded. Endoscopy and histology and computed tomography scan were performed. Stage, site, grade and type of tumor were noted. SPSS version 23 was used to analyze data. Mean and SD were calculated for quantitative variables. Frequency and percentage were calculated for qualitative variables. A Chi-square test was used to assess the significance between age and gender with type of EC. A p-value≤0.05 was taken as significant.
 Results: Mean age of the patients was 47.84. The majority of the patients had stage 2 of cancer (42.8%) and lower tumor site (62.2%) Squamous cell carcinoma was the most common histopathological type in 137 patients out of 201 (68%). The age, gender, smoking, consumption of pan, grade, site, and stage of the tumor showed a statistically significant difference when compared with esophageal squamous cell carcinoma and esophageal adenocarcinoma.
 Conclusion: The burden of esophageal squamous cell carcinoma is dramatically increasing in the Pakistani population and squamous cell carcinoma was the most common histopathological type.

Induction Chemotherapy Followed by Concurrent Chemo-Radiotherapy for Locally Advanced Gastro-Esophageal and Gastric Carcinoma

Aims: To assess the safety and efficacy of chemo-radiotherapy before radical surgery in locally advanced gastric and gastroesophageal adenocarcinoma.
 Study Design: This was a prospective phase Ⅱ single arm study.
 Place and Duration of Study: Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt, between May 2017 and June 2019.
 Methodology: Patients with pathologically proven gastric or gastroesophageal junction adenocarcinoma are included. They received one cycle of induction chemotherapy paclitaxel-carboplatin, [paclitaxel dose of 175 mg/m2, carboplatin dose of (AUC: 5)], followed by CCRT [RT 45 Gy over 25 fractions over 5 weeks concurrent with weekly paclitaxel at a dose of 50 mg/m2, carboplatin at a dose of (AUC: 2)], followed by surgery and 2 cycles of paclitaxel-carboplatin for responders.
 Results: The study included 24 patients. Most of the patients were diagnosed at stage III (83.3%). There were no major side effects of the induction chemotherapy cycle. There were no reported grade 3 or 4 toxicities for the CCRT. Only two patients suffered from late radiation toxicities (distal esophageal stenosis). Pathological complete response was achieved in seven patients (31.8%). Twenty-two patients had surgical resection with a 95% resection margin zero. The median follow-up time was 22.5 months. The median progression-free survival (PFS) and overall survival (OS) were 23, 23.5 months, respectively.
 Conclusion: The preliminary data suggested good efficacy of the studied treatment design with acceptable adverse-event rates, however a larger multicentric phase 3 trial with a longer follow-up duration is recommended.

Neoadjuvant Chemotherapy and Concomitant Boost Radiotherapy in the Treatment of Locally Advanced Rectal Cancer

Aims: This study aimed to examine the efficacy and toxicities of concomitant boost three-dimensional conformal radiotherapy along with multidrug chemotherapy (capecitabine and oxaliplatin) in neoadjuvant course for locally advanced rectal cancer (LARC).
 Study Design: A phase II interventional nonrandomized study.
 Place and Duration of Study: This Study was conducted at Clinical Oncology and nuclear medicine department of Mansoura University Hospitals (Egypt) between November 2016 and October 2019.
 Methodology: Thirty patients (18 women, 12 men; age range 18-75 years) with (cT3-T4 and/or cN+) histologically confirmed rectal adenocarcinoma located within 12 cm of the anal verge were included in this study. Patients received three-dimensional conformal radiotherapy (3DCRT) to the pelvis of 45 Gy and a concomitant boost of 10 Gy to the primary tumor in 25 fractions, and concurrent with oxaliplatin (50 mg/m2 d1 weekly) and capecitabine (625 mg/m2 bid d1–5 weekly). Radical surgery was scheduled six to eight weeks after chemoradiation. Acute toxicities were recorded according to Common Terminology Criteria for Adverse Event (CTCAE) v5.0. Potential prognostic factors were evaluated using a binomial logistic regression. Survival curves were estimated using the Kaplan-Meier method and compared with Log-rank test.
 Results: All patients received chemoradiation. Twenty-seven patients underwent surgical resection. Twenty-five patients underwent sphincter-sparing surgery (92.6%) and nine patients (33.3%) achieved pathological complete response (pCR). The incidences of grade III neutropenia, diarrhea, and radiation dermatitis were 6.7%, 6.7%, 3.3% respectively. The three-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS) rates were 7.4%, 63% and 74.1%, respectively. We found pre-surgical negative nodal status to be significantly associated with pCR (p=0.009). The pathological nodal stage was an independent prognostic factor to DFS.
 Conclusion: The combination of oxaliplatin, capecitabine, and dose escalation using concomitant boost 3DCRT is safely administrated in patients with locally advanced rectal adenocarcinoma and it offers high pCR and sphincter preservation rate.

Clinicopathological Profile of Head and Neck Cancer Patients in a University Hospital, Bangladesh

In Bangladesh, the head and neck cancer is one of the most prevalent cancers. The goal of this study was to assess at the clinicopathological characteristics of individuals with head and neck cancer. This descriptive, cross-sectional study was conducted from July to December 2018, 286 patients with head and neck cancer were included at Bangabandhu Sheikh Mujib Medical University (BSMMU), Department of Clinical Oncology. A pre-made questionnaire was used to collect data from patients during face-to-face interviews. The mean age of the patients was 56.27 (±12.23) years. The bulk of the cases (77.6%) were male, and the most of the patients consumed tobacco (86%). The most common histological type among the patients was squamous cell carcinoma (92%). In terms of primary tumor location, the oral cavity (36%) was the most prevalent. Patients were most often found in stages III (32.2%) and IV (34.6%). In conclusion, head and neck cancer occurs mainly in males and tobacco users. Squamous cell carcinoma is the most frequent histological form, with the oral cavity as the main location of tumors. The majority of the patients are in advanced stages.
 Bangladesh Med J. 2021 January; 50(1) : 23-26

EVALUATING THE EFFECT OF SELENIUM IN PREVENTING ORAL MUCOSITIS: A RANDOMIZED CLINICAL TRIAL

Introduction: Radiation-induced oral mucositis (RIOM) is one of the most common complications in head and neck cancer (HNC) patients and thought to occur through oxidative stress. Selenium(Se) has attracted tremendous interest because of its importance as antioxidant and anti-inflammatory. Objectives: Evaluating the effectiveness of Se in the prevention of radiation‐induced oral mucositis(OM). Patients and methods: A randomized controlled clinical study was conducted on 40 head and neck cancer patients undergoing radiotherapy at the Department of Clinical Oncology, Faculty of medicine, Alexandria University, Egypt. Patients were assigned equally to either control group who received conventional preventive medications or test group who received 200 mg of selenium twice daily along with the conventional preventive medications. All patients were clinically evaluated for OM severity (objective assessment) and pain (subjective assessment) at day 1 of radiotherapy, day 14, day 21 and day 42. Results: There was no significant difference comparing control and test groups regarding severity of OM and mean pain score during the 4 times of assessment. Conclusion: The administration of Se supplementation during radiotherapy has no effect on OM severity and its related pain regarding World Health Organization (WHO) scale and visual analogue scale(VAS) respectively.

Prognostic Comparison between Mucinous and Non-mucinous Rectal Adenocarcinoma

Background: We aimed to analyze the prognostic impact of mucinous and non-mucinous rectal adenocarcinoma with stage II and III rectal carcinoma treated with radical surgery plus (neo) adjuvant chemoradiotherapy and evaluate disease-free (DFS) and overall survival (OS). Method: We conducted this retrospective study on patients with pathologically proven stage II/III rectal carcinoma and treated in the Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital between January 2008 and December 2013. We designed a clinical abstract sheet and reviewed all cases in terms of history, clinical assessment, investigations done on the patients, and pathological reports including all the details, and treatment modalities, namely neoadjuvant and adjuvant. Results: The median DFS for non-mucinous adenocarcinoma (NMC) was beyond 60 months, while that for mucinous adenocarcinoma (MA) was 24 months (P=0.008). The median OS for NMC was beyond 60 months; whereas, the mean OS of MA was 25 months (P=0.002).Therefore, the difference between both groups was statistically significant regarding DFS and OS. Pathological subtype was the only statistically significant independent predictor in the three-year DFS. However, pathological subtype and lymph-vascular invasion were statistically significant independent predictors in the three-year OS. Conclusion: Histological subtype was an independent prognostic factor for both DFS ans OS in patients with stages II and III rectal carcinoma.