Memorial Research Center Research Articles

Is age just a number or a serious consideration for outcomes after pancreaticoduodenectomy in a developing country?

Background: The effect of age on outcomes after pancreaticoduodenectomy has been reported inconsistently. The objective of our study was to review the impact of age on perioperative and oncological outcomes in patients following pancreaticoduodenectomy. Methods: All patients who underwent pancreaticoduodenectomy from January 2014 to December 2018 at Shaukat Khanum Memorial Cancer Hospital and Research Center were reviewed. Postoperative morbidity and oncological outcomes were compared between patients with age ≤ 60 years (Group A) and age > 60 years (Group B). Results: A total of 161 patients underwent pancreaticoduodenectomy during the study period including 117 (73%) in group A and 44 (27%) in group B. Mean age was 46±11 years in group A and 67±5 years in group B. Most common pathology was adenocarcinoma (81%), commonest site was periampullary (53%) and most common pancreatic reconstruction technique was pancreaticogastrostomy (68%). Patients in group B had significantly higher comorbidities including hypertension (p=0.00) and ischemic heart disease (p=0.030). There was no significant difference in morbidity (p=0.856), reoperation (p= 1.000) and 30-day readmission rate (p=0.097) betweenthe two groups. Similarly, there was no difference in disease free survival (p=0.957) and overall survival (p=0.070) in both groups. On multivariate analysis, soft pancreas (p=0.00) and non-dilated pancreatic duct (p=0.00) were associated with postoperative complications while ECOG performance status and ASA score did not show significant association. Conclusion: Pancreaticoduodenectomy can be performed in elderly patients with comparable morbidity and oncological outcomes as younger patients. Comorbid conditions remain higher in elderly patients and preoperative optimization can prevent worse postoperative outcomes.

Clinicopathological Characteristics and survival analyses of Primary Mucosal Malignant Melanoma: An Experience from a Cancer of Pakistan

Introduction: Mucosal malignant melanoma (MMM) can arise from the ocular mucosal membranes, and mucosal membranes of respiratory tract, gastrointestinal and genitourinary tract. They are rare and aggressive cancers with poor prognosis. The cornerstone of management is surgical resection along with chemotherapy and radiotherapy. The aim of the study is to analyze the clinicopathological factors and survival analyses of MMM from Pakistan population. Methodology: During 1st January 1995 to 31st December 2018, patients presented with histological diagnosis of Primary MMM at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Pakistan were selected. It is a retrospective study with convenience sampling. Calculations were performed with Statistical Package for the Social Sciences (SPSS 20) for Windows version 20. Results: During the span of two decades, 269 patients presented with the histological diagnosis of MMM. 163 (60.5%) patients had cutaneous malignant melanoma, 98 (36.4%) patients had MMM, five (1.8%) patients had ocular malignant melanoma and 3 (1.1%) had visceral malignant melanoma. Of all the MMM, anal canal (59.1%) was the most prevalent site, followed by mucosal melanoma of head and neck region (19.4%) and then female genital track (14.1%). One male patient also had malignant melanoma of urethra. Mean age at the diagnosis of mucosal malignant melanoma was 53 years (23-97). Median duration of symptoms was 8 months (3-36). Genital malignant melanoma had the most favorable survival outcomes of 25 months, followed by anorectal MM (22 months). The worst survival outcomes were noticed among patients with melanoma of mucosal origin from head and neck region (10 months). Median overall survival after mucosal malignant melanoma was 19 months (3-97). Conclusion: Our study demonstrates that the overall prognosis of MMM is poor. It varies in patients with different anatomical site. Despite of the adequate treatment, risk of local or distant recurrence is high.

Preoperative biliary drainage: blessing or curse for patients undergoing pancreaticoduodenectomy?

Background: Preoperative biliary drainage by means of endoscopic biliary stenting is thought to improve outcomes by re-establishing enterohepatic circulation prior to pancreaticoduodenectomy. However, recent evidence suggests that it may be associated with increased postoperative infective complications. Objective: The objective of this study was to evaluate the relationship between preoperative biliary stenting and postoperative infectious complications. We also investigated the correlation of intraoperative bile bacteriology to postoperative bacterial culture from wound infection or deeper collection. Material and methods: All patients who underwent Pancreaticoduodenectomy at Shaukat Khanum Memorial Cancer Hospital and Research Centre from January 2014 to December 2018 were included in the study. Results: Out of 161 patients, 119 (74%) patients underwent pre-operative endoscopic biliary stenting before pancreatoduodenectomy. The overall morbidity rate was 65% and 30-day mortality was 3%. Intra-operative bile cultures were positive in 67% patients of which 37% patients had polymicrobial growth. The most common organism isolated was e-coli (35%). Bile and wound cultures had similar microbial growth in 21% patients. On comparison, bile cultures were positive in 78% of stented patients versus 33.33% in the group with no stents (p= 0.000). We found significantly higher rates of both superficial surgical site and deep incisional infections in the stented group (p=0.012, p=0.045). There was no statistical difference in the overall complications and mortality rates amongst the two groups. Conclusion: Preoperative ERCP and stent placement is a risk factor for infective complications following pancreaticoduodenectomy.

Retroperitoneal Soft-Tissue Sarcoma: Retrospective Study from a Cancer Hospital in Pakistan

Objectives: To determine the clinicopathological aspects and factors determining the recurrence and 5-year survival of patients diagnosed with retroperitoneal soft-tissue sarcoma in a Pakistani cohort of patients. Methods: This retrospective descriptive study was conducted at the Department of Surgical Oncology, Shaukat Khanum Memorial Hospital & Research Centre (SKMCH&RC), Lahore, Pakistan. Patients who underwent surgery for retroperitoneal sarcoma from January 2011 to December 2015 were included and followed for 5 years (December 2020). A total of 54 patients was included in this study. Results: Fifty-seven percent (n=31) cases were male with a median age at the time of presentation 43 (30-60) years. Well-differentiated liposarcoma was the most common variant. Non-compartmental resection was done in 40 (74%) of the cases. The overall 5-year survival was 74% with median Disease-Free Survival (DFS) of 14 (6-48) months. Recurrence was seen in 28 cases (52%). Conclusions: In the Pakistani cohort of patients. retroperitoneal soft-tissue sarcoma was more commonly seen in males at the median age of 43 years. The most common presentations were abdominal pain and mass. Well-differentiated liposarcoma was the most common histological variant. The overall 5-year survival was 74% that was affected by histological variant and grade. Recurrence was affected by histological variant and grade, margin positivity, and use of neoadjuvant therapy.

Access the Quality Service of Ganeshman Singh Memorial Hospital and Research Center

The aim of this paper is to assess the quality of services in the Ganeshman Singh Memorial Hospital and Research Center, Lalitpur, Nepal, considering that the quality is a key parameter in performance evaluation. Patients are the main actors in evaluating and judging the quality, therefore this study is based on a questionnaire completed by 53 patients and visitors between January and February, 2020. The results show that services by the paramedical staff (OPD nurses) have the highest mean value (mean = 4.17) which is closed to the excellent performance of hospital whereas the lowest mean was 3.57 rated for the cleanliness of the hospital, including the reception area, OPD and surrounding area. Though, in average (mean = 3.77), facilities of Hospital were rated as ‘Good’ in total. Similarly, the cost of medicine was slightly expensive in comparison of other cost like consultation fee, cost of diagnosis and lab test and registration. The patients had rated the cost of hospital in totality as ‘Good’ status, which indicates that the total cost of treatment was affordable for the patient. With the necessary inputs from the patients and the attendants by pointing various drawbacks or deficiencies should always be taken care of by the hospital administration that will turn into a good result of improvement in the hospital services to the satisfaction of the patients.

COVID-19-positive cancer patients undergoing active anticancer treatment: An analysis of clinical features and outcomes

BackgroundCancer patients, particularly those on active anticancer treatment, are reportedly at a high risk of severe coronavirus disease 2019 (COVID-19) infection and death. This study aimed to describe the clinical characteristics and outcomes of patients diagnosed with COVID-19 whilst on anticancer treatment in a developing country. MethodsThis is a retrospective observational study of all adult cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan, from March 15, 2020 to July 10, 2020, diagnosed with COVID-19 within 4 weeks of receiving anticancer treatment, where a purposive sampling was performed. Cancer patients who did not receive anticancer treatment and clinical or radiological diagnosis of COVID-19 without a positive reverse transcription–polymerase chain reaction (RT-PCR) test were excluded. The primary endpoint was all-cause mortality after 30 days of COVID-19 test. Data was analyzed with SPSS version 23 (SPSS Inc., Chicago, IL, USA). Categorical parameters were computed using chi-square test, keeping p value < 0.05 as significant. ResultsA total of 201 cancer patients with COVID-19 were analyzed. The median age of patients was 45 (18–78) years. Mild symptoms were present in 162 (80.6%) patients, whereas severe symptoms were present in 39 (19.4%) patients. The risk of death was statistically significant (p < .05) amongst patients with age greater than 50 years, metastatic disease, and ongoing palliative anticancer treatment. Anticancer treatment (chemotherapy, radiotherapy, hormonal therapy, targeted therapy, and surgery) received within preceding 4 weeks had no statistically significant (p > .05) impact on mortality. ConclusionsIn cancer patients with COVID-19, mortality appears to be principally driven by age, advanced stage of the disease, and palliative intent of cancer treatment. We did not identify evidence that cancer patients on chemotherapy are at significant risk of mortality from COVID-19 correlating to those not on chemotherapy.

DOG 1 EXPRESSION IN DIFFERENTIAL DIAGNOSIS OF CHONDROBLASTOMAS AND ITS HISTOLOGICAL MIMICKERS

Objective: Chondroblastoma is rare benign cartilage forming tumor of bone predominantly in individuals less than 20 years of age. Recently immunohistochemical marker DOG 1 has been reported to help in the diagnosis in difficult cases where histological features overlap with other similar entities. Current study aims to assess the sensitivity and specificity of DOG 1 in the diagnosis of chondroblastomas.&#x0D; Study design: descriptive cross-sectional study&#x0D; Place and duration of study: The study was conducted from June 2015 to July 2017 in Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.&#x0D; Patients and methods: Total fifty-two patients were included in this study including 19 chondroblastomas, 21 giant cell tumors and 12 chondromyxoid fibromas. DOG 1 antibody was applied on all the cases&#x0D; Results: DOG 1 was positive in 100 % of cases of chondroblastomas. However, intensity and proportion of staining pattern was variable among them. 78% (n=15) cases showed diffuse moderate to strong expression while 22% (n=4) cases showed focal weak expression. Only 10% (n=2) cases of giant cell tumors and 33% (n=4) of chondromyxoid fibromas expressed focal weak expression for DOG 1.&#x0D; Conclusions: This study confirms 100 % expression of DOG 1 in cases of chondroblastomas but intensity and proportion of staining pattern was variable. Therefore DOG 1 may prove to be a useful immunohistochemical marker for diagnosis of chondroblastomas in the future in difficult cases in correlation with histological and radiological features.

Outcome of first relapse of Hodgkin lymphoma: single institution experience.

To determine outcome of first relapse of Hodgkin lymphoma with standard dose chemotherapy, and to identify the prognostic factors predicting survival outcome in paediatric patients. The retrospective study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of Hodgkin lymphoma patients who relapsed at least 3 months after the completion of initial treatment from January 2001 to December 2010. Probabilities of overall survival, event-free survival and cumulative incidence were calculated. Data was analysed using SPSS 21. Of the 43 patients, 31(72%) were males and 12(29%) were females. Mean age at relapse was 11±3.3 years (range: 4-17 years). In 31(72%) patients, early post-operative intraperitoneal chemotherapy was employed. Median follow-up of the cohort was 62 months (interquartile range: 4-187 months). Overall survival and event-free survival at 10 years was 23(54%) and 15(35%) respectively. On univariate analysis, initial disease stage (p=0.021), stage at relapse (p=0.003), treatment protocol (p=0.005), treatment responsiveness at initial two cycles of salvage chemotherapy (p=0.002) and at the end of treatment assessment (p=0.0009) were statistically significant factors. Multivariate cox regression analysis revealed disease stage at relapse (p=0.004), chemotherapy regimen (p=0.025) and end-of-treatment disease evaluation (p=0.005) as the significant variables. Improved outcome with early post-operative intraperitoneal chemotherapy regimen was noted for Hodgkin lymphoma patients who had disease-free interval >2 years.

Retrospective study of ovarian malignancy managed in surgical unit at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore

To determine the oncological outcome and pattern of ovarian tumours in patients who underwent surgical management. The retrospective, descriptive hospital-based study was conducted at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised data of all patients who underwent surgical intervention for ovarian cancer between January 2010 and December 2015. Data was retrieved from the hospital database and analysed using SPSS 20. Of the 236 patients, 203(86%) had undergone open surgery, while 33(14%) had had laparoscopic surgery. Neo-adjuvant chemotherapy was given in 60(25.42%) cases and adjuvant chemotherapy in 102(43.22%). Epithelial ovarian cancer in 201(85.16%) cases was the most common tumour type. Mortality was recorded in 36(15.5%) cases, while 41(19.9%) were lost to follow-up. Ovarian tumours were found to be difficult to treat and were associated with frequent recurrence.

An audit of transfusion reaction monitoring and reporting at a cancer hospital in Pakistan - a step towards haemovigilance.

To monitor the frequencies of different adverse transfusion reactions and to assess the compliance of clinical staff with the process of sending proper transfusion reaction workup within the specified time. The retrospective audit was conducted at the blood bank of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised all transfusion reaction forms received from July 1, 2017, to June 30, 2018. The forms were analysed for type of blood component, time in which it was received by the blood bank, whether or not the form was completely filled, whether or not all required samples were provided, and the type of reaction. Of the 12,787 units dispensed and transfused, 50(0.39%) transfusion reactions were noted. Allergic was the most frequent type 24(48%). Red cells accounted for 38(76%) of the reactions. In 58(95%) cases, reaction forms were completely filled. Blood bags in 36(59%) and post-transfusion ethylenediaminetetra acetic acid samples in 35(57.3%) cases were received at blood bank within 2 hours of reaction. Incidence of transfusion reactions was found to be low as there was good compliance with procedures on the part of the clinical staff.

Toxicity Profile of Procarbazine Lomustine and Vincristine Chemotherapy in Low-Grade Glioma - Retrospective Review.

BackgroundThe role of Procarbazine Lomustine and Vincristine (PCV) chemotherapy is already established in terms of improving survival in low-grade glioma (LGG). This improved survival has led to the increasing administration of PCV to LGG patients over the past years. However, like other chemotherapies, serious hematological and non-hematological toxicities may occur. The purpose of this study was to evaluate the toxicity profile of PCV and its clinical relevance in our practice. Materials and MethodsWe reviewed 63 patients of LGG retrospectively who received chemotherapy PCV between January 2015 and January 2018 at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore.ResultsSignificant hematological toxicity as grade 3 anemia, thrombocytopenia, and neutropenia occurred in 19%, 27%, and 46% respectively with PCV. Other toxicities such as neurotoxicity, vomiting and derangement of liver enzymes occurred in 3.2%, 19%, and 19% respectively. Patients who were on concurrent anticonvulsants had no increase in PCV toxicity. Survival was not impacted by hematological toxicities up to grade 3.ConclusionPCV chemotherapy is associated with major hematological, hepatic, and clinical toxicities (vomiting, constipation, and neuropathy). Hematological toxicities influenced the course of treatment in terms of delays and interruptions.

The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates.

IntroductionFebrile neutropenia (FN) is a dreaded complication of cancer chemotherapy and frequently associated with respiratory infections. Flexible bronchoscopy (FB) serves as a useful diagnostic tool in this regard.ObjectiveTo determine the diagnostic yield, safety and clinical implications of bronchoalveolar lavage (BAL) in cancer patients with FN, having lung infiltrates on radiographic chest imaging.MethodsWe reviewed medical records of FN patients who underwent FB at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from July 2015 till July 2018. The culture yield of BAL, resultant change of management and outcome over the subsequent 30 days were retrospectively analysed. Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY) was used for data analysis.ResultsNinety FN patients, with mean age 26 ± 18 years and predominantly males (65.6%, n = 59) were included in the study. Seventy-seven (85.6%) had hematological and 13 (14.4%) solid organ malignancy. The mean absolute neutrophil count was 0.20 +/- 0.36/ µL. BAL cultures were diagnostic in 40 (44%) patients; the etiology was bacterial, fungal and mixed in 25 (62.5%), 14 (35%) and one (2.5%) patient, respectively. All patients were on empirical antibiotics prior to bronchoscopy: 32 (35.6%) on antibacterial alone and 58 (64.4%) on antibacterial plus antifungal therapy. Change of management occurred in 51 (56.7%) patients after BAL results, including de-escalation from dual antibiotics in 28 (55%) and initiation of new culture sensitive antibiotic in 23 (45%). FB-associated complications developed in three (5.6%) non-intensive care patients (ICU), including transient hypoxia in two and minor hemoptysis in one patient, while five (14.8%) mechanically ventilated patients in ICU experienced worsening of oxygenation parameters within 48 hours. Overall, 24 (26.7%) patients died. Mortality was 3.7% in non-ICU and 69% in ICU setting and significantly higher in patients with fungal pneumonias (p-value 0.01) and with prolonged neutropenia (p-value 0.001).ConclusionsBAL is a safe diagnostic tool for FN patients with lung infiltrates, with minimal complications and sufficient diagnostic yield to improve diagnosis and management of such patients.

Study on 60 cases of common bile duct stone, there different modality of management and its inference

Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD). 21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.

Pancreaticoduodenectomy: Outcomes of a complex surgical procedure from a developing country

BackgroundPancreaticoduodenectomy (PD) plays an integral part in the management of pancreatic, periampullary and duodenal cancers, along with a few other pathologies of this region. Despite advances in surgery PD continues to have significant morbidity and noteworthy mortality. The aim of this study is to provide an in-depth report on the patient characteristics, indications and the outcomes of PD) in a tertiary cancer hospital in Pakistan. Materials and methodsThe study population included patients who underwent PD between January 1, 2014 and march 31, 2019, at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC) in Pakistan. The data was retrospectively analyzed from the Hospital Information System (HIS), which is a prospectively maintained patient electronic database of SKMCH&RC. Patient characteristics, procedural details and post-operative outcomes according to internationally accepted definitions were reported. ResultsA total of 161 patients underwent PD at our hospital in the study period at a median age of 53 years, ranging from 19 to 78 years. 62% of the patients were males while 37% were females. Jaundice was the most common presenting symptom (64.6%), followed by abdominal pain (26.7%). PD with pancreaticogastrostomy was performed in 110 patients (68.3%), while pancreaticojejunostomy was performed in the rest of the cohort. Surgical site infection (SSI) was observed in 64 patients (40%). The incidence of Pancreatic Fistula grade C based on the International Study Group on Pancreatic Fistula (ISGPF) definition was 7.45% (n = 12). The 30 days mortality rate was 3.1%. Median survival of the cohort was 21 ±1.13 months and disease-free survival was 16±2.62 months. ConclusionPD can be performed with acceptable morbidity and mortality in a resource constrained country, as long as it is undertaken in a high-volume center. This is in keeping with data published from other well-reputed international centers.

Comparison of Outcomes Between Radical Radiotherapy and Radical Cystectomy in Muscle Invasive Bladder Cancer in a Cancer Specialized Unit of a Developing Country.

IntroductionRadical cystectomy (RC) is the current standard of care for treating muscle-invasive bladder cancer (MIBC), however bladder preservation by offering radical radiotherapy (RT) is gaining interest for improving the quality of life while maintaining a reasonable oncological outcome. In this study, we have compared outcomes of the two treatment options.Materials and methodsThis is a 10-year retrospective cohort study that included all patients who were treated for histologically proven muscle-invasive bladder cancer in the department of uro-oncology at Shaukat Khanum Memorial Cancer Hospital and Research Centre from January 2005 to January 2015. Data was analysed using Statistical Product and Service Solutions (SPSS), version 21 (IBM Corp., Armonk, NY). The primary end point of our study was to calculate the three- and five-year disease-free survival (DFS) and overall survival (OS).ResultsA total of 230 patients were included in the study with male gender predominating (88%). The mean and standard deviation for age was 58.32+11.128. Radical cystectomy was performed in 119 patients while 111 received RT. Clinically, 34% had stage 2 disease, while 66 % had stage 3 cancer. The median follow-up duration was 41 months (range: 2-155). During follow-up 57.4% of patients showed no recurrence. Local recurrence was found in 9.6% patients and distant metastasis in 32.2%. The three-year DFS of RC was 63% and that of RT was 57% while the five-year DFS for RC and RT were 60% and 49%, respectively (p=0.196). The three-year OS of RC was 64% and that for RT was 58%. On further analysis the five-year OS of RC was 53% and that for RT was 50% (p=0.98). Upon stage-based comparisons, we found no statistically significant difference between the three- and five-year DFS and OS of stage 2 and stage 3 when treated with either modality.ConclusionMost studies favor RC and consider it as the gold standard treatment for muscle-invasive bladder tumor treatment. The current study reveals that bladder preservation approach by chemo radiotherapy is a viable treatment option, having comparable oncological outcomes with patients receiving radical cystectomy, and can be offered to patients having muscle-invasive urothelial bladder cancer.

Oncological Outcomes of Non-Urothelial Bladder Cancers in a Specialized Cancer Hospital of a Developing Country.

BackgroundNon-urothelial bladder cancers (NUBCs) constitute only 5% of all bladder cancers. Because of the scarcity of data, no standardized treatment can be offered to these patients. Surgical treatment can be offered to patients with localized disease; however, generally, the prognosis is unfavorable.MethodologyPatients with histology-proven NUBC presenting to the Department of Uro-oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan, from January 2002 to July 2017 were identified and assessed retrospectively.ResultsA total of 20 patients with a median presenting age of 52 years (range: 34-87 years) were identified. Clinically, T3 was the commonest stage of presentation, i.e., in 11 (55%), whereas 1 (7.1%) patient had metastatic disease. Four types of NUBCs were identified: adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and inflammatory myofibroblastic tumor. Most of the patients with adenocarcinoma were offered surgical treatment in the form of either partial (64.3%) or radical (28.6%) cystectomy. Two patients with small cell carcinoma and two of the three patients with SCC could only be offered palliative chemotherapy. During a median follow-up of 40 months, 14 (70%) patients developed disease progression or recurrence. All these patients succumbed to their disease during a median period of 37.5 months (range: 5-84 months). Furthermore, three- and five-year disease-free survival was 60% and 51%, respectively, and overall survival was 65% and 31%, respectively.ConclusionsNUBC is a rare but aggressive disease that presents at an advanced stage in many cases. Treatment protocols are not uniform; therefore, further collaborative research is needed to improve survival outcomes.

Clinicopathological Characteristics and Short-Term Survival Analyses of Cutaneous Malignant Melanoma.

ObjectiveCutaneous malignant melanoma (CMM) arises from melanocytes, which are pigment-producing cells in the skin. CMM constitutes less than 5% of all cutaneous malignancies worldwide but is associated with the highest mortality rate among all skin cancers. The objective of this study was to examine the profile of clinicopathological factors, survival analyses, recurrence rate, metastatic rates, and the management of CMM at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan.MethodologyAll patients with a diagnosis of CMM treated at our institute from 2014 to 2017 were included in the study. Demographic variables and clinicopathological characteristics were collected and short-term oncological outcomes were recorded. All data were entered and analyzed in SPSS Statistics version 21 (IBM, Armonk, NY).ResultsA total of 28 patients were included in the study. The median age of the patients was 46.5 ±15.9 years. There were 16 male and 12 female patients. A family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43 ±9.09 months. The lower limb was the most common site of tumor among all patients, accounting for 46.4% (n=13) of the cases. On histopathological analyses, ulceration was seen in 53.6% (n=15) of the patients. Unclassified tumor type was present in 75% (n=21) of the patients, followed by nodular in 21.4% (n=6), and superficial spreading in 3.5% (n=1). Clark level IV was the most common presentation, constituting 46.4% (n=13) of the cases. Metastasis was seen in 50% (n=14) of the patients. Local recurrence was observed in 60.7% (n=17) of the patients; 64.3% (n=18) of the patients were alive after one year of treatment.ConclusionCMM is a disease with very high fatality rates. Although it is a disease commonly associated with fair-skinned populations, the incidence of CMM is rising in our part of the world as well. Early diagnosis and prompt management of the disease are crucial in its treatment. However, the mortality rate associated with this disease is still not favorable.

Predictive Factors Involved in Determining Response to Neoadjuvant Chemotherapy in Breast Cancer and Impact of Response on 5 Years Disease Free Survival and Overall Survival

Objective: To evaluate all the known factors that may play a role in predicting response to Neoadjuvant chemotherapy in breast cancer and to see impact of response on five years’ disease free survival (DFS) and Overallsurvival (OS). Material and Method: Data of 156 patients was reviewed retrospectively from January 2012 to December 2012 at Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore, Pakistan. All received neoadjuvant chemotherapy (NAC) and had no distant metastasis. The response was measured in term of percentage reduction from 1st radiological size on presentation to final size on histopathology (of resected specimen). Four groups were identified, complete responder (CR) (100% reduction), Responders (R) (&gt;50% reduction), Partial responder (PR) (&lt;50% reduction) and Non-responder (NR). Relationship of predictive factors with each response group was observed. Five year survival was noted for each response group. Result: Median age of patients was 45 years (25-64 years). 67% of patients underwent breast conservation surgery, while the rest underwent mastectomy. Mortality for whole group was 22%, and recurrence was shown in 34% (Majority i.e. 26% were distant, while contralateral were 3%). Out of 156 patients, 25% of patients were CR, 13% were NR, 23% were PR and 37% were R. Progesterone receptor negative and Grade III tumors showed more complete responses. The Rest of the receptor types, including triple negative, initial T and N stage and other clinical factors showed no impact on chemo-response. Survival was significantly poor in NR group (45% OS, 40% DFS), while rest of three groups had comparable survival outcome, with CR group having best survival outcome (86% OS, 80% DFS). Conclusion: Most of factors studied did not show impact on achieving good chemo response, however good chemo response did show better survival.

Synchronous Primary Endometrial and Ovarian Cancers: Trends and Outcomes of the Rare Disease at a South Asian Tertiary Care Cancer Center.

Background and objectiveThe incidence of synchronous primary endometrial and ovarian cancer is uncommon and poses a diagnostic challenge to the treating physician about their origin as either primary or metastasis. The purpose of this study was to evaluate the clinicopathological behavior, treatment modality-related outcomes, and prognosis related to primary endometrial and ovarian cancers at a tertiary care referral center in South Asia.MethodsWe retrospectively analyzed 30 patients with synchronous ovarian and endometrial cancers treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan from January 2005 to August 2017.ResultsThe median age of the patients at the time of diagnosis was 51 years (range: 25-72 years). The common presenting symptoms were irregular uterine bleeding (30%), post-menopausal bleeding (26.7%), abdominal mass (16.7%), and abdominal pain (26.7%). Endometrial adenocarcinoma type was the most common histological variant found among the participants: 90% (n=27) of uterine and 56.7% (n=17) of ovarian cancers. All patients underwent surgical intervention. Among them, 25 patients received platinum-based adjuvant chemotherapy, four received neoadjuvant chemotherapy, and 18 received adjuvant radiotherapy. The early-stage group [International Federation of Gynecology and Obstetrics (FIGO) stage I and II] had a more favorable prognosis than the advanced stage group (FIGO stages III and IV).ConclusionBased on our findings, patients with synchronous primary endometrial and ovarian cancers have better overall survival rates than patients with single primary ovarian or endometrial cancers. Also, synchronous primary endometrial and ovarian cancer endometroid types have better overall survival than patients with non-endometrioid or mixed histologic types.

Clinical Features and Treatment Outcomes of Children with Anaplastic Large Cell Lymphoma.

To describe clinical features and treatment options in pediatric patients with ALCL (Anaplastic large cell lymphoma) and their outcome over a span of 10 years. A retrospective-observational study. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore,from January 2005 to December 2015. Medical records of pediatric patients with anaplastic large cell lymphoma was retrospectively collected after IRB approval. Data was reviewed for patients confirmed on histopathology and age less than 20 years at the time of diagnosis to see clinical features and treatment outcomes. Descriptive statistics were applied. A total of 40 children, 27 males (67.5%) and 13 females (32.5%) with ALCL (CD30 +), were reviewed. B symptoms were present in 32 (80%) patients, nodal involvement in 39 (97.5%), and mediastinum involvement was present in 8 (20%) patients. Visceral (lung, liver, spleen) and cutaneous involvement was seen in 16 (40%) and 6 (15%) patients, respectively. ALK was positive in 19 patients (48%) and Bone marrow was involved in 3 patients (7.5%). Stage III was seen in 29 (72.5%). All patients were treated on ALCL 99 protocol. Five-year EFS (event-free survival) and OS (overall survival) was 30 and 60%, respectively. There were 7 relapses, 2 progressive disease, 16 death and 3 refusal for treatment. This analysis shows poor outcomes in pediatric ALCL. The most common cause of mortality was hematological toxicity and febrile neutropenia associated with it. Supportive care needs to be improved. Key Words: Clinical features, Outcomes, Anaplastic large cell lymphoma (ALCL), Children.