National Oncology Center Research Articles

Prevalence and risk factors for blood-borne viruses among multi-transfused patients in Sana'a City, Yemen

Background: Blood-borne viruses (BBVs), like hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among multi-transfused patients (MTPs), remain a major public health problem in Yemen. This study aimed to determine the seroprevalence of BBVs and associated risk factors among MTPs. Methods: A cross-sectional study was conducted on MTPs at the Yemeni Society for Thalassemia, National Oncology Center, and Al Kuwait University Hospital in Sana’a City. Data were collected through face-to-face interviews using a predesigned questionnaire. Blood samples were drawn and tested for HBsAg, anti-HCV, and HIV-1,2 by using an electrochemiluminescence immunoassay technique. Results: Among 361 MTPs, the overall seroprevalence of BBVs was 6.8%; seropositivity of HBsAg, anti-HCV, and anti-HIV-1,2 was 3.9%, 2.9%, and 0.0%, respectively. An increase in family size and low income were significantly associated factors with HBV infection. In addition, increases in age and blood transfusion units were found to be significant predictors for HCV (p<0.05). Conclusion: Although the seroprevalence of BBVs is low, it remains a major problem among MTPs. The most frequent infection was HBV, followed by HCV, with a significantly higher rate among leukemia patients. Regular mentoring for viral markers and mandatory implementation of HCV antigen-antibodies testing as well as advanced technology in blood screening are highly recommended.

DEMOGRAPHIC PROFILE AND RISK FACTORS OF HEAD AND NECK SQUAMOUS CELL CARCINOMA IN NATIONAL ONCOLOGY CENTER IN ADEN, YEMEN: PROSPECTIVE CROSS-SECTIONAL STUDY

Head and neck squamous cell carcinoma (HNSCC) is a significant health concern in Yemen, with a notable impact on the population. Major risk factors for HNSCC in this region include qat chewing, cigarette smoking, and tobacco. The goal of our study was to analyze the correlation between demographic profiles, affected anatomical sites, and risk factors. A prospective cross-sectional study was conducted using data extracted from the medical records of patients diagnosed with HNSCC at the National Oncology Center (NOC) in Aden, Yemen, covering the period from January 2023 to December 2023. Information on patient demographics, primary tumor locations, family history, and exposure to risk factors such as qat chewing and cigarette smoking was collected through a structured questionnaire. The study included 100 patients, with a male-to-female ratio of 2.45:1. The mean age of the patients was 53.2 ± 14.7 years, with a significant portion (41%) falling in the 36–54 age group and (40%) falling in the 55–73 age group. The most commonly affected site was the nasopharynx, accounting for 48% of cases. Qat chewing was the predominant risk factor among patients (74%), followed by cigarette smoking (50%) and tobacco (28%). Middle-aged individuals, particularly men aged 36–54 and 55–73 years, are disproportionately affected by HNSCC in Yemen. The nasopharynx emerges as the most prevalent site of cancer. Qat chewing stands out as a prevalent risk factor among patients, followed by cigarette smoking and tobacco. Public education on the risk factors associated with HNSCC is essential for effective disease management and prevention efforts in Yemen.

Haematological and Demographic Features of Acute Myeloid Leukemia among Patients attending the National Oncology Center, Sana’a City - Yemen.

Background: The distinctive feature of acute myeloid leukemia (AML) is the infiltration of abnormal myeloid precursors into the bone marrow and other tissues, frequently accompanied by the appearance of these abnormal cells in the peripheral blood. This study aimed to describe the hematological features and demographic characteristics of patients with AML who attended the National Oncology Center in Sana’a, Yemen. Subjects and Methods: This descriptive study was carried out on 124 newly diagnosed AML patients of all ages and both genders who attended the National Oncology Center in Sana’a City, Yemen, during the period from November 2022 to November 2023. The complete blood count test was performed by drawing a few milliliters of blood sample, then was analyzed through a hematology analyzer, which performs quantitative analysis of blood elements including white blood cell count, WBC differential count, red blood cell count, hemoglobin, and platelet count. Results: The median age of the patients was 35 years and a range (0.9-779 years); the majority of cases were older than 18 years (62.9%); and the frequency of AML was higher in males than in females (57.26% and 42.74%), respectively. Of 124 newly diagnosed AML patients, the median (range) of WBC and platelets were 50.47 (1.18-534.32 103/uL) and 45 (343 103/uL), respectively. The mean SD for RBC was 2.85 0.78 106/uL,, Hb was 8.40.94 g/dL, and Blast count was 75.26 16.04%). Leukocytosis was detected in (62.9%), Hyperleucotyosis in (25%), Erythropenia in (87.1%), and Thrombocytopenia in (86.3%). There was a significant positive correlation between age and platelets (r = 0.194, p-value = 0.03), WBC and Blast cells (r = 0.285, p-value = 0.001), and highly significant between RBC and Hb (r = 0.623, p-value = <0xC6><0xB0>0.001). For the WBC and platelet counts, there were variations between age groups and two genders; the variations were little in other hemological patterns, and there was no significance for all parameters. For WBC count, the median was 62 x 103 uL in the female group, higher than in the male group (46.5 x 103 uL), while there wasn't or little variation in the hematological features among male and female AML patients. Conclusion: Hematological features of bone marrow/peripheral blood are essential diagnostic tools in AML patients. In the present study, approximately 87% of patients present with leucotyosis or hyperleucotyosis, erythropenia, and thrombocytopenia. And the blast cell count was > 20% for all AML patients, which is considered a diagnostic reference.

Effective Algorithm for Biomedical Image Segmentation

Biomedical image segmentation plays an important role in quantitative analysis, clinical diagnosis, and medical manipulation. Objects in medical images have different scales, types, complex backgrounds, and similar tissue appearances, making information extraction challenging. To solve this problem, a module is proposed that takes into account the features of images, which will improve the biomedical image segmentation network FE-Net. An integral part of the FE-Net algorithm is the connection skipping mechanism, which ensures the connection and fusion of feature maps from different layers in the encoder and decoder. Features at the encoder level are combined with high-level semantic knowledge at the decoder level. The algorithm establishes connections between feature maps, which is used in medicine for image processing. The proposed method is tested on three public datasets: Kvasir-SEG, CVC-ClinicDB and 2018 Data Science Bowl. Based on the results of the study, it was found that FE-Net demonstrates better performance compared to other methods in terms of Intersection over Union and F1-score. The network under consideration copes more effectively with segmentation details and object boundaries, while maintaining high accuracy. The study was conducted jointly with the Department of Magnetic Resonance Imaging of the N. N. Alexandrov National Oncology Center. Access to the source code of the algorithm and additional technical details is available at https://github.com/tyjcbzd/FE-Net.

Evaluation of clinicians' knowledge and practice regarding pharmacotherapy of Non-Hodgkin's lymphoma: A multi-center study in Yemen.

Non-Hodgkin lymphoma (NHL) is a hematological malignancy that requires effective pharmacotherapy for optimal management. There is limited information regarding Yemeni clinicians' knowledge and practice of NHL pharmacotherapy. This study aims to assess the knowledge and practice of physicians and nurses in Yemen regarding pharmacotherapy of NHL. A cross-sectional study was conducted in Sana'a, Yemen, from January 1, 2022, to January 31, 2023. Two self-administrated and validated questionnaires were distributed to 99 physicians and 164 nurses involved in pharmacotherapy for NHL in different oncology centers and units across Yemen. Convenience samples were used to recruit participants. A binary logistic regression analysis was performed to identify factors associated with nurses' and physicians' knowledge and practice. The correlation coefficient was used to examine the relationship between knowledge and practice. A total of 77 physicians and 105 nurses completed the questionnaires. The results showed that 54.3% of nurses and 66.2% of physicians had poor knowledge of NHL pharmacotherapy. In terms of practice, 83.8% of nurses and 75.3% of physicians exhibited poor practice regarding NHL pharmacotherapy. Multivariable logistic regression analysis identified that nurses who received sufficient information about chemotherapy displayed a significant association with good knowledge, while nurses working in the chemotherapy administration department were significant predictors of good practice. Among physicians, those working in the National Oncology Center (NOC) in Sana'a demonstrated good practice. Correlation analysis revealed a positive relationship between nurses' knowledge and their practice. The study's results confirm deficiencies in knowledge and practice of pharmacotherapy for NHL among physicians and nurses in Yemen. Efforts should be made to enhance their understanding of treatment guidelines and to improve patient care. Improvement in educational programs and training opportunities may contribute to improving patient outcomes in the management of NHL.

Evaluation of Antiemetic Consistency in Chemotherapy-Induced Nausea and Vomiting Among NHL Patients in Sana'a, Yemen.

Chemotherapy-induced nausea and vomiting (CINV) is a prevalent and distressing adverse effect that can negatively affect a patient's quality of life and treatment adherence. This study aimed to evaluate the consistency of antiemetic use with standard guidelines and to examine the factors influencing it. This cross-sectional study was conducted at the National Oncology Center (NOC) of Al-Jomhouri Teaching Hospital, Sana'a, Yemen, from November 2022 to September 2023. Demographic data, chemotherapy and antiemetic regimens, dosages, and patient-related risk factors were collected via direct interviews, medical records, and treatment charts. This study evaluated the consistency of antiemetic practices among non-Hodgkin's Lymphoma (NHL) patients using the National Comprehensive Cancer Network (NCCN) guidelines. The chi-squared test and regression were used to determine the factors associated with guideline consistency. A total of 251 patients with NHL were recruited for the study; 57.4% were male and 60.6% were aged between 18-49. Most of the patients received moderately emetogenic chemotherapy (81.3%). The overall consistency with the NCCN guidelines was only 23.9%, with antiemetic drug selection and dosage reported inconsistently in 62.9% and 16.7% of patients, respectively. Furthermore, 62.5% of the patients received an under-prescribed antiemetic prophylactic regimen. Treatment duration, number of chemotherapy cycles, emetogenic risk potential, and overall patient risk, as well as age, sex, and marital status, were significantly associated with guideline inconsistency (p < 0.05). This study revealed a notable gap in the consistency of antiemetic prescriptions among patients with NHL. Inappropriate drug selection, dosing, and under-prescription are common problems. Patient regimen risk factors significantly influenced the consistency of the National Comprehensive Cancer Network guidelines. Personalized approaches are essential to enhance adherence to guidelines and improve antiemetic strategies.

Assessment of malnutrition in patients undergoing chemotherapy at the National Oncology Centre of the Korle-Bu Teaching Hospital, Accra, Ghana.

Globally, cancer is on the rise despite several interventions. The link between nutrition and cancer has long been established with the consequences of poor nutrition on cancer pathway being dire. Early nutrition intervention is recommended for all cancer patients. To assess malnutrition among patients undergoing chemotherapy at the National Radiotherapy Oncology and Nuclear Medicine Centre of the Korle-Bu Teaching hospital (KBTH) in Accra, Ghana. A cross-sectional study was conducted among 123 patients with different types and stages of cancer who were undergoing chemotherapy. Data was collected from December 2018 to January 2019. The PG-SGA tool was used to assess weight loss at one and six months, food intake and nutrition impact symptoms. A correlation test was used to test the association between PGSGA score and Nutritional triaging. A T-test was used to determine the association between chemotherapy cycles and nutrition. A p-value <0.05 was considered to be significant. The results revealed that 5.7% (n= 7) of the patients were well nourished, 31.7% (n= 39) were suspected of being malnourished and 62.6% (n=77) were severely malnourished. About half of the participants (48%) had experienced weight loss ranging between 1-20kg with weight loss ≤5kg being most prevalent at both one month and six months prior to the study. More than half (56.9%, n=70) of the participants were consuming less than their usual intake. Majority of the participants had 4-6 nutritional symptoms (39.0%) with symptoms being mostly mild (39.1%). Poor nutritional status was positively correlated with nutritional symptoms (r=0.747, p<0.001). The PGSGA tool identified that more than half of the patients were severely malnourished hence the need for early nutrition intervention in cancer patients.

Tunneled vascular access surgery in pediatric oncology; Experience from a national pediatric oncology center

Central venous access is essential in the treatment of children diagnosed with cancer. Therefore, as a paediatric oncologist/surgeon, it is important to identify the most optimal central venous catheter (CVC) for each patient, to accurately perform CVC surgery and to be aware of the possible complications that can occur and how to prevent and treat them. The aim of this article is to provide an overview of recommendations for CVC choice, methods for tunneled CVC surgery and strategies for perioperative complication treatment. This is based on the experience of the surgeons from our national paediatric oncology center in the Netherlands, inserting 700 CVCs each year.

IMMU-53. MONITOR THE IMMUNE MICROENVIRONMENT AND SYSTEMIC IMMUNE EFFECTS IN PEDIATRIC BRAIN TUMORS – THE MIMIC PROGRAM

Abstract INTRODUCTION Dismal outcomes of pediatric high-grade CNS tumors demand new therapeutic strategies. A better understanding of the immune system may contribute to designing better immunotherapies for these children. The MIMIC program (Dutch Trial Registry NL8967) is a prospective observational longitudinal cohort study, conducted in patients with newly diagnosed or relapsed high-grade CNS tumors with the aim of characterizing and quantifying changes in immune parameters at diagnosis and during treatment. METHODS All patients with a newly diagnosed or relapsed high-grade CNS tumor are included after obtaining informed consent. Patient study material is collected longitudinally and includes tumor tissue (TT), Cavitron Ultra Sonic Aspirator (CUSA) material and optional bone marrow aspiration (BM) at diagnosis and relapse. Cerebrospinal fluid (CSF), peripheral blood (PB) and fecal samples (FS) at diagnosis, 3 months, 6 months, 12 months, relapse and additionally collection of CSF and FS at 14 days. Furthermore, FS is collected from patient siblings as a reference. RESULTS The MIMIC program has opened in June 2021 in the Princess Máxima Center, the national pediatric oncology center in the Netherlands, including so far 47 patients (out of ~60 eligible patients annually). More than 400 samples, out of which 46 TT, 34 CUSA, 65 CSF, 14 BM, 143 PB, and 105 FS have been collected. All samples are subject to extensive immunological profiling using 70+ markers flow cytometry panels (PB, TT, CUSA, CSF, BM), (spatial single cell) RNA and protein profiling (TT, CUSA, BM), immunohistochemistry (TT), proteomics (CSF and PB), and 16S rRNA or shotgun metagenomic sequencing (FS). CONCLUSION The MIMIC program demonstrates the feasibility of obtaining various samples for pediatric high-grade CNS tumors. By incorporating multiple technologies in longitudinal samples, the MIMIC program provides insight into the different immune compartments and their relation to the tumor, forming the base for future clinical trials with immunotherapy.

Analysis of the Breast Cancer Journey in Namibia

Breast cancer (BC) is the leading cancer among women in Namibia. Examining the BC journey in this multiracial country where inequalities remain large is needed to inform effective interventions to reduce BC mortality. To describe the entire BC journey of Namibian women by race, utilizing the World Health Organization Global Breast Cancer Initiative (GBCI) framework. This cohort study used the Namibian subset of the African Breast Cancer-Disparities in Outcomes prospective cohort. Participants were all Namibian residents with confirmed incident BC who presented at the main national public oncology center of the Windhoek Central Hospital (WCH). Follow-up started from recruitment (September 8, 2014, to October 5, 2016) and ended up to 3 years after diagnosis (December 13, 2014, to September 27, 2019). Data analysis was conducted from June 2022 to August 2023. Participants' self-reported ethnicities were aggregated into 3 population groups: Black, mixed ancestry, and White. Three-year overall survival (OS) was examined using Cox models, and summary statistics were used to describe women's BC journey, including GBCI pillar key performance indicators: (1) early stage (TNM I or II) diagnosis (population benchmark ≥60%), (2) prompt diagnosis, ie, 60 days or less to first health care practitioner visit (population benchmark 100%), and (3) completion of recommended multimodal treatment (MT, ie, surgery plus chemotherapy) (population benchmark ≥80%). Of 405 women, there were 300 (74%) Black (mean [SD] age, 53 [15] years), 49 (12%) mixed ancestry (mean [SD] age, 53 [7] years), and 56 (14%) White (mean [SD] age, 59 [12] years) patients. Three-year OS was lowest in Black women (60% [95% CI, 54%-66%]; mixed ancestry: 80% [95% CI, 65%-89%]; White: 89% [95% CI, 77%-95%]), who had lower prevalence of early stage diagnosis (Black: 37% [95% CI, 31%-42%]; mixed ancestry and White: 75% [95% CI, 66%-83%]) and timely diagnosis (Black: 60% [95% CI, 54%-66%]; mixed ancestry and White: 77% [95% CI, 69%-85%]), while MT completion (Black: 53% [95% CI, 46%-59%]; mixed ancestry and White: 63% [95% CI, 50%-73%]) was low in all women. In this cohort study of 405 Namibian residents with BC, marked racial disparities in survival were paralleled by inequities all along the BC journey. To improve BC survival, interventions are needed to promote earlier diagnosis in Black Namibian women and to increase MT initiation and completion in all women.

Tumor Profiles of Late Presentation Uveal Ring Melanoma With Novel Characteristics - A Case Series.

The purpose of this study was to investigate the clinical features, tumor characteristics, including histopathology and cytogenetic analysis, and management of patients with uveal ring melanoma in New Zealand. A retrospective review was conducted on all uveal melanoma cases treated in a single national oncology center in New Zealand. The study period was from January 1, 2013 to December 31, 2022 (10 years). Written consent was obtained from all patients included in this case series. Uveal ring melanoma of ciliary body origin (n = 4) comprised 0.7% of all uveal melanomas (n = 571). Ethnicity distribution was three patients of New Zealand European ancestry and one patient of Chinese/Pasifika ancestry. Three patients (75%) were symptomatic at presentation (spontaneous hyphema, glaucoma, and cataract), whereas one was asymptomatic but subsequently developed painful refractory glaucoma. All eyes underwent enucleation. Three eyes had primary iris biopsies with subsequent enucleation for refractory glaucoma and pain and one eye underwent primary enucleation. All cases demonstrated malignant tumor characteristics including diffuse 270 to 360-degree ciliary body ring growth pattern, epithelioid-cell type and presence of either BAP-1 expression loss or gain of MYC gene. Two cases (50%) developed distant organ metastasis - liver, parotid gland, and breast. Of those, one patient was deceased at the time of follow-up whereas one had completed treatment for metastases. Uveal ring melanoma is a rare tumor that is highly invasive and malignant. When detected, prompt definitive treatment should be advocated, and patient counselling should be given regarding the high risk of developing a painful, blind eye with increased risk of metastasis in the absence of treatment.

Factors Associated With Malnutrition in Hospitalized Cancer Patients in a National Oncology Center in Conflict-Affected Settings in Sana'a, Yemen: An Institution-Based Cross-Sectional Study.

Background Cancer can significantly impact thenutritional statusof patients, which can worsen related complications and reduce the effectiveness of treatment. Malnutrition is a common complication among cancer patients, especially among older adults. This study aims to determine the prevalence of malnutrition amonghospitalized cancer patientsand identify factors associated with malnutrition. Methodology and methods The cross-sectional descriptive study was performed on 296 cancer patients admitted to the National Oncology Referral Center in Sana'a, Yemen, between February 1 and March 31, 2022. Malnutrition was diagnosed through clinical assessment andscreening toolssuch as screening tools, body mass index (BMI),weight loss percentage, and mid-upper arm circumference (MUAC).Descriptive statistics, chi-square, andmultivariable logistic regression analysiswere used to assess factors associated with malnutrition. Results Of the 296 patients included in the analysis, most were female 225 (76.0%), and the mean age was 45.8 years. The prevalence of undernutrition, as determined by the BMI score, was 48 (16.2%). The prevalence of malnutrition was higher in females 37 (16.4%) compared to males 11(15.5%). The data indicated that 49% of hospitalized patients had experienced weight loss of 5% or more. Multivariable logistic regression analysis showed that single (AOR=12.93, 95% CI: 1.17-142.77) or widowed (AOR=11.51, 95% CI: 1.05-126.03) marital status,weight loss (AOR=7.56, 95% CI: 3.00-18.69), stomach cancer (AOR=6.77, 95% CI: 1.66-27.70), andbreast cancer(AOR=2.60, 95% CI: 1.12-6.03) were associated with an increased risk of malnutrition. Conclusions The study highlights the importance of evaluating and addressing the nutritional status of cancer patients, especially at the beginning and during treatment, to improve their clinical outcomes. Prospective studies are recommended to further investigate this issue.

JS01.4.A CENTRALIZED CRANIOSPINAL PROTON THERAPY FOR MEDULLOBLASTOMA PATIENTS; AN EVALUATION OF THE CARE INFRASTRUCTURE IN THE NETHERLANDS

Abstract BACKGROUND The introduction of proton radiotherapy in the Netherlands resulted in the centralization of proton craniospinal irradiation (pCSI) for patients with medulloblastoma (MB) to a single center. For optimal outcome of MB patients, timely start of pCSI and treatment without interruptions is important. However, national-scale referrals and the complexity of delivering pCSI pose a risk for treatment delays in these patients. Therefore, to aid in high quality care, integration of pCSI within the national pediatric oncology center and collaboration within the Dutch neuro oncology society - rare cancer working group was established. In this study, we evaluated the care infrastructure for pCSI for a nationwide defined MB patient cohort in the Netherlands. MATERIAL AND METHODS All Dutch MB patients referred for pCSI to our center were included in this analysis. The interval between surgery and start of pCSI was calculated, excluding patients who received neo-adjuvant chemotherapy. Overall treatment time, use of (back-up) photon fractions and plan adaptations were evaluated. Data regarding planned and additional multidisciplinary care during pCSI were extracted from the medical records. RESULTS Between February 2018 and December 2022, 79 MB patients, including 25 (32%) adult (&amp;gt;18 years) patients, were treated with pCSI. The median interval between surgery and start of pCSI for pediatric and adult patients was 32 days (IQR 30, 35) and 41 days (IQR 35, 55) respectively, and 91% and 47% started within 40 days from surgery. The median overall treatment time for all patients was 41 days (range 11). The longest treatment interruption was 3 days in one adult patient. Eight patients received a median of 9 photon fractions (IQR 2, 11); most often because of the need to start treatment quickly. In 30% of all patients a plan adaptation was needed, mostly because of changes in patient weight during treatment. In our center, it is considered standard of care to involve the (pediatric) medical oncologist and neurologist during pCSI. Clinical care (hospitalization) was required in 42% of the patients for a median of 10 days. Anesthesia was necessary predominantly for patients aged 8 years and younger. Other (para)medical disciplines involved during pCSI were neurosurgery (6%), neuropsychology (22%), speech therapy (25%), rehabilitation therapy (46%) and nutritional specialist (73%). CONCLUSION The Dutch pCSI infrastructure for MB patients facilitated a timely start of treatment in over 90% of pediatric patients and in nearly half of the adult patients. During pCSI treatment, a well-orchestrated interplay between several (para)medical disciplines is required to provide all potential necessary care. More disciplines were involved and more clinical care was required for pediatric patients. We were able to deliver pCSI treatment with less than 3 days interruption in 98% of patients.

The Histopathological Characteristics of Gastric Tumor at The National Oncology Center in Benghazi in the Period of 2020-2021

Background: Gastric cancer is considered globally a major health issue. Many studies have shown that adenocarcinomas represent about 90% of all gastric cancers. It is subdivided into two main histological types; intestinal and diffuse. Aim: The aim of this study is to determine the frequency and the histopathological characteristics of gastric adenocarcinoma among patients of the National Cancer Center of Benghazi in the period of 2020-2021. Subjects and methods: A retrospective study of 52 gastric cancer cases from the archive of the National Oncology Center in Benghazi and data was analyzed with SPSS. Results: In the research period between January 2020 to May 2021, the total number of patients with confirmed gastric cancer was 52 cases. The patients' ages were between 29 to 86 and the mean age was 63. Thirty-one (31) cases were male (59.6%) and twenty-one (21) were female (40.4%). Diffuse adenocarcinoma was predominant over the intestinal type (25% and 19.2 % respectively). 48% of the cases were of undetermined type and 3.8% were gastrointestinal stromal tumors. Most of the cases presented at stage IV. Conclusion: The histopathological picture of gastric cancer in our study was similar to a previously published study done in Benghazi with male predominant and diffuse adenocarcinoma as the more common cancer. Some risk factors are attributed such as infection with H pylori, smoking and anemia.

Endoscopic differential diagnosis of the gastritis-like form of primary non-Hodgkin’s lymphomas and neuroendocrine tumors of the stomach

Background. The gastritis-like form of primary non-Hodgkin’s lymphomas (NHL) of the stomach is the rarest macroscopic variant of malignant neoplasms of the stomach, endoscopically resembling inflammatory changes in the mucous membrane and, in single observations, polypoid and flatly elevated forms of neuroendocrine tumors (NET) of the stomach. Despite the great experience gained in the diagnosis and treatment of primary NHL of the stomach and NET of the stomach, in clinical practice there are examples that cause difficulties in the correct interpretation of the endoscopic picture and the timely diagnosis.Aims. To analyze the data of a comprehensive endoscopic examination of patients with diagnoses of a gastritis-like form of primary NHL and NET of the stomach, and to identify the main differentially significant endoscopic criteria characteristic of each individual type of neoplasia.Materials and methods. In a prospective study conducted at the FSBI “N.N. Blokhin national medical Research Center of Oncology” of the ministry of Health of Russia in the period from 2017 to 2022, data from endoscopic and morphological studies of 69 patients with gastritis-like malignancies were analyzed. All patients underwent a comprehensive endoscopic examination of the upper gastrointestinal tract – esophagogastroduodenoscopy using all clarifying examination methods (narrow-spectrum mode, examination in magnification mode, a combination of narrow-spectrum examination with magnification mode), accompanied by the taking of biopsy material for the purpose of morphological verification of the diagnosis, and endosonographic study.Results. According to the results of a morphological study, the diagnosis of primary NHL of the stomach was confirmed in 38 patients (55.1 %), NET of the stomach – in 31 patients (44.9 %). A change in diagnosis based on the results of a morphological study occurred in 3 (4.3 %) of 69 (100 %) patients. The sensitivity and diagnostic accuracy of complex endoscopic examination were higher compared to endoscopic examination in white light mode, and amounted to 92.11, 95.65 and 13.16 %, 52.17 %, respectively.Conclusion. for a correct assessment of the endoscopic picture, it is necessary to conduct a comprehensive endoscopic examination using all clarifying diagnostic methods, which shows greater sensitivity and specificity compared to examination in white light mode.

The results of treatment for resectable gastric cancer with microsatellite instability

Background. microsatellite instability (MSI) is a prognostic marker of survival in many malignant diseases and show resistance to chemotherapy at early stages of colorectal cancer and show no benefits from chemotherapy at early stages of colorectal cancer. However, the role of MSI in resectable gastric cancer (GC) remains unknown.Aim. To study the results of treatment of resectable gastric cancer with microsatellite instability.Materials and methods. The study included 286 patients with resectable gC who received treatment at the N. N. Blokhin national medical Research Center of Oncology. All patients underwent PCR testing for MSI-H in 5 markers (BAT25, BAT26, NR21, NR24, NR27). Tumor regression grades (TRG) were evaluated according to the mandard tumour regression score, including disease-free survival and overall survival.Results. MSI indicated in 27 cases (9.44 %) out of 286 resectable gastric cancer. In group patients who received only surgical treatment, 2-year disease-free survival in patients with MSI-H was 77.80 % versus 88.29 % in MSS patients (hazard ratio (HR) 1.82, 95 % confidence interval (CI) 0.37–8.82, p = 0.45), 2-year overall survival in patients with MSI-H was 88.90 % versus 95.36 % in MSS patients (HR 2.03, 95 % CI 0.20–19.8, p = 0.54). In patients who received perioperative chemotherapy, 28.57 % (4 / 14) had progression in MSI-H tumor versus 3.61 % (6 / 166) in MSS tumor (p &lt;0.001). In group patients who received treatment combined with chemotherapy, 2-year disease-free survival in patients with MSI-H was 59.60 % versus 67.36 % (HR 1.96, CI 95 % 0.88–4.35, p = 0.09), 2-year overall survival in patients with MSI-H was 67.30 % versus 85.86 % in MSS patients (HR 1.86, 95 % CI 0.64–5.41, p = 0.25)Conclusion. MSI-H is not a favorable prognosis factor in patients with resectable GC who are treated surgically combined with chemotherapy. The prevalence of progression in patients with MSI-H-status is higher than MSS-status with perioperative chemotherapy (FLOT / FOLFIRINOX).

Imaging in rhabdomyosarcoma: a patient journey

Rhabdomyosarcoma, although rare, is the most frequent soft tissue sarcoma in children and adolescents. It can present as a mass at nearly any site in the body, with most common presentations in the head and neck, genitourinary tract and extremities. The optimal diagnostic approach and management of rhabdomyosarcoma require a multidisciplinary team with multimodal treatment, including chemotherapy and local therapy. Survival has improved over the last decades; however, further improvement in management is essential with current 5-year overall survival ranging from 35% to 100%, depending on disease and patient characteristics. In the full patient journey, from diagnosis, staging, management to follow-up after therapy, the paediatric radiologist and nuclear physician are essential members of the multidisciplinary team. Recently, guidelines of the European paediatric Soft tissue sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR), in an ongoing collaboration with the International Soft-Tissue Sarcoma Database Consortium, provided guidance for high-quality imaging. In this educational paper, given as a lecture during the 2022 postgraduate ESPR course, the multi-disciplinary team of our national paediatric oncology centre presents the journey of two patients with rhabdomyosarcoma and discusses the impact on and considerations for the clinical (paediatric) radiologist and nuclear physician. The key learning points of the guidelines and their implementation in clinical practice are highlighted and up-to-date insights provided for all aspects from clinical suspicion of rhabdomyosarcoma and its differential diagnosis, to biopsy, staging, risk stratification, treatment response assessment and follow-up.

Machine Learning Logistic Regression Model for Early Decision Making in Referral of Children with Cervical Lymphadenopathy Suspected of Lymphoma

While cervical lymphadenopathy is common in children, a decision model for detecting high-grade lymphoma is lacking. Previously reported individual lymphoma-predicting factors and multivariate models were not sufficiently discriminative for clinical application. To develop a diagnostic scoring tool, we collected data from all children with cervical lymphadenopathy referred to our national pediatric oncology center within 30 months (n = 182). Thirty-nine putative lymphoma-predictive factors were investigated. The outcome groups were classical Hodgkin lymphoma (cHL), nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), non-Hodgkin lymphoma (NHL), other malignancies, and a benign group. We integrated the best univariate predicting factors into a multivariate, machine learning model. Logistic regression allocated each variable a weighing factor. The model was tested in a different patient cohort (n = 60). We report a 12-factor diagnostic model with a sensitivity of 95% (95% CI 89-98%) and a specificity of 88% (95% CI 77-94%) for detecting cHL and NHL. Our 12-factor diagnostic scoring model is highly sensitive and specific in detecting high-grade lymphomas in children with cervical lymphadenopathy. It may enable fast referral to a pediatric oncologist in patients with high-grade lymphoma and may reduce the number of referrals and unnecessary invasive procedures in children with benign lymphadenopathy.

Correlation Hematological Malignancies in the Hadhramout Sector Pattern and Distribution

Objective: To study the pattern and distribution of hematological cancers in Hadhramout sector-Yemen and compare with the findings elsewhere in the country and worldwide. Methods: Descriptive study of patients with Hematological malignancies between January 2011 and December 2015 recorded in National Oncology center- Hadhramout. Cases were sub-grouped according to their lineage into lymphoid types which include Non-Hodgkin’s and Hodgkin’s lymphomas, acute and chronic lymphocytic leukemia and multiple myelomas, and Myeloid types which include acute myeloblastic leukemia and chronic myeloproliferative neoplasms. Patients were classified into four age groups: &lt;18, 18-40, 41-60 and &gt;60 years. Results: 661 cases of Hematological malignancies were registered (22.6% of all cancers registered). 58.7 % males and 41.3% females, (male to female ratio of 1.4:1). Slight female predominance was found in cases of chronic myeloproliferative neoplasms. Hematological malignancies occur at a young age, with an overall median age at diagnosis of 39 years. Non-Hodgkin’s lymphoma was the most common subtype (37.8%), followed by Hodgkin’s lymphoma. The majority of cases were observed among the 18-40 age groups (28%). In children and adolescents &lt;18 years old, acute lymphoblastic leukemia and acute myeloblastic leukemia were more predominant (24%, 11.4%). Multiple myeloma commonly occurred in the 41-61 age groups (57.6%). Chronic lymphocytic leukemia mostly occurred among old patients over 60 years (66.7%). Most cases were from the Hadhramout governorate (n= 507, 76.7%) and Mukalla was the most affected city. Conclusion: The distribution of Hematological malignancies in Hadhramout is more common in adults while decreased in the elder population.

The clinicopathological profile and value of multidisciplinary management of pediatric brain tumors in a low-income setting

Brain tumors are the most common solid tumors in children and a leading cause of cancer-related mortality in children worldwide. Data on the epidemiology and management of pediatric brain tumors in Uganda are limited. We aimed to assess the clinicopathological profile and management of pediatric brain tumors at the national oncology center in Uganda since the inception of weekly multidisciplinary meetings. Records of children younger than19 years diagnosed with primary brain tumors at Uganda Cancer Institute between 2017 and 2021 were retrospectively reviewed. Patient and tumor characteristics were collected with multidisciplinary team management treatment plans for analysis. There were 35 patients evaluated, most of whom were males (57.1%). Craniopharyngioma (n = 9, 25.7%) was the most common brain tumor, followed by astrocytoma (n = 5, 14.2%) and medulloblastoma (n = 4, 11.4%). Management included surgical resection in 28.5% of patients, chemotherapy (28.6%), radiotherapy (17.1%) and palliative care (20.0%). Over the last five years, there were increasing trends in the number of cases discussed in the multidisciplinary team and the number for whom the multidisciplinary management decisions were implemented. The majority (n = 18, 51.4%) of the children with brain tumors were alive and active in care, 34.2% abandoned treatment/lost to follow-up, and 8.6% died. The relative distribution of pediatric brain tumors types in Uganda Cancer Institute differs slightly from international reports, and there has been a notable increase in the number of cases over the years. Implementing multidisciplinary management decisions benefited patients and decreased abandonment and patient loss to follow-up.