Objective: This study aimed to investigate the immunohistochemical expression of c-Myc in muscle invasive urothelial carcinoma (MIUC) of the urinary bladder and to evaluate the correlation of c-Myc expression with different clinicopathological parameters and outcome, including a relatively new histopathological tumor characteristic that is the growth pattern of tumor invasion. Methods: A total of 66 formalin-fixed and paraffin-embedded sections of MIUC obtained from radical cystectomy specimens were enrolled. The sections were stained with c-Myc antibody using immunohistochemistry technique. Results: Tumor cells showed variability in nuclear c-Myc expression according to the growth pattern of invasion. The median H-score of nuclear expression of infiltrative pattern was significantly higher than that of non-infiltrative pattern (p<0.001). Nuclear expression of c-Myc in tumor tissue had a significant association with poor prognostic factors (sarcomatoid variant (p<0.001), perineural invasion (p=0.037), lymphovascular invasion (p<0.001), lymph node metastasis (p<0.001), distant metastasis (p=0.042) and advanced stage grouping (p=0.001). Kaplan Meier survival analysis demonstrated that c-Myc expression could not be significantly correlated with overall survival or disease free survival rates. Conclusion: Nuclear c-Myc seems to have a prominent role in epithelial to mesenchymal transition with consequential in tumor progression and metastasis, while it is not as much useful to predict the clinical behavior of patients with MIUC.

Background: Bacterial infection is a frequent complication in cancer and immunocompromised patients. The emergence of antibiotic resistance is a significant health problem and cancer patients are at risk of repeated infections with drug-resistant bacteria. Objective: This investigation aimed to identify predictors of repeat infections of Escherichia coli and Klebsiella pneumoniae and drug resistance in cancer patients admitted to the intensive care unit (ICU) in Upper Egypt. Methods: Blood, urine, sputum, pus, and mouth and nose swabs were collected form patients at the Pediatric Oncology and Medical Oncology ICUs during the period from February 2017 to May 2018. The samples were assessed by antibiotic susceptibility test and further evaluated by genetic testing for the temoniera (TEM) gene of β-lactamase. Samples positive for K. pneumoniae and E. coli were included and isolates positive for other microorganisms were excluded. Results: The study included 107 patients with malignant neoplasms and 136 samples. Repeated infection with K. pneumoniae and E. coli occurred in 31% and 22.45% of patients, respectively. Patients stayed for a longer period in the ICU were more likely to have repeated infections (OR 1.25, 95%CI 1.10-1.44, p=0.001) after control of other confounding factors. The type of malignant neoplasm whether it was hematologic or solid tumor (OR 7.46, 95% CI 2.56-21.7, p=0.0002) and a longer prior stay in the ICU (OR 1.14, 95% CI 1.02-1.28, p=0.025) remained the independent predictors for the drug resistance in the last infection. The TEM type of β-lactamase was encoded in 48.68% and 66.67% of K. pneumoniae and E. coli, respectively. Conclusion: Reinfection with K. pneumoniae and E. coli in patients with cancer can occur as the number of days in the hospital increases. Total prior days spent in the ICU by cancer patients were independently associated with both repeated infections and drug resistance. Samples from patients with hematologic neoplasms were associated with drug resistance.

Background: This study was performed to evaluate the efficacy and safety of switch maintenance therapy with oral vinorelbine in advanced non-small cell lung cancer (NSCLC) with adenocarcinoma limited to epidermal growth factor receptor (EGFR) wild type. Materials and Methods: In this single randomized trial, patients with advanced stage (IIIB and IV) NSCLC with adenocarcinoma EGFR wild-type status, treated with 6 cycles of platinum based chemotherapy. Patients did not show progression after first-line chemotherapy were randomly assigned to receive switch maintenance with vinorelbine (80 mg/m 2 , day 1, 8) (group I) or the best supportive care until disease progression (group II). Results: The median progression free survival (PFS) was 9.7 months for group I versus 5.7 months for group II with statistically significant difference between both groups [HR = 1.15; 95% CI 1.19 to 1.49; P value = 0.002], while the median overall survival (OS) was 13.2 months for group I versus 11.9 months for group II with no statistically significant differences between both groups [HR = 1.24; 95% CI 1.05 to 1.46; P value = 0. 3]. The patients who received oral vinorelbine had tolerable toxicity profile. Conclusion: Switch maintenance therapy with oral vinorelbine, though improve PFS, did not improve OS in patients with NSCLC with adenocarcinoma EGFR wild type.

Background: Bladder cancer is the most common genitourinary tract malignancy among Egyptian males (16%). bladder sparing therapy can be considered an alternative for patients refusing surgery or are not candidates for surgery. The objective of this study was to determine the safety and feasibility of external-beam irradiation with concomitant boost in muscle invasive bladder cancer and to determine the short-term (1-year) risk of recurrence of bladder cancer. Methods: Between October 2019 and November 2021, we enrolled 42 patients in Prospective, one arm trial. Eligible patients had pathologically confirmed TCC transitional cell carcinoma of the bladder cT2-4aN0M0, who refused surgery or had contraindications to surgery, and treated conservatively with radiotherapy. All patients underwent maximal TURB before beginning of chemoradiation therapy which was delivered in all patients The patients received radiotherapy dose 45 Gy/25 fractions (1.8 Gy) per fraction to the whole bladder+ 3 cm. with concurrent cisplatin 20 mg/ m 2 over 30 minutes before radiation on days 1,2,15,16,29, and 30. Additionally, concomitant boost limited to the bladder plus1.5 cm margin was deliverd during the last ten days of the treatment with a minimum 6 h gap between fractions, to a total dose 60 Gy, with the overall treatment time equal to 5 weeks. Results: The median overall survival OS for 42 patients with transitional cell carcinoma( TCC) of bladder treated with 3D conformal radiotherapy 3DCRT and concomitant boost was 28 months, the mean OS was 29.9±1.04, and (95% confidence interval=27.9-32). The one-year OS was 100%, 2-year OS was 81%, and 3-year OS was 26.2%.The mean loco-regional relapse free survival (LRRFS) was 31.6±1.8, 95% CI=28.1-35.1, and the median was 26.5±1.4, the one-year loco-regional RFS was 92.9%, and 2-year (LRRFS) was 66.7%.Acute and late genitourinary toxicity was grade 2 in most of patients and also acute and late toxicity of gastrointestinal was equal or less than grade 1. Conclusion: In external radiotherapy for muscle invasive bladder cancer a concomitant boost technique of invasive bladder cancer with shortening of the overall treatment time provides a high probability of local control and overall survival with acceptable toxicity.