Over 90% of non-metastatic breast cancer patients present with stagesII and III disease and a significant proportion develop distant metastasis accounting for overall long-term outcome inferior to developed countries. Efforts should be directed to raise the level of health awareness and screening programs to improve early detection in Pakistan.
Purpose: The purpose of this study was to assess the outcomes in glioblastoma patients treated with hypofractionated radiotherapy.Materials and Methods: We reviewed all glioblastoma patients treated at our specialist cancer centre over 7 and a 1⁄2 years using hypofractionated radiotherapy (HRT) postoperatively. The HRT regimen was 48 Gy given at 3 Gy/ fractions in 16 fractions. We calculated overall survival using time to event analyses. Results: A total of 62 patients were identi ed of whom 44 (71%) were male. The median age of these patients was 50 years (range: 20–71 years). Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 47 (76%) and 1 in 15 (24%) patients. 7 (11%) of the patients underwent gross total resection, 52 (83%) had subtotal resection and 3 (5%) had a biopsy only. Response assessment on magnetic resonance imaging at 3-month post-HRT showed that 14 (22%) patients had regression, 21 (34%) were stable and 22 (35%) had a progressive primary tumour. 5 (8%) patients were lost to follow up. With a median follow-up of 7.8 months, the median overall survival was 9 months. Patients with ECOG-0 showed a median survival of 7 months as compared to 6 months for those with ECOG-1. Patients with stable or partial response showed a median overall survival of 8 months in comparison to 6 months for those with progressive disease. There were no signi cant differences in median survival based on the extent of surgery. A Cox multivariate model con rmed signi cant correlation of age and response to radiotherapy with survival. Conclusion: HRT consisting of 48 Gy in 3 weeks can be used for selected glioblastoma patients to reduce the overall treatment time of conventional radiotherapy by 35–40% without apparent increased toxicity or decrement in survival in a low resource environment. Key words: Chemoradiation, glioblastoma, hypofractionated radiotherapy, survival
PURPOSE To report the chronic toxicity and disease outcomes attributable to intensity-modulated radiation therapy (IMRT) in patients with cervical cancer. METHODS AND MATERIALS Between January 2014 and December 2018, a retrospective review of medical records of patients with cervical cancer who received radiation therapy with IMRT was performed. Disease and treatment-related details were documented. Follow-up notes were reviewed, and severity of late toxicities was recorded. Overall survival (OS) and disease-free survival (DFS) at 3 years were estimated. RESULTS A total of 222 patients’ records were reviewed. Mean age was 50.7 years. Median follow-up duration was 33 months (range, 2-70 months). The most common toxicity was vaginal stricture (grade 2, n = 59, 26.6%; grade 3, n = 4, 1.80%), followed by proctitis (grade 2, n = 24; 10.8%; grade 3, n = 7; 3.20%). Seven patients (grade 2, n = 5, 2.3%; grade 3, n = 2; 0.90%) developed cystitis, and only 5 (grade 2; 2.3%) were found to have colitis. None of the patients had grade 4 or grade 5 toxicities. There was a significant difference in late complications in patients with nodal disease or those who underwent prior surgery ( P < .05). Three-year OS and DFS rates were 79.7% and 81.9%, respectively. Patients with tumor size > 5 cm and those with pelvic lymph node metastasis had poor survival rates ( P < .05). CONCLUSION IMRT is an effective and well-tolerated technique that should be considered in patients with lymph node disease and in postoperative patients. There is an inverse relationship between tumor size and nodal involvement with respect to OS and DFS.
PURPOSE To report the toxicity and pathologic response rates after adding neoadjuvant capecitabine and oxaliplatin (CAPOX) followed by concurrent radiation and capecitabine (CAPRT) and surgery in patients with locally advanced rectal cancer. MATERIALS AND METHODS We retrospectively analyzed medical records of 301 patients between January 2007 and December 2014. Patients were treated with four cycles of neoadjuvant chemotherapy comprising CAPOX, followed by radiotherapy at doses of 45-54 Gy in 25-30 fractions with concurrent capecitabine. A response assessment scan was performed at 4-6 weeks postradiation followed by surgical evaluation at 6-8 weeks. Pathologic tumor and nodal response rates as well as circumferential resection margin were assessed on surgical specimens. RESULTS The median age of the patients was 43 years (range, 16-78). Overall, 227 (75.4%) patients were able to complete four cycles of CAPOX. Neoadjuvant chemotherapy was well-tolerated with no serious adverse effects. The most common toxicity was diarrhea (grade 2, n = 108; 35.8%; grade 3, n = 57; 18.9%; grade 4, n = 25; 8.3%) followed by neuropathy (grade 2, n = 132; 43.8%; grade 3, n = 54; 17.9%) and oral mucositis (grade 2, n = 108; 35.8%; grade 3, n = 47; 15.6%; grade 4, n = 9; 2.99%). A total of 229 (76.1%) patients underwent surgery. Pathologic complete response was seen in 52 (22.7%; 95% CI, 13 to 28), whereas 200 (87.3%; 95% CI, 82 to 99) patients had a negative circumferential resection margin on pathology. CONCLUSION Neoadjuvant chemotherapy with CAPOX before CAPRT and planned total mesorectal excision surgery result in good tumor regression and substantial pathologic complete response rates with acceptable toxicity. With growing interest in organ preservation in rectal cancer, the strategy of completing all chemotherapy and chemoradiotherapy before planned surgery offers a favorable paradigm. However, further randomized clinical trials are needed to support this evidence.
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