Physical profile and clinical results of concurrent chemoradiotherapy or radiotherapy alone in the treatment of uterine cervix carcinoma using different dose rate brachytherapy

To evaluate physical profile, application techniques and clinical results of conventional external beam radiotherapy [EBRT] with different dose intracavitary brachytherapy [ICRT]. The role of concurrent cisplatin-based chemo-radiotherapy and HDR interstitial brachytherapy technique was also assessed. A total of 108 patients were prospectively studied, distributed into three treatment groups. Treatment was initiated with EBRT in all treatment groups. Groups I and II patients were divided into 2 subgroups [IA, IB], [IIA, IIB]. Both subgroups were treated by a conventional EBRT schedule, and concurrent cisplatin in group II. This was followed by ICRT either low dose rate [LDR] in subgroups IA, IIA or high dose rate [HDR] ICRT in subgroups IB, IIB. Group III patients received concurrent chemoradiotherapy followed by intertistial HDR brachytherapy. The mean age was 48 year. Vaginal bleeding was the most frequent symptom [84%, 80%, and 89% in groups I, II, and III respectively]. Exocervical lesions were the commonest presentation in groups I and II [70%]. Squamous cell carcinoma was dominant in all therapeutic groups. The clinical results showed complete response [CR] in 78% [group I] and 84% in group II, while in group III, only 61% achieved CR. Notably the associated early and late reactions were reported in group III more than the other two groups. Forty-two month actuarial pelvic/locoregional control rates were achieved in 66%, 77%, and 39% in groups I, II and III respectively [p=0.05]. The utilization of HDR ICRT compared to LDR produced a dramatically improved ability for dose distribution and optimization, not to mention patient convenience. The addition of cisplatinum with conventional EBRT and ICRT [LDR and/or HDR] demonstrated a clear positive impact on initial treatment results and subsequent progression-free and overall survival, with minimal differences in treatment related morbidities compared to radiotherapy alone. The utilization of interstitial rather than ICRT techniques, for patients with generally poor pelvic anatomy, producing more improved dose distribution/optimization, resulted in comparable actuarial 3.5-year cumulative overall survival rate

Acute coronary syndrome in young adult and old age [comparative study]

Clinical characteristics as well as biochemical profile and angiographic findings in patients with acute coronary syndrome may differ in young compared to old patients. We compared clinical, laboratory and angiographic characteristics in forty four patients with acute coronary syndrome at age 50 years [group II]. All patients presented by acute coronary syndrome and admitted to the coronary care unit at Bab-Elsharia University Hospital. The two patients groups were compared in coronary risk factors and angiographic features. STEMI were [43.2% vs 28.6%], NSTEMI [9.1% vs 7.l%] and UA [47.7% vs 643%] with no statistical significance. Smokers were high in GI [47.7% vs 35.7%] and non smokers were high in GII[45.5% vs 62.5%] with no statistical significance and the smoking index is more in Gil [1262.1 + 618.9] than GI [946.67 +/- 514.3] mostly due to longer duration of smoking. No statistical significance as regard hypertension [27.3 vs 42.9%] and DM [25% vs 32.1%] but the duration of DM has great trend in GII [7.94 +/- 6.08 II vs 5.91 +/- 4.39] [p value 0.06]. Among the diabetic patients; five [8.9%] in GII had retinopathy [p value < 0.05]. No statistical significance as regard past history of ischemic events or family history of premature coronary artery disease. There is significant correlation between LDL level and age of the patients [56.8% vs 76.8%] [p value = 0.05]. Serum TG was [59% vs 44.6%] with no statistical significant difference were detected [p value > 0.05]. The mean number of risk factors was 2.068 +/- 1.265 vs 2.143 +/- 1.368 with no statistical significance. In coronary angiography ectatic vessels with no significant stenotic lesions were [13.6% vs 5.4%] while myocardial bridge were [11.4% vs 7.1%]. Ostial and/or proximal lesions present in [31.8% vs 51.7%] while twenty six mid and/or distal lesions in [59.l% vs 78.6%] with no statistical significance. One vessel disease in [34.1% vs 30.3%], 2 vessels [11.4% vs 25%], three vessels [13.6% vs 12.5%] and more than three diseased vessels [6.8% vs 12.5%] p value > 0.05. Mean% narrowing of significant stenosis was in GI 82.915 +/- 15.821 vs 1181.114 +/- 16.286 with [p value > 0.05] but the number of segments was more in GI with p value 0.049. We still have much to learn about the pathophysiology of the acute coronary syndrome especially among thee young Egyptian patients. Age difference in acute coronary syndrome of Egyptian patients has no influence on other traditional risk factors although high prevalence of other risk factors in old age group especially serum level of low density lipoprotein [LDL-c], duration of diabetes mellitus and its micro-vascular complications may be related to long duration of these factors