ABSTRACT
Objective: To evaluate the efficacy of hypofractionated radiotherapy [HFRT] in locoregional control [LRC] in breast cancer
Study Design: Descriptive case series
Place and Duration of Study: Oncology Department of CMH Rawalpindi, from Jan 2014 to Oct 2014
Material and Methods: Fifty three female patients with histopathologically confirmed breast cancer and Eastern Cooperative Oncology Group performance status [ECOG-PS]
Results: Fifty three female patients with histopathologically confirmed breast cancer and ECOG-PS
Conclusion: It is concluded that HFRT is a simple and effective protocol for LRC in breast cancer in our set up. Large scale randomized trials and longer follow up is needed to confirm the results
ABSTRACT
Objective: The objective of this study was to investigate the effects of androgen deprivation therapy [ADT] on risk of subsequent cardiovascular morbidity in men with prostate cancer
Study Design: Quasi experimental study
Place and Duration of Study: Department of oncology Combined Military Hospital Rawalpindi, from Sep 2014 to May 2015
Patients and Methods: Thirty consecutive patients fulfilling inclusion criteria were enrolled. All patients were subjected to medical castration/ androgen deprivation therapy [ADT] with monthly 3.75 mg leuprorelin acetate intramuscular injection until castrate levels of testosterone [<50ng/dL] were achieved. We used Framingham's score for assessment of 10 years cardiovascular risk of individual patient before initiation and after completion of 6 months ADT. Serum lipid profile [fasting], systolic blood pressure, history of smoking, diabetes and antihypertensive medication were recorded. Proforma was designed to get clinical information. A p-value of <0.05 was considered significant. A paired-samples t-test was conducted to compare Framingham cardiovascular risk scores before initiation and after completion of 6 months ADT
Results: We enrolled 30 men with high/intermediate risk localized prostate cancer. Mean age was 63.47 +/- 7.32 years. All patients received 6 months ADT with monthly 3.75mg leuprorelin acetate intramuscular injection. There was a significant difference in Framingham cardiovascular risk scores before [mean +/- sd; 20.95 +/- 7.98] and after [mean +/- sd; 25.72 +/- 6.15] 6 months ADT; t [29] =-4.54, p<0.01, two-tailed. Hence ADT resulted in a significant increase [mean +/- sd; 25.7 +/- 6.15] in 10 years cardiovascular morbidity risk t [29] =-4.54, p<0.01, twotailed. Subset analyses revealed significant increase in fasting serum total cholesterol, triglycerides and Lowdensity lipoprotein [LDL] levels after 6 months ADT [p<0.01, <0.01 and <0.01 respectively] however high density lipoprotein [HDL] remained un-changed [p=0.043] in comparison to pre-ADT values
Conclusion: Androgen deprivation therapy results in significantly increased risk of cardiovascular morbidity in patients with prostate cancer however this relationship between ADT and risk of cardiovascular morbidity may be confounded by unmeasured variables like obesity, atherosclerosis and body mass index [BMI] variations
ABSTRACT
Objective: To determine the frequency of increase in serum tumor marker CEA levels in PBC patients at the time of diagnosis
Study Design: Cross sectional study
Place and Duration of Study: Oncology Department of Combined Military Hospital [CMH] Rawalpindi, from January 2014 to November 2014
Material and Methods: Sixty three female patients with histopathologically confirmed carcinoma of breast and age range from 20 to 70 years from Oncology outpatient department [OPD]/indoor patient department at CMH Rawalpindi, were selected. All patients were staged by clinical and radiological work-up that included physical examination, all base line investigations, serum biomarkers, chest radiograph, ultrasound abdomen and pelvis, bone scan, computed tomography [CT] scan/magnetic resonance imaging [MRI] of the chest [optional]. Patients serum carcino-embryonic antigen [CEA] levels were carried out only by blood sampling using chemiluminescent immunoassay with immulite 2000 CEA. Data analysis were done with the help of the Statistical Package for the Social Sciences [SPSS] version 19 software. Cut-off values of serum CEA levels >2.5 ng/ml were taken as elevated
Results: Sixty three female breast cancer patients with histopathologically confirmed carcinoma of breast revealed elevated serum CEA levels in three stages of the disease. The median age was 47 years [range, 20-70 years]. Fifteen [23.8%] patients had family history of the breast cancer. Invasive ductal carcinoma [IDCA] was the commonest histology with 60 [95.23%] patients. Most of the patients had advanced stage of the disease. Node positive cases were 53 [84.1%]. The frequency of abnormal CEA levels were varying from stage II to stage IV. Elevated serum CEA levels were noted in 4 [28.6%] of stage II, 19 [76%] of stage III and 17 [77.3%] patients of stage IV, respectively. Overall percentage increase in levels of serum CEA from stage I through IV were 0%, 6.34%, 30.2%, 26% respectively. The sensitivity of serum CEA in our primary breast cancer [PBC] patients was 63.5%
Conclusion: It is concluded that serum CEA had significant sensitivity in detecting breast cancer in our population. Elevated serum CEA levels were seen in various stages of our PBC patients
ABSTRACT
Objective: To investigate relationship between emotional intelligence and health locus of control in married women with breast cancer disease
Study Design: Cross sectional study
Place and Duration of Study: The data was collected from Nuclear Oncology and Radiology Institute [NORI Hospital] Islamabad [n=210] and from Combined Military Hospital [CMH] Rawalpindi [n=101]. Data collection was completed between the period from Oct 2013 to Feb 2014
Patients and Methods: The sample was selected using non- probability sampling technique. Collected breast cancer patients sample was n= 311 whose age range was from 18-80 years. A biographical sheet that contain personal and disease information of patient, and two scales were used: Self Report Measure of Emotional Intelligence [Khan and Kamal, 2010], and Multidimensional Health Locus of Control [Wallston, Stein, and Smith, 1994] were used to assess the constructs explored in this study
Results: Results depict that there was significant positive correlation between emotional intelligence [EI], including its sub scales Emotional Self-Regulation Skills [ESRS], Emotional Self Awareness Skills [ESAS], and Interpersonal Skills Scale [ISS] with the Internal Health Locus of Control [IHLOC]. Doctors Health Locus of Control [DHLOC] also have significant relationship to emotional intelligence's all sub divisions, whereas external health locus of control including Chance Health Locus of Control [CHLOC] and Powerful Other people Health Locus of Control [PHLOC] both are related to psychological distresses but it was observed in breast cancer population that chance was significantly correlated to ESAS, and ISS and powerful other people locus. Further on group comparison One Way Analysis of Variance [ANOVA] depicted no significant difference on disease stage groups
Conclusion: The strength factors of EI and HLOC are highlighted in current study. It was concluded that Emotional Intelligence [EI] and health locus of control [IHLOC, and DHLOC] have positive direction of relationship, both skills leads to positive adaptation and greater coping strengths
ABSTRACT
To determine the efficacy of whole brain radiotherapy [WBRT] with carboplatin as radiation sensitizer in metastatic brain disease in our adult population. Quasi-experimental study. Department of Oncology, Combined Military Hospital [CMH], Rawalpindi, Pakistan from July 2011 to September 2012. Forty two patients with metastatic brain disease having ECOG performance status [PS] 3 or less with normal hematological and biochemical profile were treated with WBRT with 6MV Photon beam on linear accelerator using parallel opposed lateral beams to a dose of 30 Gys in 10 fractions. Carboplatin was administered in a dose of 150 mg/m2 on day 1 and 6 of WBRT. Improvement in PS and radiological response on CT scan/ MRI brain before and 30 days after the WBRT using response evaluation criteria in solid tumors [RECIST] was evaluated. Out of 42 patients, 38 [90%] showed improvement in PS, 4 [10%] showed either no improvement or worsening of PS [p< 0.001]. Seventeen [41%] patients had complete response, 19 [45%] had partial response, 3 [7%] showed stable disease and 3 [7%] had progressive disease. None of the patients showed grade 3/4 toxicity during treatment. WBRT with carboplatin as radiation sensitizer is effective in palliation of patients with metastatic brain disease
Subject(s)
Humans , Female , Male , Carboplatin , Radiation-Sensitizing Agents , Neoplasm Metastasis , Disease ManagementABSTRACT
Cutis verticis gyrata is a long lasting and progressive condition in which there is hypertrophy and folding of the scalp skin. It typically affects the vertex and occipital region; however, it may involve the entire scalp. Classically, it has been divided into primary and secondary forms. Primary has been sub-divided into primary essential and non-essential. Secondary forms are commonly due to systemic diseases, inflammatory dermatoses, underlying nevoid abnormalities or trauma. The association between cutis verticis gyrata and malignancy is rare. It has been described in patients of leukemia, endocrine tumours and malignant melanoma. We present a case of cutis verticis gyrata in a patient of carcinoma breast
ABSTRACT
One of the most commonly used cranial landmarks for cephalometric tracing is sella point. The morphology and size of sella turcica is of importance because within its center lies sella point which helps in evaluation of craniofacial morphology. The objective of this study was to measure and describe the size and shape of the sella turcica and find a correlation between males and females and the three different skeletal classes. Lateral cephalometric radiographs of a total of 180 patients above age 15 years were divided equally into class I, IIand III [60 patients in each group] and with equal representation of both genders [90 males and 90 females]. The sella turcica was carefully analyzed and measured in linear dimension of length, depth and diameter. In addition the shape was also described. A student t-test was used to calculate the linear dimension difference, while a One way analysis of variance was done to study the relationship between skeletal type and sella size. Sella turcica presented with normal morphology in the greater part of the subjects [66.7%]. No significant difference was found in linear dimensions between males and females. When skeletal type was compared to sella linear dimensions no significant difference was found in any of the three dimensions as in length, depth or diameter
Subject(s)
Humans , Male , Female , Malocclusion, Angle Class I , Malocclusion, Angle Class II , Malocclusion, Angle Class III , Cephalometry , Cross-Sectional StudiesABSTRACT
To evaluate the efficacy and toxicity of 1-hour weekly Paclitaxel in metastatic breast cancer along with evaluation of overall survival. A phase II interventional trial. Oncology Department, Combined Military Hospital, Rawalpindi, between August 2001 to July 2003. Thirtysix patients were enrolled in the study. All patients with histologically confirmed and bidimensionally measurable metastatic breast cancer who had received previously either chemotherapy or hormone therapy were included in the study. Paclitaxel was administered in 1-hour weekly infusion in a dose of 100 mg/m2 for 12 doses. All patients had received previous chemotherapy with either CAF or CMF. Twenty five patients had also received hormone therapy, 61% had two or more metastatic sites involved, and lung was the common site of involvement. Complete response was observed in 4 [11.1%] patients, partial response in 14 [38.8%] patients, with an overall response rate of 50.0%. Clinical benefit was 94.4% and median overall survival was 11 months. Treatment was well-tolerated with no grade 3 or 4 toxicity. Common side effects were arthralgias, myalgias and neutropenia. Treatment with 1-hour weekly infusion of Paclitaxel is a well-tolerated chemotherapy with a substantial degree of efficacy in patients with metastatic breast cancer
Subject(s)
Humans , Female , Paclitaxel/adverse effects , Paclitaxel , Antineoplastic Agents , Infusions, Intravenous , Neoplasm Metastasis , Treatment Outcome , Paclitaxel/toxicityABSTRACT
To evaluate the clinical benefit and tolerability of letrozole after tamoxifen failure in locally advanced, recurrent or metastatic breast cancer in postmenopausal patients. A phase II non-randomized trial Oncology Department, Combined Military Hospital, Rawalpindi, from March 1999 to February 2001 over a period of 2 years. One hundred and seventeen patients with tamoxifen failure were treated with letrozole 2.5 mg once daily, through oral route. All the accrued patients were either estrogen/progesterone receptor positive or unknown with KPS of more than 50%. Patients who had prior hormone therapy other than tamoxifen, or more than one chemotherapy for recurrent or advanced disease were not enrolled in the study. Time to progression [TTP] was the primary objective, whereas objective response [OR], duration and rate of clinical benefit [complete response + partial response + stable disease >6 months], tolerability and effects on quality of life were the secondary end points. The clinical benefit was 47.0% with an objective response of 28.2%. The objective response and median time to progression in soft tissue disease was better than in the visceral and bone disease. The median time to progression for patients having positive estrogen receptor / progesterone receptors [ER/PR] was 9.5 months which is slightly higher than in patients having unknown ER/PR status. The treatment with letrozole was well-tolerated with side effects observed in only 14 patients. Letrozole is an effective hormone therapy after tamoxifen failure since it has significant clinical benefit and objective response. It can be safely used as second line hormone therapy in postmenopausal patients with locally advanced or metastatic breast cancer
Subject(s)
Humans , Female , Antineoplastic Agents/administration & dosage , Triazoles/administration & dosage , Postmenopause , Disease Progression , Administration, Oral , Treatment Outcome , Follow-Up StudiesABSTRACT
To evaluate the efficacy and toxicity profile of the combination of fludarabine, high dose cytarabine, idarubicin, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia, a study is being conducted at Armed Forces Bone Marrow Transplant Centre [AFBMTC] Rawalpindi since January 2003. Data up to June 2004 [early report] is being presented. Twelve Patients with refractory/relapsed [Ref/Rel] acute leukaemia [AL] were treated with fludarabine 30mg/m2 and cytosine arabinoside [AraC] Arac 2 g/m2 for 5 days, idarubicin 10mg/m2 for 3 days, and granulocyte colony stimulating factor G-CSF 5 micro g/kg from day 0 till neutrophil recovery [ANC >1.0 x 109/l]. Response was evaluated by bone marrow examination on day 20-post chemotherapy. Patients included were refractory acute lymphoblastic leukaemia [ALL] [n=2], relapsed ALL [n=3], refractory acute myeloid leukaemia [AML] [n=3], secondary AML [n=2] relapsed AML [n=1] and acute undifferentiated leukaemia [AUL] [n=1]. Complete remission [CR] was achieved in 8 [66.6%] patients. Three [25%] patients died of post chemotherapy complications and one patient failed to achieve remission. Out of 8 patients who achieved CR, 4 underwent allogeneic bone marrow transfusion [BMT], 1 is being evaluated for the same, 1 received idorubicin, AraC and etopuside [ICE] and high dose AraC, 1 did not receive further chemotherapy and 1 relapsed two months after remission. Seven patients are still in CR after a median follow up of 8 months [range 3-18]. Major complications encountered were diarrhoea, mucositis, toxic ileus, transient hepatic toxicity, fungal and bacterial infections. In our experience, FLAG-IDA is well tolerated and effective regimen in relapsed / refractory acute leukaemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures
Subject(s)
Humans , Male , Female , Recurrence , Cytarabine , Idarubicin , Granulocyte Colony-Stimulating Factor , Bone Marrow Examination , Leukemia, Myeloid, Acute , Precursor Cell Lymphoblastic Leukemia-LymphomaABSTRACT
Anthracyclines and vinorelbine have shown good response rates as single agent chemotherapy in metastatic breast cancer. A pahse I study has shown improved results by combining these two drugs. On the basis of this we carried out a phase II study in Oncology Department, Combined Military Hospital, Rawalpindi, in which the efficacy and side effects of epirubicin-vinorelbine as first-line chemotherapy in metastatic breast cancer evaluated. The purpose of this phase II study was to observe the effects of combination of epirubicin and vinorelbine in metastatic breast cancer as first-line chemotherapy in our population. From July 2000 to June 2001, chemo naive patients with metastatic breast cancer were given combination chemotherapy comprising epirubicin 100 mg/m2 i.v. infusion on day 1 and vinorelbine 25 mg/m2 i.v infusion on day 1 and 8. A total of six cycles were given to all patients with 3 weekly intervals. Patients with grade 3 and 4 neutropenia were also given G-CSF support. Seven out of 26 patients were pre menopausal and 73.07% were post menopausal. All patients had WHO performance status of > 3. Four [15.38%] out of 26 patients had complete response [CR] and 53.84% had partial response [PR] making and overall response of 69.22 and. Stable disease was observed in 5[19.23%] patients whereas 3 [11.53%] had progressive disease. Neutropenia was the most common side effect observed which was grade 4 in 6[23.07%] patients and grade 3 in 10 [38.46%] patients. Other side effects were mild to moderate. As first line chemotherapyv in treatment of metastatic breast cancer, the combination of epirubicin and vinorelbine is an active and cost effective regimen, with less side effects and excellent tolerability