ABSTRACT
Background: the most common cause of pain in cancer patients is bone metastases. Objective: to evaluate the different fractionation schedules
Patients and Methods: this is a prospective cross sectional study conducted at Ain-Shams University Hospitals and Nasser Institute Cancer Centre, to assess the equivalence of two fractionation regimens [20 Gy over 5 fractions versus 30 Gy over 10 fractions] as regard pain relief in painful bony metastases. Over 6 months fifty patients were assigned to either fraction arms using consecutive sampling
Results: both fractionation regimens were effective at palliating pain from bone metastases. Pain score was consistently going down from week 0 to week 12, although maximum benefit was reached earlier in the shorter arm [at week 8], both comparison groups leveled a favourable response at week 12. At 3 months, the observed overall response rate was 88% versus 84% and complete response rate was achieved in 44% versus 36% in both short- and long fractionation course respectively, with no statistical difference was found in terms of pain relief. With the median time to pain progression was 79.0 days for the short arm versus 77.0 days for the protracted arm
Conclusion: lower dose of radiotherapy may provide equivalent outcomes to higher ones in palliating bone pain. So, the the surrounding normal tissue role in pain process caused by bone metastases as well as the effect of radiation in this environment has to be furtherly investigated, which may lead to pain control augmentation
ABSTRACT
Background: malignant pleural mesothelioma [MPM] represents a common malignant disease. It is an aggressive tumor arising from the mesothelial cells lining the pleura. There is an extremely poor prognosis and a vast majority of MPM patients are diagnosed in an advanced stage. Rapid progression of the disease, no effective therapeutic approach and resistance to chemotherapy and radiotherapy resulted in a median survival time of less than 12 months
Aim of the Work: this study aimed to analyze the clinic pathological profile, the various prognostic factors and treatment response of malignant mesothelioma patients in our center in terms of overall survival and progression free survival
Patients and Methods: this retrospective was conducted on Malignant Mesothelioma patients who presented to the Department of Clinical Oncology, Ain Shams University from 1 January, 2011 to 31 December, 2014
Results: the mean age of the included patients were 61.04 years with male predominance 50.6% and female 49.1%. Occupational risk was documented in only 11.1% of included patients; most patients live in the industrial environment [67.9%] and the rest in non industrial environment [32.1%]. All patients had negative family history of cancer. All patients had negative surgical history, 66.7% of patients had positive history of asbestos exposure. The commonest co morbidity among the studied patients were HTN as it was accounted for 24.7% of the included patients followed by diabetes mellitus in 16% of patients on the other hand, only 3.7% of patients had no co morbidity. Dyspnea was the commonest symptoms [77.8%] among the included patients, followed by cough [33.3%] and chest pain in 12.3%, the other symptoms with lower presentation included hemoptysis and anemia. P.S 1[28.4%] was recorded among the included patients and 53.1% patients had P.S 2 while, rest of patients 18.5% had P.S3. Patients were diagnosed by CT chest and pleural biopsy either US guided or CT guided, chest X ray, thoracoscopic biopsy, FNAC and open pleural biopsy. The results also showed that the median PFS among the included patients was 2 months. Median OAS was 6.1 months
Conclusion: best survival data in patients with MPM were currently reported from groups using multimodality treatment including MCR achieved either by EPP or extrapleural decortication for patients qualifying as far as tumor stage and functional reserve were concerned. In general, several treatment combinations have been applied ranging from systemic [neo- or adjuvant] to localized chemotherapy, neo- or adjuvant radiotherapy and others
Recommendations: The choice of the surgical procedure should be tailored according to tumor stage, performance status, and institutional experience. Morbidity and mortality of these treatment approaches have been reduced at experienced centers indicating that this complex treatment should be performed at dedicated high volume mesothelioma centers