ABSTRACT
Objective: To compare the pathological complete response in human epidermal growth factor receptor type 2 [HER-2] positive breast cancer patients getting neoadjuvant chemotherapy with or without trastuzumab
Study Design: Retrospective randomised double-arm observational study
Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from 2008 to 2016
Methodology: HER2-positive, lymph node positive, breast cancer patients receiving neoadjuvant chemotherapy [NACT] were retrospectively observed. Patients getting neoadjuvant trastuzumab, fulfilling the inclusion criteria were studied. The comparison group included randomly selected equal number of HER2-positive breast cancer patients having similar tumor characteristics, getting NACT only. Pathological complete response [pCR] was defined as no residual invasive or in situ residual tumor in breast tissue, or in the lymph nodes. One hundred and fifty-six patients were studied. Eighty-nine patients with HER2-positive disease received trastuzumab preoperatively. Sixty-four [n=64] patients received the complete standard dose of neoadjuvant trastuzumab along with chemotherapy. Almost equal number of patients [n=67] with HER2- positive disease were selected by random assortment for the reference group who did not receive trastuzumab before surgery
Results: The pathological complete response of study group was [n=32] 50%, which was 26.1% higher than the reference group [n=16] 23.9%; and this difference was statistically significant with a p-value of 0.002 [<0.05]. The overall pCR was 36.6% [n=48]
Conclusion: Addition of trastuzumab to neoadjuvant chemotherapy doubled the pCR in HER2-positive breast cancer. Targeted therapy should be offered to all eligible patients with HER2-overexpressing breast cancer
ABSTRACT
Objective: To report experience with borderline ovarian tumors [BOTs] in a developing country like Pakistan with limited resources and weak database of health system
Methods: Patients with BOTs managed at Shaukat Khanum Cancer hospital, Lahore, Pakistan from 2004 to 2014 were included and reviewed retrospectively. Data was recorded on histopathological types, age, CA-125, stage of disease, treatment modalities and outcomes
Results: Eighty-six patients with BOT were included with a median age of 35 years. Forty-two [49%] patients had serous BOTs and 43 [50%] had mucinous BOTs, while one [1%] had mixed type. Using FIGO staging, 80 patients had stage I; two patients had IIA, IIB and stage III each. Median follow-up time was 31.5 months. All patients had primary surgery. Seventy [81%] patients underwent complete surgical resection of tumor. Forty-three [50%] patients had fertility preserving surgery. Seventy-three [85%] patients remained in remission. Recurrent disease was observed in 13 [15%] patients. Median time to recurrence was 22 months. On further analysis, age above forty years, late stage at diagnosis and incomplete surgery were significantly associated with invasive recurrence
Conclusion: Despite a low malignant potential, relapses may occur in patients above forty years of age, incomplete surgery and staging information and advanced stage at presentation. Fertility sparing surgery should be considered in young patients. Complete excision of tumor and prolonged follow-up are advised because recurrence and transformation to invasive carcinoma may occur
ABSTRACT
Hypomagnesaemia have been reported to occur with an increased frequency in type 2 diabetics compared with their counterparts without diabetes. Abnormalities of magnesium levels, such as hypomagnesaemia, can result in disturbances in nearly every organ system and can cause potentially fatal complications [e.g., ventricular arrhythmia, coronary artery vasospasm, sudden death]. Premature ventricular complexes [PVC] predict cardiovascular mortality among several adult populations. This study was done to find correlation between serum magnesium levels of diabetics and incidence of arrhythmias. We analyzed the serum magnesium levels in fifty consecutive patients with type 2 diabetes presenting with acute coronary syndrome in CCU of Services Hospital, Lahore and prevalence of cardiac arrhythmias in these patients. Serum magnesium levels were measured at presentation and twenty four hour Holter monitoring was done for the detection of arrhythmias. There were 33 male [66%]; 17 female [34%] patients and mean age of presentation was 60 years [ +/- 20 years]. 7 [14%] out of 50 patients had hypomagnesaemia [<1.7mg/dl], 2 females and 5 males. 'Ventricular premature contractions' in hypomagnesemic patients were 1.5 times the patients with normal magnesium level. There was no definite relationship observed between serum magnesium level and 'supraventricular premature contractions'. Although ventricular premature contractions are more common in patients with hypomagnesaemia and may result into life threatening arrhythmias but no life threatening arrhythmias [e.g., ventricular tachycardia and torsade de pointes] were seen in our study population with hypomagnesemia