Pre-operative chemoradiotherapy using capecitabine and cetuximab followed by definitive surgery in patients with operable rectal cancer

Background: Achieving a high rate of complete pathological response with pre-operative chemoradiotherapy in rectal cancer is an unmet need. We evaluated the efficacy and toxicity of the combination of cetuximab, capecitabine and radiation therapy in the pre-operative setting of localized rectal cancer

Patients and methods: Patients with clinically staged T3, T4 or nodepositive rectal cancer were treated with concurrent capecitabine and radiotherapy with weekly cetuximab starting one week before the start of radiation. This was followed by total mesorectal excision within 6-8 weeks. All patients achieving R0 resection received adjuvant capecitabine for 6 cycles

Results: Fifteen patients were treated and all underwent surgery. Sphincter preservation was achieved in 11 patients [73.3%] and pathological complete response in two. With a median follow up of 48 months [range 8.4-57.5], 12 patients were relapse-free and 14 were alive with 4- year relapse free survival of 80%. Overall survival was 93%. Significant grade 3 and 4 toxicity was mainly cetuximab-induced skin reactions [33%], radiation-induced skin toxicity [13%] and diarrhea [20%]

Conclusions: Adding cetuximab to pre-operative concurrent capecitabine and radiotherapy provides modest efficacy with manageable toxicity

Saudi oncology society and Saudi urology association combined clinical management guidelines for urothelial urinary bladder cancer

In this report, updated guidelines for the evaluation, medical, and surgical management of transitional cell carcinoma of the urinary bladder are resented. They are categorized according the stage of the disease using the TNM staging system 7[th] edition. The recommendations are presented with supporting level of evidence

Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer

In this report, updated guidelines for the evaluation, medical, and surgical management of prostate cancer are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7[th] edition. The recommendations are presented with supporting evidence level

Saudi oncology society and Saudi urology association combined clinical management guidelines for renal cell carcinoma

In this report, updated guidelines for the evaluation, medical and surgical management of renal cell carcinoma are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7[th] edition. The recommendations are presented with supporting evidence level

Saudi oncology society and Saudi urology association combined clinical management guidelines for testicular germ cell tumors

In this report, updated guidelines for the evaluation, medical, and surgical management of germ cell tumor of testes are resented. They are categorized according the stage of the disease using the tumor-node-metastasis staging system 7[th] edition. The recommendations are presented with supporting level of evidence

Incidence of thyroid cancer in the Kingdom of Saudi Arabia, 2000-2010

Thyroid cancer is the second most common malignancy among females at King Faisal Specialist Hospital and Research Centre [KFSH and RC] and in Saudi Arabia, accounting for about 11% of all newly diagnosed female cancers in the country in 2008. Over the past several decades, an increasing incidence of thyroid cancer has been reported in the Kingdom of Saudi Arabia. There are no comprehensive clinical epidemiological data for the trends of thyroid cancer incidence compared to the global incidence. This report reviews the thyroid cancer incidence in KFSH and RC and compares that with Saudi Arabia, the Gulf region, North America and globally from 2000 to 2010. Retrospective review of patients with thyroid cancer was carried out from 2000 to 2010, using the hospital Tumor Registry program as per the American College of Surgeons standards. Trends and patterns of all well-known prognostic factors were sub-stratified by age, stage and grade. A total of 2292 patients with thyroid cancer were treated at KFSH and RC, Riyadh, Saudi Arabia, from 2000 to 2010. Thyroid cancer constitutes about 9% of all malignancies and 12% of all female malignancies at KFSH and RC, which are significantly higher compared to the USA, where thyroid cancer represents only 2.9% of all malignancies and 4.6% of all female malignancies. Papillary adenocarcinoma was the most common histological subtype followed by papillary carcinoma, follicular variant. Median age at diagnosis was 40 for females and 44 years for males. Overall Age-Standardized Incidence Rate [ASR] was 4.4/100,000 [6.8 for female and 2/100,000 for males] in the Kingdom in 2008. Median age at diagnosis was 38 years and the highest incidence was in the 30-39 year age group in KFSH and RC. About 48% of patients presented in the localized stage and 60% underwent combined modality treatment consisting of surgery, radiation and hormonal therapy. There was significantly increased incidence among females as compared to males. The age-adjusted thyroid cancer incidence rates from 2000 to 2010 varied three-fold more for females than for males. Considerable geographical variations were present in thyroid cancer incidence in Saudi Arabia. Thyroid cancer incidence rates have increased exponentially between 2000 and 2010 and there is significant geographical variation in the incidence of thyroid cancer throughout the Kingdom. Thyroid cancer has become the second most common cancer among young Saudi women with a male to female ratio at 0.3:1. Rising incidence of thyroid cancer in Saudi Arabia may be due to the increased detection and diagnosis of the thyroid cancers and not only an increase in the true occurrence of thyroid cancer. More studies are required to determine this significant difference at the molecular level

Saudi gelines for the diagnosis and management of hepatocellular carcinoma: technical review and practice guidelines created and endorsed by the saudi association for the study of liver diseases and transplantation and the Saudi oncology society

Recognizing the significant prevalence of hepatocellular carcinoma [HCC] in Saudi Arabia, and the difficulties often faced in early and accurate diagnoses, evidence-based management, and the need for appropriate referral of HCC patients, the Saudi Association for the study of liver diseases and transplantation [SASLT] formed a multi-disciplinary task force to evaluate and update the previously published guidelines by the Saudi Gastroenterology Association. These guidelines were later reviewed, adopted and endorsed by the Saudi Oncology Society [SOS] as its official HCC guidelines as well. The committee assigned to revise the Saudi HCC guidelines was composed of hepatologists, oncologists, liver surgeons, transplant surgeons, and interventional radiologists. Two members of the task force served as guidelines editors. A wide based search on all published reports on all aspects of the epidemiology, natural history, risk factors, diagnosis, and management of HCC was performed. All available literature was critically examined and available evidence was then classified according to its strength. The whole document and the recommendations were then discussed in details by members and consensus was obtained. All recommendations in these guidelines were based on the best available evidence, but were tailored to the patients treated in Saudi Arabia. We hope that these guidelines will improve HCC patient care and enhance the multidisciplinary care needed for these patients

Whole body [18]F-FDG PET predicts progression free and overall survival in squamous cell carcinoma of the esophagus: results of a prospective trial

[18]F-FDG PET yields physiologic information that allows for identifying cancer based on altered tissue metabolism. The aim of this study was to prospectively validate the predictive value of positron emission tomography [PET] in squamous cell carcinoma [SCC] of the esophagus treated by pre-operative chemotherapy followed by esophagectomy. Prospective efficacy and toxicity study of patients enrolled between January 1999 and September 2003. Twenty-one patients with SCC of the esophagus who were potentially resectable underwent [18]F-FDG PET imaging before the first cycle of neoadjuvant chemotherapy and at least 14 days after the third cycle. A patient was classified as a metabolic responder when the metabolic activity of the primary tumor as measured by the maximum standardized uptake values had decreased by 50% or more at the time of the second [18]F-FDG PET. The median age of the study cohort was 60 years with a range of 39-70 years; 12 patients were males and 9 were females.[18]F-FDG PET had increased activity in the primary tumor in all patients. Metabolic response occurred in 14/21 patients [66%], while 7/21 [33%] patients did not show a metabolic response. Metabolic responders had a high clinical response rate [92%], a median progression free survival [PFS] of 16.4 months and a median overall survival [OS] of 35.3 months. In contrast, prognosis was poor for metabolic non-responders with a clinical response rate of 42% [P=.025], a median PFS of 7.13 months [P=.032] and median OS of 12 months [P=.038]. Our results demonstrate that changes in tumor metabolic activity after neoadjuvant chemotherapy predicts PFS and OS in esophageal SCC patients

incidence of lung cancer in the Gulf cooperation council countries

Lung cancer is the most common cancer in the world, with an estimated number of 1.3 million new cases as of 2002. This is the first report from the countries that comprise the Gulf Cooperation Council [GCC]. All the primary lung cancer cases registered in the Gulf Center for Cancer Registration during 1998 to 2001 were used to calculate the age-standardized incidence rate [ASR] per 100 000 person-years by the direct standardization method. Overall, there were 1607 [1261 males, 346 females] primary lung cancer cases registered during this period with the male to female ratio of 3.6:1. The highest ASR was in Bahrain [34.3 for males, 12.1 for females] followed by Qatar [18.5 for males, 5.5 for females] and Kuwait [13.8 for males, 4.0 for females]; the lowest rate was in Saudi Arabia [4.8 for males, 1.3 for females]. The mean age at diagnosis for males ranged from 68.7 years in Bahrain to 59.2 years in Oman. For females it ranged from 68.2 years in Bahrain to 58.0 years in Oman. Squamous cell carcinoma in males [except in Qatar] and adenocarcinoma in females were the predominant histological type. Cancer of the lung is one of the common cancers among males in all the GCC countries and ranks second among Bahraini females. Adenocarcinomas were more common in women than men

Pineal tumors: Treatment and results in 24 patients at one institution

From 1979-1991, 24 patients with pineal region tumors were treated at King Faisal Specialist Hospital. Nineteen patients had histologically Verified tumors, pineal parenchymal 14, germ cell 3 and gliomas in 2 patients. Two of the 5 patients without biopsy had elevated levels of alpha fetoproteins. Surgery was performed in 20 patients. Tumor excision was complete in one patient and partial in 11 patients. Biopsy alone was done in 7 cases. Seventeen patients required a Shunting procedure, and in one patient, it was the only surgical procedure. Twenty patients received primary radiation treatment, localized radiation to the primary site 5, whole brain irradiation followed by a boost to the primary site 6 and craniospinal radiotherapy in 9 patients. The radiation doses varied between 30-55 Gy for the primary site and from 30.6-36 for the whole neuraxis. Three patients with germ cell tumors received chemotherapy. The overall 5-year actuarial survival was 42%