Oncoplasty for breast carcinoma

To assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast-conserving surgery using oncoplastic techniques with concomitant symmetrization of the contra lateral breast. Although breast-conserving surgery is the standard form of treatment for invasive breast tumors up to 4cm, cosmetic results may be poor and clear resection margins difficult to obtain in patients with large, ill-defined, or poorly situated tumors. The integration of oncoplastic techniques with or without a concomitant contralateral symmetrization procedure is a novel surgical approach that combines both oncologic and plastic surgical procedures and allows wide excisions and prevents breast deformities. This is a prospective study of 32 patients who were operated on for breast carcinoma between August 2004 and Mars 2006 by the author. The procedure was proposed for patients in whom conservative treatment was possible on oncologic grounds but where a standard lumpectomy would have led to poor cosmetic outcomes. Standard treatment protocols were followed. All patients received postoperative radiotherapy except 2. Mean follow-up was 1.5 years. They were compared to a control group including 43 patients with the same inclusion criteria. Mean weight of excised material on the tumor side was 393 g. The actuarial 2-year local recurrence rate was about 6%, contra lateral procedure was needed in 10%. Cosmoses was favorable in 88% of cases. The use of oncoplastic techniques with or without concomitant symmetrization of the contra lateral breast allows extensive resections for the treatment of breast carcinoma and results in favorable both oncologic and esthetic outcomes. This approach might be useful in extending the indications for conservative breast therapy

B2 colon cancer: Is there a role for adjuvant chemotherapy? Mansoura experience

To evaluate the benefit of adjuvant 5-fluorouracil-based chemotherapy in .patients with Dukes' B2 colon cancer, using event-free survival [EFS] and overall survival [OS] as primary end points. Patients and Methods: One hundred patients with Dukes' B2 colon cancer, attending the outpatient clinics of Clinical Oncology and Nuclear Medicine Department, Mansoura University Hospitals, during the period from January 1998 to December 2002, were reviewed retrospectively for comparing patients who received adjuvant chemotherapy following radical surgery and those who were under follow-up. With a median follow-up of 79.5 months, the 5-year EFS and OS in the adjuvant chemotherapy arm were 101.6 and 103.3 months respectively, compared to 94.8 and 99.3 months in the control arm respectively, both were statistically insignificant. Our study does not support the routine use of adjuvant 5-fluorouracil plus leucovorin chemotherapy in all patients with Dukes' B2 colon cancer, as true benefit

Prognostic role of matrix metalloproteinase-9 [MMP-9] in patients with osteosarcoma

Osteosarcoma [OS] is a highly malignant bone tumor and is the most frequent malignant bone tumor in children and adolescents. The majority of patients with this disease harbor "micrometastasis" at diagnosis, a fact that demonstrates the need for molecular variables which can predict the presence or absence of micro-metastasis. Matrix metalloproteinases [MMPs] are a class of matrix - and basement membrane-degrading enzymes whose expression is associated with tumor cell invasive and metastatic behavior. One of these enzymes, MMP-9 is expressed in developing and remodeling bone in OS cell lines. The current study investigated the expression of MMP-9 by immunohistochemistry and its correlation with the prognosis in OS patients treated at Mansoura Clinical Oncology and Nuclear Medicine Department. MMP-9 was examined immunohistochemically using a monoclonal antibody in 20 patients with OS. The range of follow-up was 16 to 53 months with a median of 31.5 months. Correlation of the positivity of staining with prognosis was analyzed with Kaplan-Meier method. We found that MMP-9 immunohistochemical expression was positive in 85% of cases [17/20] and increased MMP-9 expression was significantly associated with poor prognosis in overall, metastasis-free and recurrence-free survivals [p=0.001, 0.001, and 0.002 respectively]. These results suggest that MMP-9 expression is common in OS and demonstrate the correlation of MMP-9 expression and the oncological outcome of OS patients

Concurrent chemoradiotherapy plus consolidation chemotherapy compared with concurrent chemoradiotherapy alone in unresectable stage III non-mall-cell lung cancer

To evaluate the addition of consolidation chemotherapy to concurrent Chemoradiotherapy in patients with locally advanced unresectable stage III non-small-cell lung cancer as regard efficacy and safety. Forty one patients were randomly assigned to either concomitant Chemoradiotherapy alone [arm 1, n = 19] or concomitant Chemoradiotherapy followed by consolidation chemotherapy [arm 2, n = 22]. In the concurrent arm, patients received weekly paclitaxel [45 mg/m[2]], carboplatin [100 mg/m[2]] and concomitant thoracic radiotherapy at a dose of 63 Gy in 34 fractions over 7 weeks. In the concurrent/consolidation arm, the same regimen was administered followed by two additional courses of paclitaxel [200 mg/m[2]] and carboplatin [300 mg/m[2]] every 3 weeks. Pre-treatment characteristics were well balanced between the two arms. Median survival was 13 months in the concurrent arm and 16.5 months in the concurrent/consolidation arm [p = 0.59]. One-, 2-, and 3- year survival rates were better in the concurrent/consolidation arm [63.6%, 36.4%, and 13.6% respectively] than in the concurrent arm [52.6%, 26.3%, and 10.5% respectively], p = 0.48. Grade 3/4 granulocytopenia occurred in 16% and 27% of patients on the concurrent and concurrent/consolidation arms respectively [p = 0.38]. The most common grade 3/4 non-hematological toxicity was esophagitis. It was more frequent in the consolidation arm than in the concurrent arm [32% v 21%], p = 0.43. Concurrent Chemoradiotherapy followed by consolidation chemotherapy represent the preferred regimen for the treatment of unresected stage III NSCLC. However, toxicity, particularly, non-hematological toxicity, remains a major obstacle