Frequency of estrogen and progesterone receptor status in breast cancer patients: a single institutional experience

Introduction: Breast cancer is hormone related disease and concerned hormones are Estrogen and Progesterone. Not all patients with breast cancer are positive for Estrogen receptor[ER] and Progesterone receptor [PR]. Western literature shows majority of patients have positivity for ER /PR or both but our experience at Allied Hospital is different as majority of patients have negativity especially the young patients. The objective of this study is to determine the frequency of ER and PR status in breast cancer patients

Material and Methods: Duration of study: January 2010 to December 2011

Study design: Descriptive case series

Place of study: Department of Clinical Oncology Punjab Medical College /Allied Hospital Faisalabad

Sample Size: All breast cancer patients visited our department in two years in all age groups

Data collection and analysis: Data was collected and entered in specified proforma and analysed manually

Results: Total number of patients enrolled in this study were 866[100%] out of which 860[99.3%] were female and 6[0.7%] were ale. 470 [55%] female patients were premenopausal and 390 [45%] were postmenopausal. Immunohistochemical staining was done in 396[45.7%] only others were not affording for it. ER positive, PR positive [both] were 130 [32.8%] patients and both negative were 205 [51.8%]. ER positive, PR negative were 40[10.1%] and ER negative, PR positive were 21[5.3%]. Among 214[54%] premenopausal patients, both positive were 70[32.7%], both negative were 116 patients [54.2%], ER +ve /PR -ve 18 [8.4%] and ER -ve /PR +ve were10 patients [4.7%]. Among 182[46%] postmenopausal patients both positive were 65[35.7%] and both negative were 93 patients [51.1%]. ER +ve / PR -ve were18 [9.9%] and ER -ve/ PR +ve were 6 [3.3%]

Conclusion: Hormone receptor positivity is less than the negativity especially in premenopausal females

Toxicity profile in cervical cancer patients receivingchemoradiation with concurrent parametrial boost

Introduction Radical surgery or chemoradiationtherapy is the options for treating early stagecervical cancer. The advanced stages are treatedwith radiation alone or concurrent chemoradiation.Concurrent cisplatinum based chemoradiation isconsidered the standard of care for carcinoma of thecervix and has shown a significantly improvedoverall survival and progression free survival inlocally advanced cancers. Despite improvedsurvival one third of the patients with advancedcancer of cervix have failure within two years. Socontinued improvement in treatment of advancedcervical cancer is needed. The concurrentparametrial boost with chemoradiation helps in locoregional control

Objective: To determine toxicityprofile in patients with cancer of cervix receivingchemo radiation with concurrent parametrial boost

Study Design: It is descriptive case series

Setting and duration: Radiotherapy DepartmentShaukat Khanum Memorial Cancer Hospital andResearch Center Lahore from December 2008 toJune 2009

Material and methods: Forty patientswith locally advanced carcinoma of cervix wereincluded. Concurrent parametrial boost was givenalong with chemoradiation. Patients were evaluatedfor toxicity weekly during treatment. SPSS softwarewas used for data analysis

Results: 40 patients withstage II-B to IV-A of carcinoma cervix werestudied. 22.5% patients suffered from Grade 1-3diarrhea, 27.5% had Anemia, 40% developedneutropenia and 17.5% suffered thrombocytopenia

Conclusion: Concurrent parametrial boost in locallyadvanced cervix carcinoma offers good results interms of acceptable toxicity

Treatment planning evaluation of sliding window and multiple static segments technique in intensity modulated radiotherapy for different beam directions

Objective: The demand of improved doseconformity of the tumor has been increased inRadiation Therapy with the advent of recentimaging facilities and efficient computertechnologies. This study was focused to investigatemore accurate dose conformity and delivery usingintensity modulated radiation therapy [IMRT]

Material and Methods: This study was conductedat department of Radiation Oncology ShaukatKhanum Cancer Hospital Lahore during January2011 to July 2011

Sample Size: Thirteen patientswere enrolled. Intensity modulated radiotherapyplans were explored for different beam directions insliding window and step and shoot technique, usingEclipse Treatment Planning System with LinearAccelerator. Thirteen patients were planned on 15MV X-ray for 5, 7, 9 and 13 fields making the doseconstraints analogous

Results: The rival plans werescrutinized using Dmean, Dmax, D1%, D95%, doseuniformity index [UI], dose conformity index [CI]and dose homogeneity index [HI]. Better coveragefor planning target volume was achieved using stepand shoot [multiple static segments] technique andreduced the dose to surrounding healthy tissues andorgans at-risk [OAR]

Conclusion: Step and shoottechnique has better results as compared to slidingwindow technique

Tamoxifen toxicity in breast cancer radiation

To see any added toxicity of tamoxifen when prescribed during radiotherapy in breast cancer. Treatment, Randomized, Open Label, Parallel Assignment. Department of Clinical Oncology Allied Hospital Faisalabad. Period: from February 2005 to June 2007. 300 patients were enrolled, age ranging from 22 to 73 years. Stage-I, II and III breast cancer were included in study. Staging was done on AJCC staging system. All were hormone positive. All patients were divided into two arms. Arm A, 150 patients given tamoxifen during radiation and arm B, 150 patients were given tamoxifen after completion of radiotherapy. All patients were examined for skin reactions and lung toxicity [pneumonitis] weekly and at six weeks after completion of radiation. Most of patients in both arms show skin reactions in 3[rd] week and pneumonitis around the end of treatment. Only 2% patients in each arm suffer from grade IV toxicity. Toxicity was manageable and comparable. There was no significant additional toxicity of concurrent use of tamoxifen with radiation

phase II study of gemcitabine concurrent with radiation in locally advanced squamous cell carcinoma of head and neck: a trial of the cancer research group Pakistan

To evaluate the efficacy and toxicity of weekly gemcitabine as a radiosensitizer concurrent with radical radiotherapy in locally advanced carcinoma of head and neck. From August 2001 to January 2002, thirty-nine patients with stage III or IV B inoperable carcinoma of head and neck were enrolled. Patients with histopathologically confirmed squamous cell carcinoma with at least one bidimensionally measurable lesion, no prior chemotherapy or radiotherapy, and a KPS of 60 or above were included. Patients with nasopharyngeal, glottic or sub-glottic cancer were excluded. Gemcitabine 150mg/m2 or a total dose not exceeding 200 mg was given on day 1, 8, 15, 22, 29, and 36 during radiation treatment. Radiation was delivered with conventional fractionation to a total dose of 66-70Gy. Miller's criteria was used for response evaluation. RTOG/EORTC acute radiation [and chemotherapy] morbidity scoring system and WHO grading of acute and sub acute toxicity criteria were used for documentation of toxicity. All 39 patients were evaluable for toxicity but only 35 patients were evaluable for response. An overall response rate of 94.3% [95% CI; 80.8-99.3] was seen with a partial response rate of 71.4% and complete response rate of 22.9% [95%CI; 10.4-40.1]. Grade 3 mucositis was seen in 28 patients [71.8%]. Grade 4 mucositis was seen in 2 patients [5.1%]. Pharyngeal toxicity was the second-most common toxicity. Grade 2 toxicity was seen in 12 patients [30.8%] and grade 3 in 6 patients [15.4%]. Despite vigorous symptomatic and supportive care acute toxicities led to treatment interruption in 40% of patients. A high overall response rate and a high rate of acute toxicity are seen at a weekly gemcitabine dose of 150mg/m2 concurrent with radiation. This shows that gemcitabine is a potent radiosensitizer with a marked tumor and normal tissue radio sensitization

Superficial bladder cancer; update treatment

The management of superficial bladder cancer should be based on a careful assessment of cancer histopathology [grade, stage, size and number], previous history of bladder cancer [number and timing of recurrences] and patient/physician preference. Patients with favorable tumor profiles at the initial diagnosis do not require intravesical therapy. Alternatively, a single intravesical administration of chemotherapy may be performed following TUR. Patients with favorable tumor characteristics that recur with similar features may be best treated with intravesical chemotherapy. The induction regimen should consist of 6+3 instillation scheme. Patients failing a single 6-week course of BCG may respond to a second 6 week course. Those patients with significant risk of disease progression [high grade, T1 with/without CIS] should be managed with caution. Although such patients are candidates for early cystectomy, they are also candidates for intravesical BCG. Patients treated with BCG intravesical chemotherapy for high-grade superficial bladder cancer are at significant long-term risk for disease recurrence, progression and even death from disease. Careful and vigilant follow-up is necessary for life in these patients. The urologist must be extremely active and diligent when treating with superficial bladder cancer. An understanding of tumor biology and current intravesical.therapies is important to appropriately treat these patients. Furthermore, and perhaps most important, the timely decision to abandon conservative therapy and proceed with radical cystectomy and urinary diversion should be kept in mind to prevent the potentially lethal sequelae of intravesical cancer