Efficacy of hypofractionated radiotherapy in loco-regional tumor control in breast

Objective: To evaluate the efficacy of hypofractionated radiotherapy [HFRT] in locoregional control [LRC] in breast cancer

Study Design: Descriptive case series

Place and Duration of Study: Oncology Department of CMH Rawalpindi, from Jan 2014 to Oct 2014

Material and Methods: Fifty three female patients with histopathologically confirmed breast cancer and Eastern Cooperative Oncology Group performance status [ECOG-PS]

Results: Fifty three female patients with histopathologically confirmed breast cancer and ECOG-PS

Conclusion: It is concluded that HFRT is a simple and effective protocol for LRC in breast cancer in our set up. Large scale randomized trials and longer follow up is needed to confirm the results

Androgen deprivation therapy and cardiovascular risk in patients with prostate cancer

Objective: The objective of this study was to investigate the effects of androgen deprivation therapy [ADT] on risk of subsequent cardiovascular morbidity in men with prostate cancer

Study Design: Quasi experimental study

Place and Duration of Study: Department of oncology Combined Military Hospital Rawalpindi, from Sep 2014 to May 2015

Patients and Methods: Thirty consecutive patients fulfilling inclusion criteria were enrolled. All patients were subjected to medical castration/ androgen deprivation therapy [ADT] with monthly 3.75 mg leuprorelin acetate intramuscular injection until castrate levels of testosterone [<50ng/dL] were achieved. We used Framingham's score for assessment of 10 years cardiovascular risk of individual patient before initiation and after completion of 6 months ADT. Serum lipid profile [fasting], systolic blood pressure, history of smoking, diabetes and antihypertensive medication were recorded. Proforma was designed to get clinical information. A p-value of <0.05 was considered significant. A paired-samples t-test was conducted to compare Framingham cardiovascular risk scores before initiation and after completion of 6 months ADT

Results: We enrolled 30 men with high/intermediate risk localized prostate cancer. Mean age was 63.47 +/- 7.32 years. All patients received 6 months ADT with monthly 3.75mg leuprorelin acetate intramuscular injection. There was a significant difference in Framingham cardiovascular risk scores before [mean +/- sd; 20.95 +/- 7.98] and after [mean +/- sd; 25.72 +/- 6.15] 6 months ADT; t [29] =-4.54, p<0.01, two-tailed. Hence ADT resulted in a significant increase [mean +/- sd; 25.7 +/- 6.15] in 10 years cardiovascular morbidity risk t [29] =-4.54, p<0.01, twotailed. Subset analyses revealed significant increase in fasting serum total cholesterol, triglycerides and Lowdensity lipoprotein [LDL] levels after 6 months ADT [p<0.01, <0.01 and <0.01 respectively] however high density lipoprotein [HDL] remained un-changed [p=0.043] in comparison to pre-ADT values

Conclusion: Androgen deprivation therapy results in significantly increased risk of cardiovascular morbidity in patients with prostate cancer however this relationship between ADT and risk of cardiovascular morbidity may be confounded by unmeasured variables like obesity, atherosclerosis and body mass index [BMI] variations

Frequency of increase in serum tumor marker carcinoembryonic antigen [CEA] levels in primary breast cancer [PBC] patients at the time of diagnosis

Objective: To determine the frequency of increase in serum tumor marker CEA levels in PBC patients at the time of diagnosis

Study Design: Cross sectional study

Place and Duration of Study: Oncology Department of Combined Military Hospital [CMH] Rawalpindi, from January 2014 to November 2014

Material and Methods: Sixty three female patients with histopathologically confirmed carcinoma of breast and age range from 20 to 70 years from Oncology outpatient department [OPD]/indoor patient department at CMH Rawalpindi, were selected. All patients were staged by clinical and radiological work-up that included physical examination, all base line investigations, serum biomarkers, chest radiograph, ultrasound abdomen and pelvis, bone scan, computed tomography [CT] scan/magnetic resonance imaging [MRI] of the chest [optional]. Patients serum carcino-embryonic antigen [CEA] levels were carried out only by blood sampling using chemiluminescent immunoassay with immulite 2000 CEA. Data analysis were done with the help of the Statistical Package for the Social Sciences [SPSS] version 19 software. Cut-off values of serum CEA levels >2.5 ng/ml were taken as elevated

Results: Sixty three female breast cancer patients with histopathologically confirmed carcinoma of breast revealed elevated serum CEA levels in three stages of the disease. The median age was 47 years [range, 20-70 years]. Fifteen [23.8%] patients had family history of the breast cancer. Invasive ductal carcinoma [IDCA] was the commonest histology with 60 [95.23%] patients. Most of the patients had advanced stage of the disease. Node positive cases were 53 [84.1%]. The frequency of abnormal CEA levels were varying from stage II to stage IV. Elevated serum CEA levels were noted in 4 [28.6%] of stage II, 19 [76%] of stage III and 17 [77.3%] patients of stage IV, respectively. Overall percentage increase in levels of serum CEA from stage I through IV were 0%, 6.34%, 30.2%, 26% respectively. The sensitivity of serum CEA in our primary breast cancer [PBC] patients was 63.5%

Conclusion: It is concluded that serum CEA had significant sensitivity in detecting breast cancer in our population. Elevated serum CEA levels were seen in various stages of our PBC patients

rapidly developing cataract in idiopathic hypoparathyroidism: a case report

Rapidly developing cataract in idiopathic hypoparathyroidism is rare. Here we report, a case of cataract which developed rapidly and was associated with idiopathic hypoparathyroidism in a 20- year-old female patient. The case is being reported for its rarity and early diagnosis which was presented in a tertiary care hospital. For cases like these, prompt treatment is essential which may result in prevention of complications like vision loss. As per literature research via pubmed.com, this is the first case report of rapidly developing cataract in a patient of idiopathic hypoparathyroidism in Pakistan

Primary embryonal rhabdomyosarcoma of the liver in a young male

Rhabdomyosarcoma [RMS] occurs infrequently in the liver. Rhabdomyosarcomas are malignant tumours that display features of striated muscle differentiation. They are the most common soft-tissue sarcomas among children. In adults however, these are very rare. We report a case of a primary embryonal rhabdomyosarcoma of the liver in a 17 years old boy. This was confirmed by histological examination using immunohistochemical analysis [LCA negative, desmin positive, myogenin focally positive and cytokeratin negative] and site was confirmed by PET CT scan. He received multiple chemotherapies including [doxorubicin, ifosfamide, dacarbazine; gemcitabine, paclitaxel; vincristine, actinomycin D, cyclophosphamide] but longest sustained stable disease was seen with gemcitabine-paclitaxel regimen. The patient died 31 months after the first presentation, secondary to complicated abundant abdominal progressive disease. The poor prognosis and early death of most previously reported cases imply the need for investigation of a more effective treatment method of this uncommon tumour

phase II study of cisplatin and 5-fluorouracil combination chemotherapy and concurrent thoracic radiation in squamous cell carcinoma of lung

To evaluate the efficacy and toxicity of cisplatin, 5-fluorouracil combination chemotherapy and concurrent thoracic radiation in squamous cell carcinoma of lung. A prospective, non randomized, quasi-experimental, phase II study which was conducted in the Department of Clinical Oncology Mayo Hospital/KEMC Lahore. This study was conducted from September 2002 to May 2004. Twenty two patients of histopathologically confirmed squamous cell carcinoma of lung were enrolled. Stage III B or stage IV patients requiring radiation therapy for control of local symptoms were included. These patients were treated with chemotherapy and concurrent chest radiation. The treatment regimen included cisplatin 80mg/m2 on day one and day "28" and 5-FU 750mg/m2 day 1-4 and day "28-31". Radia-tion was started on day one and a tumor dose of 50 Gy was delivered in 25 fractions. Common Toxicity Criteria and RTOG criteria were used to assess toxicities. Miller's criteria were used for response evaluation. Responses were evaluated two weeks after the completion of concurrent chemoradiotherapy. All the twenty two patients completed the planned treatment. Complete response was not achieved in any patient. Partial response was seen in 15 patients [68.18%], stable disease in five patients [22.73%] and progressive disease was seen in two patients [9.09%]. CTC Grade-II nausea was seen in eight patients [36.36%], vomiting in five patients [22.73%] and mucositis in six patients [27.27%]. Grade-III neutropenia was observed in three patients [13.64%] and Grade-III mucositis and diarrhea in five patients [22.72%] each. Grade-IV neutropenia was seen in two patients [9.09%]. Cisplatin and 5-Fluorouracil combination chemotherapy concurrent with 50 Gy radiation is an effective and well tolerated treatment modality for this subset of lung cancer patients