Symposium: “Oncology Leadership in Asia” / Journal of the Korean Cancer Association, 대한암학회지

The symposium on “Oncology Leadership in Asia” was held as part of the official program of the 42nd Annual Meeting of the Korean Cancer Association with International Cancer Conference. Given the increasing incidence of cancer in all countries and regions of Asia, regardless of developmental stage, and also in light of the recognized need for Asian countries to enhance collaboration in cancer prevention, research, treatment and follow-up, the symposium was held with the aim of bringing together oncology specialists from eight countries and regions in Asia to present the status in their own national context and discuss the key challenges and requirements in order to establish a greater Asian presence in the area of cancer control and research. The task of bringing together diverse countries and regions is made all the more urgent in that while Asia now accounts for more than half of all new cancer cases globally, clinical guidelines are based predominantly on practices adopted in Western countries, which may not be optimized for unique ethnic, pharmacogenomic and cultural characteristics in Asia. Recognizing the need for Asia to better gather information and data for the compilation of Asia-specific clinical guidelines, the participants discussed the current status in Asia in the national and regional contexts and identified future steps towards integrated and collaborative initiatives in Asia. A key outcome of the symposium was a proposal to combine and integrate the activities of existing pan-Asian societies, including the Asian Pacific Federation of Organizations for Cancer Research and Control (APFOCC) and Asian Clinical Oncology Society (ACOS). Further proposals included the expansion of pan-Asian society membership to include individuals and the essential need to encourage the participation of young researchers in order to ensure self-sustainability of cancer control efforts in the future.

Survival and impact of tumor grade, residual disease and age in patients suffering from epithelial ovarian cancer

Objective: to determine the overall survival and impact of histopathological grade, residual disease and age on survival of patients with epithelial ovarian cancer

Study Design: retrospective study

Place and Duration of study: department of Medical Oncology, Jinnah Hospital Lahore, from Jan 01, 2001 to Dec 31, 2002

Patients and Methods: patients with all stages of epithelial ovarian cancer with histological documentation of the disease ·were- included- in- the- study.- Patients with malignant ascites consistent with adenocarcinoma with an ovarian mass were also included. Patients with germ cell" or stromal tumors were excluded. Patients with ovarian metastases from any other malignancy were also excluded. Survival from the date of diagnosis was the end point. Overall survival was calculated from the date of diagnosis to the date of death or the date when the patient was last known to be alive. The impact of age of the patient [< 50 yrs. vs= 50 yrs.], tumor grade [low grade vs. intermediate and high grade] and residual disease [1.5 cm] on survival was evaluated. Information was collected from medical records and a thorough review was done. The data was analyzed by SPSS. Survival was. Evaluated by the Kaplan Meier Survival plot

Results: seventy-five patients were accrued to the study. Median age of the patients was 47 years. Mean overall survival was 36 months [95% C.I, 26 to 47]. Overall 5-year survival rate was 38% .Younger age at presentation, high tumor grade and bulky residual disease are poor prognostic factors, having an adverse effect on survival in epithelial ovarian cancer. Patients with well-differentiated tumors had a mean survival of 44 months as compared to just 17 months for patients with moderate to poorly differentiated tumors [p=.002]. Patients with minimal residual disease after initial surgery had a mean survival of 52 months whereas those with bulky disease had a survival of 13 months only [p=.000]. The overall survival of patients younger than 50 years was 29 months and those older than 50 years was 39 months

Conclusion: younger age at diagnosis, high histological grade and suboptimal debulking are associated with inferior survival in patients with epithelial ovarian cancer

Applicability of international prognostic index in non Hodgkin's lymphoma in Pakistan

Aggressive non Hodgkin's Lymphomas [NHL] are common in Southeast Asia, Middle East and Africa. Data on survival with relation to prognostic factors is scarce. The primary objective of the study was to evaluate the applicability of International Prognostic Index [IPI] to predict overall survival [OS] and disease free survival [DFS] in developing countries. Two hundred and nineteen patients of NHL consecutively presenting to the Department of Oncology, Jinnah Hospital Lahore between August 1998 to July 2000 were analyzed. All patients underwent initial staging according to Ann Arbor staging system. The patients were categorized by five independent risk factors: patient age, disease stage, serum lactate dehydrogenase [LDH] levels, performance status, and number of extranodal sites involved. Patients were divided into three risk categories Low [0 or one risk factors], Intermediate [2 risk factors] and High [3 or more risk factors]. According to IPI low risk category comprised of 15%, intermediate 21% and high 64% of patients, Overall survival [OS] for 2 years and 5 years [n=197] was [69%], [51%], [32%,] and [64%], [46%], [13%] respectively [p=0.0008]. Disease free survival [DFS] for 2 years and five years [n=197] was [66%], [43%], [34%] and [66%], [43%], [18%] respectively. Age adjusted [60] DFS for 2 and 5 years [n=164] was [70%], [45%], [40%] and [63%], [45%] [19%] respectively. OS for 2 and 5 years [n=164] was [71%], [52%], [34%] and [64%], [46%],[l 1%] respectively [p=0.0013]. Conclusions: The IPI accurately predicted survival in our population. Modification of treatment protocols according to specific risk groups will be beneficial to the developing countries with limited resources

Non-Hodgkin's lymphoma in Pakistan: a clinicopathological profile of 175 patients

OBJECTIVE: Non-Hodgkin's Lymphomas [NHL] are common in Southeast Asia, Middle East and Africa. The study was primarily undertaken to establish the demographic and clinicopathologic features of NHL in Pakistan. A secondary aim was to determine the applicability of the International Prognostic Index [IPI] developed by the international lymphoma task force in a developing country. METHODS: A retrospective and prospective analysis was performed on 175 patients over 14 years age who presented to the Department of Oncology between August 1994 and December 1996. All patients underwent initial staging according to Ann Arbor Staging System. Histopathologic classification was done according to the International Working Formulation. The IPI was applied to patients with aggressive lymphomas and age adjusted index to patients < 60 years, complete remission [CR], disease free survival [DFS] and overall survival [OS] were calculated. All 175 patients were evaluable. Median age of our patients was 45 years. Male to female ratio was 1.9:1. Seventeen [9.7%] patients were classified as low grade lymphomas while 158 [91.3%] had intermediate and high grade NHL. Large cell lymphoma was present in 30.9% patients. CHOP [cyclophosphamide 650 mg/m2 day 1, vincristine 1.4 mg/m2 day 1, doxorubicin--45 mg/m2 day 1 and prednisone 100 mg/m2 day 1-5] was the most common chemotherapy regimen used. Advanced stage [74.9%] > B symptoms [51%] and extranodal involvement [74.3%] were present. One hundred sixty-seven patients were evaluable for response of which 42.8% achieved CR. Median DFS was 19 months and median OS was 22 months. The IPI was applicable to 153 patients and age adjusted IPI to 124 of 153 patients. Aggressive histology, extranodal diseases, B symptoms and advanced disease are common. International index and age adjusted international index predicted outcome accurately in various risk groups

retrospective analysis of CHOP therapy in intermediate and high non-Hodgkin's lymphoma

Combination of chemotherapy with CHOP [cyclophosphamide, doxorubicin, vincristine and prednisone] for advanced stage-III and IV, intermediate or high grade non-Hodgkin's lymphoma is the accepted modality of treatment. Complete remission of 53% with a 32% cure rate has been reported with this treatment. It has been compared with new and more aggressive second and third generation regimens with no difference in complete remission, time to treatment failure and disease free survival. A retrospective analysis on 41 patients who received CHOP in the department for bulky stage II, III and IV disease with intermediate on high grade NHL was performed. Complete remission was seen in 63.3% patients. After a median follow up of 21 months, sustained complete remission of 23% was obtained. Poor prognostic factors included advanced age, stage IV aggressive histology and high LDH. These results are not different from those reported in literature. The patients with more aggressive disease and poor prognostic factors should be entered into clinical trials

Paroxysmal nocturnal hemoglubinuria

Three cases with Paroxysmal Nocturnal Hematuria [PNH] with different presentations are reported. The first case presented as chronic hemolytic anemia, the second as acute renal failure and third as hepatic vein thrombosis. Their diagnosis and management is discussed

Preliminary report on a small group of patients with advanced hodgkins disease

Six cases with pregnancy related renal failure are presented. All these patients except one presented with abortion after 28 weeks and with retention of fetus for variable periods. In five cases three had post partum haemorrhage and in one case there was severe infection. All these patients underwent peritoneal dialysis alongwith conservative management of renal failure. Three patients out of six had improvement in their kidney function after 8-12 weeks, three patients had not shown any recovery in the renal function and are on chronic peritoneal dialysis even after five months. Thus incidence of irreversible renal failure in our small number of patient is higher than 10-20% reported in the literature. This is probably due to the fact that these patients developed acute cortical necrosis because of massive heamorrhage, prolonged intrauterine death and septicemia