Concurrent cisplatin-based chemoradiation in squamous cell carcinoma of cervix

Objective: to evaluate the efficacy of cisplatin-based concurrent chemoradiation in squamous cell carcinoma of cervix and the frequency of acute toxicity

Study Design: case series

Place and Duration of Study: department of Clinical Oncology, Karachi Institute of Radiotherapy and Nuclear Medicine [KIRAN], Karachi, from September 2010 to September 2011

Methodology: eighty patients with histologically proven squamous cell carcinoma of cervix were included. Patients were treated with concurrent chemoradiation. External beam radiation was delivered with 50 Gy whole pelvis along with 40 mg/m2 weekly cisplatin followed by brachytherapy three insertions of 6.5 Gy each, one week apart. Response to treatment was assessed using response evaluation criteria in solid tumours [RECIST] criteria at 4 weeks after treatment. Acute toxicity of chemoradiation was assessed using common toxicity criteria

Results: out of the 80 patients, 8 patients were lost to follow-up. Remaining 72 patients aged 28 - 65 years with mean age of 48.03 +/- 8.9 years. Forty-eight patients [66%] were in stage II-B, 5 [7%] were in stage III-A, 7 [10%] were in stage III-B, and 12 [17%] were in stage IV-A. Overall response to treatment was 92%, in which 39 [54%] had complete response, and 27 [38%] had partial response while 6 [8%] show progressive disease. About 70% patients had diarrhea, 61.2% patients developed vomiting, 45.8% patients had dermatitis, 43% patients had vaginal mucositis, 40.3% had anemia, 13.9% patients had neutropenia, 27.8% patients had dysuria, and 22.2% patients had proctitis

Conclusion: cisplatin-based concurrent chemoradiation is an effective treatment in locally advanced stage of cervical cancer with manageable toxicity

Diagnostic accuracy of Tc-99m-MIBI for breast carcinoma in correlation with mammography and sonography

To evaluate the accuracy of 99mTc-MIBI scintimammography [SMM] in differentiating malignant breast cancer from benign breast mass and in detecting axillary lymph node metastasis in comparison with mammography and ultrasonography. Comparative cross-sectional study. At the Karachi Institute of Radiotherapy and Nuclear Medicine [KIRAN], Karachi, from December 2006 to May 2007. A total of 28 patients [both with breast lumps or/and axillary masses] included were in the study. They underwent clinical examination, mammography and ultrasound imaging followed by planar SMM using a single head detector. All subjects received a 740-1110 MBq bolus injection of [99m]Tc-Sestamibi. 5-10 minutes and 1 hour delayed images were acquired after the injection. SMM scans were considered positive when there was focal area of increased radiotracer uptake. Qualitative [visual] as well as quantitative evaluation of scans was done and compared with ultrasound and mammography, taking histopathology as Gold standard. Sensitivity, specificity, negative and positive predictive values [NPV and PPV respectively] were determined. There were 22 patients presenting with breast lesions [20 palpable, 2 non-palpable] and 6 patients with axillary lump. Scintimammography accurately predicted malignant lesions in the breast [sensitivity 93.3%, specificity. 71.4%, PPV 87.5%, NPV 83.3%, overall accuracy 86.4%] as well as in patients with axillary metastasis [sensitivity 100%, specificity 66%, PPV 75%, NPV 100%, accuracy 83%]. A combination of scintimammography with any other imaging modality provides better results than a single test to detect breast cancer. SMM has good diagnostic accuracy in the detection of breast cancer as well as in axillary metastasis in association with mammography and ultrasound

Dual phase qualitative and quantitative 99mtc-mibi scinfimammography for predicting response to neoadjuvant chemotherapy in breast cancer

To determine the role of dual phase 99mTc-MIBI scintimammography in predicting chemotherapeutic response in breast cancer. Cross-sectional study. Karachi Institute of Radiology and Nuclear Medicine [KIRAN], from September 2004 to March 2005. Female patients with locally advanced breast cancer being planned for the anthracycline-based neoadjuvant chemotherapy were included in this study. All subjects received a 740 MBq bolus intravenous injection of 99mTc-MIBI. Ten minutes and 3 hours post-injection planar images were obtained in prone, lateral and supine positions using double head gamma camera. MIBI washout was scored as follows: > 30% as a positive prognostic test [predicting a poor response to chemotherapy] and < 30% as negative prognostic test [predicting a good response to chemotherapy]. Qualitative analysis of MIBI scans was also performed and categorized as visual wash-out or no visual washout as apparent on the early and delayed images. The criterion for the good and bad response was the reduction of > 50% and < 50% in the tumour burden respectively. Accuracy analysis, Chi-square test and Wilcoxan sign rank test were applied. There were 32 females [mean age: 46.3 years; median age 46 years; age range 33-65 years]. Quantitative dual phase 99mTc-MIBI scintimammography was found to be a good predictor of chemotherapeutic response in breast cancer. These were true positive in 8 patients and true negative in 19 patients with sensitivity [Sens.] 72%, specificity [Spec.] 90%, Positive Predictive Value [PPV] 80%, Negative Predictive Value [NPV] 86.5%, p < 0.03. Receiver Operating Characteristics [ROC] curve analysis demonstrates 30% as a cut-off value for the wash-out in quantitative dual phase MIBI for the prediction of the chemotherapeutic response. In comparison, qualitative scintimammography had Sens. 82%, Spec. 53%, PPV 29%, NPV 93% and p < 0.38. Statistical difference was found between early and delayed uptake ratios in the responders and non-responders. Quantitative dual phase 99mTc-MIBI scintimammography is a simple, reliable, non-invasive and effective tool for predicting the response to neoadjuvant chemotherapy. Furthermore, quantitative assessment is more precise than qualitative [visual wash-out] approach