Trends and outcomes of non-small-cell lung cancer in Omani patients - experience at a university hospital

Objectives: The incidence of lung cancer in Oman has shown a gradual but definitive increase since 2002. This study aimed to evaluate the demographic and epidemiological characteristics and survival outcomes of patients with non-small-cell lung cancer [NSCLC] at a university hospital in Oman

Methods: This study was conducted from January to June 2016. A retrospective analysis was performed of consecutive patients diagnosed with NSCLC presenting to the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman, between March 2000 and December 2015. Clinical features at presentation and prognostic and predictive markers were reviewed. Kaplan-Meir estimates were used to determine relapse-free survival, progression-free survival [PFS] and overall survival [OS]

Results: A total of 104 patients presented to SQUH during the study period. The median age at diagnosis was 64 years. Overall, 62 patients [59.6%] had adenocarcinomas. Only 12 patients [11.5%] presented in the early stages [I or II] of the disease and the majority of patients had an Eastern Cooperative Oncology Group performance status of 1 [27.9%] or 2 [26.0%]. The prevalence of epidermal growth factor receptor mutations was 27.9%. The median PFS for patients with advanced disease [stages III or IV] was five months and the median OS for all patients was seven months. After five years, 50.0%, 60.0%, 10.0% and 8.0% of patients with disease stages I, II, III and IV, respectively, were alive

Conclusion: Patients with NSCLC in Oman were found to present at an advanced stage. However, patient outcomes were similar to those reported in the USA

Tobacco smoking and lung cancer: perception-changing fact

Tobacco smoking remains the most established cause of lung carcinogenesis and other disease processes. Over the last 50 years, tobacco refinement and the introduction of filters have brought a change in histology, and now adenocarcinoma has become the most prevalent subtype. Over the last decade, smoking also has emerged as a strong prognostic and predictive patient characteristic along with other variables. This article briefly reviews scientific facts about tobacco, and the process and molecular pathways involved in lung carcinogenesis in smokers and never-smokers. The evidence from randomised trials about tobacco smoking's impact on lung cancer outcomes is also reviewed

Metastatic invasive lobular carcinoma of the breast masquerading as a primary renal malignancy

Breast cancer is known to metastasise to different organs in the body, but an initial presentation of breast cancer with loin pain secondary to a metastatic renal mass is extremely rare. We report a 58-year-old woman who presented with recurrent left loin pain due to a metastatic deposit of invasive lobular carcinoma of the breast. The detection of a renal mass on computed tomography led to the assumption of a renal pelvic malignancy. The diagnostic dilemma posed by the detection of a breast mass during staging and the usefulness of immunohistochemistry in the confirmation of diagnosis are discussed

Customised, individualised treatment of metastatic non-small-cell lung carcinoma [NSCLC]

A series of phase II and randomised phase III trials in Asia and Europe have confirmed recently that advanced stage non-small-cell lung carcinoma patients with adenocarcinoma subtypes harbouring specific mutations when subjected to targeted therapy experience equivalent survival outcomes as those treated with chemotherapy and are spared from its side effects. The concept of chemotherapy for all is fading, and therapy optimisation has emerged as a paradigm shift in treatment. This article briefly describes cellular mechanisms involved in lung carcinogenesis which provide a molecular basis for targeted therapy. Advances in molecular biology have improved our understanding of mechanisms involved in primary or secondary drug resistance. Evolving biomarkers of prognostic and predictive importance, and the impact of translational research on outcomes are also covered. A marker is considered prognostic if it predicts the outcome, regardless of the treatment, and predictive if it predicts the outcome of a specific therapy

Improving outcomes in advanced lung cancer. Maintenance therapy in non-small-cell lung carcinoma

Systemic chemotherapy has remained the traditional treatment for metastatic non-small-cell lung carcinoma [NSCLC], enhancing survival rate at 1 year to 29%. The median survival had plateaued at around 10 months until early 2008, and in an attempt to enhance survival in advanced disease, maintenance chemotherapy trials were initiated which had recently demonstrated prolongation of survival by an additional 2-3 months in patients who had performance status [PS] 0-1 and well-preserved organ functions. Suitable patients with any degree of clinical benefit are treated with 4-6 cycles, and then one of the active agents is continued until best response, or toxicity [continued maintenance], or changed to a cross non-resistant single agent [switch maintenance]. The article briefly reviews the evolution of systemic therapy and describes key randomised trials of maintenance therapy instituting chemotherapy and targeted agents in an attempt to improve outcomes in advanced metastatic NSCLC, based on certain clinical features, histology, and genetics

Follicular dendritic cell sarcoma of the neck with pulmonary metastases

We present a case of follicular dendritic cell sarcoma in a 48 years old Saudi female who reported with slowly progressive right sided extranodal neck mass associated with pulmonary metastasis. Clinical examination, histopathologic features including distinct immunostains combine together to make the rare diagnosis of follicular dendritic cell sarcoma. This entity is often misdiagnosed due to non-consideration in differential diagnosis of sarcoma. It carries a significant potential for regional as well as distant spread and hence categorized as intermediate risk malignancy. Clinical, histopathological and immunohistochemical aspects and therapeutic options of this unusual case are discussed

role of brachytherapy in uterine cervix carcinoma

Cancer of the cervix uteri is the second most frequent female gynaecological cancer at the Nuclear Medicine Oncology Radiotherapy Institute [NORI], Islamabad. Twenty four patients with histologically confirmed squamous cell carcinoma of cervix uteri were given external beam radiotherapy [EBRT] followed by intracavitary irradiation using high dose rate [HDR, Ir source] unit. Radiation was successful in relieving subjective complaints of the patients in 87.5% of cases. At the one year followup only grade I or II complications were observed in 33% of cases which neither required surgery nor meticulous care