The Prognostic Significance of the Depth of Cervical Stromal Invasion in Women With FIGO Stage II Uterine Endometrioid Carcinoma.

OBJECTIVE: The objective of this study was to investigate the prognostic significance of the depth of cervical stromal invasion (CSI) in women with FIGO stage II uterine endometrioid adenocarcinoma (EC). METHODS: Our database of women with EC was quired for patients with stage II EC. Pathologic slides were retrieved and reviewed by gynecologic pathologists to determine cervical stromal thickness and depth of CSI as a percentage of stromal thickness (%CSI). Kaplan-Meier, univariate, and multivariate analyses were used to compare recurrence-free, disease-specific (DSS), and overall survival (OS) between women who had<50% versus ≥50% CSI. Univariate and multivariate analyses were used to assess other prognostic variables associated with survival endpoints. RESULTS: A total of 117 patients were included in our study who had hysterectomy between 1/1990 and 8/2021. Seventy-nine patients (68%) with <50% and 38 (32w%) with ≥50% CSI. After a median follow-up of 131 months, 5-year DSS was significantly worse for women with ≥50% CSI (78% vs. 91%; P =0.04). However, %CSI was not an independent predictor for any of the studied survival endpoints. Independent predictors of worse 5-year recurrence-free survival and DSS included FIGO grade 3 tumors ( P =0.02) and the presence of lymphovascular space invasion ( P =0.03). Grade 3 tumors were the only independent predictor of worse 5-year OS ( P =0.02). CONCLUSIONS: Our results suggest that deep CSI is not an independent prognostic factor for survival endpoints in women with stage II uterine endometroid adenocarcinoma. The lack of independent prognostic significance of the depth CSI needs to be validated in a multi-institutional analysis.

History and Current State of Radiation Oncology Services and Practice in Jordan.

Radiation therapy (RT) for patients with cancer in Jordan began with a small individual effort and has now grown to be one of the most prominent treatment centers in the Middle East. Currently, there are 4 different centers that provide RT not only for the people of Jordan but also for citizens of other neighboring Arab countries. Because Jordan is a developing country, it still faces problems with the insufficient number of RT machines available and their supporting staff (physicists and technologists among others). In this article, we shed light on the history and current status of radiation oncology in Jordan and discuss the challenges we face.

Successful Development of a Competency-Based Residency Training Program in Radiation Oncology: Our 15-Year Experience from Within a Developing Country.

One of the main challenges of delivering high quality of care to cancer patients in developing countries is the lack of well-trained radiation oncologists. This is a direct cause for the lack of residency programs coupled with lack of resources. This article describes and details establishments of a successful and sustainable radiation-oncology residency program in our country. The program has been in operation for 14 years and has trained and graduated radiation oncologists who are now working in various countries. The curriculum of the 4-year residency program, fashioned according to American College of Radiologists (ACR) recommendations, includes site-specific clinical rotations and didactic lectures in clinical oncology, radiobiology, medical physics, statistics, and epidemiology. It also includes a component of advanced clinical experience in the form of 3-month externship at one of collaborating centers outside the country. Evaluation of the residents is conducted annually via written exams and 360° feedback. Residents also sit for the formal certification exam in radiation oncology from the national Medical Council. The exam consists of 2 written exams and one oral. As a form of benchmarking residents' knowledge, they are required to sit for the ACR examinations held annually and conducted in Amman in tandem. The program has successfully trained and graduated 28 residents, who now work as consultant radiation oncologists locally and abroad. Each resident has gone through a structured training that includes exposure to a Western-style patient-management culture, enhancing the breadth and width of their clinical experience. The residency program, initiated in a developing country, underwent many challenges, yet it overcome all obstacles and resulted in a successful training of competent radiation oncologists serving the region.

Enhancing value of quality assurance rounds in improving radiotherapy management: a retrospective analysis from King Hussein Cancer Center in Jordan.

PURPOSE: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. MATERIALS AND METHODS: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation or re-planning prior to commencement of RT. Minor modification included treatment plan changes which didn't necessarily require RT re-planning. RESULTS: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). CONCLUSION: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/ or treatment decisions.

Advanced Tracheal Adenoid Cystic Carcinoma with Thyroid Invasion Mimicking Thyroid Cancer Treated with Definitive Radiation: Case Report and Review of the Literature.

A 54-year-old female patient, a breast cancer survivor and a case of unresectable adenoid cystic carcinoma of the trachea, with thyroid invasion, presented with suprasternal neck swelling mimicking thyroid primary. A literature search was undertaken to highlight this rare presentation. There have been few reports in the literature describing tracheal adenoid cystic carcinoma involving the thyroid.

Screening the antiangiogenic activity of medicinal plants grown and sold in Jordan.

Angiogenesis is essential for the growth, invasion, and metastasis of most solid tumors and has become a valuable pharmacological target for cancer prevention and treatment. This study was performed to assess the antiangiogenic activity of 31 medicinal plants grown and sold in Jordan. The antiangiogenic activity was assessed using the rat aortic ring assay. Out of 31 extracts, 15 extracts showed more than 50 % inhibition of the blood vessels outgrowth from the primary tissue explants (p = 0.000). Three of these 15 extracts showed a potential cytotoxic effect on normal fibroblast cells. Four extracts shared antiangiogenic and antiproliferative activity towards MCF7 breast cancer cell lines. Eight extracts demonstrated selective antiangiogenic activity. This is the first report demonstrating the potential antiangiogenic activity of Artemisia judaica, Aloysia citriodora, Salvia egyptiaca, and Calendula arvensis. Some extracts with antiangiogenic activity exhibited selectivity against the endothelial cells proliferation, demonstrating a direct inhibitory activity against the key step in tumor angiogenesis.