Clinico-pathologic characterisation of metastatic prostate cancer in the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Zaria-Nigeria: 2006-2009.

AIMS AND OBJECTIVES: To evaluate the Clinico-pathologic Characteristics of Metastatic prostate cancer patients seen in the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Nigeria. MATERIALS AND METHODS: Between January 2006 and December 2009, a period of 4 years, 72 new patients with prostate cancers were seen of which 43 patients had distant metastases. Only patients with histologic confirmation of prostate cancer and having metastases were included in the study irrespective of age, co-morbidity and performance status. Patients' folders were reviewed retrospectively with a structured pro forma. Information retrieved from patient's folder included age, histology, Gleason score, co-morbidities, interval between diagnosis and referral to oncology unit, interval between referral and presentation at oncology unit, PSA at diagnosis and presentation at oncology unit, sites of metastases, bones sites involved in bone metastases, types of treatment received and follow up status. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: 43 patients had distant metastases from prostate cancer during initial evaluation at presentation in the radiotherapy and oncology centre. The mean age was 66.2 years (range, 47-82 years, median age 66 years and modal age group was 65-69 years). Co-morbidity was seen in 18 patients, with hypertension being the commonest (HT=14, DM=2 and HIV 2 patients). No morbidity seen in 25 patients. The range of duration from diagnosis to referral was 1-84 months. Only 20 patients presented at radiotherapy and oncology centre within 6 months of diagnosis and 18 patients presented after 12 months of diagnosis. 33 patients presented within 1 month of being referred for further management. 6 patients reported within 2 months and 2 patients within 3 months and another 2 patients within 4 months. Only 27 patients had PSA done at diagnosis. No PSA was done in 16 patients. The PSA range at diagnosis was 10.0-232 ng/ml, mean PSA was 67.46 ng/ml while only 40 patients did PSA on presentation for further management with a range of 1-245 ng/ml and a mean of 57.95 ng/ml. The histology report revealed adenocarcinoma and transitional carcinoma in 42 and 1 patients respectively. The Gleason score range was 6-10, with a mean score of 7.8. The Gleason score was not reported in 3 patients. Multiple organs involvement by metastases was seen in 16 patients. Bone metastases was the commonest (35), followed by lungs (8), liver (7), Virchow's lymph nodes (6), brain (5), and soft tissue (5). The lumbar vertebrae was the commonest site of bone metastases (32) followed by the sacrum (17), pelvis (11), and long bones (7). 3 patients had metastases to the ribs and 2 patients each to the skull, sternum and cervical spines. All the patients received hormonal therapy, 30 patients received palliative radiotherapy, 29 patients had surgical castration, 25 patients had radical radiotherapy to pelvis, 18 patients had systemic chemotherapy and definitive surgery was done in 16 patients. Only 6 patients received Ibandronate due to cost. 13 patients are alive and attending follow up, 11 confirmed dead and 19 lost to follow up. CONCLUSION: The patients were referred for management late after surgery. Bones, predominately the lumbosacral spines was the commonest organ involved in metastases. Skeletal survey with bone scan and plain x-rays especially lumbosacral spines should be part of the staging investigation for all patients with advanced stage. There is need for more awareness on other treatment modalities emphasizing the multidiscipline and multimodality management of prostate cancer.

Clinico-pathologic patterns of extremity liposarcoma.

BACKGROUND: Liposarcoma is a tumour derived from primitive cells that undergo adipose differentiation. OBJECTIVE: To describe the clinico-pathological pattern of extremity liposarcoma in Lagos, Nigeria. METHODS: This is a descriptive study of patients with histologically established liposarcoma affecting the extremities seen at the Oncology unit of the National Orthopaedic Hospital, Lagos Nigeria. Demographic and clinical data ( including age, gender, presenting complaints anatomic location of lesions ), histologic type, clinical stage and treatment outcome were collected using a prepared proforma and analysed. RESULTS: Liposarcoma accounted for 6 [27.3%] of 22 cases of soft tissue sarcomas seen within the study period. All 6 were males with a M:F of 6:0. The age range was 36- 59 years. Lesions were mostly located in the thigh 5/6 (83.3%). The most common histologic type was myxoid seen in 3/6 [50%]. All presented at stage T2bNoMo. Five (83.3%) had limb salvage surgery with adjuvant radiotherapy while one had ablative surgery. Survival and recurrent rates could not be determined as all patients were lost to follow-up soon after surgery. CONCLUSION: Liposarcoma is the commonest extremity soft tissue sarcoma seen in our centre, the myxoid type being the commonest histologic subtype.

Indications for ablative surgery in extremity musculoskeletal tumours.

BACKGROUND: Surgical options for treatment of extremity musculoskeletal tumours include excision [limb sparing] surgery or amputation [limb ablation]. Ablative surgery is for advanced extremity musculoskeletal tumours when limb salvage surgery is not feasible. OBJECTIVE: To determine the indications for ablative surgery in extremity musculoskeletal tumours in our centre. METHOD: This is a 6 year prospective study of patients presenting with extremity musculoskeletal tumours at National Orthopaedic Hospital Lagos. Data such as age, gender, presenting complaints, anatomic location of the tumour, clinical stage, type of ablative surgery and adjuvant treatment offered, histologic type of tumour, and treatment outcome were documented. RESULTS: Nineteen patients had ablative surgery as a mode of treatment. 11 were male while 8 were female with a M:F of 1.3:1. The age range was 3 - 69 years. Seven patients [6 males and 1 female] refused ablative surgery and voluntarily discontinued treatment. Most tumours were located in the lower limb and all patients that had ablative treatment presented with stage 3 or 4 disease. Osteogenic sarcoma was the most common diagnosis, accounting for 4 cases [21.1%]. Six patients [31.6%] with non-malignant tumours had ablative surgery due to either late presentation or inaccurate preoperative diagnosis. Trans-femoral amputation was the most common level of amputation and this was done in 9 patients [47.4%]. Adjuvant chemotherapy was prescribed for all patients. The recurrence and survival rates could not be determined for each tumour as the patients were lost to follow-up soon after surgery with average post operative follow up of 5.5 months. CONCLUSION: Late presentation with locally advanced disease remains the dominant indication for ablative surgery in extremity musculoskeletal tumours.

Detection of skeletal metastases in Nigerian breast cancer patients: evaluation of radioisotope bone scan and radiography.

38 Nigerian patients with stage III breast cancer who presented with bone pain to the Department of Radiation Biology and Radiotherapy, Lagos University Teaching Hospital, Lagos between 1977 and 1984 were screened for bone metastases using skeletal survey and radio-isotope bone scan. A comparison of the results revealed that there was correlation in the results of both investigations in 36.8% of patients. In the remaining 63.3% there was a significant uptake of radio-isotope on bone scan while corresponding skeletal survey radiographs were negative. However every patient with known metastases on skeletal survey also had an abnormal bone scan. Possible explanations are given for the rather large proportion of our patients who had abnormal bone scan but normal radiographs.

Radiation accidents in a developing country: the Nigerian experience.

A 32 year old Nigerian industrial radiographer was accidentally over-exposed to gamma rays while using a faulty gamma ray equipment with an iridium 192 source to take radiographs of oil pipe joints for the detection of cracks. He presented with clinical signs and symptoms of radiation over-exposure. When results of personnel monitoring confirmed radiation over-exposure this patient was immediately relieved of his job by his employers without any explanation or compensation. His condition was managed conservatively and he is being followed up indefinitely in the clinic. This paper as well discusses the management of acute radiation syndromes and the implications of the presently uncontrolled use of ionizing radiation in Nigeria.

Thyroid carcinoma in Nigeria: review of management.

The records of 54 patients with thyroid carcinoma who were managed at the Department of Radiation Biology and Radiotherapy, Lagos University Teaching Hospital between 1973 and 1985 were reviewed. Most of the patients lived in the goitre-endemic belt of Southern Nigeria even though only about 14% of them were found to have had treatment in the past for what was considered to be benign thyroid enlargement. The predominant histological type was follicular carcinoma, which represented 42.9%; the female to male ratio was 2.9 to 1. Surgery, which was the initial treatment of these patients, was limited to the amount of disease present at operation in most cases so as to limit postoperative complications. The indications for other treatments employed which included radiotherapy, radioactive iodine therapy and postoperative suppression with thyroxine are discussed. Forty-eight percent of all the patients developed recurrence after treatment while 88% of these patients with recurrence had distant metastases. The 5-year survival rate was 43% after which many patients were lost to follow-up.

Chemotherapy of breast cancer in Nigerians: side-effects and quality of life.

Fifty-seven breast cancer patients under follow-up between 1987 and 1988 at the Radiotherapy Department, Lagos University Teaching Hospital following mastectomy and radiotherapy were given combination chemotherapy as adjuvant therapy or as a result of recurrent disease. With the use of a detailed questionnaire the side-effects and reactions to chemotherapy were assessed. Apart from disturbances of menstruation in 24 (53.3%) of the 45 premenopausal patients, the majority of patients tolerated treatment very well, whilst the side-effects that occurred were limited. Nigerian women may be more tolerant to the side-effects of chemotherapy than those women living in developed countries.

Paratesticular rhabdomyosarcoma in adolescents.

Paratesticular rhabdomyosarcoma is a rare tumour which occurs mostly in children and adolescents. Unlike other paratesticular sarcomas, it is associated with a much poorer prognosis. Therefore a multidisciplinary approach in the management of this condition is advocated in an effort to improve the results of treatment. In this paper we report the first 2 cases managed at this hospital.

The pattern of metastases in Nigerian breast cancer patients.

The management of breast carcinoma in Nigeria poses a big challenge as a large proportion of the patients present at an advanced stage. The records of 214 patients with carcinoma of the breast seen at the Lagos University Teaching Hospital between 1971 and 1981 were studied. Of these, 128 developed metastases within 2 years of follow-up. The pattern of metastases and local factors which influenced the results of treatment are discussed.

Radiation therapy in the management of chemodectomas in Nigeria.

Chemodectomas constitute a very rare group of tumours. They have been described at various sites in the body and their management, particularly the glomus jugulare tumours is of interest, as surgery in some cases may be hazardous and possibly fatal as a result of severe haemorrhage associated with these tumours. Radiotherapy has been advocated as the treatment of choice particularly for the glomus jugulare tumour. Our experience in the management of this rare group of tumours seen at the only Radiotherapy Unit in Nigeria between 1975 and 1979 is analysed. Radiation therapy techniques, doses given and complications noticed are analysed. There was complete control of the disease in four out of four (100%) of the cases at 1 year and three out of four (75%) at 3 years. Results from other reports in the literature are reviewed.

The treatment of Kaposi's sarcoma by combination chemotherapy in Nigeria.

Kaposi's sarcoma is known to be multicentric in origin. It starts predominantly on the skin but visceral organs can be involved as well. Previous experience in the management of this condition in Lagos, Nigeria has been based mainly on the use of local radiotherapy. A better understanding of the natural history and clinicopathological features of this disease has given prominence to the use of chemotherapy and this is now being advocated as the first line of management in most cases in place of radiotherapy. Experience and results of the use of multiple chemotherapy in 10 cases seen at the Lagos University Teaching Hospital between 1976 and 1982 are discussed. Seven patients (70%) showed complete tumour regression, two (20%) had partial response and one (10%) did not respond.