ABSTRACT
UNLABELLED: Obesity and increased body mass index (BMI) are increasing among Saudi women across all age groups with an overall prevalence of 44%. Increased BMI is associated with advanced stage breast cancer and dismal survival; however impact of BMI on locoregional control (LRC) is less studied. We aimed to evaluate the impact of BMI on LRC in Saudi patients with breast cancer after breast conserving surgery (BCS) and modified radical mastectomy (MRM). MATERIALS AND METHODS: Between February 1988 and August 2008, 112 patients with breast cancer were treated with BCS and MRM followed by adjuvant chemotherapy and radiotherapy. Median age was 47.01 years (23-76). Mean BMI was 38.1 kg/m2 (15.7-52.8); BMI < 18.5 kg/m2 (underweight) in 1 (0.9%), BMI 18.5-25 kg/m2 (normal weight) in 19 (16.9%), BMI 26-30 kg/ m2 (overweight) in 32 (28.6%), BMI 31-40 kg/m2 (obese) in 48 (42.9%) and BMI > 40 kg/m2 (morbid obese) in 12 (10.7%). Median follow up period was 9 years (5-17). Cox proportional hazard analysis was done using SPSS 19.0. RESULTS: A total of ten locoregional recurrences (8.93%) were seen. The 5 and 10 years LRC were 86.4% and 86.4% respectively. Multivariate analysis showed poor LRC in BMI < 18.5 kg/m2 (HR: 4.2; 95% CI.3.8-3.6, p 0.001) and 26-30 kg/m2 (HR: 3.4; 95% CI.3.0-3.8, p 0.01). Others factors associated with poor LRC were: age less than 40 years, premenopausal status, and no adjuvant radiotherapy, and T4, N2 and N3 stages. CONCLUSION: Underweight patients with breast cancer are more prone for locoregional recurrences as compared to obese and morbid obese patients.
ABSTRACT
UNLABELLED: We aimed to evaluate long-term treatment outcomes and toxicity profile of postoperative radiotherapy (PORT) in Saudi women with uterine cancers. METHODS AND MATERIALS: Medical records of patients with histopathologically proven uterine cancers were reviewed and identified those who received PORT (45-50.4 Gy in 25-28 fractions) followed by vaginal brachytherapy (15-20 Gy in 3 to 4 sessions) after total abdominal hystrectomy and bilateral salpingo-oophorectomy (TAHBSO) in our center between August 2007 and April 2012. Data regarding the safety profile, locoregional control (LRC) or distant metastases control (DMC) and overall survival (OS) rates were analyzed. RESULTS: Median follow-up period was 60 months (range, 12-70) for 89 patients. Predominant histological type was endometrial (59 patients), followed by carcinosarcoma (17 patients) and leiomyosarcoma (13 patients). Median age at time of diagnosis was 57.6, 56 and 51.1 years for endometrial, carcinosarcoma and leiomyosarcoma respectively. LRC rates were 80.9%, 87.1% and 100% for leiomyosarcoma, carcinosarcoma and endometrial carcinoma respectively (p 0.4). DMC rates were 69.3%, 45% and 16.3% for endometrial, leiomyosarcoma and carcinosarcoma respectively (p 0.0001). Five-year OS rates were 71.1%, 60% and 16.3% for endometrial, leiomyosarcoma and carcinosarcoma respectively (p 0.001). Coxproportional hazard ratio model showed body mass index, FIGO stage, lymphovascular invasion in endometrial carcinoma, tumor size in leiomyosarcoma and histology in carcinosarcoma important prognostic factors for LRC. Acute grade 3 and 4 proctitis/enteritis seen only in 4 patients (4.5%) and late toxicities were minimal. CONCLUSION: PORT in Saudi women with uterine cancers showed better LRC, DMC and OS rates with minimal toxicity.
ABSTRACT
OBJECTIVE: Bicalutamide is approved as an adjuvant to primary treatments (radical prostatectomy or radiotherapy) or as monotherapy in men with locally advanced, nonmetastatic prostate cancer (pca). However, this treatment induces gynecomastia in most patients, which often results in treatment discontinuation. Optimal therapy for these breast events is not known so far. We undertook a meta-analysis to assess the efficacy of various treatment options for bicalutamide-induced gynecomastia. METHODS: The medline, cancerlit, and Cochrane library databases were searched and the Google search engine was used to identify prospective and retrospective controlled studies published in English from January 2000 to December 2010 comparing prophylactic or curative treatment options with a control group (no treatment) for pca patients who developed bicalutamide-induced gynecomastia. Radiotherapy-induced cardiotoxicity was also evaluated. RESULTS: The search identified nine controlled trials with a total patient population of 1573. Pooled results from prophylactic trials showed a significant reduction of gynecomastia in pca patients treated with prophylactic tamoxifen 20 mg daily (odds ratio: 0.06; 95% confidence interval: 0.05 to 0.09; p = 0.09), and pooled results from treatment trials showed a significant response of gynecomastia to definitive radiotherapy (odds ratio: 0.06; 95% confidence interval: 0.01 to 0.24; p < 0.0001). Aromatase inhibitors and weekly tamoxifen were not found to be effective as prophylactic and curative options. For the radiotherapy, skin-to-heart distance was found to be an important risk factor for cardiotoxicity (p = 0.006). A funnel plot of the meta-analysis showed significant heterogeneity (Egger test p < 0.00001) because of low sample size. CONCLUSIONS: Our meta-analysis suggests using prophylactic tamoxifen 20 mg daily as the first-line preventive measure and radiotherapy as the first-line treatment option for bicalutamide-induced gynecomastia. Aromatase inhibitors and weekly tamoxifen are not recommended.
ABSTRACT
BACKGROUND: A meta-analysis was conducted to assess the impact of postoperative radiotherapy (PORT) in renal cell carcinoma (RCC) on overall survival (OS), disease-free survival (DFS) and locoregional failure (LRF). MATERIALS AND METHODS: The Medline, CANCERLIT, Cochrane library database and search engines were searched to identify randomized controlled studies comparing radical nephrectomy alone with radical nephrectomy followed by PORT for localized RCC. Further, radiotherapy techniques and associated side-effects were evaluated. RESULTS: Seven controlled trials with a total patient population of 735 were identified. Pooled results from these trials showed a significant reduction of LRF in patients treated with PORT (P < or = 0.0001). However, there was no difference in OS (P = 0.29) and DFS (P = 0.14). The majority of patients was treated with larger field sizes with parallel-opposed anteroposterior fields. PORT was generally well tolerated; in total, six PORT-related deaths were seen. The resultant funnel plot was broader (Egger test P = 0.14) due to low number of patients. CONCLUSIONS: PORT significantly reduces LRF but has no effect on OS and DFS. However, due to poor patient accrual and older radiotherapy techniques in previous studies, there is a need for a new trial to evaluate PORT using conformal and intensity-modulated radiotherapy techniques.
