Medullary carcinoma of the breast: ten year clinical experience of the Kuwait cancer control centre.

BACKGROUND: Medullary carcinomas of the breast account for fewer than 7% of all invasive breast cancers. Some investigators include medullary carcinomas in the favourable histologic subtype, despite its aggressive histologic appearance. However, others fail to confirm its favourable prognosis. METHODS: This was a retrospective analysis of sixty-one (61) cases of breast cancer cases diagnosed with Medullary Carcinoma, presenting to the Kuwait Cancer Control Center between 1995 and 2005. RESULTS: Median survival time was 122 months and the seven-year disease free survival was 82%. Overall survival rate was not assessed as no cases died during the study period. No cases were metastatic from the start and only eight cases developed metastases, local recurrence or contralateral breast primary. 68.8% of the cases were Stage I or IIA (i.e. no lymph node affection). CONCLUSION: There is no overt favourable prognosis of medullary carcinoma when compared to invasive ductal carcinoma. Prognosis is more related to stage than histologic subtyping. The majority of cases were negative estrogen and progesterone receptor status and node negative.

Prognostic value of hemoglobin levels prior to radiotherapy for cervical cancer--Kuwait experience.

OBJECTIVE: To evaluate hemoglobin (Hb) levels before and during radiotherapy and its role as prognostic factor on treatment results of patients treated for cancer cervix. MATERIALS AND METHODS: One hundred and seven patients with cervical cancer were registered and managed at KCCC during 1995 - 1999. The pre-treatment and mid treatment Hb levels were found for 47 patients only. Follow-up was done for these cases aiming at evaluation the overall and disease-free survival. Statistical analysis was done using SPSS statistical package version 10.0. RESULTS: The median age of patients were 45 and ranged between 26-80 years. Kuwaiti patients represented 21.3% of cases. The most common stage was Stage IIb representing 51.1% followed by IIIb representing 27.7%. Stage Ib and IIa represented 12.8%. About 89.4% were squamous cell carcinoma, while adenocarcinoma was 6.4%. Treatment outcome revealed 18 relapses (38.3%). Disease-free survival for cases with pre-treatment Hb level < 12 was 16.3%, while for those with Hb level > or = 12 g/dL it was 62.9%. The difference was statistically significant (P = 0.02). CONCLUSION: Patients with pre-treatment Hb < 12 g/dL had a significantly lower disease-free survival.

Anemia in patients with advanced or metastatic non-small cell lung cancer.

OBJECTIVE: To determine the frequency of anemia in patients with advanced or metastatic non-small cell lung cancer (NSCLC) at the time of initial oncologic consultation. MATERIAL AND METHOD: We reviewed 144 consecutive charts of patients with advanced or metastatic NSCLC, who were seen in consultation at the Hamilton Regional Cancer Center (Canada) between January and June of 1998. RESULTS: Eighty nine patients had pre-treatment hemoglobin (Hb) levels available and 30 of those patients (33.7%) had levels below 12 gm/dl. The likelihood of anemia increased with advancing stage of underlying disease, found in 25% and 40.8% of stage III and IV patients respectively. CONCLUSION: Although only 89/144 patients had Hb results available, 33.7% had hemoglobin level below 12 g/dl. Anemia was more common with an increased burden of disease. Shortness of breath and fatigue were more commonly reported in anemic patients.

Spinal cord compression, an overview for radiation oncologists.

Spinal cord compression is a major cause of morbidity and or mortality in a cancer patient. This is one of the few oncologic emergencies, as delay in therapy leads to frank paralysis. Several key areas must be considered in the diagnosis and management of spinal cord compression. Because the outcome can be devastating, a diagnosis must be made early and treatment initiated promptly. The purpose of this paper is to present an overview of the important points to radiation oncologists regarding the management of spinal cord compression in an evidence-based approach.

Local tumour control in women with carcinoma of the cervix treated with the addition of nitroimidazole agents to radiotherapy: a meta-analysis.

The purpose of this paper was to estimate the effect of nitroimidazoles on the local control and overall survival of women receiving radiotherapy for carcinoma of the cervix. Sources searched included Medline, Cancerlit and national cancer organizations. Proceedings of meetings were hand-searched. Trial selection and quality score were performed in duplicate. Data extraction was performed by a single author. Five trials involving 849 patients were included. Median follow-up was typically 4 years or greater. The odds ratio (OR) for local recurrence did not demonstrate a significant effect (OR: 1.14; 95% confidence interval (CI): 0.78-1.66). The difference in mortality was also non-significant (OR: 1.26; 95% CI: 0.95-1.66). A significant increase in neuropathy was found (OR: 3.21; 95% CI: 1.36-7.55). Subgroup analysis did not reveal any sources of heterogeneity between trials. Despite five published randomized trials, evidence supporting the use of nitroimidazoles in the treatment of cervical cancer is lacking. Meta-analysis revealed no significant effect on local tumour control with a weak, non-significant trend suggesting a decrease in overall survival. There is, however, a significant increase in the rate of neurotoxicity with the use of these compounds. This overview can not support the use of these agents.

Hemangioendothelioma of the spinal cord with intramedullary extension.

OBJECTIVE: Hemangioendotheliomas (HE) are vascular neoplasms that rarely involve the neuraxis. We report a rare case in the literature of intradural HE of the spinal cord with intramedullary extension. CLINICAL PRESENTATION AND INTERVENTIONS: A 41-year-old gentleman presented with low back pain, numbness and urinary retention. Imaging revealed a spinal tumor causing complete blockage at the level of T12. The tumor was resected and postoperative radiotherapy was delivered for residual disease. No disease was seen on MRI after 48 months of clinical and radiological follow-up. CONCLUSION: Complete excision of HE is the treatment of choice. Radiotherapy may play a role in the management of this lesion.