Durable Response to Pazopanib in a Patient with Fumarate Hydratase-Mutant Tubulocystic Renal Cell Carcinoma.

Tubulocystic carcinoma of the kidney (TC-RCC) is a rare renal tumor and has been recently included as a distinct entity in WHO classification of renal neoplasms. We report the case of a patient with metastatic tubulocystic RCC whose disease progressed through standard of care treatment for nonclear RCC. However, genetic analysis revealed a germline pathogenic variant of fumarate hydratase (FH) gene, and the patient had a sustained and durable response to pazopanib.

Programmed Death-ligand 1 (PD-L1) Expression in Bladder Cancer and its Correlation with Tumor Grade, Stage, and Outcome.

Objectives: To evaluate the expression of programmed death-ligand 1 (PD-L1) in bladder cancer cases in Oman using immunohistochemistry, and to determine whether the level of PD-L1 expression is associated with tumor grade, stage, or outcome. An additional objective was to identify the clinicopathological features of bladder cancer among Omanis. Methods: This was a retrospective cohort study of patients where we subjected archived tissue samples to prospective analysis. All patients diagnosed and treated for bladder cancer in Sultan Qaboos University Hospital from January 2006 to December 2017 and followed up for at least one year were included. Clinical and demographical information of the patients was obtained from their medical records. PD-L1 testing using immunohistochemistry was performed on formalin-fixed paraffin-embedded tissue blocks. Scoring of PD-L1 expression by tumor cells was conducted independently by two pathologists. Positivity was defined using two different cut-off values (≥ 5% and ≥ 25%) of tumor cells showing membrane or cytoplasmic staining. The outcome was divided into two categories either no recurrence at the last follow-up, or recurrence/disease progression/death. Results: There were 68 cases of bladder cancer; 72.1% were male; the age range was 35-89 years (mean = 65.3 and median = 66). The largest number of patients were diagnosed with stage II cancer (38.8%) followed by stage I cancer (32.8%). Hematuria was the most common presentation (58.7%). High-grade tumors were seen in 83.8% (57/68) of patients. Invasive urothelial carcinoma appeared in 79.4% (54/68). PD-L1 tests were performed on 63 cases where tissue blocks were available. PD-L1 was positive in 44.4% of cases using a cut-off value of 5%; however, it dropped to 30.2% at a cut-off value of 25%. At the cut-off value of 5%, PD-L1 was significantly associated with tumor grade (p = 0.033), but the significance was lost when the cut-off value of 25% was applied (p = 0.250). No significant association was found between PD-L1 expression and outcome using both cut-off values and stage at diagnosis (p = 0.798 and p = 0.102, respectively). Conclusions: This study showed that at a cut-off value of ≥ 5%, 44.4% of cases of bladder cancer were PD-L1 positive. There was a significant association between PD-L1 expression in bladder cancer and tumor grade. No statistically significant association was found between tumor stage and outcome. The results indicated the potential benefit of anti-PD-L1 immunotherapy for patients with high tumor grades.

Non-Invasive Glucose Metabolism Quantification Method Based on Unilateral ICA Image Derived Input Function by Hybrid PET/MR in Ischemic Cerebrovascular Disease.

The non-invasive quantification of the cerebral metabolic rate for glucose (CMRGlc) and the characterization of cerebral metabolism in the cerebrovascular territories are helpful in understanding ischemic cerebrovascular disease (ICVD). Firstly, we investigated a non-invasive quantification approach based on an image-derived input function (IDIF) in ICVD. Second, we studied the metabolic changes in CMRGlc after surgical intervention. We evaluated the hypothesis that the IDIF method based on the unilateral internal carotid artery could address challenges in ICVD quantification. The CMRGlc and standardized uptake value ratio (SUVR) were used to measure glucose metabolism activity. Healthy controls showed no significant differences in CMRGlc values between bilateral and unilateral IDIF measurements (intraclass correlation coefficient [ICC]: 0.91-0.98). Patients with ICVD showed significantly increased CMRGlc values after surgical intervention for all territories (percentage changes: 7.4%-22.5%). In contrast, SUVR showed minor differences between postoperative and preoperative patients, indicating that it was a poor biomarker for the diagnosis of ICVD. A significant association between CMRGlc and the National Institutes of Health Stroke Scale (NIHSS) scores was observed (r=-0.54). Our findings suggested that IDIF could be a valuable tool for CMRGlc quantification in patients with ICVD and may advance personalized precision interventions.

Clinicopathological Features, Treatment, and Outcome of Omani Patients with Metastatic Prostate Cancer.

OBJECTIVES: Prostate cancer (PCa) is the third most common cancer worldwide, with its incidence rising in the Middle East. There is a paucity of data about the clinicopathological features and outcomes of metastatic prostate cancer (mPCa) from the Middle East. We report the outcomes of mPCa from Oman. METHODS: We recruited consecutive men diagnosed with mPCa and treated at Sultan Qaboos University Hospital in Oman between January 2006 and December 2017. Information about demographics, clinical, laboratory, pathological, and radiological features at presentation, treatment, and survival outcomes was collected. Data were gathered until April 2019 or until the patient's death for progression-free survival (PFS) and overall survival (OS), whichever came first. Survival rates were estimated using the Kaplan-Meier method. Univariate and multivariate analysis and Cox regression analyses were performed to study factors affecting the PFS and the OS. RESULTS: Of the 239 men diagnosed with PCa over the study period, 62 were diagnosed with mPCa. The median age was 71 (range = 57-92) years. The majority of patients (61.3%) had a Gleason score ≥ 8. Median prostate-specific antigen (PSA) level was 100.0. Bone was the most common site of metastatic disease (90.3%). The majority of patients with the hormone-sensitive disease were treated with testosterone suppression only, while abiraterone, enzalutamide, and docetaxel were added for treating metastatic castration-resistant mPCa (mCRPC). After a median follow-up of 34.5 months, the median PFS was 17 months, while the median OS was 43 months. Median survival post mCRPC was 17 months. CONCLUSIONS: Omani patients with mPCa present with high PSA and Gleason score and with widespread metastatic disease burden. Treatments offered are according to internationally accepted standards and have comparable PFS and OS as reported elsewhere.

Beliefs and Perceptions About Cancer Diagnosis and Treatment-Seeking and Decision-Making Behaviors Among Omani Patients with Cancer: A Single-Center Study.

A cancer diagnosis is associated with anxiety and psychological distress. Cultural and societal factors greatly affect the complex process of coping mechanisms and decision making. Omani patients receiving cancer treatment at Sultan Qaboos University Hospital in Oman were interviewed about their perceptions regarding cancer, treatment, outcome, and decision making. Out of a total of 360 approached, 216 patients consented. The median age was 42 years. The results showed that 60.6% of patients considered cancer diagnosis as a test from God, 13.9% considered it as a result of an evil eye, 40% believed prayers treat cancer. Fifty-six percent of participants wanted to make treatment decisions themselves, while 2.3% preferred their family to make decisions. Our findings suggest that perceptions about cancer in Oman are specific and are associated with religion and sociocultural background.

Clinicopathological Features and Outcomes of Gastrointestinal Stromal Tumours in Oman: A multi-centre study.

OBJECTIVES: This study aimed to report the clinicopathological features, management and long-term outcomes of patients with gastrointestinal stromal tumours (GISTs) in Oman. METHODS: This retrospective study was conducted on patients treated for GIST between January 2003 and December 2017 at three tertiary referral centres in Muscat, Oman. All patients with confirmed histopathological diagnoses of GIST and followed-up at the centres during this period were included. Relevant information was retrieved from hospital records until April 2019. RESULTS: A total of 44 patients were included in the study. The median age was 55.5 years and 56.8% were female. The most common primary site of disease was the stomach (63.6%) followed by the jejunum/ileum (18.2%). Two patients (4.5%) had c-Kit-negative, discovered on GIST-1-positive disease. A total of 24 patients (54.5%) presented with localised disease and eight (33.3%) were classified as being at high risk of relapse. Patients with metastatic disease received imatinib in a palliative setting, whereas those with completely resected disease in the intermediate and high-risk groups were treated with adjuvant imatinib. Of the six patients (13.6%) with progressive metastatic disease, of which four had mutations on exon 11 and one on exon 9, while one had wild-type disease. Overall, rates of progression-free survival and overall survival (OS) at 100 months were 77.4% and 80.4%, respectively. Rates of OS for patients with localised and metastatic disease were 89.9% and 80.2%, respectively. CONCLUSION: The presenting features and outcomes of patients with GISTs in Oman were comparable to those reported in the regional and international literature.

Complications and Management of Totally Implantable Central Venous Access Ports in Cancer Patients at a University Hospital in Oman.

OBJECTIVES: Totally implantable central venous access ports (port-a-caths) are increasingly used for the safe administration of chemotherapy; however, their use is associated with complications. This study reviews patterns of complications, reasons for premature removal and the duration of the use of port-a-caths in patients receiving cancer treatment at Sultan Qaboos University Hospital (SQUH) and compares the infection rate with the literature and the researchers' experiences. METHODS: This retrospective follow-up study included patients who had received cancer treatment through a port-a-cath and were admitted to SQUH between January 2007 and April 2019. Demographic features, underlying diagnosis, clinical stage, treatment, duration of use and the cause of premature removal of the port-a-cath were recorded. RESULTS: A total of 516 port-a-caths were inserted in 482 cancer patients. The majority of devices were implanted by interventional radiologists (n = 459; 89.0%) and the right internal jugular vein was most frequently accessed (n = 396; 76.7%). The mean indwelling time of a port-a-cath was 288 days (range: 3-1,872 days) for patients with complications and 550 days (range: 7-3,123 days) for patients without complications. Port-a-cath-related infection was the main complication (n = 63; 12.2%). Patient age, gender, treatment intent, underlying diagnosis, clinical stage, chemotherapy regimen, number of treatment courses, operator implanting the port, the type of micro-organism isolated from the port-a-cath and body mass index were significant factors affecting catheter indwelling time (P <0.05). On multivariate analysis, however, none of the factors was found to be significant. CONCLUSION: Infection was the most common complication necessitating port-a-cath removal. The infection rate was much lower than the researchers' previous experience and compares favorably with several published reports.

Standard MRI-based attenuation correction for PET/MRI phantoms: a novel concept using MRI-visible polymer.

BACKGROUND: PET/MRI phantom studies are challenged by the need of phantom-specific attenuation templates to account for attenuation properties of the phantom material. We present a PET/MRI phantom built from MRI-visible material for which attenuation correction (AC) can be performed using the standard MRI-based AC. METHODS: A water-fillable phantom was 3D-printed with a commercially available MRI-visible polymer. The phantom had a cylindrical shape and the fillable compartment consisted of a homogeneous region and a region containing solid rods of different diameters. The phantom was filled with a solution of water and [18F]FDG. A 30 min PET/MRI acquisition including the standard Dixon-based MR-AC method was performed. In addition, a CT scan of the phantom was acquired on a PET/CT system. From the Dixon in-phase, opposed-phase and fat images, a phantom-specific AC map (Phantom MR-AC) was produced by separating the phantom material from the water compartment using a thresholding-based method and assigning fixed attenuation coefficients to the individual compartments. The PET data was reconstructed using the Phantom MR-AC, the original Dixon MR-AC, and an MR-AC just containing the water compartment (NoWall-AC) to estimate the error of ignoring the phantom walls. CT-based AC was employed as the reference standard. Average %-differences in measured activity between the CT corrected PET and the PET corrected with the other AC methods were calculated. RESULTS: The phantom housing and the liquid compartment were both visible and distinguishable from each other in the Dixon images and allowed the segmentation of a phantom-specific MR-based AC. Compared to the CT-AC PET, average differences in measured activity in the whole water compartment in the phantom of -0.3%, 9.4%, and -24.1% were found for Dixon phantom MR-AC, MR-AC, and NoWall-AC based PET, respectively. Average differences near the phantom wall in the homogeneous region were -0.3%, 6.6%, and -34.3%, respectively. Around the rods, activity differed from the CT-AC PET by 0.7%, 8.9%, and -45.5%, respectively. CONCLUSION: The presented phantom material is visible using standard MR sequences, and thus, supports the use of standard, phantom-independent MR measurements for MR-AC in PET/MRI phantom studies.

Clinicopathological features, treatment and outcome of Omani patients with localised prostate cancer.

Objectives: To report the outcomes of Omani men diagnosed with localised prostate cancer (PCa), as PCa incidence is increasing in developing countries and there are scarce data regarding clinicopathological features and outcomes of PCa from the Arab world. Patients and methods: All men diagnosed with localised PCa between January 2006 and December 2017, and treated at a university hospital in Oman were included in the study. Data included demographic information, clinical, laboratory, pathological and radiological features at presentation, treatment modalities, and survival outcomes. Patients were followed until April 2019 or until death for disease-free survival (DFS) and overall survival (OS) whichever came first. Survival rates were estimated using the method of Kaplan and Meier. Univariate and multivariate analysis and Cox regression analyses were performed to study factors affecting DFS and OS. Results: Out of 239 men diagnosed with PCa over the study period, only 47 had localised disease (19.7%). The median age was 69 years. The majority (53.2%) had a Gleason score of ≥8 and a median (range) PSA level of 23.71 (range 0.6 - 452.9)ng/mL. In all, 16 patients received radical surgery, 17 received hormonal therapy along with definitive radiotherapy, while 15 were treated either with medical or surgical castration only. After a median follow-up of 43 months, the median DFS was 44.0 months. The median OS was not reached for the entire cohort. The 5- and 10-year OS rates were 84% and 57%, respectively Conclusion: Omani patients with localised PCa present with a high PSA level and a high Gleason score. Potentially curative treatments options, e.g. radical surgery and radiotherapy, are underutilised. The survival outcomes are similar to studies reported internationally. Abbreviations: (P)ADT: (primary) androgen-deprivation therapy; CAPRA: Cancer of the Prostate Risk Assessment; 3D: three-dimensional; DFS: disease-free survival; HDI: Human Development Index; Linacs, linear accelerators; NCCN: National Comprehensive Cancer Network; OS: overall survival; (m)(CR)PC: (metastatic) (castrate-resistant) prostate cancer; RP: radical prostatectomy; (IM)RT: (intensity modulated) radiotherapy; SQUH: Sultan Qaboos University Hospital.

Rarest of the Rare Metastatic Tubulocystic Carcinoma of Kidney.

Tubulocystic carcinoma of the kidney is a rare neoplasm with <100 case reports. Patients are usually asymptomatic and have a relatively indolent disease course occurring predominantly in males. These tumors rarely metastasize. It was previously considered to have some similarities to various other renal cancers, although this tumor has distinct macroscopic, microscopic, and immunohistochemical features. It is now a well-established entity in renal neoplastic pathology. Herein we present a case of metastatic tubulocystic carcinoma presenting with bony metastasis.

Response evaluation of SGLT2 inhibitor therapy in patients with type 2 diabetes mellitus using 18F-FDG PET/MRI.

INTRODUCTION: Inhibitors of sodium-glucose linked transporter-2 (SGLT2i) are enhancing glucose excretion in the proximal renal tubules, and thus are increasingly used to lower blood glucose levels in patients with type 2 diabetes mellitus (T2DM). The glucose analog 2-deoxy-2-(18F) fluoro-D-glucose (FDG) can be used to quantify renal function in vivo, and due to an affinity for SGLT2 could also provide information about SGLT2 transporter function. Our objectives in this study were, therefore, to assess the impact of SGLT2i on renal function parameters in patients with T2DM and identify predictive parameters of long-term response to SGLT2i using dynamic FDG positron emission tomography (PET)/MRI. METHODS: PET FDG renal function measures such as mean transit time (MTT) and general renal performance (GRP) together with glomerular filtration rate (GFR) were determined in 20 patients with T2DM before (T2DMbaseline) and 2 weeks after initiation of therapy with SGLT2i (T2DMSGLT2i). Additionally, dynamic FDG PET data of 24 healthy subjects were used as controls. RESULTS: MTT in T2DMbaseline was significantly higher than in healthy controls (5.7 min vs 4.3 min, p=0.012) and significantly decreased to 4.4 min in T2DMSGLT2i (p=0.004). GRP of T2DMSGLT2i was higher than of T2DMbaseline (5.2 vs 4.7, p=0.02) and higher but not significantly than of healthy individuals (5.2 vs 5.1, p=0.34). Expectedly, GFR of healthy participants was significantly higher than of T2DMbaseline and T2DMSGLT2i (122 vs 92 and 86 mL/min/1.73 m², respectively; p<0.001). The higher the GRP value in kidneys of T2DMSGLT2i, the lower was the glycated hemoglobin level 3 months after therapy initiation. CONCLUSION: MTT and GRP values of patients with T2DM shifted significantly toward values of healthy control 2 weeks after therapy with SGLT2i begins. GRP in T2DMSGLT2i was associated with better long-term glycemic response 3 months after initiation of therapy. TRIAL REGISTRATION NUMBER: NCT03557138.

Utility of Absolute Quantification in Non-lesional Extratemporal Lobe Epilepsy Using FDG PET/MR Imaging.

The purpose of this study was to establish a non-invasive clinical PET/MR protocol using [18F]-labeled deoxyglucose (FDG) that provides physicians with regional metabolic rate of glucose (MRGlc) values and to clarify the contribution of absolute quantification to clinical management of patients with non-lesional extratemporal lobe epilepsy (ETLE). The study included a group of 15 patients with non-lesional ETLE who underwent a dynamic FDG PET study using a fully-integrated PET/MRI system (Siemens Biograph). FDG tracer uptake images were converted to MRGlc (µmol/100 g/min) maps using an image derived input function that was extracted based on the combined analysis of PET and MRI data. In addition, the same protocol was applied to a group of healthy controls, yielding a normative database. Abnormality maps for ETLE patients were created with respect to the normative database, defining significant hypo- or hyper-metabolic regions that exceeded ±2 SD of normal regional mean MRGlc values. Abnormality maps derived from MRGlc images of ETLE patients contributed to the localization of hypo-metabolic areas against visual readings in 53% and increased the confidence in the original clinical readings in 33% of all cases. Moreover, quantification allowed identification of hyper-metabolic areas that are associated with frequently spiking cortex, rarely acknowledged in clinical readings. Overall, besides providing some confirmatory information to visual readings, quantitative PET imaging demonstrated only a moderate impact on clinical management of patients with complex pathology that leads to epileptic seizures, failing to provide new decisive information that would have changed classification of patients from being rejected to being considered for surgical intervention.

Outcomes of Women with Non-Metastatic Triple-Negative Breast Cancer in Oman: A single-centre experience.

OBJECTIVES: Triple-negative breast cancer (TNBC) is one of the most aggressive and heterogeneous variants of breast cancer. However, little is known regarding the prevalence and outcome of this entity in the Middle East. This study aimed to evaluate the outcomes of TNBC patients at a university hospital in Oman. METHODS: This retrospective study took place at the Sultan Qaboos University Hospital, Muscat, Oman, in May 2017. All patients diagnosed with non-metastatic TNBC between December 2000 and December 2015 were included. The patients' electronic medical records were reviewed to identify their clinical and pathological characteristics as well as survival outcomes. RESULTS: A total of 79 patients were diagnosed with non-metastatic TNBC during the study period. The median age was 46 years, with approximately one-third of patients (31.6%) under 40 years of age. Almost half had an advanced tumour size (49.4%) or node-positive disease (48.1%) at presentation and only 16.6% demonstrated a complete pathological response (pCR) to neoadjuvant chemotherapy. The median survival for all patients was not reached within the study period; however, the median overall survival for stage III patients was 44.6 months. The five-year overall survival for all patients was 64%, increasing to 100% and 72% for patients with stage I and II, respectively, and dropping to 47% for those with stage III disease. CONCLUSION: The findings of this study indicate that the majority of women with TNBC in Oman present at an advanced stage; moreover, such women have low rates of pCR to neoadjuvant chemotherapy and poor five-year survival.

Outcome of Omani Women with Breast Cancer-associated Brain Metastases Experience from a University Hospital.

OBJECTIVES: Breast cancer (BC) is the leading cancer among women. Almost 20% of patients develop brain metastases (BM) and die shortly afterward. There is a dearth of data on the survival outcome of BC patients with BM from the Arab world. METHODS: Consecutive women diagnosed with BC who developed radiologically-confirmed BM during their illness were identified through the hospital's electronic patient's records. Clinicopathological features and treatment outcomes were recorded. Survival was calculated using the Kaplan-Meier method, and factors affecting survival were studied using log-rank analysis. RESULTS: Between January 2003 and June 2015, a total of 692 patients were treated for BC at our institute. Forty-eight (6.9%) developed BM. The median age at the diagnosis of BM was 45.2 years. More than half of cohort (54.2%) had HER2 positive disease, while 27.1% had the triple-negative disease. The median time interval between the diagnosis of BC and the development of BM was 21 months, and median survival after development of brain disease was seven months. On univariate analysis, pathological grade, previous systemic treatment, brain as the first site of metastases, brain as the only site of metastases, treatment of BM, systemic treatment after BM, and diagnosis-specific graded prognostic assessment (DS-GPA) score significantly affected survival. On multivariate Cox regression analysis, the brain as the first site of metastases, treatment for brain disease, treatment type, and DS-GPA score significantly affected survival post-BM. CONCLUSIONS: Our data indicate that Omani women are diagnosed with BC at a younger age, develop BM earlier, and carry a poor outcome.

Assessment of the kidney function parameters split function, mean transit time, and outflow efficiency using dynamic FDG-PET/MRI in healthy subjects.

BACKGROUND: Traditionally, isotope nephrography is considered as the method of choice to assess kidney function parameters in nuclear medicine. We propose a novel approach to determine the split function (SF), mean transit time (MTT), and outflow efficiency (OE) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) dynamic positron emission tomography (PET). MATERIALS AND METHODS: Healthy adult subjects underwent dynamic simultaneous FDG-PET and magnetic resonance imaging (PET/MRI). Time-activity curves (TACs) of total kidneys, renal cortices, and the aorta were prospectively obtained from dynamic PET series. MRI images were used for anatomical correlation. The same individuals were subjected to dynamic renal Technetium-99 m-mercaptoacetyltriglycine (MAG3) scintigraphy and TACs of kidneys; the perirenal background and the left ventricle were determined. SF was calculated on the basis of integrals over the TACs, MTT was determined from renal retention functions after deconvolution analysis, and OE was determined from MTT. Values obtained from PET series were compared with scintigraphic parameters, which served as the reference. RESULTS: Twenty-four subjects underwent both examinations. Total kidney SF, MTT, and OE as estimated by dynamic PET/MRI correlated to their reference values by r = 0.75, r = 0.74 and r = 0.81, respectively, with significant difference (p < 0.0001) between the means of MTT and OE. No correlations were found for cortex FDG values. CONCLUSIONS: The study proofs the concept that SF, MTT, and OE can be estimated with dynamic FDG PET/MRI scans in healthy kidneys. This has advantages for patients receiving a routine PET/MRI scan, as kidney parameters can be estimated simultaneously to functional and morphological imaging with high accuracy.

Massive Gastrointestinal Bleeding from Choriocarcinoma of the Ovary.

Choriocarcinoma of the ovary is a rare neoplasm and tends to metastasize early to involve the lungs, brain, and liver. Metastasis to the gastrointestinal tract is rare. We report the case of a young lady, who presented with life-threatening gastrointestinal bleeding, secondary to jejunal involvement. The site of bleeding was localized using a computed tomography angiogram following inconclusive upper and lower gastrointestinal endoscopies. The bleeding jejunal segment was resected and the metastatic disease responded to combination chemotherapy. Metastatic choriocarcinoma of the ovary should be considered a possible diagnosis in patients presenting with gastrointestinal bleeding.

Assessing the kidney function parameters glomerular filtration rate and effective renal plasma flow with dynamic FDG-PET/MRI in healthy subjects.

BACKGROUND: A method was developed to assess the kidney parameters glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) from 2-deoxy-2-[18F]fluoro-D-glucose (FDG) concentration behavior in kidneys, measured with positron emission tomography (PET) scans. Twenty-four healthy adult subjects prospectively underwent dynamic simultaneous PET/magnetic resonance imaging (MRI) examination. Time activity curves (TACs) were obtained from the dynamic PET series, with the guidance of MR information. Patlak analysis was performed to determine the GFR, and based on integrals, ERPF was calculated. Results were compared to intra-individually obtained reference values determined from venous blood samples. RESULTS: Total kidney GFR and ERPF as estimated by dynamic PET/MRI were highly correlated to their reference values (r = 0.88/p < 0.0001 and r = 0.82/p < 0.0001, respectively) with no significant difference between their means. CONCLUSIONS: The study is a proof of concept that GFR and ERPF can be assessed with dynamic FDG PET/MRI scans in healthy kidneys. This has advantages for patients getting a routine scan, where additional examinations for kidney function estimation could be avoided. Further studies are required for transferring this PET/MRI method to PET/CT applications.

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.

Role of Systemic Antibiotics in Preventing Epidermal Growth Factor Receptor: Tyrosine Kinase Inhibitors-induced Skin Toxicities.

The epidermal growth factor receptor (EGFR) is actively involved in the growth of multiple tumor types and has been found as an effective treatment target in various solid cancers, for example, lung cancer and head and neck cancer. Of effective drugs which target and inhibit EGFR functions, tyrosine kinase inhibitors have shown promising results, albeit at a cost of side effects, skin toxicity being the most common. This article provides an evidence-based strategy to oncology nurse practitioners in dealing with such toxicity.

Calpain-1 Expression in Triple-Negative Breast Cancer: A Potential Prognostic Factor Independent of the Proliferative/Apoptotic Index.

Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer in which calpain system plays an important role in its cellular processes including apoptosis and proliferation. Although such roles have been assessed in tumor pathogenesis, the correlation of its expression to the proliferating/apoptotic index has not been studied yet. Immunohistochemical staining of calpain-1 was performed on paraffin-embedded tissues to correlate its expression with clinicopathological variables and outcome. The proliferation activity was determined by calculating the percentage of cells expressing the Ki-67 antigen. The apoptotic index was assessed morphologically and biochemically using Haematoxylin & Eosin method and Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay, respectively. Calpain-1 was significantly expressed in TNBC tissues varying from low to high with a significant correlation to lymph node status but not with the other clinicopathological variables, suggesting its role as a prognostic factor. In addition, a positive correlation was found between both apoptotic counts assays (P < 0.001, r = 0.547) as well as with proliferation (P = 0.045). Calpain-1 expression had no significant correlation with either proliferation (P = 0.29) or apoptotic indices (P = 0.071 and P = 0.100). Determining calpain-1 expression may provide relevant prognostic value for TNBC cancer patients.