Clinical Oncology and Nuclear Medicine Department

Background. The most common renal tumors in adults is renal cell carcinoma. Wilms' tumor in subjects older than 16 years is rare; only 3% of Wilms' tumors are reported in adults, which explain the difficulties in diagnosis and treatment of this tumor entity in this age group. Methods. Patient with stage IV adult nephroblastoma with favorable histology was described, current treatment modalities were discussed, and the literature was reviewed. Results. Nineteen year old female patient is presented with renal mass, abdominal lymphadenopathy, and bilateral pulmonary deposits. Sonar guided biopsy from the renal mass was taken and pathology revealed nephroblastoma. Right nephrectomy was performed and the pathological examination revealed classic histology of nephroblastoma. The case diagnosed as stage IV adult Wilms' tumor with favorable histology. According to National Wilms' Tumor Study Group (NWTS-3), multimodal therapy was initiated immediately after surgery. The patient failed to respond to the first line therapy and died due to disease progression. Conclusion. Adult Wilms' tumor has no specific guidelines and this may lead to improper or incorrect treatment.

Background:Lymph node metastasis is the most important prognostic factor in breast cancer patients. The present study was carried out to evaluate the association between ER, PR and HER-2/neu expression status, separately and in combinations with axillary lymph node involvement. Patients and methods: Two hundred and fifty eight breast cancer patients treated with modified radical mastectomy with axillary lymph node dissection were included. The primary tumor tissue and axillary lymph node were evaluated histologically and the expression of ER, PR and HER-2/neu was evaluated by immune his to chemistry. Results: ER and PR expression were demonstrated in 78.7% and 76.4%, respectively and over-expression of HER-2/neu was detected in 13.2% of cases. Triple positive breast cancer is more likely to have axillary lymph node metastasis and ER+/PR+/HER-2-(PPN) is the most protected group (p<=0.001). There was a strong correlation between tumor size and tumor grade with lymph node involvement (p= 0.0001 and 0.024, respectively). Conclusion: triple positive breast carcinomas are more likely axillary lymph node metastasis. Tumor size, tumor grade and pathological subtypes correlate with axillary lymph node status. Further confirmatory studies with a larger number of patients are necessary to define factors predicting axillary lymph node status.

Objective: To share our experience in bladder preservation in Upper Egypt, Assiut and Sohag Universities, using different treatment protocols. In Sohag study patients with operable muscle invasive bladder cancer were included and underwent transurethral resection followed by radiochemotherapy (5-fluorouracil and Cisplatin) for bladder preservation. In Assiut study after maximum safe resection of bladder tumor, patients received combined chemo-radiotherapy, 60 Gy of fractionated radiotherapy over 6 weeks, with Cisplatin and Gemcitabine. Results: In Sohag study the age of patients ranged from 35–72ys with Median 56 years, 24 patients were male (80%) and 6 patients were female (20%). In Assiut study the mean of age was 57.30 years, median 58.5 years with peak incidence in 7th decade (9 cases) then in 6th decade 7 cases (23.33%). Performance status was represented as following, 23 patients (76.6%) were scale 1 and seven patients (23.3%) were scale 2. In Assiut study, 90% of patients were disease free at the time of cystoscopic reevaluation. Of concern is that within 18 months of follow up in Assiut study, 7 of 27 (74%) complete responding patients have had local recurrence and 66.7% of all cases. The recurrence free survival in Sohag study at the median follow up (17 months) was 84% and at the end of follow up (30 months) was 70%. The overall survival at the median follow up was 95%, and at the end of follow up was 84%. The disease free survival in Assiut study was 66.7% and the overall Survival in Assiut study was 76.7. Conclusion: Three significant prognostic factors were detected for overall survival, performance status, tumor size and residual of tumor and two significant prognostic factors were detected for disease free survival, tumor size and residual of tumor in Assiut study. And it was nearly similar to that reported by Sohag study as they found the completeness of TUR and early stage of the tumor had the strongest impact in response to treatment.

Purpose: To assess the efficacy of intra-arterial Lidocaine on post-procedural pain and on length of hospital stay in hepatocellular carcinoma (HCC) patients undergoing chemoembolization. Materials and methods: Thirty-nine transarterial chemoembolization (TACE) procedures were carried out for 21 consecutive patients (19M, 2F, age range 52–78).This is a prospective randomized controlled study. Lidocaine was used in 20 TACE and normal saline in 19 TACE. Visual analog scoring was used to assess pain (VAS). Results: Patients' demographic criteria, Child Pugh, tumor size and doses of chemotherapeutic emulsion and amount of used PV particles were not statistically significantly different between both groups. Average periprocedure VAS was 3.2 versus 7.4 for Lidocaine and Placebo groups, respectively (p = 0.0001). Postprocedure VAS in the Lidocaine group was 4.1 ± 1.6 and that for the Placebo group was 6.1 ± 1.3 (P = 0.001). Mean daily dose of Nalbuphine in the Lidocaine group was 8 mg versus 18 for patients in the Placebo group (p = 0.002). Average length of post procedure hospital stay was 3.7 and 3.8 days for Lidocaine and Placebo groups, respectively (P = 0.36). Conclusions: Intra-arterial administration of buffered Lidocaine before infusing the embolization particle of TACE is safe and effective in dose as low as 50 mg for reducing peri and post-procedural pain and dosage of narcotic analgesics in patients with HCC.

Background: Concurrent chemoradiation is the standard treatment for patients with advanced head and neck squamous cell carcinoma (HNSCC). The present study was carried out to assess the feasibility and efficacy of low-dose gemcitabine as a radiosensitizer when used during radical therapeutic management of patients with locally advanced HNSCC. Patients and methods: Fifty-two patients with locally advanced HNSCC (stage III, 50%; stage IVa, 50%) were enrolled during the period from July 2008 to December 2010. All received a course of radiotherapy (70 Gy over 7 weeks) concurrent with weekly infusions of gemcitabine at 50 mg/m 2 .

PURPOSE: In our study we compared low-dose gemcitabine-based chemoradiotherapy with cisplatin-based chemoradiotherapy as regards response rate, survival and toxicity profile in locally advanced head and neck cancer. Methodology: sixty patients with locally advanced head and neck cancer were included in this prospective comparative randomized study, in the period from January 2011 to September 2013. Results: The patients were treated in two randomized groups; each of them included 30 patients. In gemcitabine arm (group A), 42.3% of the patients had stage III, and 57.7% of them had stage IVa while 48.15% of the patients of cisplatin arm (group B) had stage III and 51.85% had stage IVa. The median duration of response in group A was 21 months, while in group B it was 23 months. The degree of response had a statistically significant effect on survival in group B patients. It was evident in patients who achieved partial response (PR) that showed lower survival than those with (CR). Conclusion: Gemcitabine has comparable radiosensitizing effect with acceptable toxicity profile and can be used as a radiosensitizer in head and neck cancers especially when cisplatin cannot be used. We recommend further studies to establish its rule.

AIM: To investigate characteristics of hepatitis B virus (HBV) implicated in HBV reactivation in patients with hematological malignancies receiving immunosuppres-sive therapy. METHODS: Serum samples were collected from 53 patients with hematological malignancies negative for hepatitis B surface antigen (HBsAg) before the start of and throughout the chemotherapy course. HBV reacti-vation was diagnosed when the HBsAg status changed from negative to positive after the initiation of chemo-therapy and/or when HBV DNA was detected by real-time detection polymerase chain reaction (RTD-PCR). For detecting the serological markers of HBV infection, HBsAg as well as antibodies to the core antigen (anti-HBc) and to the surface antigen were measured in the sera by CEIA. Nucleic acids were extracted from sera, and HBV DNA sequences spanning the S gene were amplified by RTD-PCR. The extracted DNA was further subjected to PCR to amplify the complete genome as well as the specific genomic sequences bearing the enhancer Ⅱ/core promoter/pre-core/core regions (nt 1628-2364). Amplicons were sequenced directly. RESULTS: Thirty-five (66%) of the 53 HBsAg-negative patients were found to be negative serologically for anti-HBc, and the remaining 18 (34%) patients were positive for anti-HBc. Five of the 53 (9.4%) patients with hema-tologic malignancies experienced HBV reactivation. Genotype D1 was detected in all five patients. Four types of mutant strains were detected in the S gene product of HBV strains and were isolated from 3 patients with HBV reactivation: T/S120, L143, and I126. HBV DNA was detected in the pretreatment HBsAg-negative samples in one of the five patients with HBV reactivation. In this patient, sequences encompassing the HBV full genome obtained from sera before the start of chemotherapy and at the time of de novo HBV hepatitis were detected and it showed 100% homology. Furthermore, in the phylogenetic tree, the sequences were clustered together , thereby indicating that this patient developed reactivation from an occult HBV infection. CONCLUSION: Past infection with HBV is a risk factor for HBV reactivation in Egypt. Mandatory anti-HBc

Background. The most common renal tumors in adults is renal cell carcinoma. Wilms’ tumor in subjects older than 16 years is rare; only 3% of Wilms’ tumors are reported in adults, which explain the difficulties in diagnosis and treatment of this tumor entity in this age group. Methods. Patient with stage IV adult nephroblastoma with favorable histology was described, current treatment modalities were discussed, and the literature was reviewed. Results. Nineteen year old female patient is presented with renal mass, abdominal lymphadenopathy, and bilateral pulmonary deposits. Sonar guided biopsy from the renal mass was taken and pathology revealed nephroblastoma. Right nephrectomy was performed and the pathological examination revealed classic histology of nephroblastoma. The case diagnosed as stage IV adult Wilms’ tumor with favorable histology. According to National Wilms’ Tumor Study Group (NWTS-3), multimodal therapy was initiated immediately after surgery. The patient failed to re...

Background: The surgical excision of a highly vascular giant tumor may be challenging. The aim of this study was to describe our experience with preoperative percutaneous embolization of massive vascular chest tumors before surgical excision. Methods: From 2009 to 2011, 8 cases of giant vascular thoracic tumor were treated at Assiut University Hospital, Assiut, Egypt, by preoperative embolization of the feeding arteries followed by successful excision after 48 h. Results: The median age of the 8 patients was 39 years. Embolization of their tumors resulted in a reduction of tumor size, and minimal blood loss was observed perioperatively. Perilesional edema and easy differentiation of ischemic tissue facilitated complete surgical removal of the tumors. Conclusions: Preoperative embolization of giant vascular thoracic tumors is useful to decrease perioperative blood loss and facilitate total excision.

Intensity modulated radiotherapy (IMRT) is a modern radiotherapy technique that was implemented in the mid-1990s. It allows closer shaping of dose, to target volumes, thereby sparing organs at risk (OARs). Before the IMRT-era, two-dimensional radiotherapy (2DRT) and later three-dimensional conformal radiotherapy (3DCRT) were the techniques of choice, but this robust way of irradiating caused more normal tissue to receive a higher dose. Radiation of cancers in the head and neck region is complex because of close proximity to critical normal tissue and the large target volumes that need to be treated at high doses. IMRT offers an elegant solution compared with 3DCRT and surgery because it allows organ preservation and improved function preservation. In this manuscript, we review the rationales for IMRT, with an emphasis on toxicity outcomes compared with 3DCRT. We performed a review of the literature and looked at the most important randomised controlled trials comparing IMRT with 3DCRT. We conclude that IMRT is safe in regard to disease outcome, and that it allows better sparing of normal tissue, thereby causing less toxicity, resulting in a smaller impact on quality of life compared with conventional radiotherapy in the treatment of head and neck cancer.