Amr Sakr | Cairo University (original) (raw)

Papers by Amr Sakr

Endoscopic Ultrasound, 2014

Objective: The objective of this study is to evaluate the role of high resolution ultrasonography... more Objective: The objective of this study is to evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasound (EUS)-elastography in predicting malignant lymphadenopathy. Patients and Methods: This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real time elastography pattern and the B-mode US/EUS images was compared with the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), tru-cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months. Results: Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% was hypoechoic while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cutoff value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%. Conclusion: Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.

European Respiratory Journal, 2011

Objective: To assess the safety and efficacy of thoracoscopic doxycycline poudrage (TDP) for pleu... more Objective: To assess the safety and efficacy of thoracoscopic doxycycline poudrage (TDP) for pleurodesis in malignant effusions. Design: Retrospective. Methods: Twenty seven patients were included in this study. Thoracoscopy was performed for diagnosis and subsequent doxycycline pleurodesis. At the end of thoracoscopy, a new method for Doxycycline delivery to the pleura was used through pneumatic atomizer insufflations where about 500-1000 mg of doxycycline were taken & prepared as a powder from the oral preparation (vibramycin 100 mg/capsule). Results: 74.1% had a successful pleurodesis, 18.5% had partial reponse and 7.4% had failed pleurodesis at one month. Adverse effects included pain (48.1%), fever (3.7%) and pain & fever (22.2%). The mean drainage time for intercostals tube was about 1.52 days. Conclusions: TDP is an inexpensive, well tolerated, reasonably effective, comparatively simple, safe, and capable of alleviating respiratory symptoms.

Purpose: The objectives of study are to evaluate efficacy and toxicity of combination chemotherap... more Purpose: The objectives of study are to evaluate efficacy and toxicity of combination chemotherapy FOLFIRINOX in Egyptian patients with inoperable or metastatic pancreatic cancer. Patients and Methods: Between September 2011 and September 2012, twenty patients with inoperable locally advanced or metastatic pancreatic adenocarcinoma were included to receive FOLFIRINOX protocol as first-line therapy. The median age was 54 years,. The majority of patients (70%) had metastatic disease. The median over all treatment period was 14 weeks (range: 8-26 weeks).A total of 168 cycles were administered with a median of 8 cycles (range 4-12) per patient. Results: Over all response rate was 65 % (PR 35%+SD30%). Median Progression Free Survival was 6 months (95% CI: 5.782-6.218). Progression-free survival rates at 6 and 12 months were 73 % and 10% respectively. Median overall survival was 10.5 months (95% CI: 8.309-12.691). Overall survival rates at 6 and 12 months were 84 % and 40% respectively. G...

Asian Pacific Journal of Cancer Prevention

preoperative than postoperative as seen in the German CAO/ARO/AIO-94 trial, where local control w... more preoperative than postoperative as seen in the German CAO/ARO/AIO-94 trial, where local control was significantly better with concomitant preoperative CRT (Sauer et al., 2012). The addition of oxaliplatin to 5FU or to capecitabine during CRT did not show any benefit and unfortunately increased the toxicity in most of the trials (

Indian journal of palliative care

With the increasing number of agents active against cancer, advanced cancer patients including me... more With the increasing number of agents active against cancer, advanced cancer patients including metastatic colorectal cancer (mCRC) patients may continue receiving palliative systemic anticancer therapy (PSAT) near the end-of-life. Validated palliative prognostic models, such as the Chuang's prognostic scale (CPS), may be helpful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT. To test the ability of the CPS to predict the survival of mCRC under treatment with PSAT. CPS was prospectively assessed in 36 mCRC patients who were receiving PSAT. The scale is based on eight items: ascites, edema, cognitive impairment, liver and lung metastases, performance status, tiredness, and weight loss. The total CPS score ranges from 0 to 8.5 with the higher score indicating worse prognosis. Patients were divided into two groups using a CPS cutoff score of 5, Group 1 with a CPS score ≤5 and Group 2 with a CPS score >5. Using this cutoff value, 3-month m...

Asian Pacific Journal of Cancer Prevention

Purpose: Radiotherapy is a very effective tool in the treatment of painful bone metastases. The a... more Purpose: Radiotherapy is a very effective tool in the treatment of painful bone metastases. The aim of this study was to compare the palliative effect of radiotherapy between the standard fractionation schedule 20 Gy over 5 fractions (20Gy/5fr) and the high biological dose schedule 27 Gy over 3 fractions (27Gy/3fr) which is frequently used in Stereotactic body radio-surgery (SBRT). Methods: Patients were randomized to receive (20Gy/5fr)or (27Gy/3fr). The primary aim of the study was pain relief using the numeric rating scale (NRS), after three months of radiation therapy. Secondary end points include pain relief immediately after finishing radiation therapy (within one week), and narcotic relief after three months of radiation therapy. Results: Twenty-two patients with painful bone metastases were included. 12 patients received (20Gy/5fr) and 10 patients received (27Gy/3fr). Male patients were predominant on both arms (81.8%) with a mean age of 58 years [ranging between 19-72 years]. For pain relief after three months of radiation therapy, partial pain relief was documented in 9 patients (75%) with (20Gy/5fr) and in 8 patients (80%) with (27Gy/3fr) with a p-value of 0.6. Additionally, narcotic relief after three months was equal for both groups. For immediate pain relief, partial pain relief was seen in one patient (8%) with (20Gy/5fr) versus seven patients (70%) with (27Gy/3fr) with a p value of 0.06. The increase in immediate pain relief in the 27Gy arm was numerically but not statistically significant. Conclusion: SBRT and standard fractionation radiation therapy had equal effectiveness for pain relief, when the assessment was done after three months of radiation therapy. Interestingly, SBRT had a better immediate pain relief.

Journal of Clinical Oncology

5557 Background: In locally advanced head and neck squamous cell carcinoma (HNSCC) weekly cisplat... more 5557 Background: In locally advanced head and neck squamous cell carcinoma (HNSCC) weekly cisplatin concurrent with radiation therapy is the standared treatment. However some patients cannot tolerate cisplatin. So we conduct a prospective randomized trial comparing cisplatin versus gemcitabine. Methods: This trial was done in Kasr El-Ainy Center of Clinical Oncology and Radiation therapy (NEMROCK), during the period from March 2010 till June 2011. Sixty patients with locally advanced HNSCC were randomized to receive Cisplatin (30 mg/m2) weekly for 6 consecutive weeks (30 patients) or Gemcitabine (50 mg/m2) weekly for 6 consecutive weeks (30 patients) both concomitant with radiation therapy reaching a dose of 70 Gy over 7 weeks. Primary end points include response rate, progression free survival and toxicity. Toxicities were graded according to NCI-CTCAE v3.0. Results: Thewhole study group included 48 (80%) males and 12 (20%) females. Mean age was 47.9 (± 6.5) years (range 26-61). Bo...

The Medical Journal of Cairo University

Background: Routine magnetic resonance imaging MRI is highly sensitive in detecting bone marrow a... more Background: Routine magnetic resonance imaging MRI is highly sensitive in detecting bone marrow alterations; however, it is of limited specificity in the evaluation of the causes of these alterations. Diffusion Weighted Imaging (DWI) is an imaging technique which probes the structure of a biologic tissue. The contrast achieved with this technique together with measurement of the apparent diffusion coefficient ADC values are useful complementary MRI tools and can be used for non-invasive tissue characterization and therefore reaching a more specific diagnosis.

Journal of Nuclear Medicine & Radiation Therapy

Journal of Clinical Oncology

ABSTRACT Background: The efficacy of vinorelbine with capecitabine was shown to be more than just... more ABSTRACT Background: The efficacy of vinorelbine with capecitabine was shown to be more than just additive in vitro. Moreover, vinorelbine-capecitabine combination demonstrated promising antitumor activity in the clinical setting. Based on this data we conducted a multicentric phase II study to evaluate the efficacy and safety of this combination. Methods: We report results for the 45 metastatic breast cancer patients enrolled (Nov 2005 to Nov 2006), first line treatment, at least one measurable lesion. Treatment schedule: vinorelbine 25 mg/m2 I.V. day 1 and 8, capecitabine 1,000 mg/m2 twice daily, day 1–14 q 21 days. Primary endpoint: objective response rate. Patients: Average age 49 years; range (28 -68). Median WHO PS 1; range (0–2). 96% of patients had received prior neo/adjuvant anthracycline based chemotherapy (CT) without taxanes. No adjuvant CT within the last 3 months. The most frequent metastatic sites were lung (76%), liver (49%), and bone (29%). 24% of pts had one metastatic site, 56% had 2, 18% had 3 and 2% had more than 3 sites. 6 pts (13%) had one or more metastatic sites associated to a local recurrence. Results: The median number of chemotherapy cycles was 6; range (3–6), total number of cycles: 244. All pts were evaluable for response. An objective tumor response was achieved in 29 pts 64%, (OR = CR + PR), complete response CR in 2 (4%) pts. 8 (18%) pts had stable disease. The median time to progression is 9 months. The median survival is not yet reached (median duration of follow-up of 13.5 months). The majority of adverse events were mild to moderate. No WHO grade 4 toxicities were noted. 6 (13%) pts developed Gr 3 neutropenia, Gr 3 nausea/vomiting and oral stomatitis were reported in 7 (16%) and 5 (11%) pts respectively. 3 patients developed Gr 3 hand foot syndrome. Conclusions: Vinorelbine-capecitabine combination shows high activity and good tolerance as first-line treatment for MBC.

Research in Oncology

Patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (R/M SCCHN) ha... more Patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (R/M SCCHN) have a poor prognosis with a median survival of 6 to 10 months 1. Selected patients with locally recurrent disease can be treated with a curative intent with locoregional therapies, such as salvage surgery and/or radiotherapy; however, the vast majority of patients die from their disease. Chemotherapy remains the cornerstone of treatment this setting 2. According to the main suggested guidelines 3,4 a wide range of options of chemotherapy is proposed. Either single agent chemotherapy or combination regimens. Single agent as cisplatin, carboplatin, methotrexate, bleomycin, 5-fluorouracil, paclitaxel or docetaxel; while combination regimens as cisplatin or carboplatin backbone with 5-Fluorouracil and/or taxanes with a possible integration of a biological targeted therapy as cetuximab. The choice of chemotherapy regimen depends mainly on the performance status of the patient. The best results achieved were by the combination of Cetuximab plus Platinum-Fluorouracil with an overall survival of 10.1 months 5. To date, there is limited data on chemotherapy outcomes in Egyptian patients with (R/M SCCHN). In order to evaluate and document our daily practice, we retrospectively analyzed the outcomes of chemotherapy in treatment of R/M SCCHN. The primary endpoint of this study was overall survival and the secondary endpoints were overall response rate, progression free survival and toxicity.

Research in Oncology

Background: The prognosis of high-grade gliomas is generally poor, There is controversy about the... more Background: The prognosis of high-grade gliomas is generally poor, There is controversy about the potential benefits of treatment when the tumor progress. The main idea of this study is the assessment of the value of nitrosourea-based chemotherapy in recurrent high grade glioma. Overall survival was the primary endpoint. Patients and Methods: between the period of January 2007 till December 2011, 112 cases with progressive high grade glioma were recruited from Kasr

Research in Oncology

aim of the work: Imatinib was approved for treatment of metastatic or unresectable gastrointestin... more aim of the work: Imatinib was approved for treatment of metastatic or unresectable gastrointestinal stromal tumor (GISTs) in February 2002. Accordingly we study the role of imatinib in Egyptian GISTs patients. Patients and Methods: Fourteen Patients with a histologically confirmed, unresectable or metastatic gastrointestinal stromal tumor that expressed CD117 (a marker of KIT-receptor tyrosine kinase) were eligible for the study. Results: fourty three percent of the patients had a partial response, while onlyone patient had achieved complete response (7%), 35.71% of patients had stable disease, and disease progression was noted in 14% percent of patients between one and three months after study entry. Imatinib was very safe drug, the most common side effect was mild to moderate (grade 1-2) edema or fluid retention (in 64.2% of patients). Nausea was seen in 50% of patients, diarrhea in 35.7%, rash related to the drug in two patients (14.2%). Conclusion: Imatinib mesylate is an active drug in advanced unresectable or metastatic GISTs. And it is a very safe drug.

Research in Oncology

The aim of the current study is to focus on treatment response in patients with malignant pleural... more The aim of the current study is to focus on treatment response in patients with malignant pleural mesothelioma (mPm) treated with combination chemotherapy using cisplatin plus vinorelbine. Secondary endpoints included, toxicity, progression-free and overall survival. Patients and Methods: This prospective study included 26 patients with histologically proven unresectable mPm treated at Kasr El-Aini Center of Clinical Oncology and Nuclear medicine (NEmROCK) from march 2003 to August 2004. Patients were assigned to receive cisplatin 75mg/m 2 on day one and vinorelbine 25mg/m 2 on days one and 8 every three weeks. Results: All 26 patients had measurable disease and were assessed for response. Six patients had partial response (23%), 14 patients had stable disease (54%), and six patients had disease progression on therapy (23%). Toxicity was acceptable and no treatment-related deaths occurred. The median progression-free survival was 5.15 months and the median overall survival for was 10.3 months, with a 42.3% one-year survival. Conclusion: Cisplatin-vinorelbine combination is an effectve regimen for management of malignant pleural mesothelioma with a tolerable toxicity profile. Further studies with a larger number of patients is necessary.

Indian Journal of Palliative Care, 2016

With the increasing number of agents active against cancer, advanced cancer patients including me... more With the increasing number of agents active against cancer, advanced cancer patients including metastatic colorectal cancer (mCRC) patients may continue receiving palliative systemic anticancer therapy (PSAT) near the end-of-life. Validated palliative prognostic models, such as the Chuang's prognostic scale (CPS), may be helpful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT. To test the ability of the CPS to predict the survival of mCRC under treatment with PSAT. CPS was prospectively assessed in 36 mCRC patients who were receiving PSAT. The scale is based on eight items: ascites, edema, cognitive impairment, liver and lung metastases, performance status, tiredness, and weight loss. The total CPS score ranges from 0 to 8.5 with the higher score indicating worse prognosis. Patients were divided into two groups using a CPS cutoff score of 5, Group 1 with a CPS score ≤5 and Group 2 with a CPS score >5. Using this cutoff value, 3-month mortality was predicted with a positive predictive value of 71%, a negative predictive value of 77%, a sensitivity of 67%, a specificity of 81% and an overall accuracy of 75%. Group 1 patients had a longer median survival of 149 days (95% confidence interval [CI]: 82-216) in comparison to Group 2 patients who had a median survival of 61 days (95% CI: 35-87). The difference in survival was statistically significant (P = 0.01). CPS may be useful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT.

The Egyptian Journal of Radiology and Nuclear Medicine, 2012

ABSTRACT To evaluate the diagnostic impact of echo planar DW imaging in distinguishing benign fro... more ABSTRACT To evaluate the diagnostic impact of echo planar DW imaging in distinguishing benign from malignant musculoskeletal soft-tissue masses using ADC mapping as a quantitative assessment tool.Patients and methodsWe evaluated 73 tumors (21 bone tumors and 52 soft-tissue tumors). MR examinations were performed with a 1.5-T system. Diffusion-weighted single-shot EPI images were obtained in all patients. Apparent diffusion coefficients (ADCs) were calculated by using b factors of 0 and 1000 s/mm2. ADC value measurements were compared with the histopathological findings.ResultsThe average ADC of benign tumors was 1.86 ± 0.67 × 10−3 mm2/s, and that of malignant soft-tissue tumors was 0.97 ± 0.35 × 10−3 mm2/s. ADC value of malignant tumors was significantly lower than that of the benign tumor group (p < 0.0001). The highest ADC value was seen in the case of ganglion cyst (2.8 ± 0.23 × 10−3 mm2/s) and cystic neurofibroma (2.5 ± 0.04 × 10−3 mm2/s), and juxta cortical enchondroma (2.65 ± 0.36 × 10−3 mm2/s) while the lowest one was seen in aggressive fibromatosis (0.37 ± 0.05 × 10−3 mm2/s). For malignant soft-tissue masses, the highest ADC value was seen in mesenchymal chondrosarcoma (2.1 ± 0.32) liposarcoma (intermediate grade) (1.4 ± 0.21) while the lowest ADC value was seen in fibrosarcoma (high grade) (0.78 ± 0.14).ConclusionMR diffusion provides additional information to the routine MRI sequences rendering it an effective non-invasive tool in differentiating between benign and malignant soft-tissue tumors.

OncoTargets and Therapy, 2013

Based on the variable benefit of taxanes in the adjuvant setting of early breast cancer in certai... more Based on the variable benefit of taxanes in the adjuvant setting of early breast cancer in certain tumor phenotypes, especially in human epidermal growth factor receptor (HER)2-positive and triple-negative disease, and with the observation of a lesser benefit in luminal A, this research article aimed at exploring the value of docetaxel in patients with an estrogen receptor-positive, HER2-negative disease phenotype, who might not derive the same benefits as those with other phenotypes. Patients and methods: This was a randomized prospective study comparing disease-free survival (DFS) and safety profile of sequential adjuvant three cycles Fluorouracil, Epirubicin, Cyclophosphamide followed by three cycles Docetaxel (FEC-D) versus six cycles classic Fluorouracil, Epirubicin, Cyclophosphamide (FEC)-100 in 60 Egyptian women who presented to Dar Al Fouad Hospital during the period June 2007 to July 2008 with (pT1-2 pN0-3 M0). The primary end point was DFS in a follow-up period of 4 years. The secondary end point was toxicity profile. Results: Four-year DFS rates were comparable in both arms: 73.3% ± 8.1% in the FEC-D arm versus 76.5% ± 7.8% in the FEC-100 arm (P = 0.83). N3 and grade III subgroups achieved the worst DFS in both subgroups (P = 0.001 and P = 0.214, respectively). The rate of nausea and vomiting was higher in the FEC-100 arm (P = 0.49), while grade III-IV neutropenia and febrile neutropenia incidence was similar between both arms. Conclusion: Sequential adjuvant chemotherapy with FEC followed by docetaxel achieved comparable DFS results to FEC alone in luminal A phenotype subgroups of breast cancer.

OncoTargets and Therapy, 2013

The majority of Egyptian patients with lung cancer present at a late stage of the disease. Bevaci... more The majority of Egyptian patients with lung cancer present at a late stage of the disease. Bevacizumab/carboplatin/paclitaxel, as well as cisplatin plus pemetrexed, are both standard regimens for advanced non-squamous bronchogenic cancer. This study compares both regimens, in terms of efficacy and toxicity profile, in Egyptian patients. Patients and methods: This is a randomized Phase II study comparing toxicity profile and survival in 41 chemotherapy-naïve patients with stage IIIB or IV non-squamous NSCLC, with an ECOG performance status of 0 to 2. The epidermal growth factor receptor (EGFR) mutation detection was performed prior to treatment of all patients. Patients in the first group received: bevacizumab 7.5 mg/m 2 on Day 1 and Day 15; carboplatin area under the curve-5 on Day 1; and paclitaxel 60 mg/m 2 on Day 1, Day 8, and Day 15 every 4 weeks. In the second group, patients received cisplatin 75 mg/m 2 and pemetrexed 500 mg/m 2 every 3 weeks. Results: The combination of bevacizumab/carboplatin/paclitaxel demonstrated higher Grade III-IV toxicity than cisplatin/pemetrexed regarding sensory/motor neuropathy (P = 0.06), DVT (P = 0.23), proteinuria (P = 0.23), and hypertension (P = 0.11), as well as Grade II alopecia (P = 0.001); however, no significant difference in toxicities between both arms was recorded regarding nausea and vomiting (P = 0.66), hematological toxicity, febrile neutropenia (P = 1) and fatigue (P = 0.66). Progression-free survival was similar for both treatment arms with a median of 6 months (P = 0.978). Overall median survival was comparable in both arms, 16.07 months versus 16.01 months (P = 0.89). Conclusion: Bevacizumab/carboplatin/paclitaxel and cisplatin/pemetrexed provided meaningful and comparable efficacy in advanced non-squamous bronchogenic carcinoma not harboring EGFR mutation. No significant difference in toxicity was observed between both treatment arms, apart from bevacizumab/carboplatin/paclitaxel-related risks as DVT, hypertension, proteinuria, sensory/motor neuropathy, and alopecia.

Endoscopic Ultrasound, 2014

Objective: The objective of this study is to evaluate the role of high resolution ultrasonography... more Objective: The objective of this study is to evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasound (EUS)-elastography in predicting malignant lymphadenopathy. Patients and Methods: This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real time elastography pattern and the B-mode US/EUS images was compared with the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), tru-cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months. Results: Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% was hypoechoic while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cutoff value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%. Conclusion: Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.

European Respiratory Journal, 2011

Objective: To assess the safety and efficacy of thoracoscopic doxycycline poudrage (TDP) for pleu... more Objective: To assess the safety and efficacy of thoracoscopic doxycycline poudrage (TDP) for pleurodesis in malignant effusions. Design: Retrospective. Methods: Twenty seven patients were included in this study. Thoracoscopy was performed for diagnosis and subsequent doxycycline pleurodesis. At the end of thoracoscopy, a new method for Doxycycline delivery to the pleura was used through pneumatic atomizer insufflations where about 500-1000 mg of doxycycline were taken & prepared as a powder from the oral preparation (vibramycin 100 mg/capsule). Results: 74.1% had a successful pleurodesis, 18.5% had partial reponse and 7.4% had failed pleurodesis at one month. Adverse effects included pain (48.1%), fever (3.7%) and pain & fever (22.2%). The mean drainage time for intercostals tube was about 1.52 days. Conclusions: TDP is an inexpensive, well tolerated, reasonably effective, comparatively simple, safe, and capable of alleviating respiratory symptoms.

Purpose: The objectives of study are to evaluate efficacy and toxicity of combination chemotherap... more Purpose: The objectives of study are to evaluate efficacy and toxicity of combination chemotherapy FOLFIRINOX in Egyptian patients with inoperable or metastatic pancreatic cancer. Patients and Methods: Between September 2011 and September 2012, twenty patients with inoperable locally advanced or metastatic pancreatic adenocarcinoma were included to receive FOLFIRINOX protocol as first-line therapy. The median age was 54 years,. The majority of patients (70%) had metastatic disease. The median over all treatment period was 14 weeks (range: 8-26 weeks).A total of 168 cycles were administered with a median of 8 cycles (range 4-12) per patient. Results: Over all response rate was 65 % (PR 35%+SD30%). Median Progression Free Survival was 6 months (95% CI: 5.782-6.218). Progression-free survival rates at 6 and 12 months were 73 % and 10% respectively. Median overall survival was 10.5 months (95% CI: 8.309-12.691). Overall survival rates at 6 and 12 months were 84 % and 40% respectively. G...

Asian Pacific Journal of Cancer Prevention

preoperative than postoperative as seen in the German CAO/ARO/AIO-94 trial, where local control w... more preoperative than postoperative as seen in the German CAO/ARO/AIO-94 trial, where local control was significantly better with concomitant preoperative CRT (Sauer et al., 2012). The addition of oxaliplatin to 5FU or to capecitabine during CRT did not show any benefit and unfortunately increased the toxicity in most of the trials (

Indian journal of palliative care

With the increasing number of agents active against cancer, advanced cancer patients including me... more With the increasing number of agents active against cancer, advanced cancer patients including metastatic colorectal cancer (mCRC) patients may continue receiving palliative systemic anticancer therapy (PSAT) near the end-of-life. Validated palliative prognostic models, such as the Chuang's prognostic scale (CPS), may be helpful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT. To test the ability of the CPS to predict the survival of mCRC under treatment with PSAT. CPS was prospectively assessed in 36 mCRC patients who were receiving PSAT. The scale is based on eight items: ascites, edema, cognitive impairment, liver and lung metastases, performance status, tiredness, and weight loss. The total CPS score ranges from 0 to 8.5 with the higher score indicating worse prognosis. Patients were divided into two groups using a CPS cutoff score of 5, Group 1 with a CPS score ≤5 and Group 2 with a CPS score >5. Using this cutoff value, 3-month m...

Asian Pacific Journal of Cancer Prevention

Purpose: Radiotherapy is a very effective tool in the treatment of painful bone metastases. The a... more Purpose: Radiotherapy is a very effective tool in the treatment of painful bone metastases. The aim of this study was to compare the palliative effect of radiotherapy between the standard fractionation schedule 20 Gy over 5 fractions (20Gy/5fr) and the high biological dose schedule 27 Gy over 3 fractions (27Gy/3fr) which is frequently used in Stereotactic body radio-surgery (SBRT). Methods: Patients were randomized to receive (20Gy/5fr)or (27Gy/3fr). The primary aim of the study was pain relief using the numeric rating scale (NRS), after three months of radiation therapy. Secondary end points include pain relief immediately after finishing radiation therapy (within one week), and narcotic relief after three months of radiation therapy. Results: Twenty-two patients with painful bone metastases were included. 12 patients received (20Gy/5fr) and 10 patients received (27Gy/3fr). Male patients were predominant on both arms (81.8%) with a mean age of 58 years [ranging between 19-72 years]. For pain relief after three months of radiation therapy, partial pain relief was documented in 9 patients (75%) with (20Gy/5fr) and in 8 patients (80%) with (27Gy/3fr) with a p-value of 0.6. Additionally, narcotic relief after three months was equal for both groups. For immediate pain relief, partial pain relief was seen in one patient (8%) with (20Gy/5fr) versus seven patients (70%) with (27Gy/3fr) with a p value of 0.06. The increase in immediate pain relief in the 27Gy arm was numerically but not statistically significant. Conclusion: SBRT and standard fractionation radiation therapy had equal effectiveness for pain relief, when the assessment was done after three months of radiation therapy. Interestingly, SBRT had a better immediate pain relief.

Journal of Clinical Oncology

5557 Background: In locally advanced head and neck squamous cell carcinoma (HNSCC) weekly cisplat... more 5557 Background: In locally advanced head and neck squamous cell carcinoma (HNSCC) weekly cisplatin concurrent with radiation therapy is the standared treatment. However some patients cannot tolerate cisplatin. So we conduct a prospective randomized trial comparing cisplatin versus gemcitabine. Methods: This trial was done in Kasr El-Ainy Center of Clinical Oncology and Radiation therapy (NEMROCK), during the period from March 2010 till June 2011. Sixty patients with locally advanced HNSCC were randomized to receive Cisplatin (30 mg/m2) weekly for 6 consecutive weeks (30 patients) or Gemcitabine (50 mg/m2) weekly for 6 consecutive weeks (30 patients) both concomitant with radiation therapy reaching a dose of 70 Gy over 7 weeks. Primary end points include response rate, progression free survival and toxicity. Toxicities were graded according to NCI-CTCAE v3.0. Results: Thewhole study group included 48 (80%) males and 12 (20%) females. Mean age was 47.9 (± 6.5) years (range 26-61). Bo...

The Medical Journal of Cairo University

Background: Routine magnetic resonance imaging MRI is highly sensitive in detecting bone marrow a... more Background: Routine magnetic resonance imaging MRI is highly sensitive in detecting bone marrow alterations; however, it is of limited specificity in the evaluation of the causes of these alterations. Diffusion Weighted Imaging (DWI) is an imaging technique which probes the structure of a biologic tissue. The contrast achieved with this technique together with measurement of the apparent diffusion coefficient ADC values are useful complementary MRI tools and can be used for non-invasive tissue characterization and therefore reaching a more specific diagnosis.

Journal of Nuclear Medicine & Radiation Therapy

Journal of Clinical Oncology

ABSTRACT Background: The efficacy of vinorelbine with capecitabine was shown to be more than just... more ABSTRACT Background: The efficacy of vinorelbine with capecitabine was shown to be more than just additive in vitro. Moreover, vinorelbine-capecitabine combination demonstrated promising antitumor activity in the clinical setting. Based on this data we conducted a multicentric phase II study to evaluate the efficacy and safety of this combination. Methods: We report results for the 45 metastatic breast cancer patients enrolled (Nov 2005 to Nov 2006), first line treatment, at least one measurable lesion. Treatment schedule: vinorelbine 25 mg/m2 I.V. day 1 and 8, capecitabine 1,000 mg/m2 twice daily, day 1–14 q 21 days. Primary endpoint: objective response rate. Patients: Average age 49 years; range (28 -68). Median WHO PS 1; range (0–2). 96% of patients had received prior neo/adjuvant anthracycline based chemotherapy (CT) without taxanes. No adjuvant CT within the last 3 months. The most frequent metastatic sites were lung (76%), liver (49%), and bone (29%). 24% of pts had one metastatic site, 56% had 2, 18% had 3 and 2% had more than 3 sites. 6 pts (13%) had one or more metastatic sites associated to a local recurrence. Results: The median number of chemotherapy cycles was 6; range (3–6), total number of cycles: 244. All pts were evaluable for response. An objective tumor response was achieved in 29 pts 64%, (OR = CR + PR), complete response CR in 2 (4%) pts. 8 (18%) pts had stable disease. The median time to progression is 9 months. The median survival is not yet reached (median duration of follow-up of 13.5 months). The majority of adverse events were mild to moderate. No WHO grade 4 toxicities were noted. 6 (13%) pts developed Gr 3 neutropenia, Gr 3 nausea/vomiting and oral stomatitis were reported in 7 (16%) and 5 (11%) pts respectively. 3 patients developed Gr 3 hand foot syndrome. Conclusions: Vinorelbine-capecitabine combination shows high activity and good tolerance as first-line treatment for MBC.

Research in Oncology

Patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (R/M SCCHN) ha... more Patients with recurrent or metastatic squamous-cell carcinoma of the head and neck (R/M SCCHN) have a poor prognosis with a median survival of 6 to 10 months 1. Selected patients with locally recurrent disease can be treated with a curative intent with locoregional therapies, such as salvage surgery and/or radiotherapy; however, the vast majority of patients die from their disease. Chemotherapy remains the cornerstone of treatment this setting 2. According to the main suggested guidelines 3,4 a wide range of options of chemotherapy is proposed. Either single agent chemotherapy or combination regimens. Single agent as cisplatin, carboplatin, methotrexate, bleomycin, 5-fluorouracil, paclitaxel or docetaxel; while combination regimens as cisplatin or carboplatin backbone with 5-Fluorouracil and/or taxanes with a possible integration of a biological targeted therapy as cetuximab. The choice of chemotherapy regimen depends mainly on the performance status of the patient. The best results achieved were by the combination of Cetuximab plus Platinum-Fluorouracil with an overall survival of 10.1 months 5. To date, there is limited data on chemotherapy outcomes in Egyptian patients with (R/M SCCHN). In order to evaluate and document our daily practice, we retrospectively analyzed the outcomes of chemotherapy in treatment of R/M SCCHN. The primary endpoint of this study was overall survival and the secondary endpoints were overall response rate, progression free survival and toxicity.

Research in Oncology

Background: The prognosis of high-grade gliomas is generally poor, There is controversy about the... more Background: The prognosis of high-grade gliomas is generally poor, There is controversy about the potential benefits of treatment when the tumor progress. The main idea of this study is the assessment of the value of nitrosourea-based chemotherapy in recurrent high grade glioma. Overall survival was the primary endpoint. Patients and Methods: between the period of January 2007 till December 2011, 112 cases with progressive high grade glioma were recruited from Kasr

Research in Oncology

aim of the work: Imatinib was approved for treatment of metastatic or unresectable gastrointestin... more aim of the work: Imatinib was approved for treatment of metastatic or unresectable gastrointestinal stromal tumor (GISTs) in February 2002. Accordingly we study the role of imatinib in Egyptian GISTs patients. Patients and Methods: Fourteen Patients with a histologically confirmed, unresectable or metastatic gastrointestinal stromal tumor that expressed CD117 (a marker of KIT-receptor tyrosine kinase) were eligible for the study. Results: fourty three percent of the patients had a partial response, while onlyone patient had achieved complete response (7%), 35.71% of patients had stable disease, and disease progression was noted in 14% percent of patients between one and three months after study entry. Imatinib was very safe drug, the most common side effect was mild to moderate (grade 1-2) edema or fluid retention (in 64.2% of patients). Nausea was seen in 50% of patients, diarrhea in 35.7%, rash related to the drug in two patients (14.2%). Conclusion: Imatinib mesylate is an active drug in advanced unresectable or metastatic GISTs. And it is a very safe drug.

Research in Oncology

The aim of the current study is to focus on treatment response in patients with malignant pleural... more The aim of the current study is to focus on treatment response in patients with malignant pleural mesothelioma (mPm) treated with combination chemotherapy using cisplatin plus vinorelbine. Secondary endpoints included, toxicity, progression-free and overall survival. Patients and Methods: This prospective study included 26 patients with histologically proven unresectable mPm treated at Kasr El-Aini Center of Clinical Oncology and Nuclear medicine (NEmROCK) from march 2003 to August 2004. Patients were assigned to receive cisplatin 75mg/m 2 on day one and vinorelbine 25mg/m 2 on days one and 8 every three weeks. Results: All 26 patients had measurable disease and were assessed for response. Six patients had partial response (23%), 14 patients had stable disease (54%), and six patients had disease progression on therapy (23%). Toxicity was acceptable and no treatment-related deaths occurred. The median progression-free survival was 5.15 months and the median overall survival for was 10.3 months, with a 42.3% one-year survival. Conclusion: Cisplatin-vinorelbine combination is an effectve regimen for management of malignant pleural mesothelioma with a tolerable toxicity profile. Further studies with a larger number of patients is necessary.

Indian Journal of Palliative Care, 2016

With the increasing number of agents active against cancer, advanced cancer patients including me... more With the increasing number of agents active against cancer, advanced cancer patients including metastatic colorectal cancer (mCRC) patients may continue receiving palliative systemic anticancer therapy (PSAT) near the end-of-life. Validated palliative prognostic models, such as the Chuang's prognostic scale (CPS), may be helpful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT. To test the ability of the CPS to predict the survival of mCRC under treatment with PSAT. CPS was prospectively assessed in 36 mCRC patients who were receiving PSAT. The scale is based on eight items: ascites, edema, cognitive impairment, liver and lung metastases, performance status, tiredness, and weight loss. The total CPS score ranges from 0 to 8.5 with the higher score indicating worse prognosis. Patients were divided into two groups using a CPS cutoff score of 5, Group 1 with a CPS score ≤5 and Group 2 with a CPS score >5. Using this cutoff value, 3-month mortality was predicted with a positive predictive value of 71%, a negative predictive value of 77%, a sensitivity of 67%, a specificity of 81% and an overall accuracy of 75%. Group 1 patients had a longer median survival of 149 days (95% confidence interval [CI]: 82-216) in comparison to Group 2 patients who had a median survival of 61 days (95% CI: 35-87). The difference in survival was statistically significant (P = 0.01). CPS may be useful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT.

The Egyptian Journal of Radiology and Nuclear Medicine, 2012

ABSTRACT To evaluate the diagnostic impact of echo planar DW imaging in distinguishing benign fro... more ABSTRACT To evaluate the diagnostic impact of echo planar DW imaging in distinguishing benign from malignant musculoskeletal soft-tissue masses using ADC mapping as a quantitative assessment tool.Patients and methodsWe evaluated 73 tumors (21 bone tumors and 52 soft-tissue tumors). MR examinations were performed with a 1.5-T system. Diffusion-weighted single-shot EPI images were obtained in all patients. Apparent diffusion coefficients (ADCs) were calculated by using b factors of 0 and 1000 s/mm2. ADC value measurements were compared with the histopathological findings.ResultsThe average ADC of benign tumors was 1.86 ± 0.67 × 10−3 mm2/s, and that of malignant soft-tissue tumors was 0.97 ± 0.35 × 10−3 mm2/s. ADC value of malignant tumors was significantly lower than that of the benign tumor group (p < 0.0001). The highest ADC value was seen in the case of ganglion cyst (2.8 ± 0.23 × 10−3 mm2/s) and cystic neurofibroma (2.5 ± 0.04 × 10−3 mm2/s), and juxta cortical enchondroma (2.65 ± 0.36 × 10−3 mm2/s) while the lowest one was seen in aggressive fibromatosis (0.37 ± 0.05 × 10−3 mm2/s). For malignant soft-tissue masses, the highest ADC value was seen in mesenchymal chondrosarcoma (2.1 ± 0.32) liposarcoma (intermediate grade) (1.4 ± 0.21) while the lowest ADC value was seen in fibrosarcoma (high grade) (0.78 ± 0.14).ConclusionMR diffusion provides additional information to the routine MRI sequences rendering it an effective non-invasive tool in differentiating between benign and malignant soft-tissue tumors.

OncoTargets and Therapy, 2013

Based on the variable benefit of taxanes in the adjuvant setting of early breast cancer in certai... more Based on the variable benefit of taxanes in the adjuvant setting of early breast cancer in certain tumor phenotypes, especially in human epidermal growth factor receptor (HER)2-positive and triple-negative disease, and with the observation of a lesser benefit in luminal A, this research article aimed at exploring the value of docetaxel in patients with an estrogen receptor-positive, HER2-negative disease phenotype, who might not derive the same benefits as those with other phenotypes. Patients and methods: This was a randomized prospective study comparing disease-free survival (DFS) and safety profile of sequential adjuvant three cycles Fluorouracil, Epirubicin, Cyclophosphamide followed by three cycles Docetaxel (FEC-D) versus six cycles classic Fluorouracil, Epirubicin, Cyclophosphamide (FEC)-100 in 60 Egyptian women who presented to Dar Al Fouad Hospital during the period June 2007 to July 2008 with (pT1-2 pN0-3 M0). The primary end point was DFS in a follow-up period of 4 years. The secondary end point was toxicity profile. Results: Four-year DFS rates were comparable in both arms: 73.3% ± 8.1% in the FEC-D arm versus 76.5% ± 7.8% in the FEC-100 arm (P = 0.83). N3 and grade III subgroups achieved the worst DFS in both subgroups (P = 0.001 and P = 0.214, respectively). The rate of nausea and vomiting was higher in the FEC-100 arm (P = 0.49), while grade III-IV neutropenia and febrile neutropenia incidence was similar between both arms. Conclusion: Sequential adjuvant chemotherapy with FEC followed by docetaxel achieved comparable DFS results to FEC alone in luminal A phenotype subgroups of breast cancer.

OncoTargets and Therapy, 2013

The majority of Egyptian patients with lung cancer present at a late stage of the disease. Bevaci... more The majority of Egyptian patients with lung cancer present at a late stage of the disease. Bevacizumab/carboplatin/paclitaxel, as well as cisplatin plus pemetrexed, are both standard regimens for advanced non-squamous bronchogenic cancer. This study compares both regimens, in terms of efficacy and toxicity profile, in Egyptian patients. Patients and methods: This is a randomized Phase II study comparing toxicity profile and survival in 41 chemotherapy-naïve patients with stage IIIB or IV non-squamous NSCLC, with an ECOG performance status of 0 to 2. The epidermal growth factor receptor (EGFR) mutation detection was performed prior to treatment of all patients. Patients in the first group received: bevacizumab 7.5 mg/m 2 on Day 1 and Day 15; carboplatin area under the curve-5 on Day 1; and paclitaxel 60 mg/m 2 on Day 1, Day 8, and Day 15 every 4 weeks. In the second group, patients received cisplatin 75 mg/m 2 and pemetrexed 500 mg/m 2 every 3 weeks. Results: The combination of bevacizumab/carboplatin/paclitaxel demonstrated higher Grade III-IV toxicity than cisplatin/pemetrexed regarding sensory/motor neuropathy (P = 0.06), DVT (P = 0.23), proteinuria (P = 0.23), and hypertension (P = 0.11), as well as Grade II alopecia (P = 0.001); however, no significant difference in toxicities between both arms was recorded regarding nausea and vomiting (P = 0.66), hematological toxicity, febrile neutropenia (P = 1) and fatigue (P = 0.66). Progression-free survival was similar for both treatment arms with a median of 6 months (P = 0.978). Overall median survival was comparable in both arms, 16.07 months versus 16.01 months (P = 0.89). Conclusion: Bevacizumab/carboplatin/paclitaxel and cisplatin/pemetrexed provided meaningful and comparable efficacy in advanced non-squamous bronchogenic carcinoma not harboring EGFR mutation. No significant difference in toxicity was observed between both treatment arms, apart from bevacizumab/carboplatin/paclitaxel-related risks as DVT, hypertension, proteinuria, sensory/motor neuropathy, and alopecia.