Yasser Bayoumi | Cairo University (original) (raw)

Papers by Yasser Bayoumi

Research paper thumbnail of Sequential Adjuvant Chemotherapy and Radiotherapy in Treatment of Early Stage Endometrial Carcinoma: Single Institutional Experience

Journal of Nuclear Medicine & Radiation Therapy, 2012

Background: Aim was to evaluate the additional benefit of adjuvant chemotherapy in patients of ea... more Background: Aim was to evaluate the additional benefit of adjuvant chemotherapy in patients of early stage endometrial carcinoma (EC) with adverse features. Materials and methods: Between June 2006 and July 2011, 56 patients with EC after surgery were randomized to receive either adjuvant radiotherapy (RT) [35 patients] or adjuvant sequential chemotherapy and radiotherapy (CRT) [21 patients]. Median age was 57.6 years (40-80). Predominant stages were FIGO IB (44.6%) and IIA (26.7%). Mean body mass index was 35.9 kg/m 2 (23-72).

Research paper thumbnail of Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

Cancer Management and Research, 2014

The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to resul... more The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs). A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded. During a median follow-up time of 60 months (18-66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal. Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.

Research paper thumbnail of Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases

Clinical Ophthalmology, 2014

Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differ... more Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to 131 I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of 131 I therapy-acquired NLDO, its correlation to 131 I therapy doses, and the surgical treatment outcome of this rare side effect. Methods: From 2000-2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with 131 I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes. Results: Nineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39-72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual 131 I doses were 311.1±169.3 millicurie (mCi) (range: 150-600 mCi). The mean duration between the date of 131 I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5-20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age .45 years and 131 I therapy doses .150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively). Conclusion: NLDO is an underestimated complication of 131 I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention.

Research paper thumbnail of Impact of body mass index on treatment outcomes in endometrial cancer patients receiving doxorubicin and cisplatin: A Gynecologic Oncology Group study

Gynecologic Oncology, 2007

R Re ev vi ie ew w O Op pe en n A Ac cc ce es ss s This is an Open Access article distributed und... more R Re ev vi ie ew w O Op pe en n A Ac cc ce es ss s This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Background: Aim was to evaluate the impact of body mass index (BMI) on locoregional control (LRC), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) in patients with endometrial carcinoma (EC) treated with adjuvant radiotherapy. Materials and methods: Between June 2006 and July 2011, 66 patients with EC received adjuvant radiotherapy. Median age was 58.02 years (40-88). Mean BMI was 35.9 kg/m 2 (23-72); BMI < 24 kg/m 2 (normal weight) in 3 (4.5%), BMI 25-30 kg/m 2 (overweight) in 19 (28.8%), BMI 31-40 kg/m 2 (obese) in 20 (30.3%) and BMI > 40 kg/m 2 (morbid obese) in 24 (36.4%). Results: Median follow-up was 55 months (6-60). The Kaplan-Meier estimates of LRC, DMC, DFS and OS were 83.3%, 74%, 78.6% and 66.3% respectively. Patients with BMI > 30 kg/m2 showed inferior LRC (74.5%-80%) with p 0.003 and inferior OS (55%-61.4%) with p value 0.001. No influence of BMI on DMC and DFS was seen {hazard ratios of 0.97 (0.78-1.24) and 0.99 (0.81-1.26) respectively}. There was positive correlation of daily treatment setup errors with BMI > 30 kg/m2 (p 0.001). No correlation with found between BMI and radiation toxicity. Conclusion: Patients with EC and high BMI had inferior LRC and OS. Emphasis shall be given on adjustment of setup errors during radiotherapy and on implementation of a national obesity prevention program.

Research paper thumbnail of Calvarium and dura mater as delayed sites of distant metastasis from papillary thyroid carcinoma

International Medical Case Reports Journal, 2015

Skull calvarium and dura mater are rare sites of distant metastasis, and mostly have been reporte... more Skull calvarium and dura mater are rare sites of distant metastasis, and mostly have been reported in lung, breast, and prostate malignancies. However, the calvarial and dural metastases from papillary thyroid cancer (PTC) are rare entities and pose diagnostic and therapeutic challenges. To date, only seven cases of calvarial metastasis with intracranial extension from PTC have been reported in literature. However, true dural metastasis from PTC has not yet been reported. A 65-year-old Saudi woman presented with 6 months history of painful posterior scalp lump, 7 years after initial diagnosis of PTC. Computed tomography and magnetic resonance imaging showed occipitoparietal calvarial lesion with massive intracranial extension. Another para-sagittal lesion was found at the top of corpus callosum mimicking a meningioma. Histopathology of para-sagittal lesion and the biopsy of calvarial mass confirmed the diagnosis of metastatic PTC. After surgical resection, residual tumors were treated with postoperative intensity-modulated radiation therapy. At 13 months of follow-up, patient was alive and without any signs of recurrence. Calvarial and dural metastases from PTC are extremely rare clinical entities. Surgical resection followed by postoperative radiotherapy is the treatment of choice. However, for such cases, multidisciplinary approach can prolong the treatment outcome and survival.

Research paper thumbnail of High-dose Chemotherapy With Autologous Stem Cell Rescue in Saudi Children Less Than 3 Years of Age With Embryonal Brain Tumors

Journal of Pediatric Hematology/Oncology

High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has been used in children unde... more High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has been used in children under the age of 3 years with embryonal brain tumors to avoid or delay the use of radiation. We reviewed the medical records of 10 Saudi children less than 3 years of age with embryonal brain tumors who underwent HDC/ASCR. All 10 patients underwent surgical resection followed by 3 to 5 cycles of induction chemotherapy and 1 to 3 cycles of HDC/ASCR using carboplatin and thiotepa. Isotretinoin was used as a maintenance therapy in 4 patients. Five patients had medulloblastoma, 3 had atypical teratoid/rhabdoid tumors, 1 had an embryonal tumor with abundant neuropil and true rosettes, and 1 had pineoblastoma. The median age of the patients was 1.9 years. A total of 19 HDC/ASCR procedures were performed. Radiotherapy (RT) was administered to 5 patients after HDC/ASCR and as a salvage therapy in 1 patient. The progression-free survival rate was 50% at 1 year and at 2 years, with a median follow-up ...

Research paper thumbnail of Skull base metastasis from papillary thyroid carcinoma: a report of three cases

International Medical Case Reports Journal, 2015

Skull base metastasis from differentiated thyroid carcinoma, including papillary and follicular t... more Skull base metastasis from differentiated thyroid carcinoma, including papillary and follicular thyroid carcinoma, is a rare manifestation. Herein, we present three cases of skull base metastasis of papillary thyroid carcinoma. The mean age of the patients was 68.6 (65-74) years, and the mean interval between initial diagnosis and skull base metastasis was 56.3 (28-89) months. Cranial nerve palsies were seen in all patients. Intensity modulated radiation therapy to deliver 6,000-6,600 cGy to the skull base metastasis was given to all patients, in addition to partial resection in one patient. At the time of last follow-up, all skull base metastases were well controlled.

Research paper thumbnail of Bladder Preservation with Concurrent Radiotherapy and Gemcitabine following Maximal Transurethral Resection for Muscle Invasive Bladder Cancer: Single Institutional Experience

Journal of Nuclear Medicine & Radiation Therapy, 2012

Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile... more Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile Engineering Advances in Pharmacoepidemiology & Drug Safety Advances in Robotics & Automation Aeronautics & Aerospace ...

Research paper thumbnail of Prevalence and treatment outcomes of second primary malignancies in Saudi patients with differentiated thyroid cancers

Saudi medical journal, 2015

To evaluate the clinicopathologic features, and explore the treatment outcomes of synchronous, or... more To evaluate the clinicopathologic features, and explore the treatment outcomes of synchronous, or metachronous second primary malignancies (SPM) in conjunction with differentiated thyroid cancers (DTC). This retrospective study was conducted on 823 DTC patients treated between 2000 and 2012 at 2 tertiary care hospitals (King Fahad Medical City and King Khalid University Hospital) in Riyadh, Kingdom of Saudi Arabia. Forty-one (5%) DTC patients were found to have SPM (61% metachronous and 39% synchronous). These patients with SPM were studied for clinicopathological features and treatment outcomes. The patients with DTC and SPM were older (median age: 54.3 years) than those without SPM (median age: 43.2 years); p=0.04. The frequency of SPM was breast (51.2%), colon (12.2%), kidney (7.3%), astrocytoma (7.3%), parotid (7.3%), rectum (4.9%), lymphoma (4.9%), nasopharynx (2.4%), and stomach (2.4%). Median follow-up was 8.05 years. Ten-year disease free survival, and overall survival (OS) ...

Research paper thumbnail of Five years treatment outcomes of postoperative radiotherapy in saudi women with uterine cancers: single institutional experience

The Gulf journal of oncology, 2014

We aimed to evaluate long-term treatment outcomes and toxicity profile of postoperative radiother... more We aimed to evaluate long-term treatment outcomes and toxicity profile of postoperative radiotherapy (PORT) in Saudi women with uterine cancers. Medical records of patients with histopathologically proven uterine cancers were reviewed and identified those who received PORT (45-50.4 Gy in 25-28 fractions) followed by vaginal brachytherapy (15-20 Gy in 3 to 4 sessions) after total abdominal hystrectomy and bilateral salpingo-oophorectomy (TAHBSO) in our center between August 2007 and April 2012. Data regarding the safety profile, locoregional control (LRC) or distant metastases control (DMC) and overall survival (OS) rates were analyzed. Median follow-up period was 60 months (range, 12-70) for 89 patients. Predominant histological type was endometrial (59 patients), followed by carcinosarcoma (17 patients) and leiomyosarcoma (13 patients). Median age at time of diagnosis was 57.6, 56 and 51.1 years for endometrial, carcinosarcoma and leiomyosarcoma respectively. LRC rates were 80.9%, ...

Research paper thumbnail of Five-year outcome of concurrent radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer: single-institution experience

Annals of Saudi medicine

We aimed to evaluate long-term treatment outcomes and toxicity profile of combined radiotherapy a... more We aimed to evaluate long-term treatment outcomes and toxicity profile of combined radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer. Retrospective study in a tertiary care cancer center in Riyadh, Saudi Arabia. The medical records of patients with histopathologically proven, locally advanced cervical cancer were analyzed. These patients received three-dimensional conformal radiotherapy with concurrent chemotherapy followed by high dose rate brachytherapy in our center between July 2007 and April 2012. The data regarding the safety profile, response rates, occurrence of locoregional or distant failure, disease-free survival, and overall survival rates were recorded. The median follow-up period was 60 months (range, 8-66) for 74 patients. The median age of study population was 52.3 years (32-78), and the stage IIB was the predominant stage (49 patients [66.2%]). A total of 45 patients (60.9%) had radiologic-positive pelvic +/- para-aortic lymphadenopa...

Research paper thumbnail of The benefit of consolidation radiotherapy to initial disease bulk in patients with advanced Hodgkin's disease who achieved complete remission after standard chemotherapy

Journal of Blood Medicine, 2015

The aim of this study was to evaluate the role of consolidation radiotherapy (RT) in advanced-sta... more The aim of this study was to evaluate the role of consolidation radiotherapy (RT) in advanced-stage Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (HD) with initial bulky sites after radiological complete remission (CR) or partial response (PR) with positron emission tomography-negative (metabolic CR) following standard chemotherapy (ABVD [Adriamycin, bleomycin, vinblastine, and dacarbazine]) six to eight cycles. Adult patients with advanced-stage HD treated at our institute during the period 2006 to 2012 were retrospectively evaluated. One hundred and ninety-two patients with initial bulky disease size (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;7 cm) who attained radiological CR/PR and metabolic CR were included in the analysis. One hundred and thirteen patients who received radiotherapy (RT) as consolidation postchemotherapy (RT group) were compared to 79 patients who did not receive RT (non-RT group). Disease-free (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method and were compared according to treatment group by the log-rank tests at P ≤0.05 significance level. The mean age of the cohort was 33 (range: 14 to 81) years. Eighty-four patients received involved-field radiation and 29 patients received involved-site RT. The RT group had worse prognostic factors compared to the non-RT group. Thirteen (12%) relapses occurred in the RT group, and 19 (24%) relapses occurred in the non-RT group. Nine patients (8%) in the RT group died, compared to eleven patients (14%) in the non-RT group. Second malignancies were seen in only five patients: three patients in the RT group compared to two patients in the non-RT group. At 5 years, overall DFS was 79%±9% and OS was 85%±9%. There was significant statistical difference between the RT group and the non-RT group regarding 5-year DFS: 86%±7% and 74%±9%, respectively (P ≤0.02). However, the 5-year OS was 90%±5% for the RT group and 83%±8% for the non-RT group, with no statistical difference (P ≤0.3). The results of our study suggest that consolidation RT in patients with advanced-stage HD with initial bulky disease who had postchemotherapy radiologic CR or PR with metabolic CR improved the DFS.

Research paper thumbnail of Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients

Cancer Management and Research, 2014

Background: Radical cystectomy (RC) with or without neoadjuvant chemotherapy is the standard trea... more Background: Radical cystectomy (RC) with or without neoadjuvant chemotherapy is the standard treatment for muscle-invasive bladder cancers. However, the locoregional recurrence rate is still significantly higher for locally advanced cases post-RC. The underuse of postoperative radiotherapy (PORT) in such cases after RC is related mainly to a lack of proven survival benefit. Here we are reporting our long-term Egyptian experience with bladder cancer patients treated with up-front RC with or without conformal PORT. Patients and methods: This retrospective study included 170 locally advanced bladder cancer (T3-T4, N0/N1, M0) patients who had RC performed with or without PORT at Damietta Cancer Institute during the period of 1998-2006. The treatment outcomes and toxicity profile of PORT were evaluated and compared with those of a non-PORT group of patients. Results: Ninety-two patients received PORT; 78 did not. At median follow-up of 47 months (range, 17-77 months), 33% locoregional recurrences were seen in the PORT group versus 55% in the non-PORT group (P,0.001). The overall distant metastasis rate in the whole group was 39%, with no difference between the two groups. The 5-year disease-free survival for the whole group of patients was 53%±11%, which was significantly affected by additional PORT, and 65%±13% compared with 40%±9% for the non-PORT group (P=0.04). The pathological subtypes did not affect 5-year disease-free survival significantly (P=0.9). The 5-year overall survival was 44%±10%. Using multivariate analysis, PORT, stage, and extravesical extension (positive surgical margins) were found to be important prognostic factors for locoregional control. Stage and lymph node status were important prognosticators for distant metastasis control. Conclusion: PORT was found to be a safe and effective tool in decreasing local recurrence rates and improving disease-free survival.

Research paper thumbnail of Lumbosacral plexus delineation, dose distribution, and its correlation with radiation-induced lumbosacral plexopathy in cervical cancer patients

OncoTargets and Therapy, 2014

To evaluate the dose distribution to the lumbosacral plexus (LSP) and its correlation with radiat... more To evaluate the dose distribution to the lumbosacral plexus (LSP) and its correlation with radiation-induced lumbosacral plexopathy (RILSP) in patients with cervical cancer treated with intensity-modulated radiotherapy (IMRT) and high-dose-rate brachytherapy. Materials and methods: After meeting eligibility criteria, 50 patients with cervical cancer were selected who were treated with IMRT and high-dose-rate brachytherapy, and the LSP was contoured. Mean volume; percentages of LSP volume absorbing 40, 50, 55, and 60 Gy (V30, V40, V50, V55, and V60) and point doses (P1, P2, P3, P4, P5, P6, P7, P8, P9, and P10); and RILSP incidence were calculated. Results: At 60 months of follow-up, four patients (8%) were found to have grade 2/3 RILSP. The mean maximal LSP dose in patients with RILSP was 59.6 Gy compared with 53.9 Gy in patients without RILSP (control; P=0.04). The mean values of V40, V50, V55, and V60 in patients with RILSP versus control were 61.8% versus 52.8%, 44.4% versus 27.7%, 8.0% versus 0.3% and 1.8% versus 0%, respectively (P=0.01, 0.001, 0.001, and 0.001, respectively). Conclusion: The delineation of the LSP during IMRT planning may reduce the risk for RILSP. The mean values of V40, V50, V55, and V60 for LSP should be less than 55%, 30%, 5%, and 0.5%, respectively; however, further studies are warranted.

Research paper thumbnail of Impact of body mass lndex on locoregional control in saudi patients with breast cancer after breast conserving surgery and modified radical mastectomy

Global Epidemic Obesity, 2014

ABSTRACT Abstract Background: Obesity and increased body mass index (BMI) are increasing among Sa... more ABSTRACT Abstract Background: Obesity and increased body mass index (BMI) are increasing among Saudi women across the all age groups, with an overall prevalence of 44%. Increased BMI is associated with advanced stage breast cancer and dismal survival; however impact of BMI on locoregional control (LRC) is less studied. We aimed to evaluate the impact of BMI on LRC in Saudi patients with breast cancer after breast conserving surgery (BCS) and modified radical mastectomy (MRM). Materials and methods: Between February 1988 and August 2008, 112 patients with breast cancer were treated with BCS and MRM followed by adjuvant chemotherapy and radiotherapy. Median age was 47.01 years (23-76). Mean BMI was 38.1 kg/m2 (15.7-52.8); BMI 18.5-25 kg/m2 (normal weight) in 20 (17.8%), BMI 26-30 kg/m2 (overweight) in 32 (28.6%), BMI 31-40 kg/m2 (obese) in 48 (42.9%) and BMI &gt; 40 kg/m2 (morbid obese) in 12 (10.7%). Median follow up period was 9 years (5-17). Cox proportional hazard analysis was done using SPSS 19.0. Results: Total ten locoregional recurrences (8.93%) were seen. The 5 and 10 years LRC were 86.4% and 86.4% respectively. Multivariate analysis showed poor LRC in BMI 26-30 kg/m2 (HR: 3.4; 95% CI.3.0-3.8, p 0.01). Others factors associated with poor LRC were; age less than 40 years, premenopausal status, and no adjuvant radiotherapy, and T4, N2 and N3 stages. Conclusion: Overweight and obese patients had better locoregional control in our study, however further larger trials are warranted. Keywords: Body mass index, breast cancer, breast conserving surgery, modified radical mastectomy

Research paper thumbnail of Locoregional recurrence of triple-negative breast cancer: effect of type of surgery and adjuvant postoperative radiotherapy

Breast Cancer: Targets and Therapy, 2014

Background/purpose: The aim was to evaluate the prognostic significance of postoperative radiothe... more Background/purpose: The aim was to evaluate the prognostic significance of postoperative radiotherapy (PORT) and surgical type on local recurrence-free survival (LRFS) and overall survival (OS) in triple-negative breast cancer (TNBC) in the Egyptian population. Patients and methods: We evaluated 111 patients with stage I-III TNBC diagnosed at our institute during the period from 2004 to 2009. Patients were stratified according to PORT into two groups: a PORT group and a non-PORT group. The influence of PORT and surgical type on LRFS and OS were evaluated. A cross-matching was done to the non-TNBC group of patients to compare the recurrence and survival rates between them and the studied group of TNBC patients. Results: The mean age of TNBC patients at diagnosis was 63±7 years. The majority of the patients had stage III disease (68.5%) and 73% had clinical or pathological positive lymph nodes. Sixty percent (67/111) of patients had modified radical mastectomy and 44/111 (40%) patients had breast-conserving treatment. PORT was given for 63% of patients, while systemic treatment was given in 89% of patients. At the time of analysis, 13 patients (11%) developed local recurrence: five of 70 (7%) in the PORT group and eight of 41 (19.5%) in the non-PORT group. Five-year LRFS for the whole group of patients was 88%±6%, which was significantly affected by PORT. The surgical type did not affect local recurrence significantly. Five-year OS for the whole group was 54%±8%. PORT and surgical type did not affect OS significantly (P-value 0.09 and 0.11, respectively). Five-year LRFS was 88%±6% and 90%±11% for TNBC and non-TNBC patients, respectively (P-value 0.8); however, OS for TNBC was significantly lower than for non-TNBC (P-value 0.04). Conclusion: TNBC is an aggressive entity compared with other non-TNBC, and these patients benefit from PORT significantly to decrease the risk of local recurrence in all stages. However, further large, prospective, randomized trials are warranted.

Research paper thumbnail of Involvement of Parathyroid Glands by Differentiated Thyroid Cancers and its Influence on Treatment Outcome

Journal of Thyroid Disorders & Therapy, 2014

Background: Parathyroid gland (PTG) involvement by differentiated thyroid cancer (DTC) patients i... more Background: Parathyroid gland (PTG) involvement by differentiated thyroid cancer (DTC) patients is rare and its influence on disease outcome has been less studied. We aimed to evaluate the frequency and patterns of PTG involvement in DTC patients and to evaluate the influence of PTG infiltration by DTC on treatment outcome in our cohort.

Research paper thumbnail of Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

Cancer Management and Research, 2014

The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to resul... more The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs). A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded. During a median follow-up time of 60 months (18-66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal. Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.

Research paper thumbnail of Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases

Clinical Ophthalmology, 2014

Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differ... more Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to 131 I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of 131 I therapy-acquired NLDO, its correlation to 131 I therapy doses, and the surgical treatment outcome of this rare side effect. Methods: From 2000-2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with 131 I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes. Results: Nineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39-72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual 131 I doses were 311.1±169.3 millicurie (mCi) (range: 150-600 mCi). The mean duration between the date of 131 I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5-20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age .45 years and 131 I therapy doses .150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively). Conclusion: NLDO is an underestimated complication of 131 I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention.

Research paper thumbnail of LINAC Stereotactic Radiosurgery for brain arteriovenous malformation: a single institutional experience from Saudi Arabia

Neuroscience Discovery, 2013

Background: Linear accelerator (LINAC) based radiosurgery for a brain arteriovenous malformation ... more Background: Linear accelerator (LINAC) based radiosurgery for a brain arteriovenous malformation (bAVM) is replacing gamma knife radiosurgery. We present clinical outcome, obliteration rates and predictor factors of treatment success following LINAC radiosurgery for bAVM which is not much addressed subject in Middle East. Methods: 13 patients who underwent LINAC radiosurgery for brain arteriovenous malformations from November 2008 to November 2011 in our radiation oncology department were retrospectively analyzed. Recollection of demographic data, AVM and treatment characteristics along with clinical and radiographic follow up information was done by reviewing the electronic data base. Results: All thirteen patients underwent stereotactic radiosurgery by linear accelerator based treatment delivery system (BrainLab) over three years. These included 7 males and 6 females, with median age of 22 years. Intracranial hemorrhage was a presenting feature in 7 (54 %) of patients. Prior embolization was done in 10 (77%) patients with 7 patients having more than once undergone this procedure. The location of AVM was superficial in 9 (70%) and deep in brain in 4 (30%) patients. The mean AVM score was 0.97 with 3 patients having AVM score ≥ 1 with mean Spetzler-Martin grade of 2.7 and 8 (62%) patients having grade 3 or more. Median follow up was 30 months. Mean dose delivered was 21.7 Gy in single fraction. Complete obliteration of AVM nidus was achieved in 9 (70%) patients while 4 patients (30%) had partial obliteration. Six patients (67 %) achieved complete obliteration among 9 who had AVM score of less than 1. Post radiosurgery neurological deficit occurred in only one patient in form of right temporal field loss. Conclusions: Linear accelerator based radiosurgery is promising treatment option for brain AVMs in majority of cases with reasonable adverse effect profile.

Research paper thumbnail of Sequential Adjuvant Chemotherapy and Radiotherapy in Treatment of Early Stage Endometrial Carcinoma: Single Institutional Experience

Journal of Nuclear Medicine & Radiation Therapy, 2012

Background: Aim was to evaluate the additional benefit of adjuvant chemotherapy in patients of ea... more Background: Aim was to evaluate the additional benefit of adjuvant chemotherapy in patients of early stage endometrial carcinoma (EC) with adverse features. Materials and methods: Between June 2006 and July 2011, 56 patients with EC after surgery were randomized to receive either adjuvant radiotherapy (RT) [35 patients] or adjuvant sequential chemotherapy and radiotherapy (CRT) [21 patients]. Median age was 57.6 years (40-80). Predominant stages were FIGO IB (44.6%) and IIA (26.7%). Mean body mass index was 35.9 kg/m 2 (23-72).

Research paper thumbnail of Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

Cancer Management and Research, 2014

The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to resul... more The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs). A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded. During a median follow-up time of 60 months (18-66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal. Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.

Research paper thumbnail of Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases

Clinical Ophthalmology, 2014

Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differ... more Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to 131 I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of 131 I therapy-acquired NLDO, its correlation to 131 I therapy doses, and the surgical treatment outcome of this rare side effect. Methods: From 2000-2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with 131 I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes. Results: Nineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39-72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual 131 I doses were 311.1±169.3 millicurie (mCi) (range: 150-600 mCi). The mean duration between the date of 131 I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5-20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age .45 years and 131 I therapy doses .150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively). Conclusion: NLDO is an underestimated complication of 131 I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention.

Research paper thumbnail of Impact of body mass index on treatment outcomes in endometrial cancer patients receiving doxorubicin and cisplatin: A Gynecologic Oncology Group study

Gynecologic Oncology, 2007

R Re ev vi ie ew w O Op pe en n A Ac cc ce es ss s This is an Open Access article distributed und... more R Re ev vi ie ew w O Op pe en n A Ac cc ce es ss s This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited Background: Aim was to evaluate the impact of body mass index (BMI) on locoregional control (LRC), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) in patients with endometrial carcinoma (EC) treated with adjuvant radiotherapy. Materials and methods: Between June 2006 and July 2011, 66 patients with EC received adjuvant radiotherapy. Median age was 58.02 years (40-88). Mean BMI was 35.9 kg/m 2 (23-72); BMI < 24 kg/m 2 (normal weight) in 3 (4.5%), BMI 25-30 kg/m 2 (overweight) in 19 (28.8%), BMI 31-40 kg/m 2 (obese) in 20 (30.3%) and BMI > 40 kg/m 2 (morbid obese) in 24 (36.4%). Results: Median follow-up was 55 months (6-60). The Kaplan-Meier estimates of LRC, DMC, DFS and OS were 83.3%, 74%, 78.6% and 66.3% respectively. Patients with BMI > 30 kg/m2 showed inferior LRC (74.5%-80%) with p 0.003 and inferior OS (55%-61.4%) with p value 0.001. No influence of BMI on DMC and DFS was seen {hazard ratios of 0.97 (0.78-1.24) and 0.99 (0.81-1.26) respectively}. There was positive correlation of daily treatment setup errors with BMI > 30 kg/m2 (p 0.001). No correlation with found between BMI and radiation toxicity. Conclusion: Patients with EC and high BMI had inferior LRC and OS. Emphasis shall be given on adjustment of setup errors during radiotherapy and on implementation of a national obesity prevention program.

Research paper thumbnail of Calvarium and dura mater as delayed sites of distant metastasis from papillary thyroid carcinoma

International Medical Case Reports Journal, 2015

Skull calvarium and dura mater are rare sites of distant metastasis, and mostly have been reporte... more Skull calvarium and dura mater are rare sites of distant metastasis, and mostly have been reported in lung, breast, and prostate malignancies. However, the calvarial and dural metastases from papillary thyroid cancer (PTC) are rare entities and pose diagnostic and therapeutic challenges. To date, only seven cases of calvarial metastasis with intracranial extension from PTC have been reported in literature. However, true dural metastasis from PTC has not yet been reported. A 65-year-old Saudi woman presented with 6 months history of painful posterior scalp lump, 7 years after initial diagnosis of PTC. Computed tomography and magnetic resonance imaging showed occipitoparietal calvarial lesion with massive intracranial extension. Another para-sagittal lesion was found at the top of corpus callosum mimicking a meningioma. Histopathology of para-sagittal lesion and the biopsy of calvarial mass confirmed the diagnosis of metastatic PTC. After surgical resection, residual tumors were treated with postoperative intensity-modulated radiation therapy. At 13 months of follow-up, patient was alive and without any signs of recurrence. Calvarial and dural metastases from PTC are extremely rare clinical entities. Surgical resection followed by postoperative radiotherapy is the treatment of choice. However, for such cases, multidisciplinary approach can prolong the treatment outcome and survival.

Research paper thumbnail of High-dose Chemotherapy With Autologous Stem Cell Rescue in Saudi Children Less Than 3 Years of Age With Embryonal Brain Tumors

Journal of Pediatric Hematology/Oncology

High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has been used in children unde... more High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has been used in children under the age of 3 years with embryonal brain tumors to avoid or delay the use of radiation. We reviewed the medical records of 10 Saudi children less than 3 years of age with embryonal brain tumors who underwent HDC/ASCR. All 10 patients underwent surgical resection followed by 3 to 5 cycles of induction chemotherapy and 1 to 3 cycles of HDC/ASCR using carboplatin and thiotepa. Isotretinoin was used as a maintenance therapy in 4 patients. Five patients had medulloblastoma, 3 had atypical teratoid/rhabdoid tumors, 1 had an embryonal tumor with abundant neuropil and true rosettes, and 1 had pineoblastoma. The median age of the patients was 1.9 years. A total of 19 HDC/ASCR procedures were performed. Radiotherapy (RT) was administered to 5 patients after HDC/ASCR and as a salvage therapy in 1 patient. The progression-free survival rate was 50% at 1 year and at 2 years, with a median follow-up ...

Research paper thumbnail of Skull base metastasis from papillary thyroid carcinoma: a report of three cases

International Medical Case Reports Journal, 2015

Skull base metastasis from differentiated thyroid carcinoma, including papillary and follicular t... more Skull base metastasis from differentiated thyroid carcinoma, including papillary and follicular thyroid carcinoma, is a rare manifestation. Herein, we present three cases of skull base metastasis of papillary thyroid carcinoma. The mean age of the patients was 68.6 (65-74) years, and the mean interval between initial diagnosis and skull base metastasis was 56.3 (28-89) months. Cranial nerve palsies were seen in all patients. Intensity modulated radiation therapy to deliver 6,000-6,600 cGy to the skull base metastasis was given to all patients, in addition to partial resection in one patient. At the time of last follow-up, all skull base metastases were well controlled.

Research paper thumbnail of Bladder Preservation with Concurrent Radiotherapy and Gemcitabine following Maximal Transurethral Resection for Muscle Invasive Bladder Cancer: Single Institutional Experience

Journal of Nuclear Medicine & Radiation Therapy, 2012

Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile... more Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile Engineering Advances in Pharmacoepidemiology & Drug Safety Advances in Robotics & Automation Aeronautics & Aerospace ...

Research paper thumbnail of Prevalence and treatment outcomes of second primary malignancies in Saudi patients with differentiated thyroid cancers

Saudi medical journal, 2015

To evaluate the clinicopathologic features, and explore the treatment outcomes of synchronous, or... more To evaluate the clinicopathologic features, and explore the treatment outcomes of synchronous, or metachronous second primary malignancies (SPM) in conjunction with differentiated thyroid cancers (DTC). This retrospective study was conducted on 823 DTC patients treated between 2000 and 2012 at 2 tertiary care hospitals (King Fahad Medical City and King Khalid University Hospital) in Riyadh, Kingdom of Saudi Arabia. Forty-one (5%) DTC patients were found to have SPM (61% metachronous and 39% synchronous). These patients with SPM were studied for clinicopathological features and treatment outcomes. The patients with DTC and SPM were older (median age: 54.3 years) than those without SPM (median age: 43.2 years); p=0.04. The frequency of SPM was breast (51.2%), colon (12.2%), kidney (7.3%), astrocytoma (7.3%), parotid (7.3%), rectum (4.9%), lymphoma (4.9%), nasopharynx (2.4%), and stomach (2.4%). Median follow-up was 8.05 years. Ten-year disease free survival, and overall survival (OS) ...

Research paper thumbnail of Five years treatment outcomes of postoperative radiotherapy in saudi women with uterine cancers: single institutional experience

The Gulf journal of oncology, 2014

We aimed to evaluate long-term treatment outcomes and toxicity profile of postoperative radiother... more We aimed to evaluate long-term treatment outcomes and toxicity profile of postoperative radiotherapy (PORT) in Saudi women with uterine cancers. Medical records of patients with histopathologically proven uterine cancers were reviewed and identified those who received PORT (45-50.4 Gy in 25-28 fractions) followed by vaginal brachytherapy (15-20 Gy in 3 to 4 sessions) after total abdominal hystrectomy and bilateral salpingo-oophorectomy (TAHBSO) in our center between August 2007 and April 2012. Data regarding the safety profile, locoregional control (LRC) or distant metastases control (DMC) and overall survival (OS) rates were analyzed. Median follow-up period was 60 months (range, 12-70) for 89 patients. Predominant histological type was endometrial (59 patients), followed by carcinosarcoma (17 patients) and leiomyosarcoma (13 patients). Median age at time of diagnosis was 57.6, 56 and 51.1 years for endometrial, carcinosarcoma and leiomyosarcoma respectively. LRC rates were 80.9%, ...

Research paper thumbnail of Five-year outcome of concurrent radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer: single-institution experience

Annals of Saudi medicine

We aimed to evaluate long-term treatment outcomes and toxicity profile of combined radiotherapy a... more We aimed to evaluate long-term treatment outcomes and toxicity profile of combined radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer. Retrospective study in a tertiary care cancer center in Riyadh, Saudi Arabia. The medical records of patients with histopathologically proven, locally advanced cervical cancer were analyzed. These patients received three-dimensional conformal radiotherapy with concurrent chemotherapy followed by high dose rate brachytherapy in our center between July 2007 and April 2012. The data regarding the safety profile, response rates, occurrence of locoregional or distant failure, disease-free survival, and overall survival rates were recorded. The median follow-up period was 60 months (range, 8-66) for 74 patients. The median age of study population was 52.3 years (32-78), and the stage IIB was the predominant stage (49 patients [66.2%]). A total of 45 patients (60.9%) had radiologic-positive pelvic +/- para-aortic lymphadenopa...

Research paper thumbnail of The benefit of consolidation radiotherapy to initial disease bulk in patients with advanced Hodgkin's disease who achieved complete remission after standard chemotherapy

Journal of Blood Medicine, 2015

The aim of this study was to evaluate the role of consolidation radiotherapy (RT) in advanced-sta... more The aim of this study was to evaluate the role of consolidation radiotherapy (RT) in advanced-stage Hodgkin&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (HD) with initial bulky sites after radiological complete remission (CR) or partial response (PR) with positron emission tomography-negative (metabolic CR) following standard chemotherapy (ABVD [Adriamycin, bleomycin, vinblastine, and dacarbazine]) six to eight cycles. Adult patients with advanced-stage HD treated at our institute during the period 2006 to 2012 were retrospectively evaluated. One hundred and ninety-two patients with initial bulky disease size (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;7 cm) who attained radiological CR/PR and metabolic CR were included in the analysis. One hundred and thirteen patients who received radiotherapy (RT) as consolidation postchemotherapy (RT group) were compared to 79 patients who did not receive RT (non-RT group). Disease-free (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method and were compared according to treatment group by the log-rank tests at P ≤0.05 significance level. The mean age of the cohort was 33 (range: 14 to 81) years. Eighty-four patients received involved-field radiation and 29 patients received involved-site RT. The RT group had worse prognostic factors compared to the non-RT group. Thirteen (12%) relapses occurred in the RT group, and 19 (24%) relapses occurred in the non-RT group. Nine patients (8%) in the RT group died, compared to eleven patients (14%) in the non-RT group. Second malignancies were seen in only five patients: three patients in the RT group compared to two patients in the non-RT group. At 5 years, overall DFS was 79%±9% and OS was 85%±9%. There was significant statistical difference between the RT group and the non-RT group regarding 5-year DFS: 86%±7% and 74%±9%, respectively (P ≤0.02). However, the 5-year OS was 90%±5% for the RT group and 83%±8% for the non-RT group, with no statistical difference (P ≤0.3). The results of our study suggest that consolidation RT in patients with advanced-stage HD with initial bulky disease who had postchemotherapy radiologic CR or PR with metabolic CR improved the DFS.

Research paper thumbnail of Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients

Cancer Management and Research, 2014

Background: Radical cystectomy (RC) with or without neoadjuvant chemotherapy is the standard trea... more Background: Radical cystectomy (RC) with or without neoadjuvant chemotherapy is the standard treatment for muscle-invasive bladder cancers. However, the locoregional recurrence rate is still significantly higher for locally advanced cases post-RC. The underuse of postoperative radiotherapy (PORT) in such cases after RC is related mainly to a lack of proven survival benefit. Here we are reporting our long-term Egyptian experience with bladder cancer patients treated with up-front RC with or without conformal PORT. Patients and methods: This retrospective study included 170 locally advanced bladder cancer (T3-T4, N0/N1, M0) patients who had RC performed with or without PORT at Damietta Cancer Institute during the period of 1998-2006. The treatment outcomes and toxicity profile of PORT were evaluated and compared with those of a non-PORT group of patients. Results: Ninety-two patients received PORT; 78 did not. At median follow-up of 47 months (range, 17-77 months), 33% locoregional recurrences were seen in the PORT group versus 55% in the non-PORT group (P,0.001). The overall distant metastasis rate in the whole group was 39%, with no difference between the two groups. The 5-year disease-free survival for the whole group of patients was 53%±11%, which was significantly affected by additional PORT, and 65%±13% compared with 40%±9% for the non-PORT group (P=0.04). The pathological subtypes did not affect 5-year disease-free survival significantly (P=0.9). The 5-year overall survival was 44%±10%. Using multivariate analysis, PORT, stage, and extravesical extension (positive surgical margins) were found to be important prognostic factors for locoregional control. Stage and lymph node status were important prognosticators for distant metastasis control. Conclusion: PORT was found to be a safe and effective tool in decreasing local recurrence rates and improving disease-free survival.

Research paper thumbnail of Lumbosacral plexus delineation, dose distribution, and its correlation with radiation-induced lumbosacral plexopathy in cervical cancer patients

OncoTargets and Therapy, 2014

To evaluate the dose distribution to the lumbosacral plexus (LSP) and its correlation with radiat... more To evaluate the dose distribution to the lumbosacral plexus (LSP) and its correlation with radiation-induced lumbosacral plexopathy (RILSP) in patients with cervical cancer treated with intensity-modulated radiotherapy (IMRT) and high-dose-rate brachytherapy. Materials and methods: After meeting eligibility criteria, 50 patients with cervical cancer were selected who were treated with IMRT and high-dose-rate brachytherapy, and the LSP was contoured. Mean volume; percentages of LSP volume absorbing 40, 50, 55, and 60 Gy (V30, V40, V50, V55, and V60) and point doses (P1, P2, P3, P4, P5, P6, P7, P8, P9, and P10); and RILSP incidence were calculated. Results: At 60 months of follow-up, four patients (8%) were found to have grade 2/3 RILSP. The mean maximal LSP dose in patients with RILSP was 59.6 Gy compared with 53.9 Gy in patients without RILSP (control; P=0.04). The mean values of V40, V50, V55, and V60 in patients with RILSP versus control were 61.8% versus 52.8%, 44.4% versus 27.7%, 8.0% versus 0.3% and 1.8% versus 0%, respectively (P=0.01, 0.001, 0.001, and 0.001, respectively). Conclusion: The delineation of the LSP during IMRT planning may reduce the risk for RILSP. The mean values of V40, V50, V55, and V60 for LSP should be less than 55%, 30%, 5%, and 0.5%, respectively; however, further studies are warranted.

Research paper thumbnail of Impact of body mass lndex on locoregional control in saudi patients with breast cancer after breast conserving surgery and modified radical mastectomy

Global Epidemic Obesity, 2014

ABSTRACT Abstract Background: Obesity and increased body mass index (BMI) are increasing among Sa... more ABSTRACT Abstract Background: Obesity and increased body mass index (BMI) are increasing among Saudi women across the all age groups, with an overall prevalence of 44%. Increased BMI is associated with advanced stage breast cancer and dismal survival; however impact of BMI on locoregional control (LRC) is less studied. We aimed to evaluate the impact of BMI on LRC in Saudi patients with breast cancer after breast conserving surgery (BCS) and modified radical mastectomy (MRM). Materials and methods: Between February 1988 and August 2008, 112 patients with breast cancer were treated with BCS and MRM followed by adjuvant chemotherapy and radiotherapy. Median age was 47.01 years (23-76). Mean BMI was 38.1 kg/m2 (15.7-52.8); BMI 18.5-25 kg/m2 (normal weight) in 20 (17.8%), BMI 26-30 kg/m2 (overweight) in 32 (28.6%), BMI 31-40 kg/m2 (obese) in 48 (42.9%) and BMI &gt; 40 kg/m2 (morbid obese) in 12 (10.7%). Median follow up period was 9 years (5-17). Cox proportional hazard analysis was done using SPSS 19.0. Results: Total ten locoregional recurrences (8.93%) were seen. The 5 and 10 years LRC were 86.4% and 86.4% respectively. Multivariate analysis showed poor LRC in BMI 26-30 kg/m2 (HR: 3.4; 95% CI.3.0-3.8, p 0.01). Others factors associated with poor LRC were; age less than 40 years, premenopausal status, and no adjuvant radiotherapy, and T4, N2 and N3 stages. Conclusion: Overweight and obese patients had better locoregional control in our study, however further larger trials are warranted. Keywords: Body mass index, breast cancer, breast conserving surgery, modified radical mastectomy

Research paper thumbnail of Locoregional recurrence of triple-negative breast cancer: effect of type of surgery and adjuvant postoperative radiotherapy

Breast Cancer: Targets and Therapy, 2014

Background/purpose: The aim was to evaluate the prognostic significance of postoperative radiothe... more Background/purpose: The aim was to evaluate the prognostic significance of postoperative radiotherapy (PORT) and surgical type on local recurrence-free survival (LRFS) and overall survival (OS) in triple-negative breast cancer (TNBC) in the Egyptian population. Patients and methods: We evaluated 111 patients with stage I-III TNBC diagnosed at our institute during the period from 2004 to 2009. Patients were stratified according to PORT into two groups: a PORT group and a non-PORT group. The influence of PORT and surgical type on LRFS and OS were evaluated. A cross-matching was done to the non-TNBC group of patients to compare the recurrence and survival rates between them and the studied group of TNBC patients. Results: The mean age of TNBC patients at diagnosis was 63±7 years. The majority of the patients had stage III disease (68.5%) and 73% had clinical or pathological positive lymph nodes. Sixty percent (67/111) of patients had modified radical mastectomy and 44/111 (40%) patients had breast-conserving treatment. PORT was given for 63% of patients, while systemic treatment was given in 89% of patients. At the time of analysis, 13 patients (11%) developed local recurrence: five of 70 (7%) in the PORT group and eight of 41 (19.5%) in the non-PORT group. Five-year LRFS for the whole group of patients was 88%±6%, which was significantly affected by PORT. The surgical type did not affect local recurrence significantly. Five-year OS for the whole group was 54%±8%. PORT and surgical type did not affect OS significantly (P-value 0.09 and 0.11, respectively). Five-year LRFS was 88%±6% and 90%±11% for TNBC and non-TNBC patients, respectively (P-value 0.8); however, OS for TNBC was significantly lower than for non-TNBC (P-value 0.04). Conclusion: TNBC is an aggressive entity compared with other non-TNBC, and these patients benefit from PORT significantly to decrease the risk of local recurrence in all stages. However, further large, prospective, randomized trials are warranted.

Research paper thumbnail of Involvement of Parathyroid Glands by Differentiated Thyroid Cancers and its Influence on Treatment Outcome

Journal of Thyroid Disorders & Therapy, 2014

Background: Parathyroid gland (PTG) involvement by differentiated thyroid cancer (DTC) patients i... more Background: Parathyroid gland (PTG) involvement by differentiated thyroid cancer (DTC) patients is rare and its influence on disease outcome has been less studied. We aimed to evaluate the frequency and patterns of PTG involvement in DTC patients and to evaluate the influence of PTG infiltration by DTC on treatment outcome in our cohort.

Research paper thumbnail of Is extended-field concurrent chemoradiation an option for radiologic negative paraaortic lymph node, locally advanced cervical cancer?

Cancer Management and Research, 2014

The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to resul... more The aim was to evaluate whether extended-field concurrent chemoradiation (EF-CCRT) leads to results better than those obtained by standard whole-pelvis concurrent chemoradiation (WP-CCRT) in locally advanced cervical cancer with radiologic negative paraaortic lymph nodes (PALNs). A total of 102 patients with histopathologically proven squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma, and radiologic negative PALN locally advanced cervical cancer, stage IIB-IVA, were accrued between July 2007 and April 2008 and were randomly assigned to WP-CCRT (50 patients) or EF-CCRT (52 patients), followed by high-dose rate brachytherapy. Data regarding the safety profile, response rates, and occurrence of local, PALN, or distant failure were recorded. During a median follow-up time of 60 months (18-66), 74/102 patients completed the treatment protocol and were analyzed. Overall PALN, distant-metastasis control, disease-free survival, and overall survival rates were 97.1%, 86.9%, 80.3%, and 72.4% in EF-CCRT respectively in comparison with WP-CCRT (82.1%,74.7%, 69.1%, and 60.4%), with P-values of 0.02, 0.03, 0.03 and 0.04 respectively. No difference in acute toxicity profile was seen between the groups, and late toxicities were mild and minimal. Prophylactic EF-CCRT can be a reasonable option in patients with locally advanced cervical cancer with radiologic positive pelvic lymph nodes and radiologic negative PALN.

Research paper thumbnail of Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases

Clinical Ophthalmology, 2014

Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differ... more Background: Radioactive iodine 131 ( 131 I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to 131 I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of 131 I therapy-acquired NLDO, its correlation to 131 I therapy doses, and the surgical treatment outcome of this rare side effect. Methods: From 2000-2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with 131 I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes. Results: Nineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39-72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual 131 I doses were 311.1±169.3 millicurie (mCi) (range: 150-600 mCi). The mean duration between the date of 131 I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5-20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age .45 years and 131 I therapy doses .150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively). Conclusion: NLDO is an underestimated complication of 131 I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention.

Research paper thumbnail of LINAC Stereotactic Radiosurgery for brain arteriovenous malformation: a single institutional experience from Saudi Arabia

Neuroscience Discovery, 2013

Background: Linear accelerator (LINAC) based radiosurgery for a brain arteriovenous malformation ... more Background: Linear accelerator (LINAC) based radiosurgery for a brain arteriovenous malformation (bAVM) is replacing gamma knife radiosurgery. We present clinical outcome, obliteration rates and predictor factors of treatment success following LINAC radiosurgery for bAVM which is not much addressed subject in Middle East. Methods: 13 patients who underwent LINAC radiosurgery for brain arteriovenous malformations from November 2008 to November 2011 in our radiation oncology department were retrospectively analyzed. Recollection of demographic data, AVM and treatment characteristics along with clinical and radiographic follow up information was done by reviewing the electronic data base. Results: All thirteen patients underwent stereotactic radiosurgery by linear accelerator based treatment delivery system (BrainLab) over three years. These included 7 males and 6 females, with median age of 22 years. Intracranial hemorrhage was a presenting feature in 7 (54 %) of patients. Prior embolization was done in 10 (77%) patients with 7 patients having more than once undergone this procedure. The location of AVM was superficial in 9 (70%) and deep in brain in 4 (30%) patients. The mean AVM score was 0.97 with 3 patients having AVM score ≥ 1 with mean Spetzler-Martin grade of 2.7 and 8 (62%) patients having grade 3 or more. Median follow up was 30 months. Mean dose delivered was 21.7 Gy in single fraction. Complete obliteration of AVM nidus was achieved in 9 (70%) patients while 4 patients (30%) had partial obliteration. Six patients (67 %) achieved complete obliteration among 9 who had AVM score of less than 1. Post radiosurgery neurological deficit occurred in only one patient in form of right temporal field loss. Conclusions: Linear accelerator based radiosurgery is promising treatment option for brain AVMs in majority of cases with reasonable adverse effect profile.