Dina Salem - Academia.edu (original) (raw)

Papers by Dina Salem

QJM: An International Journal of Medicine, 2021

Background Lung cancer represents the top cause of death and the most common cancer worldwide. In... more Background Lung cancer represents the top cause of death and the most common cancer worldwide. In the United States, lung cancer is the second most common cancer accounts for 12.9% of new cancer diagnoses and 27.4 of all cancer deaths. Non small cell lung cancer (NSCLC) represents up to 80% of all lung cancers which divided into two major types: squamous cell carcinoma (SCC) and nonsquamous cell carcinoma (NSCC, including adenocarcinoma, large-cell carcinoma, and other subtypes). Aim of the Work To assess the correlation between CEA (carcinoembryonic antigen) levels and response to platinum-based chemotherapy assessed by RECIST criteria of advanced non-small cell lung cancer patients. Patients and Methods This is a prospective study conducted between November 2018 and July 2019, 30 consecutive patients with advanced NSCLC previously treated with at least one line of chemotherapy were prospectively enrolled in thoracic malignancies department in Ain-Shams university hospital and Isma...

Ain Shams Medical Journal, 2020

Background: Follow-up care for cancer patients after definitive treatment, includes: routine foll... more Background: Follow-up care for cancer patients after definitive treatment, includes: routine follow up visits and surveillance imaging to detect recurrence, new primaries, and maintaining quality of life. Scans may cause emotional-distress, including anxiety and fear of recurrence, a condition called "scanxiety', which may lead to poor quality of life. Aim of work: To assess scanxiety and psychological distress associated with surveillance imaging at routine follow up visits among cancer patients, and different factors affecting its severity.

Ain Shams medical journal, 2020

Background: Bone metastasis in breast cancer patients can lead to the development of skeletal rel... more Background: Bone metastasis in breast cancer patients can lead to the development of skeletal related events such as pathologicalfractures, cord compression, bone marrow infiltration, hypercalcemiaof mal ignancy and the need of radiotherapy or surgery to bone. Eachof these complications may substantially reduce quality of life and, insome cases, may affect the overall survival survival. The use of bone targeted agents had led to decrease of the skeletal related events, however, prognostic and predictive markers are needed to identify patients who are at greater risk of bone disease progression and development of SRE despite using bone modifying agents.Aim of the Work: The aim of this study was assessment of the prognostic and predictive role of serum bone biomarker CTX in breast cancer patients with bone metastasis.Patients and methods: Sixty five consecutive patients who have received any type of systemic treatment (chemotherapy, hormonal therapy or targeted therapy) and zoledronic...

Quality of Life Research, 2021

Purpose The aim of this study was to explore what methods should be used to determine the minimal... more Purpose The aim of this study was to explore what methods should be used to determine the minimal important difference (MID) and minimal important change (MIC) in scores for the European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43. Methods In an international multi-centre study, patients with head and neck cancer completed the EORTC QLQ-HN43 before the onset of treatment (t1), three months after baseline (t2), and six months after baseline (t3). The methods explored for determining the MID were: (1) group comparisons based on performance status; (2) 0.5 and 0.3 standard deviation and standard error of the mean. The methods examined for the MIC were patients' subjective change ratings and receiver-operating characteristics (ROC) curves, predictive modelling, standard deviation, and standard error of the mean. The EORTC QLQ-HN43 Swallowing scale was used to investigate these methods. Results From 28 hospitals in 18 countries, 5...

Pathology and Oncology Research, 2021

Background: PD-L1 expression differs from 19 to 92% in various cancer subtypes. Its expression ca... more Background: PD-L1 expression differs from 19 to 92% in various cancer subtypes. Its expression carries a worse prognostic value in various malignancies and could also be used as a predictive marker for immune checkpoint inhibitor response. This study aimed to explore the prevalence of PD-L1 expression in soft tissue sarcomas and the correlation of PD-L1 expression with clinicopathological features. Patients and Methods: The tissue samples of 50 patients with STS were tested for PD-L1 expression using immunohistochemistry (IHC). We followed a 6-step proportional scoring system. The patients were treated at Ain Shams University Hospital from 2011 to 2017. We also explored the correlation of PD-L1 expression with different clinical features of the patients. The chi-square test was used to calculate the differences among variables. Results: Twelve cases (24%) showed positive PD-L1 expression with the highest prevalence in rhabdomyosarcoma and desmoid tumors (2/2 and 2/3 cases, respectiv...

QJM: An International Journal of Medicine, 2021

Background Breast cancer is the most common cancer among women which increases after the age of 3... more Background Breast cancer is the most common cancer among women which increases after the age of 35 till it reaches a peak at 55-64 years. Metformin is a synthetic oral biguanide that has been shown to cause a 30% reduction in the lifetime risk of all cancers in diabetic patients on Metformin. We aimed at evaluating this antineoplastic effect in terms of pathological response, concurrent with standard neoadjuvant chemotherapy in breast cancer. Methodology 60 non-diabetic breast cancer patients receiving standard neoadjuvant chemotherapy at the breast cancer outpatient clinic, Ain Shams University hospital, were randomized into two arms (30 in each arm); Arm A Group receiving Metformin (850 mg bid) with standard line of neoadjuvant chemotherapy (FEC/Taxotere +/- Herceptin). Arm B Control group receiving the standard line of neoadjuvant chemotherapy alone. Results There’s a significant difference between Metformin and control arm in terms of response (complete and partial) versus no re...

Research in Oncology, Dec 31, 2017

Journal of Solid Tumors, 2019

Background: Aromatase inhibitors (AIs) represent an effective endocrine treatment for hormone rec... more Background: Aromatase inhibitors (AIs) represent an effective endocrine treatment for hormone receptor-positive postmenopausal breast cancer patients with early stage or metastatic disease.Objective: Assessment of Cardiotoxicity in Hormone positive Postmenopausal Breast Cancer Patients receiving AIs (upfront orswitch therapy).Methods: This cross sectional study included 123 postmenopausal breast cancer patients presented to the Clinical Oncology Department, Ain Shams University (Cairo, Egypt) in the interval from August 2016 to June 2017 with hormone receptor positive receiving Aromatase Inhibitors, To assess cardiotoxicity in these patients, they were subjected to blood pressure and lipid profile measurement, electrocardiography (ECG), and electrocardiography (ECHO) and classified into patients had Nolvadex then A.I (arm 1) and others had upfront A.I (arm 2).Results: The age of patients ranged from 41 years to 85 years with mean age of 61 years. Seventy one patients (57.7%) showed ...

QJM: An International Journal of Medicine, 2018

Journal of photochemistry and photobiology. B, Biology, 2018

A green method was used for producing gold nanoparticles (Au NPs) using chitosan as a natural cat... more A green method was used for producing gold nanoparticles (Au NPs) using chitosan as a natural cationic, biodegradable and biocompatible polymer. In this method, chitosan acts as a reducing and stabilizing agent for the synthesis of Au NPs. Different concentrations of chitosan solutions (0.01%, 0.05%, 0.1%, 0.2%, 0.5% and 1%) were applied. In an attempt to mitigate the side effects of anti-cancer drug, 5-fluorouracil (5-FU), through reducing drug doses in photothermal therapy, the formed positively-charged chitosan-wrapped Au NPs were used as a drug delivery system for negatively charged 5-FU to hepatocellular carcinoma cells (HepG2). Au NPs as well as 5-FU@Au nanocomposites were characterized with UV-VIS spectroscopy, particle size, zeta potential, Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM) and High-Performance Liquid Chromatography (HPLC). The chitosan concentration was shown to be an important parameter for optimizing the dispersion of A...

Research in Oncology, 2016

Aim: To assess the efficacy of reirradiation in locoregionally recurrent head and neck cancer (HN... more Aim: To assess the efficacy of reirradiation in locoregionally recurrent head and neck cancer (HNC) and to describe results in our center in relation to other published data among similar group of patients. Methods: The medical records of 28 patients with HNC who received reirradiation with or without chemotherapy for loco-regional recurrence between 2005 and 2013 were reviewed. They were evaluated for; toxicity profile, overall survival (OS) and progression free survival (PFS). Results: The median reirradiation dose was 50 Gy (range 40-60 Gy) and median radiation cumulative dose was 119 (range 113-120). An overall response rate was seen in 36% of patients with only 3 patients showed complete response. The median OS was 9 months with 1-and 2-year survival rates being 34.1% and 10.6%. The OS and PFS were significantly better in patients who were treated with chemotherapy concomitant with radiation and received higher radiation dose. Grade 3 mucositis and skin reactions were seen in 24 % and 14% of patients, respectively. Conclusion: Reirradiation appears to be feasible in patients with recurrent HNC treated previously with radiation. The benefit of concurrent chemotherapy with reirradiation is expected. Our results are subject to limitations from the retrospective nature of the analysis, the relatively small number, and improper selection of patients.

Endocrine-related cancer, Apr 21, 2017

We pilot-tested a questionnaire measuring health related quality of life (QoL) in thyroid cancer ... more We pilot-tested a questionnaire measuring health related quality of life (QoL) in thyroid cancer patients to be used with the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire EORTC QLQ-C30. A provisional questionnaire with 47 items was administered to patients treated for thyroid cancer within the last 2 years. Patients were interviewed about time and help needed to complete the questionnaire and whether they found the items understandable, confusing, or annoying. Items were kept in the questionnaire if they fulfilled pre-defined criteria: relevant to the patients, easy to understand, not confusing, few missing values, neither floor nor ceiling effects, and high variance. A total of 182 thyroid cancer patients in 15 countries participated (n=115 with papillary, n=31 with follicular, n=22 with medullary, n=6 with anaplastic, and n=8 with other types of thyroid cancer). Sixty-six percent of the patients needed 15 minutes or less to complete the que...

The Lancet. Oncology, Jan 27, 2015

Patient-reported outcomes (PROs) might detect more toxic effects of radiotherapy than do clinicia... more Patient-reported outcomes (PROs) might detect more toxic effects of radiotherapy than do clinician-reported outcomes. We did a quality of life (QoL) substudy to assess PROs up to 24 months after conventionally fractionated or hypofractionated radiotherapy in the Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer (CHHiP) trial. The CHHiP trial is a randomised, non-inferiority phase 3 trial done in 71 centres, of which 57 UK hospitals took part in the QoL substudy. Men with localised prostate cancer who were undergoing radiotherapy were eligible for trial entry if they had histologically confirmed T1b-T3aN0M0 prostate cancer, an estimated risk of seminal vesicle involvement less than 30%, prostate-specific antigen concentration less than 30 ng/mL, and a WHO performance status of 0 or 1. Participants were randomly assigned (1:1:1) to receive a standard fractionation schedule of 74 Gy in 37 fractions or one of two hypofractionated schedules: 6...

Journal of Cancer Therapy, 2015

Background: The relatively suboptimal results of whole brain radiation therapy (WBRT) alone in er... more Background: The relatively suboptimal results of whole brain radiation therapy (WBRT) alone in eradication of brain metastases and an attempt to improve outcomes with WBRT have led to studies combining radiotherapy with chemotherapy drugs that could act as radiosensitizers with a rationale of improving local tumor control. Materials and Methods: This randomized phase II study evaluated the use of Irinotecan concomitant with 37.5 Gray (Gy) of WBRT in 2.5 Gy daily fractions × 5 days each week for 3 weeks versus Whole WBRT alone in patients with brain metastasis (BM) from solid tumors. Fifty patients were randomized to receive either WBRT alone or concomitant with three irinotecan IV infusions 80 mg/m 2 , 2 hrs before RT on days 1, 8, and 15. Results: The objective response rate (ORR) was significantly improved in patients receiving Irinotecan with radiotherapy versus radiotherapy alone (48% vs. 28%; p = 0.048). The median time to progression of brain metastasis was significantly longer in the irinotecan and WBRT arm as compared to the WBRT arm (8 vs. 5 months; p < 0.001). There was no significant difference in survival between treatment arms (p = 0.361). Irinotecan with radiotherapy was generally well tolerated and did not interfere with the delivery of WBRT. Conclusions: Irinotecan concomitant with WBRT was well tolerated and significantly improved local control of BM compared with WBRT alone. These findings require confirmation in a phase III trial with addition of quality of life assessment.

The Egyptian Journal of Radiology and Nuclear Medicine, 2015

Background and purpose: Pharyngeal squamous cell carcinoma is a unique disease, and early initial... more Background and purpose: Pharyngeal squamous cell carcinoma is a unique disease, and early initial diagnosis and follow-up after treatment are areas in which DWI may be very helpful. The purpose of our study was to evaluate the role of diffusion weighted MRI in initial diagnosis and post treatment follow-up of pharyngeal carcinoma. Material and methods: 25 patients with 58 lesions were included in this study, and patients were classified into two groups according to their clinical situation: pretreatment group coming for initial diagnosis or pretreatment staging and post treatment group coming for follow-up. All patients were submitted to MRI including DWI with measurement of ADC value and correlation with histopathological data. Results: In pretreatment group which includes 10 patients with 30 lesions DWI shows sensitivity of 89% compared to 71% and 82% for conventional and contrast enhanced (CE) MRI respectively. In post treatment group DWI shows PPV of 95% as compared to 81% and 87% for conventional and CE MRI respectively. Conclusion: Diffusion weighted imaging shows high sensitivity in terms of detection, staging and follow-up of pharyngeal carcinoma.

Journal of Cancer Therapy, 2015

Journal of the Egyptian National Cancer Institute, 2008

To evaluate the efficacy and tolerability of metronomic chemotherapy (which is the continuous adm... more To evaluate the efficacy and tolerability of metronomic chemotherapy (which is the continuous administration of chemotherapy at relatively low minimally toxic doses on a frequent schedule of administration at close regular intervals with no prolonged drug-free breaks) in metastatic breast cancer patients as salvage therapy. In this phase II study we evaluated the clinical efficacy and tolerability of low dose, oral Methotrexate (MTX) and Cyclophosphamide (CTX) in patients with metastatic breast cancer. Between January 2004 and December 2005, 42 patients received MTX 2.5mg bid on day 1 and 2 each week and CTX 50mg/day administered continuously. Forty two patients were evaluable. The overall clinical benefit was 31% complete response, partial response and stable disease (CR+PR+SD >or=24 weeks), while the overall response rate was 16.7% (none of the patients attained CR). Toxicity was generally mild. The most common non hematological toxicity was elevation in transaminases level, it...

Journal of the Egyptian National Cancer Institute, 2007

To evaluate the efficacy, safety, and clinical benefit of combined gemcitabine and carboplatin in... more To evaluate the efficacy, safety, and clinical benefit of combined gemcitabine and carboplatin in patients with previously untreated malignant pleural mesothelioma (MPM). This prospective phase II study was performed on 42 eligible patients with histologically or cytologically proven MPM presenting to Ain Shams University hospitals and Sohag Cancer Center between January 2002 and April 2006. They were assigned to receive combined gemcitabine (1250mg/m2) on days, 1 and 8 and carboplatin (AUC 6) on day 1. The regimen was repeated every 21 days. The treatment continued until disease progression or intolerable drug toxicity. The patients received a total of 227 cycles of chemotherapy (median 5.4 cycles and range from 2 to 9 cycles). The chemotherapy was generally well tolerated. Neutropenia, thrombocytopenia and anemia were the most severe (Grade 3 or 4) toxicities recorded during therapy and were reported in (14%), (9.5%), and (9.5%), respectively. Twelve patients (29%) achieved partia...

Journal of Cancer Therapy, 2015

Background: Comparing the efficacy and safety of gemcitabine at a fixed-dose rate (FDR) infusion ... more Background: Comparing the efficacy and safety of gemcitabine at a fixed-dose rate (FDR) infusion (10 mg/m 2 /min) with the standard dose rate infusion in patients with locally advanced and metastatic non-small squamous cell carcinoma (NSCLC). Methods: The study randomized 60 patients with confirmed diagnosis of NSCLC to receive gemcitabine at a dose of 1000 mg/m 2 on days 1 and 8 given as a 30-min infusion (Arm A) or at a rate of 10 mg/m 2 /min (Arm B). Cisplatin 75 mg/m 2 was administered intravenously on day 2 in both arms. Results: No difference in overall response rate (46.6% versus 43.3%). Median time to progression for Arm A was 7 months (95% CI, 6.207-7.793 months), versus 6 months for Arm B (95% CI, 4.990-7.010 months). Median survival time was comparable [12 months (95% CI, 8.588-15.412 months) versus 11 months (95% CI, 9.066-12.934 months)] respectively. Two-year survival (18% versus 11%, p = 0.38) was detected. No treatment related deaths occurred. Main hematological toxicities were grade I and II neutropenia, in 36.7% and 53.3% respectively (p = 0.044). Grade III anemia was observed in 10% and 6.7% in both arms respectively (p = 0.024). Grade I and II nausea and vomiting was observed in 50% and 46.7%. Conclusions: FDR gemcitabine in combination with cisplatin had equivalent efficacy and more severe hematologic toxicities compared to the standard 30-min gemcitabine infusion with cisplatin in patients with advanced NSCLC.

QJM: An International Journal of Medicine, 2021

Background Lung cancer represents the top cause of death and the most common cancer worldwide. In... more Background Lung cancer represents the top cause of death and the most common cancer worldwide. In the United States, lung cancer is the second most common cancer accounts for 12.9% of new cancer diagnoses and 27.4 of all cancer deaths. Non small cell lung cancer (NSCLC) represents up to 80% of all lung cancers which divided into two major types: squamous cell carcinoma (SCC) and nonsquamous cell carcinoma (NSCC, including adenocarcinoma, large-cell carcinoma, and other subtypes). Aim of the Work To assess the correlation between CEA (carcinoembryonic antigen) levels and response to platinum-based chemotherapy assessed by RECIST criteria of advanced non-small cell lung cancer patients. Patients and Methods This is a prospective study conducted between November 2018 and July 2019, 30 consecutive patients with advanced NSCLC previously treated with at least one line of chemotherapy were prospectively enrolled in thoracic malignancies department in Ain-Shams university hospital and Isma...

Ain Shams Medical Journal, 2020

Background: Follow-up care for cancer patients after definitive treatment, includes: routine foll... more Background: Follow-up care for cancer patients after definitive treatment, includes: routine follow up visits and surveillance imaging to detect recurrence, new primaries, and maintaining quality of life. Scans may cause emotional-distress, including anxiety and fear of recurrence, a condition called "scanxiety', which may lead to poor quality of life. Aim of work: To assess scanxiety and psychological distress associated with surveillance imaging at routine follow up visits among cancer patients, and different factors affecting its severity.

Ain Shams medical journal, 2020

Background: Bone metastasis in breast cancer patients can lead to the development of skeletal rel... more Background: Bone metastasis in breast cancer patients can lead to the development of skeletal related events such as pathologicalfractures, cord compression, bone marrow infiltration, hypercalcemiaof mal ignancy and the need of radiotherapy or surgery to bone. Eachof these complications may substantially reduce quality of life and, insome cases, may affect the overall survival survival. The use of bone targeted agents had led to decrease of the skeletal related events, however, prognostic and predictive markers are needed to identify patients who are at greater risk of bone disease progression and development of SRE despite using bone modifying agents.Aim of the Work: The aim of this study was assessment of the prognostic and predictive role of serum bone biomarker CTX in breast cancer patients with bone metastasis.Patients and methods: Sixty five consecutive patients who have received any type of systemic treatment (chemotherapy, hormonal therapy or targeted therapy) and zoledronic...

Quality of Life Research, 2021

Purpose The aim of this study was to explore what methods should be used to determine the minimal... more Purpose The aim of this study was to explore what methods should be used to determine the minimal important difference (MID) and minimal important change (MIC) in scores for the European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43. Methods In an international multi-centre study, patients with head and neck cancer completed the EORTC QLQ-HN43 before the onset of treatment (t1), three months after baseline (t2), and six months after baseline (t3). The methods explored for determining the MID were: (1) group comparisons based on performance status; (2) 0.5 and 0.3 standard deviation and standard error of the mean. The methods examined for the MIC were patients' subjective change ratings and receiver-operating characteristics (ROC) curves, predictive modelling, standard deviation, and standard error of the mean. The EORTC QLQ-HN43 Swallowing scale was used to investigate these methods. Results From 28 hospitals in 18 countries, 5...

Pathology and Oncology Research, 2021

Background: PD-L1 expression differs from 19 to 92% in various cancer subtypes. Its expression ca... more Background: PD-L1 expression differs from 19 to 92% in various cancer subtypes. Its expression carries a worse prognostic value in various malignancies and could also be used as a predictive marker for immune checkpoint inhibitor response. This study aimed to explore the prevalence of PD-L1 expression in soft tissue sarcomas and the correlation of PD-L1 expression with clinicopathological features. Patients and Methods: The tissue samples of 50 patients with STS were tested for PD-L1 expression using immunohistochemistry (IHC). We followed a 6-step proportional scoring system. The patients were treated at Ain Shams University Hospital from 2011 to 2017. We also explored the correlation of PD-L1 expression with different clinical features of the patients. The chi-square test was used to calculate the differences among variables. Results: Twelve cases (24%) showed positive PD-L1 expression with the highest prevalence in rhabdomyosarcoma and desmoid tumors (2/2 and 2/3 cases, respectiv...

QJM: An International Journal of Medicine, 2021

Background Breast cancer is the most common cancer among women which increases after the age of 3... more Background Breast cancer is the most common cancer among women which increases after the age of 35 till it reaches a peak at 55-64 years. Metformin is a synthetic oral biguanide that has been shown to cause a 30% reduction in the lifetime risk of all cancers in diabetic patients on Metformin. We aimed at evaluating this antineoplastic effect in terms of pathological response, concurrent with standard neoadjuvant chemotherapy in breast cancer. Methodology 60 non-diabetic breast cancer patients receiving standard neoadjuvant chemotherapy at the breast cancer outpatient clinic, Ain Shams University hospital, were randomized into two arms (30 in each arm); Arm A Group receiving Metformin (850 mg bid) with standard line of neoadjuvant chemotherapy (FEC/Taxotere +/- Herceptin). Arm B Control group receiving the standard line of neoadjuvant chemotherapy alone. Results There’s a significant difference between Metformin and control arm in terms of response (complete and partial) versus no re...

Research in Oncology, Dec 31, 2017

Journal of Solid Tumors, 2019

Background: Aromatase inhibitors (AIs) represent an effective endocrine treatment for hormone rec... more Background: Aromatase inhibitors (AIs) represent an effective endocrine treatment for hormone receptor-positive postmenopausal breast cancer patients with early stage or metastatic disease.Objective: Assessment of Cardiotoxicity in Hormone positive Postmenopausal Breast Cancer Patients receiving AIs (upfront orswitch therapy).Methods: This cross sectional study included 123 postmenopausal breast cancer patients presented to the Clinical Oncology Department, Ain Shams University (Cairo, Egypt) in the interval from August 2016 to June 2017 with hormone receptor positive receiving Aromatase Inhibitors, To assess cardiotoxicity in these patients, they were subjected to blood pressure and lipid profile measurement, electrocardiography (ECG), and electrocardiography (ECHO) and classified into patients had Nolvadex then A.I (arm 1) and others had upfront A.I (arm 2).Results: The age of patients ranged from 41 years to 85 years with mean age of 61 years. Seventy one patients (57.7%) showed ...

QJM: An International Journal of Medicine, 2018

Journal of photochemistry and photobiology. B, Biology, 2018

A green method was used for producing gold nanoparticles (Au NPs) using chitosan as a natural cat... more A green method was used for producing gold nanoparticles (Au NPs) using chitosan as a natural cationic, biodegradable and biocompatible polymer. In this method, chitosan acts as a reducing and stabilizing agent for the synthesis of Au NPs. Different concentrations of chitosan solutions (0.01%, 0.05%, 0.1%, 0.2%, 0.5% and 1%) were applied. In an attempt to mitigate the side effects of anti-cancer drug, 5-fluorouracil (5-FU), through reducing drug doses in photothermal therapy, the formed positively-charged chitosan-wrapped Au NPs were used as a drug delivery system for negatively charged 5-FU to hepatocellular carcinoma cells (HepG2). Au NPs as well as 5-FU@Au nanocomposites were characterized with UV-VIS spectroscopy, particle size, zeta potential, Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM) and High-Performance Liquid Chromatography (HPLC). The chitosan concentration was shown to be an important parameter for optimizing the dispersion of A...

Research in Oncology, 2016

Aim: To assess the efficacy of reirradiation in locoregionally recurrent head and neck cancer (HN... more Aim: To assess the efficacy of reirradiation in locoregionally recurrent head and neck cancer (HNC) and to describe results in our center in relation to other published data among similar group of patients. Methods: The medical records of 28 patients with HNC who received reirradiation with or without chemotherapy for loco-regional recurrence between 2005 and 2013 were reviewed. They were evaluated for; toxicity profile, overall survival (OS) and progression free survival (PFS). Results: The median reirradiation dose was 50 Gy (range 40-60 Gy) and median radiation cumulative dose was 119 (range 113-120). An overall response rate was seen in 36% of patients with only 3 patients showed complete response. The median OS was 9 months with 1-and 2-year survival rates being 34.1% and 10.6%. The OS and PFS were significantly better in patients who were treated with chemotherapy concomitant with radiation and received higher radiation dose. Grade 3 mucositis and skin reactions were seen in 24 % and 14% of patients, respectively. Conclusion: Reirradiation appears to be feasible in patients with recurrent HNC treated previously with radiation. The benefit of concurrent chemotherapy with reirradiation is expected. Our results are subject to limitations from the retrospective nature of the analysis, the relatively small number, and improper selection of patients.

Endocrine-related cancer, Apr 21, 2017

We pilot-tested a questionnaire measuring health related quality of life (QoL) in thyroid cancer ... more We pilot-tested a questionnaire measuring health related quality of life (QoL) in thyroid cancer patients to be used with the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire EORTC QLQ-C30. A provisional questionnaire with 47 items was administered to patients treated for thyroid cancer within the last 2 years. Patients were interviewed about time and help needed to complete the questionnaire and whether they found the items understandable, confusing, or annoying. Items were kept in the questionnaire if they fulfilled pre-defined criteria: relevant to the patients, easy to understand, not confusing, few missing values, neither floor nor ceiling effects, and high variance. A total of 182 thyroid cancer patients in 15 countries participated (n=115 with papillary, n=31 with follicular, n=22 with medullary, n=6 with anaplastic, and n=8 with other types of thyroid cancer). Sixty-six percent of the patients needed 15 minutes or less to complete the que...

The Lancet. Oncology, Jan 27, 2015

Patient-reported outcomes (PROs) might detect more toxic effects of radiotherapy than do clinicia... more Patient-reported outcomes (PROs) might detect more toxic effects of radiotherapy than do clinician-reported outcomes. We did a quality of life (QoL) substudy to assess PROs up to 24 months after conventionally fractionated or hypofractionated radiotherapy in the Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer (CHHiP) trial. The CHHiP trial is a randomised, non-inferiority phase 3 trial done in 71 centres, of which 57 UK hospitals took part in the QoL substudy. Men with localised prostate cancer who were undergoing radiotherapy were eligible for trial entry if they had histologically confirmed T1b-T3aN0M0 prostate cancer, an estimated risk of seminal vesicle involvement less than 30%, prostate-specific antigen concentration less than 30 ng/mL, and a WHO performance status of 0 or 1. Participants were randomly assigned (1:1:1) to receive a standard fractionation schedule of 74 Gy in 37 fractions or one of two hypofractionated schedules: 6...

Journal of Cancer Therapy, 2015

Background: The relatively suboptimal results of whole brain radiation therapy (WBRT) alone in er... more Background: The relatively suboptimal results of whole brain radiation therapy (WBRT) alone in eradication of brain metastases and an attempt to improve outcomes with WBRT have led to studies combining radiotherapy with chemotherapy drugs that could act as radiosensitizers with a rationale of improving local tumor control. Materials and Methods: This randomized phase II study evaluated the use of Irinotecan concomitant with 37.5 Gray (Gy) of WBRT in 2.5 Gy daily fractions × 5 days each week for 3 weeks versus Whole WBRT alone in patients with brain metastasis (BM) from solid tumors. Fifty patients were randomized to receive either WBRT alone or concomitant with three irinotecan IV infusions 80 mg/m 2 , 2 hrs before RT on days 1, 8, and 15. Results: The objective response rate (ORR) was significantly improved in patients receiving Irinotecan with radiotherapy versus radiotherapy alone (48% vs. 28%; p = 0.048). The median time to progression of brain metastasis was significantly longer in the irinotecan and WBRT arm as compared to the WBRT arm (8 vs. 5 months; p < 0.001). There was no significant difference in survival between treatment arms (p = 0.361). Irinotecan with radiotherapy was generally well tolerated and did not interfere with the delivery of WBRT. Conclusions: Irinotecan concomitant with WBRT was well tolerated and significantly improved local control of BM compared with WBRT alone. These findings require confirmation in a phase III trial with addition of quality of life assessment.

The Egyptian Journal of Radiology and Nuclear Medicine, 2015

Background and purpose: Pharyngeal squamous cell carcinoma is a unique disease, and early initial... more Background and purpose: Pharyngeal squamous cell carcinoma is a unique disease, and early initial diagnosis and follow-up after treatment are areas in which DWI may be very helpful. The purpose of our study was to evaluate the role of diffusion weighted MRI in initial diagnosis and post treatment follow-up of pharyngeal carcinoma. Material and methods: 25 patients with 58 lesions were included in this study, and patients were classified into two groups according to their clinical situation: pretreatment group coming for initial diagnosis or pretreatment staging and post treatment group coming for follow-up. All patients were submitted to MRI including DWI with measurement of ADC value and correlation with histopathological data. Results: In pretreatment group which includes 10 patients with 30 lesions DWI shows sensitivity of 89% compared to 71% and 82% for conventional and contrast enhanced (CE) MRI respectively. In post treatment group DWI shows PPV of 95% as compared to 81% and 87% for conventional and CE MRI respectively. Conclusion: Diffusion weighted imaging shows high sensitivity in terms of detection, staging and follow-up of pharyngeal carcinoma.

Journal of Cancer Therapy, 2015

Journal of the Egyptian National Cancer Institute, 2008

To evaluate the efficacy and tolerability of metronomic chemotherapy (which is the continuous adm... more To evaluate the efficacy and tolerability of metronomic chemotherapy (which is the continuous administration of chemotherapy at relatively low minimally toxic doses on a frequent schedule of administration at close regular intervals with no prolonged drug-free breaks) in metastatic breast cancer patients as salvage therapy. In this phase II study we evaluated the clinical efficacy and tolerability of low dose, oral Methotrexate (MTX) and Cyclophosphamide (CTX) in patients with metastatic breast cancer. Between January 2004 and December 2005, 42 patients received MTX 2.5mg bid on day 1 and 2 each week and CTX 50mg/day administered continuously. Forty two patients were evaluable. The overall clinical benefit was 31% complete response, partial response and stable disease (CR+PR+SD >or=24 weeks), while the overall response rate was 16.7% (none of the patients attained CR). Toxicity was generally mild. The most common non hematological toxicity was elevation in transaminases level, it...

Journal of the Egyptian National Cancer Institute, 2007

To evaluate the efficacy, safety, and clinical benefit of combined gemcitabine and carboplatin in... more To evaluate the efficacy, safety, and clinical benefit of combined gemcitabine and carboplatin in patients with previously untreated malignant pleural mesothelioma (MPM). This prospective phase II study was performed on 42 eligible patients with histologically or cytologically proven MPM presenting to Ain Shams University hospitals and Sohag Cancer Center between January 2002 and April 2006. They were assigned to receive combined gemcitabine (1250mg/m2) on days, 1 and 8 and carboplatin (AUC 6) on day 1. The regimen was repeated every 21 days. The treatment continued until disease progression or intolerable drug toxicity. The patients received a total of 227 cycles of chemotherapy (median 5.4 cycles and range from 2 to 9 cycles). The chemotherapy was generally well tolerated. Neutropenia, thrombocytopenia and anemia were the most severe (Grade 3 or 4) toxicities recorded during therapy and were reported in (14%), (9.5%), and (9.5%), respectively. Twelve patients (29%) achieved partia...

Journal of Cancer Therapy, 2015

Background: Comparing the efficacy and safety of gemcitabine at a fixed-dose rate (FDR) infusion ... more Background: Comparing the efficacy and safety of gemcitabine at a fixed-dose rate (FDR) infusion (10 mg/m 2 /min) with the standard dose rate infusion in patients with locally advanced and metastatic non-small squamous cell carcinoma (NSCLC). Methods: The study randomized 60 patients with confirmed diagnosis of NSCLC to receive gemcitabine at a dose of 1000 mg/m 2 on days 1 and 8 given as a 30-min infusion (Arm A) or at a rate of 10 mg/m 2 /min (Arm B). Cisplatin 75 mg/m 2 was administered intravenously on day 2 in both arms. Results: No difference in overall response rate (46.6% versus 43.3%). Median time to progression for Arm A was 7 months (95% CI, 6.207-7.793 months), versus 6 months for Arm B (95% CI, 4.990-7.010 months). Median survival time was comparable [12 months (95% CI, 8.588-15.412 months) versus 11 months (95% CI, 9.066-12.934 months)] respectively. Two-year survival (18% versus 11%, p = 0.38) was detected. No treatment related deaths occurred. Main hematological toxicities were grade I and II neutropenia, in 36.7% and 53.3% respectively (p = 0.044). Grade III anemia was observed in 10% and 6.7% in both arms respectively (p = 0.024). Grade I and II nausea and vomiting was observed in 50% and 46.7%. Conclusions: FDR gemcitabine in combination with cisplatin had equivalent efficacy and more severe hematologic toxicities compared to the standard 30-min gemcitabine infusion with cisplatin in patients with advanced NSCLC.