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Papers by Wael El Sheshtawy

Egyptian Journal of Bronchology

Primary pulmonary extraskeletal Ewing sarcoma (EES)/ primitive neuroectodermal tumor is an extrem... more Primary pulmonary extraskeletal Ewing sarcoma (EES)/ primitive neuroectodermal tumor is an extremely rare tumor with only few cases reported in the literature. In this study, we present two cases of primary pulmonary EES diagnosed and treated at our institution. The median age was 20 years (range: 19-21). Cough, dyspnea, and hemoptysis were the predominant features at presentation, associated with a large lung mass on imaging. Image-guided core needle biopsies were the diagnostic modalities for both patients. Initial histopathology showed malignant small round cell tumor, which has been confirmed by immunohistochemistry as EES. Both patients received neoadjuvant chemotherapy followed by surgery; postoperative pathology for the first patient showed 98% tumor necrosis, whereas the second patient's pathology showed no evidence of residual tumor after complete surgical excision.

Background: High-grade gliomas (HGG) represent the commonest primary adult brain tumors. Radiothe... more Background: High-grade gliomas (HGG) represent the commonest primary adult brain tumors. Radiotherapy plays an important role in the management of this disease. Objectives: To assess the patterns of failure, treatment-related toxicities, progression-free survival (PFS), and overall survival (OS), following limited-margins. Patients and Methods: In this prospective phase II study, patients with HGG have been treated with IMRT using the ESTRO-ACROP contouring guidelines that not include the peritumoral edema in the gross target volume (GTV) with adding 2cm margin around the GTV to create the clinical target volume (CTV), in one phase, after maximum safe resection of the tumor or stereotactic biopsy. Results: The trial included 40 patients with a median age of 49 years, 16 patients (40%) were in complete remission, 13 patients (12.5%) had partial regression, and stable disease occurred in 11 patients (27.5%). The progression/failure occurred in 28 patients (70%). Failures were located ...

Al-Azhar International Medical Journal

Background:The most important event of RT (Radiation Therapy)is to dependably expand the position... more Background:The most important event of RT (Radiation Therapy)is to dependably expand the positions to the target volume while limiting the side effects to the normal tissues. Thusly, day by day treatment arrangement is considered as a basic necessity in RT (Radiation Therapy) for an exact positions and setup accuracy for treatmentbut still the Setup errors are the inevitable features of the radiation therapy RT (Radiation Therapy) process. Aim of work:To evaluate three dimensional setup errors and propose optimum margins for target volume coverage inthe pelvic radiation therapy. Patient and Methods: This study aiming to evaluate setup uncertainty related to pelvic cancer radiotherapy in the Clinical Oncology and Nuclear Medicine Department, at Al Hussein hospital, Al-Azhar University and to estimate how large planning target volume margins are needed in the Pelvic cancer cases. Results: the mean variation for action level for plan is 3.3 mm (1) SD (Standard Deviation) for pelvic cancer cases. The greatness of precise and irregular mistakes for pelvic cancer cases in our investigation are comparable or not exactly different examinations. To contrast the outcomes and other distributed investigation, we have considered PTV (90, 95,) margin. In our investigation, the determined CTV-PTVClinical Target Volume-Planning Target Volume) edge for pelvic cancer patient in the vertical, longitudinal and Lateral Variations from iso-center position were 4.12 mm, 4.62 mm and 3.23 mm, individually. Conclusion: The consequences of this examination are distinctive to the discoveries of current work. In the present work, we have changed the isocenter in the fourth portion, which brought about decrease of the efficient mistakes. Another distinction can be ascribed to the recurrence of online confirmation.

Al-Azhar International Medical Journal

Background: major progress in the management of non-small cell lung cancer emerged in the last ye... more Background: major progress in the management of non-small cell lung cancer emerged in the last years. Survival rate markedly improved in locally advanced non-small cell lung cancer with the use of concurrent chemo-radiotherapy treatment. Novel radiation techniques decreased the incidence of toxicity from radiotherapy. Aim of the work: Assess toxicity, local control, progression-free and overall survival resulting from usage of concurrent chemo-radiotherapy treatment in locally advanced non-small cell lung cancer using intensitymodulated radiotherapy technique. Patient and methods: this study included patients with stage III nonsmall cell lung cancer, received concurrent chemo-radiotherapy using intensity-modulated radiotherapy technique. Results: out of 32 patients included 17 (53.13%) were presented in stage IIIA and 15 (46.87%) in stage IIIB. The commonest histo-pathological type was non-squamous cell carcinoma, it was detected in 21 patients (65.62%), and squamous cell carcinoma which was detected in 11 patients (34.37%). Partial response was achieved in 18 (56.25%) patients, 10 (31.25%) patients had stable disease and 4 (12.5%) patients had progressive disease. Median overall survival was 10.2 months, while median progression-free survival was 6.5 months, no patients developed ≥ grade III esophagitis or pneumonitis. Conclusion: Concurrent chemo-radiotherapy treatment with Paclitaxel-Carboplatin, and intensity-modulated radiotherapy technique is a welltolerated treatment regimen with acceptable toxicity profile and fair survival in patients with un-resectable Stage IIIA-IIIB non-small cell lung cancer.

Al-Azhar International Medical Journal

Background: breast cancer is the most prevalent cancer diagnosed in females worldwide. Radiothera... more Background: breast cancer is the most prevalent cancer diagnosed in females worldwide. Radiotherapy improves survival in breast cancer patients. Consistent evidence emerges as regard the benefit of inclusion of IMN (internal mammary lymph nodes). Novel radiation techniques decreased the incidence of toxicity from radiotherapy. Aim of the work: Assessment of acute and moderately late radiation toxicity, assessing doses to normal structures, assessing overall survival and progression-free survival. Patients and Methods: this study included 41 patient received postoperative radiotherapy including internal mammary lymph nodes with Intensity-modulated radiation therapy in Al-Hussein University hospital Results: coverage of the right-sided planning target volume and internal mammary lymph nodes was significantly higher than leftsided cases p = 0.01, 95%, p = 0.02, respectively. there was a strong, positive correlation between the volume of heart receiving 25 Gy and the volume of planning target volume receiving 95 % of the prescribed dose, p = 0.001. Significant difference skin toxicity as regard maximum dose reaching the planning target volume either ≤ 107%, 108-109%, and those ≥110, P = 0.001. Conclusion: The inclusion of the internal mammary lymph nodes in postoperative radiotherapy in breast cancer patients is well tolerable. The use of Intensity-modulated radiation therapy decreases dose to normal structures which reduce toxicity

Al-Azhar International Medical Journal

Background: worldwide, prostate cancer is the second most common cancer and the fifth leading cau... more Background: worldwide, prostate cancer is the second most common cancer and the fifth leading cause of death from cancer in men. Objective: is to study the impact of hormonal treatment in patients with metastatic prostatic carcinoma.…………………………………………. Subject and Methods: This retrospective study included all patients diagnosed with metastatic prostate cancer, treated at our center between the year 2007 and 2016, data of patients included was reviewed from the charts and analyzed for outcome.………………………………………... Results: the study included 39 patients, 21 patients (52.6 %) had subjected to primary bilateral orchiectomy as first line management while (18) patients (47.4%) received ADT. Median PFS for 1st line hormonal treatment was18.4 months and Median OS were 25.5 months. Patients with good performance (PS) status 0-II had longer overall survival than those with PS III (37 vs. 18 months) with significant Pvalue (0.05).Patients with base line PSA around 70ng/ml had longer OS (23 vs. 11 months) with significant P-value (0.05). …………………. Conclusions: Outcome of metastatic prostate cancer patients who have been treated at our center significantly affected by PS at presentation and baseline PSA level. However the absolute survival number needs to be improved by implementation of newly approved drugs in the 1st and 2nd lines, that isn't currently available in our center.

Research in Oncology

Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence... more Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence and histopathology of urinary bladder cancer. Aim: To investigate the histological pattern among patients treated for bladder cancer at our institution over a 5-year period. Methods: This retrospective study was conducted by reviewing the medical records of 632 patients treated for urinary bladder cancer at the departments of Urology and Clinical Oncology, Al Azhar Faculty of Medicine, between January 2011 and December 2015. Results: The study included 632 patients. Their age ranged from 27-87 years old with a median of 62 years. Male to female ratio was about 6:1. Fifty-nine percent of the patients had Non-Muscle Invasive Bladder Cancer (NMIBC) versus 41% had Muscle Invasive Bladder Cancer (MIBC). Patients with history of schistosomiasis were 46.5%; besides, 67.9% of the patients were smokers. Transitional Cell Carcinoma (TCC) was the predominant histological type (87.5%), followed by Squamous Cell Carcinoma (SCC) 9.1%, mixed SCC and TCC (2.8%), and other subtypes 0.6%. Conclusion: Our study confirms that the histopathological pattern of urinary bladder cancer in Egypt is still changing. Over the last decades, the incidence of bladder SCC is declining and bladder TCC is rising. Yet the incidence of bladder SCC is the lowest compared to previous reports.

Research in Oncology

Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence... more Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence and histopathology of urinary bladder cancer. Aim: To investigate the histological pattern among patients treated for bladder cancer at our institution over a 5-year period. Methods: This retrospective study was conducted by reviewing the medical records of 632 patients treated for urinary bladder cancer at the departments of Urology and Clinical Oncology, Al Azhar Faculty of Medicine, between January 2011 and December 2015. Results: The study included 632 patients. Their age ranged from 27-87 years old with a median of 62 years. Male to female ratio was about 6:1. Fifty-nine percent of the patients had Non-Muscle Invasive Bladder Cancer (NMIBC) versus 41% had Muscle Invasive Bladder Cancer (MIBC). Patients with history of schistosomiasis were 46.5%; besides, 67.9% of the patients were smokers. Transitional Cell Carcinoma (TCC) was the predominant histological type (87.5%), followed by Squamous Cell Carcinoma (SCC) 9.1%, mixed SCC and TCC (2.8%), and other subtypes 0.6%. Conclusion: Our study confirms that the histopathological pattern of urinary bladder cancer in Egypt is still changing. Over the last decades, the incidence of bladder SCC is declining and bladder TCC is rising. Yet the incidence of bladder SCC is the lowest compared to previous reports.

Egyptian Journal of Bronchology

Primary pulmonary extraskeletal Ewing sarcoma (EES)/ primitive neuroectodermal tumor is an extrem... more Primary pulmonary extraskeletal Ewing sarcoma (EES)/ primitive neuroectodermal tumor is an extremely rare tumor with only few cases reported in the literature. In this study, we present two cases of primary pulmonary EES diagnosed and treated at our institution. The median age was 20 years (range: 19-21). Cough, dyspnea, and hemoptysis were the predominant features at presentation, associated with a large lung mass on imaging. Image-guided core needle biopsies were the diagnostic modalities for both patients. Initial histopathology showed malignant small round cell tumor, which has been confirmed by immunohistochemistry as EES. Both patients received neoadjuvant chemotherapy followed by surgery; postoperative pathology for the first patient showed 98% tumor necrosis, whereas the second patient's pathology showed no evidence of residual tumor after complete surgical excision.

Background: High-grade gliomas (HGG) represent the commonest primary adult brain tumors. Radiothe... more Background: High-grade gliomas (HGG) represent the commonest primary adult brain tumors. Radiotherapy plays an important role in the management of this disease. Objectives: To assess the patterns of failure, treatment-related toxicities, progression-free survival (PFS), and overall survival (OS), following limited-margins. Patients and Methods: In this prospective phase II study, patients with HGG have been treated with IMRT using the ESTRO-ACROP contouring guidelines that not include the peritumoral edema in the gross target volume (GTV) with adding 2cm margin around the GTV to create the clinical target volume (CTV), in one phase, after maximum safe resection of the tumor or stereotactic biopsy. Results: The trial included 40 patients with a median age of 49 years, 16 patients (40%) were in complete remission, 13 patients (12.5%) had partial regression, and stable disease occurred in 11 patients (27.5%). The progression/failure occurred in 28 patients (70%). Failures were located ...

Al-Azhar International Medical Journal

Background:The most important event of RT (Radiation Therapy)is to dependably expand the position... more Background:The most important event of RT (Radiation Therapy)is to dependably expand the positions to the target volume while limiting the side effects to the normal tissues. Thusly, day by day treatment arrangement is considered as a basic necessity in RT (Radiation Therapy) for an exact positions and setup accuracy for treatmentbut still the Setup errors are the inevitable features of the radiation therapy RT (Radiation Therapy) process. Aim of work:To evaluate three dimensional setup errors and propose optimum margins for target volume coverage inthe pelvic radiation therapy. Patient and Methods: This study aiming to evaluate setup uncertainty related to pelvic cancer radiotherapy in the Clinical Oncology and Nuclear Medicine Department, at Al Hussein hospital, Al-Azhar University and to estimate how large planning target volume margins are needed in the Pelvic cancer cases. Results: the mean variation for action level for plan is 3.3 mm (1) SD (Standard Deviation) for pelvic cancer cases. The greatness of precise and irregular mistakes for pelvic cancer cases in our investigation are comparable or not exactly different examinations. To contrast the outcomes and other distributed investigation, we have considered PTV (90, 95,) margin. In our investigation, the determined CTV-PTVClinical Target Volume-Planning Target Volume) edge for pelvic cancer patient in the vertical, longitudinal and Lateral Variations from iso-center position were 4.12 mm, 4.62 mm and 3.23 mm, individually. Conclusion: The consequences of this examination are distinctive to the discoveries of current work. In the present work, we have changed the isocenter in the fourth portion, which brought about decrease of the efficient mistakes. Another distinction can be ascribed to the recurrence of online confirmation.

Al-Azhar International Medical Journal

Background: major progress in the management of non-small cell lung cancer emerged in the last ye... more Background: major progress in the management of non-small cell lung cancer emerged in the last years. Survival rate markedly improved in locally advanced non-small cell lung cancer with the use of concurrent chemo-radiotherapy treatment. Novel radiation techniques decreased the incidence of toxicity from radiotherapy. Aim of the work: Assess toxicity, local control, progression-free and overall survival resulting from usage of concurrent chemo-radiotherapy treatment in locally advanced non-small cell lung cancer using intensitymodulated radiotherapy technique. Patient and methods: this study included patients with stage III nonsmall cell lung cancer, received concurrent chemo-radiotherapy using intensity-modulated radiotherapy technique. Results: out of 32 patients included 17 (53.13%) were presented in stage IIIA and 15 (46.87%) in stage IIIB. The commonest histo-pathological type was non-squamous cell carcinoma, it was detected in 21 patients (65.62%), and squamous cell carcinoma which was detected in 11 patients (34.37%). Partial response was achieved in 18 (56.25%) patients, 10 (31.25%) patients had stable disease and 4 (12.5%) patients had progressive disease. Median overall survival was 10.2 months, while median progression-free survival was 6.5 months, no patients developed ≥ grade III esophagitis or pneumonitis. Conclusion: Concurrent chemo-radiotherapy treatment with Paclitaxel-Carboplatin, and intensity-modulated radiotherapy technique is a welltolerated treatment regimen with acceptable toxicity profile and fair survival in patients with un-resectable Stage IIIA-IIIB non-small cell lung cancer.

Al-Azhar International Medical Journal

Background: breast cancer is the most prevalent cancer diagnosed in females worldwide. Radiothera... more Background: breast cancer is the most prevalent cancer diagnosed in females worldwide. Radiotherapy improves survival in breast cancer patients. Consistent evidence emerges as regard the benefit of inclusion of IMN (internal mammary lymph nodes). Novel radiation techniques decreased the incidence of toxicity from radiotherapy. Aim of the work: Assessment of acute and moderately late radiation toxicity, assessing doses to normal structures, assessing overall survival and progression-free survival. Patients and Methods: this study included 41 patient received postoperative radiotherapy including internal mammary lymph nodes with Intensity-modulated radiation therapy in Al-Hussein University hospital Results: coverage of the right-sided planning target volume and internal mammary lymph nodes was significantly higher than leftsided cases p = 0.01, 95%, p = 0.02, respectively. there was a strong, positive correlation between the volume of heart receiving 25 Gy and the volume of planning target volume receiving 95 % of the prescribed dose, p = 0.001. Significant difference skin toxicity as regard maximum dose reaching the planning target volume either ≤ 107%, 108-109%, and those ≥110, P = 0.001. Conclusion: The inclusion of the internal mammary lymph nodes in postoperative radiotherapy in breast cancer patients is well tolerable. The use of Intensity-modulated radiation therapy decreases dose to normal structures which reduce toxicity

Al-Azhar International Medical Journal

Background: worldwide, prostate cancer is the second most common cancer and the fifth leading cau... more Background: worldwide, prostate cancer is the second most common cancer and the fifth leading cause of death from cancer in men. Objective: is to study the impact of hormonal treatment in patients with metastatic prostatic carcinoma.…………………………………………. Subject and Methods: This retrospective study included all patients diagnosed with metastatic prostate cancer, treated at our center between the year 2007 and 2016, data of patients included was reviewed from the charts and analyzed for outcome.………………………………………... Results: the study included 39 patients, 21 patients (52.6 %) had subjected to primary bilateral orchiectomy as first line management while (18) patients (47.4%) received ADT. Median PFS for 1st line hormonal treatment was18.4 months and Median OS were 25.5 months. Patients with good performance (PS) status 0-II had longer overall survival than those with PS III (37 vs. 18 months) with significant Pvalue (0.05).Patients with base line PSA around 70ng/ml had longer OS (23 vs. 11 months) with significant P-value (0.05). …………………. Conclusions: Outcome of metastatic prostate cancer patients who have been treated at our center significantly affected by PS at presentation and baseline PSA level. However the absolute survival number needs to be improved by implementation of newly approved drugs in the 1st and 2nd lines, that isn't currently available in our center.

Research in Oncology

Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence... more Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence and histopathology of urinary bladder cancer. Aim: To investigate the histological pattern among patients treated for bladder cancer at our institution over a 5-year period. Methods: This retrospective study was conducted by reviewing the medical records of 632 patients treated for urinary bladder cancer at the departments of Urology and Clinical Oncology, Al Azhar Faculty of Medicine, between January 2011 and December 2015. Results: The study included 632 patients. Their age ranged from 27-87 years old with a median of 62 years. Male to female ratio was about 6:1. Fifty-nine percent of the patients had Non-Muscle Invasive Bladder Cancer (NMIBC) versus 41% had Muscle Invasive Bladder Cancer (MIBC). Patients with history of schistosomiasis were 46.5%; besides, 67.9% of the patients were smokers. Transitional Cell Carcinoma (TCC) was the predominant histological type (87.5%), followed by Squamous Cell Carcinoma (SCC) 9.1%, mixed SCC and TCC (2.8%), and other subtypes 0.6%. Conclusion: Our study confirms that the histopathological pattern of urinary bladder cancer in Egypt is still changing. Over the last decades, the incidence of bladder SCC is declining and bladder TCC is rising. Yet the incidence of bladder SCC is the lowest compared to previous reports.

Research in Oncology

Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence... more Background: The control of schistosomiasis in Egypt was associated with changes in the prevalence and histopathology of urinary bladder cancer. Aim: To investigate the histological pattern among patients treated for bladder cancer at our institution over a 5-year period. Methods: This retrospective study was conducted by reviewing the medical records of 632 patients treated for urinary bladder cancer at the departments of Urology and Clinical Oncology, Al Azhar Faculty of Medicine, between January 2011 and December 2015. Results: The study included 632 patients. Their age ranged from 27-87 years old with a median of 62 years. Male to female ratio was about 6:1. Fifty-nine percent of the patients had Non-Muscle Invasive Bladder Cancer (NMIBC) versus 41% had Muscle Invasive Bladder Cancer (MIBC). Patients with history of schistosomiasis were 46.5%; besides, 67.9% of the patients were smokers. Transitional Cell Carcinoma (TCC) was the predominant histological type (87.5%), followed by Squamous Cell Carcinoma (SCC) 9.1%, mixed SCC and TCC (2.8%), and other subtypes 0.6%. Conclusion: Our study confirms that the histopathological pattern of urinary bladder cancer in Egypt is still changing. Over the last decades, the incidence of bladder SCC is declining and bladder TCC is rising. Yet the incidence of bladder SCC is the lowest compared to previous reports.