Eyad Fawzi AlSaeed

Correlation of pretreatment hemoglobin and platelet counts with clinicopathological features in colorectal cancer in Saudi population.

Background/Aims: In Saudi Arabia, colorectal cancers (CRCs) are registered as the second most common cancers. However, no data has been reported about correlation of the severity of the anemia and pretreatment platelets level with clinicopathological features of CRCs. We aimed to evaluate the association between pretreatment hemoglobin and platelets level and the clinicopathological features of CRC patients in Saudi Arabia. Materials and Methods: Between September 2005 and November 2011, One hundred and fifty-four confirmed CRC patients underwent thorough physical examination, blood investigations, endoscopic ultrasonography (EUS), and computed tomography (CT) for staging before surgery. Findings of physical assessment, EUS, CT, and pathological specimens were correlated with pretreatment hemoglobin and platelets levels the Pearson-Kendall tau correlative coefficients. Results: The mean age of cohort was 56.6 years (range: 26-89). Left-sided CRC were predominant (97 patients; 63%). Mean size of primary tumor was 6 cms (1-18) SD ± 3.55. Mean values of hemoglobin, red blood cells, hematocrit, white blood cells, and platelets were 11.9 SD ± 2.3, 35.5 SD ± 5.7, 4.43 × 106/mL SD ± 0.6, 7.67 106/mL SD ± 2.44, and 343 × 103/mL SD ± 164.4, respectively. Pretreatment hemoglobin was inversely correlated with primary tumor size (R: 0.71, R2: 1.55, P = 0.0001) and nodal status (R: 0.02, R2: 0.05, P = 0.01). Right-sided CRC had significantly low pretreatment hemoglobin levels (P = 0.001). Interestingly, pretreatment thrombocytosis was seen only in right-sided CRC (P = 0.0001). Conclusion: Pretreatment anemia and thrombocytosis were found mainly in right-sided CRCs and advanced primary and nodal stages. Pretreatment hemoglobin and thrombocytosis can be considered as useful prognostic markers in CRC patients.

Distal humerus as delayed site of metastasis from small cell carcinoma of gallbladder.

Background. Small cell carcinoma (SCC) of the gallbladder is a rare entity and is often seen in elderly women. SCC of gallbladder is typically a nonsecretory carcinoid tumor without overt clinical symptoms and is often discovered at advanced stages. SCC of gallbladder carries a dismal prognosis as compared to SCC of lung and adenocarcinoma of gallbladder. To date, only 73 case reports have been published in the world literature. Case Presentation. Herein, we report a case of a 73-year-old Saudi woman who presented with one week history of right upper quadrant abdominal pain and obstructive jaundice and was found to be a case of locally advanced, metastatic SCC of gallbladder cT4N1M1 (liver, para-aortic lymph nodes, and bone). The patient was treated with neoadjuvant etoposide and cisplatin (EP) chemotherapy three cycles after biliary stenting followed by radical cholecystectomy, lymphadenectomy, and adjuvant EP chemotherapy and then one year later developed distal humerus osseous metastasis. Conclusion. SCC of the gallbladder is very rare entity and is often seen at advanced stages. Osseous metastases of peripheral skeleton from SCC gallbladder are rarely reported. Surgery is curative option but only for early stage tumors. Incorporation of chemotherapy along with radical resection increases the survival.

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

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

Clinicopathological features and treatment outcomes of primary laryngeal lymphomas in saudi population

Abstract Background: Primary laryngeal lymphomas (PLLs) are rare and account for 1% -3% of all laryngeal neoplasms. Our aim was to describe the symptomology, diagnosis, histological variants and treatment outcomes of

Bleeding in Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy a Safe and Effective Non-Invasive Option for Securing Hemostasis? A Single Institution Perspective

Introduction: Control of bleeding due to locally invasive disease is of paramount importance in the management of cancer patients. This study was undertaken to explore the outcomes of palliative intent hypofractionated radiation therapy (HRT) in advanced stage pelvic malignancies that presented with bleeding. Methods: This study enrolled patients treated with palliative intent hypofractionated radiation therapy from July 2015 to November 2017. In the inclusion criteria, all these patients had the common presenting complaint of bleeding from the tumor. These patients were not treated with radiation therapy before for the same indication. Patients with known bleeding disorders and those undergoing parallel interventions for bleeding control were excluded from the study. Bleeding was categorized based on the World Health Organization (WHO) scale for the classification of bleeding. Response assessment was classified into a complete response, partial response and no response. A comparison was made for the bleeding scale before and after HRT using the Wilcoxon signed rank test. The comparison of mean hemoglobin levels before and after the HRT was calculated by paired t-test. Results: Forty-two patients with advanced pelvic malignancies qualified for inclusion in the study after applying the inclusion/exclusion criteria. Among those analyzed, the median age was 67 years (range 37 – 95 years). The male and female proportion was 38% and 62% respectively. Different cancers included uterine cancer 31%, cervical cancer 24%, bladder cancer 21%, rectal cancer 17% and vulvar cancer in 7%. The baseline bleeding scale in these cases was found to be grade 1 in 12%, grade 2 in 55% and grade 3 in 33% cases. The median dose in our cohort was 20 Gy in five fractions over one week (range was 8 Gy to 40 Gy). Following HRT, the WHO bleeding score at one month was recorded as grade 0 in 57%, grade 1 in 31%, grade 2 in 7%, grade 3 in 5% and grade 4 in none. Toxicity profile did not show any grade 3 or above acute toxicity in the study. Response rates were 57% complete response, 36% partial response and 7% no response. The mean hemoglobin level post-treatment versus pre-treatment was found to be 9.6 g/dL versus 7.3 g/dL. Conclusions: Hypofractionated radiotherapy was found to be a safe and effective non-invasive palliative treatment modality for securing hemostasis in advanced pelvic malignancies that presented with bleeding.

Changes in pulmonary function tests in breast carcinoma patients treated with locoregional post-mastectomy radiotherapy: results of a pilot study

Background The aim of present pilot study was to evaluate the changes in pulmonary function tests (PFTs) after locoregional post-mastectomy radiotherapy (PMRT) in breast cancer patients. Materials and methods Twenty consecutive patients with histopathologically confirmed breast carcinoma stages T1–T4, N1–N2, who were treated with modified radical mastectomy with neoadjuvant or adjuvant chemotherapy underwent PFTs, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow at 50%, and peak expiratory flow rate, maximum mid expiratory flow (MMEF25–75), maximal oxygen consumption (VO2max), and carbon monoxide diffusing capacity (DLCO) before, at 30 days, and at 90 days after locoregional PMRT. A two-tailed paired Student’s t-test was used to compare mean values among the variables between the groups Results A significant drop in FVC, FEV1, and DLCO was noticed at day 90 after the completion of locoregional PMRT with P-values 0.033, 0.042, and 0.031, respectively, while MMEF25–75 and VO2max were not significantly affected (P-values 0.075 and 0.062, respectively) favoring a restrictive lung injury pattern. However, no patient was found to be symptomatic. Conclusion A significant drop in reduction in PFTs occurred at day 90 after the completion of locoregional PMRT. PFTs shall be performed in all breast cancer patients receiving locoregional PMRT for early detection of radiation-induced lung toxicity as all patients in our cohort were found asymptomatic.

Five-year outcomes of preoperative chemoradiation for rectal carcinoma in Saudi population: single-institutional experience

OBJECTIVES Preoperative chemoradiation (CRT) followed by surgery is the standard treatment for locally advanced rectal cancer (LARC). The outcomes of preoperative CRT in Saudi patients with LARC have not been widely studied. The study reports long-term outcomes after preoperative CRT followed by curative surgery in Saudi patients with LARC. DESIGN AND SETTINGS A retrospective, single-institutional study performed in the tertiary care oncology center in Saudi Arabia. MATERIALS AND METHODS A total of 154 out of 204 patients with LARC were treated with preoperative CRT and followed by surgery at the oncology center between September 2005 and November 2012. Data regarding the response rates, toxicity profile, locoregional control (LRC), distant metastasis control (DMC), overall survival (OS), and disease-free survival (DFS) rates were analyzed. RESULTS The median age of the study population was 56.6 years (range: 26–89). Predominant clinical stages were IIA (70 patients; 45.4%) and IIIB (49 patients; 31.8%). Majority of patients (79.8%) underwent a complete total mesorectal excision (TME). Complete pathological response (ypT0N0) was seen in 26 patients (16.8%). At 5 years, locoregional recurrence (LR) was reported in 12 patients (7.8%), and distant metastases were noted in 33 patients (21.4%). The 5-year cumulative LRC, DMC, OS, and DFS rates were 91%, 71.3%, 78%, and 64.8%, respectively. Stage, nodal status, circumferential margins, ypT0N0, and adjuvant chemotherapy were found to be important prognostic factors for DFS. CONCLUSION The results of preoperative CRT followed by surgery and adjuvant chemotherapy in Saudi population are comparable with international data.

Elevated preoperative serum cancer antigen 15.3 levels are associated with reduced disease-free survival: a single-institution experience

BACKGROUND We aimed to evaluate the prognostic significance of the preoperative tumor-marker cancer antigen (CA) 15.3 in Saudi patients with breast cancer and to find out whether any correlation exists between preoperative CA 15.3 and tumor size and nodal status. MATERIALS AND METHODS Preoperative blood samples for serum CA 15.3 levels were taken in 112 breast cancer patients who underwent breast-conserving surgery or modified radical mastectomy between February 1988 and August 2008. Serum levels of CA 15.3 below 35 U/mL were considered normal. The correlation between pre- and postoperative CA 15.3 levels with tumor size and nodal status was calculated using Pearson correlative coefficients. Kaplan-Meier curves were used to determine disease-free survival (DFS) according to CA 15.3 groups (<35, 36-100 and above >100 U/mL). RESULTS The mean age of the cohort was 47.0 years (range 23-76, standard deviation 10.3). According to menopausal status, 93 patients (83.0%) were premenopausal, and 19 patients (17.0%) were postmenopausal. Mean preoperative CA 15.3 levels were 43.69 U/mL (1.0-209.87). Ten-year DFS rates were 100%, 84%, and 57.7% for CA 15.3 <35 U/mL, 36-100 U/mL, and >100 U/mL, respectively (P = 0.003). Preoperative CA 15.3 levels showed positive correlation with primary tumor size (R = 0.43, R (2) = 0.83, P = 0.03) and nodal status (R = 0.59, R (2) = 0.28, P < 0.0001), respectively. CONCLUSION Elevated preoperative CA 15.3 above 35 U/mL in Saudi women breast cancer patients showed correlation with primary tumor size and nodal status, and preoperative CA 15.3 level is an independent prognostic factor for DFS. Preoperative serum CA 15.3 levels may be helpful for risk stratification along with other factors.

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

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/m2 (23-72). Results: Median follow-up was 55 months (6-60). The Kaplan-Meier estimates for loco regional control (LRC), distant metastasis control (DMC) and overall survival (OS) for RT and CRT arms were; 85.7% vs. 74.2% (p 0.04), 85.7% vs. 85.7% (p 0.9) and 82.8% vs. 81% (p 0.8) respectively. Patients in CRT arm had earlier and higher pelvic recurrences {hazard ratios of 2.21 (1.45-7.85)}. Acute hematological grade3 toxicity was higher in CRT arm (9.5%) and no difference in acute or delayed non-hematological toxicities was seen between two arms. Conclusion: Adjuvant chemotherapy in patients with EC after surgery is associated with inferior LRC and no additional benefit in DMC and OS. If adjuvant chemotherapy is considered it shall be given after adjuvant radiotherapy.

Avoidance of radiotherapy-related, gastrointestinal complications in a patient with systemic lupus erythematosus: a case report and review of literature.

Systemic lupus erythematosus (SLE) is associated with major gastrointestinal complications due to radiotherapy. A patient with active SLE and grade 4 nephropathy presented with inoperable advanced cancer of the cervix which proved to be contraindicated for chemotherapy. The patient was treated with intensity-modulated radiotherapy technique (IMRT). The patient, however, did not experience severe radiotherapy-related complications as expected with conventional techniques of radiotherapy. The tolerance of SLE patients to radiotherapy can thus be achieved by proper delivery of radiation and the sparing of normal tissues by IMRT although further confirmatory studies are required.