Abstract

Objective: The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis.

Patients and methods: The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital.

Results: Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase.

Conclusion: The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.

Background: In breast cancer, painful bone metastases are common. Local radiotherapy is the standard treatment of painful bone metastases. Pain control and overall response rateswere low in radiotherapy alone.

The objectives of this study were to compare the safety and efficacy of external beam radiotherapy with concurrent capecitabine vs. external beam radiotherapy alone in pain control of painful bone metastases in breast cancer patients.

Materials and methods: Eighty-four patients with painful bone metastases from breast cancer participated in this prospective study. We randomized the patients into two groups: group A treated with radiotherapy 30 Gy in 10 fractions and group B treated with capecitabine 825 mg/m² every 12 hrs. concurrently with the same radiotherapy dose.

Results: There was no statistically significant difference between the two groups regarding early treatment toxicity. Most of the toxicity was gastrointestinal (diarrhea and nausea) and mild (grade I or II). The median pain score decreased from week one, and there was a marked response at week4. The difference in median pain score between both groups was statistically significant with p-value = 0.045. The median analgesic score in both groups was statistically significant with a p-value = 0.032 at week 12. A complete response to pain at week 4 was 19% and 42.9% in groups A and B, respectively. Conclusion: Concurrent chemoradiation in painful bone metastases from breast cancer origin was tolerable and safe; it had a higher overall response rate and pain palliation than radiotherapy alone.

Abstract: Purpose: The aim of this prospective study was to compare the efficacy and toxicities of gemcitabine to cisplatin as a radio sensitizer in trimodality treatment of bladder transitional cell carcinoma. Methods: It was a prospective study on100 patients with bladder TCC, clinical stage T2 or T3 N0 M0 who underwent concurrent radio chemotherapy after maximum safe trans-urethral resection. Patients were divided into 2 groups: gemcitabine group, received weekly doses of gemcitabine 125mg/m2 , and cisplatin group, received weekly doses of cisplatin 40mg/m2 concurrently with 66 Gy of conventional radiation therapy. Results: Disease free survival in gemcitabine group was 79.4%, while in cisplatin group was 77.6% with insignificant differences. All patients in cisplatin group tolerated treatment protocol completely, while six patients in gemcitabine group could not completed their weekly gemcitabine doses because of grade III gastrointestinal toxicity. Conclusions: Gemcitabine is a reasonable option in trimodality treatments in urinary bladder preservative strategies. [

Abstract Introduction: Skin sparing mastectomy with immediate autologous breast reconstruction has a positive psycho-social and sexual effect, however postoperative radiotherapy could adversely affect its cosmetic results. Patients and methods: This study included 24 female breast cancer patients underwent skin sparing mastectomy with or without scarifying NAC and immediate reconstruction by autologous TRAM and latissimus dorsi myocutaneous flap. They received adjuvant chemotherapy followed by 3DCRT, we evaluated them for skin complications and cosmoses. Results: Faint erythema or dry desquamation detected in 16 patients (66.6%), while 8 patients (29.2%) had moderate to brisk erythema. Two patients (8.3%) had skin edema and one patient (4.2%) had telangiectasia. Two patients complained from moderate pain Fat necrosis within the flap detected only in one patient (4.2%). Twentytwo patients (83.3%) had acceptable cosmoses while 2 patients had unsatisfactory cosmetic results. Conclusion: Postoperative radiotherapy is safe with acceptable rate of complications and very good patients satisfactions after skin sparing mastectomy and immediate autologous breast reconstruction. Keywords: Skin sparing; Immediate autologous reconstruction; Post-operative; Radiotherapy; Breast cancer

Oxaliplatin and infusional fluorouracil/leucovorin or capecitabine has emerged as important options in the adjuvant and palliative treatment of colorectal cancer. Severe Oxaliplatin induced neurotoxicity may require chemotherapy dose reduction or cessation. The incidence of oxaliplatin-induced neurotoxicity has varied from 12% - 18%. Several attempts have been proposed to prevent or treat oxaliplatin-induced neurotoxicity, but treatment of established chronic Oxaliplatin induced neurotoxicity is limited. Purpose: To assess the efficacy of parenteral Glutamine dipeptide (N2-L-Alanyl-L-Glutamine Dipeptide, 20 g·m/100ml, IV) for preventing of oxaliplatin induced neurotoxicity. Patients and Methods: A pilot study was performed. 120 patients with metastatic colorectal cancer (mCRC) entered into the study. 60 patients randomly assigned to receive IV glutamine dipeptide (20 g·m IV) day 1-2 with FOLFOX-4 to be repeated every 15 days as a first line of treatment of metastatic colorectal cancer and 60 patients assigned to receive only FOLFOX-4 (control group). Neurotoxicity symptoms and signs were evaluated before each cycle. Results: There were significantly fewer neurological symptoms in patients receiving glutamine dipeptide than in those who did not. A decreased percentage of grade 1-2 peripheral neuropathy was observed in the glutamine dipeptide group after two cycles (8.3% versus 20%; P = 0.04) and 4 cycles (13.3% vs 26.7%; P = 0.02). A significantly lower incidence of grade 3-4 neuropathy was noted in the glutamine dipeptide group after four and six cycles (6.7% versus 15%, P = 0.02 and 13.3% versus 33.3%. P = 0.04, respectively). The need for oxaliplatin dose reduction was significantly lower in the glutamine dipeptide (Dipeptiven) group (10% vs 26.7%; P = 0.02) and there were no significant differences between two groups in response to chemotherapy among patient with mCRC (48.3% vs 50%). Conclusion: These data concluded that IV dipeptide glutamine significantly decreases the incidence and severity of oxaliplatin induced neurotoxicity of mCRC without any attendant side effects.

Keywords

Colorectal Cancer, Oxaliplatin, FOLFOX-4, Alanylglutamine, Neuropathy

Abstract Despite its scarcity, malignant tumor extending to the heart is a lethal condition. Cardiac metastases are considered to occur rarely. In the present paper, we represented a single-center experience in cardiac metastases diagnosis in addition to different treatment modalities for improving the patients’ quality of life and survival. We could claim that this is the largest report of this kind to date. We retrospectively reviewed the patients’ files in our hospital, from 2009 to 2022. These patients presented with radiological/ intraoperative evidence of intracardiac extension of malignant tumor. Seven patients with transvenous intracardiac tumor extension were referred to our center. There was primary tumor in the lung in four cases (57.14%), two with synovial sarcoma (14.3%), one with renal cell carcinoma with inferior vena cava extension to the right atrium, and one with osteosarcoma. Moreover, there was one case of thymic origin (14.3%). Four patients underwent urgent surgery upon diagnosis, in order to have higher quality of life, and R0 resection which was not possible in any of them (two patients had R1 and two had R2). Among them, one received palliative chemotherapy followed by chemoradiation after debulking surgery, one received concurrent chemoradiotherapy, one received palliative chemotherapy only, and one refused to get any treatment. Survival was better in the patients who received concurrent chemoradiotherapy. According to our results, urgent/unplanned surgery could not be a good candidate for intracardiac extension of malignant tumors and does not improve survival. Combined multidisciplinary approach, on the other hand, was found to be a better option for disease control. Keywords: Heart atria, Lung, Quality of life, Cytoreductive surgical procedures

Background

Colorectal cancer (CRC) ranks as the third most common cancer and the third most killing cancer worldwide [1]. The addition of oxaliplatin to fluorouracil (FOLFOX) or capecitabine (CAPOX) has become a fundamental component of chemotherapeutic regimens and chemoradiation in adjuvant treatment of CRC cancer. Excision repair cross-complementation group 1 (ERCC1) encodes an enzyme that is essential for the efficient repair of DNA damage induced by platinum compounds including Oxaliplatin.

Purpose

This study aims to investigate the role of ERCC1 as a predictive and prognostic marker in colorectal patients receiving oxaliplatin based chemotherapy and chemoradiation.

Patients and Methods

100 annotated stage III CRC patients were prepared as immunohistochemical (IHC) analysis of ERCC1 protein expression. All of the patients received oxaliplatin based chemotherapy.

Results

Analysis of data showed that high ERCC1 expression was significantly associated with early treatment failure and disease free survival among patient with stage III CRC.

Conclusion

High ERCC1 expression was an independent predictor factor of early treatment failure (P < 0.018) and associated with lower disease free survival (P = 0.004).

Background: Based on the special pattern of recurrence in the excision cavity, secondary computed tomography (CT) can be introduced after hypofractionated whole breast radiotherapy with early breast cancer, aiming for accurate delineation of tumor bed boost and reduced toxicity. This study aimed to assess the volumetric changes in the lumpectomy cavity before and after hypofractionated whole breast radiation therapy (WBRT) and related clinical factors.

Method:  This prospective study was designed and CT simulation was done for 45 patients from September 2019 to April 2020, two radiotherapy treatment planning were generated for each patient before and after hypofractionated WBRT. The tumor bed is defined using surgical clips, seroma, and postoperative alterations. Based on the original CT and tumor bed boost CT, statistically significant decrease was examined. The relationship between various factors and the volume decrease in the excision cavity was examined. 

Results: The median value of reduction in the excision cavity was 15.4 cm³ with the statistical significance (P < 0.001). In multivariate linear regression, the significant variable which predict the volume reduction was the presence of seroma (B = 24.48, confidence interval, 13.09 to 35.87, P < 0.001). 

Conclusion: our results suggested significant benefit from re-simulation before boost planning especially for patients with clinical evident seroma.

Keywords: Breast neoplasms, Radiation dose hypofractionation, Lumpectomy cavity, Radiotherapy

Abstract

Background: Repopulation of tumor cells during radiotherapy of transitional cell bladder carcinoma is believed to be a significant cause for treatment failure, and it was reported from clinical observations that the local control rate decreased with a prolonged treatment time, so accelerated hypofractionated radiotherapy with concurrent capecitabine may provide good local control in elderly patients unfit for surgery. The study aimed to evaluate the tolerability and efficacy of hypofractionated radiotherapy with capecitabine in elderly patients with urothelial carcinoma. Methods: Between October 2019 and September 2021, 30 patients with muscle-invasive bladder cancer staged T2-4aN0M0, underwent transurethral resection of bladder tumor followed by capecitabine (825 mg/m² orally, 2 times a day) and radiation therapy (55 Gy in 2.2 Gy per fraction). Results: Thirty patients with a median age of 73.5 years (range, 65-85) were included in our study. Most patients had T2N0, and T3N0 (28 patients), furthermore 73.3% had an intermediategrade tumor, Transurethral resection of bladder tumor was incomplete in 43.3. No grade 4 toxicity was documented. Grade 3 urinary toxicities occurred in two patients requiring hospitalization and temporal radiation cessation. Regarding late toxicities, no grade 3 or 4 toxicity was reported. A complete response was obtained in 56.7% of  patients. After a median follow-up of 16 months, the locoregional control rate was 63%. Overall survival, local failure-free survival, and event-free survival were 100%, 93.3%, 80% and 43.3%, 33.3%, 30% at one and two years respectively. Conclusion: Hypofractionated chemoradiation with capecitabine, appears to be an effective and well-tolerated curative treatment strategy in the selected elderly population with urothelial carcinoma.

Keywords: Bladder cancer- elderly- hypofractionation radiotherapy- capecitabine

Abstract:

Background: The current gold standard for adjuvant radiotherapy for breast cancer nowadays is hypofractionated radiotherapy. Measures for balancing both infectious and oncologic risk among patients and healthcare professionals must be carefully considered in the context of expected resource shortages and worldwide widespread community SARS-CoV-2 infection during the COVID- 19 pandemic. Here, we document the early and late skin toxicity and efficacy outcome of a prospective institutional phase III trial comparing a 1-week course of adjuvant breast radiotherapy to a 3-week regimen after surgical treatment for early breast cancer.

Methods: A phase III, randomized controlled trial is described here. Patients who underwent breast conserving surgery or a mastectomy and had invasive ductal or lobular breast cancer (pathological stagingT1-3, pN0-1, M0) were eligible if they were at least 18 years old. Sequential tumor bed boost radiotherapy (dose of 10 Gy/ 4 fractions and 5.2 Gy/ 1 fractions, respectively) is permitted in patients who have undergone breast conservative surgery and are younger than 50 years old and those of older age with high grade tumor or lymphovascular invasion. Patients were randomly assigned to receive 40 Gy/15 fractions (F)/3 weeks or 26 Gy/5 fractions (1 week). First endpoint evaluation of immediate and delayed effects on normal tissue and cosmetic results, Clinicians evaluated the impact on normal tissue using pictures, secondary endpoint estimation of two years LRR free survival, and two years disease free survival Results: At six weeks after the end of treatment, 65 patients in the control arm and 63 patients in the test arm were assessed for the most severe acute breast skin reactions. Grade 2 reactions, which were graded using CTCAE criteria (V4.03), were present in 47.7% of the control arm patients and 27% of the test arm patients, respectively.

Our study's assessment of the late effects on normal tissue after a median follow-up of 25 months, a range of 21 to 30 months, revealed that radiotherapy- related fibrosis, Telangiectasia, and hyperpigmentation were similar between the two groups (p>0.05), with fibrosis within the tumour bed being the most prevalent moderate or marked effect at 2 years, as occurred in 2 patients (3.1%) of 65 patients who received 40 Gy and 4 patients (6.3%) of 63 patients. Ultrahypofractionation resulted in incidence    of excellent or good cosmesis over fair or poor cosmesis of 87.3% versus 12.7%, and the control arm resulted in a rate of 87.7% versus 12.3%, which is statistically insignificant (p=0.9). Two-year LRR-free survival was 96.9% in the control group and 98.4% in the ultrahypofractionation group, both of which were statistically insignificant. Of the two patients with LRR (3.1%) in the control arm and one (1.6%) patient in the ultrahypofractioation group, respectively, the disease-free survival rate was 95.3% in the control arm and 95.2% in the ultrahypofractioation arm.

Conclusion: 26 Gy in 5.2 Gy per fraction daily over 1 week is equal to 40.05 Gy in 2.67 Gy per fraction daily over 3 weeks for patients received adjuvant radiotherapy after surgical resection for early-stage breast cancer as regard normal tissue effects up to 2 years and for local tumor control and to confirm study result need longer follow up.

Keywords: Breast cancer, Ultrahypofractionation, Radiotherapy.