Background: The use of shorter radiotherapy schedules has an economic and logistic advantage for radiotherapy departments, as well as a high degree of patient convenience. The aim of this study is to assess the acute and short-term late toxicities of a hypofractionated radiotherapy schedule with a concomitant boost. Methods: We enrolled 57 eligible patients as group A. These patients received 42.5 Gy in 16 fractions of 2.66 Gy each to the whole breast over 3.2 weeks. A concomitant electron boost of 12 Gy in 16 fractions

Background: Diffuse large B-cell lymphoma (DLBCL) is commonest pathological type of gastrointestinal lymphoma and its management was changed from surgery to combined chemoimmunotherapy in the last decade however this strategy is questionable especially if rituximab is not available. Methods: 79 files were reviewed retrospectively. We divided the patients into 2 groups; (group-1) Included 37 patients who underwent surgery followed by chemotherapy and (group -2) included 42 patients who received chemotherapy .The indication of surgery was mainly due to obstruction/perforation. We compared the efficacy of using surgery between the 2 groups and between primary anatomical site subgroups regarding their PFS and OS. Results: We found using surgery before chemotherapy was superior to chemotherapy alone in term DFS p= 0.012 and OS p=0.037. But in the anatomical subgroups analysis, it did not show any significant difference in primary gastric lymphoma (PGL) regarding DFS and OS p=0.706, p=0.858, in contrary, we found significant improvement in PFS and OS p=0.032, p=0.025 in primary intestinal lymphoma (PIL) favoring use surgical approach. Conclusion Surgery is still an important strategy in case of DLBCL in PIL intestinal lymphoma however in case of PGL using chemotherapy even without rituximab achieve similar results. However our small sample size should be considered.

Background: Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of primary rectal cancer is curative surgical resection; however, a fine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. Methods: Forty nine (49) patients with low rectal carcinoma were included in a prospective study, between Jan 2007 and Jan 2012. Preoperative chemoradiation was administrated to all patients and subjected to different techniques of sphincter saving surgery. Stage I and Stage IV disease at diagnosis were excluded from the study. Results: Forty nine patients were included in the study. 27 (55%) patients were male and 22 (45%) were female; the age ranges from 23 years to 70 years with the median age 46 years. The main presenting symptoms were bleeding per rectum and tenesmus, Stage II 18 patients (36.7%), stage III 31 patients (63.3%). Complete clinical and pathological response in 3 patients (6%), and complete clinical response with only microscopically residual carcinoma in 20 patients (41%), partial re- sponse in 18 patients (36.7%), and no significant response in 8 patients (16%) 7 from 8 were mucoid carcinoma. Low anterior resection (LAR) in 22 patients (44.9%), Hartman’s procedure in 4 patients (8.1%), Coloanal pull-through (COP) was done in 19 patients (38.9%) and perineal colostomy in 4 patients (8.1%). For patients with colo-anal pull-through technique complete dehiscent and retraction observed in 2 cases, Major leakage in one case, stenosis in 4 cases. Conclusion: There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter saving surgery. Coloanal pull-through technique is not a widely spread technique for low rectal cancer with good oncological safety and acceptable functional outcome.

Background: The ECF (Epirubcin/Cisplatin/5-fluorouracil) as first line therapy in metastatic gastric is the optimal therapeutic option but its complexity limits its utility in many communities. Methods: We investigated a more convenient modification of the standard approach, "5 days CIV 5-fluorouracil 1000mg/m2". A total of 115 patients with advanced and metastatic adenocarcinoma of the stomach and gastroesophageal cancer were reviewed retrospectively to compare the efficacy of modified ECF with the reference protocols FAM and ELF Results the number of patients in each regimen was 41 patients received modified ECF while 42 received ELF and 32 received FAM. The overall response rate was 36.5% with ECF, 16.6% with ELF, and 15.6% with FAM, with significant differences p=0.001. No one achieved a complete tumor remission. However, 4 patients with locally advanced stomach were able to have total gastrectomy in ECF arm only with p=0.000. Hematologic toxicities were more common in ECF p= 0.01. On the other hand, there was no significant difference in progression free survival or overall survival between the three regimens. Conclusion Modified ECF showed significant overall response than FAM and FLF. However survival benefit is very small. So we recommend using this regimen as neoadjuvant treatment.

Background: The ECF (Epirubcin/Cisplatin/5-fluorouracil) as first line therapy in metastatic gastric is the optimal therapeutic option but its complexity limits its utility in many communities. Methods: We investigated a more convenient modification of the standard approach, "5 days CIV 5-fluorouracil 1000mg/m2". A total of 115 patients with advanced and metastatic adenocarcinoma of the stomach and gastroesophageal cancer were reviewed retrospectively to compare the efficacy of modified ECF with the reference protocols FAM and ELF Results the number of patients in each regimen was 41 patients received modified ECF while 42 received ELF and 32 received FAM. The overall response rate was 36.5% with ECF, 16.6% with ELF, and 15.6% with FAM, with significant differences p=0.001. No one achieved a complete tumor remission. However, 4 patients with locally advanced stomach were able to have total gastrectomy in ECF arm only with p=0.000. Hematologic toxicities were more common in ECF p= 0.01. On the other hand, there was no significant difference in progression free survival or overall survival between the three regimens. Conclusion Modified ECF showed significant overall response than FAM and FLF. However survival benefit is very small. So we recommend using this regimen as neoadjuvant treatment.

Background: Determination the extent of viable residual tumor preoperatively is a big issue after neoadjuvant treatment. On the other hand, some retrospective data suggest that BCS is feasible up to stage IIIA breast cancer without preoperative therapy. Methods: We analyzed retrospectively 164 patients undergone (BCS) followed by adjuvant chemotherapy and or endocrinal therapy with whole breast radiation between 2005 and 2012. Of those, 116 patients had stage I and II (group-1) and 48 patients had stage III A (group-2). Result: After median follow-up of 40.4 months, 18 (15.5%) patients in (group -1) and 8 patients (16.6%) in group-2 developed (IBTR) P=0.77. Mean time to tumor recurrence was 19 months in (group -1) and 17 months in (group -2) (P=0.5). However we found IBTR was more in hormonal negative tumors (P=0.002), high grade tumors (P=0.021), young age (P=0.017) and LN positive than negative (P=0.011) , However there is no significant difference between N1 and N2 (P=0.241). Conclusion: Our data suggest that BCS with R0 resection is feasible in stage IIIA whenever cosmetic appearance could be maintained as long as it will be followed by radiotherapy and chemotherapy. Prospective study with larger numbers is recommended for further evaluation of this issue.

Background: Determination the extent of viable residual tumor preoperatively is a big issue after neoadjuvant treatment. On the other hand, some retrospective data suggest that BCS is feasible up to stage IIIA breast cancer without preoperative therapy. Methods: We analyzed retrospectively 164 patients undergone (BCS) followed by adjuvant chemotherapy and or endocrinal therapy with whole breast radiation between 2005 and 2012. Of those, 116 patients had stage I and II (group-1) and 48 patients had stage III A (group-2). Result: After median follow-up of 40.4 months, 18 (15.5%) patients in (group -1) and 8 patients (16.6%) in group-2 developed (IBTR) P=0.77. Mean time to tumor recurrence was 19 months in (group -1) and 17 months in (group -2) (P=0.5). However we found IBTR was more in hormonal negative tumors (P=0.002), high grade tumors (P=0.021), young age (P=0.017) and LN positive than negative (P=0.011) , However there is no significant difference between N1 and N2 (P=0.241). Conclusion: Our data suggest that BCS with R0 resection is feasible in stage IIIA whenever cosmetic appearance could be maintained as long as it will be followed by radiotherapy and chemotherapy. Prospective study with larger numbers is recommended for further evaluation of this issue.

Introduction: Seropositive status and the use of T cell depleted grafts are major risk factors for CMV reactivation due to delayed immune reconstitution. However, not all recipients of T cell depleted grafts experience CMV reactivation. Thus identification of risk factors which contribute towards recurrent CMV reactivation is mandatory Patients and Methods: A retrospective study was performed from January 2004 to February 2014 at University Hospital of Wales, UK. CMV viral load was determined by real time PCR and T cell recovery was determined by flow-cytometry. Results: 124 (42%) were CMV seropositive. (R+/D+) were 53% while 46% were (R+/D-). All patients received T cell depletion . 21% had no CMV episodes reactivation during the first 100 days, 31.5% had one r episode and 42.5% had a median of 2 episodes. A CD4 count at day + 100 of 50 cell/ul was the most significant risk factor in predicting CMV reactivation p=0.002. We found that patients who were refractory to first and/or second line of chemotherapy but subsequently responded to salvage therapy achieving either CR or PR showed significant correlation with recurrent CMV reactivation and low CD4 count at day + 100 following transplant (p=0.031) Also AML as the underlying disease was associated with both failure of recovery of CD4 count and an increased risk of recurrent CMV reactivation p=0.001. On the other hand, we didn't find any significant association with other factors like recipient age (p=0.489), time from diagnosis to transplant (p=0.203), conditioning regimens (p=0.093), presence of acute GVHD (p=0.410) and concomitant fungal infection (p=0.675). Conclusion: Failure of response to first and/or second line therapy and underlying diagnosis of AML are associated with a lower CD4 count at day + 100 and increased risk of CMV reactivation in CMV seropositive recipients following T cell depleted graft.

Background: Diffuse large B-cell lymphoma (DLBCL) is commonest pathological type of gastrointestinal lymphoma and its management was changed from surgery to combined chemoimmunotherapy in the last decade however this strategy is questionable especially if rituximab is not available. Methods: 79 files were reviewed retrospectively. We divided the patients into 2 groups; (group-1) Included 37 patients who underwent surgery followed by chemotherapy and (group -2) included 42 patients who received chemotherapy .The indication of surgery was mainly due to obstruction/perforation. We compared the efficacy of using surgery between the 2 groups and between primary anatomical site subgroups regarding their PFS and OS. Results: We found using surgery before chemotherapy was superior to chemotherapy alone in term DFS p= 0.012 and OS p=0.037. But in the anatomical subgroups analysis, it did not show any significant difference in primary gastric lymphoma (PGL) regarding DFS and OS p=0.706, p=0.858, in contrary, we found significant improvement in PFS and OS p=0.032, p=0.025 in primary intestinal lymphoma (PIL) favoring use surgical approach. Conclusion Surgery is still an important strategy in case of DLBCL in PIL intestinal lymphoma however in case of PGL using chemotherapy even without rituximab achieve similar results. However our small sample size should be considered.

Background. Several studies showed better outcome in adolescents and young adults with acute lymphoblastic leukemia (ALL) treated with pediatrics protocols than similarly aged patients treated with adults protocols, while other studies showed similar outcome of both protocols. We conducted this study to compare the outcome of our pediatrics and adults therapeutic protocols in treatment of adolescents ALL. Patients and Methods. We retrospectively reviewed files of 86 consecutive adolescent ALL patients aged 15–18 years who attended to outpatients clinic from January 2003 to January 2010. 32 out of 86 were treated with pediatrics adopted BFM 90 high risk protocol while 54 were treated with adults adopted BFM protocol.We analyzed the effect of different treatment protocols on achieving complete remission (CR), disease-free survival (DFS), and overall survival (OS). Results. The 2 patients groups have almost similar characteristics. The CR was significantly higher in pediatrics protocol 96% versus 89% (