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Objective: To evaluate the outcomes of radical intent radiation therapy in early glottic carcinoma (EGC), including local control rate (LCR), disease-free survival (DFS), death specific free survival (DSFS), and overall survival (OS) rates, in Saudi patients treated at a single institution. Materials and methods: This is an institutional review board (IRB) approved, retrospective study of 27 patients with T1-2 N0 M0, early glottic carcinoma (EGC) who were treated from 2010 to 2015 at our institution with different radiotherapy (RT) fractionation regimens. The regimens included six different fractionation schedules of radiotherapy (RT): 50 Gy (20 x 2.5 Gy) dose prescribed to 95% isodose line, 52.4 Gy (20 x 2.52 Gy), 63 Gy (28 x 2.25 Gy), 66 Gy (33 x 2 Gy), and 70 Gy (35 x 2 Gy). The cohort was stratified into two groups, ≤ 52.5 Gy (n=15) and > 52.5 Gy (n=12). The median follow-up of all patients was 31.7 months (range 7-82). Results: The mean age of the cohort was 64.5 years (median 65, range: 41-83). Eleven patients (40.7%) had a history of smoking. The majority of the cohort was with T1a EGC (70.4%, n=19), and anterior commissure invasion was seen in three patients (11.1%). The mean RT doses were 55.6 Gy (range: 50-70). The five-year LCR, DFS, DSFS, and OS rates were 83.1%, 80.0%, 96.2%, and 92.6%, respectively. The LCR rates for those receiving a dose of 52.5 Gy or less were 61.3 months compared to 89.5 months for those who received more than 52.5 Gy (p=0.994). Nonsmokers and patients with an unknown smoking history achieved a five-year LCR of 100%, while patients with a positive smoking history achieved a five-year LCR of 60.6% (p=0.044). Conclusion: Radiation therapy for EGC in our patients showed reasonable five-year LCR with larynx preservation at 83.1%, DFS 80.0%, five-year OS rate 92.6%, and DSFS rate 96.2%. We found that smoking had a significant correlation with LCR. However, large prospective trials are warranted to evaluate the efficacy of overall treatment time, dose per fraction of above 2 Gy, and smoking effect.

Purpose or Objective: Our aim was to compare Vac-Lok™ and thermoplastic casts differences in interfraction set-up reproducibility in patients treated with three-dimensional conformal radiotherapy (3DCRT) for soft tissue sarcomas (STS) of extremities. Material and Methods: Retrospective review of patients with STS of extremities treated with 3DCRT was performed. Immobilization was performed for 14 patients (Vac-LOKTM= 7; thermoplastic cast = 7). A total of 307 measurements of set-up errors in each direction (vertical, longitudinal, lateral and rotational) were collected. Random (σ) and systemic errors (Σ) were computed. To evaluate the overall shift from isocenter, total vector error (TVE) was also calculated. To assess absolute mean differences between the immobilization systems, independent samples t-test was performed. Results: Median age of patients was 43.8 years (range: 18-74). Predominant STS site was lower extremity (57.1%). Preoperative RT was given to 5 patients (35.7%) and postoperative RT was given to 9 patients (64.3%). Mean displacements for the Vac-Lok™ and thermoplastic cast, respectively, were as follows: vertical, -0.01±0.06 cm vs. 0.02±0.16 cm (P = 0.63); longitudinal, 0.03±0.04 cm vs. 0.04±0.07cm (P = 0.60); lateral, 0.04±0.17cm vs. 0.00±0.11cm (P = 0.55) and TVE, 0.15±0.10 vs. 0.19±0.07 (P = 0.44). No statistical differences were seen in σ or Σ between Vac-Lok™ and thermoplastic cast. Similarly, no statistical differences were seen in the margins calculated for each axis using the two immobilization systems by using van Herk’s formula. Conclusion: Based on the findings of our study, we concluded that both the Vac-Lok™ immobilizer and thermoplastic cast had comparable results, as both systems offered better reproducibility during RT in STS of extremities without significant daily set-up displacement. A prospective study needs to be undertaken on a larger scale to better explore the outcomes of patient immobilization systems.

Introduction: Bone metastasis (BM) is a major complication of many solid tumors like breast, prostate, lung and renal cancers. BM leads to serious sequelae of pain, fractures, spinal cord compression and hypercalcemia. Radiotherapy has an established role in relieving pain caused by BM. Worldwide different radiotherapy schedules are being used for BM. The aim of this study is to determine the efficacy of single fraction palliative radiotherapy for painful bone metastases. Methods: Between April 2014 and April 2017, single fraction radiotherapy was used to treat 73 patients in our institution. They had pathologically proven breast, prostate, lung or renal cancer with radiological evidence of bone metastases. There were 39 males (53%) and 34 females (47%). The median age was 58 years (range 33–87 years). 39% patients (n = 28) had breast cancer, 35% had prostate cancer (n = 26), 23% had lung cancer (n = 17), and 3% had renal cancer (n = 2). On presentation, all the patients had a pain score of more than five on Brief Pain Inventory (BPI). Results: Response assessment to pain after three months from single fraction radiotherapy was found to be complete response (CR) in 23% patients (n = 17), partial response (PR) in 38% patients (n = 28), stable disease (SD) in 26% patients (n = 19) and progressive disease (PD) in 12% patients (n = 9). The overall efficacy of treatment was 62%, with CR 23% and PR 38%. Pre-treatment mean pain score was 8.15 compared to 4.68 post-treatment (p 0.001). Conclusions: Single fraction palliative radiotherapy of 8 Gy showed significant efficacy in painful bone metastases in our setting and merits further investigation in our population.

Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with one of the worst 5 year survival rates among all human cancer types. To date, no published data are available for the outcome of this disease in Saudi Arabia. The present study performed a single‑center, retrospective cohort study to evaluate the outcome of patients with GBM in Saudi Arabia. The Comprehensive Cancer Center at King Fahad Medical city (Riyadh, Saudi Arabia) was used in the present study. All adult patients (≥18 years) diagnosed with histologically proven GBM between January 2008 and December 2013 were included in the present study. A total of 90 patients were treated during the specified period. Of this, 73 (81%) patients underwent resection and 17 (19%) had biopsy only. The majority of patients (n=88; 98%) received radiotherapy (XRT): 67 (76%) with standard and 21 (24%) with hypo‑fractionated dosage. Of the total patients, 65 (72%) received combined modality therapy [standard XRT concurrently with Temozolmide (TMZ)]. The 6 month progression‑free survival rate was 43% for all patients and 55% for the combined modality subgroup. The median overall survival (OS) for all patients was 13.7 months. However, the median OS for patients treated with combined modality was 19.7 months. In this single‑center retrospective study, the outcomes of patients with GBM were similar to those in previously reported studies. An improved outcome was associated with an improved performance status, absence of residual disease and use of adjuvant TMZ.

Background: Electronic portal imaging device(EPID)has different dosimetric characteristics than the ionization chamber, which is considered as the gold standard detector in radiation dosimetry. The main purpose of this study was to develop the applications of EPID. Dosimetric properties of amorphous silicon EPID (aS500) need to be investigated. Materials and methods: To verify linear response with dose, images of a 10×10 cm² open field were acquired. The EPID was positioned at a fixed detector distance of 150 cm, and varying doses were delivered with monitor unit settings of 1MU and 12MU. Results: The flatness should be less than 3%. The maximum flatness value was 2.7% for field size 10×10 cm² and 1.8% for field size 18×8 cm², which are within tolerance. EPID response was compared with the chamber dose. It was found that by increasing field size, both the EPID response and chamber dose were increased. The study showed that the EPID aSi500 has the potential to be used as a relative dosimeter, making it a very simple and efficient tool for daily QA. Conclusion: All EPID measurements were performed using the linear accelerator Varian DMX. The physical characteristics measured in this work suggest that the SLIC-EPID can be used be as a relative dosimeter.

Background: Electronic portal imaging device(EPID)has different dosimetric characteristics than the ionization chamber, which is considered as the gold standard detector in radiation dosimetry. The main purpose of this study was to develop the applications of EPID. Dosimetric properties of amorphous silicon EPID (aS500) need to be investigated. Materials and methods: To verify linear response with dose, images of a 10×10 cm² open field were acquired. The EPID was positioned at a fixed detector distance of 150 cm, and varying doses were delivered with monitor unit settings of 1MU and 12MU. Results: The flatness should be less than 3%. The maximum flatness value was 2.7% for field size 10×10 cm² and 1.8% for field size 18×8 cm², which are within tolerance. EPID response was compared with the chamber dose. It was found that by increasing field size, both the EPID response and chamber dose were increased. The study showed that the EPID aSi500 has the potential to be used as a relative dosimeter, making it a very simple and efficient tool for daily QA. Conclusion: All EPID measurements were performed using the linear accelerator Varian DMX. The physical characteristics measured in this work suggest that the SLIC-EPID can be used be as a relative dosimeter.

Background: Electronic portal imaging device(EPID)has different dosimetric characteristics than the ionization chamber, which is considered as the gold standard detector in radiation dosimetry. The main purpose of this study was to develop the applications of EPID. Dosimetric properties of amorphous silicon EPID (aS500) need to be investigated. Materials and methods: To verify linear response with dose, images of a 10×10 cm² open field were acquired. The EPID was positioned at a fixed detector distance of 150 cm, and varying doses were delivered with monitor unit settings of 1MU and 12MU. Results: The flatness should be less than 3%. The maximum flatness value was 2.7% for field size 10×10 cm² and 1.8% for field size 18×8 cm², which are within tolerance. EPID response was compared with the chamber dose. It was found that by increasing field size, both the EPID response and chamber dose were increased. The study showed that the EPID aSi500 has the potential to be used as a relative dosimeter, making it a very simple and efficient tool for daily QA. Conclusion: All EPID measurements were performed using the linear accelerator Varian DMX. The physical characteristics measured in this work suggest that the SLIC-EPID can be used be as a relative dosimeter.

Background: Electronic portal imaging device(EPID)has different dosimetric characteristics than the ionization chamber, which is considered as the gold standard detector in radiation dosimetry. The main purpose of this study was to develop the applications of EPID. Dosimetric properties of amorphous silicon EPID (aS500) need to be investigated. Materials and methods: To verify linear response with dose, images of a 10×10 cm² open field were acquired. The EPID was positioned at a fixed detector distance of 150 cm, and varying doses were delivered with monitor unit settings of 1MU and 12MU. Results: The flatness should be less than 3%. The maximum flatness value was 2.7% for field size 10×10 cm² and 1.8% for field size 18×8 cm², which are within tolerance. EPID response was compared with the chamber dose. It was found that by increasing field size, both the EPID response and chamber dose were increased. The study showed that the EPID aSi500 has the potential to be used as a relative dosimeter, making it a very simple and efficient tool for daily QA. Conclusion: All EPID measurements were performed using the linear accelerator Varian DMX. The physical characteristics measured in this work suggest that the SLIC-EPID can be used be as a relative dosimeter.

micro ribonucleic acid-21 (miRNA 21) is overexpressed in multiple solid tumors, indicating that its biology is relevant to different type of cancers, in colorectal cancer (CRC), a lot of studies suggested its use as a diagnostic marker. Others as a predictive for 5-flurouracil (5 FU) sensitivity. This study was conducted to verified the significance of miRNA 21 as a prognostic and predictive marker in CRC. Patients and methods: It is a prospective study included 45 patients with stage I - IV CRC who attended at South Egypt Cancer Institute (SECI) from May 2017 to September 2018. miRNA 21 was measured by Quantitative real time polymerase chain reaction (q PCR) from peripheral blood sample and its levels of expression was correlated to the clinco pathological features of the studied patients, response to 5FU containing regimen which was assessed by response evaluation criteria in solid tumors (RECIST criteria) and to the survival. Results: High expression of the miRNA21 was significantly associated with advanced stage of CRC p 0.001, lymph node (LN) invasion p 0.001, distant metastasis p 0.01, lymphovascular invasion (LVI) p 0.01 and pre treatment level of carcinoembryonic antigen (CEA) p 0.031. Also we found that high expression of miRNA21was significantly had a bad effect on the response to 5FU containing regimen p 0.001, disease free survival (DFS) p 0.01 and overall survival (OS) p 0.01. Conclusion: miRNA 21 could be used as a non invasive prognostic and predictive marker in CRC.