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Toxicity of Hypofractionated Radiotherapy Following Breast Conservative Surgery in Breast Cancer

Journal of Cancer Therapy 2019年第5期10卷 371-381页

作者： Aiat Morsy Sara H. Hammouda Samir Shehata ali zedan Clinical Oncology and Nuclear Medicine Department Faculty of Medicine Assiut University Assiut Egypt Radiotherapy Department South Egypt Cancer Institute Assiut University Assiut Egypt Department of Surgical Oncology South Egypt Cancer Institute Assiut University Assiut Egypt

Background:Adjuvant radiotherapy has increased disease-free and overall survival rates in breast cancer. Conventionally fractionated radiotherapy delivers 50 Gy over 5 weeks which is the standard approach. A shorter duration of hypofractionated radiotherapy (HFRT) will be more convenient for patients and treatment providers if found safe and equally effective. Material and Methods: Fifty-four breast cancer patients who underwent breast conservative surgery (BCS) were enrolled in this study. The patients received 4005 cGy/15 fractions. A boost to the tumor bed was administered in all patients. In this study, radiotherapy induced toxicity was evaluated. Results: In this study, the median age of our patients was 48 years with age ranged from 28 to 69 years. Acute skin toxicity was assessed, and it was noted that grade 2 skin toxicity was shown in only 6 patients (11.1%) at the end of radiotherapy and disappeared after 6 weeks of treatment. Late skin toxicity (telangectasia, hyperpigmentation, and subcutaneous fibrosis) was assessed and showed that most patients had grade 0 toxicity with no grade 3 toxicity at all. Regarding pulmonary toxicity, 5 patients (9.3%) developed acute pneumonitis and as regards chronic lung toxicity, it was evident in only 3 patients, 2 patients (3.7%) were grade 1 and 1 patient (1.9%) was grade 2. Cardiac toxicity was evident in 2 patients (7.1%) of the left breast cancer patients. Regarding lymphoedema, most patients that showed lymphoedema were grade 1. Conclusion: The results confirm the safety and feasibility of adjuvant hypofractionated whole breast radiotherapy in breast cancer patients in terms of acute and late toxicity.

关键词： Breast Cancer Hypofractionated Radiotherapy Breast Conservative Surgery Toxicity

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Intersphincteric Resection Is the Optimal Procedure for Very Low Rectal Cancer: Techniques, Morbidity, Oncologic and Functional Outcomes

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Journal of Cancer Therapy 2019年第5期10卷 400-410页

作者： ali zedan Anwar Tawfik Ebrahim Aboeleupn Asmaa Salah Aiat Morsy Surgical Oncology Department South Egypt Cancer Institute Assiut University Egypt Radiation Oncology & Nuclear Medicine Department South Egypt Cancer Institute Assiut University Egypt Clinical Oncology and Nuclear Medicine Department Faculty of Medicine Assiut University Egypt

Background: The intersphincteric resection the most extreme form of a sphincter-preserving alternative for the abdominoperineal resection. Aim of the Work: We investigated oncological, functional outcomes and morbidity after ISR. Methods: This retrospective study included 164 patients who underwent ISR with between 2010 and 2015, Male 56.1%, Female 43.9%, with a median age was 54.5 years, Median follow-up time was of 48 months, Average surgical time was 230 min, Median blood loss was 700 mL and median hospital stay was nine days. Mean tumour size was34 mm. The surgical procedure through a laparotomy (72.6%), laparoscopically (27.4%). Neoadjuvant radiotherapy 89.6% {long-course radiotherapy 74.4%, short-course radiotherapy 15.2%}, neoadjuvant chemotherapy 28.7% and adjuvant chemotherapy 70.1%. Colonic J-pouch 16.5%, Transverse coloplasty 15.9%, a side-to-end anastomosis 26.8% and straight coloanal anastomosis 40.9%. Partial-ISR 36.6%, subtotal-ISR 37.2%, total-ISR 26.2%, diverting ileostomy 6.7%. Results: Operative mortality 1.2%, morbidity 14.6% (anastomotic leakage 3.7%, anastomotic stenosis 1.8%, a recto-vaginal fistula 2.4% bowel obstruction 3%, surgical site infection 3%. Respiratory tract infection 1.2%, local 7.9%, distant recurrence 15.2%, 5-year overall 79.8%, disease-free survival 75.8%, R0 resection 95.1%. Pathologic complete response 11%. Circumferential margin involvement 2.4%. Median number of lymph nodes 17. Mean distal margin20 mm, after 12 months Median Wexner score 6. Incontinence for (flatus 11%, liquid 4.9%, solid 4.3%). Median bowel motions in a 24-h were 3. Faecal urgency 17.7%. Stool fragmentation 18.9%. Difficult evacuation 17.7%, lifestyle alteration 14.6%. Difficulty Feces/flatus discrimination 43.3%. Nocturnal soiling in 17.1%. Daytime soiling 11%. Pad wearing 23.8%. Anti-diarrhoea medication loperamide 14%. Conclusion: ISR is a feasible surgical procedure for low rectal cancer. Oncologic and functional, outcomes after are acceptable.

关键词： Intersphincteric Resection ISR Cancer Rectum Functional Outcomes Oncologic Outcomes

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Complications of Parotid Surgery—10 Years’ Experience

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Journal of Cancer Therapy 2020年第5期11卷 306-323页

作者： ali zedan Khalid Rezk Anwar A. Elshenawy Ola Nabih Haisam Atta Department of Surgical Oncology South Egypt Cancer Institute Assiut University Assiut Egypt Department of Surgical Oncology Aswan University Assiut Egypt Department of Clinical Oncology Assiut University Assiut Egypt Department of Diagnostic Radiology South Egypt Cancer Institute Assiut University Assiut Egypt

Background: Parotid surgery with dissection of the facial nerve branches is a technically challenging surgery. Even in experienced hands, parotidectomy has well-documented post-operative complications. We aim to evaluate complications following parotid surgery. Methods: We retrospectively reviewed the charts of 187 patients who underwent parotidectomy from January 2010 to January 2020 performed in surgical oncology department South Egypt Cancer Institute, Assiut University, from patients (57.3% males and 42.7% females, average age 42.96 years). Results: 78.4% Patients had benign tumors, the most frequent being pleomorphic adenoma 55.1% followed by Warthin’s tumour 16.9%, and 21.6% malignant tumors, mucoepidermoid carcinoma being the most frequent. Superficial parotidectomy was the most common surgery 40.4% performed followed by 25.3%, total conservative parotidectomy, while 1.1%, underwent radical parotidectomy, (extended radical parotidectomy was performed 2.2%), and revision total parotidectomy (Recurrence 6.7%, and parotidectomy with modified radical neck dissection (MRND) 7.9%. The most common complication following parotidectomy was transient facial nerve palsy 21.3%. Permanent facial nerve paresis was observed in 3.9%, sensory deficit in 20.2%, sialocele in 6.7%, hematoma formation 3.4% and wound infection in 7.3%, and recurrence 7.3%. Frey’s syndrome occurred in 7.3% and salivary fistula 5.1%. Conclusion: Parotidectomy is safe procedure causing minimal complications. Transient facial palsy is the most common postoperative complication.

关键词： Pleomorphic Adenoma Major Salivary Gland Painless Swelling

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Complication versus Radicality in Papillary Thyroid Cancer Surgery: How to Keep the Balance?

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Journal of Cancer Therapy 2019年第12期10卷 1013-1024页

作者： ali zedan Badawy M. Ahmed Mohamed Ismail Omar Waleed Ahmed Diab Hemat A. Mahmoud Haisam Atta Surgical Oncology Department South Egypt Cancer Institute Assuit University Assiut Egypt Nuclear Medicine Department South Egypt Cancer Institute Assuit University Assiut Egypt Diagnostic Radiology Department South Egypt Cancer Institute Assuit University Assiut Egypt

Background: Controversy exists over the extent of surgical treatment of papillary thyroid *** may carry a significant risk of surgical complications. The aim of this study is to investigate the complications following surgical treatment of thyroid cancer and the association between the?extent of surgery and complication rates. Methods: A total of 196 patients with papillary thyroid cancer were retrospectively reviewed to identify extent of surgery and associated complications, between 2009 and 2018 atSouth Egypt Cancer Institute Assiut University. Results: Primary procedures included less-than-total thyroidectomy (near total thyroidectomy in 5.1%, subtotal thyroidectomy in 4.1%, thyroid lobectomy in 3.1%) and total thyroidectomy in 87.8% (18.9% of them are completion thyroidectomy). No lymph nodes dissection was done in 10.7%, Berry picking in 6.1%, central compartment neck dissection in 41.8%, central compartment neck dissection with modified ipsilateral radical neck dissection in 12.2%, central compartment neck dissection with modified bilateral radical neck dissection in 26.0%, central compartment dissection with both modified bilateral radical neck dissection and superior mediastinal lymph node dissection 3.1%. The most common surgical complication were transient hypoparathyroidism (16.7% - 45.8%) and 2.0% permanent, transient vocal cord palsy (7.3% - 16.7%), and 3.9% permanent, hematoma 1.5%, seroma 7.1% and chyle fistula in 2.6% of patients. Conclusion: Thyroid cancer surgeries are safe. The transient complication rates of hypoparathyroidism increased significantly with increasing the extent of surgery.

关键词： Complications Thyroid Cancer Thyroidectomy Lymph Node Dissection

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