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Low-Dose Involved-Field Radiotherapy in Relapsed Low-Grade Non-Hodgkin's Lymphoma in elderly Patients (Mansoura University Experience)

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Journal of Cancer Therapy 2014年第6期5卷 500-505页

作者： hend ahmed el-hadaad Hanan ahmed Wahba Ibrahim Awad Clinical Oncology and Nuclear Medicine Mansoura University Mansoura Egypt

Purpose: To assess the response rate, duration of response and prognostic factors affecting response after low-dose involved-field radiotherapy in patients with relapsed low-grade B-cell non-Hodgkin lymphoma. Patients and Methods: Forty-four patients were included. Patients were treated with a total dose of 4 Gy (2 × 2 Gy) using 6 - 15 Mv photon or electron beam. Results: most patients were above age of 60 years (59%) with male predominance. Follicular lymphoma was the most common pathological type;bulky disease (>5 cm) was presented in 61.4%. Patients who received only 2 regimens were 63.7% and 31.8% had >2 involved sites. No treatment related toxicity was observed. The overall response rate was 88.7%;complete response was reached in 59.1% and stable disease in 6.8%, progressive disease in 4.5%. Median time to local progression was 33 months (95% CI 23.70 - 42.29);2-year local progression free survival was 78%. Response rate was found to be dependent on age, number of involved sites and lymph node size but independent on sex, pathological type, number of prior regimens, LDH level and time since diagnosis. Conclusion: Short-course-low dose palliative radiotherapy (2 × 2 Gy) affords an attractive option for treatment of relapsed low-grade non-Hodgkin’s lymphoma due to high response rates. However, these results had to be confirmed in a larger number of patients.

关键词： Low-Grade Lymphoma Relapsed Non-Hodgkin’s Lymphoma Low-Dose Radiotherapy in Lymphoma

Concomitant Boost Radiotherapy after Conservative Breast Surgery in Early Breast Cancer

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Advances in Breast Cancer Research 2016年第3期5卷 97-102页

作者： hend ahmed el-hadaad Hanan ahmed Wahba Waleed elnahas Sameh Roshdy Clinical Oncology & Nuclear Medicine Mansoura University Mansoura Egypt Surgical Oncology Unite Mansoura Oncology Center Mansoura Egypt

Background: Radiation therapy after breast conserving surgery is a standard part of treatment for invasive breast cancer. Based on radiobiological models, it was found that shorter radiation schedules offered the promise of equivalent local control to standard radiation therapy by giving larger doses per fraction in shorter period of time. Methods: This study included 36 female patients with operable invasive stage I-II breast cancer. These patients underwent microscopic wide local excision of the primary tumor and lymph node dissection. They received adjuvant radiotherapy. The radiation dose was 40 Gy total dose in 15 fractions for whole breast and additional dose of 9 Gy in three consecutive fractions was delivered to tumour cavity simultaneously. Results: Mean age was 52 years (range: 30 - 67);most patients were of stage II disease and Grade II was the most common one. Invasive ductal carcinoma was reported in 94.4% and 72.2% of patients were hormone receptor positive. After median follow-up of 52 months, all patients were alive and ipsilateral local recurrence was reported in 1 case only. Grade IV radiation toxicity was not observed;moist desquamation was the most common acute reaction (61%) with grade III in 5.5% followed by dry desquamation in 55.6% of grade I only. Grade I erythema was recorded in 41.7% and grade II in 11%. Fibrosis was the most frequent late reaction (44.3%) with grade II in 11% followed by telengectesia then pigmentation (41.7%, 33.3% respectively). Conclusion: The regimen used in this study appears promising with acceptable acute toxicities and convenient for our patients and has the advantage of economic use of radiation facilities. However, larger number of patients and longer period of follow-up are needed for further evaluation.

关键词： Conservative Breast Surgery Radiotherapy Concomitant Boost Breast Cancer

Induction chemotherapy followed by weekly paclitaxel and carboplatin with concurrent radiotherapy in inoperable stage Ⅲ non-small cell lung cancers: results of a phase Ⅱ trial

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The Chinese-German Journal of Clinical Oncology 2013年第2期12卷 56-60页

作者： hend ahmed el-hadaad Hanan ahmed Wahba Eman Toson Clinical Oncology and Nuclear Medicine Department Faculty of MedicineMansoura University

Objective： several trials have suggested the superiority of concurrent chemoradiotherapy. It has been hypothesized that the addition of systemic dose sequential chemotherapy to concurrent chemoradiotherapy, as induction or as consolidation, might further improve survival rates. So we sought to evaluate the safety and efficacy of induction paclitaxel and carboplatin followed by weekly paclitaxel and carboplatin with concurrent radiotherapy in inoperable stage III non-small cell lung cancer （NSCLC）. Methods： Fifty-six patients with stage III inoperable NSCLC received induction chemotherapy with 2 cycles of paclitaxel 200 mg/m2 and carboplatin AUC-6 every 3 weeks then patients were assigned to concurrent chemoradiotherapy with paclitaxel 45 mg/m2 and carboplatin AUC-2 weekly along with concurrent radiotherapy at dose of 60 Gy （1.8 Gy/d x 5 d/week）. Results： Median age of the 56 eligible patients was 61 years, most of them were males （87.5%）. Squamous cell carcinoma was the most common pathological type （55.4%） and 85.7% had a performance status of 1. The majority of patients were presented with stage IIIB （62.5%）. Neutropenia was the most common toxicity during induction therapy （12.5% expressed grade 3） whereas esophagitis was the most common non hematologic adverse reaction during concurrent chemoradiotherapy （14.3% of grade 3）. The overall response rate was 71.6% with complete response in 19.6%. After median follow up of 20 months, the median survival time was 13 months （95% CI： 10.917-15.083） and 1 year overall survival rate was 53.6%. Conclusion： This regimen has demonstrated an acceptable toxicity profile and encouraging response to treatment. Evaluation of this regimen in larger number and a phase III trial are recommended.

关键词： induction chemotherapy non-small cell lung cancer (NSCLC) carboplatin paclitaxel concurrent radiotherapy

Adjuvant Pelvic Radiotherapy *** Chemoradiotherapy for High-Risk StageⅠ-ⅡEndometrial Carcinoma

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Clinical oncology and cancer researeh 2012年第3期9卷 168-171页

作者： hend ahmed el-hadaad Hanan ahmed Wahba Anas Mohamed Gamal Tamer Dawod Department of Clinical Oncology and Nuclear Medicine Mansoura University Gynecology and Obstetrics Mansoura University Medical Physics Mansoura University

Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival （OAS）, and progression free survival （PFS）; to assess the incidence of relapses over standard pelvic radiotherapy; and to evaluate the related toxicity in high-risk stage I-II endometrial carcinoma Methods Medical records were reviewed to identify high-risk stage I-1I endometrial carcinoma cases treated in the Clinical Oncology and Nuclear Medicine department between 2002 and 2008 with adjuvant radiotherapy alone （arm Ⅰ）（57 patients） or with sequential carboplatin （AUCS-6） and paclitaxel （135-175 mg/m^2） with radiotherapy （arm Ⅱ）（51 patients）. Radiotherapy was performed through the four-field box technique at doses of 45-50 Gy （1.8 Gy/day × 5 days/week）. Results The toxicity was manageable and predominantly hematologic with a grade 3 neutropenia and thrombocytopenia in 9.8% and 6% of the patients in arm Ⅰ and arm Ⅱ, respectively, without febrile neutropenia. All patients experienced hair loss. Chernoradiotherapy arm was associated with a lower incidence rate of relapse （9.8% vs. 22.7%）. After a median follow-up period of 48 months, the 5-year OAS and PFS rates for chemoradiotherapy-treated patients were significantly more favorable than those who did not receive chemotherapy （P=0.02 and 0.03, respectively）. In arm I, the OAS and PFS rates were 73.7% and 66.7% compared with those in arm II, whose rates were 90.2% and 84.3%. Conclusions Adjuvant chemoradiation with paclitaxel and carboplatin improved the survival rates and decreased the recurrence rates in patients with high-risk stage Ⅰ-Ⅱ endometrial carcinoma. Chemotherapy was associated with an acceptable rate of toxicity. However, a prospective study with a larger number of patients is needed to define a standard adjuvant treatment for high-risk stage Ⅰ-Ⅱ endometrial carcinoma.

关键词： stage I-II high-risk endometrial cancer adjuvant radiotherapy adjuvant sequential chemoradiotherapy

Impact of Thyroglobulin on Survival and Prognosis of Differentiated Thyroid Cancer

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Journal of Cancer Therapy 2018年第9期9卷 706-713页

作者： Hanan ahmed Wahba hend ahmed el-hadaad Abeer Hussien Anter Alaa M. Wafa ahmed Negm Clinical Oncology & Nuclear Medicine Department Faculty of Medicine Mansoura University Hospital Mansoura Egypt Internal Medicine Department Faculty of Medicine Mansoura University Hospital Mansoura Egypt General Surgery Department Faculty of Medicine Mansoura University Hospital Mansoura Egypt

Proper assessment of risk factors contributes to the principle management of differentiated thyroid carcinoma post operatively. Aim of the study: to investigate the effect of Thyroglobulin (Tg) levels on prognosis together with other risk factors for Differentiated Thyroid Cancer (DTC). Patients and methods: Medical records of all patients with DTC presented to Clinical Oncology and Nuclear Medicine Department referred from Diabetes & Endocrine unit (Internal Medicine Hospital) and Surgery Department Mansoura University from 2011-2016 were retrospectively reviewed. Patients with distant metastasis or who lost follow-up were excluded. So data of 220 patients were analyzed. Data collected included pre-surgical assessment, also surgical interference either total or near total thyroidectomy with or without lymph node neck dissection were reviewed. Different prognostic factors that affect progression free survival (PFS) include age, umorsize, ymph node status, ex, multifocality, capsular infiltration, vascular invasion and Tg level were evaluated through multivariate analysis. Results: Most of the patients included were el ≤ 10 ng/ml (68.2%). About 70% received ablative radioiodine. The 5-year Progression Free Survival (PFS) was 85%. On multivariate analysis of variable prognostic factors on PFS, we found that tumor size, age, lymph node status, capsular infiltration, Tg level and vascular invasion significantly affected PFS (P = 0.01, 0.005, 0.004, 0.005, 0.02, 0.003) respectively. While sex, pathological type and multifocality were not (P = 0.9, 0.4, 0.6) respectively. Conclusion: Postoperative Tg level is a statistically significa

关键词： Thyroglobulin Thyroid Cancer Differentiated Thyroid Cancer Risky Factors

Survival and Prognostic Factors in Patients with Carcinoma of Cervical Stump

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Journal of Cancer Therapy 2015年第11期6卷 1008-1012页

作者： Hanan ahmed Wahba hend ahmed el-hadaad Waleed Nabeel Abozeed Waleed elnahas Sameh Roshdy Anas Gamal Clinical Oncology and Nuclear Medicine Mansoura University Mansoura Egypt Surgical Oncology Unit Mansoura Oncology Center Mansoura University Mansoura Egypt Obstetrics and Gynecology Mansoura University Mansoura Egypt

Purpose: To evaluate patients with carcinoma of cervical stump (CCS) and analyse different clinico-pathologic factors affect prognosis. Patients and Methods: This study was carried out through review of clinical records of patients. Recorded data included information on age, tumor stage, presenting symptoms, size of tumor, histopathology, grade, type, cause of subtotal hysterectomy (STH), treatment and follow-up results. Staging according to International Federation of Gynecology and Obstetrics (FIGO) staging system was done through: PHYSICAL examination, pelvic examination under anaesthesia, chest X-ray, magnetic resonance imaging (MRI) of the abdomen and pelvis, cystoscopy, rectosigmoidoscopy and intravenous pyelography. Prognostic factors as age, size of tumor, stage, lymph node (LN) involvement, pathological type, grade and type of CCS either true or coincidental were analysed through multivariate analysis. Results: 62% of patients are above 50 years with stage II in 48.7%. Squamous cell carcinoma was more common but 54% are of GIII. 89% were true CCS. Positive lymph nodes were reported in 27%. The predominant reason for STH was abnormal bleeding (73%). In about 95% of cases, women seeked medical attention because of symptoms and the most common presenting symptom was bleeding (54%). According to the stage and performance status of patients, treatment consisted of radiotherapy either external or interstitial, chemotherapy and chemoradiotherapy. Through multivariate analysis, the following was found to have adverse impact on survival: Coincidental type (P = 0.04), high grade (P = 0.03), advanced stage (P = 0.01), larger tumor size (P = 0.02), lymph node involvement (P = 0.029) and older age (P = 0.035). While pathological type was not (P = 0.52). After median follow-up of 52 months;5-year overall survival was 65%. Conclusion: CCS has a low morbidity. Adverse survival outcomes can be anticipated in those patients with: high grade lesions, advanced stages, large tu

关键词： Carcinoma of Cervical Stump Chemo-Radiotherapy Radiotherapy Survival and Prognostic Factors

Outcomes and Prognostic Factors of Small Cell Lung Cancer: A Retrospective Study

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Advances in Lung Cancer 2018年第3期7卷 21-31页

作者： Hanan ahmed Wahba hend ahmed el-hadaad Abeer Hussein Anter Magda Abdel-Salam Ahmad Hayam Fathy Abd-el Hay Ghazy Faculty of Medicine Mansoura University Hospital Mansoura Egypt Chest Medicine Department Mansoura University Hospital Faculty of Medicine Mansoura Egypt Medical Oncology Department Mansoura Oncology Center Faculty of Medicine Mansoura Egypt

Background: Small cell lung cancer (SCLC) is a high grade neuroendocrine tumor, and has aggressive nature, so the majority of cases are presented with extensive disease. SCLC was staged into 2 categories: limited-stage disease (LS-SCLC) and extensive disease (ES-SCLC). Despite SCLC is sensitive to ra-diotherapy and chemotherapy, SCLC has high tendency for rapid dissemina-tion to regional and distant sites. Median survival time ranged from 2 - 4 months in patients with untreated SCLC. Multiagent chemotherapy was the primary treatment for SCLC. Aim of the work: This retrospective study was conducted to evaluate and analyze clinical features, treatment outcome, sur-vival and prognostic factors affecting survival in patients with SCLC presented to Clinical Oncology and Nuclear Medicine department, Chest department and Medical oncology unit in Mansoura Oncology Centre during the period from 2000-2015. Methods: Data of patients were collected from their files. The information obtained included demographic features, treatment received;its toxicity and outcome, survival and its prognostic factors. Demographic data were: age, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), smoking status, stage of disease. Data also included disease presentation and metastatic sites. Several factors affecting survival were analysed as age, sex, stage, PS, smoking status and LDH. Results: Sixty-three patients were enrolled in this study. Median age was 56.2 ± 6. Strong male predominance (92.1%) was observed;84.1% of them were smoker. Thirty six patients (57.2%) were of ECOG-PS of 0 - 1. ES-SCLC was reported in 65% of cases and LDH was high (>1.5 xN) in 47.6%. The most common symptom was chest pain (38.1%) followed by cough (31.8%), weight loss (30%). Fifteen patients had single metastatic site (23.8%) and bone was the most common site of metastasis (reported in 8 patients) followed by brain, lung and liver. 2-year overall survival rate was 35% with median survival time of 14

关键词： SCLC Lung Cancer LS-SCLC ES-SCLC

Adjuvant chemoradiotherapy versus surgery alone for gastric adenocarcinoma

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The Chinese-German Journal of Clinical Oncology 2011年第8期10卷 450-454页

作者： Yasser Saleh Hanan ahmed Wahba hend ahmed el-hadaad Mohamed Al-Hemaly Tamer Fady Youssef Department of Clinical Oncology and Nuclear Medicine Faculty of MedicineMansoura University Department of Gastro-Entrology Surgery Faculty of MedicineMansoura University Department of Surgical Oncology Faculty of MedicineMansoura University

Objective:Despite resection with curative intent,a majority of patients with gastric cancer will develop disease *** adjuvant chemo-radiotherapy increase the curability of surgery,prevent local recurrence and improve ***:Between December 2005 and February 2010,33 patients were eligible for the study,17 patients were randomly assigned for chemo-radiotherapy (GI) and 16 patients with surgery alone (GII).Patients in GI received chemotherapy (fluorouracil,425 mg/m 2/day,and leucovorin,20 mg/m 2/day,for 5 days) was initiated on day 1 and was followed by chemo-radiotherapy beginning 28 days after the start of the initial cycle of ***-radiotherapy consisted of 4500 cGy of radiation at 180 cGy/day,five days/week for five weeks,with fluorouracil (400 mg/m 2/day) and leucovorin (20 mg/m 2/day) on the first four and the last four days of *** month after the completion of radiotherapy,two five-day cycles of fluorouracil (425 mg/m 2/day) plus leucovorin (20 mg/m 2/day) were given one month ***:Grade 3 gastrointestinal toxicity was more common (23.2%) while grade 3 hematological toxicity were (5.8%).Both 3-year survival (53%) and disease free survival (41%) rates were higher in GI than in GII in which they were 43.7% and 31% *** rate was higher in GII (56.3%) than in GI (35.3%).Conclusion:The present study revealed that chemo-radiotherapy after gastric resection in patients with gastric adenocarcinoma improves survival and relapse rates with manageable ***,studies with larger number of patients are recommended to confirm our results.

关键词： adjuvant chemoradiotherapy gastric carcinoma surgery radiotherapy

Gemcitabine and Docetaxel as a Second-Line Treatment in Advanced Soft Tissue Sarcomas

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Clinical oncology and cancer researeh 2011年第3期8卷 133-137页

作者： hend ahmed EI-hadaad Hanan ahmed WAHBA Clinical Oncology and Nuclear Medicine Faculty of Medicine Mansoura University Mansoura Egypt.

OBJECTIVE Promising anti-tumor activity in patients with metastatic or unresectable soft tissue sarcomas has been reported with gemcitabine and/or docetaxel. METHODS Forty patients with advanced soft tissue sarcomas refractory to first-line chemotherapy treatment were enrolled. They received combination of gemcitabine at dose of 900 mg/m2 on days 1 and 8 and docetaxel at dose of 100 mg/m2 on day 8, and had this regimen repeated every 3 weeks. If the patients had received the pelvic irradiation in advance, gemcitabine dose was reduced to 675 mg/m2 on days 1 and 8 and docetaxel to 75 mg/m2 on day 8, and had it repeated every 3 weeks. RESULTS Gemcitabine/docetaxel combination was well tolerated by the patients with an overall response of 20%. After median follow-up of 15 months, a median overall survival time was 12 months （95% CI 7.042-16.958） and a median progression free survival time was 6 months （95% CI 5.445-6.545）. The most common hematologic toxicity was neutropenia （47.5%） while mucositis was the most common nonhematologic toxicity （45%）. The 1- and 2- year survival rates were 50% and 15%, respectively. CONCLUSION This regimen of gemcitabine/docetaxel combination as second-line treatment for the patients with advanced soft tissue sarcomas is effective with acceptable toxicities. These results should be evaluated in a large phase III trial.

关键词： soft tissue sarcomas gemcitabine docetaxel secondline chemotherapy