The Prognostic and Curative Benefits of Primary Tumor Resection versus No Resection in Stage IV Colorectal Cancer: A Comparative Study

Background: Colorectal cancer (CRC) who is initially diagnosed with single or multiple synchronous distant metastases has an incidence of about 20% of all CRC patients. There is a controversy regarding the role of resection of the primary tumors in those patients. The aim of this study was to explore the prognostic roles and survival advantages of surgical excision of the primary colonic tumor in patients with CRC who are primarily diagnosed with distant metastases. Patients and Methods: We included forty patients who were diagnosed initially with stage IV CRC. We have divided the included patients into two categories the first one included 20 patients that underwent surgical excision of the primary cancer followed by administration of chemotherapy and the remaining 20 patients were initially given chemotherapy without excision of the cancer. We followed patients for 24 months to detect progression, response to chemotherapy, recurrence free survival and overall survival rates. Results: There is statistically significant difference between patients underwent different initial management techniques regarding N stage of the tumor (p = 0.039), response to chemotherapy (p = 0.048), occurrence of relapse (p = 0.022), disease free survival (DFS) (p = 0.027) or overall survival (OS) rates (p = 0.001) (DFS and OS were significantly higher among patients who received initial surgical management. Primary surgical removal of the tumor improved OS rate by 8 months (p = 0.001). Conclusion: Surgical removal of the primary malignancy in mCRC patients before chemotherapy administration improves patients’ survival rates and response to chemotherapy that lead to a better prognosis.

CRKL and CK2 <i>β</i>over Expression Are Independent Predictors of Patients Survival in Endometrioid Endometrial Carcinoma

Context: The prognostic significance of expression of V-Crk avian sarcoma virus CT10 oncogene homolog-like (CRKL) and Protein kinase CK2 β in endometroid carcinoma is not fully clarified. Aim: To assess the prognostic values and clinicopathological roles of CRKL and CK2 β expression in endometroid carcinoma by correlation their expression levels with clinicopathological parameters, response to therapy, and recurrence of the tumor and patients survival. Settings: Faculty of Medicine, Zagazig University, and Mansoura University. Methods: CRKL and CK2 β expressions were evaluated in 50 paraffin blocks EC patients that were followed up for 5 years. The relationship between their level of expressions, clinicopathological criteria and prognosis of patients was analyzed. Statistical analysis used: SPSS 22.0 for windows (SPSS Inc., Chicago, IL, USA) and MedCalc windows (Software bvba 13, Ostend, Belgium). Results: High expression of CRKL and CK was positively correlated with higher grade of the tumor (p = 0.004 and 0.006 respectively), presence of L.N metastases (p = 0.009 and 0.003 respectively), presence of distant metastases (p = 0.029 and 0.003 respectively) and advanced FIGO stage (p 0.001), poor response to therapy (p = 0.046 and 0.005 respectively), higher incidence of recurrence of the tumor after therapy (p = 0.004 and 0.048 respectively), higher incidence of cancer progression p = 0.018 and 0.044 respectively), poor PFS (p = 0.008 and 0.013 respectively), and OS rates

Optimizing Adjuvant Radiation Planning Outcomes in Patients with Synchronous Bilateral Breast Cancer

Background: Breast cancer is the most common cancer diagnosed worldwide, synchronous bilateral breast cancer accounts for unique entity of the disease, particularly post-operative radiotherapy for Synchronous Bilateral Breast Cancer (SBBC) is challenging with lack of evidence about the best irradiation technique. In this study, we tried to explore the optimum radiotherapy technique regarding the dosimetric parameters. Methods: We recruited 15 SBBC patients in whom post-operative radiotherapy was indicated and we established three plans for each patient using 3DCRT, IMRT and VMAT, and then we compared the three plans as regard target volume coverage parameters and organs at risk (OAR) doses. Results: We found that PTV coverage parameter was superior with IMRT compared with 3DCRT and VMAT in terms of Dmean (p = 0.001), D95% (p = 0.001), Dmax (p = 0.0001), conformity index (p = 0.0001) and HI (p = 0.0001). Doses to OAR were not significantly different between the three techniques in cardiac dose and LAD maximum dose, but 3DCRT was superior in LAD mean dose (p = 0.03) and lung volume receiving 20 Gy (V20) and 10 Gy (V10) (p = 0.0001), but this difference was non-significant between 3DCRT and IMRT (p = 0.4 and 0.06 respectively), while VMAT led to the highest doses to LAD and lung. Conclusions: IMRT showed the best target coverage parameters in post-operative radiotherapy for SBBC compared with 3DCRT and VMAT. For OAR doses IMRT showed comparable results with 3DCRT, while VMAT delivered a significantly higher dose to OAR.