Capecitabine and Oxaliplatin versus 5-Fluorouracil in the Neoadjuvant Chemoradiation for Patients with Locally Advanced Rectal Carcinoma: A Comparative Study

Aim of work: This study aimed to evaluate the resectability rate, rate of conservative surgery, toxicity, local control, and disease free survival for oxaliplatin and capecitabine based chemoradiation compared to standard 5-FU based chemoradiation in locally advanced cancer rectum. Patients and methods: 65 patients were eligible;33 patients received oxaliplatin and capecitabine based chemoradiation (arm I) and 32 patients received 5-FU based chemoradiation (arm II). Results: The overall response rate in arms I and II were 78.7% and 87.5% respectively. Conservative surgery was done in 81.81% and 53.13% of patients with arms I and II, pathologic complete response (pCR) rate was significantly better in arm I than arm II (30.3% vs. 21.9%, P < 0.01). 3-year recurrence rates were 54.5% and 56.2% in arms I, II respectively;the median disease free survival (DFS) were 30 months and 15 months in arms I and II respectively. Grade III anemia, grade IV diarrhea and severe proctitis were developed in a significantly large number of patients with arm I;in addition deep venous thrombosis (DVT) was developed in 15.15% of patients with arm I but none in arm II. Conclusion: The addition of oxaliplatin to the preoperative chemo radiation increased the response rate mainly pCR rate which was considered a target goal in the neoadjuvant treatment, but it was not recommended because of higher toxicity and no significant effect on DFS in different response groups of arm I when compared to arm II, but longer follow up may be needed to evaluate the overall survival.

Comparison Study between Extracorporeal and Intracorporeal Anastomosis for Laparoscopic Right Hemicolectomy

Background: Nowadays, laparoscopic colectomy is considered a safe and effective surgical technique regarding short- and long-term outcomes, as well as specific oncologic outcomes. The anastomosis can be created intra- or extracorporeally. The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Aim of the Study: The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Methods: In the period from December 2014 to January 2019, all patients underwent laparoscopic right hemicolectomy for cancer colon who presented to surgical oncology department—south Egypt cancer institute and general surgery department—Assiut University was analyzed. Data like age, sex, body mass index (BMI), operative technique, operative times, blood loss, intra- and post-operative complications, pathology and hospital stay were reported and analyzed. Results: Twenty three (69.7%) patients underwent extracorporeal anastomosis while intracorporeal anastomosis was performed in ten (30.3%) patients. There was no significant difference in patient characteristics and demographic data in both groups (P > 0.05). There was no statistically significant difference in operative (operative time, blood loss or length of hospital stay) and postoperative (ileus, anastomotic leak, wound infection, incisional hernia, readmission, reoperation or deaths) details in the 2 groups except in length of the incision which was significantly shorter in the IA group (5.500 ± 1.269) vs. (6.565 ± 1.308) for EA (P = 0.015). Conclusion: No significant difference in short term outcomes of laparoscopic-assisted and total laparoscopic right colectomy. Intracorporeal anastomosis had shorter incision which may decrease wound-related complications.

Accelerated Hyper Fractionated Radiotherapy in Localized Ewing’s Sarcoma with or without Surgery: What’s New? A Phase II Study

Background and aim of work: We aimed from this study to determine the response and local relapse free survival (RFS) of pediatric patients with localized Ewing’s sarcoma treated with accelerated hyper-fractionated RT. Patient and methods: This study was a nonrandomized uncontrolled phase II study and was conducted at clinical oncology department and south Egypt cancer institute;it involved 28 patients with histologically confirmed Ewing’s sarcoma;all of them were subjected to PET/CT whenever possible or MRI with contrast of the primary site, MSCT chest, bone scan, and LDH to ensure absence of metastasis followed by the protocol of accelerated hyper fractionated RT. Results: The overall response rate (ORR) was 92.9% by MRI with significant effect of the type of response on local RFS (P 0.002). The median local RFS of 28 patients with localized Ewing’s sarcoma was 30 ± 8.599 months with 95% CI = 13.147 - 46.853;the 3-year local control was 35%. Conclusion: Accelerated hyper fractionated RT didn’t achieve better results than standard fractionation RT, but it is recommended to be done on a large sample size, and multiple centers, and continued follow up is also recommended to evaluate 5-year LRFS, 5-year OS.

Evaluation of GALAD Score in Diagnosis and Follow-up of Hepatocellular Carcinoma after Local Ablative Therapy

Background and Aims:Strategies for detection of early hepatocellular carcinoma(HCC)are still limited.The GALAD score is a serum biomarker-based model designed to predict the probability of having HCC.We aimed to assess the ability of GALAD score to diagnose early HCC and its validity to follow patients after local ablation therapy.Methods:This multicenter prospective study included 108 patients in two groups,58 HCC patients(67 focal lesions)with local ablative therapy(study group),and a control group of 50 patients with liver cirrhosis.The GALAD scores of the study and control groups,and of the HCC patients before and after ablative therapy were compared.Results:Most patients were men(74.1%in study group and 76%in controls)with hepatitis C virus infection(98.30%in the study group,and 94%in controls).GALAD scores were significantly higher in HCC patients than in those with benign cirrhosis(2.65 vs.−0.37,p=0.001).Ablative therapy was successful in 94.4%of focal lesions<2 cm,and in 86.10%of 2–5 cm lesions.The GALAD score was also significantly lower at 1 month after ablation in patients with well-ablated tumors(2.19 vs.0.98,p=0.001).The best cutoff values of GALAD score for diagnosis of early HCC,and for prediction of well ablation of HCC were 0.74 and≤3.31(areas under the curve of 0.92 and 0.75,sensitivities of 84.48%and 76.19%,specificities of 89.13%and 83.33%,positive predictive values of 90.74%and 94.1%,and negative predictive values of 82%and 35.7%respectively).Conclusion:The GALAD score was effective for the diagnosis of early HCC and for followup after ablative therapy.