कैंसर विज्ञान एवं चिकित्सा

Background: Cancer is now becoming an emerging public health problem in developing countries including Ethiopia. Majority (70%) of deaths from cancer occur in low- and middle-income countries due advanced stage presentation, in accessible diagnosis, and treatment. However, little is known about the problem in Ethiopia. Studies related to the area are scarce at all.

Methods: Retrospective cross-sectional study design was conducted from January to April 2018. The medical records of cancer patients diagnosed from January 1, 2016 to December 30, 2018 were reviewed. Information on sociodemographic characteristics, clinical stage at diagnosis and tumor characteristics was taken from the medical records. Descriptive statistics were used to summarize socio-demographic and clinical characteristic of study population. Tables and figures were used to describe the pattern and type of malignant tumors. Data was enetered in Epi info version-7.2 and analysed using Microsoft excel and statistical package for social science (SPSS ) version 23.

Results: A total of 188 cancer patients were included in the study. The mean age of patients at diagnosis were 45.5 ± 13.5years. There was increasing patterns of cancer cases in three years duration. The number of cancer case has increased from 42 in 2016 to 81 in 2016. With regards to case distribution, cervical 58 (30.9%), breast 47(25%), ovarian and colorectal cancer 13(6.9%) accounts the largest proportion of cancer cases. The majority, 179 (95.2%) of patients were women. About 104 (55.3%) of patients were rural residents. Family history of cancer was found on 21 (20.2%) of patients. Stage was determined only for 87 (46.3%) of the patients from which stage I accounts 17 (19.5%), stage II 23 (26.4%), stage III (39.1%) and stage IV accounts 13 (14.9%).

Conclusion and Recommendations: Overall, an increasing pattern of cancer cases were reported over a period of three years. Cancer of the cervix and breast were the commonest cancers observed mainly on the female population. Therefore evidence-based interventions shall be designed to tackle the problem through early prevention, detection and screening services both at primary health care units and hospitals.

Aim: The purpose of this dosimetric study was to find a suitable treatment & planning technique which can serve as an optimized technique with respect of PTV coverage and better sparing of concerned OAR’s.

Introduction: DIBH technique for left sided breast cancer is popular now-a-days, because as in DIBH the heart gets separated from the chest wall and left lung volume increases significantly resulting in reduced heart and left lung doses as compared to FB technique. Referring to previous available literature of DIBH studies, it is clearly showed that DIBH has advantage over FB in case of left sided breast cancer radiotherapy treatment in terms of reduced risk of cardiovascular related morbidity and mortality. DIBH is now a well-established technique in case of left sided breast cancer radiotherapy treatment. This dosimetric study explores the benefit of using a suitable treatment & planning technique in case of left sided breast cancer radiotherapy treatment.

Material and methods: In this study we have taken 10 patients of left sided breast cancer (7 MRM + 3 BCS) treated with DIBH technique at our Centre. The Varian’s RPM respiratory gating system (Varian Medical System, Palo Alto, CA) was used for respiratory motion monitoring. All patients were coached for three to four days for obtaining the desired respiratory breathing cycle. Once the patient was coached successfully, CT scans were acquired, one with conventional free breath (FB) and also three random scans with deep inspiration breath hold (DIBH) i.e., gated CT scans on SOMATOM Sensation Open CT simulator machine (Siemens Medical System’s).

On importing the acquired CT images in TPS, it showed that left lung volume increment in DIBH technique as compared to FB was significant. Patient contouring and treatment planning performed on Eclipse V13.5 and a dosimetric comparison was made between two treatment & planning techniques i.e., ((DIBH vs. FB) for (3DCRT vs. IMRT) and it is for PTV coverage, left lung, heart, left anterior descending coronary artery (LAD), left ventricle and contralateral breast.

Results: Left lung volume increment in DIBH technique as compared to FB was 69.375% showed that there was a significant increment in left lung volume, which results a larger separation of heart and the PTV chest wall. DIBH showed a significant reduction in doses of associated organ at risk.

Conclusion: This dosimetric study showed that in FB and DIBH techniques, DIBH is showing drastically dose reduction for left lung, heart C/L breast, LAD and left ventricle. From the data of DIBH and FB, we can conclude that DIBH technique in many respect has advantage over FB, which is solving the purpose of reducing cardiac and pulmonary doses without compromising the PTV coverage.

Colorectal cancer (CRC) is one of the leading causes of death worldwide, thus a public health concern. Even though most of the cases have a sporadic origin, a significant 10% are affected by a genetic predisposition. An inherited impaired function in the cellular mismatch repair (MMR) system of any MMR gene diagnoses the most frequent genetic syndrome associated with CRC, Lynch Syndrome. The faulty MMR system is directly associated with the presence of microsatellite instability. In this project, the authors present a microsatellite instability retrospective analysis in CRC samples of 252 patients, performed between 2013 and 2018, in the Molecular Analysis Laboratory of the Tumor Bank of Uruguay. Data from both high risk and general population-CRC patient samples were tested for microsatellite instability. From a cohort of 252 non-selected CRC patients who underwent MSI screening, 91 CRCs with MSI-H patients were identified to be in need of a different therapeutic and follow up approach. Additional benefits on utilizing MMR status rely on: prognosis information, differential chemosensitivity, and immunotherapy applicability. Timely management, treatment, and risk-reducing strategies are vital for MMR carriers. The modification of therapeutic standards by making a more opportune risk selection, benefits the patient, their families and has a positive economic impact. The recognition of colon cancer molecular subtypes represents the present reality for personalized medicine.

Objectives: The addition of palbociclib to endocrine therapy has been shown to improve disease free survival in hormone receptor positive metastatic breast cancer patients. This cyclin CDK4/6 inhibitor exposes patients to a grade 3 or 4 hematological toxicity leading to discontinuation or an arrest of treatment that is associate with a dose-reduction intensity and potentially a lack of efficiency. The aim of this study was to identify predictive factors of severe early hematotoxicity (ESHT).

Methods: This retrospective observational cohort study included patients who started with palbociclib in the Institut Sainte Catherine between December 1, 2016 and January 1, 2019 for the treatment of metastatic breast cancer. Individual data and particularly hematological toxicity were collected from electronic medical records. Severe early hematotoxicity was defined as the occurrence, during the first 3 cycles, of grade 4 or grade 3 hematological toxicity requiring a dosereduction of the drug.

Results: 181 patients (180 females) were included; median age was 67 years. 46 patients (25.4%) experienced an severe early hematotoxicity. Predictive factors of severe early hematotoxicity in multivariate analysis were a performance status (PS) of 2 or more (OR=3.77; 95% Cl; p=0.024) and lack of radiotherapy of bone metastasis in the previous year (OR=0.30; 95% Cl; p=0.003). Before palbociclib initiation, a neutrophil count below 3.37 G/L was predictive of severe early hematotoxicity with a sensibility of 76% and a specificity of 71%.

Conclusion: ECOG performance status, bone radiotherapy within the year and low baseline neutrophils count are associated with severe early hematotoxicity in palbociclib-treated metastatic breast cancer patients. These elements could be useful for a careful monitoring leading to adapted therapy.