Vishwadeep Mishra,¹ Sudeep Bisht¹, Shwetima chaudhary³, Laxman Pandey,¹ Archana Pandey,² Rachita Chatterjee⁴

Objective : Cervical cancer affects many women across the globe and often requires radiation for treatment. This study aimed to compare the dosimetric outcomes of Intensity-Modulated Radiation Therapy (IMRT) and Three- Dimensional Conformal Radiation Therapy (3D-CRT) in managing locally advanced cervical carcinoma.

Methods: We performed a retrospective analysis of 30 patients who received IMRT with weekly cisplatin-based medication. Corresponding 3DCRT plans were generated for comparison. Dosimetric parameters for Planning Target Volume (PTV) and Organs at Risk (OARs) were evaluated. Patients were immobilized in a supine position for simulation, according to conventional protocols.

Results: PTV coverage was similar between IMRT and 3D-CRT groups. However, IMRT showed significantly improved dosimetric outcomes for OARs, including the bladder, rectum, bowel, and bone marrow. IMRT reduced doses to critical organs while maintaining comparable PTV coverage.

Conclusion : Patients undergoing IMRT experienced reduced doses to critical organs compared to 3DCRT. Larger-scale trials with longer follow-up periods are needed to corroborate these findings and confirm IMRT's efficacy in cervical cancer treatments.

Keywords: Cervical cancer, Radiotherapy, Intensity- Modulated Radiation Therapy, Three Dimensional Conformal Radiation Therapy, Organs at Risk

Reviewed Article: Stereotactic Radiosurgery for Brain Metastasis

Reem Arif Alalawi¹, Selma Alazhar Khriji², Maram Abdullah Ambusaidi², Tariq Al-Saadi³

Background : Brain metastases pose a significant challenge in oncology, contributing to morbidity and mortality rates. These metastases originates from primary tumors in the breast, lung, and melanoma tumors and has promoted the exploration of several treatment modalities, including stereotactic radiosurgery (SRS). SRS is considered to be one of the most effective treatments for brain metastases due to its precision in delivering high doses of radiation with low damage to the surrounding tissues.

Method : A search of Scopus database was conducted using key terms like "stereotactic," "radiosurgery," "brain metastasis," and "SRS". Relevant articles were screened based on title, abstract, and full text. The top 100 articles, ranked by citation frequency, were included, and analysed for various details including title, first author, publication year, journal name, journal impact factor, country of first author, country of study, first author institution, corresponding author institution, study design, patient involvement, number of patients studied, primary aim, source of metastasis, and study conclusion.

Results : The top 100 cited articles on SRS for brain metastases were identified, with an average citation of 149 citations per article. The study found that the USA, followed by Japan and Switzerland, produced the highest number of publications on stereotactic radiosurgery for brain metastasis. The University of Pittsburgh was the leading institution in the USA. The analysis showed an increasing trend in publications from 2007 to 2017, with a peak in 2010, followed by a decline, potentially influenced by the COVID-19 pandemic.

Conclusion: Stereotactic radiosurgery (SRS) is an effective treatment for brain metastases, delivering precise high-dose radiation with rapid dose fall-off. This study revealed that the USA, particularly the University of Pittsburgh, has produced the most publications on this topic. This information can help clinicians and researchers identify valuable articles and journals related to SRS.

Keywords: Brain metastasis, Stereotactic, Radiosurgery, SRS

Tarig Fadelelmoula¹, Ashraf Ahmed², Momen Abdalla², Idris Salih³

¹ Department of Internal Medicine, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman

² Department of Pulmonology, Al Shaab Teaching Hospital, Khartoum, Sudan

³Department of Radiology, Al Ribat Teaching Hospital, Khartoum, Sudan

Background: Thoracic lesions can result from malignant, benign, and inflammatory conditions. They affect lung parenchyma, pleura, or mediastinum, and often require biopsy for a definitive diagnosis.

Objectives: We aimed to assess the safety and diagnostic yield of ultrasound-guided tru-cut needle biopsy performed by pulmonologists.

Patients and Methods: We conducted a prospective study among 45 patients undergoing ultrasound-guided tru-cut biopsies for diagnosing thoracic lesions. Data on patient demographics and procedure results were collected using a predesigned clinical data collection sheet.

Results: In this group of patients, ultrasound-guided biopsy performed by pulmonologists yielded adequate tissue samples and achieved an accurate diagnosis in 94.4% (42) of the cases. Malignant lesions were identified in 66.7% (30) of the patients. In most patients, 86.7% (39), there were no complications, and we recorded no procedure-related mortalities.

Conclusions: Our results indicated that ultrasound-guided tru-cut biopsy performed by pulmonologists yielded excellent diagnostic results and was a safe technique for diagnosing thoracic lesions.

Keywords: Benign, Biopsy, Malignant, Mediastinal, Pleural, Sudan, Thoracic

Short communication | Hallmarks of Cancer; A Summarized Overview of Sustained Proliferative Signalling Component

Zainab Al Lawati¹, Alaa Al Lawati²

Over the past fifty years, the field of cancer research has witnessed enormous growth and a wealth of knowledge gain, as it remains to be among the primary causes of death across the globe. As a result, significant advancement in cancer therapy has been achieved, particularly in the ones that target specific hallmarks in the process of tumor formation. These hallmarks are renowned as functional competences that enable malignant cells to subsist, grow and spread within the human body. Twenty-one years ago, six main traits were identified, to which two additions were made eleven years later. These are identified as self-sufficiency in growth signals, insensitivity to anti-growth signals, evasion of programmed cell death, limitless replicative potential, sustained angiogenesis, tissue invasion and metastasis, deregulating cellular energetics and avoiding immune destruction. Two supporting characteristics believed to empower the attainment of these hallmarks were also tagged, being instability and mutation of the gene and inflammation fostered by the malignant growth. This paper will highlight the main processes underpinning the self-sufficiency in growth signalling component. It will briefly discuss the process behind cell signaling and mechanisms by which tumors evade the immune system. Following that, it will delve into the therapeutic modality targeting this component and give some current illustrations of how therapies targeting this hallmark are being utilized.

Keywords: Cancer hallmarks, cell signaling, sustained proliferative signaling, EGFR antagonists.

Background : BKidney cancer accounts for 5% of all malignant tumors in men. Worldwide, 90% of kidney malignancies are renal cell carcinomas, while only less than 10% are transitional cell carcinomas. To our knowledge, only one small study conducted in Lebanon on 124 cases found that more than 20% of the renal cancers were of urothelial pathology, larger epidemiological studies are warranted.

Methods: We retrospectively analyzed 1708 renal tissues including 499 renal malignant tumors from the data collected at the pathology department in Hotel-Dieu de France University hospital, a Lebanese tertiary hospital, over a ten-year period going from 2008 to 2018, based on the WHO classification of 2016.

Results: Among 499 renal cancer patients, the mean age was 60.3 years with a median of 62 [18-90], with 68% being men and 32% women. The three most common histology types were the conventional renal cell carcinoma in only 46.7%, followed by the urothelial carcinoma in 18.2%, then the papillary renal cell carcinoma in 15.5%.

Conclusion: Compared to the literature, similar age average and sex ratio were found, however, the Lebanese population seems to have a specific histologic pattern of distribution such as a high percentage of transitional cell type and a relatively low percentage of clear cell carcinoma.

Keywords: Renal Cancer, Urothelial Carcinoma, Renal Cell Carcinoma, Cancer Epidemiology, Lebanese Population

Renindra Ananda Aman¹, Fabianto Santoso¹, Ria Amelia¹, Zharifah Fauziyyah Nafisah³, Damar Nirwan Alby³

¹1Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Introduction: Meningiomas are among the most common types of intracranial neoplasm. Sphenoorbita meningioma usually affect anatomical and functional around the orbits. This study aimed to analyse the epidemiological distribution and clinical data of patients with sphenoorbital meningioma who underwent tumor resection microsurgery with a focus on surgical outcomes.

Patients and Methodo: This is a retrospective descriptive study conducted in Dr. Cipto Mangunkusumo Hospital as a national referral hospital in Indonesia between 2018 and 2023. Epidemiological data and clinical status were collected through medical record.

Results : There were 66 patients included in this study, majority of patients were women (93.9%), with a femaleto- male ratio of 15.5:1. The mean age at tumor resection surgery was 44.68 ± 7.8 years old, with the majority of patients in the 41-50 age group (53.0%). Tumor resection in sphenoorbital meningioma presented fairlygood outcomes depending on the degree of resection, with optimum improvement in structural symptoms, such as proptosis (100%), but debatable results in functional symptoms, such as visual acuity (6.1% improvement and 83.3% stabilization).

Discussion: Sphenoorbital meningioma is a common intracranial neoplasm that can cause visual disturbances, proptosis, and other neurological symptoms. Surgical resection is the definitive treatment and the degree of total resection is commonly measured using the Simpson grading system.

Conclusion: Understanding patient outcomes is crucial to improve surgical techniques and reduce postoperative complications. This study provides valuable epidemiological and clinical data as a basic knowledge for further research about surgical management in sphenoorbital meningioma patients.

Keywords: Sphenoorbital meningioma, microsurgery, CNS tumor, tumor resection

Ghaidaa A. Alfaraj¹, Yasein B. Aswad¹, Mayson A. Ali²

¹College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
²Department of Oncology, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia

Metastatic ameloblastoma is a rare odontogenic malignancy, often presenting diagnostic and therapeutic challenges. This case report details a 77-year-old male with a history of recurrent follicular ameloblastoma of the right maxilla, initially treated with multiple surgeries and radiotherapy. After decades of stability, he presented with significant weight loss, respiratory symptoms, and a newly identified left lung mass. Subsequent biopsies confirmed metastatic ameloblastoma, a notably rare progression for this type of tumor. The patient's management involved a multidisciplinary approach, including thoracic surgery, medical oncology, radiotherapy, and palliative care, underscoring the complexities in treating metastatic ameloblastoma. This case highlights the critical need for thorough diagnostic evaluation and the consideration of metastasis in patients with a history of ameloblastoma, despite its rarity.

Keywords: Ameloblastoma, Metastatic ameloblastoma, odntogenic tumor, case report

Dr. Bhargav Shreeram Gundapuneedi¹, Dr. Ambedkar Yadala¹, Dr. Bheemanathi Hanuman Srinivas², Dr. S Pradeep³, Dr. Rajab Khan¹

¹Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
²Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
³Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Introduction or Background: Head and neck cancers, particularly those involving the oral cavity, are associated with high morbidity and mortality rates globally. Despite advancements in surgical techniques, chemotherapy, and radiotherapy, the development of second primary malignancies (SPMs) remains a critical concern for longterm survivors. The occurrence of metachronous double primary malignancies, where the second primary cancer arises at a different anatomical site and time, poses additional diagnostic and therapeutic challenges.

Case Presentation: We present a rare case of a 42-year old male with a history of chronic tobacco use, diagnosed with metachronous double primary malignancies involving the left lateral border of the tongue and left buccal mucosa, separated by a disease-free interval of 15 months. The patient initially presented with a nonhealing ulcer and left cervical lymphadenopathy. Biopsy confirmed squamous cell carcinoma, and he underwent wide local excision with left radical neck dissection followed by adjuvant chemoradiation. Following a disease-free period of 15 months, the patient developed a second primary malignancy in the left buccal mucosa. After multidisciplinary discussions, the patient received palliative chemotherapy due to the extensive involvement of critical structures, including the infratemporal fossa.

Discussion and Conclusion: The case highlights the clinical significance of field cancerization in head and neck cancer patients with long-term tobacco exposure, leading to the development of SPMs. It emphasizes the importance of ongoing surveillance, early detection strategies, and multidisciplinary approaches for optimal management. The case also underscores the complexities in distinguishing between recurrence and second primary malignancies, which have different treatment and prognostic implications. This report adds to the literature on SPMs and reinforces the need for vigilance in the follow-up of high-risk patients.

Keywords: Metachronous malignancy, second primary malignancy, head and neck cancer, oral cavity malignancy, field cancerization

Raju Prajapati¹, Vineeta Yogi^2,4, Om Prakash Singh^3,4, Hemant Kumar Ahirwar^{6, Hameeduzzafar Ghori2,4, Abhinav Narwariya5, Tushar Jassal7}

¹Department of Radiation Oncology, Sukh Sagar Medical College and Hospital, Jabalpur, Madhya Pradesh, India
²Department of Radiation Oncology, Gandhi Medical College and Associated Hamidia Hospital, Bhopal, Madhya Pradesh, India
³Department of Radiation Oncology, Mahaveer Institute of Medical science and research, Bhopal, Madhya Pradesh, India
⁴Department of Radiation Oncology, Madhya Pradesh medical science university, Jabalpur, Madhya Pradesh, India
⁵Department of Medical Oncology, BLK-MAX super specialty Hospital, Rajendra Road, New Delhi, India
⁶Department of Radiation Oncology, All India Institute of Medical Science, Bhatinda, Punjab, India
⁷Department of Radiation Oncology, All India Institute of Medical Science, New Delhi, India

Background: Patients with advanced head and neck squamous cell carcinoma (HNSCC) remain at high risk of developing local recurrence and distant metastases. Some patients do respond well to treatment but still have residual disease or develop locoregional failure within 1-2 years. Treatment options are limited in such cases with dismal survival outcomes. This study was done to assess the role of Gefitinib in residual, recurrent, and metastasis HNSCC.

Ojbective: To assess the role of Gefitinib in residual, recurrent, and metastatic HNSCC in terms of overall response, progression-free survival, and toxicity profile of the drug in the palliative setting.

Material and Methods: This was a prospective observational study with 42 patients of advanced HNSCC who had residual, recurrent, or metastatic disease after primary treatment with concurrent chemoradiotherapy. The patients were then treated with a standard dose of 250mg which was titrated as per the toxicity profile of the drug. The drug was continued till the progression of the disease or intolerable drug toxicity.

Results: All patients showed objective clinical and radiological response after the start of treatment as per RECIST 1.1 criteria. Three patients had disease progression within 4 months of start of treatment while 11 patients showed disease progression at 6 months of treatment and rest of the patient within 1 year of start of treatment. Median Progression free survival was found to be 6.1 months [95% Confidence interval 5.563 to 6.63]. Median overall survival (OS) time was 12 months [95% Confidence interval 11.84 to 12.16].

Conclusion: This study suggests the advantage of Gefitinib in patients having residual, recurrent or metastatic HNSCC in terms of clinical response, PFS and OS; similar to the Triple drug metronomic Chemotherapy regime. Though a head on comparison in a phase III trial is required for any conclusive evidence.

Keywords: Gefitinib, residual, recurrent, metastatic, squamous cell carcinoma, head and neck

Tamara Seif¹, Aseel Abusara1, Rand Barham, Enas AlKurdi1, Lama Nazer1

¹ 1Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan

Introduction: Bacteremia is a life-threatening complication in cancer patients. However, there are limited studies evaluating bacteremia in this patient population. The objective of this study was to evaluate the microbiological profile as well as the prevalence and predictors of multidrug-resistant organisms (MDROs) among cancer patients admitted with bacteremia.

Patients and Methods : A retrospective cohort study which included adult cancer patients admitted with bacteremia, between July 2020 and September 2022, at a comprehensive cancer center in Jordan. Patients under the palliative or bone marrow transplant services were excluded, as well as patients with blood cultures deemed as contaminants. Using the electronic medical records, patients' characteristics and the types of pathogens and susceptibilities were recorded. MDROs were defined as intrinsic or acquired non-susceptibility to at least one agent in = 3 antimicrobial categories. Logistic regression was used to identify predictors of bacteremia due to MDROs.

Results: A total of 651 cases of bacteremia for 531 patients were included. The mean age of the patients was 58±16 (SD) years, 290 (55%) were males, and 373 (70%) had solid tumors while the remaining had hematologic malignancies. Gram-negative bacteria were reported in most cases (n = 439, 65%), the most common being Escherichia coli (n = 252, 57%), followed by Klebsiella species (n = 63, 14%). For gram-positive bacteremia, Coagulase-negative staphylococci were the most common (n = 64, 28%) followed by Streptococcus species (n = 62, 27%) and Staphylococcus aureus (n = 49, 21%). MDROs were reported in 309 cultures (48%), with extendedspectrum- beta-lactamase-producing Enterobacterales and methicillin-resistant Staphylococcus aureus being the most common MDROs, reported in 149 (34%) and 22 (45%), of the cultures, respectively. Use of antibiotics within the previous 90 days (OR 1.5, 95% CI 1.00-2.34) and hematologic malignancy (OR 1.8 CI 1.26 - 2.67) were identified as predictors of MDRO bacteremia.

Discussion: Our study investigated the microbiological profile, prevalence, and predictors of MDRO bacteremia in a substantial cohort of adult patients with solid and hematologic malignancies admitted with bacteremia. Similar to findings from a study conducted in Lebanon, almost two-thirds of the cultures in our cohort were gram-negative. Interestingly, about half of the cases consisted of MDROs, a finding comparable to existing data as well. Additionally, we identified two predictors of MDRO bacteremia: antibiotics use within the past 90 days, which aligns with previous literature on the subject, and hematologic malignancies, which can be explained by the course of the disease, particularly the prolonged neutropenia episodes. Given the high percentage of MDROs among cancer patients with bacteremia, this study emphasizes the importance of establishing and adhering to an antimicrobial stewardship program at each healthcare institution. Furthermore, the findings of this study can serve as data sets that can be utilized to advance predictive models for MDRO bacteremia.

Conclusion: Among cancer patients admitted with bacteremia, gram-negative bacteria were the most common. About half of the bacteria were multidrugresistant. The use of antibiotics within the past 90 days and hematologic malignancy were predictors of MDRO bacteremia. Further predictive models for MDRO bacteremia are needed to help guide the empiric antibiotic prescribing decisions.

Keywords: Bacteremia, Bacterial Multidrug Resistance, Predictors, Neoplasms, Microbiology

Tahani H. Nageeti¹, Umme Salma¹, Duaa A. Alhawi¹, Omar A. Kalantan¹, Elham A. Rashaidi¹, Nesreen M. Shorbagi¹

¹ Oncology Center, King Abdullah Medical City - Holy Capital, Makkah Health Cluster, Saudi Arabia

Purpose: To evaluate target volume coverage and organs at risk (OARs) sparing comparing 3D-Conformal Radiation (3D-CRT) vs. Volumetric Arc Treatme nt (VMAT) planning based on contouring guidelines of European Society for Therapeutic Radiology and Oncology Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) for implant sparing and target volume delineation in postmastectomy radiation therapy (PMRT) after immediate breast reconstruction (IBR).

Materials and Methods: Ten eligible patients were identified via a retrospective chart review. The CTsimulation scans were used to contour target volumes applying ESTRO-ACROP guidelines and OARs. For each case, 3D-CRT and VMAT plans were generated to evaluate the best achievement of target volume coverage and minimal dose to OARs.

Results: There was a significant difference towards VMAT for PTV coverage by 90% and 95% isodose line. The VMAT, compared to 3D-CRT, showed a lower mean (PTV-105%) (8.1 vs. 17.8), (p-value 0.000034). The OARs sparing showed a significant difference in favor of VMAT for ipsilateral lateral lung V20 (p-value 0.007048), both lungs' mean dose (p-value 0.019021), and heart mean dose (p-value 0.000076). The 3D-CRT plan showed lower thyroid mean dose (19.27 vs 23cc), (p-value 0.0235), and contralateral breast Dmax, D5 and D10, p-values (0.04088, < 0.00001 and< 0.00001), respectively. In the implant doses, there was no statistical difference between Dmax (54.59Gy vs. 54.14Gy), while there was a statistically significantly lower mean implant dose for VMAT (43.83Gy) vs. 3D-CRT (50.81Gy), (p-value < 0.00001).

Conclusion: Our study showed an advantage of VMAT compared to 3D-CRT following ESTRO-ACROP consensus for implant sparing in PMRT.