Experience with neoadjuvant chemotherapy in patients with breast cancer.

OBJECTIVE: To determine the response rates to neoadjuvant chemotherapy in patients with breast cancer. METHODS: Medical records of 161 women with breast cancer, registered at Shaukat Khanum Memorial Cancer Hospital between July 2006 and March 2008 were retrospectively reviewed. Patients were stratified into two groups based on the type of chemotherapy received; Group A (Anthracycline based regimens), Group B (Anthracycline and Taxane based regimens). Response rate was noted. RESULTS: Clinical complete response rates by clinical examination were significantly higher in Group B as compared to Group A in both primary disease in breast and axillary nodes (39% vs. 20.3%, p = 0.01; 72.7% vs. 30.7%, p = 0.01, respectively). There was no difference in response rates by imaging between groups A and B in breast and axillary lymph nodes (12.5% vs. 17%, p = 0.4; 66.6% vs. 70.4%, p = 0.4, respectively). There was no difference in pCR rates between Group A and B (9.1% vs. 14.2%, p = 0.35). However, multivariate analysis showed significant increase in pCR rates by addition of taxanes (p = 0.028), in patients with poorly differentiated tumours (p = 0.028) and in those with axillary node negative disease by palpation (p = 0.016). There was no statistically significant difference in breast conservation rates between group A and B (25.4% vs. 36.7%, p = 0.1). CONCLUSION: Addition of taxanes to anthracycline based regimens improved the pathological complete response in our patients with breast cancer.

Bleomycin induced pulmonary toxicity in patients with germ cell tumours.

BACKGROUND: Bleomycin is a cytotoxic drug used in treatment of Germ Cell Tumours (GCTs) and is associated with pulmonary toxicity. Bleomycin pulmonary toxicity (BPT) manifests predominantly as pulmonary fibrosis, organising pneumonia (OP) or Nonspecific Interstitial Pneumonitis (NSIP). Our objectives were to determine the incidence of BPT, describe the common HRCT patterns of pulmonary toxicity and to find out the correlation of variables (cumulative dose of bleomycin, age and glomerular filtration rate) with pulmonary toxicity. METHODS: The study included the data of 96 patients from March 2006 to September 2008. All patients had histologically proven GCT and received bleomycin containing regimes. Variables age, GFR at the time of initial presentation along with cumulative dose of bleomycin at completion of chemotherapy or at the time of BPT were recorded. The High resolution CT chest (HRCT) of these patients was independently reviewed by two radiologists. Bleomycin toxicity was reported on the radiologic features of pulmonary fibrosis, OP or NSIP. RESULTS: Fourteen patients (14.6%) developed BPT. Common patterns of BPT were, pulmonary fibrosis (5.2%), OP (5.2%) and NSIP (4.2%). Using the Univariate regression analysis there was significant relationship between BPT and age, cumulative bleomycin dose and initial GFR at the beginning of treatment. CONCLUSIONS: Because BPT can be progressive and fatal, early recognition is important. The diagnosis of pulmonary toxicity should be considered in any patient with new or progressive respiratory complaints. BPT can be difficult to diagnose; therefore, knowledge and understanding of radiologic manifestations of toxicity caused by Bleomycin are necessary for institution of appropriate treatment. There is increasing incidence of BPT with increasing age, cumulative dose and decreasing GFR.

Bacterial spectrum and susceptibility patterns of pathogens in adult febrile neutropenic patients: a comparison between two time periods.

BACKGROUND: The aim of this study was to study trends in bacterial spectrum and susceptibility patterns of pathogens in adult febrile neutropenic patients during two time periods. METHODS: We retrospectively reviewed the medical records of 379 adult oncology patients admitted with chemotherapy induced febrile neutropenia at our institute during years 2003 and 2006. RESULTS: A total of 151 organisms were isolated during the two calendar years. Gram negative bacteria accounted for 57.6% of organisms, while gram positive organisms accounted for 42.3% of the total isolates. The most common organisms were: Escherichia coli (23.1%), Staphylococcus epidermidis (13.9%), Pseudomonas aeruginosa (12.5%) and Staphylococcus aureus (7.9%). The number of gram positive isolates showed an increase from 35% in 2003 to 47.2% in 2006 (p = 0.13). During each calendar year, Staphylococcus epidermidis and Staphylococcus aureus were 100% susceptible to vancomycin and 33% strains of Staphylococcus aureus were methicillin resistant. Escherichia coli and Pseudomonas aeruginosa strains were highly sensitive to piperacillin/tazobactam and amikacin during both time periods. Resistance of Pseudomonas aeruginosa strains to ciprofloxacin increased from 0% in 2003 to 50% in 2006 (p = 0.03). CONCLUSIONS: Gram negative organisms are the predominant organisms in adult febrile neutropenic patients at our institute. Initial empirical therapy with piperacillin/tazobactam seems appropriate to cover most gram negative pathogens while vancomycin to be added for suspected gram positive infections. During the two calendar years resistance of Pseudomonas aeruginosa strains to ciprofloxacin has significantly increased.

Colorectal Cancer Patient Characteristics, Treatment and Survival in Oman--a Single Center Study.

BACKGROUND: Colorectal cancer is the most common gastrointestinal cancer in Oman with an increasing incidence. We here report the presenting features, treatment outcomes and survival in a University hospital in Oman and compare our data with regional and international studies. MATERIALS AND METHODS: Medical records of patients with colorectal cancer were reviewed retrospectively between June 2000 and December 2013 and were followed until June 2014. RESULTS: A total of 162 patients were diagnosed with colorectal cancer. The majority were males (58.6%), with a median age of 56 years. Rectum was involved in 29.6% of patients, followed by ascending and sigmoid colon. The majority of patients had stage III (42.6%) and stage IV (32.7%) disease at presentation. K-Ras status was checked for 79 patients, and 41 (51.9%) featured the wild type. Median relapse free survival was 22 months. Median overall survival for all patients was 43 months. Observed 5 year overall survival (OS) for stages I, II and III was 100%, 60% and 60% respectively. On Log rank univariate analysis, age, BMI, diabetes, hypertension, metformin use, stage, clinical nodal status for rectal cancer, pathological T and nodal status, site of metastasis, surgical intervention, chemotherapy, radiotherapy, chemotherapy regimen, no of cycles of chemotherapy, response, RFS, site of recurrence and administration of 2nd line chemotherapy were significant factors affecting OS. On Cox regression multivariate analysis none of the factors independently affected the OS. CONCLUSIONS: The majority of patients present with advanced disease and at young age. The survival rates are comparable to the published regional and international literature.

Use of port-a-cath in cancer patients: a single-center experience.

INTRODUCTION: Central venous catheters play an important role in the management of cancer patients. Different types of devices are associated with different patterns of complications. We report on the pattern of use and rate of complications of port-a-caths in patients diagnosed with malignant cancer at a single institution. METHODOLOGY: The data were collected retrospectively from patients who received the treatment for solid tumors or lymphoma through a port-a-cath at the Sultan Qaboos University Hospital (SQUH) between January 2007 and February 2013. RESULTS: A total of 117 port-a-caths were inserted in 106 patients. The majority (86; 73.5%) were implanted by an interventional radiologist, and the right internal jugular vein was accessed in 79 (67.5%) patients. Mean catheter indwelling time was 354 (range 3-1,876) days for all patients, 252 (3-1,876) and 389 days (13-1,139) for patients with and without complications, respectively. Thirty (25.6%) port-a-caths were removed prematurely, mainly due to infectious complications, while 17 (14.5%) were removed after completion of treatment. Staphylococcus aureus was the most frequently isolated organism, found in 8 (6.8%) patients. Underlying diagnosis (p < 0.001), chemotherapy regimen (p < 0.001), sensitivity to antibiotics (p = 0.01), and any complication (p < 0.001) were significant factors affecting the duration of port-a-cath use. None of these factors were significant on multivariate cox regression analysis. CONCLUSIONS: The mean duration of port-a-cath use was almost one year. Infection was the most common complication leading to premature removal, followed by port thrombosis.

Osteosarcoma arising on a background of Paget's disease report of an unusual case.

One of the serious complications of Paget's disease (PD) is a significant increase in the risk of developing osteosarcoma. Approximately 1% of the patients with PD develop osteosarcoma. This contributes significantly to the mortality and morbidity of the patients with PD. We present the case of an elderly person, who developed osteosarcoma 1 year after being diagnosed to have PD. The patient had been diagnosed to have lymphoma 8 years prior to the diagnosis of PD. The association between PD and follicular lymphoma is discussed.