A Retrospective Analysis of the Impact of HIV Infection on Outcomes of Locally Advanced Cervical Cancers Treated With Either Conventional or Hypofractionated Radiotherapy: The Uganda Experience.

PURPOSE: We annually treat more than 800 new patients with cervical cancer, where the majority (approximately 60%) have locally advanced disease and approximately 40% of them are infected with HIV. To optimally care for this large number of patients in low-income settings is difficult. From July 2011, we started using 45.0 Gy/15# hypofractionated radiotherapy (HFRT) as a substitute to 50.0 Gy/25# conventional fractionated radiotherapy (CFRT), for the treatment of locally advanced cervical cancer (LACC). This study aims at comparing the 5-year treatment outcomes between patients with LACC, known HIV serostatus, and treated with either CFRT or HFRT. METHODS: A retrospective study was conducted according to demographic/clinical data, radiotherapy fractionations, and outcomes. Factors considered were FIGO stages IIB-IIIB, known HIV serostatus, and had completed external-beam radiotherapy and intracavitary brachytherapy. The primary end point was overall survival; the secondary end points were toxicity and compliance. RESULTS: The study included 221 patients. Squamous cell carcinomas were 95.1% and adenocarcinomas 2.3%. The median age was 45.0 (interquartile range, 38.0-52.0) years. Stages IIB, IIIA, and IIIB were 38.9%, 6.3%, and 54.8%, respectively. HIV-positive and HIV-negative were 87 (39.4%) and 134 (60.6%), respectively. Chemoradiation was administered in 100 (45.2%), and 52 (52.0%) completed chemotherapy. CFRT/HFRT were 116 (52.5%)/105 (47.5%). At 24 months, the overall response was 54.1% for HIV-negative compared with 45.0% for HIV-positive (P value .262). There was no significant differences in acute/late toxicity grades ≥ 2 for HIV-negative/positive treated with HFRT/CFRT. At 60 months, the survival probabilities were 45.7% and 27.7% for HIV-negative and HIV-positive treated with CFRT (P value = .006), whereas it was 44.2% and 30.7% for HIV-negative and HIV-positive treated with HFRT (P value = .048), respectively. CONCLUSION: For the treatment of LACC with known HIV serology, there was no significant statistical difference in terms of response, toxicity, and compliance between CFRT and HFRT. However, the difference in overall survival between HIV-negative and HIV-positive was significant.

Analysis of management decisions and outcomes of a weekly multidisciplinary pediatric tumor board meeting in Uganda.

AIM: To evaluate the efficacy of a pediatric multidisciplinary tumor board (MTB) in Uganda. PATIENTS & METHODS: We documented the discussion of cases presented at a pediatric MTB and subsequently, though retrospective chart review, determined the degree to which decision were implemented. RESULTS: 95 patients were discussed. In total, 129 of 226 (57%) distinct management decisions reached during the MTBs were implemented. Of these, 15 resulted in changes in diagnosis and 53 were classified as major changes in management. Decisions on chemotherapy were the most likely to be successfully enacted (51/58), followed by radiotherapy (18/30) and surgery (12/21). Labs/consults were less likely to be implemented. CONCLUSION: Key improvements, specifically in the documentation and implementation of management decisions, are needed to improve the MTB's efficacy.

Empty sella syndrome: Incidential findings at computerised tomography

A 43-year old female patient presented with severe dizziness; neck pain and headache. Clinical examination revealed diplopia with a horizontal gaze. Plain skull radiographs showed an enlarged sella turcica with no abnormal intracraial calcifications. Pre and post contrast axial and post contrast coronal computerised tomography scans through the sella turcia were done. an enlarged sella turcia filled with cerebrospinal fluid was demonstrated