Radiology Commons^™

Financial Toxicity Tumor Board: A Multi-Disciplinary Team Activity Required In Low And Middle-Income Countries (Lmic), Ahmed Nadeem Abbasi, Sohail Rasool, Laraib Khan

Department of Radiation Oncology

No abstract provided.

Tumor Boards During Covid-19 Pandemic, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.

Survival And Treatment Outcomes Of Metaplastic Breast Carcinoma: Single Tertiary Care Center Experience In Pakistan, Zarka Samoon, Madiha Beg, Romana Idress, Adnan Jabbar

Department of Radiation Oncology

Background: Metaplastic breast carcinoma (MBC) is a rare disease with incidence of less than 1%. MBC present with a larger tumor size, less number of nodes involved, mostly undifferentiated triple negative tumors. We aimed to determine progression-free and overall survival and reported hospital-based incidence of MBC.
Material and Methods: A retrospective closed Cohort study elicited data of 42 patients with MBC from January 2008 to December 2013; followed till August 2016. Kaplan-Meier method was applied to compute overall and progression-free survival analysis. Cox Proportional hazard ratios were computed to assess associations between survival and independent variables.
Results: Hospital-based incidence of …

Clinical Audit To Assess Delays In Chemotherapy Administration At Daycare Oncology Center At A Tertiary Care Hospital In Karachi, Pakistan, Arifa Arifa Aziz, Zarka Samoon, Afsheen Feroz, Nadia Ayoub, Safia Awan, Madhia Beg

Department of Radiation Oncology

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays. Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the …

A Suggested Plan For Specialist Doctor's Professional Growth And Development, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi

Department of Radiation Oncology

No abstract provided.

Outcomes Of High Risk Patients With Febrile Neutropenia At A Tertiary Care Center, Asif Husain Osmani, Adnan Abdul Jabbar, Manesh Kumar Gangwani, Bilal Hassan

Department of Radiation Oncology

Creative Commons Attribution LicenseFever during chemotherapy-induced neutropenia continues to be a major cause of morbidity and mortality incancer patients. Mortality depends on the duration and degree of neutropenia, bacteremia, sepsis, performance status,comorbidities and other parameters. The highest mortality rates in cancer patients hospitalized with febrile neutropenia(FN) are observed in those with documented infection. The objectives of the study were to present available tools forrisk assessment, to review pathogens causing infections in adult FN patients and to assess outcomes. Methods: Thiscross sectional study was conducted on adult culture positive FN patients admitted to the Hematology/Oncologyservice at the Aga Khan University Hospital, …

Role Of Metastasectomy And Chemotherapy In Carcinoma Of Uterine Cervix, Nasir Ali, Muhammad Atif Mansha, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi

Department of Radiation Oncology

Squamous cell carcinoma of uterine cervix is potentially a curable disease; however, many patients treated with definitive chemoradiotherapy develop distant metastases, with few of them having a single metastatic deposit. There are no guidelines for the treatment of patients with oligometastatic cervical cancer.We present a case of a patient with International Federation of Gynecology and Obstetrics (FIGO) Stage IIB squamous cell carcinoma of uterine cervix. She was successfully treated with concurrent chemoradiotherapy with definitive intent. One year later, she developed a solitary pulmonary nodule for which she underwent resection followed by chemotherapy. She is free of any local or distant …

Implementation Of Quality Measures In Site-Specific Multidisciplinary Tumour Boards, Ahmed Nadeem Abbasi, Huriye Senay Kiziltan

Department of Radiation Oncology

No abstract provided.

Incidence Of Venous Thromboembolism In Cancer Patients Treated With Cisplatin Based Chemotherapy - A Cohort Study, Muhammad Nauman Zahir, Quratulain Shaikh, Munira Shabbir-Moosajee, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.Methods: Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed …

Establishment Of Site Specific Multi Disciplinary Tumour Boards In Pakistan -Is It Really Necessary To Discuss All Cancer Cases In Multidisciplinary Tumour Board Meetings?, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.

Establishment And Maintenance Of Quality Of Site-Specific Multidisciplinary Tumor Boards In Pakistan, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.

Frequency And Severity Of Acute Toxicity Of Pelvic Radiotherapy For Gynecological Cancer, Asim Hafiz, Ahmed Nadeem Abbasi, Nasir Ali, Khurshid Ahmed Khan, Bilal Mazhar Qureshi

Department of Radiation Oncology

Objective: To determine the frequency and severity of acute toxicity of pelvic radiotherapy for gynecological cancer.STUDY Design: A case series.PLACE AND DURATION OF STUDY: Department of Oncology, The Aga Khan University Hospital, Karachi, from March 2011 to June 2012.METHODOLOGY: A total of 99 patients with histologically proven uterine and cervical cancer, receiving radiation therapy, were enrolled into the study after informed consent on justification of inclusion and exclusion criteria. Patients were evaluated for the frequency and severity of pelvic radiotherapys side effects according to toxicity criteria based on RTOG/EORTC and CTC version 2 criteria at the start, during and at …

Plasmablastic Lymphoma Of The Oral Cavity With Breast Recurrence: A Case Report, Zarka Samoon, Romana Idrees, Nehal Masood, Tayyaba Zehra Ansari

Department of Radiation Oncology

Background: Plasmablastic lymphoma is an aggressive variant of diffuse large B cell lymphoma, mostly found in the oral cavity and associated with human immunodeficiency virus. There are no clear guidelines for its treatment. Therapies more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone are not associated with a prolonged survival. Lymphomas of the breast are rare, in one series representing 0.14% of all female breast malignancies, with diffuse large B cell lymphoma comprising up to 55% of all cases. Only one case of plasmablastic lymphoma involving the breast has been reported in the literature.CASE PRESENTATION: A 30 year old Pakistani woman, …

Metastatic Pancreatic Carcinoma And Experience With Folfirinox - A Cross Sectional Analysis From A Developing Country, Muhammad Nauman Zahir, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Pancreatic cancer is the fourth leading cause of cancer related death with median survival ranging from 3 to 6 months for metastatic disease. Palliative chemotherapy has been the backbone of treatment in advanced stage and has evolved over time. Data pertaining to the disease are scarce from our part of the world where treatment poses a significant challenge due to lack of resources.MATERIALS AND Methods: A retrospective chart review was performed for all patients presenting with stage IV pancreatic carcinoma at a tertiary care hospital in Karachi, Pakistan between January 2008 and December 2012. Data were collected using a …

Treatment Updates Regarding Anaplastic Oligodendroglioma And Anaplastic Oligoastrocytoma, Khurshid Ahmed Khan, Ahmed Nadeem Abbasi, Nasir Ali

Department of Radiation Oncology

Anaplastic Oligodendroglioma / Anaplastic Oligoastrocytoma (AO/AOA) is a WHO Grade-III primary brain tumor. These tumors comprise about 5 - 10% of all gliomas, which make them the third most common primary brain tumors after glioblastoma multiforme and astrocytomas. For many years standard of treatment remained Maximum Safe Resection (MSR) followed by Radiotherapy (RT). These tumors have also been known to be sensitive to alkylator-based chemotherapy particularly the subset having 1p/19q co-deletion signature. There is robust data showing that these tumors are responsive to chemotherapy in recurrent or progressive setting. Recently, up front chemotherapy has been added to standard post-surgery RT. …

Vincristine-Induced Vocal Cord Palsy And Successful Re-Treatment In A Patient With Diffuse Large B Cell Lymphoma: A Case Report, Zarka Samoon, Munira Shabbir-Moosajee

Department of Radiation Oncology

Background: Vincristine, a type of vinca alkaloid, is widely used in the treatment of various childhood and adult malignancies. A well-known side effect of vincristine is its neurotoxicity and it is rarely indicted in vagus nerve involvement. Vincristine induced vocal cord palsy is a potentially reversible condition, with the mainstay of therapy being withdrawal of the offending drug. However, there are no clear guidelines regarding the possibility of re-treatment with the causative agent.CASE PRESENTATION: A 58 year old Asian male presented with constipation and abdominal distension. Diagnostic investigations revealed stage IVB diffuse large B cell lymphoma (DLBCL). The patient was …

Single Centre Study Of Using Bendamustine In The Treatment Of B-Cell Malignancies, Asif Husain Osmani, Nehal Masood

Department of Radiation Oncology

Objective: To evaluate the experience of bendamustine in the treatment of B-cell malignancies at a tertiary care centre.Methods: The retrospective descriptive analysis included data of all adult patients with B-cell malignancies treated with bendamustine from 2009 to 2011 at the Aga Khan University Hospital, Karachi. Data was analysed using SPSS 17.0. Frequencies and percentages were computed for baseline characteristics, responses and toxicities.Results: Of the 19 patients 15 (79%) were males and 4 (21%) were females.The mean age was 59.53+/-12.14 (with a range of 46-86). Eight (42%) had follicular lymphoma, 6 (32%) had mantle cell lymphoma, 2 (11%) had diffuse large …

Plan Dose Evaluation Of Three Dimensional Conformal Radiotherapy Planning (3d-Crt) Of Nasopharyngeal Carcinoma (Npc): Experience Of A Tertiary Care University Hospital In Pakistan, Ahmed Nadeem Abbasi, Asim Hafiz, Nasir Ali, Khurshid Ahmed Khan

Department of Radiation Oncology

Background: Radiation therapy is the mainstay of treatment for nasopharyngeal carcinoma. Importance of tumor coverage and challenges posed by its unique and critical location are well evident. Therefore we aimed to evaluate our radiation treatment plan through dose volume histograms (DVHs) to find planning target volume (PTV) dose coverage and factors affecting it.MATERIALS AND Methods: This retrospective study covered 45 histologically proven nasopharyngeal cancer patients who were treated with definitive 3D-CRT and chemotherapy between Feb 2006 to March 2013 at the Department of Oncology, Section Radiation Oncology ,Aga Khan University Hospital, Karachi, Pakistan. DVH was evaluated to find numbers of …

Outcome Of Febrile Neutropenic Patients On Granulocyte Colony Stimulating Factor In A Tertiary Care Hospital, Asif Husain Osmani, Tayyaba Zehra Ansari, Nehal Masood, Bilal Ahmed

Department of Radiation Oncology

Introduction: Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapy and improvement in absolute neutrophil count (ANC) has been linked directly to improved outcome. Evaluation of granulocyte colony stimulating factors (GCSFs) for treatment has shown reduced incidences of episodes of prolonged neutropenia and protracted hospitalization. To determine absolute neutrophil counts with GCSF in febrile neutropenic cancer patients admitted to a tertiary care centre and to co-relate the improvement in ANC with mortality and hospital discharge.Methods: A prospective cross sectional study was carried at an oncology ward at Aga Khan University hospital from January 2010 to June …

Knowledge, Attitude And Preventive Practices For Breast Cancer Among Health Care Professionals At Aga Khan Hospital Karachi, Shiyam Kumar, Ayesha Mallick Imam, Nauman Fazal Manzoor, Nehal Masood

Department of Radiation Oncology

OBJECTIVE: To assess the knowledge and practice of risk factors, symptoms and screening for breast cancer among health care professionals.

METHODS: A cross sectional study was carried out at The Aga Khan University Hospital from January 2008 to March 2008. A total of 336 health care workers including consultants (48), fellows (17), residents (76), medical officers (14), interns (37), nurses (94) and fourth and final year medical students (50) were requested to fill a questionnaire designed to assess the knowledge about the risk factors, signs and symptoms, screening tools, breast self examination (BSE) and treatment.

RESULTS: More than two third …

Old Disease, New Targets--Part-I, Solid Malignancies, Shiyam Kumar, Nehal Masood, Asim Jamal Shaikh

Department of Radiation Oncology

Targeted agents are now an integral part of treatment regimens for some cancers. Trastuzumab is established in treatment of human epidermal receptor 2 (Her2) positive breast cancers, with improvements in both, the disease free and over all survival. Monoclonal antibody (MoAB) against vascular growth factor receptor (VEGF), bevacizumab and cetuximab a MoAB against epidermal growth factor receptor (EGFR) are establishing their role in a many cancers after making their mark in colorectal cancer. Sorafenib and sunitinib have success stories in renal carcinoma. The Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial has established sorafenib role in advanced hepatocellular carcinoma, while …

Primary Cutaneous B Cell Lymphoma--Leg Type (New Eortc--Who Classification), With Nasal Sinuses Involvement, Asim Jamal Shaikh, Nehal Masood, Aamir Ahsan, Wasim Memon

Department of Radiation Oncology

Primary Cutaneous lymphomas of B cell origin are rare, there remains a controversy in truly classifying these lymphomas and an updated EORTC classification divides them on the basis of their distinct histopthological grounds rather than on the basis of their anatomic location as in WHO classification, while the new WHO- EORTC joint classification maintains some characteristics of both systems, We report an elderly gentleman who primarily had a typical Leg dominant Cutaneous lymphoma of B cell origin uniquely with involvement of nasal Sinusues, bearing the Immunohistochemical staining features of "Cutaneous lymphoma - Leg Type" befitting the new joint WHO-EORTC classification …

Clinical Features And Management Of Merkel Cell Carcinoma, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Merkel cell carcinoma (MCC) is an aggressive dermal tumour of neuroendocrine origin. MCC is a rare tumour and all information pertaining to its behaviour, therapy and prognosis is based on retrospective reports. The two potentially curative treatment modalities are surgery and radiotherapy. It is a rare, highly malignant primary skin tumour, originally called "trabecular carcinoma" of the skin. MCC poses a challenge to the clinician because of its rarity and poor prognosis. The optimal therapy is customised and tailored for each individual patient with the appropriate use of operative resection and radiation therapy. This review covers reports from several authors …