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Feasibility of Upfront Debulking Surgery versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery for Advanced Ovarian Cancer  [PDF]
Amen Hamdy Zaky, Adel Gabr, Doaa Wadie Maximous, Ahmed A. S. Salem, Amr Farouk Mourad, Haisam Atta, Marwa Ismail
Journal of Cancer Therapy (JCT) , 2018, DOI: 10.4236/jct.2018.92015
Abstract: Background: Inappropriately ovarian cancer cannot be detected until an advanced stage. Radical debulking surgery is considered the cornerstone in the management of advanced ovarian cancer pointing to complete tumor resolution. Unless optimal debulking cannot be achieved, these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been recommended as a novel therapeutic modality to a diversity of malignant tumors when the disease is not willing to optimal surgical resection at the time of diagnosis or the patient who unfit for aggressive debulking surgery. The purpose of this study is to compare survival in the patient with advanced ovarian cancer (stage III/IV) underwent primary debulking surgery followed by adjuvant chemotherapy (PDS-ACTR) to those who received neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Results: Neoadjuvant chemotherapy (NACT-IDS) showed significant complete cytoreduction and decreased in surgical morbidity in comparison to primary debulking surgery (PDS-ACTR). NACT-IDS showed significant improvement in progression-free survival (P-value 0.002) and overall survival (P-value 0.03) in comparison to PDS-ACTR. Response to NACT and residual volume were the two independent prognostic factors for overall survival. Conclusion: NACT-IDS for advanced ovarian cancer (III/IV) resulted in higher frequency of
Diagnostic value of a panel of tumor markers as a part of a diagnostic work-up for ascites of unknown etiology  [PDF]
Soha Saoud Abdelmoniem, Eman Mosad Zaki, Hala Mostafa Imam, Hosny Badrawy, Sanaa Ali, Doaa Wadeeh Maximous
Open Journal of Gastroenterology (OJGas) , 2012, DOI: 10.4236/ojgas.2012.23020
Abstract: Background & objectives: Data regarding tumor marker usefulness in diagnosing ascites of unknown etiology and determining its malignant nature are conflicting. We aim to assess the diagnostic value of ascitic and serum tumor markers in ascites of unknown etiology and to evaluate their usefulness besides other laboratory tests in a diagnostic work-up in those patients. Design & setting: A prospective case-control study conducted at Assiut University hospital and oncology institute. Patients & Methods: Three groups were included; Group I: 41 patients with ascites of unknown etiology Group II: 7 Patients with TB ascites and Group III:14 patients with cirrhotic ascites. We assessed the CEA, CEA mRNA, CA15-3, CA19.9, CA125, AFP and PSA in serum and ascetic fluid. A diagnostic work-up for group I included: IPD test, ultrasound, CT, ascetic fluid cytology, SAAG, Laparotomy and biopsy. Results: Ascetic fluid and serum levels of CA15-3 and CA125 were significantly increased in group I and were significantly increased in histopathologically proved malignant ascites compared to TB and cirrhotic ascites. In group I, CA 125 was significantly higher in ascites than serum. With the exception of PSA, all tumor markers significantly correlated in serum and ascetic fluid. No significant difference in the level of ascetic CEA messenger RNA was detected between the 3 groups. Cytology had 53% sensitivity, 94% specificity and CA 125 & CA15-3 had 81% sensitivity and 75% specificity in detection of malignant ascites repectively. Laparotomy and biopsy: diagnosed malignnancy in 53.3% and TB in 13.3%. Conclusions: A diagnostic work-up including SAAG, tumor markers in the serum and ascetic fluid may help in adjunct with ascetic fluid cytology, laparotomy and biopsy, imag- ing and other laboratory tests in diagnosing ascites of unknown etiology.
Surgical treatment for locally advanced lower third rectal cancer after neoadjuvent chemoradiation with capecitabine: prospective phase II trial
Mostafa Elwanis, Doaa W Maximous, Mohamed Elsayed, Nabiel NH Mikhail
World Journal of Surgical Oncology , 2009, DOI: 10.1186/1477-7819-7-52
Abstract: To evaluate the rate of anal sphincter preservation in low lying, resectable, locally advanced rectal cancer and the resectability rate in unresectable cases after neoadjuvent chemoradiation by oral Capecitabine.This trial included 43 patients with low lying (4–7 cm from anal verge) locally advanced rectal cancer, of which 33 were resectable. All patients received preoperative concurrent chemoradiation (45 Gy/25 fractions over 5 weeks with oral capecitabine 825 mg/m2 twice daily on radiotherapy days), followed after 4–6 weeks by total mesorectal excision technique.Preoperative chemoradiation resulted in a complete pathologic response in 4 patients (9.3%; 95% CI 3–23.1) and an overall downstaging in 32 patients (74.4%; 95% CI 58.5–85). Sphincter sparing surgical procedures were done in 20 out of 43 patients (46.5%; 95% CI 31.5–62.2). The majority (75%) were of clinical T3 disease. Toxicity was moderate and required no treatment interruption. Grade II anemia occurred in 4 patients (9.3%, 95% CI 3–23.1), leucopenia in 2 patients (4.7%, 95% CI 0.8–17) and radiation dermatitis in 4 patients (9.3%, 95% CI 3–23.1) respectively.In patients with low lying, locally advanced rectal cancer, preoperative chemoradiation using oral capecitabine 825 mg/m2, twice a day on radiotherapy days, was tolerable and effective in downstaging and resulted in 46.5% anal sphincter preservation rate.Management of rectal cancer requires multidisciplinary treatment with standardized surgical, pathological and radiotherapeutic procedures [1,2]. Preoperative chemoradiation is considered the preferred treatment option for locally advanced rectal cancer (LARC) to reduce the incidence of local recurrence. This option is based on the knowledge that irradiation before surgery is more dose- and cost-effective than postoperative irradiation and less toxic. [3-5]. Sphincter preserving surgery for cancer of the lower rectum needs a long-course of neoadjuvant treatments to reduce tumor volume, to induce downs
Fetus in fetu: a case report
Nisreen M Khalifa, Doaa W Maximous, Alaa A Abd-Elsayed
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-2
Abstract: A 2 month old girl with an abdominal mass since birth, was referred to the Cancer Institute with a suspected diagnosis of a Wilms' tumor. Conventional radiograph of the abdomen revealed a mass containing numerous calcifications. CT scan showed a heterogeneous retroperitoneal mass containing well-defined calcified structures. The decision was made to recommend surgical exploration and the mass was successfully excised. Physical examination of the mass with review of literature confirmed the diagnosis of fetus in fetu.Although it is a rare condition imaging may play an important role in the correct prospective diagnosis of fetus in fetu. Surgical excision is the recommended treatment.To our knowledge fetus in fetu was originally described by Meckel in the late 18th century [1]. Fetus in fetu, a term quoted by Willis [2], was first described as a rare condition in which a malformed parasitic twin was found inside the body of its partner usually in the abdominal cavity. It represents an aberration of monozygotic diamniotic twinning in which unequal division of the totipotent inner cell mass of the developing blastocyst leads to the inclusion of a smaller cell mass within a maturing sister embryo.This pathology is rare and the incidence is 1 per 500 000 births [3], with fewer than 100 reported cases worldwide [4]. The majority of cases occur in infancy, with the oldest reported case occurring in a 47-year-old man [1].Tharkral et al [5] reported equal male and female prevalence. In 70% of cases, the chief presenting complaint was an abdominal mass [6]. The mass was predominantly retroperitoneal in 80% of cases [2], while reported uncommon sites include the oral cavity [1], sacrococcygeal region [7], and scrotum [4].A two month old girl was hospitalized because of an abdominal mass present since birth. On physical examination, a smooth, firm, nontender, right flank mass was present.Conventional abdominal radiography showed a large right abdominal mass, which was predominan
Biological Markers and Response to Neoadjuvant Taxane-Based Chemotherapy in Patients with Locally Advanced Breast Cancer
Mohamed I. El-sayed,Doaa W. Maximous,Madeha M. Zakhary,Nabiel N. H. Mikhail
ISRN Oncology , 2012, DOI: 10.5402/2012/245891
Biological Markers and Response to Neoadjuvant Taxane-Based Chemotherapy in Patients with Locally Advanced Breast Cancer
Mohamed I. El-sayed,Doaa W. Maximous,Madeha M. Zakhary,Nabiel N. H. Mikhail
ISRN Oncology , 2012, DOI: 10.5402/2012/245891
Abstract: Introduction. Biological markers as Her2/neu, p53, and hormonal receptors (HmRs) may be reliable parameters for prognostic assessment of patients of locally advanced breast cancer (LABC). This work aims at assessing the potential value of these biological markers for the prediction of disease outcome after neoadjuvant taxane-based chemotherapy and its implication on the surgical role. Patients and Methods. From March 2006 to September 2011, 95 patients with LABC were treated by neoadjuvant taxane-based chemotherapy given at intervals of 3 weeks. Expression of Her2/neu and p53 was examined in the initial tissue biopsy by using ELISA technique. Status of HmRs was determined using a commercial enzyme immunoassay. Three weeks after the third cycle, patients underwent surgical resection followed by 3 more cycles of taxane-based chemotherapy and radiotherapy as an adjuvant therapy. Relations of Her2/neu overexpression to p53, HmRs, and conventional prognostic factors were analyzed. Results. Median followup was 61 months. The 5-year DFS and OAS rates were significantly higher in patients with positive HmRs than in those with negative HmRs, patients with Her2? than those with Her2+ breast cancer, and patients with intact p53 breast cancer than those with inactive p53. HER-2 overexpression was statistically significant associated with loss of HmR positive immunostaining ( ), grade III breast cancer ( ), advanced nodal status ( ), and younger (<50 years) age ( ). Conclusion. Her2/neu overexpression was associated with poor DFS and OAS rates, as it was significantly associated with negative HmR and high grade. 1. Introduction Neoadjuvant chemotherapy (NAC) is the standard of care in patients with locally advanced breast cancer (LABC) [1], as it improves local control and survival [2, 3]. The reported clinical response rate to NAC varied between 30% and 90% and the 5-year overall survival (OAS) was reported to range between 40% and 60% [4]. As the clinical and pathological responses of breast cancer to NAC are short-term markers for a long outcome, it is important to identify biological factors that may predict response to NAC and subsequent disease-free survival (DFS) and OAS [5, 6]. It is well established that the expression of the estrogen receptor (ER) and progesterone receptor (PR) determines the responsiveness of tumors to hormonal interventions. Nevertheless the absence or presence of these hormonal receptors does not predict response to chemotherapy [7]. However, breast cancer patients with tumors that are ER positive and/or PR positive have lower risks of
Nemytskii Operator in the Space of Set-Valued Functions of Bounded φ-Variation  [PDF]
Wadie Aziz
Advances in Pure Mathematics (APM) , 2013, DOI: 10.4236/apm.2013.36072

In this paper we consider the Nemytskii operator, i.e., the composition operator defined by (Nf)(t)=H(t,f(t)), where H is a given set-valued function. It is shown that if the operator N maps the space of functions bounded φ1-variation in the sense of Riesz with respect to the weight function αinto the space of set-valued functions of bounded φ2-variation in the sense of Riesz with respect to the weight, if it is globally Lipschitzian, then it has to be of the form (Nf)(t)=A(t)f(

Feasibility of breast conservation after neoadjuvant taxene based chemotherapy in locally advanced breast cancer: a Prospective Phase I trial
Mohamed I El-Sayed, Doaa W Maximous, Mohamed A Aboziada, Mostafa E Abdel-Wanis, Nabiel NH Mikhail
Annals of Surgical Innovation and Research , 2010, DOI: 10.1186/1750-1164-4-5
Abstract: Forty five patients had stage IIB (except those with T2N1 disease) and stage IIIA were selected to 3 cycles taxane-based neoadjuvant chemotherapy. Patient who had tumours ≤5 cm underwent a tentative BCS while patients who had tumour size >5 cm underwent radical surgery. Negative margin is essential for BCS. Adjuvant chemotherapy and 3-D radiotherapy ± hormonal treatment were given to all patients.Thirty four patients had BCS. Response to chemotherapy was the only statistically significant factor which influences the BCS. Incidence of local recurrence was 5.9% for patients who had BCS at a median follow up 24 months.Breast conservation is feasible in selected cases of locally advanced, non metastatic cancer breast. We recommend that patients who have tumour size ≤4 cm after chemotherapy are the best candidates for BCS.Long-term survival is common among women with locally advanced breast cancer; therefore, quality of life issues become vitally important. For most women, loss of a breast is emotionally disturbing [1].The patient's response to preoperative chemotherapy is a powerful prognostic factor in predicting disease-free and overall survival from locally advanced breast cancer [2,3]. By assessing the response to preoperative chemotherapy, it is possible to select out a better prognosis group of patients who will have improved long-term survival and a low rate of local recurrence. Therefore, patients who respond to preoperative chemotherapy are often the best candidates for breast conservation, allowing for less disfigurement with preservation of function [3,4].Several studies have documented the feasibility and safety of breast conservation for locally advanced breast cancer after preoperative chemotherapy. Breast conservation is possible in 27% to 90% of patients after preoperative chemotherapy [4,5]. Local recurrence rates after breast conservation are low (5% - 10%) in patients who respond to preoperative chemotherapy [6,7].Our primary outcome was the evaluatio
Preoperative gemcitabine based chemo-radiotherapy in locally advanced non metastatic pancreatic adenocarcinoma
Doaa W Maximous, Mostafa E Abdel-Wanis, Mohammed I El-Sayed, Alaa A Abd-Elsayed
International Archives of Medicine , 2009, DOI: 10.1186/1755-7682-2-7
Abstract: From March 2006 to November 2007, 25 patients with locally advanced non metastatic pancreatic cancer were treated by preoperative gemcitabine based chemo-radiotherapy. The radiation dose was 54 Gray in 30 fractions over 6 weeks prescribed to the isocenter. Gemcitabine (300 mg/m2) was given through a 30 minute intravenous infusion. This was done 30 minutes before the radiation sitting on a weekly basis throughout the radiotherapy course.Approximately 6 weeks after the completion of chemo radiation, an evaluation was performed regarding tumour response and resectability as well as acute toxicity. Pancreaticoduodenectomy was performed for operable patients with surgical reconstruction.Patients who achieved complete resection (CR) numbered 2 (8%), while those achieving partial resection (PR) totalled 11 (44%); six of these patients were considered ro be operable. Thus Pancreaticoduodenectomy was performed on 8 patients (2 with CR and 6 with PR) with surgical reconstruction. Patients who had a stable disease numbered 4 (16%), and those with progressive diseases included a group of eight (32%). The postoperative 30 day mortality occurred only in one patient (12.5%). Acute toxicity of chemoradiation occurred in the form of grade I leucopoenia and thrombocytopenia. Hepatic toxicity, nausea, and vomiting were found in 8 patients (32%), 10 patients (40%) and 4 patients (16%), respectively. The postoperative 30 day mortality occurred only in 1 patient. Also, minor biliary leakage and leakage from gastrointestinal anaestomosis both occurred in a single patient. Out of the 8 patients who underwent radical surgical resection, only one developed local recurrence and simultaneous liver metastasis during the follow up period. The median survival of all patients was 12 months.Preoperative gemcitabine based chemoradiation might benefit patients with locally advanced non metastatic pancreatic cancer by increasing the resectability without significant acute toxicity.Almost 30% of patien
Preoperative Versus Postoperative Radiation Therapy in Patients with Soft Tissue Sarcomas
Mohamed Ibrahim El-sayed,Doaa Wadie Maximos,Mostafa El-sayed Abdel-wanis,Amen Hamdy Zaky
Cancer and Clinical Oncology , 2012, DOI: 10.5539/cco.v1n2p36
Abstract: Purpose: To evaluate treatment outcome and to determine whether or not the timing of radiotherapy (RT) was associated with any difference in disease relapse, survival, or incidence of complications in patients with soft tissue sarcomas (STS). Methods: The medical files of 63 patients with a primary, nonmetastatic, STS, treated with surgery and irradiation were evaluated. Data regarding tumor stage, grade, site, dosage and timing of radiotherapy, treatment complications, disease relapse, and disease-free (DFS) and overall survival (OAS) rates were analyzed. Results: The median follow up was 47 months (range; 5-66 months). Four-year OAS and DFS rates were 82.6% and 78.8% respectively. There were significant higher 4-year OAS (p = 0.024) and DFS (p = 0.011) rates in patients with stage I and II diseases than those in patients with stage III disease. On the other hand, there were no significant differences in 4-year OAS (p = 0.83, HR: 0.743, 95% CI: 0.165 to 3.345) and DFS (p = 0.64, HR: 0.74, 95% CI: 0.21 to 2.61) rates between preoperative and postoperative RT patients. Disease relapse for preoperative versus postoperative RT patients was not statistically different (p = 0.41). Wound complications were more frequent in preoperative RT patients (25%) compared to postoperative RT patients (8%) (p = 0.0566 chi-square). Conclusions: Preoperative irradiation has not a positive impact on survival or disease relapse rates, but is associated with high wound complication rate.
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