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Objectives: Conventional fractionated irradiation (CF) has major implications on both patient quality of life and radiotherapy (RT) departments. Hypofractionated (HF) RT schedule would be more convenient for patients and for health care providers. We retrospectively evaluated OAS, DFS, locoregional control, and treatment related toxicities, in patients treated with CF and HF schedules.Methods: This retrospective study analyzed the medical records of female breast cancer patients with infiltrating duct carcinoma, and underwent surgery and received adjuvant systemic and radiation therapies.The schedule of adjuvant radiotherapy was divided into two groups; CF (n = 162), and HF (n = 181).The log-rank test examined differences in OAS and DFS rates. Data of radiation toxicities, and disease relapse in both CF and HF groups were compared using Chi-square test. Results:The median follow up was 42 months (range: 6 -127 months). Four-year OAS & DFS rates for the whole group were 86.5% & 83.8% respectively. There were no significant differences in 4-year OAS regarding age at diagnosis (p = 0.18, HR 0.66, 95% CI: 0.36 -1.22), disease stage (p = 0.06), HR status (p = 0.1, HR 0.52, 95% CI: 0.241 -1.135), type of surgery (p = 0.28, HR 1.44, 95% CI: 0.74 -2.79), and fractionation schedule (p = 0.12, HR 0.63, 95% CI: 0.35 -1.34). Disease stage (p = 0.032, in favour of early stages) and fractionation schedule (p = 0.039, HR 0.553, 95% CI: 0.315 -0.970 in favour of HF) were associated with significant differences in 4-year DFS rates. Conclusion:Hypofractionated radiation therapy was safe and resulted in comparable OAS and disease relapse rates, to that in CF.

Purpose: To compare the outcome among patients with invasive bladder cancer treated with cystectomy alone with outcome among those treated with combined-modality treatment in a randomised phase III trial.Patients and methods: Patients with histologically confirmed invasive non-metastatic bladder cancer T2-3, N0 and M0 were randomly assigned to two arms: Arm 1: of which all patients underwent radical cystectomy (RC) alone; and Arm 2, of which all patients were subjected to maximal transurethral resection of bladder tumour, followed 2 weeks later by combined chemoradiotherapy. The whole pelvis received 46 Gy in 23 fractions over 4?5 weeks. Chemotherapy was administered concomitantly with radiotherapy with: cisplatin 70 mg/m 2 q. 3 weeks and Gemcitabine 300 mg/m 2 D 1, 8 and 15 q. 3 weeks for two cycles. Patients who had complete response were shifted to phase II treatment: 20 Gy/10 fractions/2 weeks to the bladder. Patients with residual tumour underwent RC.Results: Of the 80 patients assigned Arm 2, a visibly completed transurethral resection of the bladder tumour was possible in 48 patients (60%). Phase I of combined chemoradiotherapy (CCRT) was accomplished in 74 patients. Post-induction urologic evaluation revealed no evidence of disease in 62 patients (83?8%) and residual disease in 12 patients (16?2%). Phase II of CCRT was completed in 58 of the 62 patients. The median follow-up for all patients is 27 months (range: 4-49). The 3-year overall survival (OS) for the combined-modality group and for the surgery group were 61 and 63%, respectively (p 5 0?425), whereas the disease-specific survival (DSS) for each group was 69 and 73%, respectively (p 5 0?714). The 3-year OS with bladder preservation for Arm 2 patients was 50%. Multivariate analysis for the whole series showed that tumour stage and performance status (PS) were the only factors independently associated with DSS, although PS was the only factor independently associated with OS. In addition, residual disease after transurethral resection of the bladder tumour in Arm 2 patients was independently associated with both DSS and OS. Acute toxicity was moderate and most of the late toxicities were grade 2 with no grade 4 toxicity and no treatment-related deaths, none required cystectomy for bladder contraction. 428Conclusion: This study demonstrates that trimodality bladder-preserving approach represents a valid alternative for suitable patients. The OS and DSS rates of patients treated with trimodality bladder-preserving protocol are comparable to the results reported on patients treated with immediate radical cystectomy.

Objective High-grade gliomas (HGGs) carry dismal prognosis with survival typically reported as less than a year. We explored the predictive value of qualitative and quantitative evaluations of post-treatment 99m-technetium-labelled methoxyisobutylisonitrile (99mmTc-MIBI) brain single-photon emission computed tomography-computed tomography (SPECT/CT) tumor uptake in relation to overall survival (OS) in patients with HGG. Methods Thirty patients with pathologically or radiologically documented high-grade glioma (HGG) were prospectively recruited for this study (24 male, 6 female; mean age 43 ± 14 years). All patients had a clinical or radiological suspicion of residual/recurrent tumor after initial therapy. 99mTc-MIBI brain SPECT/CT scanning was performed, and the scans were evaluated qualitatively on a five-point probability score (1–5, scores ≥3 considered positive for residual/recurrent tumor); and quantitively via drawing volumes of interest (VOI) on the suspected lesions and normal contralateral brain tissue. All patients were followed up for 1 year or till death. Results Positive visual MIBI results were associated with poor survival. Among 10 patients with negative MIBI scores, only two patients died (OS = 75%), while 11/20 patients reported positive on MIBI died, with a median survival of 9 months (OS = 14.5%; P = 0.03). All patients with active isocontour volume ≤1.96 cm3 were alive at the end of the study, compared to a median survival of 9 months and OS of 12% for patients with an isocontour volume of >1.97% (P = 0.003). Conclusion In patients with HGG, post-therapy brain SPECT/CT with 99mTc-MIBI can provide useful prognostic information.

BackgroundLocal pelvic recurrence after radical cystectomy for muscle invasive bilharzial related squamous cell carcinoma accounts for 75% of treatment failures even in organ confined tumors. Despite the proven value of lymphadenectomy, up to 60% of patients undergoing cystectomy do not have it. These factors are in favor of adjuvant radiotherapy reevaluation. objectives: to evaluate the effect of adjuvant radiotherapy on disease free survival in muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder and to test the predictability of radio-sensitivity using the anti apoptotic protein Bcl-XL.MethodsThe study prospectively included 71 patients, (47 males, 24 females) with muscle invasive bilharzial related squamous cell carcinoma of the bladder (Stage pT2a-T3N0-N3M0) who underwent radical cystectomy in Assiut university hospitals between January 2005 and December 2006. Thirty eight patients received adjuvant radiotherapy to the pelvis in the dose of 50Gy/25 fractions/5 weeks (Group 1), while 33 patients did not receive adjuvant radiotherapy (group 2). Immunohistochemical characterization for bcl-xL expression was done. Follow up was done every 3 months for 12 to 36 months with a mean of 16 ± 10 months. All data were analyzed using SPSS version 16. Three years cumulative disease free survival was calculated and adjusted to Bcl-XL expression and side effects of the treatment were recorded.ResultsThe disease free cumulative survival was 48% for group 1 and 29% for group 2 (log rank p value 0.03). The multivariate predictors of tumor recurrence were the positive Bcl-XL expression (odd ratio 41.1, 95% CI 8.4 - 102.3, p < 0.0001) and radiotherapy (odd ratio 0.19, 95% CI 0.05 - 0.78, p < 0.02). With Cox regression, the only independent multivariate predictor of radio-sensitivity was the Bcl-XL expression with odd ratio 4.6 and a p value < 0.0001. All patients tolerated the treatment with no life threatening or late complications during the period of follow up.ConclusionsAdjuvant radiotherapy for muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder has potential effectiveness and minor side effects. Moreover, Bcl-XL expression is a valuable tool for predicting those who might not respond to this adjuvant treatment.