BackgroundSarcoma encompasses an uncommon group of cancer and the data is insufficient from Pakistan. We report our four years experience of Sarcoma of soft tissues and bones.MethodsThis cross sectional study was carried out at Aga Khan University Hospital from 2004 to 2008. The patients were divided into two groups from the outset i.e. initially diagnosed and relapsed group and separate sub group analysis was conducted.ResultsOut of 93 newly diagnosed patients, 58 belonged to bone sarcoma and 35 to soft tissue sarcoma group. While for relapsed patients, 5 had soft tissue sarcoma and 9 had bone sarcoma. Mean age was 32.5 years. At presentation, approximately two third patients had localised disease while remaining one third had metastatic disease. The Kaplan Meier estimate of median recurrence free survival was 25 months, 35 months, and 44 months for Osteogenic sarcoma, Ewing's sarcoma and Chondrosarcoma respectively. For Leiomyosarcoma and Synovial sarcoma, it was 20 and 19 months respectively. The grade of the tumour (p = 0.02) and surgical margin status (p = 0.001) were statistically significant for determination of relapse of disease.ConclusionThe median recurrence free survival of patients in our study was comparable to the reported literature but with significant lost to follow rate. Further large-scale, multi centre studies are needed to have a more comprehensive understanding of this heterogeneous disease in our population.

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Urothelial cancers usually recur distantly rather than loco-regionally. In patients with pT2 and pT3/pT4 tumors, local recurrence has been observed in 3-4% and 11-16%, respectively, whereas distant failure has occurred in 10-27% and 19-35%, respectively. Despite local therapy most patients with muscle invasive transitional cell carcinoma (TCC) of the bladder die of systemic relapse, indicating a need for effective adjunctive systemic treatment. We determined whether neoadjuvant chemotherapy improved overall survival. This study evaluated the role of neoadjuvant combination chemotherapy with gemcitabine/cisplatin (GC) in improving the outcome of this group of patients. A total of 44 patients (84% Male, 16% Female) with newly diagnosed bladder cancer (T3-4, N0-2, M0) were subjected to initial 3 cycles of GC, then managed according to response. Patients were assessed clinically after each cycle and by Interim CT scan after 3 cycles of chemotherapy and those who achieved complete or partial response underwent radical cystectomy. We enrolled 63 patients, 19 of whom were found to be ineligible; thus, 44 were assigned to receive neoadjuvant chemotherapy followed by surgery. Average size of the largest tumor was greater that 30mm in 77% patients. According to Computed Tomographic findings 70% patients belonged to Stage T4A. The overall response rate to GC was 50%, and incomplete response was achieved in 25% whereas 25% patients were lost to follow up. Twenty two patients who had complete response, underwent cystectomy and diversion. It was observed that those patients who underwent radical cystectomy with ureterosigmoidostomy had an increased serum creatinine in comparison to patients who had ileal conduit. The size of the effect is modest and combination chemotherapy can be administered safely without adverse outcomes resulting in delayed local therapy. Further efforts to identify the patients most likely to benefit from neoadjuvant therapy are necessary to optimize its use.

Introduction:Cancer patients are at risk of severe symptoms because of COVID 19 virus. Cancer patients are prone because they are immune-comprised due to their cancer and due to treatment with chemotherapy/immunotherapy. It is difficult to treat cancer patients in this pandemic due to limited data. Incidence of severe complications related to this virus in cancer patients is high then non cancer patients of same age group. They need more ICU admission and invasive ventilation. Since clinical data is relatively scarce in this perspective. This study is being carried out to perceive incidence and severity and outcome of this viral infection in cancer population in under developed country. Methods: All cancer patients who were receiving active oncological treatment and on surveillance visited the oncology clinic or required inpatient hospital care were included in this study. Aim was to assess the incidence and outcome of COVID 19 infection in oncology patients treated in our institute. Files of all adult cancer patients who were COVID positive and required inpatient care or managed at home from March 2020 till March 2021 were reviewed retrospectively. Purposive non-random sampling has been used for sampling technique. All details related to this infection have been recorded on a predesigned Proforma. Results: Total number of patients who visited Oncology clinics during 1 st wave and 2 nd wave of covid-19 were: n-7877 [M :F-1.5 :1]. During these waves total oncology patients who contracted COVID virus were: N= 170[170/ 7877=2.1 %, M: F-1.8: 1]. Only n-18 patients expired, Mortality according to severity of infection was: mild [4.7%], moderate [1.7%] and severe [4.1%]. More patients died secondary to this virus were urinary bladder [22.8%] and prostate cancer [15%] followed by GI [11.5%]. Patients with mild infection died because they had associated sepsis and uncontrolled malignancy. Mortality according to age, total [n-18], 5, 5, 8, and 0 according to age group 1, 2, 3 and 4. Mortality with co-morbidities, only chronic kidney disease [n-03], only hypertension [n-4], only ischemic heart disease [n-0], with multiple co-morbidities Afshan Asghar Rasheed et al.