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Background: Proliferating trichilemmal tumors (PTTs) are rare benign neoplasms that arise from the outer sheath of a hair follicle. Group III PTTs are high-grade malignant tumors reported to exhibit a high recurrence rate, lymph nodes, and a tendency to develop distant metastasis. Case Presentation: A 25 years old female patient was presented to us with a history of recurring soft tissue scalp lesions. The lesion recurred three times within 1 year. There was no history of trauma. Every time the lesion was excised but no histopathology of the specimen was done. Upon the third recurrence, it came out to be a malignant proliferating trichilemmal tumor (MPTT). Considering the young age of the patient and keeping in view the history of multiple recurrences with positive deep margin even after the third surgery, the patient was planned external beam radiotherapy (RT) 50 Gy/25 fx to scalp with 9 Mev electron using 0.5 cm bolus. The post-RT follow-up currently of 2 years is uneventful. Conclusion: The mainstay of treatment is surgery with wide surgical margins as local recurrence is most common in MPTT. Adjuvant RT was used in this case to prevent recurrence. [ABSTRACT FROM AUTHOR]

Background/aim: Smokeless tobacco has been associated with oral cavity cancer for several decades. The incidence of oral cavity cancer is higher in some parts of the world especially South and South-East Asia including Pakistan. The aim of current study was to evaluate the risk of oral cavity cancer among smokeless tobacco users in our country. Materials and methods: A case-control study was conducted between November 2016 and September 2017. Patients diagnosed with oral cavity cancer receiving treatment were included as cases and the attendants of various cancer patients visiting the hospital during the study period were included in the study as controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated and all reported P-values were considered significant at < 0.05. Results: The crude OR for the "ever smokeless tobacco users" among cases and controls came out to be 4.98 (95%CI; 2.76-9.01). The OR for snuff users among cases and controls was 4.82 (95%CI; 2.37-9.80) and that for betel leaf users was 4.42 (95%CI; 1.66-11.91) after adjusting for smoking and age. Conclusion: Our study provided strong evidence for snuff and betel leaf to be independent risk factors for oral cavity cancer. [ABSTRACT FROM AUTHOR]

Single nucleotide polymorphisms (SNPs) lead to genetic differences in breast cancer (BC) susceptibility among women from different ethnicities. The present study aimed at investigating the involvement of SNPs of three genes, including fibroblast growth factor receptor 2 (FGFR2), trinucleotide-repeat-containing 9 (TNRC9) and mitogen-activated protein kinase kinase kinase 1 (MAP3K1), as risk factors for the development of BC. A case-control study (90-100 cases; 90-100 controls) was performed to evaluate five genetic variants of three genes, including FGFR2 (SNPs: rs1219648, rs2981582), TNRC9 (SNPs: rs8051542, rs3803662) and MAP3K1 (SNP: rs889312) as BC risk factors in Pakistani women. Significant associations were observed between BC risk and two SNPs of FGFR2 [rs2981582 (P=0.005), rs1219648 (P=9.08e-006)] and one SNP of TNRC9 [rs3803662) (P=0.012)] in Pakistani women. On examining the different interactions of these SNPs with various clinicopathological characteristics, all three associated genetic variants, rs2981582 rs1219648 and rs3803662, exhibited a greater predisposition to sporadic, in comparison to familial, BC. Furthermore, there was an increased effect of BC risk between haplotype combinations of the two SNPs of FGFR2 (rs2981582 and rs1219648) in Pakistani women. The results of the present study suggest that variants of FGFR2 and TNRC9 may contribute to the genetic susceptibility of BC in Pakistani women. [ABSTRACT FROM AUTHOR]

The current study emphasizes the synthesis of iron oxide nanoparticles (IONPs) and impact of hydrophilic polymer polyvinyl alcohol (PVA) coating concentration as well as anticancer drug doxorubicin (DOX) loading on saturation magnetization for target drug delivery applications. Iron oxide nanoparticles particles were synthesized by a reformed version of the co-precipitation method. The coating of polyvinyl alcohol along with doxorubicin loading was carried out by the physical immobilization method. X-ray diffraction confirmed the magnetite (Fe3O4) structure of particles that remained unchanged before and after polyvinyl alcohol coating and drug loading. Microstructure and morphological analysis was carried out by transmission electron microscopy revealing the formation of nanoparticles with an average size of 10 nm with slight variation after coating and drug loading. Transmission electron microscopy, energy dispersive, and Fourier transform infrared spectra further confirmed the conjugation of polymer and doxorubicin with iron oxide nanoparticles. The room temperature superparamagnetic behavior of polymer-coated and drug-loaded magnetite nanoparticles were studied by vibrating sample magnetometer. The variation in saturation magnetization after coating evaluated that a sufficient amount of polyvinyl alcohol would be 3 wt. % regarding the externally controlled movement of IONPs in blood under the influence of applied magnetic field for in-vivo target drug delivery. [ABSTRACT FROM AUTHOR]

Water-based suspension of silver nanoparticles (AgNPs) and dextran coated AgNPs (dextran-AgNPs) are fabricated and characterised for intravenous administration. A simple method for radiolabelling of nanoparticles with 99mTc was used. Labelling efficiency for AgNPs and dextran-AgNPs was found to be more than 80 and 88%, respectively. In vivo tissue uptake of nanoparticles during dynamic phase, after systematic administration by biodistribution analysis with single-photon emission computed tomography imaging has been evaluated. Biodistribution analysis revealed that 99mTc-AgNPs and 99mTc-dextran-AgNPs are mainly accumulated in liver/spleen region but 99mTc-dextran-AgNPs delayed recognition and uptake by liver. Results indicate that dextran-AgNPs are able to evade reticuloendothelum system with enhanced blood retention time. Accumulation of nanoparticles in liver/spleen region implicates the utilisation of AgNPs for liver cancer treatment. [ABSTRACT FROM AUTHOR]

Objective Methotrexate (MTx) is an anticancer agent used in the treatment of various cancers. The objective of this study was to document the biodistribution of 99mTc-labelled Mtx (99mTc-MTx) in normal subjects and patients with breast cancers. Methods We prepared the 99mTc-MTx kit by a direct labelling method and studied its biodistribution in volunteer subjects and patients with breast carcinoma breast. This clinical study was preceded by animal trials [1]. Results The normal biodistribution pattern in humans was characterized by nonspecific uptake in the body with the 99mTc-MTx behaving like a blood pool agent with no evidence of specific organ uptake. The kidneys were seen to be the main route of excretion. Biodistribution data of patients with carcinoma breast showed excellent tracer uptake in the tumour and showed no other nonspecific tracer uptake. Conclusion This initial clinical trial showed that 99mTc-labelled anticancer drug can be successfully used for tumour scintigraphy, which appears to be a major breakthrough as this method of labelling and scanning may be useful in future tumour staging, calculating the sensitivity of tumours to certain anticancer agent and response evaluation during chemotherapy. [ABSTRACT FROM AUTHOR]

Objective Methotrexate (MTx) is an anticancer agent used in the treatment of various cancers. The objective of this study was to document the biodistribution of 99mTclabelled Mtx (99mTc-MTx) in normal subjects and patients with breast cancers. Methods We prepared the (99mTc-MTx kit by a direct labelling method and studied its biodistribution in volunteer subjects and patients with breast carcinoma breast. This clinical study was preceded by animal trials [1]. Results The normal biodistribution pattern in humans was characterized by nonspecific uptake in the body with the (99mTc-MTx behaving like a blood pool agent with no evidence of specific organ uptake. The kidneys were seen to be the main route of excretion. Biodistribution data of patients with carcinoma breast showed excellent tracer uptake in the tumour and showed no other nonspecific tracer uptake. Conclusion This initial clinical trial showed that 99mTclabelled anticancer drug can be successfully used for tumour scintigraphy, which appears to be a major breakthrough as this method of labelling and scanning may be useful in future tumour staging, calculating the sensitivity of tumours to certain anticancer agent and response evaluation during chemotherapy. [ABSTRACT FROM AUTHOR]

The Society of Surgeons of Pakistan and The Society of Surgical Oncology of Pakistan with factions from various major centres comprising of surgical oncology, medical and radiation oncology collaborated to reach consensus on breast cancer management guidelines and a framework of "good practice" minimum standards of care. The aim of the task force was to enhance treatment standards, which have a direct correlation with improving patient mortality and morbidity and long-term survival whilst taking into consideration economic limitations of access to leading centers of excellence as well as minimum expertise required in health care. These multidisciplinary guidelines, whilst not exhaustive, aim to provide an algorithm of care for breast cancer patients at tertiary care centres and district level hospitals to provide most appropriate treatment.

Introduction: Breast cancer is one of the leading causes of cancer-related deaths in women; it is the most frequently diagnosed cancer in women in the United States with a lifetime risk of dying of about 3.4%. Regional lymph node involvement is quite early in breast carcinoma and axillary lymph node metastasis is an important predictor of recurrence and survival, particularly in invasive ductal histology of breast carcinoma. Localization of sentinel lymph node/nodes followed by frozen section and histopathological evaluation helps to prevent unnecessary axillary nodal dissection and, hence, reduces associated post-surgical morbidity. Sentinel nodes are the first ones to receive lymph-borne metastatic cells and, hence, lymphoscintigraphy followed by biopsy is quite reliable to detect nodal metastasis, particularly at an early stage (I, II) of breast cancer., Methods: Here we will share our experience of introducing procedure, personnel training, and workflow of sentinel lymph node lymphoscintigraphy in breast cancer patients at our cancer institute to help other centers establish programs for this study., Results: Initially, 10 procedures were performed, all of which were successful in the localization of sentinel nodes and played a substantial part in the surgical planning of breast cancer. Planar lymphoscintigraphy and single-photon emission computerized tomography (SPECT)-CT images of our first patient revealed radiotracer avidity in the lymph node in the ipsilateral axilla, which was later on diagnosed as metastatic resulting in axillary nodal clearance., Conclusions:  In multidisciplinary/closely-placed surgical, pathological, and hybrid imaging facility settings, lymphoscintigraphy provides a quick, accurate, and better way of nodal localization leading to correct surgical decision-making. In addition to planar imaging, SPECT-CT acquisition significantly improves the specificity of the lymphoscintigraphy procedure, which is beneficial for patients to avoid false-positive results, thus saving breast cancer patients from potential adverse effects of surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Yasmin et al.)

A joint effort by the Society of Surgeons Pakistan and Society of Surgical Oncology Pakistan, these guidelines provide a framework for the practicing surgeons involved in care and management of patients with colorectal cancer. The guidelines take into account the issues related to our local circumstances and provide a minimum standard of care that must be given to these patients. The Guideline Committee had members from all disciplines, including surgery, surgical oncology, medical oncology and radiation oncology. The guidelines have attempted to simplify things to understand and follow for the practicing surgeons. With these guidelines we wish to eliminate disparities in treatment among institutions and prevent any under treatment of patients.

Objectives: To determine the frequency and grades of acute side effects with three-dimensional brachytherapy in carcinoma cervix using RTOG/EORTC acute radiation morbidity scoring criteria., Study Design: Descriptive study., Place and Duration of Study: Department of Radiotherapy, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan from July 2016 to September 2017., Methodology: A total of 55 histologically proven patients of squamous cell carcinoma of the cervix, aged between 16-70 years, were included. Patients with previous radiotherapy in pelvic area, inflammatory bowel diseases and known diabetics, were excluded. All patients were given a radiation dose of 7 Gray in 4 insertions through 3-dimensional conformal brachytherapy planning. Acute vaginal, gastrointestinal, and genitor-urinary side effects of brachytherapy were assessed., Results: Mean age of the patient population was 47.09 ±13.10 years (Range: 21-68). Mean time to presentation was 5.65 ±2.32 months and mean tumor size was 3.67 ±1.47 cm. Majority, i.e. 18 (32.7%) patient presented in stage III. Most of the patients, 26 (47.3%), had ECOG-2 performance status. Grade-1 genitourinary toxicity was significantly high (p <0.001). In lower gastrointestinal toxicity, Grade-1 was the highest being 54.5%. Conversely, vaginal toxicities of grade-2 and 3 were most commonly seen. Stratification of acute side effectswith respect toage, stage and tumor size revealed no significant association except in mucosal membrane toxicity, which was affected by tumor size (p = 0.004)., Conclusion: Three-dimensional brachytherapy in carcinoma cervix is a safe and tolerable procedure with minimal acute side effects. Key Words: Cervical cancer, Brachytherapy, Acute toxicities, Computed tomography.

Objective: To determine the outcome of sonographically-guided indigenous low-cost metallic clip placement for tumour localisation in patients of early breast cancer undergoing neoadjuvant chemotherapy. ., Methods: The prospective analytical study was conducted at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, from May 2016 to December 2017, and comprised biopsy-proven breast cancer cases. Under sonographic guidance, metallic clips were placed as markers within the lesions before their scheduled preoperative neoadjuvant chemotherapy. The procedure was performed using an 18 gauge lumbar puncture needle and 25 gauge needle by a locally devised simple and cost-effective technique. Post-procedure mammography was performed to confirm the location of clips within the lesions and to evaluate its role in imaging assessment of treatment response after neo adjuvant chemotherapy. SPSS 20 was used for data analysis., Results: There were 30 women with a mean age of 40.43+11.35 years (range: 21-60 years). These women had 32 lesions with a mean size of 26.72+9.85mm (range: 8-58mm). Breast conserving surgery was performed on 28(87.5%) lesions and negative margins were achieved in all these cases. Modified radical mastectomy was performed on 4(12/5%) non-responding lesions. No complication was noted in association with metallic clip placement, and the clips were easily visualised on mammograms without causing any interference with treatment response., Conclusions: Sonographically-guided metallic clip placement by a simple indigenously devised technique before neoadjuvant chemotherapy was found to be a well-tolerated, safe and cost-effective method for accurate preoperative localisation of tumour bed and to assess response to therapy.

Background: The Pakistan Atomic Energy Commission Cancer Registry (PAECCR) program has made availability of a common cancer incidence database possible in Pakistan. The cancer incidence data from nuclear medicine and oncology institutes were gathered and presented., Materials and Methods: The cancer incidence data for the last 30 years (1984-2014) are included to describe a data set of male and female patients. The data analysis concerning occurrence, trends of common cancers in male and female patients, stage-wise distribution, and mortality/follow-up cases is also incorporated for the last 10 years (2004-2014)., Results: The total population of provincial capital Lahore is 9,800,000. The total number of cancer cases was 80,390 (males 32,156, females 48,134). The crude incidence rates in PAECCR areas were 580.8/105 during 2010 to 885.4/105 in 2014 (males 354.1/105, females 530.1/105). The cancer incidence rates for head and neck (15.70%), brain tumors (10.5%), and non-Hodgkin lymphoma (NHL, 9.53%) were found to be the highest in male patients, whereas breast cancer (46.7%), ovary tumors (6.80%), and cervix (6.31%) cancer incidence rates were observed to be the most common in female patients. The age range distribution of diagnosed and treated patients in conjunction with the percentage contribution of cancer patients from 15 different cities of Punjab province treated at the Institute of Nuclear Medicine and Oncology, Lahore are also included. Leukemia was found to be the most common cancer for the age group of 1-12 years. It has been identified that the maximum number of diagnosed cases were found in the age range of 51-60 years for males and 41-50 years for female cancer patients., Conclusions: Overall cancer incidence of the thirty years demonstrated that head and neck and breast cancers in males and in females respectively are the most common cancers in Punjab province in Pakistan, at rates almost the highest in Asia, requiring especial attention. The incidence of brain, NHL, and prostate cancers among males and ovarian and cervix cancers among females have increased rapidly. These data from a major population of Punjab province should be helpful for implementation of appropriate planning, prevention and cancer control measures and for determination of risk factors within the country.

Methotrexate (MTX) is being used in clinical oncology for the treatment of a wide variety of cancers. The aim of the present study was to label directly MTX with (99m)Tc by using Sn/pyrophosphate as reducing agent and to use this labeled compound as a potential anticancer radiopharmaceutical for breast cancer imaging. We studied the labeling efficiency of the (99m)Tc-MTX compound by paper chromatography and instant thin layer chromatography (ITLC) in acetone and saline and found it to be more than 95%. In vitro stability of labeled MTX in serum was studied up to 5h. Partition coefficient in n-octanol and saline indicated that the labeled radiopharmaceutical was hydrophilic. We then tested (99m)Tc-MTX in 5 breast cancer female patients. Protein bound (99m)Tc-MTX showed rapid clearance from blood. The biodistibution data suggested that (99m)Tc-MTX was cleared by the kidneys and the liver. Patients ' data also showed highly significant uptake of (99m)Tc-MTX in breast cancer. In conclusion, this study indicated that (99m)Tc-MTX may be used as a potential diagnostic agent for breast cancer patients imaging and may show treatment efficiency in case MTX is to be used for treatment.

Intracranial haemangiopericytomas are very rare tumours. Their radiological appearance resembles that of meningioma. Recommended treatment is total surgical excision, if possible, followed by radiotherapy. A vigilant, long-term clinical and radiological follow up is very essential due to a high rate of late onset recurrence along with neural and extraneural metastases. A case report and review of literature is presented.

Objective: To summarize the data and look into the various treatments offered to cervical cancer patients at Institute of Nuclear Medicine and Oncology (INMOL) to highlight the most likely causes of treatment failure., Methods: In this retrospective study, case files of all patients presenting with invasive carcinoma of uterine cervix during 1993-2002 were studied in respect to personal profile, disease related risk factors, pathological characteristics, treatment administered and outcome in the form of tumour response and survival., Results: Early age at marriage, multiple marriages of self or spouse, multiparty, prolonged use of contraceptives and smoking were some of the risk factors for cervical cancer in this group of patients. Out of 618 patients presenting with invasive cervical cancer, 65% presented in advanced stages II and III. Apart from advanced stage at presentation, anaemia, poor nutrition, and ignorance about self-hygiene and lack of follow-up were main causes of treatment failure. Outcome of treatment was improved when chemotherapy was added to radiation., Conclusion: Advanced stage at diagnosis and lack of follow-up were main causes of treatment failure. Implementation of screening programs on national level for early detection is therefore recommended.