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Background Clinical effectiveness and safety data of pazopanib in patients with advanced or mRCC in real-world setting from Asia Pacific, North Africa, and Middle East countries are lacking. Methods PARACHUTE is a phase IV, prospective, non-interventional, observational study. Primary endpoint was the proportion of patients remaining progression free at 12 months. Secondary endpoints were ORR, PFS, safety and tolerability, and relative dose intensity (RDI). Results Overall, 190 patients with a median age of 61 years (range: 22.0-96.0) were included. Most patients were Asian (70%), clear-cell type RCC was the most common (81%), with a favourable (9%), intermediate (47%), poor (10%), and unknown (34%) MSKCC risk score. At the end of the observational period, 78 patients completed the observational period and 112 discontinued the study; 60% of patients had the starting dose at 800 mg. Median RDI was 82%, with 52% of patients receiving < 85%. Of the 145 evaluable patients, 56 (39%) remained progression free at 12 months, and the median PFS was 10 months (95% CI: 8.48-11.83). 19% of patients (21/109) were long-term responders (on pazopanib for >= 18 months). The best response per RECIST 1.1 was CR/PR in 24%, stable disease in 44%, and PD in 31%. Most frequent (> 10%) TEAEs related to pazopanib included diarrhoea (30%), palmar-plantar erythrodysesthesia syndrome (15%), and hypertension (14%). Conclusions Results of the PARACHUTE study support the use of pazopanib in patients with advanced or mRCC who are naive to VEGF-TKI therapy. The safety profile is consistent with that previously reported by pivotal and real-world evidence studies., Novartis Pharmaceuticals Corporation, The PARACHUTE study was sponsored by Novartis Pharmaceuticals Corporation; pazopanib is an asset of Novartis AG as of 1 March 2015.

Purpose The aim of the current study was to compare toxicity, cosmesis, and local control between the once daily and the twice daily fractionation schemes for external beam accelerated partial breast irradiation. Methods and Materials From December 2012 to June 2018, we enrolled 113 patients with ductal carcinoma in situ or invasive breast cancer, node negative disease, and tumors less than 3 cm in size to receive accelerated partial breast irradiation (APBI) to a total dose of 38.5 Gy over 10 fractions given either once (oAPBI) or twice daily (tAPBI). Sixty patients were included in the tAPBI arm and 53 patients were included in the oAPBI arm. Results Median follow-up was 74 months (range, 24-105). The median pain score during treatment was 3 out of 10 in the oAPBI and 5 in the tAPBI (P = .001). No differences were observed in GIII early skin toxicity (P = .4) or GI early pulmonary toxicity (P = 1.0) between the 2 treatment arms. GIII late skin toxicity developed in 3.8% and 11.7% of patients in the oAPBI and tAPBI arms, respectively (P = .001). GIII subcutaneous fibrosis developed in 1.9% and 8.3% of patients in the oAPBI and tAPBI, respectively (P = .001). The rate of patients with adverse cosmesis (poor/fair) was 7.5% at 12 months and at 24 months in the oAPBI arm compared with 21.7% and 26.7% in the tAPBI arm (P = .03 and .008, respectively). Conclusions oAPBI is a safe, well-tolerated schedule with more favorable outcomes than the tAPBI schedule with regards to late toxicity and cosmesis.

BackgroundPerforator flaps are the latest development in reconstructive surgery. Pedicled chest wall perforator flaps can be utilized in many cases of partial breast reconstruction. This research compares the outcome and technique of Thoracodorsal Artery Perforator Flap (TDAP) and the Lateral Intercostal Artery Perforator Flap (LICAP) in reconstruction of partial breast defects.MethodsPatient records were reviewed for the time period between 2011-2019 at the breast unit of the National Cancer Institute of Cairo University. Eighty three patients were accessible for the study. (46 cases of TDAP flap and 37 cases of LICAP flap). Relevant clinical data were extracted from patients’ records. A special visit was organized for all 83 patients ,where a digital photograph was taken in an antro-posterior view. The photographs were later processed via BCCT.core software to obtain an objective cosmetic outcome assessment.ResultsComplication rates and cosmetic outcome were comparable for both techniques. TDAP flap flap proved to require more tedious dissection and preoperative Doppler mapping to localize perforator vessels. On the other hand LICAP was technically easier with more consistent perforators.ConclusionPedicled chest wall perforator flaps constitute an excellent reconstructive option in partial breast defects. They have replaced musculocutaneous flaps to a large extent.

Breast conserving surgery (BCS) is currently the standard of care for early breast cancer. One of the key determinants for the line of treatment in breast cancer is the size of the tumor in relation to the breast size. The aim of this study is to determine the effect of the ratio of the excised specimen to breast volume on the cosmetic outcome after conventional BCS. This is a retrospective study conducted on female patients with early stage breast cancer who underwent BCT at National Cancer Institute, Cairo University. The study included 41 patients with stage I and II breast cancer. Breast volume was calculated using mammography, and ratio of the specimen to breast volume was determined. This ratio was correlated with the cosmetic outcome using the BCCT.core software. Thirty-six out of the 41 breast cancer patients completed the study. Favorable outcome (excellent + good) was detected in 52.7% of patients, while 47.3% had unfavorable outcome (fair + poor). Breast volume, tumor site, patients’ age, and weight did not seem to alter the cosmetic result. The only statistically significant factors affecting the cosmetic outcome were the specimen volume and the ratio of the specimen to the normal breast volume (p = 0.006 and 0.019 respectively). In order to obtain a satisfactory cosmetic outcome after conventional BCS, the ratio of the excised specimen to breast volume has to be seriously considered.

Chronic postmastectomy pain syndrome (PMPS) has a considerable negative impact on the quality of life of breast cancer patients.The objective of this study was to assess the possible preventive role of perioperative pregabalin in PMPS.This randomized controlled study included 200 patients with breast cancer scheduled for elective breast cancer surgery. They were randomly assigned to one of two treatment groups. The pregabalin group received 75 mg of pregabalin twice daily for seven days and the control group received oral equivalent placebo capsules. The primary outcome was development of neuropathic PMPS. Neuropathic pain was assessed using the Grading System for Neuropathic Pain. Secondary outcome measures were safety and Visual Analogue Scale scores.Neuropathic pain was significantly less frequent in the pregabalin group compared to the control group at four weeks (P = 0.005), 12 weeks (P = 0.002), and 24 weeks (P 0.001) postoperatively. PMPS was diagnosed in 11 patients (11%) of the pregabalin group and 29 patients (29%) of the control group (P 0.001, relative risk: 0.26, 95% CI: 0.12-0.56). At the three follow-up time points, Visual Analogue Scale scores during the first three postoperative weeks were comparable in both groups while they were significantly lower in the pregabalin group at 4, 12, and 24 weeks. These two groups were comparable in the frequency of adverse events (P = 0.552).Perioperative oral pregabalin 75 mg twice daily, starting at the morning of surgery and continued for one week, could reduce the frequency of postmastectomy pain syndrome.

Background Due to the high variability of incidence and prevalence of intra-mammary lymph nodes (IMLNs), they might be overlooked during clinical and radiological examinations. Properly characterizing pathological IMLNs and detecting the factors that might influence their prevalence in different stages of breast cancer might aid in proper therapeutic decision-making and could be of possible prognostic value. Methods Medical records were reviewed for all breast cancer patients treated at the National Cancer Institute of Cairo University between 2013 and 2019. Radiological, pathological, and surgical data were studied. Results Intra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phyllodes tumors and two cases had ductal carcinoma in situ (DCIS). All ten cases were excluded. The remaining 90 cases all had invasive breast cancer and were divided into two groups: one group for patients with malignant IMLNs (48) and another for patients with benign IMLNs (42). Pathological features of the malignant IMLN group included larger mean tumor size in pathology (4.7 cm), larger mean size of the IMLN in pathology (1.7 cm), higher incidence of lympho-vascular invasion (65.9%), and higher rate of extracapsular extension in axillary lymph nodes (57.4%). In addition, the pathological N stage was significantly higher in the malignant IMLN group. Conclusion Clinicians frequently overlook intra-mammary lymph nodes. More effort should be performed to detect them during preoperative imaging and during pathological processing of specimens. A suspicious IMLN should undergo a percutaneous biopsy. Malignant IMLNs are associated with advanced pathological features and should be removed during surgery.

Shimaa A Metwally,1 Maha A Abo-Shadi,1 Nasra F Abdel Fattah,2 Ahmed B Barakat,3 Omar A Rabee,3 Ahmed M Osman,2 Amany M Helal,4 Tarek Hashem,5 Manar M Moneer,6 Wassim Chehadeh,7 Samah A Loutfy2,8 1Microbiology & Immunology Department, Faculty of Pharmacy for Girls, Al-Azhar University, Cairo, Egypt; 2Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; 3Microbiology Department, Faculty of Science, Ain Shams University, Cairo, Egypt; 4Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt; 5Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt; 6Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt; 7Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait; 8Nanotechnology Research Center, British University in Egypt (BUE), Cairo, EgyptCorrespondence: Samah A LoutfyVirology and Immunology Unit, Cancer Biology Department, National Cancer Institute (NCI), Cairo University, Cairo, EgyptTel +201222840964Email samah.loutfy@gmail.comBackground: Oncogenic viruses, their possible association with breast cancer (BC) and effect on its clinical course are interesting issue. The present study evaluates the presence of human papillomavirus (HPV), EpsteinBarr virus (EBV), and human mammary tumor virus (HMTV) in BC and their relation with clinico-pathological characteristics.Patients and Methods: This study was conducted on 80 Egyptian women with BC and 30 control women without known oncological disease. Forty formalin-fixed paraffin-embedded (FFPE) tissues, forty fresh tissue samples, and white blood cells (WBCs) of BC patients and WBCs of controls were subjected to a qualitative polymerase chain reaction (PCR). Quantitative real-time PCR was used to measure viral loads in fresh tissues of BC. The result was correlated with clinico-pathological characteristics of BC.Results: HPV was detected in 33 (41.25%), EBV in 30 (37.5%) and HMTV in 33 (41.25%) BC patients. None of the control women was positive for HPV or EBV while HMTV was detected in 7 (23.3%). Among 40 BC WBCs specimens, HPV/HMTV were found together in 25%, followed by EBV/HMTV in 2.5% and EBV/HPV in 2.5%. However, the three viruses (HPV/EBV/HMTV) were found together in only 5%. In the 40 fresh BC tissues, the three viruses were found together in 12 (30%), EBV/HMTV in 7 (17.5%), HPV/HMTV in 4 (10%), and HPV/EBV in 4 (10%). EBV, HMTV, or multiple viral infections were associated with younger age of BC women. HPV, EBV, and HMTV median loads in fresh tissues were 4.8× 103 copies/μL, 6.3× 103 copies/μL, and 97 copies/μL, respectively.Conclusion: WBCs could be a more suitable specimen instead of fresh tissue for HMTV detection in BC patients to avoid invasive procedures. The presence of HPV, EBV, and HMTV together in Egyptian women with BC was significantly associated with younger age.Keywords: HPV, EBV, HMTV, young age, breast cancer, quantitative real-time PCR, viral load

BackgroundDue to the high variability of incidence and prevalence of intra-mammary lymph nodes(IMLNs), they might be overlooked during clinical and radiological examinations. Properly characterizing pathological IMLNs and detecting the factors that might influence their prevalence in different stages of breast cancer, might aid in proper therapeutic decision making and could be of possible prognostic value. Methods Medical records were reviewed for all breast cancer patients treated at the National Cancer Institute of Cairo University between 2013-2019. Radiological, pathological and surgical data were studied.ResultsIntra-mammary lymph nodes were described in the final pathology reports of 100 patients. Five cases had benign breast lesion. Three cases had phylloides tumors and two cases had duct carcinoma in situ. All ten cases were excluded. The remaining 90 cases had all invasive breast cancer and were divided into two groups. One group for patients with malignant IMLNs (48) and another for patients with benign IMLNs (42). Pathological features of the malignant IMLN group included larger mean tumour size (4.7 cm) , larger mean size of the IMLN (1.4 cm), higher incidence of lymphovascular invasion( 65.9%) and a higher rate of extracapsular extension in axillary lymph nodes (57.4%). All these criteria were statistically significant. In addition the pathological N stage was significantly higher in the malignant IMLNs group.ConclusionIntra-mammary lymph nodes are frequently overlooked by clinicians. More effort should be done to detect them during preoperative imaging, and during pathological processing of specimens. A suspicious IMLN should be biopsied by FNAC . Malignant IMLN are associated with advanced pathological features and should be removed during surgery.

Background The extended latissimus dorsi (ELD) flap can provide adequate volume for breast reconstruction without an implant. The aim of this study was to identify a simple method to estimate preoperatively if the ELD flap would provide enough volume for breast reconstruction and good cosmetic outcome. The proposed model was based on correlating the preoperative body mass index (BMI) and breast cup size. Methods This retrospective cohort study included 64 patients who underwent immediate breast reconstruction with ELD at the National Cancer Institute, Cairo University, between January 2014 and January 2016. Preoperative breast cup size and patients' BMI were recorded. The primary end point was cosmetic outcome score assessed by three independent breast surgeons and the patients. Correlation analysis was performed between the preoperative factors and final cosmetic outcome. Results Sixty-four patients underwent immediate reconstruction following skin-sparing mastectomy. BMI range was 23–38 kg/m 2 with a median of 28. All patients with cup size A had aesthetically pleasing results. As the breast cup size increased, the favorable cosmetic outcomes were noted with lower BMI. All patients with BMI higher than 33 had unfavorable results. Conclusion Favorable cosmetic outcomes are expected after ELD reconstruction in patients with cup size A regardless of the BMI. As the breast cup size increases, favorable cosmetic outcomes are expected in patients with lower BMI than in those with higher BMI. At a BMI of 34, no favorable cosmetic outcomes are expected. The prediction model will be validated in a prospective study.

Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a strong association with endometriosis. Although having better prognosis than other sarcomas, yet these tumors may relapse (whether local or distant) in up to 56% of cases, even as late as 20 years after surgery. We report a case of a 30-year-old female patient with a mass in the inferior vena cava and right atrium which was surgically removed using cardiopulmonary bypass and deep hypothermic circulatory arrest and turned to be an entometrioid stromal sarcoma. The patient gave a history of endometriosis followed by the appearance of a low-grade ovarian endometrioid stromal sarcoma 4 years before the development of the mass in the IVC and right atrium.

Introduction High risk human papillomaviruses (HR-HPVs) has a possible role in development and pathogenesis of breast cancer (BC) disease. Other oncogenic viruses showed to be linked to BC such as Epstein Barr virus (EBV), and Human mammary tumor virus (HMTV). Presence of high risk HPV genotypes, EBV or HMTV could affect the severity course of BC. Therefore, the aim of the current study is to explore distribution of HPV with regards to its genotypes and the presence of EBV and HMTV among Egyptian BC women with its correlation to age and hormonal status. Patients & Methods This study was conducted on 40 fresh tissues of BC patients and blood samples from 30 apparently healthy controls. All samples were investigated for detection of HPV, EBV and HMTV DNAs using qualitative PCR. Detection of HPV viral load was performed using quantitative real time PCR. HPV genotypes were determined on 10 purified positive PCR product using Sanger sequencing of HPV L1 region. The obtained sequences were compared to the known HPV DNA sequences at National center for biotechnology information (NCBI) and/or Papillomavirus Episteme (Pave) data bases using their online BLAST and taxonomy tools. Data were correlated with age and hormonal status. Results All the tested 3 oncogenic viruses were not detected into 30 controls. HPV, EBV and HMTV were detected in 20 (50%), 23 (57.5%), 28 (70%) respectively of the 40 BC patients by using PCR assay. HPV median load of the 20 positive samples was 4800 copies/μL. Seven different HPV genotypes were detected included high risk genotypes ((HPV 18 in 3 samples), 70 and 52), low risk genotype (11) detected into only one sample along with 3 other genotypes (102, 114 and 151). One sample showed no significant similarity with any sequence registered in the used databases. Presence of EBV and HMTV DNAs and high risk HPV genotypes was more associated with young age (lower than 50 years), P value = 0.015, 0.001 and 0.05, respectively but were not associated with hormonal status of BC patients. Conclusion HMTV was the most detected viral DNAs among BC patients, High risk HPVs were identified into 10% of studied Egyptian BC patients and were associated with young age. Further larger sample size study is needed to evaluate role of HPV genotypes on pathogenesis and outcome of BC disease. STDF Acknowledgment This project was supported financially by the Science and Technology Development Fund (STDF), Egypt, Grant No.22944. Citation Format: Nasra F Abdel Fattah, Shimaa A Metwally, Samah A Loutfy, Maha A Abo-Shadi, Ahmed B Barakat, Omar A Rabee, Ahmed M Osman, Amany M Helal, Tarek M Hashem, Manar M Moneer. Molecular detection and genotyping of human papillomavirus in presence of some oncogenic viruses among Egyptian breast cancer women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2264.

Introduction: Breast cancer (BC) is a multifactorial disease, that is attributed to non-familial factors such as environmental or genetic factors that play a vital role in the development of the disease. BRCA1/2 mutations represent a high risk of breast cancer. The current study focused on exploring the relationship between the presence of BRCA1/2 mutations and some clinicopathological characteristics which might impact the pathogenesis of BC disease. Material and Methods: Genomic DNA samples were obtained from 19 fresh tissues using Gene JET Extraction Kit (Thermo Scientific/US, Canada), and 29 FFPE using QIAamp DNA FFPE Tissue Kit (Qiagen, Valencia, USA) obtained from pretreatment BC patients. Library preparation was performed using Devyser BRCA NGS kit (DEVYSER, Stockholm, Sweden), according to the manufacturer's instructions. The reagent kit V2, 500 Cycles PE, on the Illumina MiSeq System (Illumina, San Diego, CA, USA). The BRCA1 and BRCA2 genes reference were: NM_007300 and NM_000059, respectively. Variants were called using freebayes (1.1.0.46) and annotated using ANNOVAR(version2019Oct24). All samples were subjected for detection of Human Mammary Tumor Virus (HMTV) and Human Papillomavirus (HPV) DNAs using qualitative PCR assay. Result: The study identified 40 and 54 different BRCA1 and BRCA2 mutations, mostly in the form of frameshift and stop codon mutations. Regarding, BRCA1, 14 pathogenic mutations were detected, exon10 and exon 9 showed to be the most affected exons representing (c.C1612T (25%) and c.C1471T(22.9%), respectively. For BRCA2, only five pathogenic mutations were identified, exon 11 and exon 14 showed to be the most affected exons (cT4001A(6.25%) and c.7231delA(4.16%), respectively. Regarding relation between BRCA1/2 genes mutations and clinicopathological parameters, BRCA1 and BRCA2 carriers were younger than non-carriers though not significant (p=0.440). Regarding the tumor characteristics, BRCA1/2 carriers had large tumor size (p=0.091), high tumor grade compared to non-carriers but without significance (P=0.098). Micro-classifications positivity (60%) was also more frequently among BRCA1/2 carrier than non-carrier (p= 0.082). Regarding detection of HMTV and HPV, BRCA1/2 mutation carriers has a skew towards negative results (P= Conclusion: Our data suggest that BRCA1/2 mutations might contribute to the pathogenesis among both familial and non-familial Egyptian breast cancer patients, but we need more sample size to confirm the findings. It also identifies the most affected exons in preparation for establishing a diagnostic tool like HRM for genetic counseling, which will help when selecting treatment modalities for BC patients. STDF Acknowledgment: This project was supported financially by the Science and Technology Development Fund (STDF), Egypt, Grant No.22944 Citation Format: Samah A. Loutfy, Nasra F. Abdel Fattah, Ahmed B. Barakat, Omar R. Alfarouk, Tarek M. Hashem, Ahmed M. Osman, Shimaa A. Metwally, Maha A. Abo-Shadi, Amany M. Helal, Shaza A. Habib, Ahmed A. El Sherif, Abdel Wahab El Ghareeb, Mohamed M. Mouneer, Manar M. Moneer, Marwa A. Abdel-Wahed, Mona A. Salem, Asmaa M. M. M. Salama, Fatma S. Hafez, Sara H. Agwa, Hesham Elghazaly, Manal M. El-Mahdy, Mark J. Dunning, Sherif F. El-Khamisy. BRCA1 and BRCA2 mutations and its clinical relevance among egyptian breast cancer women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2512.

Background: Recent advances in breast reconstruction and the introduction of oncoplastic techniques have resulted in significant improvement in quality of life and psychological well-being of most patients. Nipple sparing mastectomy is a surgical technique that removes breast tissue while preserving the native skin envelope, infra-mammary fold and the NAC, which allows immediately reconstructed breasts to have an excellent cosmetic outcome. Aim: Our primary end point was for objective assessment of aesthetic outcome after NSM via more accurate new method and subsiding bias in that assessment and the secondary end point was for evaluating the influence of incision choice and recommending which incision is the best for each patient putting in mind cup size, degree of ptosis and body mass index of Egyptian patients. Methods: Starting January 2013 to November 2015, 74 patients with breast cancer underwent NSM with immediate reconstruction using LD flap with or without implant augmentation. Results: Incisions used are elliptical (37.8%), lateral (27%), peri-areolar (21.6%) and infra-mammary (13.5%). In 81.1% of the patients, the procedure was performed using extended LD flaps only, while in the remaining 18.9% the flaps were augmented using implant insertion. Axillary dissection was done in 68.9% of patients and SLN in 24.3% of patients. Overall aesthetic results were done by patient self-assessment, assessment by the surgeon, assessment by professional plastic breast surgeon and assessment by onco-plastic surgeon, and this was followed by statistical analysis of the agreement between the plastic surgeon and the onco-plastic surgeon. Conclusion: NSM is safe, feasible and offers adequate oncologic results along with excellent cosmetic outcome. Choice of incision and reconstruction should be tailored to suit each patient. Breast cancer patients can benefit from sound resection and enjoy a sense of wholeness.

Highlights • Laparoscopic adjustable gastric banding is one of the most common bariatric procedures done. • The most reported complications of this technique are related to the band around the stomach. • This case report describes a case of acute abdomen caused by the connecting tube of the gastric band. • The tube looped around the root of mesentry and caused incarceration of the small intestine. • This complication, although rare, should be kept in mind due to its serious effects., Introduction Laparoscopic adjustable gastric banding is one of the most frequently done procedures for morbid obesity. In most reported cases, the band itself is the cause of complications. There are only a few reports of morbidities caused by the connecting tube. This presentation describes a case of acute abdomen due to small bowel herniation between the connecting tube and the abdominal wall. This case report aims to remind clinicians of possible complications caused by the connecting tube of a gastric band. Case presentation We report about a 24-year-old male patient, who presented with acute abdomen. He had undergone gastric banding three years ago. According to his clinical presentation, the patient was diagnosed as having acute appendicitis. Abdominal exploration revealed, total small bowel herniation between the connecting tube and the abdominal wall. Discussion Although a simple procedure, laparoscopic gastric banding could have serious complications. Some of these complications could present years after the application of the gastric band. There are a few reports about complications caused by the connecting tube of the gastric band. Conclusion Complications caused by connecting tube should always be in mind, when assessing acute abdomen in patients with laparoscopic gastric band.

Purpose: High interest in triple-negative breast cancers is not surprising as this category of patients benefits neither from hormonal therapies nor from anti HER2 treatments. Blockade of angiogenesis by metronomic chemotherapy as well as other antiangiogenics might improve outcomes in this group of patients. This study aims to evaluate the tolerability and efficacy of metronomic capecitabine as extended adjuvant treatment for women with triple-negative breast cancer. Methods: This is a prospective phase II study that included 41 patients diagnosed with triple-negative breast cancer and who were indicated for adjuvant chemotherapy. They received capecitabine 500 mg PO twice daily and continuously for six months after finishing six cycles of adjuvant FEC100 ± postoperative radiotherapy. Results: Forty-one patients were enrolled in this study between June 2010 and December 2013. Median age was 50 years ranging from 27 to 67 years. Treatment was well tolerated. Adverse effects were grade 1 palmar–plantar erythrodysesthesia in 13 patients (31.7%); grade 1 diarrhea in five patients (12.2%); and grade 1 vomiting in two patients (4.9%). Estimated median follow-up duration was 34 months. Estimated mean disease-free survival (DFS) was 42.4 months (95% CI, 39.02–45.79), while median DFS was not reached. Estimated mean overall survival was 44.34 months (95% CI 41.9–46.9). Conclusion: Extended adjuvant metronomic capecitabine is well tolerated with patient compliance. These results need to be compared in a study with control arm, larger sample, as well as longer follow-up. Keywords: Triple-negative breast cancer, Metronomic chemotherapy, Capecitabine, Extended adjuvant treatment

Background The aim of this study is to compare the results of batwing mammoplasty and Wise pattern mammoplasty in the surgical management of upper pole breast tumours. Methods This is a retrospective observational study including 126 breast cancer patients who presented between 2009 and 2015 to the National Cancer Institute of Cairo University in Egypt. All patients were candidates for breast conservation, with upper pole tumours, which was defined as tumours between 3 and 9 o’clock. Patients were categorized into two groups. Group A (64) included patients who underwent inferiorly based therapeutic mammoplasty, while group B (62) was designated for patients who had batwing mammoplasty. The results of both groups were compared and analyzed. Results Wise pattern mammoplasty group had statistically significant higher complication rate. The overall aesthetic result of Wise pattern technique was superior to batwing mammoplasty. However, batwing mammoplasty showed a statistically significant higher rate of patient satisfaction. Conclusions Both techniques are valid options for upper pole breast tumours. Wise pattern therapeutic mammoplasty remains aesthetically superior; however, batwing mammoplasty is an easy, simple technique with acceptable results to patients.

This corrigendum corrects the author list and affiliations of the article: Abd El Bary et al. Cost Effectiveness Analysis of Letrozole Compared with Tamoxifen as Initial Adjuvant Therapy for Postmenopausal Women with Endocrine Responsive Breast Cancer. Kasr El-Aini J Clin Oncol Nucl Med. 2009; 5(3-4): 11-17.In response to a request supported by documents from the corresponding author, the name Dr. Mohamed Elsherbini was added to the list of authors and the affiliation of Dr. Mohamed Abdeen was mentioned.The corrected version of this article replaces the primarily published one.

Background and aim Thoracodorsal artery perforator flap (TDAP) is one of the relatively new techniques in breast reconstruction. In this study, we try to evaluate the outcome of this flap in oncoplastic procedures. Methods This study included 40 patients of stage II breast cancer who underwent partial mastectomy with skin excision at the National Cancer Institute of Cairo University between 2011 and 2014. The resultant defects were immediately reconstructed using the thoracodorsal artery perforator flap. Operative time and complication rates were recorded. The cosmetic outcome was assessed through a questionnaire. Results The mean operative time was 227 min. The total complication rate was 20% with flap congestion being the most common complication. The cosmetic outcome was acceptable with 80% of patients rating their outcome as either good or excellent. The subjectively assessed functional outcome showed a mean time of 10 days postoperative for patients to regain their full range of shoulder movements. Conclusion Thoracodorsal artery perforator flap can play a significant role in oncoplastic surgery and breast reconstruction with acceptable cosmetic and functional outcome.

Identifying leukemia stem cells (LSCs) is a challenge and a critical step in understanding their respective biology and may provide insights into a more efficient treatment of acute lymphoblastic leukemia (ALL). This cohort study aimed at detecting LSCs expressing CD19, CD34, and CD38Low in the bone marrow of 20 de novo Egyptian pediatric B-ALL patients at the time of the diagnosis and after the induction of chemotherapy. LSCs were detected in 80% of cases at the time of diagnosis and in 70% of the cases after the induction of chemotherapy. Patients were followed up for 12–18 months. No statistically significance difference was encountered between LSC-positive and LSC-negative patients as regards their clinical and laboratory data at the time of diagnosis. Furthermore, there was no statistically significant difference between the percentages of LSC-positive patients before or after induction of therapy. On follow-up, two patients died; they had residual LSCs after the induction therapy. However, the existence of LSCs did not affect the patient's 1-year disease-free survival rate. LSC may resist the traditional lines of treatment applied for childhood B-ALL; it may be used in minimal residual disease monitoring as well as being a target for new therapeutic lines to improve the outcome of treatment especially in patients with high-risk and relapsed ALL.

Background: Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer-related death worldwide, affecting one million people per year. Currently, gastric cancer is still the seventh most common cause of cancer-related death in the USA, and the prognosis of advanced gastric cancer remains poor. Objectives: The aim of this study was to assess the frequency of Her-2 overexpression and amplification in Egyptian patients with gastric/gastroesophageal adenocarcinoma, in correlation with tumor histology, grade, size, and location (cardia vs. noncardia). Patients and methods: This study included 39 eligible patients with pathologically proven gastric/gastroesophageal carcinoma presented to Menoufia University Oncology Hospital, Alexandria Military Hospital, from January 2012 until the end of June 2013. Results: It was found that the mean age was 55.3 years. There was slightly higher incidence in the male population (51.3%). All of them had tumors of diffuse histopathological type. Stage at presentation was as follows: localized, one (2.6%); locally advanced, 20 (51.3%); and metastatic, 18 (46.2%). Her-2 was found to be overexpressed in four out of 39 patients (10.3%). Her-2-negative patients had a significantly longer overall survival (9 months in Her-2 negative-patients vs. 4 months in Her-2-positive patients) (P= 0.01). Progression-free survival (PFS) was significantly prolonged in Her-2-negative patients. Her-2-negative patients had a PFS of 8 months, versus only 4 months in Her-2-positive patients (P= 0.01). Median survival and PFS in locally advanced disease were significantly affected by the Her-2 status (P= 0.02). Neither median survival (P= 0.8) nor PFS (P= 0.5) was affected in metastatic disease. Conclusion: Her-2 is a prognostic factor in a small cohort of Egyptian patients with gastric/gastroesophageal carcinoma.

Background: Hepatocellular carcinoma (HCC) accounts for between 85 and 90% of primary liver cancer. Surgery is considered curative treatment; however, local ablative technique has a high rate of recurrence. Different attempts are being tried to decrease time of recurrence with less side effects and toxicities. Metronomic chemotherapy is an emerging method of treatment with less side effects and good tolerability. Objectives: The aim of the study was to evaluate the effect and toxicity of metronomic capecitabine in HCC patients after localized intervention. Material and methods: This study included 30 patients with HCC who have been treated with locoregional interference (tranarterial chemoembolization, radiofrequency, or both) and have got complete response (CR) or partial response (PR). The patients were selected from the clinical oncology department, faculty of medicine, Menoufyia University; they received capecitabine 1000 mg/day continuously. Patient characteristics, disease-free survival, time to progression, effect of primary localized intervention on the outcome, and toxicity were evaluated using univariate and multivariable analysis. Results: Most patients were men with mean age of 54 years and hepatitis C virus positive (73%). Median disease-free survival was 8 months for patients who had CR after localized interference. Median time to progression was 8 and 4.4 months for CR and PR patients, respectively, which was statistically significant (P = 0.001). No grade IV toxicity was found. Grade III toxicity was hepatic toxicity (hyperbilirubinemia) and was found in three patients (10%); renal toxicity (elevated creatinine and urea) was found in one patient (3.3%); and one patient stopped due to deterioration of general condition. The most common hematological toxicity was thrombocytopenia grade I (50%) of the studied group. Four patients stopped treatment due to persistent grade III toxicity and one stopped it due to deteriorated performance. Effect of the initial response to localized treatment or the type of this localized intervention on the end outcome was insignificant. Conclusion: Metronomic capecitabine has a modest antitumor efficacy on HCC patients in CR or PR after localized intervention. However, because of its low toxicity profile, it deserves further attention as a convenient, outpatient-based chemotherapy regimen. We recommend more randomized controlled trials and phase III trials with comparative arm in larger populations.

Background Maintenance therapy for non-small cell lung cancer (NSCLC) aims to extend disease control after first-line chemotherapy with active and well-tolerated agents. The utility of continuation maintenance therapy requires further research. Methods This multicenter, randomized, phase 2 study compared continuation maintenance therapy with pemetrexed (500 mg/m2 every 21 days) and best supportive care (BSC) versus BSC alone in patients with advanced, non-squamous NSCLC who had not progressed after 4 cycles of induction chemotherapy with pemetrexed (500 mg/m2) and cisplatin (75 mg/m2). The primary endpoint was progression-free survival (PFS) from randomization, was analyzed using a Cox model, stratified for the tumor response at the end of induction therapy, at a one-sided alpha of 0.2. Secondary endpoints: response and disease control rates, overall survival (OS), one year survival rates, and treatment-emergent adverse events (TEAEs). Results A total of 106 patients commenced induction therapy, of whom 55 patients were randomized to maintenance pemetrexed/BSC (n = 28) or BSC (n = 27). Although the median PFS time for maintenance phase for both arms was 3.2 months, the one-sided p-value for the PFS HR comparison was less than the prespecified limit of 0.2 (HR = 0.76, two-sided 95% confidence interval [CI]: 0.42 to 1.37; one-sided p-value = 0.1815), indicating that PFS was sufficiently long in the pemetrexed/BSC arm to warrant further investigation. Similar PFS results were observed for the overall study period (induction plus maintenance) and when the PFS analysis was adjusted for sex, baseline disease stage, and the ECOG PS prior to randomization. The median OS for the maintenance phase was 12.2 months (95%CI: 5.6 to 20.6) for the pemetrexed/BSC arm and 11.8 months (95% CI: 6.3 to 25.6) for BSC arm. The one-year survival probabilities were similar for both arms for the maintenance phase and the overall study period. Both the induction and continuation maintenance therapies were generally well-tolerated, and similar proportion of patients in each arm experienced at least 1 grade 3/4 TEAE (pemetrexed/BSC, 17.9%; BSC, 18.5%). Conclusions Continuation pemetrexed maintenance therapy resulted in promising PFS with an acceptable safety profile in a Middle Eastern population with advanced non-squamous NSCLC and is worthy of further investigation. Trial registration NCT00606021

Objective The aim of the study was to evaluate the toxicity, feasibility, and efficacy of concurrent capecitabine (Xeloda) with adjuvant radiotherapy in the treatment of high-risk breast cancer patients. Background Breast cancer ranks as the first malignancy affecting women. Patients with breast cancer have high risk of locoregional and/or distant failure: the locoregional failure rate is variable depending mainly on the disease stage and the adjuvant treatment. Different radiotherapy schedules are used in the adjuvant treatment of breast cancer. Concurrent chemoradiotherapy is the standard for many solid tumors; it is promising to be investigated in breast cancer. Patients and methods This study was conducted at the Clinical Oncology Department, Menoufia University Hospital, and included patients with a high risk of breast cancer after mastectomy and adjuvant chemotherapy. They were randomized to receive radiotherapy 40 Gy in 15 fractions through 3 weeks with or without concurrent capecitabine 825 mg/m 2 every 12 h on radiotherapy days. Patients were assessed for treatment regularity, toxicity, and recurrence. Results In this study, 100 patients were enrolled from April 2011 to October 2011 and followed up for 2 years; patients were randomized into 50 patients in each treatment group. Generally, the incidence of acute and late toxicities were comparable in both treatment groups with no incidence of grade III/IV early toxicity; only a mild increase in gastrointestinal side effects was noticed with capecitabine; however, 96% of the patients were able to finish their concurrent capecitabine therapy and all patients finished radiotherapy; no radiotherapy interruption occurred due to toxicity. Most of the late radiation adverse effects were grade I/II. Regarding efficacy, the concurrent capecitabine arm had better disease control locally and systemically and better disease-free survival, but the difference was statistically insignificant. Conclusion Concurrent capecitabine with postmastectomy hypofractionated radiotherapy is highly feasible, safe, and effective, but a longer follow-up is recommended.

Objective The aim of this study was to assess the impact of primary tumor resection on the survival and quality of life in women with stage IV breast cancer. Background About 3-10% of patients with breast cancer have distant metastases (stage IV) at initial presentation. Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined strictly to palliation. However, retrospective studies have shown improved survival in patients who have undergone surgery for their primary tumor. Thus, new clinical questions have emerged in terms of surgery of the primary site in those women with metastatic disease and a resectable intact primary tumor. Patients and methods This study included patients with stage IV breast cancer who presented to the Clinical Oncology Department, Menoufia University, from September 2009 till August 2011. Patients were divided on the basis of treatment into two groups: those who underwent surgery and those who did not undergo surgery. All patients then received anthracyclin-based chemotherapy, followed by hormonal treatment according to hormonal status. Patient characteristics and survival were evaluated using univariate and multivariable analyses. Results In total, 151 patients were included in this analysis; 61 patients underwent surgery and 90 patients did not. The median survival of the patients who underwent surgery for their primary tumor was significantly longer than that for the patients who did not undergo surgery (39 vs. 24 months). The median time to progression in the surgery group was 26 months versus 13 months in the no-surgery group. The 2-year survival was 73.8% in the surgery group compared with 38.9% in the no-surgery group. A multivariate proportional hazards model identified the grade of tumor as a significant independent prognostic factor. Conclusion Primary tumor resection increased survival in patients with metastatic breast cancer. Thus, the role of surgery in women with stage IV breast cancer needs to be re-evaluated.

667 Background: Combined radiation and hormone therapies have become common clinical practice in recent years for locally advanced prostate cancer. The use of such concomitant therapy in the treatm...