Abstract Background The pediatric diffuse intrinsic pontine glioma (DIPG) outcome remains dismal despite multiple therapeutic attempts. Purpose To compare the results of treatment of pediatric ...diffuse intrinsic pontine glioma (DIPG) using hypofractionated versus conventional radiotherapy. Patients and methods Seventy-one newly diagnosed DIPG children were randomized into hypofractionated (HF) (39 Gy/13 fractions in 2.6 weeks) and conventional (CF) arm (54 Gy/30 fractions in 6 weeks). Results The median and one-year overall survival (OS) was 7.8 months and 36.4 ± 8.2% for the hypofractionated arm, and 9.5 and 26.2 ± 7.4% for the conventional arm respectively. The 18-month OS difference was 2.2%. The OS hazard ratio (HR) was 1.14 (95% CI: 0.70–1.89) ( p = 0.59). The hypofractionated arm had a median and one-year progression-free survival (PFS) of 6.6 months and 22.5 ± 7.1%, compared to 7.3 and 17.9 ± 7.1% for the conventional arm. The PFS HR was 1.10 (95% CI: 0.67–1.90) ( p = 0.71). The 18-month PFS difference was 1.1%. These differences exceed the non-inferiority margin. The immediate and delayed side effects were not different in the 2 arms. Conclusions Hypofractionated radiotherapy offers lesser burden on the patients, their families and the treating departments, with nearly comparable results to conventional fractionation, though not fulfilling the non-inferiority assumption.
•The cancer burden, radiotherapy availability and mortality-incidence ratio in Arabic countries showed a shortage of radiotherapy service especially in low income and politically unstable countries.
...Arab countries share a common location, history, language and culture with different economic characteristics. In this study, we analyze the availability and factors influencing radiotherapy services and cancer mortality incidence ratio (MIR) in Arabic countries.
Data were collected from GLOBOCAN report, World Health Organization, World Bank, United Nation and Directory of Radiotherapy Centre databases.
The average number of megavoltage machines (MVM) in Arab countries is 0.84 machine per 1000 cancer patients. The number of MVM per 1000 cancer patients was found to be significantly correlated with gross domestic product (GDP) per capita (r = 0.583, P = 0.006). In addition, it was found to be significantly more in politically stable countries compared to unstable ones (P = 0.004) and more in high and upper-middle income countries (median 0.94 ± 1.0) compared to lower-middle and low income countries (median 0.3 ± 0.51) (P = 0.013). MIR was found to be significantly correlated with GDP per capita, physicians per 1000 population, MVM per 1000 cancer patients and absolute MVM deficit (r = −0.555, −0.625, −0.42, −0.436 and P = 0.009, 0.006, 0.047, 0.043, respectively). On multivariate regression analysis, the number of physicians per 1000 population had the strongest prediction of MIR in Arabic countries (P = 0.01).
Although the economic status is of paramount importance, it is not the only factor determining the quantity and quality of radiotherapy services in the Arab world. More efforts are urgently needed to improve the status of radiation oncology and fill its gap in the Arab countries.
•One-third of pediatric tumor patients require radiotherapy.•High pediatric radiotherapy utilization rate in a middle-income country.•Pediatric soft tissue sarcoma requires the highest radiotherapy ...utilization rate.•Palliative radiotherapy is frequently used for brainstem glioma patients.•Palliative radiotherapy is underutilized in childhood cancers.
Although the radiotherapy utilization rate (RUR) is determined for most adult cancers, it is seldom reported in childhood tumors, particularly in low- and middle-income countries (LMIC) where the majority of pediatric cancer patients reside. This study aims to investigate the real-life RUR for pediatric tumors in a large LMIC center.
The electronic files of patients treated at a single institution during 2010–2017 were reviewed and the RUR was defined as the percentage of patients who received at least one radiotherapy (RT) course from the total number of patients.
A total of 4390 out of 13,305 pediatric cancer patients received at least one RT course with a RUR of 33%. The curative, salvage, and palliative RURs were 27.8%, 2%, and 5.7%, respectively. There was a considerable variation in the RUR between various tumors, ranging from 0% in choroid plexus papilloma and other rare tumors to 100% in intracranial germinoma. Moreover, the RUR varied among different stages within each tumor type. Overall, 753 patients received 920 palliative RT courses (range 1–9) at a median dose of 30 Gy. The most commonly irradiated metastatic sites were the bone (34%) and the brain (9.8%).
This is the first analysis to provide valuable insights into the RUR for childhood tumors. Together with population-based pediatric cancer registries, this will help decipher pediatric RT needs and deficits. Additionally, the underutilization of palliative RT calls for multidisciplinary palliative care provision for pediatric cancer patients.
This study explores the prognostic factors and outcomes of different treatment modalities in focal brain stem glioma (FBSG).
Pediatric FBSG patients diagnosed during 2010–2017 were retrospectively ...reviewed for clinical and therapeutic data.
A total of 71 cases were identified and the median age was 6.4 years. The 5-year overall- and progression-free survival were 74.5 and 70.6%, respectively. Radiotherapy was the main line of treatment (66.2%) and there were no survival differences between radiotherapy, chemotherapy and surveillance groups. Two independent poor prognostic factors were identified on multivariate analysis: age <8 years and cervicomedullary tumor site (p = 0.02 for both).
Surveillance, radiotherapy and chemotherapy have comparable clinical outcomes in pediatric FBSG.
With the advancement in endoscopic surgery, radiation treatment planning and execution, as well as the use of new chemotherapeutic regimens, bladder conservation has evolved into a competing ...alternative to radical cystectomy. Trimodality treatment has the great advantage of preserving a normally functioning urinary bladder. Despite the absence of direct randomized trials comparing both modalities, trimodality treatment comprising maximal transuretheral resection of bladder tumors followed by different regimens of combined radiochemotherapy achieved comparable results to radical cystectomy in many trials. Those who did not achieve complete remission after induction radiochemotherapy were salvaged by radical cystectomy. Improving the radiotherapeutic window is a challenging issue. In radiotherapy for bladder cancer, uncertainties include set-up errors, patient movement, internal organ movement and volume changes due to bladder filling (both inter- and intrafraction). The advancement in treatment verification procedures in modern radiotherapy and the use of fiducial markers reduces set-up errors, while adaptive radiotherapy could decrease the unnecessary irradiation of normal tissues by tracking bladder volume changes. In addition, new radiotherapeutic techniques, such as intensity-modulated radiotherapy and volume-modulated radiotherapy, permit dose escalation to the target without increasing the dose to the surrounding normal tissues.
Obelisks presented an important element in the architecture of ancient Egypt. This research is concerned with the re-erection of an obelisk that belongs to the famous Pharoah Ramses II. It was found ...broken and was transported to the Grand Egyptian Museum for restoration and display. An observation of Ramses II Cartouche at the bottom side of the obelisk base inspired the authorities to provide an innovative architectural design to display the obelisk elevated. The supporting structure was designed to allow the visitors to walk underneath the obelisk and observe Ramses II's signature. The idea of elevating the obelisk presented several challenges including evaluating the obelisk's current condition, restoration and fixation methodology, structural stability, and uncertainties of material characteristics, amongst others. To control the obelisk deformations under lateral loading, state-of-the-art base isolators were introduced. For the task to be achieved, a multidisciplinary team including historians, conservators, archaeologists, architects, and engineers with different specialties was appointed. The team performed the task successfully and currently, the obelisk stands at the entrance piazza of the Grand Egyptian Museum representing the world's first elevated obelisk.
The Paleozoic rocks in North Africa are prolific with source rocks that contribute petroleum to giant fields especially in Algeria and Libya. The coeval subsurface source rocks from the Devonian and ...Carboniferous in the Western Desert of Egypt have been evaluated in the present study. The rocks from Zeitoun, Desouqy, and Dhiffah formations have been evaluated based on integration of the palynofacies, organic geochemical analysis, and well logging. The study depends on samples from five wells that are Buchis-1X, Phiops-1X, Siwa-D-1X, Tayim West-1X, and WKAL C-1XST. The distribution of palynofacies categories are statistically investigated by the principal component analysis (PCA) that specified the proximal-distal environmental trends by the values of component 1 that attributed to the terrestrial organic sources. The analyses revealed mostly poor, fair to good organic enrichments and poor to fair source potential in the studied rocks. The samples are mostly thermally mature, uncontaminated, and of gas prone type III and mixed oil/gas prone type II/III kerogen. The geological conditions that lead to the large difference in the hydrocarbon source potentiality between western North Africa and source rocks evaluated in this study from Egypt have been discussed. It is suggested that these differences resulted from the larger thickness of Paleozoic rocks and the increase in burial depths of the depocenters in the western side that lead to higher maturity levels that are responsible for the organic conversions and hydrocarbon expulsion.
•Faghur Basin is a division of northern African Desert Paleozoic petroleum regime.•The studied rock units are Zeitoun, Desouqy, and Dhiffah of Devonian Carboniferous.•The studies revealed mature ...Paleozoic source rocks.•The studied formations reached to oil zone without any gas cracking at Cretaceous age.
Paleozoic Zeitoun, Desouqy and Dhiffah formations represent source rocks to hydrocarbon in Faghur basin, north Western Desert, Egypt. They are characterized by a sufficient amount of organic matter belonging to kerogen type III and mixed type II/III, which are in maturation stage. A 1D-basin modeling was performed by using geological and geochemical data of the Paleozoic source rocks from five wells in Faghur basin, north Western Desert, Egypt. These data used in 1D basin modeling for constructing and understanding of burial and thermal geo-histories of Faghur basin and for simulating and predicting the timing of petroleum and expulsion for the Paleozoic source rocks in the studied wells. Burial and thermal history models indicate that the Zeitoun Formation entered onset of oil generation in the studied wells during Late Cretaceous (100.10–91.65 my) with transformation ratio (TR) 10–25, peak oil during Late Cretaceous (91.65–79.30 my) with TR 25–50 and late oil stage at Late Cretaceous (79.30 my-0) to present day with TR 50–60.45. Desouqy Formation entered onset of oil generation also during Late Cretaceous (94.43–73.60 my) with TR 10–25 in the studied wells, peak oil during Late cretaceous (73.60–62.40 my) with TR 25–50 and Late oil stage during Late Cretaceous to present day (62.40 my-0) with TR 50–61.82. Dhiffah Formation entered onset of oil generation in the studied wells during Early to Late Cretaceous (102.11–92.27 my) with TR 10–25, peak oil during Late Cretaceous (92.27–86.40 my) with TR 25–50 and late oil stage at Late Cretaceous to present day (86.40 my-0) with TR 50–67.27. No cracking oil to gas in the studied Paleozoic source rocks in the studied wells. These basin modeling results also suggest that the Paleozoic source rocks act as an effective source rock where a significant amount of petroleum is expected to be generated and expelled to any nearby prospect reservoir rocks in the Faghur basin.
Milk thistle or its purified extract, silymarin (
Silybum marianum), is widely used in treating acute or chronic hepatitis. Although silymarin is hepatoprotective in animal experiments and some human ...hepatotoxic exposures, its efficacy in ameliorating the symptoms of acute clinical hepatitis remains inconclusive. In this study, our purpose was to determine whether silymarin improves symptoms, signs and laboratory test results in patients with acute clinical hepatitis, regardless of etiology.
This is a randomized, placebo-controlled trial in which participants, treating physicians and data management staff were blinded to treatment group. The study was conducted at two fever hospitals in Tanta and Banha, Egypt where patients with symptoms compatible with acute clinical hepatitis and serum alanine aminotransferase (ALT) levels >2.5 times the upper limit of normal were enrolled. The intervention consisted of three times daily ingestion of either a standard recommended dose of 140
mg of silymarin (Legalon
®, MADAUS GmbH, Cologne, Germany), or a vitamin placebo for four weeks with an additional four-week follow-up. The primary outcomes were symptoms and signs of acute hepatitis and results of liver function tests on days 2, 4 and 7 and weeks 2, 4, and 8. Side-effects and adverse events were ascertained by self-report.
From July 2003 through October 2005, 105 eligible patients were enrolled after providing informed consent. No adverse events were noted and both silymarin and placebo were well tolerated. Patients randomized to the silymarin group had quicker resolution of symptoms related to biliary retention: dark urine (
p=0.013), jaundice (
p=0.02) and scleral icterus (
p=0.043). There was a reduction in indirect bilirubin among those assigned to silymarin (
p=0.012), but other variables including direct bilirubin, ALT and aspartate aminotransferase (AST) were not significantly reduced.
Patients receiving silymarin had earlier improvement in subjective and clinical markers of biliary excretion. Despite a modest sample size and multiple etiologies for acute clinical hepatitis, our results suggest that standard recommended doses of silymarin are safe and may be potentially effective in improving symptoms of acute clinical hepatitis despite lack of a detectable effect on biomarkers of the underlying hepatocellular inflammatory process.
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