Issue 44Issue No. 44, January 2024
Electronic ISSN 2521-3881
Issue No. 44 - January 2024
7-15 Assessment of Uncertainty in Volume Estimation of Non-Static Target: A Phantom Study using Racemosa Wood

TR Verma1, NK Painuly1, SP Mishar2, MLB Bhatt1, 2

1King George Medical University, India.

2Dr. Ram Manohar Lohia Institute of Medical Sciences, India.


Introduction : CT information of the target undergoing motion/movement during its scanning has been questioned by many researchers for its preciseness as well as accuracy. The present study was taken with aim to validate the racimosa wood as lung equivalent and to assess the uncertainty in volume estimation during virtual simulation of non-static target of known dimension such as in lung cancer radiotherapy.


Materials and methods: The racemosa wood was validated as lung equivalent material with the help of two methods. Wood insert with tumor model was put into the hollow cylinder space of dimension 6.4 cm in diameter provided in CIRS phantom. First CT image of rest position was taken and given name " No Movement" . Subsequently the tumor was shifted +/-5mm, +/-15mm and +/-25 mm with respect to " Rest Position" . CT images of the CIRS phantom containing tumor in wood cylinder were acquired after each movement given to wood cylinder.


Results: The relative electron density of racemosa wood corresponding to HU value -724 was found to be 0.275 gm/cm3. The true volume of the target was 7.8.cm3 however variation up to 9.5 cm3 was observed in CT produced volume of the target over the range of different movements.


Discussion : The racemosa wood was found to be having range of density (- 850 HU to - 400 HU) similar to real human lung density variation. Various studies have been performed using uniform density lung structures in their experimental setups to assess the accuracy in lung cancer radiation delivery. However, in the present work approximately real clinical setting was reproduced by putting the wood cylinder with density variation from 0.2 gm/cm3- 4.5 gm/cm3in hollow space provided in one lung structure the phantom used in this study.


Conclusion : The racemosa wood was found to be lung equivalent which is available locally and cost-effective as well. Overestimation in the target volume (by CT imaging) showed a trend of increase with 3 directional movement amplitudes. The results of this study can be utilised in lung cancer radiotherapy as the same were derived from setup having clinical settings in terms of lung density variation, shape, compositions of the phantom maximally as found during the real patient radiotherapy.


Keywords: Racemosa wood, Lung motion, CT volume uncertainty, Soft liner


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2 16-24

Immunohistopathological Study of Papillary Squamotransitional Carcinoma of Uterine Cervix


Bhagyashree Dhande 1, Siddhi Gaurish Sinai Khandeparkar1, Bageshri P. Gogate1, Avinash R. Joshi1, Shital Subhash Gosavi1, Pooja Vinod Mishra1,

1 Smt. Kashibai Navale Medical College and General Hospital


Introduction : Papillary squamotransitional cell carcinoma (PSTCC) arising from the uterine cervix is a distinctive histomorphological subtype of squamous cell carcinoma (SCC) not otherwise specified (NOS) of cervical epithelial tumors.

Aim : The present study was undertaken to study the histopathological features and immunoexpression of CK7, CK20, p53 and Ki-67 in PSTCC of the cervix.


Materials and Methods : This study included 43 cases of PSTCC of cervix. A technique of manual tissue array was employed along with IHC staining of entire section in some cases. The expression pattern of CK7, CK 20, p53 and Ki67 in PSTCC was studied and clinico-pathological correlation of various parameters with IHC expression of CK7 and CK20 was observed. Results were subjected to statistical analysis and were considered significant when the p-value was less than 0.05.


Results : Out of 43 PSTCC cases, there were 38 squamotransitional type and 5 papillary type. Histomorphologically, all the cases studied were having fused papillae with rounded contours and fibrovascular cores with highest number of cases having intermediate cell type morphology (86%). Stromal invasion was seen in 74.4% of cases. Koilocytosis were seen in 39.3% of cases. Thirty-two cases showed CK7 immunopositivity (+) and CK20 immunonegativity (-), nine cases were both CK7 and CK20 - and two cases were CK7- and CK20+. Among them 90.7% cases were p53 positive and all cases were positive for Ki67 immunostaining with highest number of cases showing moderate proliferative activity (74.4%); followed by nine cases showing high (20.93%) and two cases showing low proliferative activity (4.65%).


Conclusions: The distinct histomorphology and CK7/CK20 immnunoprofile of PSTCC along with Ki67 and p53 could help in arriving at an accurate diagnosis as well predicting its biological behavior.

Keywords: CK-7, CK-20, p53, cervical carcinoma, Ki67, papillary SCC.


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3 25-29 Clinical and Pathological Characteristics of Breast Cancer Among Emirati National Patients

Rafal R. Iskanderian1, Ahmed Matalkah1, Aya Abdoh1, Asma Al Hashmi1, Bassel Jallad1, Fady Geara1, Stephen R. Grobmyer1

1 Breast Service, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates


Introduction: Breast cancer is the most frequent cancer among Emirati women and is the second leading cause of death among women in the UAE. To date, published studies regarding breast cancer in the UAE have investigated a mixed population of different ethnicities with a low percentage of UAE nationals. This is the first study to highlight the clinical and pathological data of a large cohort of exclusively Emirati national breast cancer patients diagnosed at a tertiary care medical facility.

Materials and Methods: This is a retrospective study involving breast cancer patients in UAE women who were evaluated and/or treated at the Cleveland Clinic Abu Dhabi during the period from May 2015 until June 2021.

Results : This study initially included 372 participants. The median age at diagnosis was 48 years (24-86 years) and 12.3% of patients had screening detected tumors. 30% of patients presented with locally advanced disease and 20% had stage IV disease at presentation. 24% were 40 years or younger at the time of diagnosis.


Discussion:To our knowledge, this is the largest study to date focusing exclusively on the presentation and characteristics of Emirati women with breast cancer. The median age of incidence was 48 years and the percentage of patients diagnosed with breast cancer at age 40 or younger years was 24%. This is an agreement with data published in the Middle East, but is significantly below what is reported in Caucasian women in the Western world. In this study, Emirati patients presented with advanced stages of disease. More advanced disease, and higher stage 4 at presentation is another reflection of the low screening rates, but also an indication of a higher patient thresholds for reporting breast health concerns to medical professionals for evaluation.


Conclusions:Findings of our study do suggest the need to focus efforts on continuing to understand the exact presentation of breast cancer among Emirati women and underscore the need to pursue efforts to improve public education, increase screening utilization and early detection to reduce the burden of disease and address an essential health care need for this unique population

Keywords: Breast cancer and United Arab Emirates


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4 30-38

Evaluation of Dentist's Knowledge and Practice About Dental Management of Oral Cancer Patients


Faezeh khozeimeh1, Hossein Hadi1, Hanieh Haghpanah1, Bahareh Tahani2

1 Department of oral and Maxillofacial Medicine, Dental Research center, Dental Research institute, School of Dentistry, Isfahan University of Medical science, Isfahan, Iran

2Dental Student' Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Department of Oral Public Health, Dental Research center, Dental Research institute, School of Dentistry, Isfahan University of Medical science, Isfahan, Iran.


Background : Dentists play a key role in and the management of oral cancer treatment complications. This study aimed to evaluate the general and specialist dentists' knowledge and practice regarding the dental management of such patients.

Methods: This cross-sectional analytic study was conducted among 370 general and specialist dentists in Isfahan, Iran 2020. A self-administrative questionnaire was designed and validated. The questionnaire had 18 questions in Knowledge section, 10 questions to measure performance, and 3 questions to evaluate dentist's opinion toward their management ability. The collected data were analyzed by descriptive and analytic tests such as T-Test, Kruskal-Wallis, Mann-Whitney, Chi-square, and Fisher's Exact statistics (P = 0.05).

Results: The mean knowledge score was 9.96+/-2.87 in specialists and 7.59+/-2.36 in general dentists (out of 18, P < 0.001). There was no statistically significant difference between the mean knowledge based on gender, employment type, work experience of general and specialist, or the number of working days in a week. In addition, there was a significant relationship between the mean knowledge and having patients with oral cancer undergoing radiotherapy or chemotherapy (P = 0.012).

Conclusion: This study indicated that specialists' knowledge level is higher than general dentists. It was also shown that knowledge directly relates to practice and attitude. Besides, regarding insufficient knowledge of dentists in this field, it is necessary to hold training programs and retraining sessions.

Keywords: Knowledge; Practice, Dental Management; Chemotherapy; Radiotherapy; Oral cancer

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5 39-47 A Prospective Study of the Incidence of Chronic Xerostomia and the Quality of Life in Patients Undergoing Radiotherapy for Head and Neck Malignancies with IMRT or VMAT Techniques

Nishant Gaurav Pathak1, Mahadev P2, Yash Alok3

1Department of Radiation Oncology, Malabar Cancer Centre, Thalasseri, Kerala, India.
2Department of Radiation Oncology, Apollo Hospital, Chennai, India.
3Department of Community Medicine, Kasturba Medical College, Karnataka, India.


Background : Radiation therapy in Head and neck cancers often leads to xerostomia which often leads to a decline in quality of life. The aim of the study was to compare xerostomia among cancer patients undergoing IMRT and VMAT techniques for head and neck malignancies and follow them up via quality of life assessment.

Methodology: It was a hospital based prospective study with follow up at 0, 3 and 6 months among total 80 patients divided in 2 groups of VMAT and IMRT respectively. Patients were assessed using a quality of life questionnaire. Data analysis was done using SPSS 25.0

Results: It was observed that there was no significant difference between the two groups for xerostomia and quality of life over the follow up period. However, there was improvement of symptoms over time in both groups.

Discussion: Similar results were observed in other international studies as well with respect to the quality of life.

conclusions: It was found that both technologies were similar when it came to treatment related xerostomia in patients undergoing radiotherapy for head and neck malignancies with either technique.

Keywords: Quality of Life, Intensity-Modulated Radiotherapy, Xerostomia, Head and Neck Neoplasms

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6 48-50 URS-SM procedure using Pneumatic lithotriptor for the management of ureteral stones-our experience

Xh. Çuni1,2, S. Mehmeti2, A. Neziri2, L. Çuni2, D. Mucaj2, D. Çuni3

1 M.College "Universum", Prishtine
2 Clinic of Urology, Prishtine
3 Faculty of Medicine, Prishtine


Introduction: We assessed the effectiveness of URS-SM procedure for ureteral stones located in different parts of ureter and to determine outcomes in terms of success rate, complications, and operation time.

Methods: After obtaining approval of the Institutional Clinical Board of urology, we reviewed data of consecutive 102 patients treated at our Urology Department with URSSM procedure in cohort study January 2023-May 2023.

Results: There were 44 (43,2%) men and 58 (56,8%) women with a mean age of 43.7 (range 7-78) years old. Most patients had stone on left side 46 ptts (52%), 39 ptts. on right side (38,2%) and on both sides in 10 ptts. (9.8%). The overall success rate after session of URSSMs was 87,3%. Postoperative complications we had only in one case, urosepsis in a diabetic old man (75 years). Operation time was 36 (+/- 13) min.

Conclusion: The URS-SM procedure is an effective treatment with a low rate of complications.

Keywords: URS-SM, ureter stones, pneumatic device

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7 51-53 Long-term Outcomes of Cancer Patients Admitted to the ICU with Septic Shock

Wedad B. Awad1 Lama Nazer1

1 King Hussein Cancer Center, Department of Pharmacy, Amman, Jordan


Introduction: Several studies evaluated the outcomes of cancer patients treated with septic shock in intensive care units (ICUs), but limited data is available on the long-term outcomes of this patient population. In this report, we aimed to evaluate the one-year mortality in cancer patients who were discharged alive following their intensive care unit (ICU) admission for septic shock.

Materials and Methods : A retrospective study that was conducted at an oncologic ICU of a comprehensive cancer center. The study included all adult cancer patients who were admitted to the ICU with septic shock between 2008 and 2019. Septic shock was defined as the need to start vasopressors within the first 24 hours of ICU admission with sepsis. Patient baseline characteristics and longterm outcomes were evaluated. Descriptive analysis was used to report the data.

Results: Of the 1408 cancer patients who were admitted to the ICU with septic shock, 494 patients (35%) were discharged alive from the hospital. Their mean age was 56.3+/-16.5 (SD) years, 321 (65%) were males, and 326 (66%) had solid tumors. At 1-year, 258 patients died as follows: 129 (50%) died during the first 3-months, 69 (27%) patients died between 3 and 6-months, and 60 (23%) patients died between 6 and 12-months, resulting in a mortality rate of 74%, 78.9% and 83.2%, at the 3-months, 6-months and 1-year, respectively.

Discussion and conclusion: In this cohort of cancer patients, we described the long-term outcomes of patients treated in the ICU with septic shock. The majority of the included patients died during the first year following their ICU admission. Future studies should identify measures to improve the outcomes of this patient population.

Keywords: sepsis; shock, cancer; neoplasms, mortality, critical illness, long-term

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8 54-65 Physiotherapy in Head, Neck, Lung and Breast Cancer Survivors: A Systematic Review.

Fatima Abdul Rashid, Wajiha Anwar, Samiya Malik, Meruna Bose, Praveen Kumar Kandakurti, Animesh Hazari

Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates


Background: Cancer is a medical condition where some cells of the body reproduce uncontrollably and metastasize to other parts of the body. This study attempts to review the effect of physiotherapy application on head and neck, lung and breast cancer survivors on important clinical outcomes such as pain, strength, fatigability, coordination, balance, activities of daily living (ADLs), psychosocial aspects, cognitive aspects, and quality of life (QoL)

Methods : A systematic review was conducted following PRISMA guidelines. Scientific articles were retrieved from electronic databases including Cochrane, Medline, EBSCO, Science Direct, Springer and Web of Science. Studies using only experimental design measuring the effectiveness of physiotherapy methods in head and neck, lung and breast cancer patients were selected for the review. Articles from 2012 till date were selected to find a piece of evidence for the latest physiotherapy practice in the last decade.

Results: 19 articles out of 9343 records were selected (Head & Neck HN = 3, Lung LU = 5, Breast BR = 11) which demonstrated that there was a significant effect of various physiotherapeutic techniques on the selected outcomes among patients with head and neck, lung and breast cancer.

conclusion: In this review study, we conclude that head and neck cancer patients can benefit from physiotherapy exercises and muscle awareness. However, more evidence is needed to prescribe a specific exercise regimen. It was found that a combination of fitness training along with aerobic training has the maximum gain in advanced lung cancer patients. For breast cancer patients, combined aerobic and resistance training along with stretching and relaxation is the current suggested treatment.

Keywords: "Upper Body Cancer", "Physiotherapy", "head and neck cancer", "lung cancer", and "breast cancer".

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9 66-80 Trends in Stereotactic Radiosurgery for Meningioma: the Top 100 Most Cited Articles

Tariq Al Habsi1, Hashim Alibrahim1, Utba Al Manthari1, Adham Al-Rahbi1, Tariq Al-Saadi2,3

1 College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
2 Department of Neurology & Neurosurgery - Montreal Neurological Institute, Faculty of Medicine, McGill University, QC, Canada, Montreal, Quebec, Canada.
3 Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman.


Background: Stereotactic radiosurgery is a well-known and influential management option for meningioma. This article aims to highlight the most cited publications on this topic.

Methods: All Scopus articles published in English under Stereotactic radiosurgery and meningioma were sorted according to the number of citations. The keywords used were: "Stereotactic radiosurgery, SRS, Meningioma, Intracranial meningioma". The top 100 cited articles meeting the criteria were included. Certain features of these articles were collected and analyzed using Microsoft Excel and SPSS.

Results: The included articles were published between 1991 and 2020 with a total of 9149 citations. The most cited article is "Meningiomas: Knowledge base, treatment outcomes, and uncertainties. A RANO review" by Rogers L. et al. 2015 with 349 citations. No significant association was found between the number of citations and the impact factor of the publishing journal.

Conclusion: This study gives a concise and updated summary of impactful research on stereotactic radiosurgery and meningioma, highlighting the main contributors and scientific connections.

Keywords: Stereotactic radiosurgery , SRS, Meningioma, Intracranial meningioma

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10 81-93 Biomarkers in Prostate Cancer: A Review

Nizar Ahmadieh1, Toufic Zeidan1, Celine Chaaya1, David Cain2, Marc Aoude1, Anita Abouchahla3, Hampig Raphael Kourie1, Elie Nemer1

1 Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
2 Royal Shrewsbury Hospital, Shrewsbury, Shropshire, United Kingdom
3 University of Bristol, Bristol, United Kingdom


Background: Prostate cancer (PC) is the second most common cancer in men worldwide. Itís the second leading cause cancer men in death. Prognostic tests based on molecular and biomarker analysis of tumor tissue may improve risk stratification of prostate cancer2.

Materials and methods: After a search on Pubmed for PC biomarkers, 72 papers responded to the objectives and will be included in the review.

Results: A plethora of biomarkers are predictive for the prognosis of PC and its response to certain therapies, while others, once thought to be indicative of prognosis in PC, were not.

Conclusion: This study can help in the development of diagnostic and prognostic tests of PC and contribute to the ongoing research into already existing tests.

Keywords: Prostate Cancer, Biomarkers, Diagnosis, Prognosis.

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11 94-102 Synergizing Expertise and Technology: The Artificial intelligence Revolution in Radiotherapy for Personalized and Precise Cancer Treatment

Fadila Kouhen1, 2, Hanae EL Gouach1, 2, Kamal Saidi3, Zineb Dahbi1, Nadia Errafiy4, Hafsa Elmarrachi5, Nabil Ismaili5

1 Mohammed VI University of Sciences and Health (UM6SS). Casablanca, Morocco. Radiotherapy Department, International University Hospital Sheikh Khalifa.
2 Laboratory of Neurosciences and Oncogenetics, Neurooncology and oncogenetic Team, Mohammed VI Center for Research &Innovation
3 Hassan First University of Settat, High Institute of Health Sciences, Laboratory of Sciences and Health Technologies
4 Laboratory of Neurosciences and Oncogenetics, Neurosciences and Cellular Physiology Team, Mohammed VI Center for Research & Innovation
5Mohammed VI University of Sciences and Health (UM6SS). Casablanca, Morocco. Medical oncology Department, International University Hospital Sheikh Khalifa.


Abstract: Artificial intelligence (AI) has truly revolutionized many fields, including healthcare. In radiation oncology, AI has emerged as a powerful tool for improving the speed, accuracy and overall quality of radiotherapy treatments. The radiotherapy workflow involves complex processes that require coordination between healthcare professionals with diverse skills. AI and deep learning methods offer unprecedented potential to transform this workflow by leveraging imaging modalities, digital data processing and advanced software algorithms. Despite the revolutionary potential, challenges remain in seamlessly integrating AI into clinical workflows. Ethical considerations, data privacy, and algorithm interpretability necessitate cautious implementation. Additionally, fostering interdisciplinary collaboration between AI experts and radiation oncologists is imperative to harness the technology's full potential. This paper explores the impact of AI in four key areas of radiotherapy: automated segmentation, dosimetric and machine quality assurance, adaptive radiation therapy, and clinical outcome prediction.

Keywords: Artificial intelligence, Radiotherapy, Workflow, Accuracy, cancer ,machine-learning.

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12 103-106 Clear Cell Meningioma with Tyrosine Crystals: a Case Report with Review of Literature

Rashim Sharma1, Poonam Abhay Elhence1, Deepak Vedant1, Jigish Ruparelia2, Suryanarayanan Bhaskar2, Sarbesh Tiwari3

1 Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, India.
2 Department of Neurosurgery, All India Institute of Medical Sciences, India.
3Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, India.


Introduction or Background: Clear cell meningioma is a rare WHO grade 2 tumour and runs an aggressive course Tyrosine crystals are very uncommon in meningioma.

Case Presentation: We present a case of a 43-year female with right middle and posterior cranial fossa space occupying lesion (SOL) diagnosed as clear cell meningioma with presence of numerous tyrosine crystals.

Discussion and Conclusion: Whether these crystals are incidentally noted or if there is an actual relationship of these crystals with tumour environment must be found as they are seen in many other conditions too.

Keywords: Tumour, Meningioma, Central nervous system, Tyrosine

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