Background: The treatment of medulloblastoma involves surgery, radiotherapy, and adjuvant chemoth... more Background: The treatment of medulloblastoma involves surgery, radiotherapy, and adjuvant chemotherapy. In radiotherapy, craniospinal irradiation (CSI) is prescribed, where two lateral cranial fields and one or two spinal beams are applied in CSI. Different multi-field techniques (coplanar and/or noncoplanar) are used to register the prescribed dose. The purpose of this study was to assess plan quality in terms of dose coverage of the spine with both photon and electron beam therapy and the sparing of organs at risks (OARs).Methods: Ten pediatric patients (ages 6 to 10 years) were immobilized in the prone position for simulation. The Clinical Target Volume (CTV) of the organ under treatment, Planning Target volume (PTV) of the organ under treatment, and OARs were contoured. Prowess Panther (v4.71) was used for dose computations. Two lateral parallel-opposed 6 MV photon cranial fields with the spinal beam(s) (either 6 Photons or 21 MeV electrons) were used in planning. Electron beams...
Objective Metastatic castration resistant-prostate cancer (mCRPC) is deadly condition that remain... more Objective Metastatic castration resistant-prostate cancer (mCRPC) is deadly condition that remains incurable despite various therapies. Initial studies have shown promising results with Lutetium-177 prostate-specific membrane antigen (177Lu-PSMA) therapy for advanced prostate cancer. However, most of the published efficacy and safety data is retrospective. The purpose of the study was to prospectively evaluate the therapeutic efficacy and safety results of 177Lu-PSMA therapy in mCRPC patients after 2 cycles. Methods Twenty-five patients of mCRPC, treated with standard care treatment were enrolled for 2 cycles of 177Lu-PSMA therapy. Prostate-specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, Visual Analogue Score (VAS) and Analgesic Quantification Scale (AQS) for efficacy and hemoglobin, total leukocyte, platelets and serum creatinine for toxicity were recorded pre and post-therapy. Paired sample t-test was used for statistical analysis. Results Tre...
Objective: This study aimed to ascertain the response of concurrent chemo-radiotherapy (CCRT) in ... more Objective: This study aimed to ascertain the response of concurrent chemo-radiotherapy (CCRT) in patients with locally advanced (Stage III-IVB) nasopharyngeal carcinoma. Design: It was a retrospective case series. Setting: Institute of Nuclear Medicine and Oncology, Lahore Subjects: Thirty three eligible patients out of 89 with Stage III-IVB were included. Interventions: The TNM staging used for the purpose of this study was that described in the 7 edition of AJCC Cancer Staging Manual. Patients received 2 cycles of Cisplatin 75 mg/m and 5-FU 1000 mg/m, D1 and D1-D5, 3 weekly as neo-adjuvant chemotherapy followed by definitive CCRT of 66-70 Gy in 33-35 fractions. Main outcome measures: CT/MRI images were done after 6 weeks of completion of chemoradiation and were compared with base line imaging for response evaluation. Three y OS, 3 y LRFS and 3 y DMFS were primary endpoints of study. Results: Median age of the patient population was 49 years. Male to female ratio was 1.75:1.00. WHO...
Thyroid hormones significantly influence the proper growth, development and performance of kidney... more Thyroid hormones significantly influence the proper growth, development and performance of kidney, and, in case of hormonal imbalance, kidney function is adversely affected. Many studies have been done on thyroid medication to identify their effectiveness in hyper and hypothyroidism, but the true efficacy of thyroid drug should also be acquainted with their capability in normalizing abnormal renal profiles. The present study was based on identifying the effectiveness of routinely used thyroid drugs in Punjab, Pakistan to distinguish their role in renal dysfunction due to thyroid ailment. Patients of hyper and hypothyroidism were included in this study along with normal subjects as control. Hyperthyroid patients were administered carbimazole and propylthiouracil while hypothyroid patients were given thyroxine. The renal profiles of patients were compared with profiles of normal subjects and results were statistically analyzed by using analysis of variance test to identify significanc...
Hepatic functions dependency on thyroid hormones has been reported in many past studies. Momentou... more Hepatic functions dependency on thyroid hormones has been reported in many past studies. Momentous change in physiology and chemistry of thyroid gland not only affects the glandular function but also profoundly impinge working of liver markers causing hepatic dysfunction. Consequently, in order to give better response for thyroid diseases, the efficiency of thyroid drug is also calculated in persuading liver markers towards standard ranges which previously have been disturbed due to thyroid invasion.
Abstract. Some novel derivatives of 2-(9H-Purin-6-ylsulfanyl)acetohydrazide were synthesized by r... more Abstract. Some novel derivatives of 2-(9H-Purin-6-ylsulfanyl)acetohydrazide were synthesized by reacting it with respective aldehydes in ethanol. The antithyroid effect of these compounds was ascertained in vitro by studying their complexation with iodine spectrophotometrically. In vivo, the hormonal as well as histological variations in male Wistar rats demonstrated significant antithyroid potential (p ≤ 0.05) of these compounds. Key words: Hyperthyroidism, Antithyroid activity, Hydrazides, In
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To evaluate the efficacy of concurrent chemoradiation in patients with locally advanced... more OBJECTIVE To evaluate the efficacy of concurrent chemoradiation in patients with locally advanced inoperable squamous cell carcinoma of oral cavity in terms of local control and toxicity. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from January 2008 to December 2013. METHODOLOGY Sixty-nine patients with locally advanced inoperable oral cavity cancer, registered in INMOL hospital from January 2008 to December 2013 who fulfilled a pre-defined eligibility criteria, were enrolled in the study. Concurrent chemoradiation protocol consisted of conventional fractionation delivering 70 Gy with weekly Cisplatin (50 mg/m2) during the course of radiation. Tumor response was calculated by RECISTcriteria version 1.1 along with the median overall survival and disease-free survival. Acute treatment related toxicities were graded as (G). RESULTS Thirty-six (52.17%) patients showed complete response; while 19 (27.54%), 8 (11.59%) a...
Aims The aim of the study was to determine the incidence of hyperprolactinaemia, document the und... more Aims The aim of the study was to determine the incidence of hyperprolactinaemia, document the underlying causes and consequences of hyperprolactinaemia, and to investigate the correlation between hyperprolactinaemia and hypothyroidism in a group of patients referred for hormonal profile assessment from local hospitals and clinics. Methods This study includes 1365 subjects (46 males, 1319 females) referred to the Centre for Nuclear Medicine in Lahore, for hormonal estimation to investigate the possibility of an underlying hormonal disorder based on clinical grounds. Serum Prolactin and thyroid stimulating hormone levels were measured using IRMA kits. Results In our study population, the incidence of hyperprolactinaemia was estimated at 4.90 percent. Menstrual irregularity appeared to be the major consequence in females.In male subjects, the major complaints observed were infertility and azoospermia. The incidence rate was the highest in the age range of 22-27 years. Hypothyroidism in...
in colorectal carcinoma, carcinoembryonic antigen (CEA) is a recommended marker for surveillance ... more in colorectal carcinoma, carcinoembryonic antigen (CEA) is a recommended marker for surveillance after curative resection. The aim of the present study was to determine the association of preoperative CEA with recurrence of colorectal carcinoma in our population. The study included 55 patients with all operable stages of colorectal adenocarcinoma treated during the 2012-2014 period, evaluated retrospectively and followed-up for recurrence for 2 years. Data on the baseline (preoperative) CEA levels were retrieved from patient files. On data analysis, SPSS 16.0 was used. in patients with normal preoperative CEA, the rate of recurrence was significantly low (p=0.008) and the likelihood of no recurrence 1.55-fold greater as compared to patients with raised initial CEA levels (p=0.028). in patients with raised preoperative CEA, the risk of recurrence was 5.26-fold greater as compared to those with normal CEA levels (p=0.028). A significant weak positive correlation (r s =0.297) was found between raised CEA and recurrence. A highly significant (p=0.002) moderate positive correlation was recorded in patients aged <50 and moderate positive correlation of borderline significance in males (r s =0.324, p=0.058). Sensitivity was 94.4% and specificity 32.4% in predicting recurrence. Accordingly, preoperative elevated CEA showed a significant weak positive correlation with recurrence while normal preoperative CEA moderately decreased the likelihood of recurrence.
Journal of the College of Physicians and Surgeons Pakistan
Objectives: To determine the frequency and grades of acute side effects with three-dimensional br... more 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.
Background/aim: Smokeless tobacco has been associated with oral cavity cancer for several decades... more 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 SouthEast 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.
Resumen en: Some novel as well as known derivatives of 8-sulfanyl-3,9- dihydro-1H-purine-2,6-dion... more Resumen en: Some novel as well as known derivatives of 8-sulfanyl-3,9- dihydro-1H-purine-2,6-dione were synthesized and their antithyroid activity was measured in ra...
Introduction: Some unique physiological changes occur in breast volume and water content during p... more Introduction: Some unique physiological changes occur in breast volume and water content during pregnancy which makes the radiological evaluation of the breast difficult. As a result, diagnosis of Pregnancy Associated Breast Cancer. is often delayed. Objective: To find out the diagnostic accuracy of ultrasonography in detection of pregnancy associated breast cancer taking histopathology as gold standard. Methodology: Present Cross-sectional study was carried out at INMOL Hospital, Lahore. Ultrasound of 200 women was performed. The patient was laid supine and then turned slightly in oblique position to scan the breast with high frequency linear probe (7.5-10 MHz). The contra-lateral breast and both axillae were also scanned in the same way. Findings were categorized on the basis of Breast Imaging Reporting and Data System (BI-RADS) assessment categories. Subsequently the breast tissue was sent to histopathology laboratory for tissue diagnosis. The pathologist was blinded of the res...
Objectives Different clinicopathological and molecular features have been demonstrated between ri... more Objectives Different clinicopathological and molecular features have been demonstrated between right and left sided colon cancers. We aimed to characterize colon cancer and sidedness among a North-Pakistani rural population diagnosed with colon cancer in our institution. Methods Seventy patients were included in the study that received adjuvant chemotherapy at Bannu Institute of Nuclear Medicine Oncology and Radiotherapy) Bannu, Pakistan from January 2014 to December 2017. Chi-square test was used for significance of categorical variables. p-Values less than 0.05 were considered significant. Results Mean age at diagnosis for right side colon cancer patients was 43.94 years and for left side colon cancer, it was 49.83 with no significant difference. Male patients were presented more with right (77% vs. 54%, p = 0.044) and females with predominantly left sided tumours i.e. (46% vs. 23%, p = 0.044). Right sided cancer tended to be more poorly differentiated (20% vs. 0%, p = 0.020). Muc...
Background: The treatment of medulloblastoma involves surgery, radiotherapy, and adjuvant chemoth... more Background: The treatment of medulloblastoma involves surgery, radiotherapy, and adjuvant chemotherapy. In radiotherapy, craniospinal irradiation (CSI) is prescribed, where two lateral cranial fields and one or two spinal beams are applied in CSI. Different multi-field techniques (coplanar and/or noncoplanar) are used to register the prescribed dose. The purpose of this study was to assess plan quality in terms of dose coverage of the spine with both photon and electron beam therapy and the sparing of organs at risks (OARs).Methods: Ten pediatric patients (ages 6 to 10 years) were immobilized in the prone position for simulation. The Clinical Target Volume (CTV) of the organ under treatment, Planning Target volume (PTV) of the organ under treatment, and OARs were contoured. Prowess Panther (v4.71) was used for dose computations. Two lateral parallel-opposed 6 MV photon cranial fields with the spinal beam(s) (either 6 Photons or 21 MeV electrons) were used in planning. Electron beams...
Objective Metastatic castration resistant-prostate cancer (mCRPC) is deadly condition that remain... more Objective Metastatic castration resistant-prostate cancer (mCRPC) is deadly condition that remains incurable despite various therapies. Initial studies have shown promising results with Lutetium-177 prostate-specific membrane antigen (177Lu-PSMA) therapy for advanced prostate cancer. However, most of the published efficacy and safety data is retrospective. The purpose of the study was to prospectively evaluate the therapeutic efficacy and safety results of 177Lu-PSMA therapy in mCRPC patients after 2 cycles. Methods Twenty-five patients of mCRPC, treated with standard care treatment were enrolled for 2 cycles of 177Lu-PSMA therapy. Prostate-specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) performance status, Visual Analogue Score (VAS) and Analgesic Quantification Scale (AQS) for efficacy and hemoglobin, total leukocyte, platelets and serum creatinine for toxicity were recorded pre and post-therapy. Paired sample t-test was used for statistical analysis. Results Tre...
Objective: This study aimed to ascertain the response of concurrent chemo-radiotherapy (CCRT) in ... more Objective: This study aimed to ascertain the response of concurrent chemo-radiotherapy (CCRT) in patients with locally advanced (Stage III-IVB) nasopharyngeal carcinoma. Design: It was a retrospective case series. Setting: Institute of Nuclear Medicine and Oncology, Lahore Subjects: Thirty three eligible patients out of 89 with Stage III-IVB were included. Interventions: The TNM staging used for the purpose of this study was that described in the 7 edition of AJCC Cancer Staging Manual. Patients received 2 cycles of Cisplatin 75 mg/m and 5-FU 1000 mg/m, D1 and D1-D5, 3 weekly as neo-adjuvant chemotherapy followed by definitive CCRT of 66-70 Gy in 33-35 fractions. Main outcome measures: CT/MRI images were done after 6 weeks of completion of chemoradiation and were compared with base line imaging for response evaluation. Three y OS, 3 y LRFS and 3 y DMFS were primary endpoints of study. Results: Median age of the patient population was 49 years. Male to female ratio was 1.75:1.00. WHO...
Thyroid hormones significantly influence the proper growth, development and performance of kidney... more Thyroid hormones significantly influence the proper growth, development and performance of kidney, and, in case of hormonal imbalance, kidney function is adversely affected. Many studies have been done on thyroid medication to identify their effectiveness in hyper and hypothyroidism, but the true efficacy of thyroid drug should also be acquainted with their capability in normalizing abnormal renal profiles. The present study was based on identifying the effectiveness of routinely used thyroid drugs in Punjab, Pakistan to distinguish their role in renal dysfunction due to thyroid ailment. Patients of hyper and hypothyroidism were included in this study along with normal subjects as control. Hyperthyroid patients were administered carbimazole and propylthiouracil while hypothyroid patients were given thyroxine. The renal profiles of patients were compared with profiles of normal subjects and results were statistically analyzed by using analysis of variance test to identify significanc...
Hepatic functions dependency on thyroid hormones has been reported in many past studies. Momentou... more Hepatic functions dependency on thyroid hormones has been reported in many past studies. Momentous change in physiology and chemistry of thyroid gland not only affects the glandular function but also profoundly impinge working of liver markers causing hepatic dysfunction. Consequently, in order to give better response for thyroid diseases, the efficiency of thyroid drug is also calculated in persuading liver markers towards standard ranges which previously have been disturbed due to thyroid invasion.
Abstract. Some novel derivatives of 2-(9H-Purin-6-ylsulfanyl)acetohydrazide were synthesized by r... more Abstract. Some novel derivatives of 2-(9H-Purin-6-ylsulfanyl)acetohydrazide were synthesized by reacting it with respective aldehydes in ethanol. The antithyroid effect of these compounds was ascertained in vitro by studying their complexation with iodine spectrophotometrically. In vivo, the hormonal as well as histological variations in male Wistar rats demonstrated significant antithyroid potential (p ≤ 0.05) of these compounds. Key words: Hyperthyroidism, Antithyroid activity, Hydrazides, In
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To evaluate the efficacy of concurrent chemoradiation in patients with locally advanced... more OBJECTIVE To evaluate the efficacy of concurrent chemoradiation in patients with locally advanced inoperable squamous cell carcinoma of oral cavity in terms of local control and toxicity. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from January 2008 to December 2013. METHODOLOGY Sixty-nine patients with locally advanced inoperable oral cavity cancer, registered in INMOL hospital from January 2008 to December 2013 who fulfilled a pre-defined eligibility criteria, were enrolled in the study. Concurrent chemoradiation protocol consisted of conventional fractionation delivering 70 Gy with weekly Cisplatin (50 mg/m2) during the course of radiation. Tumor response was calculated by RECISTcriteria version 1.1 along with the median overall survival and disease-free survival. Acute treatment related toxicities were graded as (G). RESULTS Thirty-six (52.17%) patients showed complete response; while 19 (27.54%), 8 (11.59%) a...
Aims The aim of the study was to determine the incidence of hyperprolactinaemia, document the und... more Aims The aim of the study was to determine the incidence of hyperprolactinaemia, document the underlying causes and consequences of hyperprolactinaemia, and to investigate the correlation between hyperprolactinaemia and hypothyroidism in a group of patients referred for hormonal profile assessment from local hospitals and clinics. Methods This study includes 1365 subjects (46 males, 1319 females) referred to the Centre for Nuclear Medicine in Lahore, for hormonal estimation to investigate the possibility of an underlying hormonal disorder based on clinical grounds. Serum Prolactin and thyroid stimulating hormone levels were measured using IRMA kits. Results In our study population, the incidence of hyperprolactinaemia was estimated at 4.90 percent. Menstrual irregularity appeared to be the major consequence in females.In male subjects, the major complaints observed were infertility and azoospermia. The incidence rate was the highest in the age range of 22-27 years. Hypothyroidism in...
in colorectal carcinoma, carcinoembryonic antigen (CEA) is a recommended marker for surveillance ... more in colorectal carcinoma, carcinoembryonic antigen (CEA) is a recommended marker for surveillance after curative resection. The aim of the present study was to determine the association of preoperative CEA with recurrence of colorectal carcinoma in our population. The study included 55 patients with all operable stages of colorectal adenocarcinoma treated during the 2012-2014 period, evaluated retrospectively and followed-up for recurrence for 2 years. Data on the baseline (preoperative) CEA levels were retrieved from patient files. On data analysis, SPSS 16.0 was used. in patients with normal preoperative CEA, the rate of recurrence was significantly low (p=0.008) and the likelihood of no recurrence 1.55-fold greater as compared to patients with raised initial CEA levels (p=0.028). in patients with raised preoperative CEA, the risk of recurrence was 5.26-fold greater as compared to those with normal CEA levels (p=0.028). A significant weak positive correlation (r s =0.297) was found between raised CEA and recurrence. A highly significant (p=0.002) moderate positive correlation was recorded in patients aged <50 and moderate positive correlation of borderline significance in males (r s =0.324, p=0.058). Sensitivity was 94.4% and specificity 32.4% in predicting recurrence. Accordingly, preoperative elevated CEA showed a significant weak positive correlation with recurrence while normal preoperative CEA moderately decreased the likelihood of recurrence.
Journal of the College of Physicians and Surgeons Pakistan
Objectives: To determine the frequency and grades of acute side effects with three-dimensional br... more 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.
Background/aim: Smokeless tobacco has been associated with oral cavity cancer for several decades... more 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 SouthEast 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.
Resumen en: Some novel as well as known derivatives of 8-sulfanyl-3,9- dihydro-1H-purine-2,6-dion... more Resumen en: Some novel as well as known derivatives of 8-sulfanyl-3,9- dihydro-1H-purine-2,6-dione were synthesized and their antithyroid activity was measured in ra...
Introduction: Some unique physiological changes occur in breast volume and water content during p... more Introduction: Some unique physiological changes occur in breast volume and water content during pregnancy which makes the radiological evaluation of the breast difficult. As a result, diagnosis of Pregnancy Associated Breast Cancer. is often delayed. Objective: To find out the diagnostic accuracy of ultrasonography in detection of pregnancy associated breast cancer taking histopathology as gold standard. Methodology: Present Cross-sectional study was carried out at INMOL Hospital, Lahore. Ultrasound of 200 women was performed. The patient was laid supine and then turned slightly in oblique position to scan the breast with high frequency linear probe (7.5-10 MHz). The contra-lateral breast and both axillae were also scanned in the same way. Findings were categorized on the basis of Breast Imaging Reporting and Data System (BI-RADS) assessment categories. Subsequently the breast tissue was sent to histopathology laboratory for tissue diagnosis. The pathologist was blinded of the res...
Objectives Different clinicopathological and molecular features have been demonstrated between ri... more Objectives Different clinicopathological and molecular features have been demonstrated between right and left sided colon cancers. We aimed to characterize colon cancer and sidedness among a North-Pakistani rural population diagnosed with colon cancer in our institution. Methods Seventy patients were included in the study that received adjuvant chemotherapy at Bannu Institute of Nuclear Medicine Oncology and Radiotherapy) Bannu, Pakistan from January 2014 to December 2017. Chi-square test was used for significance of categorical variables. p-Values less than 0.05 were considered significant. Results Mean age at diagnosis for right side colon cancer patients was 43.94 years and for left side colon cancer, it was 49.83 with no significant difference. Male patients were presented more with right (77% vs. 54%, p = 0.044) and females with predominantly left sided tumours i.e. (46% vs. 23%, p = 0.044). Right sided cancer tended to be more poorly differentiated (20% vs. 0%, p = 0.020). Muc...
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