Abstract Background Positron emission tomography/computed tomography (PET/CT) scan is useful if clinically indicated. It is not for conventional routine use due to its high cost. Moreover, it can be confusing if ordered in non-indicated conditions. We evaluate if the pattern of PET/CT ordered in gastrointestinal cancers (non-colorectal origin) has followed evidence-based guidelines and whether it helped in the improvement of patient’s outcome. This study included non-colorectal gastrointestinal cancer patients from 2007 to 2008 who had one or more PET/CT scans done during their management. In each case, data collected revealed whether PET/CT affected the management or the stage or not. Patients were identified through the hospital tumor registry software CNExT (C/NET Solutions, Berkeley, CA). Tabulation and statistical data analysis were done using JMP-SAS statistical software application (version 9.4: SAS Institute, Cary, NC, USA). The scan report quality and use indications were outlined. Results Seventy-seven patients were identified, with 107 PET/CT scans done. Their median age is 59 (21–86) years. Males were 45 (58.5%). Tumor origin was 46.8% esophageal and gastroesophageal junction cancer, 15.6% gastric cancer, 11.7% pancreatic cancer, 11.7% hepatobiliary tumors, 10.4% neuroendocrine tumors, 2.6 % gastrointestinal stromal tumors, and 1.3% small bowel cancer. Indications of the PET/CT were as follows: staging in 59.8%, follow-up after finishing treatment in 14.9%, restaging at relapse in 8.4%, assessing response after/during treatment in 3.7%, follow-up of previous PET/CT in 12.1%, and others in 0.9%. PET/CT changed the stage in 19.6% and affected the management plan in 11.2% only. Fifty-two scans needed pathological pursuit as decided by investigators; of them, PET/CT for the lesions that could have changed the stage reported indeterminate/equivocal results in 32 (29.9%) of all scans. The pathological pursuit for the equivocal lesions on PET/CT scans was done in only 12 of 52 (23.1%) scans. Conclusions Local guidelines for ordering PET/CT scan are suggested because overuse was documented, and an evidence-based approach should be respected before its use.
Background. The outcome of patients with refractory metastatic colorectal cancer (mCRC) treated with trifluridine/tipiracil (FTD/TPI) beyond the second-line has not been studied in Saudi Arabia. Therefore, this multicenter retrospective analysis was conducted to evaluate the efficacy of FTD/TPI. Methods. This multicenter retrospective analysis included five centers in Saudi Arabia. FTD/TPI was administered to all the patients beyond the oxaliplatin- and irinotecan-based chemotherapy regimens. The electronic medical records were reviewed, and progression-free survival (PFS) and overall survival (OS) were determined. Results. The study included 100 patients with a mean age of years. The overall response to FTD/TPI was 4%. The median PFS was 4 months (95% confidence interval (CI) 3.487–4.513), and the median OS was 11 months (95% CI, 9.226–12.771). In a Cox regression analysis of the independent predictors for PFS, advanced stage of the disease ( ; HR, 2.614; and CI, 1.102–7.524), presence of lymph node metastasis ( ; HR, 3.664; and 95% CI, 1.187–8.650), and >2 metastatic sites ( ; HR, 1.723; and 95% CI, 1.089–2.727) were independent factors predicting disease progression. The Cox regression analysis confirmed that years ( ; HR, 1.667; and 95%, 1.097–3.100), advanced disease stage ( ; HR, 1.283; and 95% CI, 1.035–2.940), prior use of adjuvant chemotherapy ( ; HR, 0.892; and 95% CI, 0.481–0.994), liver metastasis ( ; HR, 2.015; and 95% CI, 1.091–3.720), >2 metastatic sites ( ; HR, 1.248; and 95% CI, 1.036–1.846), development of neutropenia after receiving first cycle of FTD/TPI ( ; HR, 1.505; and 95% CI, 1.064–2.167), and increased number of FTD/TPI cycles ( ; HR, 0.769; and 95% CI, 0.664–0.891) were independent variables for OS. Conclusion. Treatment with FTD/TPI is feasible and effective in daily clinical practice in Saudi Arabian patients. The risk of progression increased with advanced disease stage, lymph node metastasis, bone metastasis, and metastasis to >2 sites. years, advanced disease stage, liver metastasis, metastasis to >2 sites, neutropenia after the first cycle of FTD/TPI, and increased number of FTD/TPI cycles were independent factors predicting mortality.
Colorectal cancer is the second most common cancer in Saudi Arabia with estimated prevalence rates for males and females at 9.9% and 6.4%, respectively.It is also the most common cancer in males and the third most common cancer in females in the kingdom.In general, the evidence regarding knowledge and awareness of colorectal cancer in Saudi Arabia is conflicting among different studies.Accordingly, we conducted a systematic review that aims to formulate strong evidence regarding the awareness and knowledge of colorectal cancer in Saudi Arabia.A systematic search was conducted through several databases to find the relevant articles.A total of 19 cross-sectional investigations were found fit in our inclusion criteria and were included in the final data.The sample size was hugely variable among these studies, ranging between 127 and 5,720, with a total of 18,525 included participants.Most studies recruited participants from the general population, however, some studies recruited school teachers, medical and university students as well as healthcare workers.Results show that the prevalence of poor awareness levels and inadequate knowledge of colorectal cancer in Saudi Arabia is high.Although the levels of knowledge among healthcare workers was high, most of them did not follow advisable screening protocols for colorectal cancer.Nationwide programs should be inaugurated to increase the level of awareness and knowledge among the Saudi population and enhance the prognosis and outcomes of colorectal cancer across the Kingdom.
To investigate the molecular characteristics of Hepatitis C Virus (HCV) detected in patients with chronic HCV infection in Jordan.The study included 48 Jordanian treatment-naïve patients with active chronic HCV recruited from seven governorates. HCV genotype and the resistance-associated substitutions (RAS) profile were investigated by next-generation sequencing of the NS5B, NS5A, and NS3 regions of HCV."Unusual genotype 4 subtypes" were detected in four (8.3%) patients (4n-n = 1, 4o-n = 2, 4v-n = 1); one patient (2.1%) was co-infected by genotypes 1b+4a. Overall prevalence of NS5A RASs was 38.3% (3% cutoff); genotype 4a showed the highest NS5A RAS prevalence (n = 11, 55.0%). Overall prevalence of NS3 RASs was 21.8% (7/32), all genotype 1a-infected patients.We report, for the first time in Jordanian patients with chronic HCV infection, the detection of unusual genotype 4 subtypes 4n, 4o, and 4v. Baseline RASs in NS5A are frequent, with complex RASs patterns in some of the unusual subtypes. Our data support the need for sequencing surveillance programs in sub-Saharan Africa, Asia, and the Middle East and North African region to monitor response to treatment in these subtypes and to facilitate the World Health Organization's 2030 elimination strategy.
e17529 Background: PET/CT scan is useful in certain clinical indications. However, because of high cost and maintenance demand, its routine use is not recommended. Moreover, PET scanning in many non-indicated conditions can be useless or even confusing. The National comprehensive cancer network (NCCN) has set up evidence based guidelines for the use of PET/CT. We retrospectively evaluated the local value and pattern of PET/CT scan use in non-colorectal GI cancers in our hospital, and whether it follows the evidence based guidelines or not and whether it’s use actually improves the patient’s outcome or not. Methods: Patients, who were diagnosed with non-colorectal GI cancers during 24 months (2007-2008) at our hospital, were included in this study if they had one or more PET/CT scans. Questions were answered as to whether PET/CT changed the stage or affected the management in each case. The indications of use as well as quality of the scan report were outlined. Results: Results: 77 patients with 107 PET/CT scans were included. Median age: 59 (21-86). Males: 58.8%36. Diagnosis: 46.8% esophageal cancer and GEJ cancer, 15.6% gastric, 11.7% pancreatic, 11.7% heptobiliary, 10.4% neuroendocrine tumors, 2.6 % GIST, 1.3% small bowel cancer. Indications of the PET/CT: staging in 59.8%, follow up after finishing treatment in 14.9%, restaging at relapse in 8.4%, assessing response after/during treatment in 3.7%, FU of previous PET/CT in 12.1% and others in 0.9%. PET/CT changed the stage in 19.6%, and affected the management plan in 11.2% only. The PET/CT for the lesions that could have changed the stage reported indeterminate result in 29.9% of cases. Pathological pursuit of the PET/CT result for lesions that were indeterminate and could have changed the stage was done in only 23.1% of cases. Conclusions: PET/CT scan use in our hospital does not follow an evidence based approach. Overuse was documented. Therefore, local guidelines of use are suggested.
Regorafenib is a multi-kinase inhibitor approved for treatment of refractory advanced colorectal cancer. It was found in the clinical trials to have a modest benefit and significant toxicity. Our aim was to assess the outcome in our local clinic practice.Records of patients with confirmed colorectal cancer treated with regorafenib were reviewed. Clinical, pathological, and molecular data were collected. Efficacy and factors of possible prognostic significance were analyzed.A total of 78 patients with metastatic colorectal cancer were treated with regorafenib from February 2014 to February 2016 in 4 different institutions (median age: 50.5 years; male: 40 [51.3%]; KRAS mutant: 41 [52%]; right colonic primary: 18 [23%]). A total of 52 patients (66.7%) had Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 1, whereas in 25 patients (32.1%) it was >1. In total, 58 patients (74%) had dose reduction. No patient achieved objective response, 15 patients (19%) achieved stable disease, and 56 patients (72%) had progressive disease. With a median follow-up of 6.5 months, the median progression-free survival was 2.8 months (95% confidence interval [CI], 2.5-3.3) and overall survival was 8.0 months (95% CI, 6.2-9.7). Only performance status of ⩽1 had a statistically significant impact on progression-free survival and overall survival in both univariate and multivariate analyses.Regorafenib in our clinical practice has equal efficacy to reported data from pivotal registration trials. Our data suggest that performance status is the most important prognostic factor in patients treated with regorafenib, suggesting a careful selection of patients.
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