ABSTRACT

Extensive intra oral and extra oral defects present a rehabilitative challenge to a Prosthodontist and have a debilitating effect on the cosmetic, functional and psychological well-being of the patient. Prosthetic restorations are the preferred option for the rehabilitation of simple to complex clinical scenarios. The restorations involve either a single or two part intra oral prostheses and/or extra oral prosthesis, which improve patients’ Quality of life.
The challenges that a Prosthodontist faces during rehabilitation include size of the defect, lack of a stable underlying bed of supportive hard and soft tissue, proximity of vital structures.
Prosthetic rehabilitation of such patients can be achieved using a multidisciplinary approach involving surgical and prosthetic personnel for the improvement of aesthetics and various functions like mastication, speech and deglutition.
Prosthetic Rehabilitation of edentulous lower arch with hemi-mandibulec

omy or a pathological defect is very challenging. These patients benefit from implants much more than patients with any other removable prosthesis.
This paper presents a series of patients who have been treated and rehabilitated by complex prostheses and implants which are critical requirements to improve quality of life for individuals whose rehabilitation is a lifelong challenge, in addition patient’s attitude, temperament and his ability to adapt to the prosthesis is also very vital.

PURPOSE

The objective of this prospective study was to determine the efficacy of stereotactic radiosurgery (SRS) as a salvage treatment in patients with recurrent malignant gliomas.

METHODS

Between December 2012 and January 1017, 110 patients were treated with SRS as a salvage treatment for recurrent malignant gliomas at a single institution. Clinical outcome were analyzed Relapsed malignant brain tumors are devastating disease characterized by resistance to available therapeutic approaches and relentless malignant progression that includes widespread intracranial invasion, destruction of normal brain tissue, progressive disability, and death. Stereotactic radiosurgery (SRS) is used in patients with recurrent malignant brain tumors to complement traditional treatments such as resection, conventional external beam radiotherapy, and chemotherapy. SRS are powerful noninvasive therapeutic modalities well suited to treat focal neoplastic lesions through the

elivery of precise, high dose radiation. Although no randomized clinical trials have been performed, a variety of retrospective studies have been focused on the use of SRS for recurrent malignant brain tumors . In this presentation we have reviewed the current applications and efficacy of SRS in the treatment of malignant brain tumors , highlighting its value for recurrent focal disease. We included pts who relapsed after surgery and after adjuvant conventional radiation with or without chemotherapy. With cyberknife SRS we treated these cases with three or five fractions with high radio surgical doses and observed its results with three monthly MRI with contrast follow ups.

RESULTS

As we are in process of acquiring our data by continues follow ups we will present our results in presentation at conference.

CONCLUSIONS

SRS is a established as safe and effective modality in selected patients with recurrent small-sized gliomas our results will confirm its efficacy and progression free interval.

Dr Mohammad Usman

Abstract

Chronic myeloid leukemia is characterized by increase white cell count along with granulocytic hyperplasia, splenomegaly and positivity of Philadelphia chromosome on cytogenetic studies. Before the introduction of tyrosine kinase inhibitors, the only curative treatment options was Allogenic bone marrow transplant. Imatinib was introduced in Pakistan in 2003 for patients who showed resistant to interferon followed by first line treatment for all CML patients in 2006. Subsequently, Nilotinib was introduced as 2nd generation tyrosine kinase inhibitor TKI).
These two drugs are available in Pakistan which has change the dismal outcome of CML patients. Despite the availability, the results of these drugs are inferior to what is reported in western literature. Similarly now the guidelines are available that when to stop these drugs and a possible cure in future.
I will going to discuss the importance of monitoring of CML patients who are on TKI. I will also s

ggest some cost effective strategies for implementation in Pakistani scenario.

Prof. Abid Jameel

Objective

Gastrointestinal stromal tumors (GIST) constitute less than 1% of all gastrointestinal tumors but are the commonest mesenchymal tumors of the gastrointestinal tract. Adjuvant treatment with Imatinib has changed the survival pattern of GIST patients. Risk stratification has become important to decide the treatment strategy after surgery. We conducted this study to identify risk factors along with treatment outcome of GIST patients.

Methods

We studied the demographic profile of patients diagnosed with GIST presenting to Hayatabad Medical Complex (HMC), Peshawar which is the main referral center of the province for GIST patients. Morphology and CD117/DOG-1 positivity were mandatory for diagnosis. Pre- and post-surgical CT scans were performed while tumor characteristics as reported in histopathology were also studied. Patients with advanced disease, incompletely resected tumors and/or intermediate-high risk factors were treated with Imatinib 400–800 mg

day.

Results

Eighty GIST patients with intermediate-high risk factors presented to HMC between November 2011 and December 2015. Fifty-six (70%) patients were male (M:F ratio 2:1). Median age at diagnosis was 50 years (range 17–75 years; SD 11.67). Commonest site at presentation was stomach in 39%, small intestine in 22.5% followed by colon in 17.5%. Tumor size was up to 5 cms in 11% patients, 6-10 cms 31% while 50% had tumors greater than 10 cms. Median tumor size was 11.16 cms (SD 5.29). Mitotic count/50 HPF was <5 in 21% tumors; 6-10 in 22.5% tumors and >10 in 42.5%. Fifty (62%) patients were recurrence free while eighteen (23%) patients had died after a median follow-up of 36 months. Recurrence of tumor conferred the worse prognosis in our patient population.

Conclusion

Research studies in Western countries and in Indo-Pakistan sub-continent have reported different figures regarding median age, male to female ratio and frequency of presentation. Incidence of GIST was found to be low in our region while our patients presented at an age that is a decade lower (median 50 years) than Western countries. Most of our patients had aggressive disease features. Response to Imatinib after surgery was found to be satisfactory with 81% patients alive at 3-years while treatment was well tolerated.

Dr. Jabeen H., Dr. Nasir M., Dr. Nisar H.

Abstract

DLBCL is the most common subtype of non-Hodgkin lymphoma accounting for 30%-40% of all cases. There are several types of DLBCL, with most people being diagnosed with the subtype known as DLBCL. The standard chemotherapy regimen was CHOP for the treatment of DLBCL till 2000. Now a monoclonal antibody is introduced and has become standard option in DLBCL patients when added to standard chemotherapy. The purpose of this study is to compare these two regimens in the treatment of DLBCL. The study is done retrospectively from 2010 to April, 2012. Data collection was done in INMOL hospital, Lahore. The end points of the study are i) efficacy in terms of response to treatment (CR, PR, SD and DP), DFS and 3 year overall survival and ii) toxicity profile of treatment both acute and long term. Patients of all age group, stage II-IV and good performance status are included who were treatment naïve at the time of enrollment. 67.5% of them are male and 32.5% are females. Patien

s randomly received CHOP and RCHOP and 50% of them also received radiation therapy to PET positive residual, initial bulky and primary symptomatic disease. Patients were regularly followed and assessed and any signs of toxicity were noted along with the response to treatment. Patients are followed for 3 years after completion of treatment. The three year overall survival in CHOP group was 42% while in RCHOP group it was about 70%. Median DFS was similar in both groups about 2 years. Response rate was superior in RCHOP arm both in terms of CR and PR, and disease progression was common among control group. Toxicity profile was slightly higher in CHOP arm but it was not statistically significant.

Dr. Naeem Ahmed Laghari, Dr. Naseema Muneer, Dr. Arshia Adeel, Dr. Jawad Ali

Background

Brest Cancer is a common in this part of world, 1 out of 9 women are suffering from breast cancer in Pakistan. Patient from rural areas are often presenting with advance disease due to illiteracy, poverty and social factors. Detection of breast cancer in its early stage provides a greater chance of cure, especially when disease is only confined to the breast. This Institute has Mobile Mammography Unit who is covering 360 kilometers radius for the awareness drive with collaboration of provincial Government health system and Aga Khan Health system. For this project equipment and manpower were provided by the NIMRA.

Material and Methods

This study was carried out from January, 2011 to December, 2015 during this period the team comprising oncologist, radiologist, female nurse and other essential staff is paying visit fortnightly to the District Hospitals, Rural Health Centre and Basic Health units of the area.
Total 1128 patients were screened.

In these hospitals, presentation was arranged for medical community and female community on awareness about cancer and self-examination of breast followed by Mammography and USG of breasts.

Results

Out of 1128 screened patients 172 were suspicious for Malignancy, 148 were Benign and 808 were normal, suspicious malignant patients were referred to Breast care clinic at NIMRA for tissue diagnosis with cytology/ True cut biopsy and then management with surgery, chemotherapy, and radiotherapy and hormone therapy accordingly.

Conclusion

Mobile Mammography unit and breast cancer awareness programs help poor civil society women for screening of the disease at their door step and educating health care professionals in early detection and self examination of breast.

Mahwish.S, Aisha.S, M.A.Memon.

Background

A significant proportion of advanced stage head and neck cancer patients are incurable and have a limited life expectancy. This study reports a single institution experience with a novel, short duration, palliative radiotherapy schedule for inoperable head and neck cancer evaluated in terms of palliation of cancer-related symptoms and acute toxicities.

Materials and Methods:

Fifty patients with inoperable head and neck cancer were included in the study All patients received 48Gy in 16 fractions (equivalent dose: 62.4 Gy in conventional fractionation) once daily dose of 3 Gy, 5 fractions per week. Treatment-related toxicity was assessed using Radiation Therapy Oncology Group criteria.

Inclusion criteria

Surgical unresectable stage IV head and neck cancer (extension to infratemporal fossa extension, carotid space invasion, prevertebral fascia invasion, fixed-fungating nodal mass) Stage IVA disease-poor performance status, si

nificant comorbid illness No previous history of radiotherapy/chemotherapy Non nasopharyngeal, non-PNS, and non salivary gland primary No previous history of cancer. Radiation planning and treatmentPatients were immobilized in supine position and head fixed with thermoplastic ray cast. Primary and nodal gross tumor volumes were outlined based on clinical examination, ENT examination including nasopharyngolaryngo endoscopy. Radiotherapy portal included gross tumor volume with 2 cm margin and the high-risk nodal regions. Radiotherapy was delivered by parallel opposed lateral technique in LINAC and Co60 MACHINES .

Quality of life analysis

There was improvement in all the aspects of the quality of life (physical, social, emotional, and functional well-being) at the end of radiotherapy. Patients were assessed on biochemical tests and computedtomographic scans pre and post treatment

Aim

With this background, we aim to report the feasibility of a novel, short duration, hypofractionated, palliative radiotherapy schedule for locally advanced inoperable head and neck cancer for palliation of cancer-related distressing symptoms.

Dr Aisha Siddiqa, Dr Furqan Hashmi, Dr Raheela, Dr Iqbal, Dr Najam, Salman Farrukh, Munib Ahmed, Dr Muhammad Ali Atomic Energy Medical Centre, JPMC, Karachi, Pakistan

INITIAL EXPERIENCE WITH IMAGE GUIDED BRACHYTHERAPY IN CERVICAL CANCER PATIENTS IN AEMC, KARACHI.

Dr Aisha Siddiqa, Dr Furqan Hashmi, Dr Raheela, Dr Iqbal, Dr Najam, Salman Farrukh, Munib Ahmed, Dr Muhammad Ali

Atomic Energy Medical Centre, JPMC, Karachi, Pakistan                 

Objective:

Cervical cancer is the second commonest female malignancy worldwide and is more common in developing countries. Radical treatments depend on the stage of the disease. Surgery is limited to early stages only and for advanced stages, definitive concurrent chemoradiation with EBRT and brachytherapy is the sole treatment. Brachytherapy plays a critical role in the successful treatment and locoregional control co-relates with the cure and the survival. Adjacent critical structures often preclude oncologic non-exentrative surgeries in thes

sites, increasing the importance and potential benefit of curative local radiation therapy. We are presenting our initial experience with image guided brachytherapy.

Material & Methods:

Total 10 patients with squamous cell cervical cancer stages IB-IVA were treated with definitive concurrent chemoradiation with a curative intent. All patients received 3D- conformal external beam radiotherapy to whole pelvis with dose ranging from 45 Gy to 50 Gy depending on the stage prior to brachytherapy. Chemotherapy cisplatin 40 mg/m² weekly starting from first day of radiotherapy was given to all patients. Intracavitatory brachytherapy was started 1 week after completion of external beam radiotherapy. Before brachytherapy, all patients underwent per vaginal examination, MRI pelvis in 8 and CT Scan pelvis in 2. Before each session, PV examination findings were noted and compared with previous one. Also CT scan was done before each session as a part of planning for brachytherapy. High risk CTV was defined on Ocentra^TM version 4.1 brachytherapy planning system along with organ at risk according to ABS guidelines in consultation with in house radiologist.

Result & Conclusion:

 

ONLY FOR POSTER PRESENTATION

Mean age of the patients was 52 years (39-65 years). One patient each was in stage IB2, IIA and IVA, 2 patients each were in stage IIB and IIIA, 3 patients were in stage IIIB. Pre-external beam mean size of the high risk CTV was 544 cm³ in stage IIIB, 428 cm³ in stage IVA, 156 cm³ in stage IIIA, 107 cm³ in stage IIB, 83 cm³ in IIA and 121 cm³ in stage IB2. After completion of external beam the post-EBRT MRI and CT-scan done within 1 week shows marked reduction in the tumour volumes, noted 140 cm³, 76 cm³, 89 cm³, 51 cm³, 60 cm³ and 65 cm³ in stage IIIB, IVA, IIIA, IIB, IIA and IB2. All patients had 3-4 sessions of brachytherapy with a dose range 5-7.5 Gy/session. One patient experienced acute rectal toxicity which is continued during EBRT and brachytherapy. Three patients had acute urinary toxicity. All patients assessed for response at 6-8 weeks by MRI pelvis there was CR radiologically in 9 patients. Till date patients have been followed for 5 months and are disease free. As the numbers of patients treated with Image guided brachytherapy are expected to increase shortly, further data will be discussed with more variables.