Journal club Dr Eyad Al-Saeed Radiation Oncology 8-Sep-2007

Prophylactic cranial Irradiation in Extensive Small Cell Lung Cancer ► Inclusion Criteria : ► Age ► PS (0 – 2) ► Documented extensive SCLC before starting CTR ► Response after 4 – 6 cycle ► Interval of no more than 5/52 between the last cycle of CT and Radiation ► No evidence of brain metastases ► No Hx of Rad to H/N area ► No Hx of CS use ► No Previous or other current cancer

► PCI :- ► 2 lateral fields ► Co, 4 – 18 MV ► Daily RX / 5 weeks ► Dose was 20Gy / 5–8 fx 24 Gy / 12 fx 24 Gy / 12 fx 25 Gy/ 10 fx 25 Gy/ 10 fx 30 Gy/ 10 –12 fx 30 Gy/ 10 –12 fx. Radiation started 4 – 6 weeks after CT

► Point in the study:- ► End Point : Development of symptomatic brain metastases including : ► 1- HA ► 2- N/V ► 3- cognitive or affective disturbance ► 4- Seizures ► 5- Focal neurological symptoms

Role of PCI ?? Role of PCI ?? The role of PCI in patient who do not have complete response to CTR is unclear - Usually they don’t have complete response

Characteristic of Patients: There were no significant differences between patients in the irradiation group and those in the control group in any category

Results - Patient in the irradiation group had a lower risk of symptomatic brain metastases - Cumulative risk of brain metastases within 1 year was : 14.6% in the irradiation group. 40.4% in the control group. - The 1 year survival rate was 27.1% in irradiation group and 13.3% in the control group.

Cumulative Incidence of Symptomatic Brain Metastases.

Disease-free Survival

Overall Survival

Conclusion: PCI reduce the incidence of symptomatic brain met and prolongs DFS + OS and prolongs DFS + OS

MRI Evaluation of the Contralateral Breast in Women With Recently Diagnosed Breast Cancer Aim of study: - ► ----To detect contralateral breast cancer by MRI and histological confirmed. ► ---- Prevent patient to undergo a second round of cancer therapy rather than a single round if DX had been made initially. a single round if DX had been made initially. ► ---- To detect SS, NPV, PPV value of MRI a/w positive biopsy.

Patient Eligibility:- 1 ) > 18 Y/O 2 ) DX of unilateral breast cancer within 60 days before MRI performed. performed. 3 ) Patient had normal clinical & Mammogram in the contralateral breast within 90 days before enrollment. breast within 90 days before enrollment.

Excluding Criteria:- 1 ) If patient had MRI within 12 months before enrollment 2 ) Pregnant. 3 ) Contraindication of MRI. 4 ) Dx > 60 days.

Characteristics of Eligible Patients:-

Results:- out of 969 patient 1) MRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study  3.1% 2) BX was performed on basis positive MRI finding in 121 of the 969 women ( 12.5%) ► 30  24.8% positive for Cancer  18 out of 30 specimens  positive for invasive cancer.  12 out of 30 specimens  positive in situ carcinoma. 3) Sensitivity of MRI in the contra lateral breast  91% 4) Specificity  88% 5) NPV of MRI  99%

Conclusion:- MRI can detect cancer in contra lateral breast that is missed by mammogram and clinical examination at the time of the initial breast cancer diagnosis.