Journal of Cancer and Allied Specialties Feed

Outcomes of Methotrexate-Based Therapy for Paediatric Osteosarcoma: A Decade of Experience from a Cancer Centre in Pakistan

Thu, 10 Sep 2026 00:00:00 GMT

IntroductionOsteosarcoma is the most common bone malignancy in children. We describe the survival outcomes of children diagnosed with osteosarcoma at a tertiary care cancer centre in Pakistan treated with a methotrexate-based treatment regimen.Materials and MethodsThis was a retrospective review of electronic medical records at our institute for patients diagnosed with osteosarcoma between January 1st, 2011, to December 31st, 2020. Kaplan Meier curves were generated. Overall survival (OS) was defined as the time from diagnosis to death or last follow up. Event-free survival (EFS) was defined as time from diagnosis to death, progression, relapse, treatment abandonment, or last follow up.ResultsWe identified 372 medical charts, of which 35 were excluded (34 abandoned prior to therapy, 1 chondrosarcoma), leaving 337 records for analysis. Median age was 13.8 years (range 2.4 – 17.9 years). At baseline, 295 patients (87.5%) had localized disease, and the lower extremity was the most common primary tumour site (286, 84.9%). The median follow-up time was 55 months (range, 1–149 months), during which 100 deaths were observed (75 attributed to disease progression, 18 infection-related, 7 due to cardiotoxicity), while 42 (12.5%) patients abandoned active treatment. The median overall survival was not reached. The estimated 3-year, 5-year, and 10-year overall survival rates with 95% confidence intervals were 72% (67 – 78%), 65% (59 – 71%), and 55% (44 – 69%), respectively. The median EFS was 26.6 months. The estimated 3-year, 5-year, and 10-year EFS rates with 95% CI were 43% (39 – 49%), 40% (35 – 46%), and 25% (16 – 40%), respectively.ConclusionSurvival outcomes for localized osteosarcoma with a methotrexate-based treatment regimen are near regional estimates but reflect a high rate of infection-related mortality, treatment abandonment, and amputations.

Treatment Patterns and Long-Term Survival Outcomes in Muscle-Invasive Bladder Cancer: A Decade-Long Single-Institution Retrospective Cohort Study

Thu, 10 Sep 2026 00:00:00 GMT

IntroductionMuscle-invasive bladder cancer (MIBC) is an aggressive malignancy with heterogeneous treatment approaches and outcomes. Long-term survival data from real-world settings remain limited. We evaluated treatment patterns and 10-year survival outcomes in a large single-institution cohort of patients with MIBC.Materials and MethodsThis retrospective cohort study included 349 patients with MIBC who were treated at Shaukat Khanum Cancer Hospital and Research Centre, Pakistan between 2010 and 2020. Treatment strategies comprised neoadjuvant chemotherapy followed by radical cystectomy or definitive chemoradiotherapy or radiotherapy, upfront cystectomy, definitive bladder-preserving chemoradiotherapy, radiotherapy alone, and palliative treatment. Overall survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors.ResultsThe median age was 57 years, with male predominance of 82.2%. High-grade disease was present in 88.5% of patients. At last follow-up, 67.9% of patients were alive. Overall survival differed significantly across treatment strategies (log-rank p < 0.001). Median overall survival was not reached in curative-intent treatment groups, whereas patients treated with palliative intent had an inferior median overall survival of 30 months. In multivariate analysis, Stage IV disease (adjusted HR 2.41, 95% CI 1.33 to 4.37) and palliative treatment (adjusted HR 3.30, 95% CI 1.49 to 7.31) were independently associated with worse survival. After adjustment, no statistically significant differences in overall survival were observed between definitive surgical and bladder preserving approaches, noting the limitations of non-randomized treatment allocation.ConclusionDefinitive treatment was associated with durable long-term survival in appropriately selected patients. Disease stage and treatment intent remained the dominant determinants of outcome. Bladder-preserving chemoradiotherapy was an effective definitive option in selected patients in this real-world cohort.

Outcomes of Pediatric Precursor B Cell Acute Lymphoblastic Leukemia: A Tertiary Care Cancer Center Experience from a Lower-Middle-Income Country

Thu, 10 Sep 2026 00:00:00 GMT

IntroductionPrecursor B-cell acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. While cure rates in high-income countries (HICs) exceed 90%, outcomes in low- and middle-income countries (LMICs) remain suboptimal. This study evaluated treatment outcomes for pediatric pre-B cell ALL patients at a tertiary cancer hospital in an LMIC.Materials and MethodsPediatric precursor B-cell ALL patients treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan between September 2017 and September 2022 were included.ResultsA total of 436 pediatric patients were analyzed, with a median age of 3 years and a male predominance (61.5%). Most patients (96.3%) were classified as standard risk, while CNS and testicular involvement were rare. Among standard-risk patients, 81.8% achieved complete remission, and 17.4% remained minimal residual disease (MRD)-positive after induction. For high-risk patients, 75% achieved complete remission, and 25% remained MRD-positive at the end of induction. In total, 374 patients achieved remission, but 56 (14.9%) relapsed, most often as isolated bone marrow relapse (53.6%). Early relapse was most common. Overall mortality was 26.1%, with induction mortality at 11.7%. Sepsis was the leading cause of death (59.7%), followed by relapse (29%). Five-year overall survival (OS) and event-free survival (EFS) were 75.8% and 66.4%, respectively.ConclusionOur study demonstrates good outcomes for pediatric precursor B-cell ALL in a resource-limited LMIC setting. Sepsis and relapse were the main causes of mortality.

Long-Term Survival Patterns in Childhood B-Cell Non-Hodgkin Lymphoma in Resource-Constrained Countries

Thu, 10 Sep 2026 00:00:00 GMT

IntroductionThe B cell non-Hodgkin lymphomas (NHL) of childhood and adolescence are among the fifth most common pediatric malignancies worldwide. We conducted a retrospective study and evaluated risk factors influencing long-term survival outcomes in patients with B-cell NHL treated at a tertiary cancer care hospital.Materials and MethodsThis retrospective descriptive study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center. This study included data of patients diagnosed with B-cell NHL from January 2016 to December 2020, following approval from the institutional review board. Statistical significance was defined as a two-tailed p-value < 0.05. Kaplan-Meier curves were generated in SPSS version 27 (IBM Corporation). Overall survival (OS) was defined as the time from diagnosis to death or last follow-up. Event-free survival (EFS) was defined as the time from diagnosis to death, progression, relapse, treatment abandonment, or last follow-up.ResultsA total of 276 patients with B-cell NHL were registered between January 2016 and December 2020. The median age of the patients was 5 years (IQR: 2). Baseline LDH was strongly associated with mortality, with a greater proportion of deaths occurring among patients with LDH ≥ 2× the upper limit of normal (54.1% vs 19.6%; p<0.01). Advanced stage, tumor lysis syndrome, and poor reassessment response were significantly associated with mortality (p<0.001). In multivariate analysis, patients with TLS had a 2.9-fold higher risk of death compared with those without TLS (2.86; 95% CI: 1.837–4.456; p<0.001). The estimated 5-year overall survival rate was 63.7%, and the event-free survival rate was 62%.ConclusionOur study emphasized that the long-term survival outcome of pediatric B-cell NHL in LMIC is significantly inferior in comparison to developed countries due to high disease burden at presentation, along with tumor lysis syndrome, which led to complications such as sepsis. Sepsis was the major cause of death in our population.

Systemic treatment of advanced pancreatic cancer: A Comprehensive Review

Thu, 10 Sep 2026 00:00:00 GMT

ImportancePancreatic adenocarcinoma (PDAC) is an uncommon but potentially catastrophic diagnosis with historically poor prognosis. It is the tenth most prevalent cancer in the US & UK. Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies worldwide, with a five-year survival rate of approximately 10%. Despite increasing understanding of its molecular biology, systemic treatment options for advanced disease remain limited, and survival outcomes have improved only modestly over the past decade.ObservationsThis narrative review traces the evolution of systemic therapy for advanced PDAC from gemcitabine monotherapy through the landmark FOLFIRINOX (PRODIGE trial) and gemcitabine/nab-paclitaxel (MPACT trial) combination regimens, which remain the standard of care. Second-line options including liposomal irinotecan plus 5-FU/LV (NAPOLI-1) and maintenance olaparib for germline BRCA1/2-mutated disease (POLO) are also reviewed. Emerging data on sequential treatment strategies (SEQUENCE trial), biomarker-driven treatment selection (PRIMUS-001, PASS-01), and precision medicine approaches targeting actionable molecular subgroups, including dMMR/MSI-H, NTRK fusions, and homologous recombination deficiency are discussed. Real-world evidence comparing FOLFIRINOX and gemcitabine/nab-paclitaxel is critically appraised, including the challenges of patient selection, tolerance, and applicability outside clinical trial settings.Conclusion and RelevanceDespite incremental progress, the treatment landscape of advanced PDAC remains challenging. Molecular stratification and biomarker-driven precision oncology represent the most promising path forward. This review serves as a clinical reference for physicians managing advanced pancreatic cancer, highlighting current evidence, evidence limitations, and future research priorities including prospective biomarker-driven trials and improved access to genomic testing.

Long-Term Outcomes and Prognostic Analysis of Endometrial Cancer: A 10-Year Tertiary Care Experience

Tue, 01 Sep 2026 00:00:00 GMT

IntroductionEndometrial carcinoma (EC) is a common gynecologic malignancy with rising incidence globally, including in low- and middle-income countries. Local data on clinicopathological characteristics, treatment patterns, and survival outcomes remain limited in Pakistan.Materials and MethodsThis retrospective cohort study included 622 women aged ≥18 years with histologically confirmed EC treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre between 2010 and 2020. Clinical, pathological, treatment, and outcome data were extracted from the institutional electronic medical records. Survival outcomes were estimated using Kaplan–Meier analysis, and prognostic factors were evaluated using Cox proportional hazards regression. Statistical analyses were conducted using IBM SPSS Statistics 27.0. The study was approved by the Institutional Review Board of Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan (IRB exemption number EX-17-12-25-01).ResultsThe median age was 56 years (range 24–87), and 36.3% were aged ≥60 years. Mean BMI was 32.8 kg/m2, reflecting a high prevalence of obesity. Most patients presented with FIGO stage I disease (71.4%), and deep myometrial invasion (≥50%) was present in 47.7%. Nodal metastasis was identified in 5.8%. Primary surgical treatment was performed in 94.4% of patients, with frequent use of adjuvant radiotherapy (57.2%), brachytherapy (60.6%), and chemotherapy (83.6%). The 5-year overall survival (OS) was 88.6% (95% CI: 85.6–91.7). On multivariate analysis, FIGO stage, nodal status, age and BMI were independent predictors of Overall Survival (OS).ConclusionKey prognostic factors in EC, including age, stage, nodal involvement, histology, and performance status, are consistent with international and Asian data. Regional differences in age at diagnosis, obesity prevalence, and histologic distribution highlight the need for context-specific management strategies in LMICs. Prospective studies incorporating molecular profiling may further refine risk stratification and improve outcomes.

Outcomes and Long-term Follow-up of Epithelial Ovarian Cancer: Experience from the Lead Cancer Center of Pakistan

Tue, 01 Sep 2026 00:00:00 GMT

Pancreato-duodenal cancers in Pakistan: Patterns of presentation, disease burden and outcomes at a tertiary cancer facility

Mon, 03 Aug 2026 00:00:00 GMT

IntroductionCancers of the pancreato-duodenal region carry a poor prognosis and are resource-intensive to manage. Long-term data from specialized cancer centers in Pakistan are limited. We aimed to determine the long-term outcomes of patients with duodenal, peri-ampullary, distal bile duct, and pancreatic cancers treated at a tertiary cancer center in Pakistan.Material and methodsWe retrospectively evaluated data from all patients with pancreaticoduodenal cancer registered at our institute between January 2000 and December 2020. The Kaplan-Meier method was used to examine significant differences in survival distributions across subcategories, with results considered significant at an alpha level of 0.05. SPSS 27 was used for descriptive and comparative data analysis.ResultsThe mean age at presentation was 53 years, with peri-ampullary cancers being the most common histology. Pancreatic cancers were associated with poor prognosis as compared to duodenal cancers and pancreatic Neuro-Endocrine Tumors (pNET). For patients with pNET undergoing resection, the 5-year overall and disease-free survival was 90% and 75%, respectively. Patients who achieved textbook outcomes after surgery had better OS and DFS.DiscussionThe current study showed that in our part of the world, patients are younger and have advanced stages at the time of diagnosis of pancreato-duodenal cancers. We also found that the long-term survival is associated with an early stage at diagnosis.

Role of Preoperative Tapentadol in Reduction of Peri-operative Analgesics Requirements After Breast Conservative Surgery in Cancer Patients: A Randomized Controlled Trial

Mon, 29 Jun 2026 00:00:00 GMT

IntroductionTapentadol, a centrally acting μ-opioid receptor agonist and noradrenaline reuptake inhibitor, has shown promise in providing potent analgesia with fewer opioid-related side effects. This study evaluated its role as a pre-emptive analgesic in cancer patients undergoing breast conservation surgery.Materials and MethodsA prospective, double-blinded, randomized controlled trial was conducted on 70 American Society of Anesthesiologists class II adult females, scheduled for conservative breast surgery, randomized into two groups after informed consent. Group A received 75 mg oral tapentadol, and Group B an oral placebo, one hour before induction. Intraoperatively, more than 20% increase in mean arterial pressure from baseline, and postoperatively, pain score (at 1, 2, 3, and 4 hours) greater than 3 was treated with intravenous morphine (up to 0.1 mg/kg). Data regarding total morphine used (dose and number of patients) intra-operatively and postoperatively, time to first rescue dose, and pain scores postoperatively, and side effects were documented.ResultsMean intraoperative morphine requirement was significantly lower in the tapentadol group (1.11 ± 1.53 mg) compared with the placebo group (3.36 ± 1.60 mg; p < 0.001). Only 13 (37.1%) patients in the tapentadol group required intraoperative morphine compared to 31 (88.6%) in the placebo group (p < 0.001). Postoperative pain scores were lower in the tapentadol group at 1 hour (1.89 ± 0.83 vs 2.46 ± 1.15, p = 0.020) and 3 hours (1.06 ± 0.24 vs 1.23 ± 0.43, p = 0.042). Rescue morphine use post op was lower in the tapentadol group [5 (14.3%) vs.10 (28.6%), p = 0.145] with a longer time to first rescue dose (58.0 ± 21.7 vs. 43.5 ± 27.3 minutes, p = 0.290).ConclusionPre-emptive tapentadol administration significantly reduced perioperative morphine use and improved postoperative pain scores at certain time points. However, the increase in time to first rescue analgesia was not statistically significant.

Integrated Palliative care in Metastatic gastrointestinal Cancer: A Retrospective Experience from a Lead Cancer Centre in Pakistan

Mon, 29 Jun 2026 00:00:00 GMT

BackgroundThe goal of palliative care is to alleviate the suffering of patients with advanced cancer, such as through pain management. Multiple randomized controlled trials have supported the early integration of palliative care. Despite the undeniable advantages of early palliative care, most data have come from developed countries. This study offers real-life insights into the integration of palliative care services for patients with advanced gastrointestinal cancer and their impact on quality of life in a developing country.Materials and MethodsWe retrospectively evaluated patients with metastatic gastrointestinal cancer treated at our center from January 2018 to December 2022. The subjects included patients with metastatic gastrointestinal (GI) cancer who received palliative care either within 90 days of diagnosis (early group) or after 90 days (late group). The impact of early versus late integration of palliative care was assessed.ResultsA total of 216 patients were included in the analysis — 123 in the early group and 93 in the late group. While the majority of patients were referred electively to palliative care, emergency referrals were more frequent in the early group (62 total; 40 [64%] in the early group, 22 [36%] in the late group, p = 0.15). The number of patients receiving chemotherapy in the last 30 days of life was 39 (early group: 17; late group: 22; p = 0.06). On the Edmonton Symptom Assessment Scale (ESAS), symptoms such as pain, nausea, and wellbeing were better controlled in the early group, although the differences were not statistically significant. The disease burden was significantly higher in the early group (p = 0.01).ConclusionDespite a higher disease burden in the early group, symptom control was comparable between the groups. The greater number of emergency referrals in the early group highlights the role of palliative care during crises and underscores the need for better integration of palliative care services.

Outcome of Classic Hodgkin Lymphoma Treated with ABVD Regimen- A Single Center Experience

Mon, 29 Jun 2026 00:00:00 GMT

IntroductionClassic Hodgkin lymphoma (cHL) treatment has evolved over recent years, driven by advances in novel agents. In low-income countries with resource constraints, ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy is the cheapest and most curative option. Here we highlight the outcome of the ABVD regimen in adults with classic Hodgkin lymphoma (cHL) and associated factors.Materials and MethodsA retrospective cohort study conducted at Aga Khan University Hospital, Karachi, Pakistan, from 1st January 2013 to 31st December 2023, included 246 patients (aged 18 years or older at cHL diagnosis) who received ABVD as their first chemotherapy regimen. Median OS and PFS were estimated using the Kaplan-Meier method, and the association between variables was assessed using the log-rank test. Univariate and multivariate analyses were used to identify significant factors using Cox regression.ResultsThe median age of our cohort was 35 years, with a male predominance (1.6 male-to-female ratio). Out of 246 patients, 78 (31.7%) had early-stage disease, while 168 (68.3%) had advanced-stage disease. The median overall survival and progression-free survival (PFS) were not reached. Median follow-up duration was 35 months. Two hundred and five (83.3%) patients remained alive at the end of the study. OS and PFS at 2 years were 85.6% and 74.7%, respectively. Factors that significantly affected OS were age, stage, bulky disease, and ECOG.ConclusionOur findings show that ABVD is still an effective and economical regimen in developing parts of the world and signifies the importance of age, bulky disease, ECOG, stage, and the risk stratification approach.

Outcome of Autologous Stem Cell Transplant in Relapsed/Refractory Hodgkin Lymphoma - A Single Center Study

Mon, 29 Jun 2026 00:00:00 GMT

IntroductionIn relapsed/refractory (R/R) classic Hodgkin lymphoma (cHL), the preferred treatment is autologous stem cell transplantation (ASCT) after receiving high-dose chemotherapy (HDC). Here, we describe and discuss the single-center experience, including outcomes and associated factors.Materials and MethodsTo provide insight into our experience, our single-center retrospective cohort study included 33 patients (aged 18 years or older at the time of diagnosis) who received HDC/ASCT at Aga Khan University Hospital, Karachi, Pakistan, from January 2013 to December 2023.ResultsFourteen (42.4%) patients experienced post-transplant relapse, while 10 (30.3%) patients died. The transplant-related mortality (TRM) was seen in 2 (6.1%) patients. Median overall survival (OS) was 65 months, while the median progression-free survival (PFS) was 31 months. The 2-year PFS and OS were 62.1% (95% CI: 45.8–84.1%) and 77.9% (95% CI: 64.6–93.8%), respectively. On univariate analysis, factors associated with lower survival rates included a relapse within one year of initial chemotherapy and the failure to achieve complete remission (CR), both before and after transplantation. Multivariate analysis was not performed due to the small sample size and limited number of events.ConclusionThis study emphasizes that disease status before and after transplant affects outcomes, showing that achieving CR before ASCT yields better outcomes than achieving PR.

Diagnostic Challenge of Gastric Glomangioma Mimicking Gastrointestinal Stromal Tumor: A Case Report

Mon, 29 Jun 2026 00:00:00 GMT

IntroductionGastric glomus tumors (GGTs) are rare benign mesenchymal neoplasms of the stomach, often mistaken preoperatively for more common submucosal lesions such as gastrointestinal stromal tumors (GISTs). Accurate diagnosis requires a combination of endoscopic ultrasonography, histopathology, and immunohistochemistry.Case DescriptionWe report a 51-year-old female with a two-year history of epigastric burning, anorexia, and unexplained weight loss. Initial evaluation included EUS, which identified a 1.8 × 2.4 cm hypoechoic submucosal lesion arising from the muscularis propria at the gastric antrum. Contrast-enhanced CT demonstrated a 2 cm avidly enhancing antral lesion with persistent venous-phase enhancement; no evidence of lymphadenopathy or metastasis was noted. Subsequent EUS-guided fine-needle biopsy (FNB) demonstrated an epithelioid neoplasm. Initial immunohistochemistry excluded GIST (CD117−, DOG1−), leiomyoma (desmin−), and schwannoma (S100−). Additional glomus tumor-specific markers were not performed at this stage due to limited biopsy material and a stepwise diagnostic approach. Given the peri-pancreatic location, diagnostic uncertainty, and lesion size exceeding 2 cm, the decision was made to proceed with laparoscopic distal gastrectomy. Final histopathology confirmed glomangioma, positive for SMA and vimentin; Ki-67 ~1%; 0 mitoses per 50 high-power fields (HPF); no atypia, necrosis, lymphovascular invasion, or clear margins. Postoperative surveillance CTs showed no recurrence; no adjuvant therapy was indicated.ConclusionThis case highlights the clinical and radiologic overlap between GGT and other submucosal gastric lesions. Comprehensive immunohistochemistry and careful surgical planning are essential for accurate diagnosis and management.

Brown Tumor in Primary Hyperparathyroidism and Hungry Bone Syndrome Post-Parathyroidectomy: Two Rare Entities

Fri, 03 Apr 2026 00:00:00 GMT

Barriers to Palliative Care for Terminally Ill Children in a Developing Country Cancer Hospital: A Qualitative Study

Fri, 03 Apr 2026 00:00:00 GMT

IntroductionPediatric palliative care (PPC) aims to improve the quality of life for children with life-limiting illnesses and support their families by addressing physical, psychological, social, and spiritual needs. Globally, significant barriers to PPC delivery include limited integration into health systems, inadequate provider training, restricted access to pain medications, and communication challenges. These issues are particularly pronounced in low- and middle-income countries, where cultural, infrastructural, and resource constraints further complicate care. Despite growing recognition of PPC’s importance, there is limited understanding of the experiences of children, families, and healthcare providers in these contexts. This study explores barriers to PPC provision in a developing-country cancer hospital, highlighting context-specific challenges and opportunities for improvement.Materials and MethodsA retrospective qualitative content analysis of clinical documentation was conducted for 150 pediatric patients (≤18 years) referred to the palliative medicine team at a tertiary care cancer hospital between 1st January 2019 and 27th August 2024, at which point thematic saturation was achieved. Clinical notes were analyzed using Braun and Clarke’s thematic analysis framework and coded in NVivo 15. Key themes and subthemes emerged. Ethical approval was obtained from the Institutional Review Board.ResultsFive themes were identified as challenges in palliative care provision to children. These were barriers to effective care, psychological and family-related challenges, impact on quality of life, financial constraints and resource limitations, medical adherence, and treatment non-compliance.ConclusionThese findings underscore the urgent need to address multifaceted medical, psychosocial, and socioeconomic challenges to pediatric palliative care in developing countries. Prioritizing a multidisciplinary approach, raising awareness, expanding access to pain management, and reinforcing psychosocial support are imperative steps. Through concerted efforts, the quality of life for children with life-limiting illnesses and their families can be meaningfully improved.

Evaluating Technical Feasibility and Surgical Outcomes of Laparoscopic Excision of Abdominopelvic Solid Tumors in Children: A Retrospective Review

Fri, 03 Apr 2026 00:00:00 GMT

IntroductionMinimal invasive surgery for abdominopelvic solid organ tumors in paediatric patients is a growing field. Technical challenges persist despite potential benefits, such as reduced postoperative pain and shorter recovery times.Materials and MethodsThis was a retrospective review of all paediatric patients who underwent laparoscopic excision for abdominopelvic tumors. Parameters such as demographics, tumor histology, tumor location and size, blood loss, operation duration, and early outcomes were analyzed.ResultsThirty-five patients underwent laparoscopy. The median age was 13 years. Females constituted the majority (29). Tumor sites included the pelvis (n=29), right kidney (n=2), retroperitoneal (n=3), and colon (n=1). The average tumor size was 11 cm. Successful laparoscopic excision was achieved in 32 cases, without postoperative complications, with a mean hospital stay of two days.ConclusionsLaparoscopic excision is technically feasible for paediatric abdominopelvic solid organ tumors, offering minimal complications. However, further studies are needed to define long-term outcomes.

Outcomes of Pediatric and Adolescent Girls with Malignant Ovarian Germ Cell Tumors after Chemotherapy and Surgery: A Single Institutional Experience

Fri, 03 Apr 2026 00:00:00 GMT

IntroductionMalignant ovarian germ cell tumors are rare and vital cancers in the pediatric age group of females, affecting 1–2% of all ovarian malignancies. Advances in surgical management, chemotherapy, and patient care have significantly improved survival.Materials and MethodsThis retrospective study investigates the treatment outcomes of 116 pediatric patients diagnosed with Malignant ovarian germ cell tumors at a tertiary care center in Pakistan between 1999 and 2022. The study focuses on patterns of care, survival rates, recurrence, and complications associated with therapy.ResultsThe median age was 13.5 years, with dysgerminomas predominating (38.7%). Most patients had upfront surgery (87.9%), followed by adjuvant chemotherapy, including JEB (Carboplatin, etoposide, bleomycin) (64.7%), BEP (bleomycin, etoposide, cisplatin) (25.0%), and PEB (cisplatin, Etoposide, Bleomycin) (4.3%). The five-year event-free survival (EFS) and overall survival (OS) were 87.1% and 90.5%, respectively. Histology, chemotherapy regimen, and risk group classification were key factors influencing survival, with dysgerminoma showing the best prognosis. In patients whose tumor markers normalized rapidly, event-free survival (EFS) was better. Relapsed disease was observed in 2.6% of patients, and disease progression occurred in 7.8%.ConclusionOur study shows good outcomes for girls with ovarian tumors. This study highlights the effectiveness of multimodal treatment strategies, including both surgery and chemotherapy, in improving survival outcomes for pediatric patients with malignant ovarian germ cell tumors in low-resource settings.

Outcomes of Medulloblastoma Treated with Volumetric Modulated Arc Therapy Craniospinal Irradiation: A Retrospective Study

Fri, 03 Apr 2026 00:00:00 GMT

IntroductionCranio-spinal irradiation (CSI) is essential in treating central nervous system malignancies such as medulloblastoma, but conventional 3D-conformal radiotherapy poses challenges in dose uniformity and toxicity. Advanced techniques like Volumetric Modulated Arc Therapy (VMAT) offer improved target coverage and organ sparing, yet data on its use in resource-limited settings remain scarce. This study aimed to evaluate the clinical feasibility, dosimetric performance, toxicity profile, and early outcomes of CSI delivered via VMAT in medulloblastoma patients treated at a tertiary care center in Pakistan.Materials and MethodsThis retrospective study included 113 patients (median age 12 years, range 4–37) diagnosed with medulloblastoma and treated between 2018 and 2024. Patients underwent surgical resection followed by VMAT-based CSI, with doses ranging from 23.4 to 36 Gy and tumor boosts of 54–55.4 Gy. Dosimetric parameters including planning target volume (PTV) coverage, conformity index (CI), homogeneity index (HI), and organ-at-risk (OAR) doses were analyzed. Acute toxicities were graded, and disease-free survival (DFS) was assessed over a median follow-up of 15 months.ResultsGross total or near-total resection was achieved in 38.1% of patients. Mean PTV coverage was 94%, with median CI and HI values of 1.02 and 0.10, respectively, indicating excellent dose conformity and homogeneity. The majority of patients required multiple isocenters for complete cranio-spinal coverage. Acute toxicities were predominantly mild to moderate, with esophagitis (11%), bone marrow suppression (12%), and nausea/vomiting (10%) most commonly observed. Organ doses remained within acceptable limits. The two-year DFS rate was 76%.ConclusionVMAT-based CSI is a feasible and effective treatment modality for medulloblastoma in a resource-constrained setting, providing superior dosimetric outcomes with manageable toxicity. These findings support the broader adoption of advanced radio-therapy techniques like VMAT in similar clinical environments.

Presentation of Metastatic Colorectal Carcinoma at a Tertiary Care Center in Pakistan

Fri, 03 Apr 2026 00:00:00 GMT

IntroductionMetastatic colorectal cancer (mCRC) poses significant challenges in low- and middle-income countries (LMICs) due to limited access to comprehensive care. This study aims to analyze the clinical characteristics, treatment patterns, and outcomes of patients with metastatic colorectal cancer (mCRC) at a single tertiary care center in Pakistan.Materials and MethodsA retrospective cross-sectional study was conducted on 141 patients diagnosed with mCRC at the Aga Khan University Hospital (AKUH) between January 2020 and December 2022. Data on demographics, tumor characteristics, metastasis patterns, treatment modalities, and outcomes were extracted from electronic medical records. Descriptive statistics and survival analysis were performed.ResultsThe mean age of the cohort was 51 years (SD ± 17.43), with 56.7% male patients. The study included patients from all over Pakistan, with the majority residing in Sindh (71.1%). Additionally, 8.5% of patients were from outside Pakistan. Rectum (27.5%) and sigmoid colon (20.4%) were the predominant tumor locations. Adenocarcinoma was the most common histological type (90.1%). Liver-only metastases were observed in 27.5% of patients, with 48.2% presenting multisite metastases. Chemotherapy was administered to 74.6% of patients, with FOLFOX being the most common regimen (38.3%). Primary tumor resection was performed in 43.7% of cases, and metastatic lesion resection in 7.7%. Fragmented care was observed, with 21.4% of patients receiving diagnostic or therapeutic interventions outside AKUH as well. The median time from diagnosis of metastasis to death was 4.9 months (IQR: 1.1–9.3).ConclusionmCRC patients in Pakistan present with a younger age, higher prevalence of multisite metastases, and limited access to advanced multimodal treatments compared to HICs. These findings underscore the need for tailored public health initiatives, including age-specific screening programs, improved diagnostic and treatment infrastructure, and enhanced access to advanced therapies to improve outcomes in LMICs.

The Efficacy of Esophageal Stenting in Managing Esophageal Tumor Perforation: A Retrospective Study

Fri, 03 Apr 2026 00:00:00 GMT

IntroductionEsophageal tumor perforation is a serious complication, seen in patients undergoing chemo-radiotherapy for advanced-stage cancer, and can lead to life-threatening conditions like sepsis and empyema. Esophageal stenting with self-expandable metal stents offers a safer, less invasive alternative to surgery, helping restore oral intake and improve patient comfort. This study aims to determine the effectiveness of esophageal stenting in managing esophageal tumor perforation at different disease stages and to assess long-term outcomes.Material and MethodThis retrospective cohort study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center in Peshawar by reviewing 600 patient records presenting with esophageal tumor perforation from January 2016 to December 2021, and retracted between October and December 2024. Eighty patients who underwent esophageal stenting were enrolled in the study. Data on demographics, tumor characteristics, treatment history, and survival status were collected from the hospital’s electronic system. SPSS-25 was used for analysis purposes. The chi-square test was employed to determine statistical significance (p ≤ 0.05).ResultsThe mean age of patients was 46.98±11.62 years, and most patients were male (45, 56.3%). Squamous cell carcinoma was the most prevalent histological type, accounting for 74(92.5%) of cases. Advanced-stage disease was observed in the majority of cases, with T3 at 48 (60.5%) and T4 at 15 (18.8%). Additionally, 34(42.5%) exhibited nodal involvement (N1 and N2 each) and 23(28.7%) had metastatic. The median stent insertion during the study period was 83 days, with a range from 1 day to 7 years. Survival status was suboptimal, with 76(95%) deceased, 4(5%) surviving. Kaplan-Meier analysis demonstrates a median survival of 200 days.ConclusionEsophageal stenting is an effective palliative intervention for managing tumor-induced esophageal perforation, particularly in patients with advanced disease, and prolongs survival.