AIM: To determine the working independent prognostic factors and the prognostic index of adenocarcinoma of the urinary bladder. The effect of adding postoperative radiotherapy to radical cystectomy on this prognostic index was also investigated.

PATIENTS AND METHODS: Two hundred and sixteen patients having adenocarcinoma of the urinary bladder were treated with radical cystectomy and pelvic lymphadenectomy with (82 patients) or without (134) postoperative radiotherapy. Postoperative radiotherapy (PORT) was given to the whole pelvis in a dose of 50 Gy/25 fractions over 5 weeks, and started 4-10 weeks after surgery.

RESULTS: The 5-year disease-free survival rate was 44 +/- 4% for the whole group. Postoperative radiotherapy improved the disease-free survival significantly from 33 +/- 6% for cystectomy alone Introduction to 58 +/- 6% for PORT patients (P = 0.002). The independent prognostic factors for DFS were the pathological stage, histological subtypes, nodal involvement and the addition of postoperative radiotherapy. The stratification of patients using prognostic indices according to the pathological findings produces identifiable prognostic groups. Postoperative radiotherapy improved the DFS significantly in the intermediate and high risk indices (p = 0.0004 and 0.0002 respectively).

CONCLUSIONS: The identified prognostic indices with their prognostic group could be used not only as a predictor of disease-free survival but also as a good predictor for the need to add adjuvant therapy in adenocarcinoma of the urinary bladder.

Purpose: A retrospective study was performed to investigate the relationship between spontaneous apoptosis and angiogenesis uterine cervix squamous cell carcinoma patients. The prognostic value of each (and both) of these biologic parameters was also tested.Methods and Materials: The pathologic materials of 40 cervical uteri squamous cell carcinoma patients were examined and immunohistochemically stained to determine the tumor angiogenesis (tumor microvascular score), using factor VIII-related antigen, and their tumor apoptotic index (AI), using the TdT-mediated dUTP nick end-labeling (TUNEL) method. Three patients were Stage I, 18 were Stage II, 15 were Stage III, and 4 were Stage IV (FIGO classification). All patients were treated with radical radiotherapy and all had follow-up for more than 2 years.Results: The mean AI was 15.1 ± 12.8, with a median of 8.3. The mean tumor microvascular score was 3 9.7 ± 14.4, with a median of 3 8. The patients' age and tumor grade did not seem to significantly affect the prognosis. On the other hand, AI and angiogenesis (tumor microvascular score) were of high prognostic significance. The 3-year disease-free survival (DFS) rate for the patients having AI above the median was 78% (confidence interval [CI] 69-87%), compared to 32% (CI 22-42%) for those having AI below the median. The DFS was 18% (CI 9-27%) for patients having an angiogenesis score above the median, while it was 86% (CI 78-94%) for those patients having a score below the median.Conclusion: Determination of both tumor microvascular score and AI can identify patients with the best prognosis of 100% DFS (with low angiogenesis score and high AI). Women with a high score and low AI had the worst prognosis (DFS = 3%, CI 1-5%). Moreover, high AI can compensate partially for the aggressive behavior of tumors showing a high rate of angiogenesis. Copyright (C) 2000 Elsevier Science Inc.

Our most respected professor Hassan K. Awwad passed away on January 5th, 2007, at the age of 81. He was considered as the father of radiotherapy in Egypt. He was always named "The Professor", as he was the founder of the radiotherapy departments at the National Cancer Institute, Cairo University&Faculty of Medicine, Alexandria University. He also shared in developing NEMROCK (Kasr El Aini Center of Radiation Oncology and Nuclear Medicine), the place where he graduated and worked during his early years of experience. He, together with professor Reda Hamza, dean of NCI, Cairo at that time, had initiated 7 oncology centers all over Egypt, from Aswan in the South to Dammietta and Damanhour in the North. These 7 centers were developed by the Ministry of Health. Prof. Awwad and Prof. Hamza were responsible for facility providing and plans. They chose all the necessary equipment, tools and personnel. These centers were in action since 1988 and are currently taking care of the oncology patients in a wide area of the country. Prof. Awwad graduated from the Faculty of medicine, Cairo University, in 1949. He had his Medical Doctorate (MD) in Radiotherapy from Alexandria University in 1956. The International Atomic Energy Agency (IAEA) awarded him fellowships in France (Institute Gustave Rossy) to gain experience in brachytherapy in 1956 and 1971, England 1956, 1959. Another fellowship was awarded to Prof Awwad in Harvard University (Peter Bent Brigham Hospital) in radiobiology and radiotherapy during the years 1964-1965. He personally and with other members of the National Cancer Institute gave much of their efforts and time to teach, train and guide young radiotherapists, biologists, physicists and radiation therapists through direct on-hand teaching and training as well as holding training courses for radiation oncologists, physicists and technologists. He insisted to ensure its regularity 4 times yearly. These courses trained a lot of personnel from all over Egypt, Sudan, Libya, Palastine, Iraq, Uganda, Nigeria and other countries. He himself had many teaching missions in different Arab countries (Saudi Arabia, Kuwait and others) for the sake of groups of his students that could not come to Egypt. He served as the head of the Department of Radiation Oncology for more than 15 years (1970-1985), full time Professor in Radiation Oncology and Radiobiology (1985-2007), Professor of Radiotherapy, Alexandria University (1954-1970), Chief of the Department of Nuclear Medicine, Medical Research Institute, University of Alexandria (1963-1964), Chief of the Radiotherapy Unit in the Heliopolis Hospital, Ministry of Public Health, 1985-2007. He was co-founder of the Egyptian Society of Cancer and acted as vice present and head of the scientific committee of the society. He shared the activities of many Egyptian, Arab and international scientific societies. His activities in these societies were great. Prof. Awwad had direct contact with his students that never ended, even after some of them left to work in other places in USA, Canada, Europe or Arab Countries. His students' specialty varied between radiobiology, pharmacology, biochemistry, tumor biology, radiation oncology, medical oncology and surgical oncology. Prof. Awwad had more than 100 published articles on hypoxia and hypoxic cell radiosensitizers, biology of growth of human tumors, biology and clinical models of the time factor in external beam radiotherapy, biology and mathematical models of time factor in brachytherapy, radioactive dynamic cancer studies of plasma protein metabolism, radioactive dynamic factor studies of blood disorders and lymphoma, radiation damage of DNA and normal tissues,head and neck cancer, bladder cancer, breast cancer, cervical cancer and development and optimization of clinical radiotherapy. He had continuous cooperation and collaboration with many of the great scientists and clinicians in Holland, France, United Kingdom, USA and Japan. He continued to exchange ideas with these great people all through his life and till the last moments of his extended fruitful life. Prof. Awwad wrote many books for a wide diversity of readers, for the lay people in Arabic, for radiographers, young oncologist, and the highly experienced radiation oncologists and radiobiologists. His book "Radiation Oncology: Radiobiological and Physiobiological Perspectives" was a real translation of radiobiology language to the oncologist and at the same time translation of the oncologist language to the biologist. This book ended with establishing a common language for both teams. In addition, it led other books in these specialties to communicate with the same language. The good news is that Prof. Awwad had completed the second edition of this book just before passing away. This second edition is really a totally new book coping with the advancement of knowledge reached till the end of 2006. We are sure that this book with all other good deeds performed by Prof. Awwad, will keep his memory in Egypt as well as elsewhere in the whole world.

BACKGROUND: The pediatric diffuse intrinsic pontine glioma (DIPG) outcome remains dismal despite multiple therapeutic attempts.

PURPOSE: To compare the results of treatment of pediatric diffuse intrinsic pontine glioma (DIPG) using hypofractionated versus conventional radiotherapy.

PATIENTS AND METHODS: Seventy-one newly diagnosed DIPG children were randomized into hypofractionated (HF) (39Gy/13 fractions in 2.6weeks) and conventional (CF) arm (54Gy/30 fractions in 6weeks).

RESULTS: The median and one-year overall survival (OS) was 7.8months and 36.4±8.2% for the hypofractionated arm, and 9.5 and 26.2±7.4% for the conventional arm respectively. The 18-month OS difference was 2.2%. The OS hazard ratio (HR) was 1.14 (95% CI: 0.70-1.89) (p=0.59). The hypofractionated arm had a median and one-year progression-free survival (PFS) of 6.6months and 22.5±7.1%, compared to 7.3 and 17.9±7.1% for the conventional arm. The PFS HR was 1.10 (95% CI: 0.67-1.90) (p=0.71). The 18-month PFS difference was 1.1%. These differences exceed the non-inferiority margin. The immediate and delayed side effects were not different in the 2 arms.

CONCLUSIONS: Hypofractionated radiotherapy offers lesser burden on the patients, their families and the treating departments, with nearly comparable results to conventional fractionation, though not fulfilling the non-inferiority assumption.

Purpose: To evaluate the prognostic potential of inflammatory response biomarkers neutrophil to lymphocyte
ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR) and lymphocyte to
monocyte ratio (LMR) in predicting the outcome of gastric cancer patients undergoing neoadjuvant chemoradiation
prior to surgical resection.
Methods: Patients with localized, gastric adenocarcinoma received two cycles of induction chemotherapy of
fluorouracil, docetaxel, and cisplatin (TPF) followed by 45 Gy of radiation and concurrent fluorouracil plus docetaxel
then surgery for non-metastatic patients. Baseline NLR, dNLR, PLR and LMR calculated from peripheral blood cell
count taken at pre-operation were compared with clinicopathological parameters. The prognostic value of baseline
NLR, dNLR, PLR and LMR for disease free survival (DFS) and overall survival (OS) were assessed using Log rank
and Cox regression.
Results: The final analysis included 80 patient who had resection after neoadjuvant chemoradiation. The
receiver operating curve (ROC) cut off values of baseline NLR, dNLR, LMR and PLR in predicting outcome were
2.4, 1.7, 5.1 and 130 respectively. Elevated NLR, dNLR, PLR, LMR, age of patients (≥ 50 years), stage III, grade 3
tumors, R1 resection and partial response to preoperative chemoradiation course with >10% residual tumor were
significantly associated with decreased OS, and DFS. Multivariate analysis revealed that elevated NLR and dNLR
were independent factors for worse OS and DFS hazard ratio (HR) 2.04 (95% CI=2.41-8.24), 6.63 (95% CI, 1.61-
10.32) and DSF with (HR) 1.84 (95% CI=3.27-7.36), 4.63 (95% CI=3.61-12.12) respectively.
Conclusion: The baseline NLR, dNLR, LMR and PLR showed a significant association with different
clinicopathological prognostic factors in gastric cancer patients receiving preoperative chemoradiation. Additionally,
NLR, dNLR may be considered as potential independent prognostic indicators of clinical outcomes in this group of
patients.

Soleaaegyptiaca was successfully transplanted into Lake Qaroun from the Mediterraneansea to improve the yield of its original strain in the lake and this process continued at different timeintervals. Salinity of the lake increases during summer season due to high evaporation rates andchanges in the inflow regime. The deterioration of water resources in the lake during the summerseason is considered as a serious threat to the aquatic life. Therefore, this study was carried out duringsummer and beginning of autumn seasons where fish are exposed to severe alterations in the aquaticenvironment. Water quality indices of Lake Qaroun showed significant differences and the studiedwater heavy metals (Cu+2, Zn+2, Mn+2 and Pb+2) were in accordance with values of residual heavymetals in tissues, the bioaccumulation process showed also specificity to fish tissues. Histologicalsections in gills, liver and kidneys of S. aegyptiaca collected during June showed much moreimprovement than samples collected during other months. Histopathological alterations and cleardamages were obvious in samples collected during late summer and beginning of autumn (July,August and September) generally in accordance with the results of residual heavy metals in water andtissues. Moreover, the results revealed significant differences in values of growth indices, meat quality,blood parameters and plasma constituents of S. aegyptiaca collected from Lake Qaroun. Generally,the values were deteriorating during late summer and showed much more improvement during Juneand September.

To date, radical cystectomy has continued to be the treatment of choice for muscle-invasive bladder cancer. It is associated with a 5-year disease-free survival rate ranging from 27-55%. This outcome is significantly worse when reporting upon locally advanced cases. The independent prognostic factors include: tumor stage, grade, pelvic nodal involvement and some other additional factors. Beside the higher reported incidence of distant metastasis, local recurrence either alone or combined with systemic relapse has been shown to be experienced by 23-50% of locally advanced patients - a rate that was much more frequent than previously believed. Nonrandomized trials of preoperative radiotherapy have suggested improved survival rates. However, only one out of the six randomized preoperative trials in the literature published in English has proved to be significant. On the other hand, the only randomized trial and most retrospective studies dealing with postoperative radiotherapy revealed a significant increase in disease-free survival. Late complications of post operative radiotherapy, contrary to former belief, were acceptable and generally depended upon the volume of the irradiated normal tissues and the radiotherapy techniques used. Most of these adjuvant or neoadjuvant reports were performed in the 1970s and 1980s using conventional radiation techniques. Modern radiotherapy, delivering higher doses to the tumor while saving a significant amount of the surrounding normal structure, has not been rigorously tested. However, these techniques have already succeeded in improving treatment end results in other pelvic tumors.

A joint symposium between Mansoura and Cleveland Universities, and the University of California, San Francisco (CA, USA) was held by the Egyptian Cancer Society in Mansoura, Egypt. The Symposium extensively discussed two topics: prostate and bladder cancer. The experiences of American and Egyptian scientists were shared in a trial to increase understanding, improve management, increase treatment outcome and decrease morbidity. Comparisons between treatment policies, management techniques and survival end results in Egypt and the USA, as well as internationally, were performed in both bladder and prostate cancer in order to determine the best policies for their management.

Intensity-modulated radiotherapy is used for delivering more efficient homogenous dose to the target and lowering of dose to the surrounding normal tissues. However, a second malignant neoplasm may develop after prolonged latent period. The use of modern precise radiotherapy techniques in the pediatric age group has many controversial issues in spite of its proven dosimetric distribution advantages and the considerable decrease of normal tissue complication probability (NTCP). This concern is due to many factors; mainly the exposure of a larger volume of normal tissues to low dose radiotherapy. Children have more proliferating tissues compared to the adults. However, the epidemiological data did not detect an increase in the incidence of radiation-induced second malignancy. This issue is still controversial as IMRT and other precise radiotherapy techniques were not widely used except recently. This may entail a thorough careful follow up for children treated with these techniques to detect any incidence increase.