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Zaghloul, M. S., and M. K. Bishr, "Radiation Oncology in Egypt: A Model for Africa.", International journal of radiation oncology, biology, physics, vol. 100, issue 3, pp. 539-544, 2018 Mar 01. Abstract
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Zaghloul, M. S., "Adjuvant and neoadjuvant radiotherapy for bladder cancer: revisited.", Future oncology (London, England), vol. 6, issue 7, pp. 1177-91, 2010 Jul. Abstract

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.

Zaghloul, M. S., A. Nouh, M. Moneer, M. El-Baradie, M. Nazmy, and A. Younis, "Time-trend in epidemiological and pathological features of schistosoma-associated bladder cancer.", Journal of the Egyptian National Cancer Institute, vol. 20, issue 2, pp. 168-74, 2008 Jun. Abstract

OBJECTIVE: To investigate the different emerging trends in the features of bladder cancer along 17 years.

PATIENTS AND METHODS: During a 17-year period (1988- 2004), 5071 epithelial bladder cancer patients underwent radical cystectomy at the National Cancer Institute (NCI), Cairo University, Egypt. The time was divided into 3 time periods to detect changes of the clinicopathologic features of patients in these periods.

RESULTS: There was a significant progressive increase in the patients' age with time and decrease in squamous/transitional ratio, with transient increase in male predominance during the 2nd time period. Moreover, there was a decrease in the well differentiated (grade 1) tumor (p<0.001) and an increase in the frequency of pelvic nodal involvement (p<0.001). Transitional cell carcinoma (TCC) patients were significantly older than those with squamous cell carcinoma (SCC) (p<0.001). Progressive increase of age with time was evident in TCC, SCC and adenocarcinoma patients. Male to female ratio changed significantly in TCC and SCC.

CONCLUSION: Time trend was confirmed with relative decrease in frequency of SCC and increase of TCC with changes in their pathological details. The differences between their characteristics and that of the Western countries are decreasing.

Zaghloul, M. S., E. Eldebawy, S. Ahmed, A. G. Mousa, A. Amin, A. Refaat, I. Zaky, N. El Khateeb, and M. Sabry, "Hypofractionated conformal radiotherapy for pediatric diffuse intrinsic pontine glioma (DIPG): a randomized controlled trial.", Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, vol. 111, issue 1, pp. 35-40, 2014 Apr. Abstract

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.

Zaghloul, K. H., W. A. Omar, A. A. Abdel-Khalek, and S. Abo-Hegab, "Ecological Monitoring of Mediterranean Solea Aegyptiaca Transplanted into Lake Qaroun, Egypt", Australian Journal of Basic and Applied Sciences, vol. 5, issue 7, pp. 851-862, 2011. australian_journal.pdf
saied zaghloul, H., "Screening of Alcohol and drugs of abuse in trauma and burn patients' impact on severity and outcomes ", the 2nd annual conference of Forensic Medicine and Toxicology, Faculty of Medicine Cairo Unversity, November,1998.
Zaghloul, M. S., "Joint genitourinary cancer symposium between Egyptian and American centers.", Expert review of anticancer therapy, vol. 11, issue 5, pp. 697-9, 2011 May. Abstract

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.

saied zaghloul, H., "Influence of storage temperature on Morphine stability in Biological samples ", Egyptian Journal of Legal Medicine and Forensic Sciences, vol. 9, issue 3, pp. 147-156, 1997.
Zaghloul, M. S., "Intensity modulated radiotherapy (IMRT) for pediatric cancer patients: the advantage and fear of second malignant neoplasm.", Journal of the Egyptian National Cancer Institute, vol. 25, issue 1, pp. 1-3, 2013 Mar. Abstract

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.

Zaghloul, M. S., M. M. Khalaf, W. N. Thabet, and H. N. Asham, "Effect of Extracorporeal Shock Wave Therapy on Post Burn Scars", International Journal of PharmTech Research, vol. 9, issue 3, pp. 78-85, 2016. 78-85v9n3pt.pdf
Zaghloul, M. A. S., M. Wang, S. Huang, C. Hnatovsky, D. Grobnic, S. Mihailov, M. - J. Li, D. Carpenter, L. - W. Hu, and J. Daw, "Radiation resistant fiber Bragg grating in random air-line fibers for sensing applications in nuclear reactor cores", Optics express, vol. 26, issue 9: Optical Society of America, pp. 11775-11786, 2018. Abstract
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saied zaghloul, H., "Organochlorine residues in adipose breast tissues and risk of Breast cancer in Egyptian females ", Mansoura Journal of Forensic Medicine and Clinical Toxicology , vol. Vii, issue 2, pp. 189-201, 1999.
Zaghloul, M. S., "Has hypofractionated radiotherapy become the standard of care in pediatric DIPG?", Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, vol. 31, issue 8, pp. 1221-2, 2015 Aug. Abstract
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d Zaghloul, M. S. a, M. a El Naggar, A. b El Deeb, H. c Khaled, and N. b Mokhtar, "Prognostic implication of apoptosis and angiogenesis in cervical uteri cancer", International Journal of Radiation Oncology Biology Physics, vol. 48, no. 5, pp. 1409-1415, 2000. AbstractWebsite

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.

Zaghloul, M. S., "Re: patterns of initial transitional cell recurrence in patients after cystectomy.", The Journal of urology, vol. 178, issue 2, pp. 730; author reply 730, 2007 Aug. Abstract
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Zaghloul, M. A. S., M. Wang, G. Milione, M. - J. Li, S. Li, Y. - K. Huang, T. Wang, and K. P. Chen, "Discrimination of temperature and strain in Brillouin optical time domain analysis using a multicore optical fiber", Sensors, vol. 18, issue 4: Multidisciplinary Digital Publishing Institute, pp. 1176, 2018. Abstract
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Zaghloul, K. H., W. A. Omar, A. A. Abdel-Khalek, and S. Abo-Hegab, "Ecological Monitoring of Mediterranean SoleaAegyptiaca Transplanted Into Lake Qaroun, Egypt", Australian Journal of Basic and Applied Sciences, 2011. Abstract

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.

Zaghloul, M. S., E. Eldebawy, S. Ahmed, H. Ammar, E. Khalil, H. A. Rahman, W. Zekri, H. E. Zomor, H. Taha, and A. Elnashar, "Does primary tumor volume predict the outcome of pediatric nasopharyngeal carcinoma?: A prospective single-arm study using neoadjuvant chemotherapy and concomitant chemotherapy with intensity modulated radiotherapy.", Asia-Pacific journal of clinical oncology, vol. 12, issue 2, pp. 143-50, 2016 Jun. Abstract
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Zaghloul, M. S., "Radiation oncology facilities in Africa: what is the most important: equipment, staffing, or guidelines?", International journal of radiation oncology, biology, physics, vol. 71, issue 5, pp. 1600-1; author reply 1601, 2008 Aug 01. Abstract
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Zaghloul, P. D. H. S., P. D. S. S. E. Ghaleb, and D. M. A. M. Morse, Retrospective study on thermal injury cases referred to Kasr AL-Aini hospitals, , 2014.
Zaghloul, M. S., E. Eldebawy, E. Attalah, S. Ahmed, M. Nazmy, and H. Aboel Anin, "Supine craniospinal irradiation in children: patient position modification, dose uniformity and early adverse effects.", The Gulf journal of oncology, issue 11, pp. 7-15, 2012. Abstract

BACKGROUND: Different craniospinal irradiation techniques are complex. The homogeneity of the dose to the target and the normal tissues at risk affect both the control rate and the level of adverse effects.

PATIENTS AND METHODS: Thirty one patients were treated with CSI in the supine position. Custom-made Styrofoam was tailored for each patient to straighten the convexity and concavity of the spinal axis allowing better dose distribution uniformity during CSI technique. In the first 6 patients, CT simulation were performed twice: one time with the patient lying directly on the vacuum mattress without the foam (the conventional way) and the second while lying on the foam. Dose distribution was calculated using a 3D conformal planning. The gap between the fields was determined using isodose alignment method. All treatment portals were verified during the first 3 treatment sessions and once weekly thereafter using either cone-beam or portal image device. Weekly feathering (shifting of the junction between the 2 adjacent radiation fields) was routinely performed.

RESULTS: The 95% dose distribution had better coverage with the foam (p=0.042) while the hot volume of 110% and 105% dosage were significantly lesser than conventional technique (both p=0.028). The organs at risk received nearly similar radiation doses in the 2 positions. The CSI led to minimal immediate adverse effects that were reversible. Weight loss was experienced by 55% of patients.

CONCLUSION: This modified technique of CSI is simple, ensuring better dose distribution to CSI target without increasing the dose to the surrounding organs at risk. It is tolerable and safe to apply.

Zaghloul, M. S., J. P. Christodouleas, A. Smith, A. Abdallah, H. William, H. M. Khaled, W. - T. Hwang, and B. C. Baumann, "Adjuvant Sandwich Chemotherapy Plus Radiotherapy vs Adjuvant Chemotherapy Alone for Locally Advanced Bladder Cancer After Radical Cystectomy: A Randomized Phase 2 Trial.", JAMA surgery, vol. 153, issue 1, pp. e174591, 2018 Jan 17. Abstract

Importance: Locoregional failure for patients with locally advanced bladder cancer (LABC) after radical cystectomy (RC) is common even with chemotherapy and is associated with high morbidity and mortality. Adjuvant radiotherapy (RT) can decrease locoregional failure but has not been studied in the chemotherapy era.

Objective: To investigate if adjuvant sequential RT plus chemotherapy can improve locoregional recurrence-free survival (LRFS) compared with adjuvant chemotherapy alone.

Design, Setting, and Participants: A randomized phase 3 trial was opened to compare adjuvant RT vs sequential chemotherapy plus RT after RC for LABC, but a third arm was added later as a randomized phase 2 trial to compare chemotherapy plus RT vs adjuvant chemotherapy alone, an emerging standard. The intent-to-treat phase 2 trial reported herein enrolled patients from December 2002 to July 2008. Data were analyzed from August 3, 2015, to January 6, 2016. Routine follow-up and surveillance pelvic computed tomographic (CT) scans every 6 months during the first 2 years were performed. The setting was an academic center. Patients with bladder cancer 70 years or younger having 1 or more risk factors (≥pT3b, grade 3, or positive nodes) with negative margins after radical cystectomy plus pelvic lymph node dissection were eligible. Patients had Eastern Cooperative Oncology Group performance status of 0 to 2, no evidence of distant metastases on CT scan of the abdomen and pelvis or on chest imaging, and adequate renal, hepatic, and hematologic function. Ninety-one percent (109 of 120) had ≥ pT3 disease.

Interventions: Chemotherapy plus RT included 2 cycles of gemcitabine (1000 mg/m2 intravenously on days 1, 8, and 15) and cisplatin (70 mg/m2 intravenously on day 2) before and after RT to 4500 cGy in 150 cGy twice-daily fractions over 3 weeks using 3-dimensional conformal techniques. Chemotherapy alone included 4 cycles of gemcitabine and cisplatin.

Main Outcome and Measure: Locoregional recurrence-free survival.

Results: The chemotherapy plus RT arm accrued 75 patients, and the chemotherapy-alone arm accrued 45 patients, with a weighted randomization to speed accrual. Fifty-three percent (64 of 120) had urothelial carcinoma, and 46.7% (56 of 120) had squamous cell carcinoma or other. The arms were balanced except for age (median, 52 vs 55 years; P = .04) and tumor size (mean, 4.9 vs 5.8 cm; P < .01), both favoring chemotherapy plus RT. Two-year outcomes and overall adjusted hazard ratios (HRs) for chemotherapy plus RT vs chemotherapy alone were 96% vs 69% (HR, 0.08; 95% CI, 0.02-0.39; P < .01) for LRFS, 68% vs 56% (HR, 0.53; 95% CI, 0.27-1.06; P = .07) for disease-free survival, and 71% vs 60% (HR, 0.61; 95% CI, 0.33-1.11; P = .11) for overall survival (OS). Five patients (7%) had RT-associated late grade 3 gastrointestinal tract adverse effects in the chemotherapy plus RT arm.

Conclusions and Relevance: Adjuvant chemotherapy plus RT was reasonably well tolerated and was associated with significant improvements in LRFS and marginal improvements in disease-free survival vs chemotherapy alone in LABC. The addition of adjuvant RT should be considered for LABC. This regimen warrants further study in phase 3 trials.

Trial Registration: clinicaltrials.gov Identifier: NCT01734798.

Zaghloul, M. S., R. Boutrus, H. El-Hossieny, Y. AbdelKader, I. El-Attar, and M. Nazmy, "A prospective, randomized, placebo-controlled trial of zoledronic acid in bony metastatic bladder cancer.", International journal of clinical oncology, vol. 15, issue 4, pp. 382-9, 2010 Aug. Abstract

BACKGROUND: Zoledronic acid treatment reduces the incidence of skeletal-related events (SREs) in patients with bone metastases from breast, lung, and urologic cancers including prostate and renal cancer. The aim of this study was to evaluate the effect of zoledronic acid on SREs in patients with bone metastases from bladder cancer.

PATIENTS AND METHODS: Patients with bone metastases from bladder cancer who were receiving palliative radiotherapy were randomized to placebo or zoledronic acid (4 mg intravenous monthly) for 6 months.

RESULTS: The patients (n = 40) were evenly distributed between the two treatment groups, and the baseline demographics of the two groups were similar. The follow-up varied from 8 to 65 weeks (median 24 weeks). Compared with patients receiving placebo, those receiving zoledronic acid had a lower mean incidence of SREs (2.05 +/- 1.0 vs. 0.95 +/- 0.9, respectively), and a larger proportion did not experience an on-study SRE (2 vs. 8 patients, respectively). Zoledronic acid also prolonged the median time to first SRE compared with the placebo (16 vs. 8 weeks, respectively). Multiple event analysis of SREs revealed that zoledronic acid decreased the risk of SRE development by 59% (hazard ratio 0.413). Zoledronic acid also increased the 1-year survival rate compared with placebo (36.3 +/- 11.2 vs. 0%, respectively). Zoledronic acid was generally well tolerated in our patient population.

CONCLUSIONS: Zoledronic acid therapy decreased the incidence of SREs and improved the 1-year survival rate of patients with bone metastases from bladder cancer, potentially through its anticancer activity.