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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.

Zagloul, I., A. Farouk, and A. Badr, "Applying Machine Learning Techniques for Classifying Cyclin-Dependent Kinase Inhibitors", International Journal of Advanced Computer Science and Applications (IJACSA) - , vol. 9, issue 11, 2018.
Zaher, M., A. - W. EL-Ghareeb, H. Hamdi, A. Essa, and S. Lahsik, "Anatomical, Histological and Histochemical Adaptations of the Reptilian Alimentary Canal to Their Food Habits: I. Uromastyx aegyptiaca", Life Sci J, vol. 9, issue 3, pp. 84-104, 2012.
Zaher, A., H. Moustafa, W. Omar, H. Farag, and I. Ezzat, "Assessment of treatment response and tumour viability using Tl201, Tc-MIBI and Tc-MDP in bone and soft tissue sarcoma", First Egyptian International Nuclear Medicine Meeting, Hurghada , 25-27 February, Submitted.
Zaher, M., A. - W. EL-Ghareeb, H. Hamdi, A. Essa, and S. Lahsik, "Anatomical, Histological and Histochemical Adaptations of the Reptilian Alimentary Canal to Their Food Habits: I. Uromastyx aegyptiaca", Life Sci J;9(3), pp. 84-104, 2012.
Zaher, M., A. - W. EL-Ghareeb, H. Hamdi, and F. A. Amod, "Anatomical, histological and histochemical adaptations of the avian alimentary canal to their food habits: I-Coturnix coturnix. ", Life Sci J, vol. 9, issue 3, pp. 253-275., 2012.
Zaher, M., A. - W. EL-Ghareeb, H. Hamdi, and F. A. Amod, "Anatomical, histological and histochemical adaptations of the avian alimentary canal to their food habits: I-Coturnix coturnix", Life Sci J; 9(3):, pp. 253-275, 2012.
Zaher, M., and M. Marzouk, "Artificial Intelligence Exploitation in Facility Management using Deep Learning", Construction Innovation: Information, Process, Management, vol. 20, issue 4, pp. 609-624, 2020.
Zaher, H. A., H. I. GAWDAT, R. A. HEGAZY, F. N. Mohammed, A. M. AlOrbani, N. A. Ibrahim, and K. S. Sayed, "Assessment of the role of spleen tyrosine kinase and zeta-chain-associated 70-kDa protein (tyrosine) kinase in the pathogenesis of psoriasis.", Indian journal of dermatology, venereology and leprology, vol. 86, issue 1, pp. 85-87, 2020.
Zahra, M. K., S. A. El-Gizawy, and N. F. Nasr, "Application of Hazard Analysis and Critical Control Points (HACCP) System in Small-Scale Cheese Plants.", Egyptian Journal of Applied Sciences, vol. 22, issue 6b, pp. 631–651, 2007. Abstract
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Zahran, M. A., and A. Tawfik, "Adaptive Tuning For Statistical Machine Translation (AdapT)", International Conference on Intelligent Text Processing and Computational Linguistics (CICLing), Cairo, Egypt., Springer LNCS, 2015.
Zahran, S. A., M. Ali-Tammam, A. G. M. Hashem, R. K. Aziz, and A. E. Ali, "Azoreductase activity of dye-decolorizing bacteria isolated from the human gut microbiota", Scientific Reports, vol. 9, no. 1: Nature Publishing Group, pp. 5508, 2019. Abstract
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mohamed el zahwy, R. mounir, said kamal, and M. mounir, "Assessment of vertical ridge augmentation and marginal bone loss using autogenous onlay vs inlay grafting techniques with simultaneous implant placement in the anterior maxillary esthetic zone: A randomized clinical trial", clinical implant dentistry and related research, vol. 21, issue 6, pp. 1140-1147, 2019.
Zaid, R. A. A., S. S. El-Mahdy, N. A. Sherif, S. A. Nassif, A. A. Mourad, H. A. Hussein, and A. A. El-Sanousi, "Assessment of vector HVT-F vaccine in one-day-old chicks using different vaccination programs and quantification of genome load in feathers and immune organs.", International Journal of Veterinary Science, vol. 9, issue 2: Faculty of Agriculture, Nnamdi Azikiwe University, pp. 182-188, 2020. Abstractassessment_of_vector_hvt-f_vaccine_in_one-day-old_chicks_using_different_vaccination_programs.pdf

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Zaid, A. A. A., N. A. Ezzeldeen, and F. A. Nazar, "Antibacterial effect of some types of nanoparticles against methicillin- resistant Staphylococcus aureus isolated from milk.", International Journal of Pharmaceutical Research & Allied Sciences, vol. 5, issue 1, pp. 122-134, 2016. ijpras-2016-5-122-134_2_1.pdf
Zaid, L. A., F. Kleinermann, and O. De Troyer, "Applying semantic web technology to feature modeling", Proceedings of the 2009 ACM symposium on Applied Computing: ACM, pp. 1252–1256, 2009. Abstract
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Zainhoum, A. A., H. M. A. Farrag, S. M. Abdel-Wahab, and H. M. Kamal, "Attempts for Reducing Microbial Contaminations on Zaghloulate Palm Fruits by Using Safe Treatments", Applied Science Reports, vol. 21, issue 1, pp. 1-7, 2018. Abstract

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zakaria, M., S. Azab, and M. Raafat, "Assessment of risk factors of pediatric urolithiasis in Egypt", Transl Androl Urol 2012;1(4):209-215, vol. 1, issue 4, pp. 209-2015, 2012. renal_sones_-_final_-_net.pdf
Zakaria, E., M. A. Aziz, M.Morgan, T. Fayad, N. M.Elsayed, and B.Habashy, "Association of IL-6 - 174 G/C promoter polymorphism with nee onset disbetes after renal transplantation", Journal of Applied Sciences Research, vol. 9, pp. 3212- 3218, 2013.
Zakaria, E., T. Fayad, M. Rizk, and N. Ghanem, "Association between insulin resistance, metabolic syndrome and duration of Hepatitis C in Egyptian patients ", BIT First Annual World Congress on Endometabolism , China, 25 Jan, 2011.
Zakaria, Y., A. BahaaElDin, and M. Hadhoud, "Applying Feature Selection to Rule Evolution for Dynamic Flexible Job Shop Scheduling", ECTA, Vienna, Austria, 17 September, 2019.
Zakaria, Y. A., A. M. K. E. Safty, E. E. Abdel-Rafaa, and M. M. Sherif, "Alteration in the balance between type 1 and type 2 immune responses among lead exposed population", British Journal of Applied Science and Technology, vol. 7, issue 3, pp. 289-294, 2015.
Zakaria, E., M. Aziz, T. Fayed, N. El-Sayed, M. Ishak, and B. Habashy, "Association of IL-6-174 G/C promotor polymorphism with new onset diabetes after renal transplantation ", Mediterranean Kidney Society, Milzzo, Italy, April, 2013.
Zakaria, A. S., M. M. Hafez, J. Ochi, K. S. Zaki, M. Loloi, and A. Abou-Sayed, "Application of Genetic Algorithms to the Optimization of Pressure Transient Analysis of Water Injectors using Type Curves", SPE European Formation Damage Conference, Noordwijk, The Netherlands, 7-10 June, 2011. Application of Genetic Algorithms to the Optimization of Pressure Transient Analysis of Water Injectors using Type Curves
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