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Although concurrent radio-chemotherapy and adjuvant temozolomide (TMZ) treatment for 6 cycles has been established as a standard of care for newly diagnosed glioblastoma multiforme (GBM) patients, the recommended duration of adjuvant TMZ remains a matter of debate. Hereby, we aimed to report for the first time our experience from Upper Egypt through comparing survival and toxicity profile between two treatment modalities of adjuvant TMZ (> six cycles versus six cycles) and delineating factors of prognostic significance in Egyptian patients with newly diagnosed GBM treated by radiation therapy with concomitant and adjuvant TMZ. Between June 2016 and February 2018, the medical records of 121 patients were eligible to be retrospectively reviewed to extract the study relevant data. All patients received concurrent radio-chemotherapy, followed by TMZ for 6 cycles in 29 patients (Group 1) and for >6 cycles in 26 patients (Group 2). Patients in Group 1 had a median PFS of 15 months (95% CI: 10.215-19.785), while those in Group 2 had a median PFS of 18 months (95% CI: 16.611-19.389). After a median follow up duration of 20 months (range: 12-41), the median OS was 18 months (95% CI: 13.420-22.580) in Group 1 and 22 months (95% CI: 18.777-25.223) in Group 2. There was no statistically significant correlation between the number of chemotherapy cycles and PFS ( P =0.513) or OS ( P =0.867). The extent of surgical resection was the only independent prognostic factor for both PFS ( P =0.015) and OS ( P =0.028) by multivariate analysis. Three grade ≥3 hematologic toxicity were encountered in 3 patients. One in the six-cycle group (neutropenia), and two in the extended cycles group (one had neutropenia and the other one developed thrombocytopenia). No statistically significant difference in the toxicity profile between both groups. The results of our study suggest that extended TMZ therapy is safe and tolerable, however it did not significantly improve PFS or OS as compared to the standard six-cycle course. Larger randomized studies are required to shed more light on this issue., Competing Interests: None., (AJCR Copyright © 2022.)

Aim: To evaluate the ability of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between benign and malignant bony tumours., Materials and Methods: This prospective study was conducted from October, 2018 to December, 2019. The study included 62 patients (37 male and 25 female) with clinically suspected bony lesions referred to the Radiology Department. Patients underwent clinical examination, radiography, computed tomography (CT), and ultrasonography examinations. MRI studies were conducted using a 1.5-T MRI machine, and post-processing analysis was done using a Philips Extended MRI workspace workstation., Results: The mean apparent diffusion coefficient (ADC) value of benign lesions ranged between 0.85 × 10 -3 and 2.44 × 10 -3 mm 2 /s. The lowest ADC values were measured in a giant cell tumour and in an inclusion epidermoid cyst (0.85 × 10 -3 and 0.93 × 10 -3 mm 2 /s, respectively). The highest measurement was in bony cysts (2.44 × 10 -3 mm 2 /s) followed by osteoid osteoma (2.2 × 10 -3 mm 2 /s) and osteochondroma (1.85 × 10 -3 mm 2 /s). Amongst malignant lesions, ADC values ranged from 0.42 × 10 -3 to 2.4 × 10 -3 mm 2 /s. The lowest value was measured in malignant round cell tumour Ewing's/primitive neuroectodermal tumour (PNET), and the highest was measured in conventional chondrosarcoma. Metastatic lesions were observed in 11 patients with a mean ADC value of 0.71 × 10 -3 mm 2 /s, followed by osteosarcoma in six patients with a mean ADC value of 0.74 × 10 -3 mm 2 /s., Conclusion: There was a significant difference between the mean, minimum, and maximum ADC values of benign and malignant tumours. The present findings indicate that the best cut-off ADC range to predict malignancy is 0.78-0.86 × 10 -3 mm 2 /s, with a sensitivity of 89.47%, specificity of 97.22%, and accuracy of 94.55%., (Copyright © 2021. Published by Elsevier Ltd.)

Aim: Evaluation of the analgesic efficacy of radiofrequency thoracic sympathectomy for sympathetically maintained post-mastectomy pain syndrome (PMPS)., Methods: Patients with PMPS randomized to Group TS (n = 33) received radiofrequency thoracic sympathectomy, and those randomized to Group Sham (n = 33) received no radiofrequency current. Postoperative pain treatment consisted of duloxetine, pregabalin, and tramadol for both groups. The outcome variables were the proportion of patients who showed >50% reduction in their VAS pain score, the pain intensity measured by VAS score, and the global perceived effect (GPE) evaluated during the 6-month follow-up period., Results: A significantly higher proportion of patients experienced >50% reduction in pain in Group TS (Group TS 25/30 [83.3%] vs. Group Sham 18/31 [58%], P = 0.032); the proportion of patients who experienced >50% reduction in their pain without analgesics was significantly higher in Group TS (Group TS 10/25 [40%] vs. Group Sham 0/18 [0%], P = 0.001). Furthermore, the proportion of patients treated with tramadol + duloxetine + pregabalin who experienced >50% reduction in their pain was significantly lower in Group TS (Group TS 0/25 [0%] vs. Group Sham 13/18 [75%], P = 0.001). The VAS pain score was significantly lower in Group TS at 2 weeks and at 1, 2, 3, and 6 months following the procedure. The GPE was significantly higher in Group TS (Group TS median GPE [interquartile range]) 7 [5, 7] vs. Group Sham median GPE [interquartile range]) 5 [4, 6]) P < 0.001)., Conclusions: Radiofrequency thoracic sympathectomy for sympathetically maintained PMPS decreased VAS pain scores and reduced the need for anti-neuropathic drugs, particularly opioid medications, and provided better patient satisfaction., (© 2020 World Institute of Pain.)