Metaplastic breast cancer (MetBC) represents a therapeutic challenge. We evaluated the impact of clinicopathological characteristics and treatment modalities on outcomes among MetBC patients treated at our center. Women with stage I-III MetBC were reviewed from our database from 2005-2018. Kaplan-Meier method was used to calculate locoregional-failure-free survival (LRFFS), overall-survival (OS) and distant-metastases-free survival (DMFS). We assessed associations with survival outcomes by log-rank tests. Multivariate Cox proportional-hazards models were used to identify independent predictors of LRFFS, OS and DMFS. 81 patients were eligible for the study. Median age at diagnosis was 48 years. 90.1% had G-III tumors, 64.2% were pathologically node negative and lympho-vascular invasion (LVI) was absent in 72.8%. 67.8% were triple negative, and 7.4% were HER2-neu positive. Most (66.7%) patients underwent mastectomy. Free margins were achieved in the entire cohort, however, 17.3% had close margin (<2 mm). Almost all patients received chemotherapy. 75.3% received radiotherapy, 23.5% received hormonal therapy and 6.2% received Trastuzumab. With a median follow-up of 54 months, 18.5% developed loco-regional recurrence and 34.6% relapsed distally. Five-year OS was 66.0%. On multivariate analysis: adjuvant radiotherapy correlated with better OS (P < .0001), and tumor size >5 cm, nodal involvement and LVI correlated with worse OS, (P = .019, P = .021, P = .028, respectively). There were no survival differences with respect to age, triple negativity, and morphologic subtype. We report the largest single institutional series on MetBC in the Middle East region. MetBC confers worse survival outcomes, and more aggressive local and systemic treatment strategies should be investigated.

Background/Objectives: Adult medulloblastoma is a rare entity, with management data extrapolated from pediatric medulloblastoma cases. We aim to report the clinical characteristics, prognostic factors, and treatment outcome of a cohort of adult patients with medulloblastoma. Methods: Fifty-three patients aged ≥ 18 years with medulloblastoma treated at King Hussein Cancer Center between 2007 and 2019 were retrospectively reviewed. Patients’ diseases were staged according to modified Chang’s staging system. All patients received adjuvant craniospinal irradiation followed by a posterior fossa boost. Baseline disease characteristics, including molecular subgrouping, were tested as prognostic factors of progression-free survival (PFS) and overall survival (OS) by using univariate analysis. Results: Median follow-up was 70 months (range 37.5–104.5 months). Twenty-two tumors were of the SHH-activated subtype. Conversely, WNT-activated and group 4 tumors had three cases each. Only 37.7% of patients died. The mean 3-year, 5-year, and 10-year OS were 85% (75–95%), 74% (62–87%), and 50% (33–75%), respectively. Significant differences in OS were associated with the extent of surgery (p = 0.017), M stage (p = 0.009), and risk status (p < 0.001). Relapses were detected in 28.3% of cases. The 3-year, 5-year, and 10-year PFS were 81% (71–92%), 75% (63–88%), and 66% (52–83%), respectively. Significant differences in PFS were associated with the extent of surgery (p = 0.008) and risk status (p = 0.012). Molecular subgrouping did not correlate with OS or PFS. Conclusions: Our results revealed poor survival of patients with high-risk disease, which may necessitate the intensification of chemotherapy. Molecular subgrouping did not correlate with the outcome in this cohort.

Purpose: Though less than 5% of patients with breast cancer present with De Novo Metastasis (dnMBC) in Western societies, this percentage may reach 30% in developing countries. In this study, we present survival outcomes of patients diagnosed with dnMBC treated at a tertiary center in a developing country. Patients and Methods: Using hospital-based database, consecutive patients with dnMBC diagnosed between 2013 and 2017 were identified. Demographic data, tumor characteristics, types of treatment, and survival data were retrospectively collected. Results: A total of 435 patients were included; median age (range) at time of diagnosis was 51 (24– 85) years. Most of the tumors expressed hormone receptors (81% Estrogen Receptor positive, 77% Progesterone Receptor positive). Human epidermal growth factor receptor-2 (HER2) overexpression was reported in 134 (30.9%) patients, while only 24 (5.5%) had Triple Negative (TN) disease. Bone, lung and liver were the most common sites of metastasis involved in 70.6%, 36.1%, and 32.0%, respectively. The median Overall Survival (OS) for all patients was 38 months, and 5-year OS was 32.6%. On univariate analysis, high tumor grade, advanced T-stage, TN-disease and metastasis to multiple sites, but not HER2 status, were associated with poor OS. On multivariate analysis, high tumor grade (Hazard Ratio =1.6, p=0.002), advanced T-stage (Hazard Ratio=1.6, p=0.003), and triple negative status (Hazard Ratio= 2.1, p=0.008) predicted poor OS. Conclusion: The overall survival of patients with dnMBC remains poor. Better understanding of the disease behavior and factors affecting survival is required for optimal utilization of available regimens and new drugs to hopefully improve patients’ outcomes.

Intracranial solitary fibrous tumor is a rare central nervous system tumor that lacks a reliable prognostic clinical model. Uncertainty persists regarding the treatment outcomes of surgery and adjuvant radiotherapy (ART). To address this, we investigated the efficacy of ART and applied machine learning (ML) to develop accurate prognostic models. The Surveillance, Epidemiology, and End Results database was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using 5 ML algorithms to predict 5-year survival. A validation method incorporating the area under the curve of the receiver operating characteristic curve was used to validate the accuracy and reliability of the models. We investigated the role of ART and surgery using Kaplan-Meier survival analysis, competing risk analysis, and Bias Reduction through Analysis of Competing Events method. The study population comprised 747 patients. Among them are 316 patients with "surgery" and 431 patients with "surgery + ART." The therapeutic groups showed significant differences in overall survival. Multivariate Cox regression analysis revealed that older age and surgery alone were poor prognostic factors. The most significant prognostic factors were the local tumor excision, followed by lobectomy and age. Although ART did not lead to a substantial decrease in cancer-specific deaths, it did improve overall survival. This underscores the broader health benefits of ART, including effective management of comorbid conditions. Caution is advised when interpreting these survival benefits because of potential confounding factors in patient health and treatment management. Our web tool and ML models aid in clinical decision-making.

PURPOSE: To assess the clinical outcomes and evaluate Freedom from Introduction or Switching of Systemic Treatment (FISST) in patients with oligometastatic (OM) and oligoprogressive (OP) disease undergoing stereotactic body radiotherapy (SBRT). METHODS: The primary end points were FISST and local control (LC) rates of lesions that received SBRT. The secondary end point was overall survival (OS) after SBRT. To calculate FISST, event was defined as the need to introduce or switch the systemic line of treatment for any reason or inability to provide systemic treatment when needed because of poor performance status (PS) (Eastern Cooperative Oncology Group PS ≥3) or other reasons. OS was a secondary outcome. RESULTS: A total of 200 patients were included. The median age was 60 (IQR, 49-70) years. The most common primary tumors were colorectal (61, 30.5%), breast (30, 15.0%), lung (28, 14.0%), head and neck (23, 11.5%), and prostate (16, 8.0%). A total of 257 metastatic lesions were treated. Bone was the most frequent site (115, 44.7%), followed by the liver (55, 21.4%), lung (44, 17.1%), lymph nodes (25, 9.7%), and adrenal glands (11, 4.3%). The median follow-up was 15 months. FISST at 1 and 2 years were 52% and 39%, respectively. LC at 1 and 2 years were 86.3% and 80%, respectively. OS at 1 and 2 years were 76.5% and 64.8%, respectively. Grade III toxicity was reported in 1.5% of patients overall, with no observed grade IV or V toxicity. CONCLUSION: SBRT is effective and safe for treating OM and OP solid cancers, prolonging FISST and potentially delaying systemic treatments, particularly in settings with limited access to advanced therapies.

Isolated Locoregionally Recurrent Pancreatic Adenocarcinoma (ILRPA) accounts for 25–30% of recurrences after radical resection, yet the role of salvage radiation (RT) in this setting remains controversial due to limited data. We aimed to evaluate the impact of salvage RT on survival outcomes compared with non-salvage RT in patients with ILRPA. We retrospectively analyzed data of patients with ILRPA post-radical resection treated at our centre between 2012 and 2021. Patients were categorized into two cohorts based on whether salvage RT was administered post-recurrence. Patients who received a minimum of 30 Gy in 10 fractions (BED₁₀ ≥ 39 Gy) were included for analysis. The clinical characteristics, treatments, and outcomes were analyzed. The chi-square or Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon rank sum test for continuous variables were utilized for comparisons. The Kaplan–Meier method and log-rank test were performed to compare overall survival (OS) and progression-free survival (PFS) between the two groups. OS and PFS were calculated from the time of locoregional recurrence until event or loss of follow-up. Thirty-two patients were identified, with sixteen patients in each group. The patients and tumour characteristics were balanced between the two cohorts, except for chemotherapy, where the salvage RT group tended to receive palliative chemotherapy more than the non-salvage group (p = 0.007). The median radiotherapy dose received for the salvage RT cohort was 50.4 Gy (BED₁₀ = 59.5 Gy). Chemotherapy was restarted in 75% either before, after, or during radiation, and only in 31.25% of patients in the non-salvage group (p = 0.013). Patients who received salvage RT had statistically significantly better median OS and PFS than those who did not (25.2 vs. 8.4 months, p = 0.0006, HR 0.25, 95% CI (0.11–0.59)), (15.6 vs. 7.2 months, p = 0.0006, HR 0.26, 95% CI (0.11–0.58), respectively). Ten patients (62.5%) developed distant metastases (DM) at least 3 months post-recurrence in the salvage RT cohort compared to five patients (31.25%) in the non-salvage RT cohort (p = 0.08). In the salvage RT group, 10/16 patients (62.5%) maintained locoregional disease control post-RT. Salvage RT was associated with better OS and PFS in patients with ILRPA, highlighting its potential as an essential treatment modality. While salvage RT appears beneficial, confounding factors like chemotherapy disparities between groups necessitate further investigation in prospective cohorts.