Princess Norah Oncology Center

Jeddah, Saudi Arabia

Princess Norah Oncology Center

Jeddah, Saudi Arabia
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Al-Shahri M.Z.,King Faisal Specialist Hospital And Research Center | Al-Zahrani A.S.,King Faisal Specialist Hospital And Research Center | Alansari A.,Palliative Care Center | Abdullah A.,Palliative Care Center | And 5 more authors.
American Journal of Hospice and Palliative Medicine | Year: 2017

Background: Impeccable assessment of symptoms is central to palliative care (PC) practice. Objectives: The study objectives are (1) to test the validity of the Arabic Questionnaire for Symptom Assessment (AQSA) as a self-administered (SA) tool for assessing the severity of the listed symptoms among PC patients and (2) to test the validity of AQSA when completed by a proxy. Methods: The AQSA is a tool for assessing the severity of 11 symptoms in addition to the overall suffering experience on a 0 to 10 numeric scale. Symptom scores on the SA AQSA were compared to scores obtained through interviews with patients. The same procedure was repeated with patients’ sitters to explore the validity of using the tool for symptom assessment by proxy. Results: The study involved 107 pairs (a patient and a sitter, each) with a mean age of 46.3 years (females 59.8%) for patients and 35.9 years (females 65.7%) for sitters. The correlation coefficient (r) for agreement between SA and interview-based (IB) scores for patients ranged from.65 (P <.0001) for drowsiness to.86 (P <.0001) for pain. The SA AQSA showed positive correlation between sitters’ and patients’ scores, with r ranging from.28 (P =.004) for depression to.62 (P ≤.0001) for vomiting. Conclusions: The strong positive correlation between SA and IB AQSA indicates that the former is a valid tool. When the SA AQSA is used by proxy, it showed moderate to strong positive correlation with patients’ actual scores for most of the symptoms. © 2016, © The Author(s) 2016.


Mail N.,King Abdullah International Medical Research Center | Mail N.,Princess Norah Oncology Center | Yusuf M.,King Abdulaziz University | Alothmany N.,King Abdulaziz University | And 6 more authors.
Journal of Applied Clinical Medical Physics | Year: 2016

Cone-beam computed tomography CBCT systems are used in radiation therapy for patient alignment and positioning. The CBCT imaging procedure for patient setup adds substantial radiation dose to patient's normal tissue. This study presents a complete procedure for the CBCT dosimetry using the InLight opticallystimulated-luminescence (OSL) nanoDots. We report five dose parameters: the mean slice dose (DMSD ); the cone beam dose index (CBDI W ); the mean volume dose (D MVD ); point-dose profile, D(FOV); and the off-field Dose. In addition, CBCT skin doses for seven pelvic tumor patients are reported. CBCT-dose measurement was performed on a custom-made cylindrical acrylic body phantom (50 cm length, 32 cm diameter). We machined 25 circular disks (2 cm thick) with grooves and holes to hold OSL-nanoDots. OSLs that showed similar sensitivities were selected and calibrated against a Farmer-type ionization-chamber (0.6 CT) before being inserted into the grooves and holes. For the phantom scan, a standard CBCT-imaging protocol (pelvic sites: 125 kVp, 80 mA and 25 ms) was used. Five dose parameters were quantified: D MSD, CBDI W, D MVD, D(FOV), and the off-field dose. The D MSD for the central slice was 31.1 ± 0.85 mGy, and CBDI W was 34.5 ± 0.6 mGy at 16 cm FOV. The D MVD was 25.6 ± 1.1 mGy. The off-field dose was 10.5 mGy. For patients, the anterior and lateral skin doses attributable to CBCT imaging were 39.04 ± 4.4 and 27.1 ± 1.3 mGy, respectively. OSL nanoDots were convenient to use in measuring CBCT dose. The method of selecting the nanoDots greatly reduced uncertainty in the OSL measurements. Our detailed calibration procedure and CBCT dose measurements and calculations could prove useful in developing OSL routines for CBCT quality assessment, which in turn gives them the property of high spatial resolution, meaning that they have the potential for measurement of dose in regions of severe dose-gradients. © Creative Commons Attribution 3.0 Unported License.


Abrar M.B.,King Abdulaziz University | Al-Shehri A.S.,Princess Norah Oncology Center
Saudi Medical Journal | Year: 2014

Objectives: To identify factors that increase the risk of developing febrile neutropenia (FN) during the first cycle of chemotherapy in breast cancer patients. Methods: In this retrospective study, we reviewed the records of 211 patients with confirmed breast cancer treated with chemotherapy at the Princess Norah Oncology Center, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia between January 2010 and May 2012. Statistical analysis was conducted using descriptive analysis, univariate, and multivariate logistic regressions. A multivariate regression of FN occurrence in the first cycle was developed. Results: The median age of patients was 48 years. Febrile neutropenia was documented in 43 (20.3%) of 211 patients. Twenty-one (49%) of the 43 patients had FN during the first cycle of chemotherapy. A multivariate logistic regression revealed that age (odds ratio [OR] 1.059, 95% confidence interval [CI]: 1.007-1.114), non-anthracycline and/or taxane-based chemotherapy regimens (OR of 39.488; 95% CI: 4.995-312.187), and neo-adjuvant chemotherapy (OR of 8.282; 95% CI: 1.667-41.152) were the most important independent risk factors of FN. Conclusion: Identifying risk factors of FN may help to target high-risk patients with granulocyte colony-stimulating factor prophylaxis and reduce FN incidences, with subsequent morbidities and mortalities.


PubMed | King Khalid Hospital, King Faisal Specialist Hospital And Research Center, Comprehensive Cancer Center, King Saud University and 6 more.
Type: Journal Article | Journal: Urology annals | Year: 2016

This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.


PubMed | King Khalid Hospital, King Faisal Specialist Hospital And Research Center, Comprehensive Cancer Center, King Saud University and 6 more.
Type: Journal Article | Journal: Urology annals | Year: 2016

This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.


The presence of high-density material in the oral cavity creates dose perturbation in both downstream and upstream directions at the surfaces of dental filling materials (DFM). In this study, the authors have investigated the effect of DFM on head and neck RapidArc treatment plans and delivery. Solutions are proposed to address (1) the issue of downstream dose perturbation, which might cause target under dosage, and (2) to reduce the upstream dose from DFM which may be the primary source of mucositis. In addition, an investigation of the clinical role of a custom-made plastic dental mold/gutter (PDM) in sparing the oral mucosa and tongue reaction is outlined. The influence of the dental filling artifacts on dose distribution was investigated using a geometrically well-defined head and neck intensity modulated radiation therapy (IMRT) verification phantom (PTW, Freiberg, Germany) with DFM inserts called amalgam, which contained 50% mercury, 25% silver, 14% tin, 8% copper, and 3% other trace metals. Three RapidArc plans were generated in the Varian Eclipse System to treat the oral cavity using the same computer tomography (CT) dataset, including (1) a raw CT image, (2) a streaking artifacts region, which was replaced with a mask of 10 HU, and (3) a 2 cm-thick 6000 HU virtual filter [a volume created in treatment planning system to compensate for beam attenuation, where the thickness of this virtual filter is based on the measured percent depth dose (PDD) data and Eclipse calculation]. The dose delivery for the three plans was verified using Gafchromic-EBT2 film measurements. The custom-made PDM technique to reduce backscatter dose was clinically tested on four head and neck cancer patients (T3, N1, M0) with DFM, two patients with PDM and the other two patients without PDM. The thickness calculation of the PDM toward the mucosa and tongue was purely based on the measured upstream dose. Patients' with oral mucosal reaction was clinically examined initially and weekly during the course of radiotherapy. For a RapidArc treatment technique, the backscatter dose from the DFM insert was measured to be 9.25±2.17 in the IMRT-verification-phantom. The measured backscatter upstream dose from DFM for a single-field was 22% higher than without the DFM, whereas the downstream dose was lower by 14%. The values of homogeneity index for the plans with and without the application of mask were 0.09 and 0.14, respectively. The calculated mean treatment planning volume (PTV) dose differed from the delivered dose by 13% and was reduced to 2% when using the mask and virtual filter together. A grade 3 mucosa reaction was observed in the control group after 22-24 fractions (44-48 Gy). In contrast, no grade 3 mucositis was observed in the patients wearing the PDM after 25-26 fractions (50-52 Gy). The backscatter from the DFM for a single, parallel-opposed fields, and RapidArc treatment technique was found significant. The application of mask in replacing streaking artifacts can be useful in improving dose homogeneity in the PTV. The use of a virtual filter around the teeth during the planning phase reduces the target underdosage issue in the phantom. Furthermore, a reduction in mucositis is observed in the head and neck patients with the use of PDM.


Emwas A.-H.M.,King Abdullah University of Science and Technology | Al-Talla Z.A.,King Abdullah University of Science and Technology | Guo X.,King Abdullah University of Science and Technology | Al-Ghamdi S.,Princess Norah Oncology Center | Al-Masri H.T.,Taibah University
Magnetic Resonance in Chemistry | Year: 2013

Copper is an essential nutrient for the normal development of the brain and nervous system, although the hallmark of several neurological diseases is a change in copper concentrations in the brain and central nervous system. Prion protein (PrP) is a copper-binding, cell-surface glycoprotein that exists in two alternatively folded conformations: a normal isoform (PrPC) and a disease-associated isoform (PrPSc). Prion diseases are a group of lethal neurodegenerative disorders that develop as a result of conformational conversion of PrPC into PrPSc. The pathogenic mechanism that triggers this conformational transformation with the subsequent development of prion diseases remains unclear. It has, however, been shown repeatedly that copper plays a significant functional role in the conformational conversion of prion proteins. In this review, we focus on current research that seeks to clarify the conformational changes associated with prion diseases and the role of copper in this mechanism, with emphasis on the latest applications of NMR and EPR spectroscopy to probe the interactions of copper with prion proteins. Copyright © 2013 John Wiley & Sons, Ltd.


Jastaniah W.,Princess Norah Oncology Center | Aseeri M.,Princess Norah Oncology Center
Journal of Oncology Pharmacy Practice | Year: 2010

Purpose. Standardizing body surface area (BSA) determination is essential for avoiding variation in chemotherapy dosage calculations. In this study, we compared variation in BSA calculation using weight and height by the Mosteller formula with weight alone using recently adapted table at a local oncology center. Methods. Cross-sectional study of pediatric oncology patients presenting to a pediatric oncology clinic over a week period of time. Results. One-hundred consecutive pediatric oncology patients presented to the clinic. The mean BSA calculated by the Mosteller formula was 0.83 m2 (SD 0.24) and the mean BSA determined by the table (based on weight alone) was 0.82 m2 (SD 0.25). The mean variation in dosing between the two methods was 1.64% (SD 3.4). Only 13 out of 100 patients (13%) had equal dosing using both methods and 21 out of 100 patients (21%) had dosing variation greater than 5%. When comparing both methods, using paired t-test, the difference was statistically significant (t(99) = 3.99 and p < 0.001). Conclusion. Significant differences in BSAbased chemotherapy dosing exist in our center. The Mosteller method should remain the standard until prospective studies are performed to determine the significance of this dosing variability on toxicity and survival outcome. © The Author(s), 2010.


PubMed | Princess Norah Oncology Center
Type: Case Reports | Journal: Neurosciences (Riyadh, Saudi Arabia) | Year: 2015

Glioblastoma multiforme (GBM) is the most common and malignant form of the glial tumors. Advanced and treated GBM is rarely associated with pregnancy for many reasons. Glioblastoma multiforme presenting during pregnancy carries unique challenges to the patient, baby, family, and health care providers. We describe an unusual case of advanced GBM that was treated with maximum doses of chemotherapy and radiations, and she became pregnant and presented at eighteenth weeks of gestation. Her medical management was associated with a significant ethical dilemma. We managed to deliver the baby safely through cesarean section at week 28 despite the critical condition of the mother. Unfortunately, the mother died 2 weeks post delivery. We concluded that although recurrent and treated GBM is rarely associated with pregnancy and carries dismal prognosis, but if it occurs, it can still be carried, and a multidisciplinary team work is the key for successful outcome.


PubMed | Princess Norah Oncology Center
Type: Journal Article | Journal: Medical physics | Year: 2013

The presence of high-density material in the oral cavity creates dose perturbation in both downstream and upstream directions at the surfaces of dental filling materials (DFM). In this study, the authors have investigated the effect of DFM on head and neck RapidArc treatment plans and delivery. Solutions are proposed to address (1) the issue of downstream dose perturbation, which might cause target under dosage, and (2) to reduce the upstream dose from DFM which may be the primary source of mucositis. In addition, an investigation of the clinical role of a custom-made plastic dental moldgutter (PDM) in sparing the oral mucosa and tongue reaction is outlined.The influence of the dental filling artifacts on dose distribution was investigated using a geometrically well-defined head and neck intensity modulated radiation therapy (IMRT) verification phantom (PTW, Freiberg, Germany) with DFM inserts called amalgam, which contained 50% mercury, 25% silver, 14% tin, 8% copper, and 3% other trace metals. Three RapidArc plans were generated in the Varian Eclipse System to treat the oral cavity using the same computer tomography (CT) dataset, including (1) a raw CT image, (2) a streaking artifacts region, which was replaced with a mask of 10 HU, and (3) a 2 cm-thick 6000 HU virtual filter [a volume created in treatment planning system to compensate for beam attenuation, where the thickness of this virtual filter is based on the measured percent depth dose (PDD) data and Eclipse calculation]. The dose delivery for the three plans was verified using Gafchromic-EBT2 film measurements. The custom-made PDM technique to reduce backscatter dose was clinically tested on four head and neck cancer patients (T3, N1, M0) with DFM, two patients with PDM and the other two patients without PDM. The thickness calculation of the PDM toward the mucosa and tongue was purely based on the measured upstream dose. Patients with oral mucosal reaction was clinically examined initially and weekly during the course of radiotherapy.For a RapidArc treatment technique, the backscatter dose from the DFM insert was measured to be 9.252.17 in the IMRT-verification-phantom. The measured backscatter upstream dose from DFM for a single-field was 22% higher than without the DFM, whereas the downstream dose was lower by 14%. The values of homogeneity index for the plans with and without the application of mask were 0.09 and 0.14, respectively. The calculated mean treatment planning volume (PTV) dose differed from the delivered dose by 13% and was reduced to 2% when using the mask and virtual filter together. A grade 3 mucosa reaction was observed in the control group after 22-24 fractions (44-48 Gy). In contrast, no grade 3 mucositis was observed in the patients wearing the PDM after 25-26 fractions (50-52 Gy).The backscatter from the DFM for a single, parallel-opposed fields, and RapidArc treatment technique was found significant. The application of mask in replacing streaking artifacts can be useful in improving dose homogeneity in the PTV. The use of a virtual filter around the teeth during the planning phase reduces the target underdosage issue in the phantom. Furthermore, a reduction in mucositis is observed in the head and neck patients with the use of PDM.

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