Libyan International Journal of Oncology

Establishing the National Brain Tumor Registry of Libya (NBTRL): A Comprehensive Approach to Enhance Patient Care

Seraj Ajaj — 2024-09-17

Brain tumors, both benign and malignant, represent a significant and complex health challenge due to their impact on the central nervous system. In Libya, the absence of a centralized database has hindered the ability to accurately track the incidence, outcomes, and trends of brain tumors, leading to gaps in effective management, treatment, and re-search. This research proposal outlines the establishment of a National Brain Tumor Reg-istry in Libya, aimed at systematically collecting, managing, and analyzing data on brain tumor cases across the country. This initiative is intended to enhance patient care, facili-tate research, and inform public health policies. The primary objective of the National Brain Tumor Registry of Libya (NBTRL) is to es-tablish a comprehensive national registry that will systematically collect and manage data on brain tumor cases from major hospitals and specialized oncology centers across Libya. This registry is designed to enhance patient care by providing insights into treatment out-comes based on data-driven analysis. Additionally, it aims to facilitate both national and international research collaborations by offering a robust dataset on brain tumor epide-miology and clinical characteristics. Furthermore, the registry seeks to inform public health policies and guide resource allocation for brain tumor treatment and research.

Prognostic Value of Carcinoembryonic Antigen (CEA) and Carbohydrate Antigen (CA19-9) in Colorectal Cancer

Mussa Alragig — 2024-09-17

The present study analysed the tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19 9 (CA19 9) in correlation with clinicopathological variables and survival outcomes in Libyan patients with colorectal cancer (CRC). The clinicopathological variables of 397 patients with CRC di-agnosed at the National Cancer Institute in Misurata, Libya, between 2008 and 2017 were retrospec-tively analyzed. Blood samples from these patients were analyzed for serum CEA and CA19 9 levels before treatment by electrochemiluminescence immunoassay (double antibody sandwich ELISA) on a Roche cobas e 602 modules. The relationships between CEA CA19 9 expressions (separately and combined) with clinicopathologic variables and survival outcomes were analyzed using the Kaplan Meier method, log rank test and Cox regression analyzes. Cut off values for serum CEA and CA19 9 levels were 5 ng/ml and 37 U/ml, respectively. The mean serum levels of CEA and CA19 9 for all CRC tumors were 70.0 ng/ml and 473.0 U/ml, respectively. Tumors with higher serum CEA and CA19 9 levels were found in 60.0% and 46.0 % of CRC cases. Higher CEA and CA19-9 expression were significantly associated with more indicators of a malignant phenotype, including a young age <50 years, high histological grade, large tumor size, positive lymph nodes, advanced stage and distant metastases. The median follow-up duration was 46 months and 44.3% of patients had died of CRC. Patients with higher expression of the biomarkers CEA and CA19-9 had shorter overall survival and lower disease-free survival. Patients with both tumour markers increased showed a remarkably shorter 5-year survival rate (29.3%) and lower disease-free survival rate (p<0.0001). The Cox regression analysis emphasizes these results (p value < 0.0001). The combination of CEA and CA19-9 appear as an independent prognostic marker for survival. More intensive therapy in patients diagnosed with an advanced CRC with combined elevation of tumor markers (CEA and CA19-9) is highly considered. Measuring CEA and CA19-9 preoperatively in CRC patients is highly significant and could be useful as a prognostic marker.

Adult Metastatic Spinal Cord Tumors: A clinical Audit

Faisal Taleb — 2024-09-17

The treatment scheme for patients with spinal cord metastasis is complex, but it had evolved in the last decade by introducing new technologies and techniques. Stereotactic radiosurgery, robotic, minimally invasive procedures, immunotherapy, and advanced imaging facilities all are incorporated to treat spinal cord metastasis aiming to improve outcome and quality of life. However, surgery is still the core stem for management in the majority of cases. In this prospective study, we discussed 22 cases suffering from spinal cord metastasis and their outcome. This was a prospective study of 22 cases whose data were collected as per the pre‑prepared datasheet as a single Neurosurgeon experience in frame time between January 2020 to December 2021. Management of 22 patients with complete data were analyzed. Of 22 patients, 13 (59%) were male, 9 (41%) were female and the mean age of all cases was (59) years. Pre-operative walk status was documented in all cases utilizing ASIA score. Pre-operatively, Class (E) ASIA were found in (13) patients, and ASIA class [B, C, D] were found in one, three, and five patients, respectively. Post-operatively the ASIA score was improved by one point higher in nine patients and no change from the pre-operative score in the rest. Kyphotic spinal changes due to metastasis were cal-culated and showed a range between 13 to 29 degrees in the affected spinal level were documented in 20 patients while 2 patients showed a Kyphotic angle of 38 to 58 degrees, respectively. Surgical and ra-diological interventions have an acceptable role regarding treating spinal metastases as we observed in our cases. The goal of surgery should be tailored according to patient status and to prolong the survival of the already diseased patient to slow the disease progression. Further studies are mandatory to evaluate if aggressive surgical intervention would prolong the survival in our population and what is the burden and costs to achieve optimal results.

إن مخطط العلاج لمرضى نقائل النخاع الشوكي معقد، لكنه تطور في العقد الماضي من خلال إدخال تقنيات وأساليب جديدة. يتم دمج الجراحة الإشعاعية التجسيمية، والإجراءات الروبوتية، والإجراءات الأقل توغلاً، والعلاج المناعي، ومرافق التصوير المتقدمة لعلاج نقائل النخاع الشوكي بهدف تحسين النتيجة ونوعية الحياة. ومع ذلك، لا تزال الجراحة هي الأساس لإدارة غالبية الحالات. في هذه الدراسة الاستشرافية، ناقشنا 22 حالة تعاني من نقائل النخاع الشوكي ونتائجها. كانت هذه دراسة استشرافية لـ 22 حالة تم جمع بياناتها وفقًا لورقة البيانات المعدة مسبقًا كخبرة جراح أعصاب واحد في إطار زمني بين يناير 2020 وديسمبر 2021. تم تحليل إدارة 22 مريضًا ببيانات كاملة. من بين 22 مريضًا، كان 13 (59٪) من الذكور، و 9 (41٪) من الإناث وكان متوسط عمر جميع الحالات (59) عامًا. تم توثيق حالة المشي قبل الجراحة في جميع الحالات باستخدام درجة ASIA. قبل الجراحة، تم العثور على ASIA من الفئة (E) في (13) مريضًا، وتم العثور على ASIA من الفئة [B، C، D] في مريض واحد وثلاثة وخمسة مرضى على التوالي. بعد الجراحة، تحسنت درجة ASIA بمقدار نقطة واحدة أعلى في تسعة مرضى ولم يحدث أي تغيير عن درجة ما قبل الجراحة في البقية. تم حساب التغيرات الحدبية في العمود الفقري بسبب النقائل وأظهرت نطاقًا يتراوح بين 13 إلى 29 درجة في مستوى العمود الفقري المصاب وتم توثيقه في 20 مريضًا بينما أظهر مريضان زاوية حدبية تتراوح من 38 إلى 58 درجة على التوالي. للتدخلات الجراحية والشعاعية دور مقبول فيما يتعلق بعلاج النقائل الشوكية كما لاحظنا في حالاتنا. يجب تصميم هدف الجراحة وفقًا لحالة المريض وإطالة بقاء المريض المصاب بالفعل لإبطاء تقدم المرض. مزيد من الدراسات إلزامية لتقييم ما إذا كان التدخل الجراحي العدواني سيطيل بقاء المريض في مجتمعنا وما هو العبء والتكاليف لتحقيق نتائج مثالية