CTR Conference Booklet

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Welcome Message
Distinguished Researchers and Participants,
It gives me great pleasure to welcome you to the 6th edition of the joint conference of the King
Hussein Cancer Center, the American University of Beirut Medical Center, and MD Anderson Cancer
Center!
This year, our schedule is full of interactive sessions, presentations, and networking opportunities.
The first conference day is dedicated to sharing recent advances in hematology oncologic
research. The second day holds a diverse range of sessions; in which researchers from participating
institutions present their original work in the form of posters or oral presentations. I am excited to
see the leap that this joint venture has taken over the years. The exceptional number of submitted
abstracts is a testament to the growth in quality, quantity, and complexity of oncology research in
Jordan and Lebanon. Collaborating institutions and sponsors have consistently contributed to the
advancement of clinical and translational research in the MENA region; a mission to be commended
and supported by stakeholders in the healthcare sector.
On behalf of the organizing committee, I invite you to join the conversation. Take time to connect
and network with experts and speakers from around the world, while enjoying the heritage, beauty,
and diversity of Amman.
Sincerely,
Asem Mansour, MD
Director General
King Hussein Cancer Center
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SCIENTIFIC PROGRAM
DAY 1: Friday; 22nd, March 2019

Hematologic Malignancies
Time Topic Speaker
8:25 Welcome Remarks Dr. Asem Mansour
Moderators:
Session-I
Dr. Nazmi Kamal, Dr. Amal Abu Ghosh, Dr. Jean El-Cheikh
8:30-8:55 Acute lymphocytic leukemia Dr. Hagop Kantarjian
8:55-9:20 Acute Myeloid Leukemia Dr. FarhadRavandi
9:20-9:45 Acute Myeloid Leukemia in Elderly Dr. Amer Zeidan
9:45-10:00 Q&A
10:00-10:25 Coffee Break & Poster View
Moderators:
Session-I
Dr. Ahmad Telfah, Dr. Husam Abu Jazar, Dr. Khalid Halahleh
10:25-10:50 Allogeneic Stem Cell Transplantation Dr.Ali Bazarbachi
10:50-11:15 Chronic Myeloid Leukemia Dr. Hagop Kantarjian
11:15-11:40 Myelodysplastic syndromes Dr. Amer Zeidan
11:40-11:50 Q&A
11: 50- 1:10 Lunch and Jumah Prayers
Moderators:
Session-3
Dr. Ali Bazerbashi, Dr. Sana Al-Sukhun, Dr. Abdelghani Tbakhi
1:10-1:35 The Highly Curable Leukemia's Dr. FarhadRavandi
1:35-2:00 Multiple Myeloma Dr. Sameer Yaser
2:00-2:25 Acute lymphocytic leukemia Dr. Hagop Kantarjian
2:25-2:50 Update on CAR-T Therapy Dr. Jean El-Cheikh
2:50- 3:00 Q&A
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Time Topic
Moderators:
Session-4
Dr. Abdallah Al-Abbadi, Dr. Lina Marie, Dr. Salwa Saadeh
O-1; Comparable efficacy of peripheral stem cell mobilization using

3:30-3:40 biosimilar G-CSF Nivestim(R) to original Neupogen(R) in healthy donors
Dr. Rula Najjar
O-2; safety and efficacy of 4 cycles of BrentuximabVedotinas

consolidation after autologous peripheral stem cell
3:42-3:52
transplantation in relapsed/refractory Hodgkin’s lymphoma
Dr. JeriesKort
O-3; The role of Anti-thymocyte globulin with Thiotepa-

Busulfan-fludarabine based conditioning in patients
3:54-4:04 undergoing haploidentical stem cell transplant
and post-transplant cyclophosphamide.
Dr. Jean El-Cheikh
O-4; Imatinibmesylate is safe and effective in maintaining

cytogenetic and molecular response achieved with 1 year
4:06-4:16 nilotinib first line in newly diagnosed chronic myeloid
leukemia: preliminary results of a prospective clinical trial
Dr. Nour M. Moukalled
O-5; Hematopoietic recovery and transfusion needs after

Haploidentical stem cell transplantation with post-transplant
4:18-4:28
cyclophosphamide in adult patients with hematologic malignancies
Dr. Razan Mohty
O-6; The value of interim FDG- PET/CT in assessing

response to therapy in Hodgkin Lymphoma patients
4:30-4:40
at King Hussein Cancer Center (KHCC)
Dr. Farah Anwer
O-7; Outcome of Relapsed Acute Lymphoblastic Leukemia in

4:42-4:52 Children and Adolescent Treated At King Hussein Cancer Center
Dr. Mayada Abu Shanap
4:55-5:00 Closing Remarks; Dr. Hagop Kantarjian
5:00-5:30 Reception
5:30- 6:30 Opening Ceremony
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DAY 2: Saturday; March 23rd, 2019
Research Day
Time Hall-A/ Fourth Floor
Session-1/ Plenary Session

08:15-10:30 Moderators: Dr. Ali Taher, Dr. Mahmoud AlMasri,
Dr. Fady Geara; Dr. Ali Al Ebous
08:15-08:30 Welcome Remarks
O-8; Activation of androgen receptor induces epithelial - to

- mesenchymal transition of molecular apocrine breast MDA-
08:30-08:40
MB-453 cancer cells: alterations of a molecular network
Dr. Mamoun Ahram
O-9; Investigating the diagnostic accuracy of CT,
18F-FDG PET/CT and EBUS/TBNA in preoperative
08:42-08:52
mediastinal nodal staging of NSCLC
Dr. Akram Al Ibraheem
O-10; Deep Targeted Sequencing Analysis of Hot Spot Mutations
08:54-09:04 in Non-small Cell Lung Cancer Patients from the Levant
Dr. Ghina Fakhri
O-11; Postmastectomy Radiation Therapy: “No One Size Fits All”

09:06-09:16
Dr. Youssef H. Zeidan
O-12; Intravenous Ferric Carboxymaltose (FCM), without

Erythropoiesis-Stimulating Agents (ESA), is Safe and Effective
09:18-09:28
in the Treatment of Chemotherapy Induced Anemia (CIA)
Dr. Hikmat Abdel-Razeq
O-13; Salvage chemotherapy using irinotecan and temozolamide

09:30-09:40 in pediatric and adult populations with relapsed Ewing Sarcoma
Dr. Samer Salah
O-14; CYR61/CCN1 Expression in Resected
09:42-09:52 Pancreatic Adenocarcinoma
Dr. Christelle Dagher
O-15; Modeling EGFR mutation detection for liquid biopsy

09:54-10:04
Dr. Osama Alsmadi
O-16; Diagnostic Performance of FDG-PET/ CT scan as Compared

to US-Guided FNA in Prediction of Axillary Lymph Node
10:06-10:16
Involvement in Patients with Newly Diagnosed Breast Cancer
Dr. Vanessa Akiki
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Time Hall-A/ Fourth Floor Hall-B/ Sixth Floor
Session-2/ Breast Session-3/ Lung

Moderators: Dr. Hazem Moderators: Dr. Akram Al-
11:00-13:00
Assi, Dr. Said Al-Natour, Ibraheem, Dr. Feras Hawari,
Dr. Ghadeer Abdeen Dr. Abdulmajeed Dayyat
Year-in-Review; Year-in-Review;
11:00-11:28
Dr. Nagi Al Saghair Dr. Arafat Tfayli
O-24; Effect of PD-L1

O-17; Androgen receptor
Expression on Survival in
influences behavior of breast
Advanced Stage NSCLC
cancer cells via microRNAs:
Patients Harboring
11:30-11:40 evidence of stronger
EGFR mutations and
transcriptional than post-
Receiving EGFR TKIs
transcriptional regulation
Dr. Kamal Alrabi
Dr. Mamoun Ahram
O-18; Genetic Counseling

O-25; Prevalence of
and Genetic Testing for
Programmed Death Ligand
Germline BRCA1/2 Mutations
1 in Patients Diagnosed
11:42-11:52 among High Risk Breast
with Non-Small Cell Lung
Cancer Patients in Jordan,
Cancer in the Levant
a Study of 500 Patients
Majd Al-Assad
O-19; Availability, Rate

of Usage, and Impact of O-26; Neutrophil Lymphocyte
Commercialized Genomic Ratio Association with Baseline
11:54-12:04 Tests on Adjuvant Treatment Brain Metastasis in Stage IV
Decisions in Early-Stage Breast Non-Small Cell Lung Cancer
Cancer Patients in Lebanon Dr. Kamal Alrabi
Dr. Nour Abdul Halim
O-20; Breast Cancer among

Session-4/ Genitourinary
Elderly Jordanian Patients;
Moderators: Dr. Ali Al
Tumor Characteristics,
12:06-12:16 Daghmin, Dr. Imad Jaradat,
Treatment Modalities
Dr. Mohammad Salameh
and Outcomes
O-21; Effectiveness of
Cyanoacrylate (Glubran 2(R)) in O-27; Establishment and
Reducing Seroma Formation Characterization of Prostate
12:18:12:28 in Breast Cancer Patients Cancer Patient-derived
Post-Axillary Dissection, Organoids and Cells
Randomized controlled trial Dr. Wassim Abou-Kheir
Dr. Mahmoud Al-Masri
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O-22; Amenorrhea and O-28; Prostate cancer (PC)

Fertility Preservation among in the Jordanian population:
Young Women Treated with Disease trends and
12:30-12:40
Chemotherapy for Early- outcomes at King Hussein
Stage Breast Cancer Cancer Center (KHCC)
Dr. Omar Shahin Dr. Amal Al-Omari
O-23; Fertility in Breast Cancer

O-29; EMT Markers in Locally-
Survivors Following Breast
Advanced Prostate Cancer:
12:42-12:52 Cancer Treatment at AUBMC:
Predicting Recurrence?
A Retrospective Study
Dr. Wassim Abou-Kheir
Dr. Rasha Kakati
13:00-14:00 Lunch and Poster View
Session-5/Supportive care Session-6/ Pediatrics

Moderators: Dr. Sami Al- Moderators: Dr. Faris
14:00-15:30
Khatib, Dr. Hussein Abu Madanat, Dr. Rawad Rihani,
Khudair, Dr. Debrah Mukhraji Dr. Hasan Hashem
O-37; Differential Gene Expression

O-30; Statin use improves the of Neuroblastoma Identifies
survival of colorectal cancer a Pattern that Predicts
(CRC) patients in Jordan: An Prognosis and Highlights the
14:00-14:10 observational study at King Role of Transcription Factor
Hussein Cancer Center (KHCC) Activating Protein 2 beta
Dr. Mahmoud A. Alfaqih (TFAP2B) in Spontaneous
Regression of Stage 4s
Dr. Iyad Sultan
O-31; Predictors of Augmented O-38; The Impact Of

Renal Clearance in Critically- Retinoblastoma Screening
14:12-14:22
Ill Patients with Cancer Program for High Risk Children
Dr. Lama Nazer Dr. Yacoub A. Yousef
O-32; Impact of Using

O-39; Rb Awareness
Perioperative Pulmonary Care
among First Contact
Bundle on Postoperative
14:24-14:34 Physicians in Jordan
Pulmonary Complications,
Dr. Tamara Alnawaiseh
Cancer Center Experience
Dr. Riad Abdel Jalil
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O-33; Fertility Counseling and

Session-7/ Sarcoma
Sperm Banking among Male
Moderators: Dr. Abdulla
Adolescents and Young Adults
14:36-14:46 Nofal, Dr. Faiha Bazzeh,
Treated for Cancer with Curative
Dr. Samer Abdel Al
Intent in a Developing Country
O-40; Timing of local control

O-34; High Incidence of Venous
as a significant predictor of
Thromboembolic Events (VTE)
survival of patients with Ewing
14:48-14:58 in Patients with Diffuse Large
sarcoma of the extremities
B-Cell Lymphoma (DLBL)
Dr. Samer Salah
Dr. Mohammad Ma’koseh
O-35; Decision Making O-41; Quality Assurance Rounds

Preferences Among Patients with for Sarcoma Radiotherapy
15:00-15:10 Advanced Cancer In A Tertiary Patients: Twelve-Year Results
Cancer Center in Jordan Dr. Ramiz Abu-Hijlih
Dr. Mahmoud Abu Nasser
O-36; Original filgrastim

(Neupogen(R) and biosimilar
filgrastim (Nivestim(R)): O-42; The Outcome of Limb
Comparison of effectiveness Salvage Surgery in Developing
15:12-15:22 and safety in primary Country, KHCC Experience
prophylaxis of chemotherapy- Dr. Ahmad Shehadeh
induced febrile neutropenia
Dr. Suzan Hammoudeh
15:30-16:00 Coffee Break and Poster View
Hall-A/ Fourth Floor

Session-8/General
16:00
Moderators: Dr. Faiez Daoud, Dr. Omar
Shamieh, Dr. Abdulla Al-Rashdan
O-43; Body Mass Index (BMI) and Long Term Outcomes in Patients
16:00-16:10 with Colorectal Cancer (CRC) at King Hussein Cancer Center (KHCC)
Dr. Amal Al-Omari
O-44; Laparoscopic versus open pancreaticoduodenectomy:

16:12-16:22 a case-matched comparative study
Dr. Balqees Al-Omari
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Time Hall-A/ Fourth Floor
O-45; Knowledge, Attitudes and Practices (KAP) of

Cancer Patients towards Biobanking in Jordan: A
16:24-16:34
study at King Hussein Cancer Center (KHCC)
Dr. Maysa Al-Hussaini
O-46; Female oncologists in the Middle East and

16:36-16:46 North Africa: progress towards gender equality
Dr. Yolla Haibe
O-47; Cytoreduction and Hyperthermic intraperitoneal chemotherapy

16:48-16:58 in Lebanese patients in a single institution. A retrospective study
Dr. Muhieddine Seoud
O-48; Early Stage Oral Tongue Squamous Cell Carcinoma:

17:00-17:10 Treatment Outcomes and Analysis of Recurrence Risk Factors
Dr. Issa Mohamad
O-49; Laparoscopic versus open insertion of feeding gastrostomy tube

17:12-17:20 in patients with head and neck cancers: a matched comparative study
Dr. Basil Ammori
O-50; Clinical Characteristics and Treatment Outcome for Adult

17:22-17:32 Medulloblastoma: A Tertiary Cancer Center Experience
Dr. Abdelatif Almousa
O-51; Neuro-Onco-2; Prognostic Significance of O6-

Methylguanine-DNA-methyltransferase (MGMT) Promoter
Methylation and Isocitrate Dehydrogenase-1 (IDH-1) Mutation in
17:34-17:44
Glioblastoma Multiforme Patients: A Single-Center Experience
in the Middle East and North Africa (MENA) Region.
Dr. Firas Kreidieh
17:45-18:00 Closing Remark; Dr. Hikmat Abdel-Razeq
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O-1
Comparable Efficacy of Peripheral Stem Cell Mobilization Using Biosimilar
G-CSF Nivestim(R) to Original Neupogen(R) in Healthy Donors
Corresponding Author Rula Najjar
Presenting Author Rula Najjar
Shanta Sharma, Rand Farraj, Duaa Muffaraj, Eman Khattab, Moham-

mad Ma'koseh, Khaled Halahleh, Hussam Abu-Jazar, Mayada Abu
Co-author(s)
Shanab, Rawad Rihani, Hasan Hashem, Nilly Hussein, Anas Haroun,
Abdelghani Tbakhi
Affiliation King Hussein Cancer Center
Contact rnajjar@khcc.jo
Country JO
Introduction:
Biosimilars impacts cost of therapy in oncology with similar efficacy. We aim to review and compare
efficacy of biosimilar product Nivestim(R) (filgrastim), to the reference product, Neupogen(R) in terms
of peripheral CD34+ cell mobilization in healthy donors subsequent to its replacement in the formulary
at King Hussein Cancer Center.
Methods:
We conducted a retrospective comparative analysis on 160 healthy related donors who received
either Neupogen(R) or Nivestim(R) for peripheral stem cell mobilization during a 2 year period from
September 2014 to September 2016 in a single center institution. Donors received filgrastim at a
dose of 5 mcg/kg/dose subcutaneously every 12 hours for 4 days. Complete blood count (CBC)
and CD34+cell enumeration was done on donor’s peripheral blood samples during the mobilization
period and immediately prior to leukapheresis (between day 4 to day 6 of mobilization). The actual
number of circulating CD34+ cells per microliter of peripheral blood was used to determine the
optimum time for stem cell collection.
Results:
A total of 158 healthy donors received filgrastim for stem cell mobilization over a period of 2 years.
Neupogen(R) was used in 89 donors, while 69 donors received Nivestim(R). Mean age of donors at
collection was 24 years (2-57). Fifty-seven percent of donors were males. The average circulating
CD34+ cells per microliter was 97.18 in the Neupogen(R) group, while it was 83.75 in the Nivestim(R)
group, that was not statistically significant (p=0.287). The mean total number of doses needed for
stem cell mobilization was 8.79 doses and 7.93 doses, for Neupogen(R) and Nivestim(R) respectively
with statistically difference (p=.028).
Conclusions:
Biosimilar Nivestim(R) showed comparable efficacy with the reference product, Neupogen(R) in terms
of peripheral stem cell mobilization in healthy donors with less number of doses required. The use
of Nivestim may lead to significant cost containment. Presented observation should be verified with
wider prospective research.
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O-2
Safety and Efficacy Of 4 Cycles of Brentuximab Vedotinas Consolidation After
Autologous Peripheral Stem Cell Transplantation in Relapsed/Refractory
Hodgkin’s Lymphoma
Corresponding Author Jeries Kort
Presenting Author Jeries Kort
Amanda Chidiac, Radwan Massoud, Nohra Ghaoui, Rita Nehme, Ali

Co-author(s)
Bazarbachi, Jean El-Cheikh
Affiliation American University of Beirut Medical Center
Contact jk68@aub.edu.lb
Country LB
Introduction:
Brentuximab Vedotin (BV) is a chimeric anti CD30 IgG1 antibody, conjugated to synthetic antitubulin
momomethyl auristatin. BV is approved for the treatment of classical Hodgkin lymphoma (HL) in
relapse either after autologous stem cell transplantation (ASCT) or after two lines of combination
chemotherapy in transplant ineligible patients. The AETHERA trial revealed increased PFS when BV is
used as maintenance therapy for 16 cycles in high risk patients after ASCT. However, this schedule is
associated with a high cost and significant toxicity. Our primary objective is to assess the efficacy of 4
cycles Brentuximab as consolidation therapy after ASCT for relapsed/refractory (R/R) HL.
Methods:
This is a retrospective single center analysis. We included in this study consecutive patients with R/R
HL who underwent ASCT between 2014 and 2018, and received BV consolidation post-ASCT.
Results:
We identified 18 consecutive adult patients with R/R HL treated with BV 1.8mg/kg IV every 3 weeks as
consolidation therapy after ASCT. The indications for BV consolidation was primary refractory disease
in 11 patients (61%), early relapse in 6 patients (33%) (after a median time of 10 months; range, 3-11)
and extranodal involvement in one patient (6%).
The median number of lines of therapy pre-ASCT was 3 (range, 2-5). The median time to BV initiation
post-ASCT was 76 days (range, 35-188). Patients received a median of 4 cycles (range, 3-4) of BV post-
ASCT. After a median follow up of 30 months (range, 8-50), five (28%) patients relapsed after ASCT.
The median time to relapse was 7 months (range, 4-21). Median PFS and OS were not reached. We
did not observe any significant toxicities during or after therapy.
Conclusions:
4 cycles of BV consolidation after ASCT seem to be safe and effective in preventing relapse, however
our findings need to be confirmed with larger prospective studies.
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O-3
The Role of Anti-Thymocyte Globulin with Thiotepa-Busulfan-Fludarabine based
Conditioning in Patients Undergoing Haploidentical Stem Cell Transplant and
Post-Transplant Cyclophosphamide
Corresponding Author Jean El-Cheikh
Presenting Author Jean El-Cheikh

Raynier Devillier, Remy Dulery, Radwan Massoud, Nour Moukalled,
Co-author(s) Nohra Ghaoui, Thomas Pagliardini, Fabrizio Marino, Ali Bazarbachi,
Luca Castagna, Mohammad Mohty, Didier Blaise
Contact je46@aub.edu.lb
Country LB
The Thiotepa-Busulfan-Fludarabine (TBF) based conditioning regimen is widely used in T-cell repleted
haploidentical transplantation (Haplo) with post-transplant cyclophosphamide. However, the use of
Anti-thymocyte globulin (ATG) has not been well established. It decreases the incidence of graft
versus host disease however some claim that it’s at the cost of increased relapse. We conducted this
multi centric study to compare the outcomes of patients who underwent Haplo with TBF conditioning
regimen with ATG to those without.
This is a multicentric retrospective study. Data was collected from 4 centers, the American University of
Beirut Medical Center, Hospital Saint Antoine Paris, institute Paoli Calmette Marseille, and Humanitas
Research Hospital Milan. We included all consecutive adult patients who underwent Haplo with TBF
conditioning. The conditioning consisted of thiotepa 5 mg/kg per day infused on days -7 and/or -6,
fludarabine 30 mg/m2 infused on day -5 to day -2; and busulfan 130 mg/m2 infused on day -5 to day
-3. Graft versus host disease (GVHD) prophylaxis consisted of post transplantation cyclophosphamide
50 mg/kg per day on day +3 and day +5, cyclosporine on day +6 and readjusted according to level,
and mycophenolate mofetil 500 mg every 6 hours beginning on days +6 to +28 or +35 dependinbg
on the center. Patients who received ATG received a dose of 2.5 mg/kg per day. We included a total
of 268 patients, 69 of whom (26%) received ATG (group 2) as part of the conditioning chemotherapy.
Patients who received ATG had a younger median age compared to the second group without ATG
(group 1) (53 and 58 years respectively; p value 0.004). (63% vs 61%) of each group had acute
leukemia, and (71% vs 70%) were in complete remission at the time of transplant, while 47 patients
(24%) in the group 1 had progressive disease at transplant. 151 patients (56.5%) had an intermediate
disease risk index (DRI). In the ATG group, 59 patients (30%) compared to 50 (73%) in the other group
received 5mg/kg Thiotepa, while 140 (70) and 19 (27%) received 10mg/kg respectively. Peripheral
blood stem cells were the most common graft source in both groups (83% and 88% respectively). At a
median follow-up of 15.4 months, patients receiving ATG had a statistically significant decreased risk
of acute graft versus host disease (aGVHD) (RR 0.47; p value 0.031), and non-relapse mortality (NRM)
at 24 months (RR 0.5; p value 0.027). ATG also resulted in higher progression and overall survival
at 24 months, which was not statistically significant (66.2% and 59.8%; p value 0.168, with 76.6%
and 67.8%; p value 0.056 respectively) ATG as part of the pre-transplantation conditioning leads to
significant reduction in aGVHD and NRM at 24 months without significant effects on PFS or OS.
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O-4
Imatinib Mesylate is Safe and Effective in Maintaining Cytogenetic and Molecular
Response Achieved With 1 Year Nilotinib First Line in Newly Diagnosed Chronic
Myeloid Leukemia: Preliminary Results of A Prospective Clinical Trial
Corresponding Author Ali Bazarbachi
Presenting Author Nour M. Moukalled

Co-author(s) Radwan Massoud, Rami Mahfouz, Jean El-Cheikh
Contact bazarbac@aub.edu.lb
Country LB
Introduction:
Achieving complete cytogenetic response (CCyR) at 12 months for patients with chronic phase chronic
myeloid leukemia (CML) treated with imatinib as first line, is associated with significantly improved
progression-free survival. Nilotinib has shown a faster and higher rate of CCyR and molecular response
as compared to imatinib. However, nilotinib use is associated with diet restriction, higher financial costs,
and its long-term use is incriminated with cardiovascular and metabolic complications.
Methods:
In this prospective single center trial, we evaluated the ability of imatinib to maintain a CCyR achieved
after 12 months of first-line treatment with nilotinib. Inclusion criteria were adult patients with previously
untreated Philadelphia -positive CML in chronic phase, with a WHO performance status ≤ 2. Patients
received 1-year treatment with nilotinib (300mg twice daily) then were shifted to imatinib 400mg daily.
Results:
Eleven patients (5 females) were so far enrolled in the study, with a median age at diagnosis of 50 years
(range 31-83). Patients were started on Nilotinib at a median of 29 days (range 2-32) from diagnosis.
One patient had to discontinue nilotinib after 6 months and start dasatinib due to recurrent pancreatitis
that resolved upon interruption of nilotinib. Eight patients completed one year of nilotinib, and were
switched to Imatinib. The remaining 2 patients are currently on nilotinib as per protocol (less than 12
months since inclusion). Three patients on imatinib had to be switched back to nilotinib, because of
imatinib intolerance (n=2; elevated liver transaminases and myositis) or because of loss of MMR (n=1).
Therefore, at last follow up (median 64 months), 5 patients are on imatinib, 5 on nilotinib and 1 on
dasatinib. All patients (100%) achieved complete hematological response (CHR) and CCyR at 3 and
18 months respectively, and maintained them thereafter. At 12 months, 6 out of 8 eligible patients
achieved complete molecular response (CMR; n=3) or major molecular response (MMR; n=3). At 36
months, all eligible patients (n=7) were either in CMR (n=2) or in MMR (n=5). All patients who reached
4 years (n=6), 5 years (n=5) or 6 years (n=3) of follow up remained in either MMR or CMR. No patient
developed long-term serious adverse event including cardiovascular or metabolic complications.
Conclusions:
These findings suggest that imatinib can maintain MMR achieved on short-term nilotinib therapy.
This strategy is a potentially safe and effective long-term treatment approach, minimizing costs and
cardiovascular and metabolic complications. This however, needs confirmation with a larger number of
patients.
.
Dem o
4
O-5
Hematopoietic Recovery and Transfusion Needs after Haploidentical Stem Cell
Transplantation with Post-Transplant Cyclophosphamide in Adult Patients with
Hematologic Malignancies
Corresponding Author Mohamad Mohty
Presenting Author Razan Mohty

Annalisa Ruggeri, Eolia Brissot, Rmy Dulery, Giorgia Battipaglia,
Co-author(s) Frederica Gianotti, Simona Sestili, Clmence Mediavilla, Florent
Malard
Saint-Antoine hospital, Paris, American university of Beirut medical
Affiliation
center
Contact Ra335@aub.edu.lb
Country LB
Several factors were shown to affect hematopoietic recovery after Haploidentical stem cell
transplantation (Haplo-SCT) using post-transplant cyclophosphamide (PT-Cy) including age at
transplant, initial diagnosis, stem-cell source, graftâ€™s CD34 count, conditioning regimen
intensity, infections. The aim of this study was to evaluate immune reconstitution, transfusion
needs and main transplant outcomes after Haplo-SCT and to identify factors affecting recovery.
This study included 72 consecutive patients who underwent haplo-SCT between December 2012
and March 2018, in a single center. Graft was either bone marrow (n=21) or peripheral blood SC
(n=51). Patients were given PT-Cy (50mg/kg/d) for one (n=20) or two days (n=52). Conditioning
regimen was reduced intensity (RIC) in 69% (n=50) and myeloablative (MAC) in 31% (n=22) of
patients. The median CD34+ cells infused was 10.62x10^6/kg (range, 1.02-15.06). The median
time to neutrophil recovery >500/µL and >1000/µL were 16 days (range, 5-29) and 17 days (range,
5-32) respectively. Platelets recovery >20.000/µL and >50.000/µL were observed at a median of
13 days (range, 10-193) and 60 days (range, 10-193) respectively. 45 (63%) and 49 (68%) patients
had a platelets count >50.000/µL at days +30 and +60 respectively. At day +90, 61 patients were
assessable with 56 (92%) of them having a platelets count >50.000/µL. In this series, 61 patients
(85%) needed platelets transfusion with a median number of 13 units (range, 2-60), transfused at a
median of 26 days (range, 5-198). Similarly, 59 patients (82%) needed packed RBCs transfusion with
a median of 6 units (range, 1-60) at a median of 31 days (range, 5-147). 23 patients (32%) received
growth factors, erythropoietin in 14 patients (19%) and thrombopoietin in 15 patients (20%) for
anemia or thrombocytopenia. In all, 6 patients received unmanipulated CD34+ donor stem cells,
â€œboostâ€. Such boost proved to be successful in 4 patients while 2 patients had an incomplete
response with persistent anemia and/or thrombocytopenia. In the multivariable analysis, donor age
>40 years and CMV reactivation within the first 3 months were shown to meaningfully affect day
+90 platelets recovery >100 x10^9/L (HR 4.86, 95%CI 1.08-21.80, p=0.04 and HR 5.15, 95% CI,
1.22-21.7, p=0.03). Number of CD34, conditioning regimen, stem cell source and disease status at
transplant have no impact on platelet recovery at day +90.
In conclusion, our data show that Haplo-SCT is associated with a fast hematopoietic recovery
with an acceptable rate of transfusions. While the adverse impact of CMV reactivation on platelet
recovery was expected, the relation between donor age >40 years and platelets recovery is new.
This finding should guide in selecting potential donors for Haplo-SCT.
5
O-6
The Value of Interim FDG- PET/CT in Assessing Response to Therapy in Hodgkin
Lymphoma Patients at King Hussein Cancer Center (KHCC)
Corresponding Author Akram Al-Ibraheem
Presenting Author Farah Anwer
Co-author(s) Aysar Khalaf
Contact aibraheem@khcc.jo
Country JO
Introduction:
The aim of this study was to assess the value of interim FDG PET/CT in predicting response to
treatment of HL patients at KHCC.
Methods:
We retrospectively reviewed the records of HL patients who underwent FDG PET/CT between
January 2014 and December 2017. 254 patients were included in this study whose records
comprised initial PET, interim PET after cycle 2 or cycle 4 of ABVD and end of therapy PET. All had
their PET scans in KHCC. The Deauville 5-point scoring (5-ps) was considered for the classification
of patients as complete metabolic responders (CMR) if patients achieved 5-ps 1-3 in interim PET
or as non-complete metabolic responders (nCMR) if patients achieved 5-ps 4 and 5. The decision
of the multidisciplinary team based on the results of the end of treatment PET were adopted to
classify patients as having complete response (CR) or residual active disease (RAD).
Results:
Our patient cohort are illustrated in Table 1 Interim FDG-PET scan (either after cycle 2 or cycle 4
of ABVD therapy) was classified as CMR in 188/254 (74%) with their final FDG-PET showed CR in
185/188 (98.4%) of cases and 3 (1.6%) patients with RAD within the first 6 months follow up. In the
remaining 66 (26%) patients, interim FDG-PET was nCMR with Score 4 in 60 patients (23.6%) and
Score 5 in 6 patients (2.4%). In the aforementioned 60 patients with 5-ps 4 who continued the ABVD
protocol, end of treatment FDG- PET imaging showed RAD in 25 patients (41.6%) of patients, CR in
30 patients (50%) and indeterminate response in 5 patients (8.4%). Statistical analysis revealed that
interim FDG- PET after 2 or 4 cycle of ABVD had a negative predictive value of 98.4% and positive
predictive value of 45.4%. Significant percent of patients with nCMR didnt achieve further response
on this ABVD regimen at the end of treatment.
Conclusions:
This study showed that interim FDG-PET/CT scan after cycle 2 or 4 has a valuable role in predicting
response to ABVD treatment in HL. Escalating treatment in patient with nCMR on interim PET
should be considered.
6
O-7
Outcome of Relapsed Acute Lymphoblastic Leukemia in Children and Adolescent
Treated At King Hussein Cancer Center
Corresponding Author Mayada Abu Shanap
Presenting Author Mayada Abu Shanap

Rawad Rihani, Hasan Hashem, Iyad sultan, Abdelghani Tbakhi,
Co-author(s) Amal Abu Ghosh,Zebin Alzebin, Maha Riziq, Ismaeel Azayyat, Faris
Madanat
Contact da.09010@khcc.jo
Country JO
Introduction:
The overall survival (OS) rate for acute lymphoblastic leukemia (ALL) in children is approximately 80%.
Despite improvements in treatment, 20% of patients experience relapses. We sought to define response
rates and survival rates in patients treated for relapsed ALL at King Hussein Cancer Center (KHCC).
Methods:
From December 2003 until May 2018, a total of 93 children and adolescents with ALL in first and
subsequent relapse were retrospectively assigned to validated risk adapted therapy. Treatment of
relapse consisted of reinduction regimens frequently include many of the same drugs used in frontline
ALL therapy. After remission reinduction patients received continuation therapy which includes
intensive chemotherapy with or without radiation therapy or underwent hematopoietic stem cell
transplantation (HSCT) based on risk adapted protocol.
Results:
Of 93 patients with relapsed ALL (ages 1-18 years), the relative incidence of bone marrow (BM) relapse
was 65.5% (61/93), combined relapse 11.8 % ( 11/93) and isolated extra-medullary Relapse (IEM)
relapse 22.5% (21/93), of these 14 patients had CNS relapse and 7 had testicular relapse. Complete
remission (CR2) rates for all patients were 67% and vary according to time and site of relapse (100%
for IEM, 29% for late relapses, and 25% for early relapses). The median follow up was 63.8 month (3.9-
177 month). The estimated 5-year EFS and OS for the whole group were 25% and 39 %, respectively.
Five-year OS for patients with BM relapse was 32%, combined relapse 42%, and IEM 58% (5-year
OS for CNS and testicular relapse were 50% and 80 %, respectively). The probability of 5 year OS
for patients assessable MRD post reinduction chemotherapy was favorable for those with negative
MRD vs MRD >=0.01%- 5%) 68% vs 19%. Thirty four patients (36%) underwent HSCT (23 in CR2, 11
in CR3 and above), of them 17 patients (50%) are alive at last follow up. In univariate and multivariate
analysis, worse OS was observed in patients <1 and >= 10 years at diagnosis of ALL, those who had
initial high risk features, T-cell immunophenotype, and very early and early BM + combined relapse.
Conclusions:
Our data suggest more than one third of relapsed ALL patients were cured. However, survival rates
are low in HR relapsed ALL (very early and BM +Combined). Novel therapies are needed to improve
outcomes in this population.
7
O-8
Activation of Androgen Receptor Induces Epithelial-to-Mesenchymal Transition
of Molecular Apocrine Breast MDA-MB-453 Cancer Cells: Alterations of a
Molecular Network
Corresponding Author Mamoun Ahram
Presenting Author Mamoun Ahram
Co-author(s) Randa Bawadi, Mohammad Salah, Dana Alsafadi, Ebtihal Mustafa
Affiliation The University of Jordan
Contact Dr.Ahram@gmail.com
Country JO
Introduction:
Epithelial-to-mesenchymal (EMT) is an early event that occurs as cancer cells progress from a
carcinoma in situ stage into the more aggressive invasive phenotype. Treatment of MDA-MB-453
cells, a model system of luminal androgen receptor (AR) breast cancer, with dihydrotestosterone
(DHT) induces a mesenchymal phenotype via AR. In this study, DHT-induced EMT in MDA-MB-453
cells at the cellular and molecular levels was investigated.
Methods:
A plethora of techniques were used including cell imaging, Immunofluorescence, PCR arrays,
immunoblotting, immunoprecipitation, cell fractionation, and siRNA transfection.
Results:
Treatment of cells with DHT results in an remodeling of the actin cytoskeleton concomitant with
increased cell migration. The changes are gradual and more prominent after 3 days of treatment
with DHT. Exposure of cells to DHT for a few hours is sufficient to induce these cellular changes
indicating altered gene expression. Investigating the expression of 84 EMT-related genes has
revealed up-regulation of Slug and regulator of G-protein signaling protein 2 (RGS2) and down-
regulation of β-catenin. These alterations are confirmed at the protein level. However, the
expression of RGS2 is down-regulated at earlier time points suggesting that it is an anti-EMT factor.
On the other hand, expression of Slug, an EMT inducer, is up-regulated after 16 hrs of treatment.
AR-Slug and AR-RGS2 interactions are stimulated by DHT. In addition, knocking down expression
of Slug abolishes DHT-induced EMT of the cells, but not DHT-induced migration. On the other
hand, transfection of cells with RGS2 siRNA results in EMT-like phenotype in the absence of DHT,
which is blocked upon inhibiting AR. Inhibition of the Wnt/ β-catenin pathway does not seem to
be a role in DHT-induced EMT.
Conclusions:
These results indicate that AR induces EMT in luminal AR cells via altering a network of signaling
molecules with roles of Slug mediating AR action and RGS2 blocking it.
8
O-9
Investigating the Diagnostic Accuracy of CT, 18F-FDG PET/CT and EBUS/TBNA
in Preoperative Mediastinal Nodal Staging of NSCLC
Corresponding Author Akram Al-Ibraheem
Presenting Author Ula Al-Rasheed
Co-author(s) Nader Hirmas
Contact dr.ulasalih@gmail.com
Country JO
Introduction:
Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging,
endoscopic and surgical techniques. This retrospective cohort study aims at investigating the
diagnostic accuracy of 18F-FDG PET/CT, CT scan and endobronchial ultrasound/transbronchial
needle aspirate (EBUS/TBNA) in preoperative MLN staging of NSCLC in comparison to
mediastinoscopy and histopathologic diagnosis.
Methods:
We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center
in Amman, Jordan, between July 2010 and December 2017. We collected their relevant clinical,
radiological and histopathological findings. Per-patient analysis was performed on all patients
(N=101) and then on those with histopathological confirmation (N=57), followed by a per-lymph-
node-station basis overall, and then according to distinct N-stage categories (N0, N1 and N2/3).
Results:
18F-FDG PET/CT supersedes the sensitivity, specificity, PPV, NPV and accuracy of CT scan in
MLN staging, with slightly lower accuracy compared to mediastinoscopy and EBUS/TBNA, and
comparable NPV to the latter modalities. Dividing patients into N1 disease vs. those with N2/
N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA
in patients with histopathological confirmation shows 28 correlated true positive and negative
findings. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise
remained undiscovered by EBUS/TBNA alone. On the other hand, EBUS/TBNA conferred accurate
staging in one patient who had positive sub-carinal LN TBNA result which was missed by 18F-FDG
PET/CT. Finally, EBUS/TBNA showed true negative findings in six cases that were deemed false
positive by 18F-FDG PET/CT.
Conclusions:
18F-FDG PET/CT surpasses EBUS/TBNA in excluding MLN metastases in NSCLC, has better overall
diagnostic utility than CT scan, and has comparable NPV to mediastinoscopy. Positive 18F-FDG
PET/CT MLNs, particularly if such a result would change treatment decisions and outcomes, should
be verified histopathologically.
9
O-10
Deep Targeted Sequencing Analysis of Hot Spot Mutations in Non-small Cell
Lung Cancer Patients from the Levant
Corresponding Author Arafat Tfayli
Presenting Author Ghina Fakhri

Pierre Khoueiry, Ghina Fakhri, Reem Akel, Majd El Assaad, Rami
Co-author(s) Mahfouz, Fadlo Khuri, Hassan Chami, Jason Petersen, Sarah Viet,
Gareth Davies, Humam Kadara, Arafat Tfayli
Contact gbf00@mail.aub.edu
Country LB
Introduction:
The overall 5-year survival of lung cancer remains dismal despite the current treatment regimens.
Testing for driver mutations has become routine practice for oncologists due to the presence of
targeted therapy readily available for patients. Deep targeted sequencing through next generation
sequencing is an adequate methodology to detect mutations at multi-genetic levels. The molecular
pathology of non-small cell lung cancer is poorly understood in the Middle East and, to date, no
other reports have been published on deep targeted sequencing of lung adenocarcinoma tissues.
Methods:
Deep targeted sequencing using TruSeq Amplicon Cancer panel of 48 genes was performed on
85 formalin-fixed paraffin-embedded tissues from patients with lung adenocarcinoma who were
treatment-naive at the time of the collection. Variants with an allele frequency higher than 10%
were retained.
Results:
Variant calling identified a total of 2455 variants of which missense mutations were the most frequent
(75.6%). All of our samples showed at least one mutation in one of the 10 most commonly mutated
genes with FLT3 being the gene with the highest mutation rate (67%). TP53, KRAS and STK11 were
the second, third and fourth most commonly mutated genes, respectively while EGFR mutation
rate reached 22.4%.
Conclusions:
To the best of our knowledge, this is the first hot spot profiling study on patients from this area.
The frequencies of mutated genes presented in our study showed similarity to other reported
outcomes. At least one mutation was detected in our cohort of lung adenocarcinoma.
10
O-11
Postmastectomy Radiation Therapy: “No One Size Fits All”
Corresponding Author Youssef H. Zeidan
Presenting Author Youssef H. Zeidan
Co-author(s) Joseph Abi Jaoude, Aurelie Mailhac, Hani Tamim
Contact yz09@aub.edu.lb
Country LB
Introduction:
Historical studies reported improved survival with postmastectomy radiation therapy (PMRT) for
node-positive breast cancer. The current work evaluates the impact of PMRT in patients with HER-2
positive tumors and 1-3 positive lymph nodes enrolled on two large randomized trials.
Methods:
The BIG 02-98 trial randomized patients to receive adjuvant anthracycline with or without taxane
chemotherapy. The HERA trial evaluated the impact of Herceptin in patients with HER-2 positive
breast cancer. This current analysis was performed on participants with HER-2 positive breast
cancer and 1-3 positive lymph nodes who had undergone mastectomy. The primary objective of
the present study was to examine the effect of PMRT on risk of locoregional recurrence (LRR), breast
cancer specific survival (BCSS) and overall survival (OS).
Results:
We identified 684 patients on the BIG 02-98 trial who met the inclusion criteria, of whom 337 (49%)
had received PMRT. Of the HERA patients 2415 patients were included in our study of whom 1368
(56.6%) patients received PMRT. At 10 years, LRR risk was 2.5% in the PMRT group and 6.5% in the
no PMRT group (HR =0.29, 95% CI, 0.12 to 0.73; P=0.005). An incremental benefit in LRR control
after PMRT was noted for patients randomized to receive adjuvant chemotherapy with no taxane
(10-year LRR: 3.4% vs. 9.1%, P=0.02). No statistically significant differences in BCSS (at 10 years:
84.3% vs. 83.9%, (PMRT vs no)) or in OS (at 10 years: 81.7% vs 78.3%) were observed according to
PMRT.
Conclusions:
Our analysis shows a significant improvement in LRR after PMRT in women with T1-2 tumors
and 1-3 positive lymph nodes, with a larger absolute benefit in the absence of adjuvant taxane
chemotherapy. HER2 positive/node positive breast cancer patients receiving PMRT have better
loco-regional control, but the addition of Trastuzumab ameliorates this LRR benefit. As such, PMRT
is not necessary for all women with HER-2 positive and 1-3 positive nodes, and decisions could be
tailored to individual risks.
11
O-12
Intravenous Ferric Carboxymaltose (FCM), without Erythropoiesis-Stimulating
Agents (ESA), is Safe and Effective in the Treatment of Chemotherapy Induced
Anemia (CIA).
Corresponding Author Hikmat Abdel-Razeq
Presenting Author Hikmat Abdel-Razeq

Hazem Abdulelah, Razan Malhis,, Salwa Saadeh, Sameer Yasser,
Co-author(s)
Rana Eljaber, Ghaida Khalaf, Dalia Rimawi
Contact habdelrazeq@khcc.jo
Country JO
Introduction:
Anemia in cancer patients undergoing active treatment with chemotherapy is commonly encountered
and may worsen their quality of life. The benefits of blood transfusion is often temporary and may
be associated with serious adverse events. Because of recent concerns about their negative effect
on overall survival and serious adverse events, ESA are not commonly prescribed. This study will
assess the efficacy and safety of intravenous FCM therapy in such patients.
Methods:
Adult patients with nonmyeloid malignancies on chemotherapy with Hb ≤ 11.0 g/dL and a life
expectancy >24 weeks were recruited. Based on serum ferritin (sFr) level and transferrin saturation
(TSAT), patients were categorized into three Groups: Group-I with Absolute Iron Deficiency (AIDA)
had sFr <30 ng/mL and TSAT < 20%: 26 (31.0%) patients. Group-II with Functional Iron Deficiency
Anemia (FIDA) had sFr 30-800 ng/mL and TSAT <20%: 24 (28.6%). Patients with TSAT >20% were
placed in group-III as “others” : 34 (40.5%). According to Hb level and body weight, patients were
given FCM in one or two short intravenous infusions. Hemoglobin level was measured at 0, 3, 6, 9
and 12 weeks. Written informed consents were obtained.
Results:
A total of 84 patients; 70 (83.3%) females were recruited. Median age [standard deviation] was
53.8 [10.6] years. Chemotherapy varied according to the primary cancer and many had it as a
second-line or beyond. The median Hb level at baseline was 10.2 (range: 8.3-11.0 ) g/dL. At
week-12, patients with AIDA and FIDA had a significant increment in Hb (median: 2.35 and 1.5 gm/
dL) respectively. Patients in Group-III had limited or no response, Figure-1. Most of the increment
(≥1.0 g/dL) occurred as early as week-3. No immediate infusion-related adverse events were
reported. Hypophosphatemia was observed in 39 (46.4%) patients, more so in patients with AIDA
(65.4%) who had the highest Hb increment. All were asymptomatic, treated with oral phosphate
supplements and subsided with the next blood testing.
Conclusions:
Intravenous FCM, without ESA, is effective in the treatment of anemia in cancer patients undergoing
active treatment with chemotherapy. Hypophosphatemia was commonly encountered complication
but was brief, treatable and asymptomatic.
12
O-13
Salvage Chemotherapy using Irinotecan and Temozolamide in Pediatric and
Adult Populations with Relapsed Ewing Sarcoma
Corresponding Author Samer Salah
Presenting Author Samer Salah

Taleb Ismail, Sameer Yaser, Ahmad Shehadeh, Anoud Alnsour,
Co-author(s) Omar Shahin, Iyad Sultan, Rasha Aldoury, Samer Abdelal, Abdellatif
Almousa, Muthana Abdelhalim, Ahmad Ibrahimi, Omar Khozouz
Contact samer.salahmd@gmail.com
Country JO
Introduction:
Irinotecan and temozolomide (IT) is a widely used regimen for relapsed Ewing Sarcoma (ES),
although studies are largely limited to the pediatric population. We aimed to compare tolerability
and efficacy of IT between pediatric and adult patients.
Methods:
We retrospectively reviewed pediatric (<18 years) and adult patients treated with salvage IT
chemotherapy at two institutions from March 2010 to June 2018. Toxicities were graded according
to common terminology criteria of adverse events (CTCAE v. 4.03) and compared using the Chi
Square test. Responses were interpreted by Response Evaluation Criteria in Solid Tumors (RECIST).
The Kaplan-Meyer method was used to estimate progression free survival (PFS); survival comparisons
were carried out by the Log-rank test.
Results:
Fifty-three patients were included (n=16 pediatric; n=37 adult). IT was given as second-line (n=34;
64%) or ≥third-line (n=19; 36%). There was no difference in ≥grade 3/4 hematologic toxicity
between pediatric and adult patients (31% vs. 35% respectively; p=0.76), whilst febrile neutropenia
was observed in two patients (4%). The frequency of diarrhea of any grade was similar (38% in
each group). Of 43 patients assessable for response, 12 (28%) had objective response (1 CR, 11
PR), 19 (44%) had disease progression and 12 (28%) had stable disease. Objective response rate
did not differ between the two groups (36% in pediatrics vs. 25% in adults; p = 0.47). Median PFS
was superior in pediatrics vs. adults (7.4 vs. 2.1 months, p = 0.001). Superior PFS for the pediatric
population was observed in both, the second-line (6.2 vs. 2.2 months; p=0.060) and ≥third-line
setting (7.4 vs. 1.2 months,p=0.014).
Conclusions:
IT is an effective salvage regimen for ES, with favorable toxicity and equally observed objective
responses in pediatric and adult populations. The observed superior PFS for the pediatric cohort
requires further confirmation in a larger prospective study.
13
O-14
CYR61/CCN1 Expression in Resected Pancreatic Adenocarcinoma
Corresponding Author Walid Faraj
Presenting Author Walid Faraj

Wassim Abou-Kheir, Deborah Mukherji, Ola Hadadeh, Eman
Saleh, Hisham F. Bahmad, Mariam Kanso, Mohamad Khalifeh, Ali
Co-author(s)
Shamseddine, Sally Tamraz, Rola Jaafar, Christelle Dagher, Ibrahim
Khalife,
Contact wf07@aub.edu.lb
Country LB
Introduction:
CCN1 is an extracellular matrix-associated protein thought to be implicated in tumor-stromal
interaction in a number of solid tumors. The aim of our study was to evaluate the correlation between
CCN1 staining in stromal cells, Pancreatic Intraepithelial Neoplasia (PANIN) and pancreatic ductal
adenocarcinoma cells in resected pancreatic adenocarcinoma specimens. We also assessed the
correlation between CCN1 expression in pancreatic ductal adenocarcinoma cancer cells and clinical
outcome.
Methods:
Paraffin-embedded tumor specimens were stained for CCN1 and evaluated via immunohistochemical
analysis by one pathologist. Clinical data were extracted from medical charts and statistical analysis
was performed to correlate between CCN1 expression profiles in tumor tissues and clinicopathological
parameters of patients.
Results:
A total of 42 pancreatic adenocarcinoma tissues were analyzed by immunohistochemistry (IHC).
Our results showed an increase in CCN1 expression in PANIN with higher PANIN grade, and higher
PANIN CCN1 expression was associated with higher tumor stage and grade in this sample. A linear
correlation was seen in CCN1 expression among PANIN, ductal tumor and adjacent stromal cells.
Increased ductal tumor CCN1 expression was not found to be associated with poor outcome.
Conclusions:
This is the first study to investigate the relationship between CCN1 expression and PANIN, tumor
cells and the adjacent stroma in resected pancreatic adenocarcinoma specimens. The associations
demonstrated between CCN1 expression in PANIN and tumor-adjacent stroma suggest that
CCN1 plays an important role in the interaction between the pancreatic tumors, their surrounding
microenvironment and their precursors.
.Demo
14
O-15
Modeling EGFR Mutation Detection for Liquid Biopsy
Corresponding Author Osama Alsmadi
Presenting Author Osama Alsmadi

Osama Alsmadi, Suha Abu-Alrub,Niveen Abdulla, Walid M. Naser,
Co-author(s)
Farah Alul, Abdelghani Tbakhi
Affiliation King Hussain Cancer Center
Contact oa.12163@khcc.jo; atbakhi@khcc.jo
Country JO
Introduction:
Lung cancer is a leading cause of cancer deaths. NSCLC exemplify approximately 90% of all lung
cancer types. Mutations EGFR exist in 10-30% of NSCLC. Patients with mutated EGFR benefit from
personalized treatment, using tyrosine kinase inhibitors, and do experience a progression-free survival.
College of American Pathologists guidelines recommend the use of fresh/frozen or FFPE specimens
for the PCR-based EGFR mutation testing. More recently however, liquid biopsy was approved by the
FDA for this testing, and has been regarded as a surrogate for tissue EGFR mutational testing.
Methods:
A modeling approach is applied to validate and implement the use of liquid biopsy scheme in our
center. T790M and L858R EGFR mutations were selected for this purpose. DNA sample (20ng/µl)
extracted from two independent NSCLC FFPE tissues (30% tumor), were spiked into normal plasma
then serially diluted. DNA was recovered from each dilution using EZ1 instrument (QIAGEN), then
subjected to mutation testing using our real-time EGFR Plasma-Specific kit (QIAGEN). Plasma from
a previously confirmed patients with EGFR-positive using FFPE ware also assessed using the same
Qiagen Kit.
Results:
With respect to the TM mutation, we could only detect the first dilution point, whereas the remaining
points were negative, suggestive of a low TM mutation titer. LR deletion mutation however was
positive for 6 out of 8 dilution points, consistent with a high mutation titer sample. Negative control
samples showed no EGFR mutation positivity. Several patients positive by FFPE for TM and LR plasma
had also revealed positivity for both mutations using their post therapy plasma.
Conclusions:
The input DNA with the TM mutation is estimated at 1ng ( ̴5x109 genomic copies). DNA derived
from FFPE is cross linked and fragmented. The EGFR deletion mutation on the other hand, did show
a linear dynamic range, with a CT value of 27 for the first dilution point, allowing us to monitor the
linearity and robustness of our modeling assay. Despite a poor integrity of the recovered spiked
DNA (FFPE origin), we had managed in this modeling to detect key EGFR mutations from FFPE
samples. Further investigations in our center comparing more paired lung cancer samples is planned
to address the robustness of liquid biopsies utility for our lung cancer patients. Plasma mutation
positivity was concordant with the FFPE results, which ratifies the importance of using liquid biopsy
for monitoring therapy outcomes. Results and experience from KHCC using liquid biopsy as tool for
therapy monitoring will be presented.
.
Demo
15
O-16
Diagnostic Performance of FDG-PET/ CT scan as Compared to US-Guided
FNA in Prediction of Axillary Lymph Node Involvement in Patients with Newly
Diagnosed Breast Cancer
Corresponding Author Hazem Assi
Presenting Author Vanessa Akiki

Mohamad Haidar, Eman Sbaity, Ghina Berjawi, Lara Nassar, Jaber
Co-author(s)
Abbas, Nagi Saghir
Contact ha157@aub.edu.lb
Country LB
Introduction:
Axillary lymph node involvement is one of the most important prognostic factors in newly diagnosed
breast cancer patients. Although, non-invasive imaging modalities are being investigated lately in
evaluating axillary lymph nodes, the gold standard method remains an invasive surgical procedure
for consequent pathologic evaluation.
The aim of this study is to compare the diagnostic performance of PET/CT (Positron Emission
Tomography) versus US (Ultrasound) guided FNA (Fine Needle Aspirate) in evaluating axillary lymph
node metastasis in newly diagnosed breast cancer patients.
Methods:
In this retrospective study we included newly diagnosed breast cancer patients, referred to AUBMC,
from January 2014 till June 2017. 115 patients underwent both FDG PET/CT and US guided FNA
for staging and were included. EHR (Electronic health Record) was reviewed for each patient, PET/
CT, cytology and pathology reports were also retrieved. Se (Sensitivity), Spe (Specificity), PPV
(Positive predictive value) and NPV (negative predictive value) were calculated for PET CT and US
guided FNA. Both techniques were compared to each other and to final pathology report that was
considered the reference standard when available.
Results:
PET fairly correlated with cytology results with 80% agreement (Cohen’s k:0.35).FNA guided biopsy
was shown to be a sensitive method for detection of axillary involvement with a Se of 95.83%,Spe60.00
%,PPV 79.31% ,NPV 90.00 %.PET/CT correctly classified 24 of the 39 cases; twelve false-positive
and three false-negative PET results were found. The overall sensitivity, specificity, PPV and NPV of
PET for axillary metastases were 86.36%, 29.41 %, 61.29% and 62.50 % respectively.
Conclusions:
PET CT showed good overall sensitivity in detecting Lymph node metastasis is newly diagnosed
breast cancer patient thus is a valuable tool for staging. However FDG-PET/CT, cannot replace
histological evaluation of axillary status since a high false positive rate can be encountered. Technical
evolution of the PET CT modality and the development of more specific radiopharmaceuticals may
spare breast cancer patients invasive and painful procedures in the near future.
.
Demo
16
O-17
Androgen Receptor Influences Behavior of Breast Cancer Cells via Micrornas:
Evidence Of Stronger Transcriptional than Post-Transcriptional Regulation
Corresponding Author Mamoun Ahram
Presenting Author Mamoun Ahram

Nihad Al-Othman, Nahid S. Saber, Randa Bawadi, Mohammad
Co-author(s) Salah, Dana Alsafadi, Ebtihal Mustafa, Hana Hammad, Maysa Al-
Husseini
Affiliation The University of Jordan
Contact dr.ahram@gmail.com
Country JO
Introduction:
Androgen receptor (AR) plays an important role in the biology of the breast cancer of different
classifications. In this study, AR control of breast cancer cell behavior via microRNA molecules
(miRNAs) and their mRNA target(s) was investigated in T47D cells and MDA-MB-231 cells, which
represent luminal and triple negative breast cancer (TNBC), respectively. In addition, profiling of
miRNA expression in TNBC tissues in association with AR expression was examined.
Methods:
Regulation of miRNA expression was assessed using PCR arrays. Validation of molecular alterations
was confirmed by real-time PCR and/or immunoblotting. Cellular behavior was studied following
treatment of cells with dihydrotestosterone (DHT) and/or transfection of cells with miRNA mimic or
anti-sensemolecules.
Results:
In MDA-MB-231 cells, expression of miR-328-3p was found to be highly up-regulated following
treatment with DHT. The same miRNA was found to be significantly over-expressed in AR+ TNBC
tissues in addition to 4 other miRNAs found to have altered expression in DHT-treated cells. As
a target of miR-328-3p, it was found to mediate the effect of DHT on the expression and function
of CD44. MiR-328-3p was found to mediate the effect of DHT on expression and function of
CD44. However, it appeared that the negative transcriptional regulation of CD44 by DHT was
more significant than the post-transcriptional, miRNA-mediated regulation.
On the other hand, treatment of T47D cells with DHT resulted in expression changes of 3 miRNAs
including miR-148-3p. The latter miRNA negatively targets metalloprotease-13 (MMP13). However,
DHT stimulated expression and release of MMP13 in association with increased MMP13-dependent
migration and invasion. Transfection of cells with miR-148-3p caused a reduction in the release of
MMP13, but did not block DHT-induced MMP13.
Conclusions:
These results indicate that although AR can regulate the behavior of breast cancer cells via miRNA,
its transcriptional regulation is stronger than its post-transcriptional regulation via miRNAs.
17
O-18
Genetic Counseling and Genetic Testing for Germline BRCA1/2 Mutations among
High Risk Breast Cancer Patients in Jordan, a Study of 500 Patients
Corresponding Author Hikmat Abdelrazeq
Presenting Author Hikmat Abdelrazeq

Lama Abujamous, Amal Al-Omari, Sara Edaily, Abdelghani Tbakhi,
Co-author(s)
Hazem Abdulelah
Country JO
Introduction:
Breast Cancer is the most common cancer among Jordanian women. Almost 50% of patients are
diagnosed before the age of 50. Knowledge of BRCA1/2 mutations has significant clinical impact
on the management and prevention of breast cancer. In this study, we evaluate the prevalence of
germline mutations in BRCA1/2 among high-risk Jordanian patients selected as per the updated
NCCN guidelines.
Methods:
Jordanian breast cancer patients, stages I-IV, with a selected high risk profile treated at our institution
were invited to participate. Blood samples were obtained for DNA extraction and BRCA sequencing
was performed at Leeds Cancer Center, Leeds-United Kingdom. BRCA1/2 mutations were classified
as pathogenic/likely pathogenic and variant of uncertain significance (VUS). Clinical and pathological
data were obtained from patients’ medical records and a detailed 3-generation family history was also
obtained by a genetic counselor.
Results:
A total of 501 patients were enrolled and genetic testing and counseling have been completed for all.
Median age at diagnosis was 38 (range: 19-78) years. Among the whole group, 65 (13.0%) patients
had pathogenic/likely pathogenic BRCA1/2 variants while 44 (8.8%) others had VUS. Among the 308
(61.5%) patients who were 40 years or younger, the pathogenic/likely pathogenic mutations were
observed in 35 (11.4%) patients and 26 (8.4%) others had VUS. Among 168 (33.5%) patients who had
one or more close relatives with breast cancer, diagnosed at age 50 years or younger, 35 (20.8%) had
pathogenic/likely pathogenic mutations and 12 (7.1%) others had VUS. Patients with triple-negative
(TN) disease (n=62) had higher rates of pathogenic/likely pathogenic mutations (33.9%) and such
positive mutation rate was significantly higher (60.0%) among 15 patients with positive family history,
too. No founder mutations could be identified.
Conclusions:
As we reported previously, BRCA1/2 mutations are not uncommon and may contribute to the
pathogenesis of familial breast cancer among Jordanians. Young age, per se, has the weakest
association with positive BRCA1/2 mutations while TN-disease especially when associated with positive
family history has significantly higher mutation rate. The establishment of Clinical Cancer Genetics
program made running such culturally-sensitive genetic testing and counseling more acceptable even
in societies like ours.
18
O-19
Availability, Rate of Usage, and Impact of Commercialized Genomic Tests on
Adjuvant Treatment Decisions in Early-Stage Breast Cancer Patients in Lebanon
Presenting Author Nour Abdul Halim

Juliett Berro, Eman Sbaity, Maya Charafeddine, Arafat Tfayli, Fadi
Co-author(s)
Farhat, Fadi Karak, Nagi Saghir
Country LB
Introduction:
Breast cancer patients with the same stage can have different outcomes. Advances in genomic
techniques have been important tools aiding physicians in taking decisions regarding the patients’
treatments. This results in improved personalized patient care. Several multigene assays have been
developed in an attempt to identify the category of patients with ER positive breast cancer that have
the potential of benefitting from chemotherapy. These assays include Oncotype DX, Prosigna, and
Endopredict. Patients with ER-positive tumors are always offered chemotherapy and/or hormonal
therapy. Some patients might be overtreated and others undertreated. Therefore, having reliable
prognostic factors is of utmost importance. The primary objective of this study is to show the impact
of commercialized genomic tests on adjuvant treatment decisions in early stage breast cancer patients
in Lebanon. In patients with early stage hormone positive HER-2 negative breast cancer, the adjuvant
treatment following surgery consists of chemotherapy followed by hormonal therapy or hormonal
therapy alone.
Methods:
Patients diagnosed with early stage breast cancer at 3 main hospitals in Lebanon were selected and
the physician’s choice of treatment was recorded before and after the results of the multigene assay
tests were out. Baseline demographics and pathological data of each patient was collected from the
treating oncologist and medical records.
Results:
A total of 102 patients were followed up. 55 patients underwent oncotype DX genomic analysis, 33
underwent Prosigna, and 14 underwent Endopredict. Out of the 102 patients, the decision to change
treatment was taken in 56 patients. Out of the 56 patients whose treatment regimen was changed,
the decision to deescalate treatment to only hormonal therapy after receiving the genomics assay
results was exhibited in 49 patients. Moreover, the decision to escalate treatment to both hormonal
and chemotherapy was taken in 7 patients. However, for the rest of the 46 patients, no change in
treatment occurred before and after the genomics assay.
Conclusions:
The results have shown that more than 50% of the patients have exhibited treatment de-escalation.
Such findings shed the light on the importance of genomic analysis in reducing chemotherapy
prescription, taking into account its deleterious side effects and cost.
19
O-20
Breast Cancer among Elderly Jordanian Patients; Tumor Characteristics,
Treatment Modalities and Outcomes
Corresponding Author Hikmat Abdelrazeq
Presenting Author Hikmat Abdelrazeq

Hanan Al-Masri, Hazem Abdelelah, Mahmoud Abu Nasser, Mourad
Co-author(s)
Salam, Ayat Taqash
Country JO
Introduction:
Breast cancer is the most common cancer and its incidence is higher among older women. Less
than 10% of newly diagnosed breast cancer in our region, compared to 30% in western societies,
are diagnosed in women older than 70 years. Such group of patients remains underrepresented in
clinical trials, their treatment plan is less clear and have poor outcomes. In this paper, we describe
clinical presentation, tumor characteristics, treatment modalities and outcomes among elderly
Jordanian breast cancer patients.
Methods:
Consecutive patients aged 65 years or older with pathologically-confirmed diagnosis of breast
cancer, treated and followed up at our institution, were included. Medical records and hospital
databases were searched for patients’ characteristics and treatment outcomes.
Results:
A total of 593 patients, median age 70 (range: 65-91) years, were included. On presentation, 117
(19.7%) patients had metastatic disease and was mostly visceral (89: 76.1%). Patients with non-
metastatic disease had poor pathological features including node-positive in 275 (59.7%), GIII in
180 (38.3%) and lymphovascular invasion in 180 (44.2%). Among the patients with known HER-2
status, 94 (17.7%) were positive and 40 (6.8%) were triple-negative. Among patients with non-
metastatic disease, 171 (35.9%) had no chemotherapy and 37 (7.8%) had no surgery mostly because
of patients’ refusal, comorbidities or poor performance status. Modified radical mastectomy was
the most performed surgery (306; 69.7%) while 129 (29.4%) patients had breast conserving surgery
and only 22 (5.0%) had reconstruction. Among the patients with metastatic disease, only 17 (14.5%)
were treated with chemotherapy. After a median follow up of 40 months, 5-year overall survival
for the whole group was 68.9%. Survival was better for patients with non-metastatic disease (80.1%
vs. 26.0%, P<0.0001) and for those with node-negative (87.4%) compared to 74.9% for those with
node-positive disease, P=0.0003 (Figure-1). On Cox regression, only positive lymph nodes was
associated with poor outcome in patients with non-metastatic disease (Hazard Ratio [HR], 2.4; 95%
CI: 1.44-3.95, P=0.0007).
Conclusions:
Elderly Jordanians with breast cancer present with aggressive features and advanced-stage disease
that reflect poorly on treatment outcomes. Because of comorbidities and poor performance status,
many patients were not aggressively treated.
.
20
O-21
Effectiveness of Cyanoacrylate (Glubran 2(R)) in Reducing Seroma Formation in
Breast Cancer Patients Post-Axillary Dissection, Randomized controlled trial
Corresponding Author Mahmoud Al Masri
Presenting Author Mahmoud Al Masri
Co-author(s) Faeiz Daoud, Basem Hamdan, Ali Ebous, Hani Al-Najjar
Contact malmasri@khcc.jo
Country JO
Introduction:
Axillary dissection is still considered in managing patients with node positive breast cancer. Seroma
formation being the most common complication faced after axillary dissection and currently there is
no conclusive data available to support the use of any modality to decrease seroma formation. This
trial aimed to test effect of Cyanoacrylate on reducing seroma formation in patients undergoing
Axillary dissection.
Methods:
Single-center, randomized, single-blinded, and two-arm parallel study. Enrolled women with Node
positive breast cancer proven by FNA or sentinel lymph node and eligible for Axillary dissection.
Patients with a BMI greater than 35, those who needed immediate breast reconstruction surgery and
those received neoadjuvant chemotherapy were excluded. Patients randomized to Cyanoacrylate
or no Cyanoacrylate in 1:1 ratio. The primary objective is to analyze the difference in total volume
of Seroma formation, calculated through the total drained and total aspirated volume after drain
removal between the two groups. Secondary objectives will look at safety, cost-effectiveness, Time
to drain removal and Number of Seroma aspirations.
Results:
Between January 2014 and April 2018, 111 patients were randomized (57 into Cyanoacrylate arm,
54control into control arm), results from 105 patients were analyzed after exclusion of six patients,
four of whom lost follow up and 2 duo to post-operative hematoma. 69 underwent breast conserving
surgery, and 38 underwent modified radical mastectomy. There was no significant difference in the
total volume of seroma between the two arms; with a mean volume of 1304(60-4950) ml in the
Cyanoacrylate arm and 1446(100-5223) ml in the control arm (p -value 0.458). Wound infection, flap
necrosis and number of manual aspirate were not statistically different between the two groups.
Time to drain removal was shorter in the Cyanoacrylate arm 11.04 VS 13.84(p-value 0.015).The
use of cyanoacrylate in axillary dissection is not cost effective with mean cost of 586.93$(550–748)
in Cyanoacrylate arm vs 29.63 $(0–198) in control arm(p-value<.001). Subgroup analysis showed
that Modified radical mastectomy, the increase in Age, and BMI more than30 kg/m2 correlate with
higher volume of seroma.
Conclusion:
Cyanoacrylate use in axillary dissection did not reduce seroma formation.
21
O-22
Amenorrhea and Fertility Preservation among Young Women Treated with
Chemotherapy for Early-Stage Breast Cancer
Presenting Author Omar Shahin
Co-author(s) Khawla Ammar, Lina Yousef, Razan Mansour, Hadil Zureigat
Country JO
Introduction:
Almost half of women in Jordan are premenopausal at time of breast cancer diagnosis. Additionally,
more than 15% of them, compared to 5% in western societies, are below the age of 40 years at
time of diagnosis. Standard cytotoxic chemotherapy regimens for breast cancer do appear to cause
some ovarian toxicity. Given the nature of cancer as an illness, patients are usually overwhelmed
by, and focused exclusively on the cancer diagnosis and may not pay the same attention to fertility-
related issues. In this paper we looked at the rate of amenorrhea and fertility counseling among
young patients diagnosed and treated for breast cancer in Jordan.
Methods:
Premenopausal women with early-stage breast carcinoma age 40 years or younger treated and
followed up at our center were identified. Majority (n=86, 89.6%) of the patients were treated
with adjuvant anthracycline while 68 (70.8%) were also given a taxane (docetaxel or paclitaxel).
Additionally, 78 (84.8%) were on endocrine therapy, too. Amenorrhea was defined as absence of
menstruation for ≥ 12 months after the completion of all chemotherapy.
Results:
At time of reporting, 94 patients met the eligibility criteria and were included in this analysis.
The median age at diagnosis was 35.7 (range, 22-44) years. All patients, except 10 (10.6%) had
regular pretreatment menses, 79 (87.8%) respondents were counseled by their oncologists about
amenorrhea as a complication of chemotherapy and 37 (40.7%) were considering having children
post treatment. Fifty-one (55.3%) patients developed long-term amenorrhea. Patients who received
chemotherapy for ≥ 24 weeks tended to have higher incidence of amenorrhea compared to those
who had a shorter course of chemotherapy (67.7% versus 47.2%, p=0.068). The addition of taxanes,
however, to anthracycline-based chemotherapy increased the risk of amenorrhea (57.8% versus
38.9%, P<0.0001). Younger patients (≤ 35 years) had lower amenorrhea rate (51.3% versus 58.5%),
but the difference was not statistically significant.
Conclusions:
Our rates of amenorrhea is significantly higher than others had previously reported. The sequential
addition of taxanes to standard adjuvant anthracycline-based chemotherapy resulted in statistically
significant higher rate of amenorrhea. Our study is still recruiting; larger number of patients will
hopefully empower our conclusions.
22
O-23
Fertility in Breast Cancer Survivors Following Breast Cancer Treatment at
AUBMC: A Retrospective Study
Presenting Author Rasha Kakati

Rose Mary Attieh, Juliett Berro, Eman Sbaity, Jaber Abbas, Faek
Co-author(s)
Jamali, Ali Shamseddine, Ziad Salem, Arafat Tfayli, Nagi Saghir
Country LB
Introduction:
By the time they complete breast cancer therapy; many women are still of childbearing age and
have not yet completed their families. The main goal is to estimate the incidence of pregnancies
in women who have completed breast cancer treatment and are still of reproductive age, and the
percentage of patients who received fertility counseling prior to therapy initiation.
Methods:
Electronic health records (EHR) of patients treated for breast cancer between 2008 and 2011 at
AUBMC were screened for exclusion criteria of having metastatic disease or known infertility, still
receiving therapy, being above 42 years at diagnosis, or lacking follow up at AUBMC. Data about
therapy and tumor characteristics was obtained from EHR for the remaining patients, who were then
interviewed via telephone for information about pregnancy intention, pregnancies achieved after
therapy cessation, use of fertility preservation techniques, and discussion with primary oncologists
concerning infertility.
Results:
451 patients met the inclusion criteria between 2008 and 2014, and 39 patients with valid data
remained after exclusions from EHR and telephone interviews. 84.61% (n=33) of patients already had
children prior to diagnosis, and 30.76% (n=12) wanted more children at diagnosis. 10.25% (n=4) of
all patients achieved one or more pregnancy after a median time of 3.83 years after completion of
therapy. 23.07% (n=9) of patients discussed fertility with their primary oncologist prior to treatment
initiation. 35.89% (n=14) of patients were aware of fertility preservation technique availability before
starting therapy, but none of these patients used one.
Conclusions:
The observed rate of pregnancy is 10.25% (n=4), which is comparable to studies from the US (13%).
There is an overwhelming lack in fertility counseling of breast cancer patients compared to the US.
The rate of use of fertility preservation techniques is very low despite prior knowledge about their
availability, unlike in other reports.
.
Demo
23
O-24
Effect of PD-L1 Expression on Survival in Advanced Stage NSCLC Patients
Harboring EGFR mutations and Receiving EGFR TKIs
Corresponding Author Kamal Al-rabi
Presenting Author Kamal Al-rabi

Maher Sughayer, Faris Tamimi , Abdellah Tell, Tala Awabdeh,
Co-author(s)
Sameer Yaser, Husam abu Jazar, Taher Abu Hijleh
Contact ka.10798@khcc.jo
Country JO
Introduction:
In NSCLC, EGFR mutations and increased PD-L1 expression are associated with enhanced tumor
response to TKIs and PD-1/PD-L1 antibodies, respectively. Alternatively, NSCLC patients with
EGFR mutation are less likely to benefit from PD-1/PD-L1 antibodies. The effect of increased PD-L1
expression on response to EGFR TKIs in NSCLC is still debatable.
Methods:
After IRB approval was obtained, we retrospectively reviewed the data on NSCLC patients harboring
EGFR mutations at King Hussein Cancer Center (KHCC) between 2013 and 2019. Demographic and
clinical characteristics including PD-L1 expression level by immunohistochemistry were collected.
The effect of PD-L1 expression level on progression free and overall survival in the EGFR mutated
patients was examined using Kaplan-Meier curves and Log-Rank tests. Statistical analysis was done
using SPSS.
Results:
A total of 47 EGFR mutated advanced stage NSCLC cases were included. The median age was 60
years (range: 30-91). Smoking history was identified in 20 patients (42%). PD-L1 expression was
<1% in23 (48%) tumors, 1-49% in 15 (31.9%) tumors, and ≥50% in 9(19.1%) tumors. Thus, most
patients, 38/47 (80.8%), had PD-L1<50%. All patients received Gefitinib except for 1 patient who
received Erlotinib as an EGFR TKI. Progression-free survival was significantly worse for patients with
PD-L1 ≥50 % compared to those with PD-L1 <50% (11.1 vs 8.5 months, p=.023). PD-L1≥50% was
also associated with significantly worse overall survival in comparison to patients with PD-L1<50%
(32.7 vs. 17.6 months, P=.011). The multivariate analysis also showed worse survival for cases with
PD-L1 ≥50% after adjusting for multiple covariates (Table 1)
Conclusions:
In advanced stage EGFR mutated NSCLC, 80.8% of the patients had PD-L1 <50%. In spite of
receiving EGFR TKIs, PD-L1 ≥50% was associated with significantly worse survival compared to
PDl-L1 <50%. It is unknown whether newer generation EGFR TKIs such as will prove more effective
in cases with higher PD-L1 levels.
24
O-25
Prevalence of Programmed Death Ligand 1 in Patients Diagnosed with Non-
Small Cell Lung Cancer in the Levant
Corresponding Author Arafat Tfayli
Presenting Author Majd Al Assad

Ghina Fakhri, Reem Akel, Ibrahim Khalifeh, Hassan Chami, Adel Hajj
Co-author(s)
Ali, Humam Kadara
Contact ma464@aub.edu.lb
Country LB
Introduction:
Programmed death ligand-1 (PD-L1) expression has been shown to be a good predictor of response
to cancer therapy with checkpoint inhibitors. Its expression varies among different tumors types
and among non-small cell lung cancer (NSCLC) patients with different clinical and demographic
characteristics. The prevalence and determinants of PDL-1 expression have been previously reported
from various regions of the world but data from the Levant region are lacking. Our study examines
the prevalence and the clinical, demographic and pathologic predictors of PD-L1 expression in
patients diagnosed with NSCLC in the Levant region.
Methods:
Medical records of 180 patients diagnosed with primary NSCLC at the American University of
Beirut Medical Center and tested for PD-L1 expression were reviewed. Clinical, demographic and
pathological information were collected and correlated with PDL-1 expression using Chi-square
test and logistic regression.
Results:
111 of the 180 NSCLC tumor samples tested positive for PD-L1expression (61.7%). 27.2% of those
tumor samples expressed PD-L1 in 1-49% of tumor cells, while 34.4% of tumor samples expressed
PD-L1 in 50% or more of their cells. Squamous histology and advanced stage were significant
predictors of PD-L1 expression (OR=2.79, 95%CI [1.13-6.90], p=0.012 and OR=2.48, 95%CI [1.23-
4.99], p=0.044 respectively).
Conclusions:
Similar to reports from other populations, our results suggest that PDL-1 expression in NSCLC is
highly prevalent in the Levant population, especially in patients with advanced stage at diagnosis or
squamous cell carcinoma histology. Testing for this immune marker expression should be therefore
considered in the Levantine population in view of its importance to optimal therapy for NSCLC.
25
O-26
Neutrophil Lymphocyte Ratio Association with Baseline Brain Metastasis in
Stage IV Non-Small Cell Lung Cancer
Corresponding Author Taher Abu Hejleh
Presenting Author Osama Abu-Shawer

Abu-Shawer M, Alwazani A, Alkhatib A, Abu-Hussain B, Aladawi M,
Co-author(s) Alkderat M, Ismail S, Altamimi, T, Alrabi K, Yaser S, Zhang J, Furqan
M, Clamon G.
Contact taher-hejleh@uiowa.edu
Country JO
Introduction:
High neutrophil-lymphocyte ratio (NLR) is associated with poor survival in lung cancer. This study
evaluates whether NLR is associated with baseline brain metastasis in stage IV Non-Small Cell Lung
Cancer (NSCLC).
Methods:
Medical records of stage IV NSCLC patients treated at King Hussein Cancer Center (Amman-Jordan)
between 2006 and 2016 were reviewed. Patients with baseline brain imaging and CBC were included.
Receiver Operating Characteristic (ROC) curve was used to identify the optimal cutoff value for the
association between NLR and baseline brain metastasis. Correlation between age, gender, location
of the primary tumor, histology and NLR was assessed using univariate and multivariate logistic
regression analyses.
Results:
A total of 722 stage IV NSCLC patients who had baseline brain imaging were included. Median
age was 59 years. Baseline brain metastasis was present in 280 patients (39%). Nine patients had
inconclusive findings about brain metastasis. The ROC curve value of 4.3 was the best fitting cutoff
value for NLR correlation with baseline brain metastasis. NLR ≥ 4.3 was present in 340 patients
(48%). The multivariate analyses showed that high baseline NLR (≥ 4.3) was significantly associated
with higher odds of baseline brain metastasis (OR 1.6, 95% CI: 1.2-2.2; P= 0.004). Adenocarcinoma
histology was also associated with baseline brain metastasis (OR 0.4, 95% CI: 0.25-0.6; P= 0.001).
Conclusions:
High NLR is associated with baseline brain metastasis in advanced stage NSCLC. In the era of
immunotherapy and targeted therapies, whether high NLR predicts response of brain metastasis to
treatment is unknown.
26
O-27
Establishment and Characterization of Prostate Cancer Patient-derived
Organoids and Cells
Corresponding Author Wassim Abou-Kheir
Presenting Author Wassim Abou-Kheir

katia Cheaito, Hisham Bahmad, Ola Hadadeh, Miza Hammoud,
Co-author(s)
Ayman Tawil, Marwan El-Sabban, Albert El-Hajj, Deborah Mukherji
Contact wa12@aub.edu.lb
Country LB
Introduction:
The currently available cancer models fail to recapitulate the heterogeneity of Prostate cancer (PCa),
its metastasis, and progression to castration-resistant states. Many drug candidates that succeed
in preclinical models fail to deliver a good outcome in clinical trials, resulting in ineffective patient
treatment and misused resources. In this aspect, the development of three-dimensional (3D) organoid
culture systems render it feasible to recap the convolution of organogenesis in vitro, promoting the
generation of novel and more representative cancer models. Thus, the aim of this study is to generate
patient-specific 3D organoids and two-dimensional (2D) cell lines, then characterize these models to
identify potential prognostic biomarkers and treatments for PCa while correlating the outcome with
the collected clinical parameters.
Methods:
We are employing the R-spondin-1 based organoids technology to generate PCa organoids and
primary cell lines derived from fresh unaffected and tumor tissues of treatment-naïve patients
undergoing radical prostatectomy. Consequently, molecular characterization of the different patient-
derived PCa organoids and cell lines will be performed, followed by assessing different classical and
in-clinical trial drugs.
Results:
We were successful in generating 26 unaffected and 24 tumour patient-derived organoids, out of a
total of 30 patients, and capable of culturing organoids for up to 6 generations. Interestingly, 2D cells
were derived from these organoids using the same culture media and were continuously passaged
for up to 30 passages (more than 3 months). Our preliminary data indicates that our patient-derived
organoids and cell lines show a typical epithelial phenotype and express Cytokeratin 5, Cytokeratin 8,
Androgen Receptor and Prostate Specific Antigen. These models were further used to assess clinically
used drugs and treatment approaches including chemotherapeutic agents (Docetaxel), Androgen-
deprivation therapy (Bicalutamide and Enzalutamide). Our results show differential drug effects from
one patient to the other.
Conclusions:
In this study, we are employing a novel methodology to establish patient-derived 3D organoids and
cells to be used as a model for drug screening and to further characterize the mutational landscape of
PCa. Consequently, the molecular characterization of this model when combined with pharmacological
profiles can aid in personalizing the treatment of PCa.
27
O-28
Prostate Cancer (PC) in the Jordanian Population: Disease Trends and Outcomes
at King Hussein Cancer Center (KHCC)
Corresponding Author Amal Al Omari
Presenting Author Amal Al Omari

Sana’a Otoom, Mahmoud A Alfaqih, Maysa Al-Hussaini, Dalia Al-Rima-
Co-author(s)
wi, Samer Salah.
Contact asomari@khcc.jo
Country JO
Introduction:
PC is the fourth most common cancer among Jordanian adult males with crude incidence of 8.1% in
2015. Studies on PC trends in Jordan are few and data is scarce on patients and disease characteristics.
We thus conducted a comprehensive epidemiological evaluation of PC at KHCC to better understand
disease trends and outcomes.
Methodology:
A retrospective chart review of all PC cases referred to KHCC over a ten-year period (2006-2016)
was performed. Collected variables included: age, PSA at time of diagnosis, stage, pathological
classification, treatment, drug history, comorbidities, dates of any PSA or radiologic progression,
and dates of last follow-up or death. Survival rates were estimated using Kaplan-Meier method and
compared between groups using Log-rank test. Multivariate Cox-regression was used to assess
prognostic factors.
Results:
A total of 910 cases were identified. Median age at diagnosis was 68 (range: 40- 94 years). Thirty-one
percent of patients presented with metastatic-disease, 62% were smokers and 79% were overweight/
obese. Thirty-seven percent of patients had PSA >20 ng/mL and 44.9% presented with Gleason-score
(GS) â‰¥8. At a median follow up of 32 months, median overall survival (OS) was significantly longer
in patients with localized compared to metastatic-disease (188 months vs. 58 months, respectively,
p<0.001). Smokers with metastatic disease had lower median OS compared to never-smokers (47
months vs. 64 months respectively, p=0.038), Figure 1. However, using multivariate Cox-regression
adjusting for age, smoking, BMI, PSA, GS and visceral metastasis, only PSA >20ng/ml was a significant
predictor of OS in metastatic-patients [HR 1.89(95%CI: 1.13-3.19), p=0.016], Table 1. In patients
with localized-disease: age, clinical T-stage, PSA and GS at diagnosis emerged as independent
prognostic factors for OS in multivariate analysis, p-values= 0.055, 0.002, 0.002, 0.013, respectively,
Table 2, while PSA, GS and statin-use were independently associated with progression-free survival,
p-values=0.0161, 0.0006, 0.0928, respectively.
Conclusions:
In this first study evaluating PC trends and outcomes at KHCC, prognostic factors were largely not
different from other cohorts. However, the finding that one third of PC is metastatic at presentation
compared to only 5% in western cohorts deserves further investigation and may highlight the need
for national screening programs.
28
O-29
EMT Markers in Locally-Advanced Prostate Cancer: Predicting Recurrence?
Corresponding Author Wassim Abou-Kheir
Presenting Author Wassim Abou-Kheir

Katia Cheaito, Hisham F. Bahmad, Ola Hadadeh, Eman Saleh,
Christelle Dagher, Miza Salim Hammoud, Mohammad Shahait, Zaki
Co-author(s) Abou Mrad, Samer Nassif, Ayman Tawil, Muhammad Bulbul, Raja
Khauli, Wassim Wazzan, Rami Nasr, Ali Shamseddine, Sally Temraz,
Marwan El-Sabban, Albert El-Hajj, Deborah Mukherji
Contact wa12@aub.edu.lb
Country LB
Introduction:
Prostate cancer (PCa) is the second most frequent cause of cancer-related death in men worldwide. It
is a heterogeneous disease at molecular and clinical levels which makes its prognosis and treatment
outcome hard to predict. The epithelial-to-mesenchymal transition (EMT) marks a key step in the
invasion and malignant progression of PCa. We sought to assess the co-expression of epithelial
cytokeratin 8 (CK8) and mesenchymal vimentin (Vim) in locally-advanced PCa as indicators of EMT
and consequently predictors of the progression status of the disease.
Methods:
Co-expression of CK8 and Vim was evaluated by immunofluorescence (IF) on paraffin-embedded
tissue sections of 122 patients with PCa who underwent radical prostatectomies between 1998
and 2016 at the American University of Beirut Medical Center (AUBMC). EMT score was calculated
accordingly and then correlated with the patients’ clinicopathological parameters and PSA failure.
Results:
The co-expression of CK8/Vim (EMT score), was associated with increasing Gleason group. A highly
significant linear association was detected wherein higher Gleason group was associated with
higher mean EMT score. In addition, the median estimated biochemical recurrence-free survival
for patients with less than 25% EMT score was almost double that of patients with more than 25%.
The validity of this score for prediction of prognosis was further demonstrated using cox regression
model. Our data also confirmed that the EMT score can predict PSA failure irrespective of Gleason
group, pathological stage, or surgical margins.
Conclusions:
This study suggests that assessment of molecular markers of EMT, particularly CK8 and Vim, in radical
prostatectomy specimens, in addition to conventional clinicopathological prognostic parameters,
can aid in the development of a novel system for predicting the prognosis of locally-advanced PCa.
29
O-30
Statin Use Improves The Survival of Colorectal Cancer (CRC) Patients in Jordan:
An Observational Study at King Hussein Cancer Center (KHCC)
Presenting Author Mahmoud A. Alfaqih
Co-author(s) Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, Nour Awad
Country JO
Introduction:
CRC is the most common cancer among Jordanian men and the second most common among
women. Prior studies demonstrated the survival benefits of statin in CRC. Despite being a major
health problem, the association of statin with patient survival in Jordan was not tested.
Methods:
We retrospectively reviewed the medical records of 1902 patients diagnosed with CRC at KHCC
between January 2004 and December 2012 and identified 245 patients who were statin users at the
time of their first evaluation at KHCC. Other variables included: age, sex, Body Mass Index (BMI),
TNM stage at diagnosis, type 2 diabetes mellitus (T2DM) status and the use of aspirin, progression
free (PFS) and overall survival (OS). We then compared median PFS and OS between statin-users
and non-users using Kaplan Meir methods and Log-rank sum test. Multivariate Cox regression was
used to test if the effect of statin on OS was independent of all other variables.
Results:
Statin-users had significantly longer OS (OS; median OS was not reached) and PFS (PFS; median
PFS was not reached) than non-users (OS: 51 [95% CI, 44-58] months, p<0.001; PFS: 23 [95%
CI, 20-26] months; p<0.001). Following the adjustment for age, sex, BMI, aspirin and CRC stage,
statin-users had 31% reduction in mortality (hazard ratio, 0.69 [95% CI, 0.5-0.93]; p=0.013).
Conclusions:
Our findings are in agreement with other cohorts that statin improve PFS and OS of CRC patients.
Although this still requires validation, our findings highlight the potential use of statin for the
treatment of CRC in the adjuvant setting.
30
O-31
Predictors of Augmented Renal Clearance in Critically-Ill Patients with Cancer
Corresponding Author Lama Nazer
Presenting Author Lama Nazer
Co-author(s) Lama Sheikha, Nadeen Anabtawi
Contact lnazer@khcc.jo
Country JO
Introduction:
Augmented renal clearance (ARC) has been reported in critically ill patients. It is characterized by
enhanced renal function and may result in subtherapeutic levels of renally eliminated drugs that are
essential for the management of cancer patients. With limited data on ARC in critically-ill patients
with cancer, this study aimed to evaluate the incidence of ARC and identify risk factors associated
with ARC in this population.
Methods:
A single-center prospective study in an oncologic intensive care unit (ICU). Patients ≥ 18 years with
no renal dysfunction upon ICU admission and a serum creatinine ≤ 1 mg/dL had their urine collected
from the time of ICU admission to ICU transfer (up to a total of 5 days). Creatinine clearance (ClCr)
was calculated from a 24-hour urine collection; ARC was defined as ClCr >130 mL/min/1.73m2.
Univariate and logistic regression analyses were used to identify predictors for ARC. For significant
predictors, a receiver operating characteristic (ROC) curve was constructed and the area under
the ROC curve (AUROC) as well as the sensitivity, specificity, and cut-off points with the highest
predictability for ARC were determined.
Results:
Over the 1-year study period, 425 urine samples were collected from 138 patients. Most patients
were males (n=80, 58%) with solid malignancies (n=103; 74.6%). The most common admission
diagnosis were infectious (n=77, 56%) and respiratory (n=29, 21%). Mechanical ventilation was
required for 62 (45%) patients, and thrombocytopenia and neutropenia upon admission were
reported in 47 (34%) and 20 (15%) patients, respectively. ARC was reported in 32 (23%) patients
on the first day of ICU admission and 47 (34%) patients on any of the study days. Age was the only
predictor significantly associated with ARC. The AUROC for age and ARC was 0.744 (95% CI 0.645-
0.843) with a sensitivity of 0.818 (95%CI 0.742-0.894) and specificity of 0.594 (95%CI 0.424-0.764).
The cut-off point with the highest predictability for ARC was age ≤ 43 years old.
Conclusions:
ARC was reported in about one-fourth of the critically-ill cancer patients, with age as a significant
predictor of ARC. Future studies should evaluate the impact of ARC on drug levels and outcomes
in this patient population.
31
O-32
Impact of Using Perioperative Pulmonary Care Bundle on Postoperative
Pulmonary Complications, Cancer Center Experience
Corresponding Author Riad Abdel Jalil
Presenting Author Riad Abdel Jalil
Co-author(s) Mahmoud Al-Masri, Faeiz Daoud, Hani Al-Najjar
Country JO
Introduction:
Postoperative pulmonary complication can be a major catastrophic consequence of major surgeries
can lead to a high morbidity and mortality as well as increase the hospital stay and the cost. Many
protocols have been tried to reduce such a serious adverse outcomes with effective strategies
including a bundle of preoperative, intraoperative and postoperative techniques.
Methods:
A before - after trial comparing our data from National Surgical Quality improvement program
(NSQIP) based on their reports. Data collected prospectively for the patients undergo major
surgeries in King Hussein Cancer Center during the year 2017 and compare it with data collected
retrospectively for the patients undergo same type of surgeries in the year 2016. The primary end
point is the decrease in the incidence of postoperative pulmonary complications. The secondary
end point is the decrease in the incidence of postoperative complications other than the pulmonary
one.
Results:
We studied the potential risk factors for the postoperative pulmonary complications for 1665
patients divided to 2 groups (2016 vs. 2017); 764(45.9%) vs. 901 (54.1%)Respectively; these were
no significant differences regarding Gender (male 46.7% vs. 46.4% P value = 0.891, female 53.3%
vs. 53.6% P value = 0.39), mean of age (53.5 year vs. 5.28 year P value = 0.296), mean of BMI (28.6
vs. 6%, 28.6 P value = 0.95), smoking status; ( 69.6% vs. 65.1% P value = 0.052), Ventilator use
(0.3% vs. 0.4% P value = 0.693) and COPD (1.4% vs. 1.4 with P value = 0.996 Respectively). the
data showed significant reduction in the postoperative pneumonia between the 2 groups (2016 vs.
2017) (2.7% vs. 0.9% P value = 0.004 Respectively and showed significant reduction in unplanned
intubation 1.4% in 2016 vs. 0.7% in 2017 in trend as well.
Conclusions:
standardization of perioperative pulmonary care bundle including smoking cessation, perioperative
pulmonary interventions and early mobilization significantly reduce the incidence of postoperative
pulmonary complications as well as many other complications in cancer patients.
32
O-33
Fertility Counseling and Sperm Banking among Male Adolescents and Young
Adults Treated for Cancer with Curative Intent in a Developing Country

Nayef Abdel-Razeq, Ahmad Mahadeen, Hashem Abdalwahed, Ronza
Co-author(s)
Gammoh, Kamal Rabie, Anas Al Hur, Nadira Al-Hassan
Country JO
Introduction:
Cancer is one of the leading causes of morbidity and mortality in Jordan. Almost 17% of all cancer
cases reported by our National Cancer Registry are diagnosed among adolescents and young adults
(AYA) aged 15-39 years. Over the last decades, cancer survival rates for most cancers had significantly
improved and younger patients survive their disease more often. Many of the cancer treatment
modalities, especially chemotherapy, may have negative impact on fertility both in males and females.
Methods:
Medical records and hospital database of AYA male patients with newly-diagnosed cancer and planned
to start curative chemotherapy were reviewed for fertility counseling and sperm cryopreservation. A
self-administered questionnaire was also utilized.
Results:
A total of 186 patients, mean age: 32.9 (range: 18-53) years were included. One hundred and eight
(58.1%) patients were married and 98 (52.7%) had children prior to cancer diagnosis. Non-Hodgkin’s
lymphoma 59 (31.7%), leukemia 48 (25.8%), Hodgkin’s lymphoma 26 (14.0%) and testicular cancer
15 (8.1%) were the most common tumors encountered. Among the patients with stagable cancers,
28.4% had an advanced-stage disease. Sperm banking was performed by 34.2% of the whole study
group. Patients failed to do sperm banking because they were not informed about the risk of infertility
(26.2%), not informed about the availability of the service (25.4%) or they thought that sperm banking
would delay their treatment (20.0%). Sperm banking rates were significantly higher among single
patients (53.4% vs.17.7%, p=0.000), those who had no children (51.8% vs.14.3%, p= 0.000) and
among highly-educated patients (47.6% vs. 17.1%, p=0.001). A total of 129 (75.0%) respondents
received fertility counseling by their oncologist prior to their treatment. Counseling rates were higher
among patients with early-stage disease (82.4% vs. 58.1%, p=0.038) and tended to be higher among
younger (<40 years) patients (78.8% vs. 64.0%, p=0.055). Level of education and income were not
significant factors.
Conclusions:
Fertility counseling and sperm banking among AYA patients treated for cancer are not optimal.
About a quarter of the patients failed to do sperm banking because of avoidable reasons. Better
communication and patients’ education will probably improve the utilization of this vital service.
33
O-34
High Incidence of Venous Thromboembolic Events (VTE) in Patients with Diffuse
Large B-Cell Lymphoma (DLBL)
Presenting Author Mohammad Ma'koseh

Asem Mansour, Mohammad Manasrah, Mohammad Rawashdeh, Mo-
Co-author(s)
hammad Almomani, Alaa’ Abu Farra, Mais Zmaily, Rula Amarin
Country JO
Introduction:
Venous thromboembolic events (VTE) is higher among cancer patients, especially while on
chemotherapy. Diffuse large B-cell lymphoma (DLBL) is the most common lymphoma. Studies that
speciﬁcally evaluated the risk of VTE in patients with different kinds of lymphomas reported a
risk ranged from 1.5% to 14.6%. In this study, we specifically address VTE in a unified lymphoma
population.
Methods:
Medical records and hospital databases were searched for patients with a diagnosis of DLBL and
VTE. All patients were diagnosed, treated and followed up at our institution. The Khorana and
“Throly” risk assessment models (RAM) were applied on all patients and known risk factors for VTE
were studied.
Results:
A total of 393 patients (52.4% males), median age: 49 (range: 18-90) years were included. At
diagnosis, 163 (41.5%) were stage IV, 116 (29.5%) had bulky disease and 197 (50.1%) had high
LDH. All patients were treated on a unified guidelines using R-CHOP chemotherapy; 285 (72.5%)
achieved CR while 72 (18.3) had salvage chemotherapy. Venous thromboembolic events were
reported in 57 (14.5%) patients. Pulmonary embolism (PE) with or without deep venous thrombosis
(DVT) was reported in 24 (42.1%), 8 of them (33.3%) were incidental. Upper extremity DVT were seen
in 18 (31.6%); only 4 (22.2%) were associated with a vascular device. Thrombosis was diagnosed in
ambulatory sitting in 30 (52.6%) and majority of the VTE occurred while on active chemotherapy;
20 (35.1%) while on initial induction and 15 (26.3%) while on salvage chemotherapy, however,
19 (33.3%) occurred before the initiation of any chemotherapy. Among the 35 patients on active
chemotherapy, only 6 (17.1%) had high Khorana risk score. In a multivariate analysis, significantly
higher rates of thrombosis were associated with stage-IV disease, high LDH and high International
Prognostic Index (IPI). Sex, age, BMI, and the Khorana risk score were not.
Conclusions:
Incidence of VTE in patients with DLBL is high and majority of such events occurred in ambulatory
setting were VTE prophylaxis is not offered. Upper extremity DVT and incidental PE were exceptionally
high. Stage at diagnosis, IPI score and LDH are important in predicting the risk for thrombosis.
34
O-35
Decision Making Preferences Among Patients with Advanced Cancer In A
Tertiary Cancer Center in Jordan
Corresponding Author Omar Shamieh
Presenting Author Mahmoud Abu Nasser
Co-author(s) Al-Hawamdeh A, Alomary M, Amin Z, Aiad O , Al Tabba’ A, Yennu S
Contact oshamieh@khcc.jo
Country JO
Introduction:
Decisional control is described as having the power to participate in decisions aimed to achieve
acceptable outcomes. The understanding of the patients’ expectations and preferences toward
decisional control is considered a key in the success of performed efforts to enhance patients
centered care, promote patient satisfaction, and quality of care.
To describe the status and aspects of decision-making preferences among patients which advanced
cancer in Jordan.
Methods:
This is a site specific analysis for a conducted international cross sectional survey study that included
11 countries, for patients with advanced cancer who were referred to palliative care at King Hussein
Cancer center in Amman, Jordan. Decision-making preferences and patient satisfaction were
collected using Control Preferences Scale and Satisfaction with Decision Scale.
Results:
A total of 200 patients were included in this site-specific analysis. Shared, active, and passive
decision control preferences were 36.5%, 25%, and 38.5%, respectively. Shared, active, and
passive actual decision making were 25%, 25%, and 50%, respectively. The patients with advanced
cancer supported passive decisional control preference by their physician (94.8%) more than they
supported passive decisional control by their family (5.2%). Concordance between the actual
decision-making and decision control preferences was significant (r=.602, p=0.00). Passive decision
control preference was only significantly associated with (odds ratio per point, p-value) employment
status (5.2/point, 0.001).
Conclusions:
Passive decision control preferences were more common (38.5%) than shared and active decision
control preference in Jordan. Significant predictor of passive decision control preferences was
employment status.
35
O-36
Original Filgrastim (Neupogen® and Biosimilar Filgrastim (Nivestim®):
Comparison of Effectiveness and Safety in Primary Prophylaxis of Chemotherapy-
Induced Febrile Neutropenia
Corresponding Author Abeer Al Rabayah
Presenting Author Suzan Hammoudeh
Co-author(s) Ola Al Mashni, Esraa Hanoun,Weam Al Qasem,Deema Al Momani
Contact arabaiah@khcc.jo
Country JO
Introduction:
Despite the demonstrated efficacy and safety of the biosimilar filgrastim products, few studies have
compared the effectiveness and safety of the original filgrastm, Neupogen®and the biosimilar
brands. Our aim was to evaluate the effectiveness and safety of Nivestim® compared to Neupog®
in the primary prophylaxis of chemotherapy-induced febrile neutropenia (FN).
Methods:
This was a cross sectional retrospective cohort study. All adult cancer patients at King Hussein
Cancer Center who received filgrastim for primary prophylaxis for chemotherapy-induced febrile
neutropenia between January 2014 and December 2016 were identified. The primary end-point,
incidence of febrile neutropenia, was compared between patients who had received Nivestim (cohort
1) and those who received Neupogen (cohort 2). The secondary end-points were: admissions for
febrile neutropenia, and the incidence of adverse drug reactions. Chi-squared tests were performed
to evaluate differences among groups.
Results:
A total of 238 patients were identified, of whom 156 had received Nivestim and 82 had received
Neupogen. Among the patients, 154 (65%) were females, 160 (67%) had solid tumors, and the
remaining had hematological malignancies. The mean (range) age of patients for cohort 1 was 46.4
(44.6,48.3) and for cohort 2 was 48.9 (45.7,52.1). Febrile neutropenia was reported in 16(10.5%)
patients in cohort 1 and 12(15.2%) patients in cohort 2, p=0.322. There was no statistically significant
difference between the two cohorts in the incidence of admission for febrile neutropenia. In addition,
there was no statically significant difference in the incidence of adverse drug reactions among the
two groups.
Conclusions:
There were no significant differences between Neupogen and Nivestim in the incidence of febrile
neutropenia or adverse events when used for primary prophylaxis. Future larger studies are required
to better compare the two drugs in various settings and patient populations.
36
O-37
Differential Gene Expression of Neuroblastoma Identifies a Pattern that Predicts
Prognosis and Highlights the Role of Transcription Factor Activating Protein 2
beta (TFAP2B) in Spontaneous Regression of Stage 4s
Corresponding Author Iyad Sultan
Presenting Author Iyad Sultan
Co-author(s) Hasan Hashem, Abdelghani Tbakhi
Contact isultan@khcc.jo
Country JO
Introduction:
Stage 4s Neuroblastoma (NB) is diagnosed in infants and characterized by special metastatic
pattern to the liver, bone marrow and skin. Patients typically undergo spontaneous remission of
the primary and metastatic tumors without therapy. This process is poorly understood on molecular
level despite its predictable clinical behavior.
Methods:
Open-access repositories were searched for a comprehensive dataset of patients with NB who have
sufficient phenotypic data. GSE49711 was identified as a suitable data source. Logarithmically
transformed gene expression values were downloaded. Data was checked for normality and missing
values. Patients with stage 4s NB (4sNB) were compared to those with high risk neuroblastoma
(HRNB). EdgeR package was used to define the most significant genes. Hierarchal clustering and
principal component analysis were utilized to stratify patients.
Results:
GSE49711 had a total of 498 patients with NB. After vigorous selection we compared 49 4sNB to
137 HRNB patients. The top 100 differentially expressed genes based on lowest adjusted p-values
were selected for further analysis. Hierarchal clustering and principal component analysis were then
conducted on all samples (N=498) based on these 100 genes and showed fairly good discrimination
of patients when mortality, risk category and MYCN amplification were used as endpoints. A new
group of patients with intermediate risk was categorized. When risk based on DGE was included
in a multiple regression analysis, it showed significant impact on survival. The involved genes were
analyzed for common ontologic or pathway references. The only identified category was DNA
motifs associated with TFAP2B binding.
Conclusions:
This study highlights the unique gene expression of 4sNB and extends this pattern to other cases
of neuroblastoma where it acted as a surrogate marker for different outcomes. It seems that these
genes are linked through transcriptional activation rather than cellular functions, and may hint to
extracellular signaling and microenvironmental factors as initiators of cellular differentiation. The
role of TFAP2B in NB differentiation is supported by previously published research.
.
Demo
37
O-38
The Impact of Retinoblastoma Screening Program for High Risk Children
Corresponding Author Yacoub A. Yousef
Presenting Author Yacoub A. Yousef

AbdalRahman Al-Abadi, Ibrahim AlNawaiseh, Mustafa Mehyar, Iyad
Co-author(s)
Sulta, Rasha Deebajah, Imad Jaradat
Contact drjaqub@yahoo.com
Country JO
Introduction:
To study the impact of Retinoblastoma (Rb) screening program (in absence of genetic testing) on
management and outcome of high risk children.
Methods:
This is a retrospective, clinical case series of 76 children from families who were involved in RB
screening program. The data collection required review of medical records and Ret-Cam images,
and included status of the child (with disease or free of disease), method of diagnosis (screening
vs signs), demographic data, laterality, age at diagnosis, presenting signs, tumor stage, treatment
modalities, eye salvage, and mortality.
Results:
Seventy six children were evaluated, 48 (63%) were male, 34 (45%)children presented with signs of
RB, and 42 (55%) were followed by screening program. Overall 46 had Rb. In screening group, 12
(29%) had RB, and 30 (71%) were free of disease. Twelve patients were diagnosed by screening.
The mean age at diagnosis was 2.4 months, 9 (75%) had bilateral Rb, no single eye was group D
or E, no single eye was enucleated or radiated, 6 (50%) were cured without chemotherapy, and
the visual acuity was 0.5 or better in 55% of eyes. In the other hand, 34 patients were diagnosed
with signs of Rb. The mean age at diagnosis was 15.8 months, 22 (65%) had bilateral Rb, 29 (52%)
eyes were group D or E, 19 (34%)eyes were enucleated, 3 (5%) eyes received EBRT, and 31 (91%)
patients had to received chemotherapy during management. Thirty children (71%) were followed
in the screening program (all have family history of RB) and did not have Rb, 22 (73%) were male,
the mean age at time of first EUA was 2 months, and the mean number of EUAs was 12 per child.
No one had a major side effect of general anesthesia.
Conclusions:
Screening for children with risk for RB (even without genetic testing) is effective in enhancing early
diagnosis, and improving visual outcome, and increasing eye salvage rate with limited need to
aggressive therapy.
38
O-39
RB Awareness among First Contact Physicians in Jordan
Corresponding Author Yacoub Yousef
Presenting Author Tamara Alnawaiseh
Co-author(s) Ibrahim Alnawaiseh
Contact tamara.nawaiseh@hotmail.com
Country JO
Introduction:
Early diagnosis and timely management of Retinoblastoma (RB) patients are essential in improving
eye salvage and survival. The objective of this study is to evaluate the level of knowledge for the
first contact physicians (students in last year of medical school, pediatricians, and ophthalmologists)
about RB.
Methods:
A questionnaire about RB (with photo of leukocoria) was completed by 138 medical students, 65
pediatricians, and 65 ophthalmologists. Descriptive statistics from the population were obtained
and all answers were analyzed.
Results:
Even the majority of participants in the 3 groups recognized leukocoria as an abnormal sign, 45%
of medical students did not recognize that this could be a sign of life threatening disease. Only
2% of medical students and pediatricians, and 14% of ophthalmologists got a proficiency grade,
and around 2 thirds of medical students and pediatricians failed to achieve the sufficiency score
(70%) in this questionnaire. Ophthalmologist showed better level of knowledge about RB than
medical students and pediatricians, even though 42% of them failed to achieve the sufficiency
score. Of interest, only 72(52%) of medical students, 41 (63%) of pediatricians, and 46 (71%) of
ophthalmologists know that RB needs urgent management.
Conclusions:
Both medical students and pediatricians involved in the study lack the knowledge to detect and
timely refer patients with signs of RB. It is necessary to develop continuous medical educational
programs for first contact physicians.
39
O-40
Timing of Local Control as A Significant Predictor of Survival of Patients with
Ewing Sarcoma of the Extremities

Fawzi Abuhijleh, Sameer Yaser, Hadeel Halalsheh, Taleb Ismaeel, Iyad
Co-author(s) Sultan, Ahmad Shehadeh, Samer Abdel-Al, Abdellatif Almousa, Ramiz
Abuhijleh
Country JO
Introduction:
Treatment of localized Ewing sarcoma (ES) includes chemotherapy and local control with surgery or
radiation, which is typically performed on week 12 of the IE/VAC chemotherapy protocol. We sought
to assess the impact of delay (at > 15 weeks) of timing of local control on overall survival (OS).
Methods:
Data of consecutive patients with primary non-metastatic ES of the extremities were retrospectively
collected. The impact of delay of timing of local control, demographics, and disease characteristics
on overall survival (OS) was examined in univariate analysis.
Results:
Following excluding 3 patients who progressed on primary chemotherapy, 43 patients were
included. Femur was the most common primary tumor site (12 patients; 28%), followed by tibia
(11; 26%), humerous (10; 23%), and others (10; 23%). All patients received chemotherapy with
ifosfamide and etoposide alternating with vincristine, doxorubicin, and cyclophosphamide. Local
control was by surgery in 36 patients (84%) and radiation in 7 (16%). A total of 16 patients (37%) had
delay in local control. At a median follow up of 48 months, delay in local control predicted inferior
OS compared to timely local control (5-year OS 56% vs. 80% respectively, p = 0.044). Other factors
that predicted inferior OS included local control with radiation as opposed to surgery (5-year OS
25% vs. 79% respectively, p = 0.041) and tumor necrosis < 90% compared to ≥ 90% (5-year OS
55% vs. 90% respectively, p = 0.01). Delay in local control did not correlate with age, gender, type
of definitive therapy, or requirement of amputation.
Conclusions:
Delay in timing of local control, radiation as opposed to surgery and poor post-chemotherapy
tumor necrosis predict inferior OS in ES. Adopting strategies to minimize delay in local control
could result in improvement of survival outcomes of ES patients.
40
O-41
Quality Assurance Rounds for Sarcoma Radiotherapy Patients: Twelve-Year
Results
Corresponding Author Ramiz Abu-Hijlih
Presenting Author Ramiz Abu-Hijlih

Fawzi Abuhijla , Abdullah Alrashdan, Issa Mohamad, Abdelatif
Co-author(s)
Almousa
Contact rhijlih@khcc.jo
Country JO
Introduction:
Quality assurance (QA) rounds are crucial for radiation safe practice. This study evaluated the
changes in sarcoma radiotherapy (RT) plans recommended by QA review rounds.
Methods:
Prospectively collected data of the RT plans for sarcoma patients who were treated at King Hussein
Cancer Center between June 2007 and October 2018 were retrieved. Plans subjected to major or
minor modifications were recorded; major modifications were defined as any significant change in
target volume definition, dose prescription, planning objectives which require re-planning. While
minor modification included trivial treatment plan change which doesn’t require re-planning.
Results:
A total of 378 sarcoma plans were discussed at our QA rounds. Planning was performed using
3D-conformal radiotherapy (3D-CRT) in 236 (62%) cases, while intensity modulated radiation
therapy (IMRT) was implemented in 98 (26%) plans and volumetric arc radiotherapy (VMAT) in 44
(12%) patients. Adjuvant RT was delivered to 303 cases (80%), definitive RT was employed in 41
(11%) patients, and neo-adjuvant RT in 34 (9%) patients. From the whole cohort, 344 (91%) were
approved without modification, 15 (4%) needed minor modifications, while 19 (5%) required major
modifications. Major modifications included significant changes in target volume definition (e.g.
to include edema; n=6, 32%), RT prescription dose (e.g. higher dose based on operative and/
or radiological finding, n=4, 21%), planning objectives criteria (n=9, 47%). Among plans which
required major modifications, seven out of 236 (3%) were planned with 3D-CRT, and 12 out of 142
(8%) were planned with IMRT or VMAT.
Conclusions:
QA rounds detect potential deviations prior to start of RT. They harmonize the practice within
radiation oncology team and enhance the safety and accuracy of radiation treatment, especially in
patients treated with new techniques (IMRT and VMAT). Further studies are required to evaluate
QA rounds in a prospective fashion.
41
O-42
The Outcome of Limb Salvage Surgery in Developing Country, KHCC Experience
Corresponding Author Ahmad Shehadeh
Presenting Author Ahmad Shehadeh

Sameer Yaser, Iyad Sultan, Ramez Abu Hijleh, Abdelateef Musa, Samer
Co-author(s)
Salah, Samer Abedel Al
Contact ashehadeh@khcc.jo
Country JO
Introduction:
Limb salvage surgery (LSS) became the standard surgical treatment for bone sarcomas since the
late 1970s; however, LSS has high cost and numerous complications that make it less applicable in
developing countries.
Objectives:
To show that LSS in developing countries can be compared to developed countries, when; teamwork,
expert surgeon and enough resources are available.
Methods:
Since July 2006, a multidisciplinary team of sarcoma was established. This team consisted of
pediatric and medical oncologists, radiation oncologists, radiologist, nurse coordinator and a full-
time orthopedic oncology surgeon. The team was supported by a service for physical therapy.
Clinical practice guidelines were established and a special protocol for rehabilitation following
surgery was applied. Two hundred and thirty eight patients with malignant or benign aggressive
bone tumors presented at the study period, 44 patients received primary amputation, 194 patients
received LSS (82 % of all patients) included in our analysis, with mean follow up of 70 months
(range, 6-120 months). Tumors were located in the extremities (n=172), in the scapula (n=7) and
the pelvis (n=15).
Results:
At 6 yr. median follow up, local control was achieved in 88% of patients , 82% of patients has
no complications,8% developed infection, 4% developed mechanical complications,95% of limbs
survived, MSTS functional score=87%.
Conclusions:
Our results in term of local control, prosthesis related complications, limb survival and function are
compared favorably to most of the literature in developed countries. Patients with sarcoma are
managed better within a multidisciplinary team that is familiar with highly specialized procedures
including LSS. Inappropriate initial intervention in outside facility was the most common cause of
amputation.
42
O-43
Body Mass Index (BMI) and Long Term Outcomes in Patients with Colorectal
Cancer (CRC) at King Hussein Cancer Center (KHCC)
Presenting Author Hadeel Abdelkhaleq

Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, Mahmoud A
Alfaqi, Nour Awad. From the Office of Scientific Affairs and Research,
Department of Pathology and Laboratory Medicine, Department of
Co-author(s) Internal Medicine, Department of Pharmacy, King Hussein Cancer
Center, Amman, Jordan and Department of Physiology and Biochem-
istry, School of Medicine, Jordan University of Science and Technology,
Irbid, Jordan
Country JO
Introduction:
The effect of BMI on the outcome of CRC patients has been extensively investigated albeit with mixed
results. The aim of this study was to examine the association between BMI and survival after CRC diagnosis.
Methods:
A retrospective chart review of all colorectal adenocarcinoma cases referred to KHCC between January
1st, 2004 and December 31st, 2012 was conducted. Among 1902 patients, 1664 cases had information on
BMI (kg/m2) at the time of diagnosis and classified into the following BMI groups: normal (18.50-24.99),
underweight (<18.50), overweight (25.00-29.99), and obese (≥30.00). Overall survival rates were estimated
using Kaplan-Meier method and compared between BMI groups using Log-rank test. Multivariate Cox-
regression models were used to assess prognostic factors in each cancer stage. Lost to follow up cases were
excluded from final survival analyses. All analyses were performed using SPSS version 22.
Results:
Among 1664 patients included in the study, there were 31.1% normal weight, 3.8% underweight, 37.7%
overweight, and 27.5% obese patients. With all stages combined together, the overall 5-year survival
rates for underweight, normal weight, overweight, and obese patients were 27.80%, 48.80%, 54.80%, and
57.40% , respectively (p< 0.001). Using multivariate Cox-regression, the difference in overall survival was
not statistically significant when underweight, overweight, and obese patients were compared to normal
weight stage 1 patients. However in stage 2 patients, underweight negatively impacted survival (HR= 4.0,
p=0.004) while obese patients demonstrated significantly better survival (HR=0.5, p=0.047). In stage 3 and
4 patients combined, the underweight group demonstrated a significant disadvantage (HR=1.6, p=0.031)
while overweight and obese patients had lower mortality compared to the normal weight group (HR=0.816,
p=0.049 and HR=0.765, p=0.024, respectively).
Conclusions:
BMI is an important consideration in patients with CRC. Our results corroborate a positive effect for the
increase in BMI on survival, and the outcomes are stage-dependent. Importantly, being underweight is a
significant negative predictor of outcome and overweight can be protective. The underlying mechanisms
linking obesity to cancer are still a matter of debate, and future prospective studies are needed to validate
these findings.
43
O-44
Laparoscopic Versus Open Pancreaticoduodenectomy: A Case-Matched
Comparative Study
Corresponding Author Basil J. Ammori
Presenting Author Balqees Al-Omari

Omari B, Almajali F, Alawneh F, Abdullah N, Najjar H, Dabous A,
Co-author(s)
Daoud F, Almasri
Contact ba.12813@khcc.jo
Country JO
Introduction:
The laparoscopic approach to pancreaticoduodenectomy (LPD) is technically demanding, but may
offer benefits over open surgery (OPD). The aim of this study was to compare the outcomes of
these two approaches at King Hussein Cancer Center.
Methods:
Patients who underwent LPD and OPD between 2015 and 2018 were retrospectively reviewed. One
surgeon performed LPD for all comers, while the other surgeons performed OPD. Patients were
matched on 1:2 basis for pathology (benign vs. malignant), malignancy size (±1cm) and whether the
pancreatic duct was dilated (>3mm). The outcomes studied were reported as median (range) or per
cent as appropriate. Statistical significance was set at P<0.05.
Results:
A total of 46 patients underwent pancreaticoduodenectomy (LPD n=12, OPD n=34), of whom 33
were included in the study (LPD n=11, OPD n=22). The groups were comparable for age (57 vs.
63 years, p=0.123) and sex distribution (female; 55% vs. 45%, p=0.721), tumour size (3cm in each
group), frequency of pancreatic duct dilatation (45% in each group) and malignant pathology (82%
in each group). There were no conversions to open surgery. Although the operating time for LPD
was significantly longer (313 vs. 680 minutes, p<0.0001), LPD was associated with significantly
shorter primary hospital stay (4.7 vs. 7.8 days, p<0.0001) and total hospital stay that included
readmissions (4.7 vs. 8.9 days, p<0.0001), and a trend towards reduction in intraoperative blood
loss (200 vs. 325 ml, p=0.082). There were no significant differences in overall complication rate
(36.4% vs. 59.1%, p=0.282) or clinically relevant complications (Clavien-Dindo III complication; 9%
vs. 22.2%, p=0.643), and readmission (0 vs. 4 patients). In patients with malignant disease there
were no differences with regard to the number of lymph nodes retrieved (18 vs. 12, p=0.095) and
frequency of R0 resections (77.8% in each group).
Conclusions:
In experienced hands, the laparoscopic approach to pancreaticoduodenectomy offers advantages
over open surgery in terms of reduction in hospital stay while offering an equivalent oncologic
resection.
44
O-45
Knowledge, Attitudes and Practices (KAP) of Cancer Patients towards Biobanking
in Jordan: A study at King Hussein Cancer Center (KHCC)
Presenting Author Maysa Al-Hussaini

Khawlah Ammar, Hala Sultan, Yasmine Obeidat, Lamees Zyoud, Huda
Co-author(s) Abu Al-Shamat, Nour Kasasbeh, Ahmad Karkash, Razan Mansour,
Yanal Omari
Country JO
Introduction:
Biobanks have provoked a range of ethical and legal challenges. Currently there are no regulations to
control biobanking in Jordan. The objective of this study was to evaluate KAP of cancer patients related
to biobanking to aid in developing standard operating procedures (SOPs) and informing policy-makers.
Methods:
This was a cross-sectional study utilizing a semi-structured questionnaire designed specifically for the
study. Patients were approached in the waiting areas of KHCC adult outpatient clinics between February
2017 and June 2018. A pilot phase with 20 respondents confirmed the questionnaire’s validity and
reliability.
Results:
300/312 participants completed the survey with a response rate of 96%. Male: Female ratio was 1.2:1,
68.1% were above the age of 46 and 60.1% finished a diploma or higher-education. 87.6% never heard
the term “biobank” , and 94.9% never donated samples for research. Willingness to donate urine, blood
and saliva was high (82.4%, 82% and 80.3%, respectively) while it was 63.6% for tissue. Males were
significantly more willing to donate samples than females (p<0.05), Figure 1. A higher-education was
also associated with willingness to donate blood and tissue (p=0.007 and 0.004, respectively). Trust”
in the custodian research organization and employees were the main driving forces for participation
in biobanking research (84.2% and 85.3%, respectively), followed by knowledge about associated
adverse-effects and protection of privacy and confidentiality (82.9% and 72.9%, respectively), Figure 2.
55.1% of respondents preferred a broad-consent, while 44.9% preferred either a tiered or specific (per-
study) consent. 43.8% preferred coding of samples, while 33.6% opted for anonymization. Interestingly,
74% and 72.6% of respondents wanted to know and share results with family members, respectively,
with the younger and more-educated more willing to share results, p=0.033 and <0.001, respectively.
60.6% believed they should retain some ownership of donated samples, while 86.6% would not mind
using their samples in research by “for-profit” third-parties if they were initially informed. A vast majority
(255/277, 94%) wanted information about biobanking by written material or a facility representative.
Conclusions:
Jordanian cancer patients are willing to donate biospecimens for biobanking research. Many of
the findings should be taken in consideration when establishing local SOPs to ensure successful
implementation of the endeavor.
45
O-46
Female Oncologists in the Middle East and North Africa: Progress Towards
Gender Equality
Corresponding Author Deborah Mukherji
Presenting Author Yolla Haibe

Rana Salem, Christelle Dagher, Charelle Salem, Ali Shamseddine,
Co-author(s) Nizar Bitar, Joseph Makdessi, Sami Khatib, Hamouda Boussen,
Farouk Benna, Sana Al Sukhun, Nagi El Saghir
Contact dm25@aub.edu.lb
Country LB
Introduction:
Female Doctors are increasingly choosing oncology as a career while they are still under-represented
in leadership positions globally. The European Society of Medical Oncology has recently surveyed
its members regarding gender equality in the work place. Limited data are available from the
Middle East. The aim of our study was to survey female oncologists practicing in the Middle East
to identify common challenges and suggest areas for improvement.
Methods:
A cross-sectional survey was distributed among female participants attending the annual Lebanese
Society of Medical Oncology meeting in March 2018, and in the Pan-Arab annual meeting in April
2018. The questionnaire used included questions assessing socio-demographic characteristics,
involvement in leadership and academic positions and the impact of career on family life.
Results:
Overall, 88 questionnaires were collected from women practicing all over the Middle East. 59%
reported that a male doctor was responsible for the work team, however 57% covered a managerial
or leadership role within their job. 64% of the female oncologists believed that their gender had at
least moderate, significant and even major impact on their career Participants reported that their
careers have a considerable impact on their relationship with friends and social networking (49%)
and their family and marriage (44%). 58% report having problems with finding balance between
work and family, and 50% find barriers to attend international meetings. Several ways to improve
were suggested, 56% voted for offering development and leadership training specifically women,
45% suggested implementing a flexible work schedule.
Conclusions:
In what is considered a male dominant environment, gender equality according to female oncologists
working in the Middle East, is very comparable to the world data provided. Several strategies have
been identified to continue progress in this domain with the aim to improve academic leadership
opportunities and work-life balance for all.
.
Demo
46
O-47
Cytoreduction and Hyperthermic intraperitoneal chemotherapy in Lebanese
patients in a single institution. A retrospective study
Corresponding Author Muhieddine Seoud
Presenting Author Muhieddine Seoud

Faek Jamali, Alaa Husheimi, Iman Jaafar, Ali Shamseddine, Mohamad
Co-author(s)
Khalifeh.
Contact mike@aub.edu.lb
Country LB
Introduction:
Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median-survivals
reported in literature of 6-12months. Cytoreductive surgery (CRS) and hyperthermic-intraperitoneal
chemo-therapy(HIPEC) have gradually gained acceptance as standard of care in managing selected
cases of PC. Excellent results have been achieved in well-selected patients but there is a very steep
learning curve when starting a new program.
Methods:
A program for multidisciplinary treatment of peritoneal surface malignancies of gastrointestinal or
gynecological origin was initiated in January 2007 at AUBMC. Patients enrolled in program were treated
using multimodality therapy with combinations of systemic therapy, CRS, and HIPEC. We present results
of our initial experience using a retrospective review of a prospectively collected database.
Results:
From 2007 to 2016, 36patients were treated with CRS and HIPEC with an average follow-
up of: 2-8/yr. There were: 19male and 17female patients. Most common indications were
Colorectal cancer(25%),Pseudomyxoma and 1ry mucinous low-grade-tumors(47.2%), Ovarian
malignancies(13.9%),Gastric cancer(5.5%) and Mesothelioma(5.5%). The Mean surgery-duration
was 9.8+2.8(6-16)hours. The mean Peritoneal Cancer Index(PCI) was 24.92% of the patients had
complete macroscopic cytoreduction. Perioperative mortality-rate was: 2.7%(1/36) whereas 12%were
lost for-follow-up. Mean-hospital-stay was: 16(8-39) days. So far, the median overall-survival(OS)
and progression-free-survival(PFS) are: 26.7+22.6 and 18.1+16.2months.The ovarian ‫ آ‬and primary-
peritoneal cancer group(N=6) when compared to colorectal cancer group (N=4): had higher-average-
PCI(Mean=25.39.9 vs 21.310.2 ;P=0.78),higher average-age (Mean=5115.4 vs 43.716.8 years;P=0.8)
,higher intra-operative parameters of estimated blood-loss ( Mean=866.6163.3 vs 462.5249.6cc ;P=0.4)
and operative-time(Mean=122.3 vs 81.4 hours;P=0.5), higher average of postoperative-hospital-
stay (Mean=17.759.6 vs 14.28.1days;P=0.385), higher PFS(27.3930.6 vs 14.39.6months;P=0.12) and
OS(37.6.331.5 vs 27.2.322.1 months ;P=0.238). However, there was no statistically-significant difference
because of small sample size.
Conclusions:
We report successful establishment of an active peritoneal surface malignancy multidisciplinary treatment
program with excellent early results comparable to those of reputable centers as published in literature.
Careful patient selection, a multidisciplinary approach and proper surgical training and technique are
essential for successful program.
47
O-48
Early Stage Oral Tongue Squamous Cell Carcinoma: Treatment Outcomes and
Analysis of Recurrence Risk Factors
Corresponding Author Bassem Youssef
Presenting Author Issa Mohamad

Lara Hilal, Paul Ramia, Roger Moukarbel, Mustafa Jammal, Ihab
Hassanieh, Ranim Thebian, Ibrahim Khalifeh, Sami Bannoura, Fady
Co-author(s)
Geara MD, Wesam Al Gargaz, Taher Abu Hejleh, Omar Al Saraireh,
Ebrahim Mayta
Contact by04@aub.edu.lb
Country LB
Introduction:
The aim of this study is to report the oncologic outcomes of patients with T1/T2N0M0 squamous
cell carcinoma (SCC) of the oral tongue treated with partial glossectomy and lymph node dissection
(PGLND), in addition to adjuvant therapy in selected patients with high-risk features.
Methods:
Sequential patients treated with PGLND for T1/T2N0M0 oral tongue SCC at 2 institutions, The
American University of Beirut Medical Center and King Hussein Cancer Center, between 2000 and 2016
were retrospectively reviewed under an approved Institutional review board protocol. Demographics,
disease stage, pathology and treatment characteristics were extracted. Locoregional control (LRC)
and overall survival (OS) outcomes at 2 and 5 years follow-up were calculated. Both univariate and
multivariate analyses were performed to investigate the correlation of patient, tumor, and treatment-
related factors with disease control and survival endpoints.
Results:
A total of fifty-five patients were included in the analysis. The median follow up was 41 months, the
median age was 54 years (range 18-69 years) 38 (69%) of the patients were male. 61% of the patients
are smokers. Of the 55 patients, only 3 (5.5%) have positive margins, 36 (65.5%) have tumor thickness
above 4mm, 8 (14.5%) have PNI, and 4 (7.3%) have positive LVSI. 13 patients (23.6%) received post-
operative radiotherapy (RT). The LRC and OS rates at 2- and 5-years were 84% and 77%, 87% and
81%, respectively. In multivariate analyses, of the examined variables (age, smoking, margins, tumor
thickness, PNI, LVSI, post-operative RT), the only two that were significantly associated with decreased
LRC were LVSI (p=0.03) and positive pathological margins (p=0.04). Adjuvant therapy had no effect on
LRC.
Conclusions:
Our patients’ oncological outcomes are consistent with those reported in the literature with good 5
years LRC and OS. Positive margins and lympho-vascular invasion were significantly associated with
poorer outcomes. Other factors like thick tumors and the use of adjuvant treatment had no significant
effect on 5 year outcomes. Our findings are limited by the small size of the cohort, and by the occurrence
of only few oncologic events.
48
O-49
Laparoscopic Versus Open Insertion of Feeding Gastrostomy Tube in Patients
with Head and Neck Cancers: A Matched Comparative Study
Presenting Author Basil J. Ammori
Co-author(s) Balqees Al-Omari, Huthaifa Asmar, Hani Al-Najjar
Country JO
Introduction:
Patients with head and neck cancers may require feeding tube gastrostomy (FTG) during the
course of their treatment. Surgical gastrostomy is indicated in patients who failed or unsuitable for
endoscopic or radiologic FTG insertion. The aim of this study was to compare the outcomes of the
laparoscopic versus open approaches to FTG.
Methods:
One surgeon performed FTG laparoscopically in “all comers” while others adopted the open
approach. Patients who underwent FTG for management of dysphagia related to head and neck
cancers were included while those who had other infrequent indications were excluded. Patients
who underwent laparoscopic procedure were matched to those who had open procedure based
on whether or not additional procedures were concomitantly performed. The results reported
represent median (range) or number (percent) as appropriate.
Results:
Between January 2017 and January 2019, 10 consecutive patients who underwent laparoscopic
FTG insertion were matched to 20 patients who underwent open procedure. The groups were
comparable for age, sex distribution and body mass index. Concomitant additional procedures
were carried out in 30% of patients in each group. There were no conversions to open surgery.
There were no differences between the laparoscopic and open groups with regard to the operating
time (45 vs. 60 min, p=0.109), but the laparoscopic approach was associated with a significantly
shorter hospital stay (0.35 vs. 3.85 days, p=0.010) and greater proportion of procedures being
performed as day case (50% vs. 0%, p=0.002). There were no differences in the 30-day mortality
(10% vs. 15%, p=1.000).
Conclusions:
Laparoscopic insertion of gastrostomy feeding tube is safe, can be performed as day case procedure
and is associated with shorter hospital stay compared with open surgery. The laparoscopic approach
to FTG should be the preferred option over open surgery where local expertise exists be performed
safely in patients with large proximal gastrointestinal stromal tumours.
49
O-50
Clinical Characteristics and Treatment Outcome for Adult Medulloblastoma: A
Tertiary Cancer Center Experience
Corresponding Author Abdelatif Almousa
Presenting Author Abdelatif Almousa

Yusef Ismael, Khalid Dibs, Nasim Sarhan, Alaa Saleh, Rula Amarin,
Co-author(s)
Maher Elayyan, Ramiz Abu-Hijlih
Contact aalmousa@khcc.jo
Country JO
Introduction:
The purpose of this study is to report clinical characteristics, prognostic factors and treatment
outcome for patients treated with surgery and radiotherapy.
Methods:
A total of 42 patients aged 18 years or more with medulloblastoma treated at King Hussein Cancer
Center (KHCC) between 2007 and 2016 were retrospectively reviewed. Patients were staged
according to Chang’s staging system. All patients received adjuvant cranio-spinal irradiation (CSI)
followed by posterior fossa boost. Patients’ baseline and disease characteristics were tested as
prognostic factors for progression-free survival (PFS) and overall survival (OS) using univariate and
multivariate analyses.
Results:
The follow up time reached 9.5 years (median 36 months). Five-year progression free survival (PFS)
and overall survival (OS) were 67% and 71% respectively. For standard risk patients, 5-year PFS
and OS were correspondent at 90%, and for high risk patients were 34% and 44% respectively. On
univariate analysis, higher risk group and presence of metastasis were poor prognostic factors for
PFS (p=0.004; p=0.008 respectively) and OS (p=0.032; p=0.043 respectively). While on multivariate
analysis all prognostic factors have failed to show statistically significant difference. Eleven patients
(26%) have relapsed after a median time of 27 months (range, 11-68 months); 6 relapses were local
and 4 distant, one patient had both local and distant relapse.
Conclusions:
Management of adult medulloblastoma lacks evidence-based guidelines, our results revealed
poor survival rates in high-risk patients, this fact may necessitate treatment intensification with
chemotherapy. Recent molecular sub-grouping may help in predicting disease prognosis and
pattern of relapse in adults.
50
O-51
Prognostic Significance of O6-Methylguanine-DNA-methyltransferase (MGMT)
Promoter Methylation and Isocitrate Dehydrogenase-1 (IDH-1) Mutation in
Glioblastoma Multiforme Patients: A Single-Center Experience in the Middle
East and North Africa (MENA) Region
Presenting Author Firas Kreidieh

Zeina Ayoub, Fady Geara, Marwan Najjar, Youssef Comair, Rami
Co-author(s) Mahfouz, Nathalie Khoueiry-Zgheib, Pierre Khoueiry, therese Andraos,
Fadi Saadeh, Ghassan Skaf
Country LB
Introduction:
To determine the prevalence and prognostic value of MGMT promoter methylation and IDH1
mutation in glioblastoma multiforme (GBM) patients from the Middle East.
Methods:
Records of patients diagnosed between 2003 and 2015 were reviewed. MGMT promoter methylation
was measured using methylation-specific polymerase chain reaction and IDH-1 mutation was
reported. The primary endpoint was overall survival (OS).
Results:
A total of 110 patients were included. The median age was 51 years and 71 patients (64.5%) were
males. The median diameter of GBM was 4.6 cm and 29 patients (26.4%) had multifocal disease.
Gross total resection was achieved in 38 patients (24.9%). All patients received adjuvant radiation
therapy, and 96 patients (91.4%) received concomitant temozolomide. At a median follow up of
13.6 months, the median OS was 17.2 months, and the OS at 1 and 2 years were 71.6% and 34.8%,
respectively. On multivariate analysis, age at diagnosis (HR 1.019; P = 0.044) and multifocality (HR
2.373; P = 0.001) were the only independent prognostic variables. MGMT promoter methylation
was found in 28.2% of patients but did not significantly correlate with survival (HR 1.160; P =
0.635). IDH-1 mutation was found in 10 % of patients was associated with a non-significant trend
for survival improvement (HR 0.502; P = 0.151).
Conclusions:
Patients with GBM from the Middle East have adequate survival outcomes when given the optimal
treatment. In our patient population, MGMT promoter methylation did not seem to correlate with
outcomes, but patients with IDH1 mutation had numerically higher survival outcomes.
.
Demo
51
52
POSTERS
53
P-1
Self-Reported Adherence to Oral Endocrine Therapy among Breast Cancer
Patients in Jordan
Corresponding Author Nour Al Faqeer
Presenting Author Nour Al Faqeer

Alia Al Gharabli, Maha Dalbah, Khawalah Ammar, Randa Agha,
Co-author(s)
Hala Shanees, Hala Sroji, Rawaa Al Rabie.
Contact nfaker@khcc.jo
Country JO
Introduction:
Patients with breast cancer who are estrogen receptor positive are considered for oral endocrine
therapy, as it reduces recurrence and improves survival. We conducted this study to establish a
baseline of patients’ adherence to endocrine therapy.
Methods:
The study was conducted at King Hussein Cancer Center in Jordan between October 2017 and July
2018 from responses to a questionnaire completed by patients with breast cancer who had been
on endocrine therapy for at least 1 month. The questionnaire included questions on adherence (the
number of missed doses in the previous month), as well as on demographics, the type of endocrine
therapy, patients’ perceptions of endocrine therapy, information about their treatment, and side
effects. Associations between adherence and patient-related factors were assessed in chi-square
tests.
Results:
The questionnaire was completed by 202 patients with a mean age of 45.8 years (±10.7SD). Of
the 190 patients who answered the question on adherence, 122 (64%) reported that they had
not missed any doses during the previous month, 51 (26.8%) reported that they had missed one
to two doses, 16 (8.4%) reported that they had missed their medication three to six times, and 1
patient reported having missed more than 6 doses. The level of adherence was associated with the
duration of treatment (P = 0.048). The most common side-effects reported were hot flushes, bone
pain, and mood changes.
Conclusions:
Adherence reported by this cohort of patients with breast cancer in Jordan was high. Further studies
should be conducted of longer duration and with follow-up of patients to further investigate non-
adherence.
54
P-2
BRCA Mutation Screening and Patterns Among High-Risk Lebanese Subjects
Corresponding Author Deborah Mukherji
Presenting Author Christelle Dagher

Chantal Farra, Christelle Dagher, Rebecca Badra, Miza Salim
Co-author(s) Hammoud, Raafat Alameddine, Johnny Awwad, Muhieddine
Seoud, Jaber Abbas, Fouad Boulos, Nagi El Saghir.
Contact dm25@aub.edu.lb
Country LB
Introduction:
Previous studies have suggested that the prevalence of BRCA1 and 2 mutations in the Lebanese
population is low despite the observation that the median age of breast cancer diagnosis is
significantly lower than European and North American populations. We aimed at reviewing the
rates and patterns of BRCA1/2 mutations found in individuals referred to the medical genetics unit
at the American University of Beirut. We also evaluated the performance of clinical prediction tools.
Methods:
We retrospectively reviewed the cases of all individuals undergoing BRCA mutation testing from
April 2011 to May 2016. To put our findings in to context, we conducted a literature review of the
most recently published data from the region.
Results:
Two hundred eighty-one individuals were referred for testing. The prevalence of mutated BRCA1
or 2 genes were 6 and 1.4% respectively. Three mutations accounted for 54% of the pathogenic
mutations found. The BRCA1 c.131G > T mutation was found among 5/17 (29%) unrelated subjects
with BRCA1 mutation and is unique to the Lebanese and Palestinian populations. For patients
tested between 2014 and 2016, all patients positive for mutations fit the NCCN guidelines for
BRCA mutation screening. The Manchester Score failed to predict pathogenic mutations.
Conclusions:
The BRCA1 c.131G > T mutation can be considered a founder mutation in the Lebanese population
detected among 5/17 (29%) of individuals diagnosed with a mutation in BRCA1 and among 7/269
families in this cohort. On review of recently published data regarding the landscape of BRCA
mutations in the Middle East and North Africa, each region appears to have a unique spectrum of
mutations.
55
P-3
Clinicopathological Characteristics and Treatment Outcomes of Breast Cancer
among Adolescents and Young Adults in Jordan

Hanan Al-Masri, Hazem Abdelelah, Mahmoud Abu Nasser, Mourad
Co-author(s)
Salam, Fadwa Abdel-Rahman, Dalia Rimawi
Country JO
Background:
Breast cancer is the most common cancer among women in Jordan. Compared to western societies,
diagnosis is usually made at a younger age (median age: 51 years) and with more advanced-stage
disease. Almost 15% of all breast cancer patients are diagnosed below the age of 40. Breast cancer
in younger patients tends to be more aggressive and may result in a higher likelihood of long-term
treatment-related toxicity and unique psychosocial problems.
Patients and Methods:

Consecutive patients aged 40 years or younger with pathologically-confirmed diagnosis of breast
cancer, treated and followed up at our institution were included. Medical records and hospital
databases were searched for patients’ characteristics, treatment offered and outcomes.
Results:
A total of 417 patients were included. Median age at diagnosis was 35 (range: 21-40) years. First-
degree family history of breast cancer was reported in 72 (17.3%). On presentation 63 (15.1%)
patients had metastatic disease; 50 (79.4%) with visceral metastasis. Many of the patients with
non-metastatic disease had poor pathological features including: Node-positive (72.3%), G-III
(52.0%), lympho-vascular invasion (52.9%) and HER2-positive (31.5%). Patients were treated on an
institutional unified clinical practice guidelines based on standard international ones. Among the non-
metastatic patients, 25.7% had neoadjuvant chemotherapy, 32.9% had breast-conserving surgery
and 24.1% had skin-sparing mastectomies. Only 129 (36.5%) women had breast reconstruction
surgery; 56 (25.0%) and 102 (45.5%) of the patients who had no reconstruction surgery had a T1
and T2 disease, respectively. At a median follow up of 59 months, 5-year overall survival for the
whole group was 72%; 84% for non-metastatic and 13% for those with metastatic disease. On Cox
regression, nodal metastasis (Adjusted Hazard Ratio [HR], 3.4; 95% CI: 1.5-8.0, P=0.0047) and G-III
disease (HR, 2.2; 95% CI: 1.3-3.7, P=0.0044) were associated with poor outcome, Figure-1.
Conclusions:
Adolescents and young Jordanian adults with breast cancer present with more advanced-stage
disease and more aggressive clinical and pathological features that reflect poorly on treatment
outcomes. Almost two-third of the non-metastatic patients had no reconstruction surgery. Given
the above findings, intense implementation of early detection and awareness programs are highly
needed.
56
P-4
Breast Cancer during Pregnancy and in Postpartum Period; does the Survival
Differ?
Corresponding Author Mahmoud Al-Masri
Presenting Author Fawaz Hashim
Co-author(s) Hani Al-Najjar, Fadi Al-Zumot
Country JO
Introduction:
Breast Cancer is the second most common cancer during pregnancy. The bad prognosis of breast
cancer during pregnancy and postpartum period is related to the delay in diagnosis and the
advanced stage at presentation. Recent data suggest that breast cancer during postpartum period
has worse outcome in comparison to the pregnancy associated breast cancer.
Methods:
To compare between the overall survival (OS) and disease free survival (DFS) associated with
pregnancy and in the postpartum period.
Results:
Retrospective analysis of medical records of 108 patients with pregnancy and postpartum associated
breast cancer between 2005-2018 from the cancer registry of KHCC. The mean age at presentation
was 34.9 years, the most common stage at diagnosis was stage III for both pregnant and postpartum
arms 41.8% vs 43.9% respectively (P .303). Regarding the histologic grade; the most observed was
grade III for both pregnant and postpartum arms 66.7% vs 71% respectively (P .388). DCIS was
present in 26.9% vs 30% of the specimens respectively (P .727) and the Lymphovascular invasion was
evident in 54.4% vs 58.8% respectively (P .680). Moving to the hormonal receptors, the pregnancy
arm had a larger percentage of estrogen positivity in comparison to the postpartum arm 73.8% vs
61.5 respectively (P .188). Concerning the triple negative status; about 13% of the patient had triple
negative breast cancer, five were lactating and nine were pregnant. Five year overall survival (OS)
between the two groups was 98.3 vs 94.7 respectively (P .1548).
Conclusions:
The analyzed data showed no significant overall survival between the two groups of patients. But a
trend in decreased overall survival in the postpartum group.
57
P-5
Comparison of Estrogen Receptors, Progesterone Receptors and HER2-NEU
Immunohistochemistry Results in Breast Cancer with Those of Oncotype Dx.
Corresponding Author Maher Sughayer
Presenting Author Sallam Alhasson
Co-author(s) None
Contact msughayer@khcc.jo
Country JO
Introduction:
Oncotype Dx (ODx) recurrence score (RS) is used in early breast cancer to guide the use of adjuvant
therapy. In addition to RS the test produces results of reverse transcriptase-polymerase chain reaction
(RT-PCR) of Estrogen receptors (ER), Progesterone receptors (PR) and Human epidermal growth factor
receptor 2 (HER2-neu). Our goal was to determine the correlation between Immunohistochemistry
(IHC) and RT-PCR testing of ER, PR and HER2-neu.
Methods:
111 patients with ER+, HER2-neu - breast cancers that underwent ODx testing were analyzed by
Pearson correlation coefficient and for concordance rates.
Results:
A total of 102 patients had ER+/PR+ tumors and 9 patients had ER+/PR- tumors by IHC, the average
RS were 17.77±9.5 and 31.2±8.67 respectively. The Pearson correlation coefficient between IHC
and ODx results were 0.507 (95% CI 0.354-0.634) for ER and 0.826 (95% CI 0.756-0.877) for PR.
The concordance rate between IHC and ODx was 97.3% for ER, 90.2% for PR and 99.1% for HER2-
neu. 3 specimens were discordant for ER (2.7%) and 10 were discordant for PR (9.8%).
The ER discordant cases were as follows: one was just positive above cutoff with 1% and one was
reported by outside lab and was not available for review. The last case was highly positive (90%) so
a repeat was ordered for ODx testing. The 10 discordant cases for PR were low positive (8/10 were
< 10% and 2 cases were 30% and 70%).
Conclusions:
Our study shows that ER+/PR- breast cancers are associated with a significantly higher ODx scores.
Our data also show that the IHC results were moderately correlated with RT-PCR for ER, and strongly
correlated for PR.
58
P-6
Breast Cancer in Young Woman at The American University of Beirut Medical
Center
Corresponding Author Nagi El Saghir
Presenting Author Joud El Dick

Lana Khalil, Maya Charafeddine, Paul El Tomb, Johny Fares, Nagi El
Co-author(s)
Saghir
Contact ns23@aub.edu.lb
Country LB
Introduction:
Studies from Lebanon and Arab countries have shown that about 50% of patients with breast
cancer are below the age of 50. Young age is thought to add a poor prognosis. We present data on
very young patient’s ≤ 40 years (y) with breast cancer at The American University of Beirut Medical
Center (AUBMC).
Methods:
Charts of patients between the years 2005 to 2018 were reviewed. Characteristics and outcomes
are presented. IRB approval was obtained.
Results:
Total number of patients ≤ 40 was 345. The median age at diagnosis was 36 years. Invasive ductal
carcinoma (IDC) was present in 94.5% of cases, invasive lobular carcinoma (ILC) in 1.2% of cases,
and ductal carcinoma in situ (DCIS) in 4.3%. HER2 positive patients in 28.9%, hormone receptor
positive (ER &/or PR) in 75.9%, and triple negative in 14.8%. Partial mastectomy was done in
58.5% of patients and total mastectomy in 41.8%. 72.3% of patients received neoadjuvant/adjuvant
chemotherapy with anti-HER2 therapy if they were HER2 positive. All hormone receptor positive
patients received adjuvant hormonal therapy.
DCIS was present in 4.5% of patients at diagnosis, Stage 1 disease in 22.8%, Stage 2 in 36.8%,
Stage 3 in 22.4%, and Stage 4 in 13.5% of patients. 5y Overall Survival (OS) for all stages combined
is 89.6% at 5y and 70% at 10y. 5y DFS in node negative disease (T1, T2, T3, T4N0) is 75.3% and
65.5% in 10y while OS is 97.4% at 5y and 75.4% at 10y. For node positive disease, 5y DFS is 71.3%
and 10y DFS is 48.0% while 5y OS is 86.7% and 10y OS is 70.6%.
Conclusions:
We report a shift in staging to more early breast cancer at diagnosis (as a result of awareness
and early detection campaigns), and excellent survival rates for young patients with breast cancer
treated at AUBMC.
59
P-7
The Application of Gail Model to Predict the Risk of Developing Breast Cancer
Among Jordanian Women
Co-author(s) Luna Zaru, Ahmed Badeeb, Shadi Hijjawi
Country JO
Introduction:
Breast cancer has been the most common cancer affecting women in Jordan. Individualized risk
assessment can improve the cost-effectiveness of breast cancer prevention and early detection
programs. Gail model is widely used tool to stratify patients into different risk categories. However,
concerns about its applicability across different ethnic groups do exist. In this study, we report our
experience with the application of a modified version of this model among Jordanian women.
Methods:
Consecutive women, aged 18 years or older, with histologically-confirmed diagnosis of breast
cancer were included. The mean 5-year risk score and the mean life-time risk score were calculated
using the SAS program downloaded from NCI website. Patients were included in the analysis with
the hypothetical assumption that they had not developed breast cancer. Gail risk assessment model
(RAM) was modified using local vital statistics. The mean calculated risk score for women aged â‰¥
60 years (n=391) was 0.65. This number, which corresponds to the Gail original score of 1.66, was
used as a cutoff point to categorize patients as high risk.
Results:
A total of 1786 breast cancer patients with a mean age of 50 (range: 19-93) years were included.
Similar to the methodology used by the original Gail RAM, the modified version was applied on
patients aged 35-59.9 years (n=1213). The mean estimated risk for developing invasive breast
cancer over the following five years was 0.54 (95% CI: 0.52, 0.56) and the lifetime risk was 3.42 (95%
CI: 3.30, 3.53). Only 210 (17.3%) women, already known to have breast cancer, had a risk score >
0.65 and thus categorized as high risk. First-degree family history of breast cancer was identified
among 120 (57.1%) patients in this high risk group.
Conclusions:
A modified Gail risk assessment model, reflecting the country’s cancer registry and vital statistics,
would have been able to stratify only 17% into high risk category. Therefore, the use of this RAM
in breast cancer early detection program in our population, even after modification, is not helpful.
60
P-8
Effect of Time to Surgery After Completion of Neoadjuvant Chemotherapy in
Breast Cancer Patient on Survival Outcomes
Corresponding Author Mahmoud Al-Masri
Presenting Author Basim Jalabneh
Co-author(s) Hani Al-Najjar, Tamadur Alshamaileh
Country JO
Introduction:
Neoadjuvant chemotherapy has become one of the cornerstones of the treatment of breast cancer.
However, the time between surgery and chemotherapy has been more clearly agreed upon in
the adjuvant setting as there is no defined consensus on the optimal time between neoadjuvant
chemotherapy and surgery. Our goal is to analyze the effect of time between the end of neoadjuvant
treatment and surgery on overall survival (OS) and event-free survival (EFS).
Methods:
We retrospectively analyzed 468 patients with stages I-III breast cancer who received and completed
the same regimen of neoadjuvant treatment (Anthracyclines and Taxanes) in King Hussein Cancer
Center, Jordan between 2006 and 2014. We divided the patients into 3 groups, <4 weeks, 4-8
weeks and >8 weeks between end of chemotherapy and the date of surgery.
Results:
In our cohort, the majority of patients had stages II-III breast cancer with only four patients with
stage I. 96.8% were either invasive ductal or invasive lobular carcinomas. 76.2% and 74.1% had ER
and PR positivity, respectively. 27.9% were Her2/neu positive. 95.9% had adjuvant radiotherapy
and 84% were alive at the time of the analysis. Local recurrence rate was 6.6% (31/468). 92 patients
(19.7%) had complete pathological response (PCR). Median follow up time was 3.8 years. In our
analysis, the groups had equivalent EFS. However, OS was detrimentally affected if patients had
undergone surgery beyond 8 weeks compared to between 4-8 weeks.
Conclusions:
Performing surgery in the first 8 weeks after completion of chemotherapy had no impact on survival,
which will give surgeons time for planning operations. However, it is not recommended to delay
surgery more than 8 weeks
61
P-9
Role of Sentinel Lymph Node Biopsy (SLNBx) in Mucinous Breast Cancer: Is it
Time to Reconsider?
Corresponding Author Mahmoud Abu Dakka
Co-author(s) Hani Al-Najjar, Mahmoud Al-Masri
Contact ma.12852@khcc.jo
Country JO
Introduction:
Mucinous carcinoma (MC) is a rare yet well-defined entity in breast cancer. Histologically, they are
well-differentiated subtypes of invasive carcinoma known for their favorable prognosis.
MC is defined as a tumor where the mucinous component represents 50% or more of the tumor.
Mucinous cancers are known for low incidence of local recurrence, L.N involvement and distant
metastasis. This favorable outcome has encouraged many to evaluate the need for axillary surgery
in this group of patients. Evaluate the prevalence of the nodal disease in patients with Mucinous
cancers and identifying a subgroup of patients in whom SLNB could be safely omitted.
Methods:
Patients who underwent axillary surgery after the diagnosis MC at KHCC between (2008-2017) were
identified through retrospective data collection. Preoperative investigation and clinicopathological
data were analyzed
Results:
Seventy two patients with MC were identified, only 64 had axillary surgery. 28 out of 64 patients
(44%) whom had axillary surgery were found to have at least one positive lymph node for metastasis.
The positive nodes group had lymphovascular invasion in 12 out of 28 cases (43%) while in the
negative nodes group, the lymphovascular invasion was found in 3 out of 36 cases (8%) p value
0.0012. Evaluating the HER-2 status in the node positive group results in 8 out of 28 positive cases
(28%) and in the node negative group it was 8% (p value 0.033). Regarding the estrogen receptor
(ER) negative cases, the node positive group had 2 out 28 (7%) cases with negative (ER) status but
the node negative group had only one case with negative (ER) status (3%) (p value 0.41).
Conclusions:
Our small sized cohort showed that nearly 40% of mucinous breast cancer patients presented with
positive axilla. Our analysis could not identify a subgroup of patients in whom we can safely omit
the sentinel lymph node biopsy. Despite the general perception of favorable outcome of mucinous
breast cancer, our results still in favor of performing sentinel lymph node biopsy in such cancer.
62
P-10
A Review on Breast Cancer Publications Across the Cancer Care Pathway in
Conflict Settings of the Mena Region
Corresponding Author Rima Abdul-Khalek
Presenting Author Rima Abdul-Khalek

Ghassan Abu-Sitta, Nassim El Achi, Aya Noubani, Ahmad Elamine,
Co-author(s)
Bachar Chaya, Fahad Ahmed, Richard Sullivan
Contact rimaabdulkhalek@hotmail.com
Country LB
Introduction:
Breast cancer research capacity varies in different countries of the MENA region. This review aims
to analyze methodologies used in breast cancer publications across different stages of the cancer
care pathway and across different conflict affected countries of the MENA region.
Methods:
We followed PRISMA-Scr methodology. We searched for peer-reviewed breast cancer publications
in 10 databases using both controlled vocabulary and keywords. Publication abstracts and full-text
versions were screened in duplicate and included in our study based on pre-specified eligibility
criteria. We used a structured data extraction form to extract information related to the publication
and its methodology, and the cancer care pathway being studied.
Results:
A total of 19215 citations were retrieved from our search. After removing duplicates, a total of 8622
articles remained. Title and abstract screening retained 2886 publications. After analyzing full-text
versions, 2375 publications remained. Most of the breast cancer publications were research papers
that originated from Turkey and Israel. Quantitative methodologies with cross-sectional designs
were mostly used. Policy and implementation research received less attention relative to other
types of research such as early epidemiological research, and was lower in countries with high
breast cancer incidence including Lebanon. Most of the publications focused on cancer diagnosis
and therapy and a much lower number focused on palliative care.
Conclusions:
Breast cancer publications vary across conflict affected countries of the MENA region. Improving
research capacity is necessary for improving cancer care in these settings.
63
P-11
Effect of Scalp Cooling System in the Prevention of Chemotherapy-Induced
Hair Loss Among Jordanian Women with Breast Cancer. Influence of Hijab and
Chemotherapy Regimen on Success Rates
Presenting Author Hazem Abdulelah
Co-author(s) Amer Kleib, Tala Awabdeh, Majd Hamed-Alleh, Ayat Taqash
Country JO
Introduction:
Hair loss is one of the most feared complications of chemotherapy. Alopecia is associated with
psychosocial stress and is common especially so with anthracyclines and taxanes commonly used
for breast cancer. Scalp cooling is increasingly used in an attempt to prevent chemotherapy-induced
alopecia and racial differences had been noted in its success. In this paper, we will study the
effectiveness of scalp cooling in preventing alopecia among a group of Jordanian women treated for
breast cancer and will also address the effect of wearing head cover (Hijab) and other clinical variables
on its success rate.
Methods:
Breast cancer patients treated with anthracyclines and/or taxanes, and used scalp cooling system were
identified. Paxman Scalp Cooling System (Paxman Coolers Limited, Huddersfield, UK) was utilized.
The median duration of cooling before and after chemotherapy infusion were 30 and 60 minutes,
respectively. Scalp-cooling treatment was deemed successful if a patient reported not wearing a wig
or head cover during their final scalp-cooling session.
Results:
A total of 157 women, median age 47 (range: 22-76) years were identified; 15 (9.6%) patients stopped
the scalp cooling during or after the first session because of adverse events (n=13) or financial reasons
(n=2). As defined above, scalp cooling was successful in 80 (56.3%) patients. Success rate was higher
(58.9%) among 107 women wearing Hijab compared to 48.6% among 35 women without. Additionally,
5-Flurouracil-Epirubicin-Cyclophosphamide followed by docetaxel (FEC-D) regimen was associated
with less alopecia (38.0%), compared to those who received Adriamycin-Cyclophosphamide followed
by docetaxel (AC-D) (49.4%). However, in both occasions the difference was not statistically significant.
In multivariate analysis, age, body mass index (BMI), anemia, smoking, hair thickness and length
were not significant factors. Most common adverse event encountered were headache (80.3%), cold
sensation (64.3%), dizziness (22.3%) and pruritus (5.1%). One patient had reversible bradycardia and
hypotension.
Conclusions:
Scalp cooling, utilizing the new Paxman system is effective in preventing hair loss among Jordanian
breast cancer patients treated with anthracyclines and or taxanes. Women wearing Hijab and those
treated with FEC-D, compared to AC-D, might have better success rates. The study is still recruiting
to better verify these findings.
.
64
P-12
Streamlining the Interventional Breast Imaging Workflow by Lean Methodology
Implementation
Corresponding Author Suha Ghoul
Presenting Author Suha Ghoul
Co-author(s) Dana Nashawati, Sawsan Mutlak, Asem Mansour, Abdullah Jamil
Contact dg.08087@khcc.jo
Country JO
Introduction:
Prolonged wait times for image-guided breast interventions are ruining the patient experience and
negatively affect healthcare workers. Adopting lean methodology helps streamline the process and
improve patient satisfaction.
Methods:
This is a quality improvement project which aims to create an efficient interventional breast imaging
workflow using lean methodology by reducing wastes of all kinds including time and materials. It
aims to improve patients’ satisfaction by decreasing the wait times Materials and Methods: We used
the lean six Sigma Define, Measure, Analyze, Improve and Control (DMAIC). The team members
used tools such as affinity diagram to define the current problems in the workflow and the root
cause of prolonged wait times. Team members gathered observations. Root cause analysis using a
fishbone diagram and wasteful steps were identified. Brainstorming sessions discussed ideas for
improvement. A consensus was reached on counter-measures and a pilot project was planned.
Results:
The target of decreasing the wait time was met on the days when the counter measures were fully
implemented.
Conclusions:
Streamlining the breast imaging intervention is considered in its preliminary phase; further work and
reviews are needed towards full implementation and sustainability. Despite the many challenges,
embarking on quality improvement project and promoting lean culture not only helped us to meet
the target of decreasing wait time but have improved the work environment and patient satisfaction
65
P-13
BRAFV600E Mutations in Papillary Thyroid Carcinoma: KHCC Experience
Presenting Author Tawfeeq Al-shobaki

Rafal iskendarian, Enas Younis, Neveen Abdullah, Husasam Haddad,
Co-author(s)
Abdelghani Tbakhi, Hani Al-Najar
Country JO
Introduction:
Papillary thyroid carcinoma (PTC) is the most common thyroid neoplasm, and accounts for 88% of
all thyroid malignant neoplasms. The incidence of PTC has been steadily increasing over the years.
BRAF mutations, represent the most common genetic event in thyroid carcinomas and has the
highest incidence in PTC, ranging between 29-88% of all cases according to multiple studies with
different demographic settings. Recently, it has emerged as a promising prognostic marker for risk
stratification of patients with papillary thyroid carcinoma. There is controversy in considering BRAF
mutation as a prognostic test.
Methods:
The primary endpoint is the proportion of BRAFV600E mutation in papillary thyroid carcinoma
at King Hussain Cancer Center (KHCC). The secondary end points are the rate of lymph nodes
involvement, loco-reginal recurrence, distant disease free & over-all survival in BRAF positive
patients.
Methods:
We analyzed BRAF V600E mutational status in the primary lesion of 128 PTC cases and their
corresponding lymph node metastasis who underwent hemi or total thyroidectomy with or without
lymph node dissection between January 2000 and December 2014. The relationship between
BRAF(V600E) mutation and gender, age (below 55), lymph node metastasis, surgery type, loco-
reginal recurrence, distant disease free & overall survival was investigated.
Results:
BRAF(V600E) mutation was found to be present in 91/128 (71% of patients). We found BRAF(V600E)
mutation was not correlated with any of the prognostic factors including age (below 55), male
gender, surgery type, lymph node metastasis, loco-reginal recurrence, , distant disease free survival
& overall survival among patients.
Conclusions:
Although the percentage of BRAF V600E mutation is high among KHCC patients, being BRAF
V600E mutation positive does not affect the lymph node involvement, loco-reginal recurrence nor
distant metastasis survival nor overall survival.
66
P-14
Role of the Laparoscopic Approach to Insertion of Feeding Tube Gastrostomy in
Patients with Head and Cancers: An Early Experience
Presenting Author Huthaifa Asmar
Co-author(s) Hani Al-Najar
Country JO
Introduction:
Patients with head and neck cancers may require feeding tube gastrostomy during the course of
their treatment. Surgical gastrostomy is indicated in patients who failed or unsuitable for endoscopic
or radiologic gastrostomy tube insertion. Open tube gastrostomy is associated with high morbidity.
We sought to investigate the role of the laparoscopic approach in this setting.
Methods:
The laparoscopic approach -for which we present a video- involved 3 ports, the creation of a 1.5cm
anterior gastrotomy 1cm parallel to the mid-lesser curve and a puncture 1cm above the greater
curvature of the distal body of the stomach. A 24Fr gastrostomy tube was then passed through
and the gastrotomy was suture closed. Patients were allowed fluid intake either via the gastrotomy
or orally immediately after surgery. The outcomes are reported as median (range) or percent as
appropriate.
Results:
Between January 2018 and January 2019, 10 patients (6 male) aged 54 (26-78) years underwent
laparoscopic insertion of gastrostomy feeding tube. The indications were therapeutic in six patients
and prophylactic (prior to radiotherapy) in four patients. Three patients underwent additional
concomitant procedures. There were no conversions to open surgery and all procedures were
uneventful. The operating time and hospital stay were 45 (20-70) minutes and 0.5 (0-13) days
respectively. The procedure was carried out as day-case in five patients while two patients were
discharged on the first postoperative day.
Conclusions:
Laparoscopic insertion of gastrostomy feeding tube is safe and can be performed within an
ambulatory setting in most patients.
67
P-15
Improved Care of Head and Neck Cancer Patients with persistent Tracheostomy
by Passy-Muir Valve, retrospective study in KHCC
Corresponding Author Ibrahim Al-Maayta
Presenting Author Ibrahim Al-Maayta
Co-author(s) Omar Al Saraireh
Contact emayta@khcc.jo
Country JO
The tracheostomy tube decreases the ability of patient to communicate effectively. The ability to
speak provides an important improvement in the quality of life for a patient with tracheostomy.
The speaking valve is a button like piece of equipment that is placed on the outer hub of the
tracheostomy tube. The one-way valve opens to let air in through the tracheostomy when the
patient inspires. The valve closes during expiration, causing the air to follow the normal route of
expiration and permitting speech passy-muir valve found to be helpful with restores communication,
improves swallowing and may reduce aspiration, restores natural positive airway pressure, facilitates
secretion management, improves oxygenation, expedites ventilator weaning and decannulation,
facilitates infection control, and improves smell, taste and sensation.
68
P-16
Predictors of Outcome in Intermediate Risk Acute Myeloid Leukemia
Corresponding Author Mohammad Ma'koseh

Kamal Al-rabi, Lina Marie, Ahmed Al-Shyoukh, Rami Alwardat,
Co-author(s)
Hikmat Abdel-Razeq
Contact dm.09744@khcc.jo
Country JO
Introduction:
Intermediate-risk acute myeloid leukemia (AML) includes heterogeneous group of patients without
favorable or unfavorable cytogenetic aberrations. Recently, novel molecular markers have refined
their risk stratification, but testing for these markers is not widely available. Significant predictors of
outcome in these patients are not well-studied.
To evaluate the effect of different clinical, laboratory, cytogenetic and treatment variables on
outcome of intermediate-risk AML.
Methods:
Among patients diagnosed with AML from 2008 till 2016 and treated with standard induction
chemotherapy, intermediate risk AML patients were identified using European Leukemia Net genetic
risk stratification. The effect of different demographic , laboratory , cytogenetic and treatment
related factors including number of inductions needed to achieve complete response (CR) and
type of consolidation on overall survival (OS) and event free survival (EFS) were examined through
univariate and multivariate Cox-regression analysis.
Results:
Out of 213 AML patients, 122 were classified to be intermediate risk. Median age on diagnosis was
39 years. Following induction, 95 (78%) achieved CR; 82(86%) were consolidated with high dose
cytarabine and 13 (14%) were consolidated with allogeneic stem cell transplant. Median follow-up
was 47 months. OS rate at 3 years and 5 years was 37.9% and 30.6%, respectively. EF at 3 years
was 28.9% and at 5 years was 21%. On multivariate analysis, initial white blood cell count (WBC) >
100.000 (HR: 2.68, 95% CI: 1.39 -23.43, p= 0.021) was significantly associated with worse OS, while
initial WBC > 50.000 (HR: 2.08, 95% CI: 1.28-3.38 p= 0.002) was associated with worse EFS.
Conclusions:
Among multiple clinical, laboratory, and treatment related variables, initial WBC is the most
important predictor of EFS and OS in patient with intermediate risk AML. This may be helpful in risk
stratification and treatment decision where novel molecular markers are not available.
69
P-17
The Severity of Fatigue among Bone Marrow Transplantation Patients Post
Transplant
Corresponding Author Osama Abdalrahman
Presenting Author Osama Abdalrahman
Co-author(s) Ezzaldeen Almashaikh, Hala Aljarrah
Contact orahman@khcc.jo
Country JO
Introduction:
Fatigue interferes with the individual’s functioning and quality of life in patients with cancer. After
chemotherapy and post Bone Marrow Transplantation (BMT), fatigue is not adequately addressed
and prioritized among health care providers.
This study aimed to determine the prevalence and severity of fatigue among patients with cancer
post BMT and after receiving chemotherapy.
Methods:
A cross-sectional descriptive, correlation design was utilized, Piper Fatigue Scale (PFS) Arabic
version was used to measure participants’ level of fatigue. The scale measures four dimensions
of subjective fatigue: Behavioral, Affective, Sensory, and Cognitive. Patients above 18 years old,
received chemotherapy and do BMT between Oct 2016 and Oct 2017 were included in this study.
Results:
100 patients participated in this study, 52% diagnosed with leukemia, 32% lymphoma, and
16% hematology. Thirty-nine patients (39%) had no or mild fatigue level, and they do not need
any medical intervention; but, 47% and 14% classified as moderate and severe level of fatigue
respectively, equal to 61% of the total sample who need medical intervention. Overall, fatigue
severity categories; mild, moderate, and severe, shows that there is a significant difference in term
of severity sub scale in sensory and behavioral dimensions (p= .03, .004) respectively. However,
other sub scales dimension did not significantly differ among patient (p > .05), the highest mean
sub scale score occurred in the behavioral dimension (M = 4.8, SD = 2.37), while the lowest mean
sub scale score occurred in the cognitive dimension (M=2.59, SD=2.35), The overall score mean of
the male patients regarding the fatigue severity was 45.18 ( n=74), and for the female patients the
mean was 57.03 (n=26), and the result shows that there was a significant difference between male
patients and female patients (t (98)= -2.2, p< 0.05).
Conclusions:
Fatigue-related to BMT is a serious and prevalent problem among patients with cancer. Fatigue
may impair quality of life among this group of patients; further studies may be conducted to assess
the effect of fatigue on quality of life and activity of daily living. Implications for Practice: It is
essential to include fatigue assessment as a priority for BMT patients.
70
P-18
Outcomes of Acute Myeloid Leukemia Treated with Standard Induction
Chemotherapy in Jordan
Corresponding Author Mohammad Ma'koseh

Rami Al-wardat, Kamal Al-Rabie, Lina Marie, Dalia Al-Rimawi,
Co-author(s)
Anas al-Bawaliz, Ahmad El-shoyoukh
Contact dm.09744@khcc.jo
Country JO
Introduction:
Outcome of Acute Myeloid Leukemia (AML) treated with standard anthracycline and cytarabine
based chemotherapy is affected by multiple factors. Little is known about disease characteristics
and potential factors affecting the outcome of these patients in Jordan.
Methods:
To evaluate different prognostic factors in Jordanian patients with AML. Materials and Methods: We
retrospectively reviewed the files of adult patients diagnosed at King Hussein Cancer Center with
AML treated with anthracycline and cytarabine based induction from July 2008 till June 2016. The
effect of different demographic, laboratory , cytogenetic and molecular factors on overall survival
(OS) and event free survival (EFS) was examined through univariate and multivariate cox-regression
analysis.
Results:
A total of 213 patients were included . Median age on diagnosis was 39 years. Cytogenetics were
known for 184 patients (86%) and FLT-3 ITD mutation status was known for 111 patients (52%).
According to European Leukemia Net (ELN) genetic risk stratification , 23 ( 10.8%) were favorable
risk, 122 ( 57.3%) were intermediate risk while 68 ( 31.9%) were poor risk category. 164 (77%)
patients could achieve complete remission(CR), 32 (19.5%) were consolidated with allogeneic stem
cell transplant while 132 (80.5%) were consolidated with high dose cytarabine. Median follow-up
was 40.36 months. Median survival was 15.3 months. On multivariate analysis , age > 60 years (HR:
2.01 , 95% CI: 1.02 - 3.96, p= 0.043) and cytogenetic risk status ; intermediate vs. good (HR: 5.75,
95% CI: 1.79 - 18.42, p= 0.003) and poor vs. good (HR: 7.13, 95% CI: 2.17 - 23.43, p= 0.001) were
significant predictors of OS, while the only significant predictor of EFS was cytogenetic risk status;
intermediate vs. good (HR: 4.18, 95% CI: 1.65 - 10.28, p= 0.002) and poor vs. good (HR: 5.89, 95%
CI: 2.28 - 15.23, p= 0.0003).
Conclusions:
In Jordanian AML patients treated with standard induction chemotherapy, cytogenetic risk status
rather than other demographic and laboratory features was the best predictor for both OS and EFS.
.
Demo
71
P-19
Audit on the Adequacy of Bone Marrow Specimens at King Hussein Cancer
Center, During the Year 2018
Corresponding Author Nazmi Kamal
Presenting Author Madiha Erashdi
Co-author(s) Maher AlSughayer
Contact nkamal@khcc.jo
Country JO
Introduction:
Bone marrow studies (aspiration and biopsy) are crucial in the management of wide range of
neoplastic and non-neoplastic disease as a diagnostic tool, or for follow up. The bone marrow
involvement is focally involved in large number of diseases, therefore, adequate, representative
specimens are required for proper assessment. As per the 2016 world health organization (WHO)
classification of tumours of haematopoietic and lymphoid tissues, an adequate bone marrow
core biopsy specimen should be at least 15.0 mm in length with at least 10 partially pre-served
intertrabecular spaces. However, some authors recommend longer biopsies.
Methods:
This is a retrospective project included approximately 18% of bone marrow aspirates and biopsies
received in the department of pathology and laboratory medicine, at King Hussein cancer center
(KHCC), throughout the year 2018. Specimens were assessed microscopically. The WHO criteria
were used as a cut off for adequacy.
Results:
Total number of cases was 276. Pediatric cases were”81 (29.3%)”. The in- house cases were“167
(60.5%)”. Spicular aspirate specimens were 180 (65.2%). The average bone marrow length was 12.9
mm. The average number of inter-trabecular spaces per core was 10.6. biopsies with bone marrow
≥ 15 mm and > 10 intertrabecular spaces were 103 (37.3%). Specimens with spicular aspirate, bone
marrow biopsy ≥ 15 mm and > 10 intertrabecular spaces were 72 (26%). Crushing artifacts were
present in 145 (52.5%), Aspiration site was present in 230 (83.3%), both were seen in 137 (49.6%)
cases. We reached diagnosis in 252 cases (91.3%). Table (1).
Conclusions:
Only 26%of our specimens were adequate, however, we reached a diagnosis in 91.3% of cases.
72
P-20
Prognosis and Outcome in patients with Pulmonary Carcinoid Tumors: A Single
Center Experience at the American University of Beirut Medical Center
Presenting Author Haidar El Darsa

Firas Kreidieh, Juliett Berro, Pierre Sfeir, Ali Shamseddine, Arafat
Co-author(s)
Tfayli
Country LB
Introduction:
Pulmonary carcinoid tumors are neoplasms that belong to the pulmonary neuroendocrine family.
Consisting of typical and atypical types, pulmonary carcinoids can be divided according to their
differentiation status and grade and are characterized by cell size, mitotic index, and presence
of necrosis. They are rare with an incidence of approximately 1% worldwide (1). While patients
generally have a good prognosis, risk of death with metastatic disease can range from 5 up to
30% (1, 2). In this study, we aim at studying the general characteristics, prognosis and outcome of
pulmonary carcinoid tumor patients at the American University of Beirut Medical Center (AUBMC).
Methods:
We conducted chart review and phone calls for collection of information on all carcinoid tumor
patients who sought medical attention at AUBMC between 1993 and 2017. Patients had consented
to be contacted for follow-up. We collected information about demographics, tumor characteristics,
staging, and recurrence and survival status.
Results:
36 patients were included in this study, half of whom were males (53%). The average age at diagnosis
was 47 years. 13 (37%) patients were smokers. One quarter of the patients was asymptomatic at
the time of diagnosis, and 37.9% had respiratory symptoms, including cough and pneumonia. 23
(63.89%) patients had pulmonary carcinoid tumor involving the right lung. 26 (92.9%) of tumors
were unifocal, and the average largest tumor diameter was 2.6 cm. 75% belonged to the typical
type. 69.56% of patients had stage I disease. 75% underwent surgical resection while the remaining
patients received chemotherapy, including Cisplatin, Etoposide, and Taxotere, or Sandostatin. only
27.78% received chemotherapy, and 8% received radiation therapy. Three patients had disease
recurrence with an average time to recurrence of 9.67 years, while 2 patients had progression of
disease. The median time to recurrence/progression was 74 months. The median time of follow up
was 74 months. 2 (5.56%) patients passed away due to disease progression, and the median overall
survival was 72 months.
Conclusions:
Our study showed that the prognosis of pulmonary carcinoid is good, for both typical and atypical
types, with very low death and recurrence rates and a median overall survival of 72 months.
Recruiting our sample number of patients for a rare disease like carcinoid, however, has an added
clinical value of reflecting the status of this disease population at our center.
.
Demo
73
P-21
Variables Altering the Impact of Respiratory Gated CT Simulation on Planning
Target Volume in Radiotherapy for Lung Cancer
Corresponding Author Fawzi Abuhijla
Presenting Author Fawzi Abuhijla

Abdellatif Al-Mousa, Ramiz Abuhijlih, Lubna Hammoudeh, Khalid
Co-author(s)
Dibs, Adhoob Al-Hammadi, Taher Abuhejleh, Jamal Khader
Contact fhijle@khcc.jo
Country JO
Introduction:
Respiratory gated CT simulation (4D-simulation) has been evolved to estimate the internal body
motion. This study aimed to evaluate the impact of tumor volume and location on the planning
target volume (PTV) for primary lung tumor when 4D simulation is used.
Methods:
Patients who underwent CT simulation for primary lung cancer radiotherapy between 2012-2016
using a 3D-(free breathing) and 4D-(respiratory gated) technique were reviewed. For each patient,
gross tumor volume (GTV) was contoured in free breathing scan (3D-GTV), and 4D-simulation scans
(4D-GTV). Margins were added to account for the clinical target volume (CTV) and internal target
motion (ITV) in 3D and 4D simulation scans. Additional margins were added to account for planned
target volume (PTV). Univariate and multivariate analyses were performed to test the impact of the
volume of the GTV and location of the tumor (relative to the bronchial tree and lung lobes) on PTV
changes by more than 10 % between the 3D and 4D scans.
Results:
A total of 10 patients were identified. 3D-PTV was significantly larger than the 4D-PTV; median
volumes were 182.79 vs. 158.21 cc, p=0.0068). On multivariate analysis, neither the volume of the
GTV (p=0.5027), nor the location of the tumor (peripheral, p=0.5027 or lower location, p=0.5802)
had an in impact on PTV differences between 3D-simulation and 4D-simluation.
Conclusions:
The use of 4D-simulation reduces the PTV for the primary tumor in lung cancer cases. Further
studies with larger samples are required to confirm the benefit of 4D-simulation in decreasing PTV
in lung cancer.
74
P-22
Predicting Survival in Patients with Advanced Cancer in Home Care Setting
Using Palliative Prognostic Index
Corresponding Author Fadi Abu-Farsakh
Presenting Author Fadi Abu-Farsakh
Co-author(s) Omar Shamieh
Contact ffarsakh@hotmail.com
Country JO
Introduction:
Predicting survival in patients with advanced cancer receiving care at home is quite challenging,
because we usually depend on subjective data. The palliative prognostic index (PPI) is commonly
used to predict the life expectancy. It is a useful tool to predict survival, it is the sum of Palliative
performance scale (PPS) and other clinical variables (oral intake, edema, resting dyspnea, and
delirium). The PPI can acceptably predict whether or not a patient will survive >3 or >6 weeks, and
it has been tested by other authors in inpatient setting, but was not studied at patient’s home.
Methods:
Retrospective analysis of records of 80 patients received home health care visits at King Hussein
Cancer Center, in Jordan.
Results:
PPI has a high sensitivity to predict survival in the last 3 weeks (sensitivity of 97.5%). The presence
of delirium and dyspnea at rest are highly specific to approaching toward the end-of-life. PPI score
below 6 can predict a survival of more than 3 weeks
Conclusions:
PPI is a useful tool to predict survival. However, more prospective studies should be done in inpatient
and home care settings to determine the cutoffs values to predict survival accurately.
75
P-23
Are Patients Willing to Participate in Palliative and End-of-Life Research? Findings
from a Tertiary Care Cancer Center in Jordan
Corresponding Author Amal Al-Tabba'
Presenting Author Amal Al-Tabba'
Co-author(s) Omar Shamieh, Khawlah Ammar, Ismail Abusheikh, Henry Silverman
Contact aa.11661@khcc.jo
Country JO
Introduction:
Providing quality and patient centered palliative and end-of-Life (EoL) care to terminally ill patients
present many challenges to healthcare providers. This is due to the advanced nature of their illness,
pain and physical symptoms in addition to the psychosocial and spiritual needs. For each of these
areas, evidence from research is needed to support best clinical practices. This study aims to assess
the perceptions of cancer patients and their family caregivers at King Hussein Cancer Center (KHCC)
toward palliative and EoL research.
Methods:
This is a cross-sectional survey study. A convenient sample of patients and/or their family caregivers
referred to KHCC’s palliative care services were invited to complete the survey. The survey consisted
of three parts to assess participants’ overall perceptions, perceived potential benefits and barriers
of participation in palliative and EoL research. Demographics including age, gender, and education
were collected.
Results:
A total of 118 participants (31 patients and 87 family caregivers) completed the survey. Mean
age was 45 years and 56% were females. The majority of patients (24/31, 77.4%) and caregivers
(78/87, 89.6%) reported general positive views toward palliative patients’ participation in research.
Nonetheless, lower percentages were reported when asked about willingness to participate in
specific types of research, Table 1. Most frequently reported barriers to research participations
by both patients and caregivers were feeling too sick (83.9% and 83.9%, respectively), being
already overwhelmed (54.8% and 60.9%, respectively) and concern about being experimented on
(48.4% and 52.9%, respectively), Figure 1. Most frequently reported potential benefits to research
participation by both patients and caregivers were to improve the healthcare provided to patients
(77.4% and 85.1%, respectively) and altruism, i.e., helping others (77.4% and, 73.6%, respectively),
Figure 2.
Conclusions:
Several characteristics related to patients’ advanced illness proved to be barriers to research
participation. Educational and awareness efforts are needed to improve patients’ recruitment in
palliative and EoL research in addition to developing innovative research designs that are more
sensitive to the mentioned barriers.
76
P-24
Protecting Palliative and End-of-Life Research Subjects: Are We Overdoing It?
Corresponding Author Amal Al-Tabba'
Co-author(s) Omar Shamieh, Khawlah Ammar, Henry Silverman
Country JO
Introduction:
Many challenges hinder palliative and end-of-life (EoL) research. Some healthcare providers are
reluctant to conduct research involving patients at the EoL. Accordingly, they adopt protective
attitudes regarding recruiting their patients in research. Additionally, many researchers report that
paternalism of Institutional Review Boards (IRB) and their views of patients at EoL as vulnerable
subjects have created barriers towards recruitment of patients for palliative and EoL research. This
study aims to assess the perceptions of palliative healthcare providers and IRB members at King
Hussein Cancer Center (KHCC) towards palliative and EoL research.
Methods:
This is a cross sectional survey study. All healthcare providers working in the palliative care department
and members of the IRB at KHCC were invited to complete the survey. The Survey consisted of
three parts to assess overall perceptions towards palliative and EoL research, perceived potential
research benefits, and potential concerns preventing their research participation.
Results:
A total of 51 participants (31 palliative healthcare providers and 20 IRB members) completed the
survey. Of these respondents, 93.5% of healthcare providers and 100% of IRB members reported
general positive views towards palliative and EoL research. Nonetheless, when asked whether
palliative patients should be given the opportunity to participate in different types of research,
lower percentages were reported, Table 1. Both healthcare providers and IRB members agreed
that patients’ poor health condition to be the most important potential concern (90.3% and 85.0%,
respectively) and improving the healthcare provided to patients to be the most important potential
benefit for research participation (87.1% and 80.0%, respectively), Figures 1 and 2.
Conclusion:
This study highlights the need to find a balance between identified concerns that contribute to
the reluctance to recruit patients at the EoL and the autonomy of such patients to participate in
research. Such research is of vital importance at this stage of illness trajectory. Our results should
guide the design of palliative and EoL research to overcome the alleged gate-keeping role of
palliative healthcare providers and IRB members at KHCC.
77
P-25
Intensity of Cancer Care Near the End-of-Life at a Tertiary Care Cancer Center
in Jordan
Presenting Author Mahmoud Abu Nasser

Omar Shamieh, Moath Nassar, Yazan Samhouri , Bashar Abu Qayas
, Joud Asfour, Joud Jarrah, Zaid Abdulrahman , Zaid Ameen ,
Co-author(s)
AbdelRahman Al- Hawamdeh , Mohammed Al-Omari , Amal Al-
Tabba’, Dalia Al-Rimawi, David Hui
Country JO
Introduction:
Chemotherapy use in the last month of life is an indicator of poor quality of end-of-life care. We
assessed the frequency of chemotherapy use at the end-of-life at our comprehensive cancer center
in Jordan, and identified the factors associated with chemotherapy use.
Methods:
We conducted a retrospective chart review to examine the use of chemotherapy in the last 30 days
and 14 days of life in consecutive adult cancer patients seen at King Hussein Cancer Center (KHCC)
who died between January 1, 2010 and December 31, 2012. We collected data on patient and
disease characteristics, palliative care referral, and end-of-life care outcome indicators.
Results:
Among the 1714 decedents, 310 (18.1%) had chemotherapy use in the last 30 days and 142 (8.3%)
in the last 14 days of life. Over half (910; 53.1%) had a palliative care referral. Chemotherapy use in
the last 30 and 14 days of life were associated with younger age (odds ratio [OR] 0.99/yr, P=0.01;
and OR 0.99/yr, P=0.01, respectively) and hematological malignances (OR 1.98, P<0.001; and OR
2.85, P<0.001, respectively). Palliative care referral was significantly associated with decreased use
of chemotherapy in the last 30 (OR 0.30, P<0.001) and 14 (OR 0.15, P<0.001) days of life.
Conclusions:
A sizable minority of cancer patients at KHCC received chemotherapy at the end-of-life. Younger
patients and those with hematological malignancies were more likely to receive chemotherapy
while those referred to palliative care were significantly less likely to receive chemotherapy at the
end-of-life.
.
Demo
78
P-26
Clinical Trials in Social Media: Content Analysis of available YouTube Videos in
Arabic Language
Corresponding Author Maysa Al-Hussaini
Co-author(s) Amal Al-Omari
Contact mhussaini@khcc.jo
Country JO
Introduction:
Clinical trials are fundamental to the advancement of cancer care; nonetheless, recruitment remains
inadequate. A frequently reported barrier to participation is the lack of awareness and understanding
about clinical trials. Research showed that the internet is being used now as a primary source for
health-related information. We aim in this study to review available videos in the YouTube, one
of the most-visited websites worldwide, about clinical trials in Arabic language and evaluate the
comprehensiveness of its content.
Methods:
YouTube videos were searched using the keywords “ ” and “ ”, i.e.
“clinical trials” and “clinical studies”, respectively. Only videos targeting the public were included in
the study. Videos targeting medical students/ healthcare professionals, discussing country-specific
laws, longer than 30 minutes, or found irrelevant were excluded from the analysis.
The following video characteristics were recorded: number of views, likes and dislikes, video length,
year published, country of origin, video source, YouTube video category, theme and presentation
style. Based on the researchers experience and using the National Cancer Institute (NCI) Clinical
Trials Information for Patients and Caregivers series of documents as the reference standard, the
content of each video was grouped into five categories: clinical trial purpose, trial phases, study
design, safety and ethics, and participant considerations.
Results:
Eight videos about clinical trials were included in the analysis. The mean length of videos was
5:53 minutes (range: 1:37-16:53 minutes). Half of the videos (n=4) were created by TV/ Internet
Channels, published in the year 2018 and produced in Saudi Arabia. Most common theme and
presentation style were neutral and vlog, receptivity (3/8, 37.5%; for both), Table 1. Only 1 video
was related specifically to cancer clinical trials (12.5%). For videos’ content, the most frequently
mentioned items were animal testing conducted before clinical trials, clinical trials are conducted
on several phases and phase I clinical trials (n=5, 62.5%; for all items), Table 2.
Conclusions:
This study identified a clear scarcity of YouTube videos about clinical trials in the Arabic language, as
well as, potential gaps in the comprehensiveness of the content presented. Different stakeholders
need to pay more attention to the use of social media in prompting clinical trials and providing
comprehensive and reliable sources of information to the public.
79
P-27
The Impact of The Open-Access Status on Journal Indices: Oncology Journals
Corresponding Author Saif Aldeen AlRyalat
Presenting Author Faris Tamimi

Esraa Al-fraihat, Lama Assaf, Razan Ghareeb, Mahmoud Masoudi,
Co-author(s)
Mohammad Al-Essa
Affiliation Jordan University Hospital
Contact s.alryalat@ju.edu.jo
Country JO
Introduction:
The field of oncology is among the highest productive fields in medicine, with the highest impact
journals. During the last few decades, the emergence of open access (OA) publishing provided a
new way of oncology advancement. The impact of OA journals is still understudied in the field of
oncology. In this study, we aim to study the open-access status of oncology journals and the impact
of the open-access status on journal indices.
Methods:
We collected data on the included journals from Scopus Source List on 1st of November 2018.
We filtered the list for oncology journals for the years from 2011 to 2017. Open Access Journals
covered by Scopus are indicated as Open Access if the journal is listed in the Directory of Open
Access Journals (DOAJ) and/or the Directory of Open Access Scholarly Resources (ROAD). We
compared citation metrics between OA and non-OA journals.
Results:
There were 318 oncology journals compared to 260 in 2011, an increase by about 24.2%, and the
percentage of OA journals has increased from 19.6% to 23.9%. Although non-OA journals have
significantly higher scholarly output (p= 0.001), percent cited and Source Normalized Impact per
Paper SNIP were higher for OA journals.
Conclusions:
This study found a clear incentive for researchers to publish their work in oncology OA journals.
Publishing in oncology OA journals will yield more impact, in term of citations, and will reach
boarder audience.
80
P-28
Predictors of Oxaliplatin-Induced Hepatotoxicity: Increase in Spleen Volume or
Liver Fibrosis and Steatosis?
Corresponding Author Ali Shamseddine
Presenting Author Fadi Haddadin

Malek Kreidieh, Alaa Chami, Fadi Haddadin, Monita Al Darazi, Ali
Co-author(s) Haydar, Nadim Muallem, Firas Ershaid, Walid Faraj, Mohammad
Khalifeh, Deborah Mukherji, Sally Temraz, Haifa Dbouk
Contact as04@aub.edu.lb
Country LB
Introduction:
Oxaliplatin is a third-generation platinum compound mainly used in gastrointestinal carcinomas.
Increase in spleen-volume has been proposed as an indirect tool to predict oxaliplatin-induced
hepatotoxicity. FibroScan might have prognostic value in this setting. The primary aim of this study
was to measure spleen-volume and extent of fibrosis before and during oxaliplatin to check whether
detection of early-fibrosis by FibroScan predicts oxaliplatin-toxicity before change in spleen-volume.
Methods:
This is a prospective pilot-study conducted at AUBMC on 38 patients started on oxaliplatin. Increase
in spleen-volume and liver-fibrosis were measured using IntelliSpace Portal system and FibroScan,
respectively, at baseline, 3-months, and 6-months.
Results:
13(34.2%), 26(76.5%), and 26(70.3%) patients developed thrombocytopenia, AST-elevation, or ALT-
elevation following oxaliplatin, respectively. 29(76.3%) patients developed peripheral-neuropathy (all
grades), of which 31.6% and 20.0% developed grades2/3 peripheral-neuropathy at 3-months and
6-months, respectively. 2 patients presenting with grades2/3 peripheral-neuropathy had fibrosis initially
and constituted 28.6% of patients with baseline-cirrhosis. No significant correlation existed between
early-fibrosis and development of grade2/3 peripheral-neuropathy at 3- or 6-months, respectively.
19(54.3%) and 21(70%) patients developed an increase in liver-fibrosis at 3-months (p-value=0.239) and
6-months (p-value=0.173), respectively. Increase in liver-fibrosis was significantly correlated with AST
and ALT-elevation (p-values=0.020 and 0.011) but not with thrombocytopenia or neuropathy. 24(80%)
and 26(86.7%) patients developed a statistically significant increase in spleen-volume at 3-months
and 6-months, respectively (p-values<0.05). No significant correlation existed between increase in
spleen-volume and thrombocytopenia, ALT-elevation, AST-elevation, or neuropathy probably due to
small sample.
Conclusions:
Our study suggests that increase in liver-fibrosis correlates better with transaminase-elevation than
does spleen-enlargement. Performing a FibroScan, rather than the challenging process of splenic-
volume measurement, might serve as a practical predictor of oxaliplatin-toxicity, especially in patients
with baseline liver-fibrosis. Although our analysis reveals no correlation between early-fibrosis and
worse toxicity-profile, the study is ongoing and data on a larger sample will be analyzed.
81
P-29
Modified GTX Second-Line Therapy in Pancreatic Adenocarcinoma
Corresponding Author Sally Temraz
Presenting Author Farah Nassar
Co-author(s) Wajdi Al Bonji, Maya Charafeddine, Ali Shamseddine
Contact fjn00@mail.aub.edu
Country LB
Currently, advanced pancreatic adenocarcinoma has no standard second-line therapy after

progression on first line chemotherapy of either FOLFIRINOX or Gemzar/Abraxane. Modified
regimen of Gemcitabine, docetaxel, and capecitabine (GTX) has been suggested for advanced
pancreatic cancer knowing that GTX combination induces synergistic apoptosis in human pancreatic
cancer cells. We have previously conducted a retrospective study on the use of modified GTX
regimen at our institution and it had good tolerability with response rate of 33%. Therefore, we
conducted prospective analysis to evaluate the radiological response rates, toxicity and survival
of modified GTX in pancreatic cancer patients progressing on first-line chemotherapy. 28 patients
presenting to AUBMC between March 2013 and January 2019 with locally advanced unresectable or
metastatic pancreatic adenocarcinoma and progressing on first-line chemotherapy were recruited.
Patients received modified GTX that consists of intravenous administration of docetaxel (40mg/m2)
on days 1 and 15 and gemcitabine (1000mg/m2) on days 8 and 22 as well as oral administration
of capecitabine (625mg/m2) twice daily on days 6-10 and days 20-24 with cycles repeated every
28 days. The mean age at diagnosis was 58.4 years (range: 36-82). The median overall survival
and progression free survival was 8 months and 3 months respectively. The overall survival for 6
months was 66.8% while for 12 months was 14.3% and the progression free survival for 6 months
was 21.2%. The mean follow up in this cohort was 4.86 months. According to RECIST guidelines,
71.4% of the patients had progression, 21.4% had stable response and 3.5% had partial response
after 3 months of treatment. The percentage of patients treated with GTX as second-line therapy
was 46.4% and as third-line and beyond was 53.5%. Patients administering GTX had mild adverse
events such as anemia (92.9%), neutropenia (46.4%), thrombocytopenia (25%), mucositis (14.3%),
nausea and vomiting (14.3%), diarrhea (7.1%) and infection (21.4%). Further prospective studies
with a larger sample should be performed in order to assess the efficacy of GTX as second line
treatment for advanced pancreatic cancer.
82
P-30
Perioperative Management of Pancreaticoduodenectomy: Avoiding Admission
to the Intensive Care Unit

Deborah Mukherji, Hussein Nassar, Samar Jabbour ,Chakib Ayoub,
Co-author(s)
Marwan Risk, Mariam Kanso, Rola F. Jaafar, Mohamad Khalife
Country LB
Introduction:
Pancreaticoduodenectomy is considered to be a complex high-risk surgical procedure. With the
advancement in surgical expertise at high-volume centers and advances in peri-operative management
pancreaticoduodenectomy is becoming safer and remains gold standard for treating periampullary
pathologies. We describe our experience in optimizing perioperative management in order to avoid
admission to the Intensive Care Unit and improve outcomes.
Methods:
Retrospective data was collected on 370 surgical patients who underwent a pancreaticoduodenectomy
between the years 1994 to 2016.Of the 370, 200 patients operated between 2009 and 2016 did not
require intensive care admission, blood transfusion or central line insertion.
Results:
The results were compared between different time intervals; before the year1998, between the year
1998-2008, and between the years 2009-2016. The median blood loss dropped from 800 to 400 to 300cc
respectively. The median operative time also dropped from 360 to 335 to 215 minutes respectively. In
addition, the median length of hospital stay decreased from 25 to 16 to 7 days respectively.
Conclusions:
With the centralization of pancreaticoduodenectomy in high-volume center and with specialized
surgeons performing the surgery, there is a significant decrease in the onset of post-operative
complications with a lesser need for blood transfusions and, subsequently, better recovery of patients
without the need for Intensive Care Unit admission.
.
www.tec-it.com
83
P-31
Obesity and Outcome of Rectal Cancer Surgery after Neoadjuvent Chemo-
Radiotherapy
Presenting Author Tawfeeq Al-Shobaki
Co-author(s) Amro Mureb, MD, Hani Al-Najjar
Country JO
Introduction:
Colo-rectal cancer is the 2nd most common cancer in Jordanian in total and number one in males.
Obesity as risk factor for CRC is associated with increase post-operative morbidity, however there
is controversy regarding the effect of obesity on oncological outcome of rectal cancer.
Objective:
The aim of this study is to evaluate the effect of obesity on short and long term oncological outcome
in rectal cancer patients who received neoadjuvant CRT followed by surgery, and on postoperative
complication.
Material and Methods:

The medical records of 294 patients with stage II-III rectal cancer who received CRT followed by
surgery were reviewed in the period between 2006-2018.The effect of obesity on oncological
outcome and post-operative morbidity was evaluated.
Results:
294 patients were evaluated ,with mean follow up of 42 months(1-146 months).The patient were
classified into two groups; group one with BMI<30 (140 patients) and group two with BMI≥30 (154
patients).
Conclusions:
Obesity in rectal cancer patients treated with neoadjuvant CRT and surgery had increase rate of
postoperative complication, improved pathological CR, DFS and similar OS.
84
P-32
Laparoscopic Liver Resection For All Comers: A Report Of 15 Consecutive
Patients
Presenting Author Basil J. Ammori
Co-author(s) None
Country JO
Introduction:
There is a growing interest in function preserving partial gastrectomy for early gastric cancer. This
concept is particularly applicable to gastrointestinal stromal tumours (GIST) where lymphadenectomy
is not usually required.
Methods:
A 59-years-old man presented with upper gastrointestinal bleeding from an 8.6cm GIST of the
cardia and fundus of the stomach with liver metastases and underwent embolisation of the
ascending branch of the left gastric artery. He received imatinib therapy. We proceeded to perform
a vagus-sparing proximal gastrectomy laparoscopically with an intracorporeally sutured end-to-end
oesophageo-gastric anastomosis and present a video of the procedure.
Results:
The surgery was uneventful with an operating time of 190 minutes and 50ml blood loss. He resumed
liquid diet on the first postoperative day and was discharged on the third postoperative day. His
subsequent recovery was uneventful with no delay in gastric emptying.
Conclusions:
Vagus-sparing proximal gastrectomy can be performed safely in patients with large proximal
gastrointestinal stromal tumours.
85
P-33
An All Comers Approach with Enhanced Recovery Program to Laparoscopic
Pancreaticoduodenectomy: Comparison With A Selective Approach
Presenting Author Balqees Al-omari
Co-author(s) Omari B, Almajali F, Abdullah N, Najjar H, Ammori BJ
Country JO
Introduction:
It is a common practice to apply selective criteria when offering the laparoscopic approach to
pancreaticoduodenectomy (LPR). This study compares the outcomes of a selective approach to
LPD versus “all comers” approach with enhanced recovery program (LPDERP) adopted by the
senior surgeon in the UK and at King Hussein Cancer Center respectively.
Methods:
Patients who underwent selective LPD (2003-2013, n=16) were compared with “all comers” who
underwent LPDERP (2017-2018, n=12). The outcomes studied were reported as median (range) or
per cent as appropriate. Analyses were performed on intention-to-treat basis. Statistical significance
was set at p<0.05.
Results:
The groups were comparable for age, sex distribution, BMI and frequency of malignant disease.
The proportion of patients with dilated pancreatic duct was significantly greater in the LPD group
(100% vs. 41.7%, p=0.001). The LPD patients had significantly larger pancreatic duct diameter (8.3
vs. 3.0 mm, p<0.0001) and a tendency towards smaller tumours (2.1 vs. 3.3 cm, p=0.095). There
were no differences between the groups with regard to operating time (470 vs. 615 min, p=0.189),
blood loss (275 vs. 200 ml, p=0.241), portal vein resection (0 vs. 1 patient), conversion to open
surgery (1 vs. 0 patients), frequency of overall and clinically significant complications (38% vs. 42%,
p=NS; 31% vs. 17%, p=0.662) and of R1 resections (45% vs. 22%, p=0.374). The LPDERP patients
had significantly shorter intermediate and intensive care stay (48 vs. 16.6 hours, p=0.006) and
postoperative hospital stay (9 vs. 4.7 days, p=0.0001).
Conclusions:
The conversion from a selective approach to LPD to an “all comers” approach is feasible and safe.
Despite a greater frequency of high-risk pancreata, the addition of an ERP after LPD was associated
with a significantly shorter hospital stay.
86
P-34
The Rates of Complete Pathological and Complete Clinical Response in Locally
Advanced Rectal Cancer After Neoadjuvant Chemo-Radiation Followed by
Total Mesorectal Excision or Non-Operative Follow Up
Corresponding Author Kholoud AL-Qasem
Presenting Author Kholoud AL-Qasem

Mumen Ayyat, Abeer Daoud, Rand Omari, Ali Dabous, Neveen
Co-author(s)
Abdullah
Contact ka.08177@khcc.jo
Country JO
Introduction:
Outcome of Acute Myeloid Leukemia (AML) treated with standard anthracycline and cytarabine based
chemotherapy is affected by multiple factors. Little is known about disease characteristics and potential
factors affecting the outcome of these patients in Jordan.
Methods:
To evaluate different prognostic factors in Jordanian patients with AML. Materials and Methods: We
retrospectively reviewed the files of adult patients diagnosed at King Hussein Cancer Center with AML
treated with anthracycline and cytarabine based induction from July 2008 till June 2016. The effect
of different demographic, laboratory, cytogenetic and molecular factors on overall survival (OS) and
event free survival (EFS) was examined through univariate and multivariate cox-regression analysis.
Results:
A total of 213 patients were included. Median age on diagnosis was 39 years. Cytogenetics were known
for 184 patients (86%) and FLT-3 ITD mutation status was known for 111 patients (52%). According to
European Leukemia Net (ELN) genetic risk stratification, 23 (10.8%) were favorable risk, 122 (57.3%)
were intermediate risk while 68 (31.9%) were poor risk category. 164 (77%) patients could achieve
complete remission (CR), 32 (19.5%) were consolidated with allogeneic stem cell transplant while 132
(80.5%) were consolidated with high dose cytarabine. Median follow-up was 40.36 months. Median
survival was 15.3 months. On multivariate analysis , age > 60 years (HR: 2.01 , 95% CI: 1.02 - 3.96, p=
0.043) and cytogenetic risk status ; intermediate vs. good (HR: 5.75, 95% CI: 1.79 - 18.42, p= 0.003)
and poor vs. good (HR: 7.13, 95% CI: 2.17 - 23.43, p= 0.001) were significant predictors of OS, while
the only significant predictor of EFS was cytogenetic risk status; intermediate vs. good (HR: 4.18 , 95%
CI: 1.65 - 10.28, p= 0.002) and poor vs. good (HR: 5.89, 95% CI: 2.28 - 15.23, p= 0.0003).
Conclusions:
In Jordanian AML patients treated with standard induction chemotherapy, cytogenetic risk status rather
than other demographic and laboratory features was the best predictor for both OS and EFS.
Demo
87
P-35
Feasibility of the Laparoscopic Approach to Pancreatic Resections for all Comers:
A Report Of 15 Consecutive Patients
Presenting Author Balqees Al-omari
Co-author(s) Omari B, Najjar H, Abdullah N
Country JO
Introduction:
Surgeons adopting the laparoscopic approach to pancreatic resections (LPR) commonly adopt
selective criteria. We investigated the feasibility and outcomes of an “all comers” approach to LPR
at King Hussein Cancer Center.
Methods:
Patients who underwent an attempted LPR between November 2017 and November 2018 were
included. One surgeon performed the LPR in all comers. The outcomes studied were reported as
median (range) or percent as appropriate.
Results:
A total of 15 patients (7 female) aged 62 (41-72) years underwent LPR (pancreaticoduodenectomy
n=11, pancreaticoduodenectomy with portal vein resection n=1, distal pancreaticosplenectomy
n=1, completion spleen-preserving distal pancreatectomy n=1, and spleen-preserving total
pancreaticoduodenectomy n=1). Malignant disease was the indication for surgery in 11 patients
(73%) with a tumor size of 3 (0.7-5) cm. In patients undergoing pancreaticoduodenectomy the
pancreatic duct diameter was 3 (1-5) mm. There were no conversions to open surgery. The median
(range) intraoperative blood loss, operating time, intensive care stay and hospital stay were 200 (40-
700) ml, 10.9 (6.4-15.2) hours, 12.6 (9.7-60.2) hours, and 4.7 (3.0-7.5) days respectively. Clinically-
relevant complications (Clavien Dindo grades 3-5) and 90-day mortality occurred in 16.7% and 0%
respectively. Readmission within 30-day of discharge was required in one patient (6.7%) for one
day. The number of lymph nodes retrieved in cancer patients were 18 (8-36) nodes and the rate of
R0 resection was 81.8%.
Conclusions:
In experienced hands, the laparoscopic approach to pancreatic resection is feasible and associated
with low morbidity and a short postoperative hospital stay. The early oncologic outcomes in patients
with malignant disease are satisfactory.
88
P-36
Preoperative Chemoradiation for Locally Advanced Rectal Cancer: Comparison
of Radiation Dose on Complete Radiological and Pathological Response
Presenting Author Fawzi Abuhijla

Jamal Khader, Sondos Alkhatib, Yazan Halayqa, Sami Koro, Hebah
Co-author(s) Abu Dawabeh, Ayah Arjan, Wafa Asha, Sara Mheid, Ramiz Abuhijlih,
Issa Mohammad
Country JO
Introduction:
The standard radiation dose for patients with locally advanced rectal cancer treated with preoperative
chemoradiotherapy is 45-50 Gy in 25-28 fractions. We aimed to assess whether a difference exists
within this dose fractionation range.
Methods:
A retrospective analysis was performed for patients with locally advanced rectal cancer who were
treated with long course radiotherapy concurrent with chemotherapy at King Hussein Cancer Center
(KHCC). Patients received 50 Gy in 25 fractions, or 45 Gy in 25 fractions to the whole pelvis. Complete
radiological response was defined as complete resolution of the rectal mass and any pre-treatment
gross lymph nodes by pelvic MR and CT scans. Pathological complete response (pCR) was defined
as no residual disease in surgical specimen post resection (T0N0) or pathological confirmation of no
residual disease via biopsy from the tumor bed if clinical exam and colonoscopy showed no evidence
of residual disease.
Results:
Between Jan 2015 and Dec 2017, 123 patients treated with neoadjuvant concurrent chemoradiotherapy
were eligible for analysis (98 patients received 45Gy, 25 patients received 50Gy). Descriptive analysis
showed 38 patients had complete radiological response, with only 17 out of these patients showed
pCR. The total number of patient who had pCR (with or without radiological complete response) were
29 patients (24%). Evaluating the percentage of pCR for each fractionation regemin, the pCR for 45Gy
was 19/98 (19%) while pCR for 50Gy was 10/25 (40%)
Conclusions:
Our results for the different dose fractionation recommended by the National Comprehensive Cancer
Network may suggest higher pCR when using the 50Gy over the 45Gy regimen.
89
P-37
Pancreaticoduodenectomy in the Middle East: Achieving Optimal Results
through Specialization and Standardization

Hussein Nassar, Ahmad Zaghal, Deborah Mukherji, Ali
Co-author(s)
Shamseddine, Mariam Kanso, Rola F. Jaafar , Mohamad Khalife
Country LB
Introduction:
Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the
treatment of localized peri-ampullary pathologies. The concept of treatment standardization has
been well-established in many high-volume centers in the world. Here, we present our experience
in pancreaticoduodenectomy from 1994 to 2015.
Methods:
We performed a retrospective review of the medical charts of patients who underwent
pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and
analyzed. The Mann-Whitney U and Fisher’s exact tests were used to report statistical differences
between groups.
Results:
Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5-
and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of
5.0% (15 patients). The median age of the patients was 61 (13-84) years, with 193 (64.3%) males and
107 (35.7%) females. The median operative time was 300 (130-570) min. The median postoperative
length of hospital stay was 12 (6-100) days. Thirty-two patients required re-laparotomies; 10 for
pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients
developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A
significant improvement in surgical outcome was observed in cases done after 2008 which indicates
the important role of specialized team in surgical management.
Conclusions:
The number of patients undergoing pancreaticoduodenectomy has been increasing annually over
the past twenty-two years in our institution with results comparable to published series from high-
volume centers. Through standardization of surgical techniques and perioperative management
carried out by a specialist team, our results continue to improve despite the increasing complexity
of cases referred to our unit.
.
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90
P-38
Surgical Management of Invasive Gallbladder Cancer: A Single Center Experience
in the Middle East

Hussein Nassar, Ahmad Zaghal, Deborah Mukherji, Ali
Co-author(s) Shamseddine, Mariam Kanso, Rola Jaafar, Sebastian Mondaca,
Ghassan Abu Alfa, Mohamad Khalife
Country LB
Introduction:
Gallbladder cancer (GBC) is a very aggressive tumor associated with poor prognosis unless identified
at an early stage. There is a wide geographic distribution of GBC incidence across the globe, and this
variation correlates with the incidence of cholelithiasis and gallstones. We are reporting our experience
in a single center in the Middle East.
Methods:
All data collected were for all patients who underwent surgery with the final pathology being gallbladder
from 2000 to 2016. 62 patients were identified during that period of time. The American Joint Committee
of Cancer (AJCC), 8th edition was used for Tumor, Node, Metastasis (TNM) classification and staging.
Results:
The median age was 63 years (range 42-93). The overall 1, 3, and 5 years survival rate were 73 %,
46%and 35% respectively. Of the 62 patients, 6 died within 30 days of hospital stay; of which 3 died from
sever sepsis, 2 from small for size liver and 1 cardiac event. Postoperative morbidity was bile leak in 7
patients, bleeding in 4 and wound infections in 11 patients. The TNM classification were as follows: 12
Stage I (T1bN0M0), 18 Stage II (T2N0M0),7 stage IVA (T3N0M0), 23 stage IVB (T2N1M0 and T3N1M0),
1 Stage IVA (T3N2M0) and one Stage IVB (T4N2M1). The pathologies were: 54 adenocarcinoma, 4
squamous cell carcinoma, 3 sarcomas and 1 intraductal papillary carcinoma.
Conclusions:
A complete R0 resection is the standard of care in patients with GBC, and the only potential curative
therapy.
.
Demo
91
P-39
Laparoscopic Vagus-Sparing Proximal Gastrectomy for a Large Gastrointestinal
Stromal Tumour
Presenting Author Ahmad Al-Qaisieh
Co-author(s) None
Country JO
Introduction:
There is a growing interest in function preserving partial gastrectomy for early gastric cancer. This
concept is particularly applicable to gastrointestinal stromal tumours (GIST) where lymphadenectomy
is not usually required.
Methods:
A 59-years-old man presented with upper gastrointestinal bleeding from an 8.6cm GIST of the
cardia and fundus of the stomach with liver metastases and underwent embolisation of the
ascending branch of the left gastric artery. He received imatinib therapy. We proceeded to perform
a vagus-sparing proximal gastrectomy laparoscopically with an intracorporeally sutured end-to-end
oesophageo-gastric anastomosis and present a video of the procedure.
Results:
The surgery was uneventful with an operating time of 190 minutes and 50ml blood loss. He resumed
liquid diet on the first postoperative day and was discharged on the third postoperative day. His
subsequent recovery was uneventful with no delay in gastric emptying.
Conclusions:
Vagus-sparing proximal gastrectomy can be performed safely in patients with large proximal
gastrointestinal stromal tumours.
92
P-40
Nerve-sparing Radical Cystectomy and Neobladder Urinary Diversion: Functional
& Immediate Perioperative and Oncological Outcomes
Corresponding Author Ali Al-Daghmi
Presenting Author Ali Al-Daghmi
Co-author(s) Hani Al-Najjar, Malik Ghashan
Country JO
Introduction:
Transitional cell carcinoma remained the third most commonly diagnosed genitourinary malignancy.
Estimated 58,240 incident cases and 8,210 cancer related deaths in the United States. 30% of bladder
cancers are muscle-invasive and fatal if untreated, with <15% 2-year survival. Radical cystectomy
and ex-pelvic lymphadenectomy is considered the standard of care for clinically localized muscle
invasive bladder cancer and high grade recurrent non-muscle invasive bladder cancer
Methods:
A 35 Orthotropic neobladders during the last 36 month: 13 unilateral nerve-sparing, 9 bilateral
nerve-sparing, and 13 no-nerve-sparing all surgeries done by Single surgeon experience, they
are undergoing follow up on regular basis. Four potential spaces identified: Peri-ureteral Spaces,
Lateral Pelvic Spaces, Recto-vesical Space, and Space of Retzius. The ureters are dissected to the
vesico-ureteric junction (VUJ) distally. The ureter are then clipped, transected and the margins
sent for frozen-section analysis. The rectovesical plane is created and initial preservation of the
neurovascular bundles. To preserve the nerves, which are located close to, the tips of the seminal
vesicles, this dissection is immediately next to the walls of the seminal vesicle, between the vesicle
and the posterior layer of Denonvillier’s fascia.
Results:
A 35 Orthotropic neobladder, Complications defined as occurring within 30 day of surgery, has
been reported in the range of 20-65%, Length of hospital stay 10 (5-27), Estimated blood loss
700 (300-1500), overall complication 26%, Duration of surgery hrs. 5.4 (5-8), Return to theater in
30 days one patient for wound dehiscence. Immediate Pathologic Outcomes Soft tissue margins
Lymph node yield; Pathologic stage; Organ confined (23 (67%)) Non-organ confined (12 (33%)),
Number of lymph nodes (mean) 38 (27-54) Lymph node metastasis11 (30%) Surgical margins
were all negative. Type of tumor 30 high grade transitional cell carcinoma, 2 adenocarcinoma, 1
squamous cell carcinoma, and 2 large cell neuroendocrine carcinoma. Erectile dysfunction: Three
months, sex month, and twelve months for unilateral nerve-sparing (38%, 40%, 50% respectively),
Bilateral nerve-sparing (44%, 44%, 85% respectively)
Conclusions:
Preservation of the autonomic innervation is important for sexual, lower urinary tract function.
Therefore, under the proper circumstances, nerve-sparing RC & NB is to be strongly recommended.
93
P-41
Volumetric-Modulated Arc Therapy Versus Intensity-Modulated Radiotherapy
for Localized Prostate Cancer: A dosimetric Comparative Analysis of Moderate
Hypofractionated Radiation

Khalid Dibs, Jamal Khader, Mohammad Abd Al-Raheem, Wafa Al-
Co-author(s) hajal, Ibrahim Al Rjoub, Sara Mheid, Wafa Asha, Abdelatif Almousa,
Fawzi Abuhijla, Shatha Afifi
Country JO
Introduction:
The use of hypofractionated radiation has been established for localized prostate cancer, however
eligibility for this approach is dependent on strict dosimetric constrains. The aim of this study is to
perform a dosimetric comparison between intensity-modulated radiotherapy (IMRT) and volumetric-
modulated arc radiotherapy (VMAT) for patients receiving moderate hypofractionated radiation.
Methods:
CT simulation datasets of 10 patients with prostate adenocarcinoma were analyzed. For each
patient a step and shoot IMRT plan and VMAT plan were generated. Plans were optimized to
meet target coverage and organs at risk constrains, the dose volume histogram numbers were
compared. Monitor units, treatment times, conformality and homogeneity indices were calculated.
Hypofractionated regimen parameters were assessed for each technique to evaluate plan eligibility
for short course approach (60 Gy over 20 fractions).
Results:
Compared with IMRT plans, VMAT resulted in better planning target volume (PTV) coverage
(p=0.002) and significantly decreased bladder and rectal (D50) doses (p=0.023 and p=0.003,
respectively). Both conformality and homogeneity were improved with VMAT. The mean monitor
units were less with VMAT (654 vs 725). Moreover, treatment time was shorter with VMAT (mean;
1.5 vs 7.5 minutes, p=0.002).
Three IMRT plans did not meet hypofractionated endpoints and deemed not eligible for short
course treatment.
Conclusions:
VMAT resulted in improvement of PTV (D99) coverage and more sparing of surrounding tissues.
VMAT used less monitor units and shorter treatment time. VMAT was able to meet all constrains
and made patients eligible for hypofractionated radiotherapy. VMAT may be the preferred modality
for those patients.
94
P-42
Optimizing Prostate Gland Contouring: Lessons Learnt From Co-Registered 3 T
And 1.5 T Prostate MRI with Endorectal Coil
Co-author(s) Hazem Masarei , B Marami; A Fenster
Country JO
Introduction:
To introduce the concept of MRI- based contouring and its relationship with prostate MRI image
quality and pitfalls in endorectal tube insertion.
Methods:
Prostate contouring is an integral part in prostate cancer care from image-based registration to
prostate focal radiotherapy planning. The presentation will discuss the technique of endorectal coil
insertion as part of prostate MRI protocol and common pitfalls. In addition, common artifacts on
prostate MRI images as a consequence of improper handling of the endorectal coil will be reviewed.
Prostate MRI- based contouring will be systemically explained; including prostate gland anatomy
and relevant anatomical landmarks, methodology and recommendations.
Conclusions:
Proper endorectal coil insertion technique provides better quality prostate MRI images and
decreases the potential artifacts. Sound knowledge of pelvic and prostate gland anatomy plays an
important role in prostate gland contouring in radiology, radiation oncology and medical imaging
research.
95
P-43
Prevalence, Characteristics and Survival Outcomes of Patients with Gynecological
Malignancies Diagnosed at King Hussein Cancer Center

Nader Hirmas, Isam Lataifeh, Ayat Taqash, Imad Jaradat, Ghad-
Co-author(s) eer Abdeen, Lian Otay, Osama Badran, Qais Shatnawi, Areej Abu
Sheikha, Abdulmajeed Dayyat, Fawzi Abuhijla, Mousa El Khaldi
Country JO
Introduction:
To report our experience with gynecological malignancies at King Hussein Cancer Center (KHCC)
to shed light on the similarities and differences with international incidence rates.
Methods:
We collected relevant medical data on all female patients diagnosed with gynecological malignancies
according to international classification of diseases for oncology (ICD-O) C51-58 and C48 (ovarian,
corpus uteri, uterine cervix, fallopian tubes, vagina, vulva, peritoneum and gestational trophoblastic
tumors) between January 2006 and December 2016. Descriptive analysis of patients’ information
was performed. The Kaplan-Meier method was used to estimate event free survival (EFS) and
overall survival (OS) outcomes.
Results:
Data were analyzed on 885 women with gynecological cancers who met the inclusion criteria. The
median age of patients upon diagnosis was 55.1 years, with most of the patients (83.6%) diagnosed
above the age of 40 years. Jordanian patients constituted the majority (81.6%) of the cohort. The
highest incidence was for endometrial cancer (34.2%), followed by cervical (29.5%) and ovarian
(27.1%) cancers. Most cases presented with early clinical stages. At last follow up, 60.1% of patients
were alive. Median EFS was 34.49 months and OS was 62.23 months. Sub-analyses were performed
on cervical, endometrial and ovarian cancers among Jordanian patients.
Conclusions:
This study sheds light on the prevalence and characteristics of the main female genital tract cancers.
We believe these findings are crucial to focus the efforts on the more prevalent cancers in a country
with limited resources.
96
P-44
Impact of Pathology Review on Alteration of Patient Management Plan in
Uterine Malignancy

Imad Jaradat , Maysa Al Husseini, Isam Lataifeh, Ghadeer Abdeen,
Co-author(s) Abdelmajeed Dayyat, Areej Abu Shiekha, Osama Badran, Qais
Shatnawi, Layan Otai, Mousa Alkhaldi
Country JO
Introduction:
Accurate pathology results are considered a cornerstone for the appropriate management of
uterine malignancies. We aim is to summarize our experience of the impact of pathology review in
the management of uterine malignancies.
Methods:
This is a retrospective chart review of the pathology reports for all patients diagnosed with uterine
malignancies between Jan 1st, 2016 and Dec 30th, 2018. The frequency with which the pathology
review at the King Hussein Cancer Center (KHCC) changed the referral pathological diagnosis
outside KHCC, including tumor type, grade, lymphovascular invasion, and FIGO stage, and
whether the change impacted the patient management were determined.
Results:
A total of 102 patient’s charts were reviewed. 68 (67%) pathology results remained unchanged. The
most common change was in tumor grade in 30 cases (29%), resulting in alteration in management
plan in 6 out of 30 patients. Tumor type was changed in 4 patients (4%), while tumor FIGO stage
was changed in 2 patient (2%), both of which resulted in changes in patient management. In total,
the final management plan was altered in 12 out of 102 (12%) of all patients. Four out of these 12
patients had their final alteration in management during the GYN multidisciplinary clinic (MDC)
resulting from the second pathology review in preparation of the MDC.
Conclusions:
Pathology review of uterine malignancies has a major impact on the management of patients. In
addition, the process facilitates cooperation of the multidisciplinary team and provides a valuable
educational forum to enhance patient care.
97
P-45
Vulva carcinoma: An Overview of a Rare Disease and Summary of Experience
from King Hussein Cancer Center (KHCC)
Presenting Author Madiha Erashdi
Co-author(s) None
Country JO
Introduction:
Carcinoma of the vulva is rare, accounting for 5% of gynecological malignancies. Recently, an
increase in the number of reviewed vulva carcinoma was noted.
Methods:
This is a retrospective chart review of all vulva carcinoma cases referred to KHCC from 2004-
2018. Demographic data, changes in the trends over the years, pathology findings, treatment and
outcome are summarized (Table-1).
Results:
A total of 62 patients were diagnosed with vulvar squamous cell carcinoma, neither of which was
associated with cervical nor vaginal squamous cell carcinoma. A dramatic increase in the number of
cases is noted, with 59.7% of the included cases diagnosed between 2016 and 2018 (Figure-1). The
mean age at diagnosis was 56 (35 to 79 years), with the highest proportion (19.4%) observed among
the age group 51-55 years. From those with available data, tumors were mainly unifocal (88.6%).
Labia were the most frequently involved sites, (65.8%,n=25). The average tumor size and depth of
invasion were 30.1mm and 7.73mm, respectively. The most frequent histologic type was squamous
cell carcinoma, NOS (62.7%,n=37). Vulvar intraepithelial neoplasia was seen in 14 patients (77.8%).
According to FIGO staging, stage I, II, III and IV were 46.2%, 5.8%, 28.8%, and 19.2%, respectively.
Surgical resection offered to 82.8% of cases (n=48), with or without chemotherapy or radiotherapy.
With a mean follow up of 18.4 months, 40 patients (64.5%) are alive, most of whom are in complete
remission (n=36), while 19 patients (30.6%) are dead. At 5 years, the event free survival rate is
67.65%, and the overall survival rate is 55.51% (Figure-2).
Conclusions:
Carcinoma of the vulva is a rare disease that is witnessing an increased trend in the last few years.
It is associated with a favorable outcome when treated properly. The underlying predisposing and/
or associated risk factors need to be further indicated.
98
P-46
Uterine Cervical Cancer Staging By MRI in view of Revised FIGO and 8th TNM
Staging Systems
Co-author(s) Hazem Masarei
Country JO
Introduction:
To introduce and discuss MRI- based uterine cervical cancer staging and its role in cervical cancer
management.
Methods:
Cervical cancer is the most common gynecologic malignancy worldwide. Cervical cancer staging
by MRI plays an integral part in cervical cancer care from staging to radiotherapy planning.
Cervical cancer staging by MRI in view of the recent 8th TNM staging system will be discussed. The
presentation reviews uterine cervix MRI anatomy and imaging protocol. MRI findings of cervical
cancer and their correlate in revised FIGO and 8th TNM staging systems will be reviewed.
Conclusions:
Staging of uterine cervical pathology by MRI has a direct impact on cervical cancer management
and prognosis.
99
P-47
Evaluating Performance Status Prior to ICU Admission, Utilizing the Palliative
Performance Scale Version 2 (PPS), as a Predictor of Mortality in Cancer Patients
Corresponding Author Sewar Salmany
Presenting Author Sewar Salmany

Abeer A.Al-Rabayah, Feras I. Hawar, Manal Rayyan, Rawan
Co-author(s)
Alferoukh, Bayan Alnajjar, Omar Shamieh, Lama Nazer
Contact ssalmany@khcc.jo
Country JO
Introduction:
To evaluate the ability of performance status (PS) prior to ICU admission using the Palliative
Performance Scale Version 2 (PPS), to predict mortality in cancer patients.
Methods:
A prospective cohort study of critically ill adult patients with cancer. Caregivers were asked a set of
questions, utilizing the PPS, to determine the PS of patients within the week prior to ICU admission.
Patients were classified into three groups, based on their PPS score: low PS (PPS <40%), reduced PS
(40%-60%), and good PS (70%-100%). To evaluate the predictive value of PS prior to ICU admission,
a receiver operator characteristic (ROC) curve was constructed and the area under the ROC (AUROC)
was determined. The cutoff value of the PPS score and the predictive values (sensitivity, specificity,
negative predictive value (NPV) and positive predictive value (PPV)) were calculated. A significance
criterion of p< =0.05 was used.
Results:
PS prior to ICU admission was assessed for 96 patients. Despite no significant differences between
the three groups, there was a significant difference in mortality, with the highest reported in patients
with poor PS (82.4%). Based on the ROC, the AUROC for mortality and PPS prior to ICU admission
was 0.6451 and the PPS score of 40% was identified as the cut-off point that best predicts overall
mortality with a sensitivity of 54%, specificity 70%, PPV 71%, and NPV 51%.
Conclusions:
PS prior to ICU admission, assessed utilizing the PPS, was a predictor of mortality in cancer patients
treated in the ICU.
100
P-48
Obesity Prevalence Among Cancer Patients: A Retrospective Descriptive
Analysis 2014-2015
Corresponding Author Gheyath Reaf Alnaim
Presenting Author Gheyath Reaf Alnaim
Co-author(s) Shahd Abu Zahra , Khawlah Ammar, Alia Khamis
Contact ga.12099@khcc.jo
Country JO
Introduction:
Obesity prevalence on a rise, many diseases are linked to Obesity, and more studies have shifted
their focus towards establishing the association between obesity and cancer. Recent observational
studies demonstrated an increased risk of up to 13 different cancers linked to obesity. The Middle
East now has the highest BMI globally. This study explores the impact of obesity on the incidence
of cancer in adults.
Methods:
Retrospective examination study of cancer patients their database collected at KHCC with BMI
â‰¥30 (obese), and BMI <30 (Non-obese) for different type cancers from 2014 to 2015. All statistics
were performed by SPSS to analyze data using Chi square test.
Results:
Of 5516 total adult cancer cases collected, 537 patients had missing data regarding weight and
height, BMI was calculated for 4979 (90.3%). Of those 4979, females represented 55.3%, N=3051,
Jordanians 76.3%, N= 4210 obese 37%, N=1843 and stage 4 cancer 41%, N= 1541. Breast cancer
was the most common cancer counting 1379 cases, followed by 286 cases of colon cancer. Cancers
that counted 100 or more were analyzed. A positive correlation between age and high BMI was
found, hence the obese group had the highest mean for the age at diagnosis (53.69) compared with
underweight (45.97) and normal weight (47.39) of the cancer patients. Percentages of overweight
and obese cases were calculated among different type of cancers with corpus uteri cancer being
the highest at 89%followed by breast cancer 79.9% and prostate cancer 77.7%. Surprisingly, the
survival rate was significantly higher among obese patients 82.9% vs 76.8%, P= 0.000.
Conclusions:
This study revealed that all cancer incorporated have a positive association with obesity as well as
over obesity through both sex especially corpus uteri followed by breast and
101
P-49
ICU Readmission of Patients With Cancer: Incidence, Risk Factors and Mortality
Corresponding Author Feras Hawari
Presenting Author Aseel AbuSara
Co-author(s) Lama H. Nazer
Country JO
Introduction:
Few studies evaluated ICU readmission in cancer patients. This study aimed to describe the
incidence and risk factors for ICU readmission in cancer patients and the association with mortality.
Methods:
A retrospective cohort study at a comprehensive cancer center, which included cancer patients
who were discharged after their initial ICU admission over a 5-year period. The characteristics and
outcomes of patients who required ICU readmission within 30 days of discharge were compared
to those who did not require readmission during the study period. Multivariate analyses were
performed to identify factors associated with readmission and to evaluate the association between
readmission and mortality.
Results:
Among 1,582 patients discharged from the ICU, 313(19.8%) were readmitted after a median of 6
days. The most common readmission diagnoses were respiratory failure and sepsis. Mechanical
ventilation (OR 5.80; 95% CI 4.29-7.84) and thrombocytopenia (OR 1.66; 95% CI 1.16-2.38), on the
first ICU admission were associated with readmission. Readmission was associated with a higher risk
of 28-day and 90-day mortality, (OR 3.02; CI 2.3-4.00) and (OR 3.47; 95% CI 2.69-4.49), respectively.
Conclusions:
ICU readmission was associated with increased mortality. Mechanical ventilation and
thrombocytopenia at the first admission were associated with ICU readmission.
102
P-50
Atrial fibrillation in Active Cancer Patients who Develop Stroke
Corresponding Author Ismail Hamam
Presenting Author Alia Khamis
Co-author(s) Zakaria Shkoukani, Tamer Salhab Altamimi
Contact ih.10782@khcc.jo
Country JO
Introduction:
Stroke is a known cerebrovascular complication in cancer patients and in patients with atrial fibrillation
(AF). It is unclear how commonly AF is diagnosed in the setting of active cancer complicated by
stroke and whether combining both cancer and AF in stroke patients is common. The purpose of
this study was to assess the relation between cancer, AF and stroke.
Methods:
We completed a retrospective review and analysis of the electronic medical records of all active
cancer patients who developed stroke between 2014 and 2018.
Results:
145 patients had documented stroke , 54% of patients were males , mean age of the patients were
62 ±14 years, 58% had metastatic cancer , and 62% were on active cancer treatment at the time
of stroke. 26% had gastrointestinal cancer, 15 % had breast cancer, and 15 % had lung and plural
cancer, where 11% had urological cancer. The mean CHA2DS2VASc score for all patients were 2.98
± 1.87. Of these pts, 23 pts (16%) had documented AF at the time of event, 35% of them had AF
diagnosed for the first time and 65% were known to have AF before stroke. These patients with AF
had mean age of 67 ±12 year, 64 % of them were males, 23 % had gastrointestinal cancer and they
had mean CHA2DS2VASc score of 4 ±1.84
Conclusions:
AF is a common finding in active cancer patients who develop stroke. The majority of patients
were known to have AF before the time of stroke. These patients tend to be older and have higher
CHA2DS2VASc score than the patients who were not found to have AF. A larger study with a
control group to assess these findings is underway.
.
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103
P-51
Validation of Edmonton Symptom Assessment System (ESAS) In Arabic Language,
ESAS-A
Corresponding Author Omar Shamieh
Presenting Author Omar Shamieh

Zaid Amin, Fadi Abu Farsakh, Abdulrahman Al-Hawamdeh, ,
Mahmoud Abu Naser, MD, Mohammad Al-Omari, Omar Muhtadi,
Co-author(s)
Abdullah Elayan, Sawsan Al- Ajarmeh, Omar Aiad, , Amal Al
Tabba’, Khawla Ammar, Dalia Al- Rimawi, David Hui
Contact oshamieh@khcc.jo
Country JO
Introduction:
The Edmonton Symptom Assessment System - ESAS is widely used in clinical practice and researches
around the world an in the Arab region. Although there are many symptoms assessment tools that
validated in Arabic languages, the original the original ESAS was not validated in Arabic language.
To validate the Arabic version of ESAS for in patients diagnosed with cancer in palliative settings.
Methods:
This is a cross-sectional survey for patients with advanced cancer in the palliative care services at
King Hussein Cancer (KHCC) in Jordan. Reverse translation method was used to translate the original
ESAS to Arabic. All patients completed ESAS, EORTC-Pal 15 and HADS Internal consistency was
tested using Cronbach’s Alpha; Concurrent, convergent, and discriminant validity were tested using
Spearman’s correlation coefficient and multitrait analysis test; responsiveness test was evaluated by
intra-observer responsiveness T-test; and utility test by identifying the completion time.
Results:
244 patients were included, Our results showed that the overall Cronbach’s Alpha was (.843) which
was confirmed the good internal consistency. All ESAS-A items were significantly correlated with
their similar symptoms in valid scale (>.40). 100% of ESAS-A symptoms were significantly correlated
with their similar symptoms (>.40) and higher than the correlations with not similar symptoms in
valid scale, and the scale able to differentiate 87% of their symptoms from not similar symptoms
when comparing to valid scale. The results of responsiveness test showed that were significant
positive differences between pretest and posttest in all symptoms in both groups except the pain
in the outpatient setting. The average time to complete questionnaire was 4.65 minutes.
Conclusions:
ESAS-A has been confirmed to be valid, reliable, responsive and feasible based on the results of
comprehensive psychometric properties.
104
P-52
Chemotherapy-Related Adverse Events Resulting in Change of Treatment Plan
at The Ambulatory Chemotherapy Infusion Unit
Corresponding Author Ola Mashni
Presenting Author Ola Mashni
Co-author(s) Maha Dalbah, Haya Balasmeh, Haya Khalil
Contact omashni@khcc.jo
Country JO
Introduction:
The information available regarding chemotherapy-associated adverse events is mostly based
on findings from controlled clinical trials. There is limited data on adverse events encountered
in routine clinical care. This study aimed to describe chemotherapy-related adverse drug events
(ADRs) identified in the ambulatory chemotherapy infusion unit that resulted in modifications of the
chemotherapy treatment plan.
Methods:
This was a retrospective study evaluating all chemotherapy related ADRs that were reported for
patients presenting to the ambulatory chemotherapy unit at King Hussein Cancer Center, between
January 2017 and December 2018. ADRs were entered prospectively by the clinical pharmacists
into the pharmacy ADR electronic system. ADRs that were included were those that resulted
in reducing chemotherapy dose, delaying chemotherapy, or the administration of additional
supportive therapies. The patient characteristics, type of medications, type of ADR, as well as the
consequences of the ADR were recorded.
Results:
Over the study period, 561 ADRs were reported in the ambulatory chemotherapy infusion unit.
The average age of patients with reported ADRs was 51±14 (SD) years and the majority were
females (n=392, 70%). The most common drugs associated with ADRs were docetaxel in 140 (25%)
patients, oxaliplatin in 42 (7%) patients, and paclitaxel in 36 (6%) of the patients. The most common
type of ADRs were hematological (n=142, 25%), dermatological (n=97, 17%), and gastrointestinal
(n=90, 16%). The ADRs resulted in reducing the chemotherapy dose in 160 (29%) patients, delaying
chemotherapy in 119 (21%) patients, and required providing additional supportive care to continue
the chemotherapy sessions in 331 (59%) cases.
Conclusion:
Chemotherapy-related ADRs are common among cancer patients and may result in change in the
chemotherapy plan for patients. Future studies should evaluate strategies to reduce the incidence
and impact of ADRs to ensure that patients receive the full chemotherapy regimen that would
provide optimal therapeutic goals.
105
P-53
Validation of the Arabic Version of the Chemotherapy-Induced Peripheral
Neuropathy Assessment Tool
Corresponding Author Abdullah Obaid
Presenting Author Abdullah Obaid

Aqel El-Aqoul, Ahmad Alafafsheh, Hussien Abu-Khudair, Murad
Co-author(s)
Saleh, Amer Klaib
Contact a.obaid555@gmail.com
Country JO
Chemotherapy-induced peripheral neuropathy (CIPN) produces multidimensional neurological and

muscular symptoms as a result of damaging the nerves or impairment in the peripheral nerves function
which interferes with the patients’ daily life. This study aimed to translate the CIPN Assessment
Tool (CIPNAT) to Arabic, and to examine its psychometric properties among adult cancer patients.
Descriptive study design was used as well as translation methods with considering the cross cultural
issues to produce the Arabic version of CIPNAT. A convenience sample of 210 was assigned into
two groups; 135 who received chemotherapies of known neurotoxic potential, and 75 who served
as a comparison group. Content and construct validity were assessed to test the validity of the tool,
while for assessing the reliability; test-retest, and internal consistency reliability were tested. The
Content Validity Index was satisfied (0.83). The data supports the evidence of discriminant validity
as significant differences were found between the groups with regard to symptom experience
(t = 8.51, p = < 0.001); interference (t = 5.60, p = < 0.001); and the total score (t = 7.88, p = <
0.001). The scores of test-retest were highly correlated in the overall scale (r = 0.98, p = < 0.001),
as well as the subscales of symptom experience (r = 0.97, p = < 0.001), and interference (r = 0.96,
p = < 0.001). Cronbach’s α coefficients were high (α = 0.97, 0.96, and 0.95) for the total score,
symptoms experience, and interference scales, respectively. Items to total correlation were ranged
from moderate to strong (0.55 to 0.81) which showed strong evidence of reliability. The Arabic
version of the tool showed adequate validity and reliability to screen for CIPN symptoms and its
interference in the Arab countries. Further studies are needed to evaluate the concurrent validity.
106
P-54
Assessment of Patients` Meal Intake During Hospitalization
Corresponding Author Ahmad Ishaq
Presenting Author Ahmad Ishaq
Co-author(s) Haitham Abu Huq
Contact aisalem@khcc.jo
Country JO
Introduction:
Malnutrition related to cancer, has many negative outcome. In addition malnutrition can develop
as a consequence of deficiency in dietary intake, increased requirements associated with a disease
state, from complications of an underlying illness such as poor absorption and excessive nutrient
losses
To develop a nutritional assessment tools that can be used clinically to assess patients’ nutritional
intake on daily basis during hospitalization for oncology patients.
Methods:
8 research articles met the inclusion criteria for the purpose of this EBP project, which reside mainly
in assessing the best method to measure patients’ daily intake. They were systematically compared
for common concepts to recognize similarities and differences in scope and findings across the
studies.
Results:
From literature, four instruments were used to assess an individual’s intake include: Weighed
Food Records, Estimated Dietary Record (DR), 24 Hour Dietary Recall (24HR), and Food Frequency
Questionnaires (FFQ) and semi-quantitative (SFFQs)
Conclusions:
Each tools have Strengths and Weaknesses, associated errors and practical difficulties to be
considered when choosing one method above another.
107
P-55
Assessment of Alarm Fatigue Risk among Jordanian Nurses
Corresponding Author Hamza Al-Quraan
Presenting Author Hmazeh Al-Quraan
Co-author(s) Amjad Eid, Ahmad Abu Rafee
Contact ha.11759@khcc.jo
Country JO
Using technology in the clinical setting where clinical alarms frequently occur, resulting in many
false alarms, which is called alarm fatigue, alarm fatigue may increase nurse’s distraction, and
that might affect negatively to patient safety. This study aimed to assess alarm fatigue among
Jordanian nurses. A non-experimental, descriptive cross-sectional design was performed in non-
profit specialized cancer center in Amman-Jordan. A self-reported questionnaire was answered
by all nurses who participated in the study. A total of 222 questionnaires were analyzed with more
than 95% response rate. More than half of the sample (60.4%) was females. The participants were
young nurses with mean age of 25.18±3.33 years. The total mean score for the whole sample was
31.62±7.14. In conclusion, Alarm fatigue is a global issue which affects a lot of area of practice,
educational program is recommended for nurses to know how to deal with alarm fatigue.
108
P-56
Early Versus Delayed Administration of G-CSF Following Chemotherapy in
Pediatric Patients With Ewing Sarcoma
Corresponding Author Deema Almomani
Presenting Author Deema Almomani
Co-author(s) Weim Alqasem, Rawan Kasht, Iyad Sultan
Country JO
Introduction:
The optimal timing of initiating granulocyte-colony stimulating factor (G-CSF) following
chemotherapy in pediatric patients has not been clearly defined. This study aimed to compare the
administration of G-CSF on day 1 (D1) versus day 3 (D3) post-chemotherapy in pediatric patients
with Ewing sarcoma (ES).
Methods:
A retrospective study of pediatric patients with ES who received G-CSF following chemotherapy
between January 2016 and September 2018 at a comprehensive cancer center. The institution’s
chemotherapy protocol for ES was modified in April 2017 to include G-CSF initiation on (D3) instead
of (D1) post-chemotherapy. Febrile neutropenia (FN) requiring hospitalization, duration of hospital
stay, and chemotherapy delay were compared for patients before and after the protocol change.
Results:
Over the study period, 250 cycles were evaluated with (D1) G-CSF and 221 cycles with (D3) G-CSF.
There were no differences between the (D1) and (D3) groups in the number of cycles associated with
FN requiring hospitalization (34 vs 19, p=0.086), and the length of FN-related hospitalization (mean
4±2.1 vs 4.6 ±1.8, p=0.123). However, delay in chemotherapy due to neutropenia was reported in
significantly more cycles in the (D1) group, compared to the (D3) group (37 vs 16, p 0.01).
Conclusions:
FN resulting in hospital admission and the length of hospital stay was not different between pediatric
patients with ES who received G-CSF on (D1) or (D3) post-chemotherapy. Chemotherapy delay due
to neutropenia was higher in patients who received G-CSF on (D1). Larger studies are required to
fully determine the impact of delayed initiation of G-CSF.
109
P-57
The Outcome Of Modular Cemented Endoprosthetic Reconstruction for Bone
Tumors, Review of 118 Patients, KHCC_Jordan
Co-author(s) Samer Abd Al, Abedlatif Al Mousa, Taleb Ismaeel
Country JO
Introduction:
Endoprosthetic reconstruction is considered the most favorable modality of reconstruction of
skeletal defect after resection of bone tumors, in most centers in the developed countries, however,
its use in developing countries still not as common, due mainly to its high cost and lack of availability.
Objectives:
To study the outcome of use of Modular cemented endoprosthsis reconstruction in the lower
extremity in a single institute in Jordan.
Methods:
From July 2006 till July 2018, 118 patients, age (16 -65 years), received Modular cemented
endprosthesis for reconstruction of skeletal defect after resection of aggressive bone tumor in the
lower extremities. Distal femur (DF n=67), Proximal tibia (PT n=31), Proximal femur (PF n=20).In all
proximal femur we used Bipolar femoral heads. We excluded all expandable and custom made
implants from our analysis.
Results:
At median follow up of 7 years, (1-12yr), deep infection was found in 10 patients (8%). Seven of
them PT, 2 PF, and 1 DF. Soft tissue complications were encountered in 6 patients (5%), 3 PT, and
3 DF. MSTS score for DF = 93%, PT= 83%, PF = 86%. Secondary amputation in 6 patients (5%) (5
PT, 1 DF), 2 of them for local recurrence and 4 for deep infection. Mechanical complications in 5
patients, all are DF, one broken stem, 2 loosening, 2 periprosthetic fracture, all required revision.
One patient with PF developed acetabular erosion and needed revision with cage.
Conclusions:
The outcome of using modular endoprosthesis for reconstruction in bone tumors in our center in
terms of complications rate and function, is comparable to that achieved in developed countries.
Proximal tibia remain the anatomical location, which is associated more with infection and secondary
amputation (22%, 16% respectively). Using of bipolar heads in our study was not associated with
high incidence of acetabular erosion.
110
P-58
Outcomes of Extra-Skeletal Versus Skeletal Ewing Sarcoma Patients Treated
with Standard Chemotherapy Protocol

Fawzi Abuhijla, Taleb Ismail, Hadeel Halalsheh, Sameer Yaser, Iyad
Co-author(s) Sultan, Ahmad Shehadeh, Samer Abelal, Abellatif Almousa, Ramiz
Abu- Hijlih
Country JO
Introduction:
Extra-skeletal Ewing sarcomas (ES) are rare, and data on outcomes following standard chemotherapy
is very limited.
Methods:
We retrospectively collected data on ES patients who presented with localized disease. Survival
was estimated by the Kaplan-Meier method. Overall survival (OS) and local recurrence free survival
(LRFS) were compared between the two groups (skeletal and extra-skeletal) by the Log-rank test.
Results:
A total of 120 patients were included. Twenty-nine (24%) had extra-skeletal and 91 (76%) had
skeletal ES. Location was extremity in 51 (43%), non-extremity in 69 (57%). For extra-skeletal ES, the
tumors originated from soft tissue in 23 (79%) and viscera in 6 (21%). All patients received standard
ifosfamide and etoposide alternating with vincristine, doxorubicin, and cyclophosphamide (IE/
VAC) chemotherapy, with the intention to provide local control at week 12. At a median follow up
of 38 months, there was no difference in 5-year OS between skeletal and extra-skeletal ES patients;
70% and 67% respectively, p = 0.96. Patients with visceral ES had inferior 5-year OS compared
to all others; 33% vs. 72%; p = 0.013. Resectability was not different between skeletal and extra-
skeletal patients (69% and 54% respectively, p=0.11). Furthermore, there was no difference between
skeletal and extra-skeletal ES patients in R0 resection (89% and 86% respectively, p=0.52) and
poor (<90%) tumor necrosis (46% and 62% respectively, p=0.31) among patients who had surgery.
However, more local recurrences (28% vs. 10%, p= 0.034) and inferior 5-year LRFS (74% vs. 83%; p
= 0.042) were observed in the extra-skeletal group, although a higher proportion of extra-skeletal
ES patients received adjuvant radiotherapy; 11 (73%) vs. 21 (36%), p = 0.01.
Conclusions:
Patients with non-metastatic extra-skeletal ES have comparable OS outcomes to patients with
skeletal ES utilizing the standard IE/VAC protocol. However, extra-skeletal ES patients are at
significantly higher risk for local recurrence.
111
P-59
Growth Factor Support and Outpatient Chemotherapy Administration Facilitates
Interval Compression for Children with Ewing Sarcoma
Corresponding Author Iyad Sultan
Presenting Author Iyad Sultan

Samer Salah, Anwar Alnassan, Abdellatif Almousa, Ibrahim Altbakhi,
Co-author(s)
Ahmad Shehadeh
Contact isultan@khcc.jo
Country JO
Introduction:
Interval Compression has become the standard approach to deliver intensive multiagent
chemotherapy for patients with Ewing sarcoma (ES). Efficacy and safety of this regimen is well-
established. However, concerns regarding practicality of this regimen in low and middle income
countries are still present.
Methods:
We reviewed patients with ES who presented to KHCC from Jan2010 till Dec2017. Of note, we
started using compressed regimen since Jun2013. GCSF was given routinely for compressed
cycles. Demographics, characteristics at presentation, therapy details and outcome were recorded.
Results:
Fifty nine patients received the compressed regimen and were compared to 36 patients who
had received the conventional regimen. The majority of cycles were given on outpatient basis
(78%). There was no significant difference in patients’ characteristics in terms of gender, age, site
of tumor or metastatic status. Patients who received the compressed regimen had significantly
less episodes of febrile neutropenia (FN, 12% vs. 20% of all cycles, P=0.009). Other toxicities
including neutropenia, thrombocytopenia, bacteremia and hematuria were similar in the 2 groups.
The estimated 5-year EFS of patients with localized disease was 77±10% for patients received the
conventional regimen vs. 86±8% for patients receiving the compressed regimen (P=0.62). Patients
with metastatic disease had more remarkable improvement (5-year EFS of 46±11% vs. 13±8%,
p=0.15).
Conclusions:
At our center, interval compression was safe and lead to improved outcome. The administration of
GCSF was associated with fewer episodes of FN. Metastatic patients benefited from this approach
and should be treated with this regimen. Financial savings and adherence to protocol were achieved
by utilizing our outpatient unit for chemotherapy administration.
.
www.tec-it.com
112
P-60
How Accurate A Free Hand Core Needle Biopsy Can be in the Diagnosis of Soft
Tissue and Bone Sarcoma
Co-author(s) Marwa Shatti, Omar Jaber
Country JO
Introduction:
Classic teaching has advocated the use of open biopsy to diagnose and grade extremity sarcoma.
Reported advantages of core needle (Tru-cut) biopsy include the minimal morbidity, cost, and time.
The perceived disadvantage has been diagnostic inaccuracy, and sample insufficiency.
To present an institutional experience in core needle biopsy without image guidance; for diagnosis
and grading of bone sarcoma with palpable soft tissue component and soft tissue sarcoma.
Methods:
From July 2006 till April 2011, 84 patients received core needle biopsy on outpatient bases at
orthopedic oncology clinic at King Hussein Cancer Center (KHCC). Fifteen patients with Bone
sarcoma with palpable soft tissue component (Osteosarcoma n=12, Ewing’s sarcoma n=12,
Chondrosarcoma, Giant Cell Tumor and metastatic leiomyosarcoma to bone 2 each), and 54
patients with Soft tissue sarcoma (STS). Forty located in the thigh and femur, 10 in the buttock and
iliac bone, 12 in the upper limb and 8 in other places ,all biopsies were performed by the lead
author using a 12 gauge Tru-cut needle, under local anesthesia, 6 to 8 cores were obtained by
redirection of the needle through the same entry with correlation to the MRI extent and location
of the lesion. Radiological size of the tumors ranged from 5-30 cm. All samples were sent to our
pathology lab for study.
Results:
All specimens obtained were adequate to make the diagnosis. All histological diagnoses were
concordant with the resection diagnosis; two biopsies graded low were found to be intermediate
to high on the resection specimen. Two patients developed hematoma, and treated with local
compressive dressing.
Conclusions:
When performed by expert sarcoma surgeon and read by expert pathology lab, the result of core
needle biopsy for Soft tissue sarcoma and bone sarcoma with extra osseous component, provide
accurate diagnostic information for malignancy and grade, adequate core needle biopsy enables
to avoid open biopsy which decreases tissue planes contamination and facilitate subsequent
resection of the biopsy tract.
113
P-61
Soft Tissue Sarcoma Abutting/Invading the Bone, A Proposed Guideline for
Surgical Management
Co-author(s) Samer Salah, Abdlatif Al Mousa, Samer Abdel Al
Country JO
Introduction:
The incidence, surgical treatment and effect on overall survival and recurrence of bone invading/
abutting soft tissue sarcoma, still poorly described in the literature.
To present an institutional experience regarding; surgical treatment and outcome of soft tissue
sarcoma abuts the bone.
Methods:
From July 2006 -Dec. 2016, 212 patients with wide local/compartment resection, at KHCC. Forty
three patients (20%) the tumor were attached to the bone. Patients divided into 3 groups: Group
1: bone abutment only (n=25) Group 2: cortical invasion (n=10) Group 3: either medullary canal
invasion or total encasement of bone (n=8) Tumor location includes: extremity 21, one case pelvic
and one case chest wall, once case sacrum. All patients with group 1 received subperiosteal
resection of the tumor, group 2 received hemicortical resection, and group 3 received segmental
bone resection of the involved bone.
Results:
At mean follow up of 56 month (16-78mo) 8 patients died of disease metastasis 4 patients developed
local recurrence at the soft tissue, all of them the pathology of the resection show negative margin,
2 from group 1, and 2 from group 2. Two patients had radiation related femur fracture
6/10 patients with bone invasion on MRI, found to have bone invasion in histopathology exam.
5 yr. EFS = 53% 5 yr. OS = 76%.
Conclusions:
This is a small group retrospective pilot study; the results show that STS abutting bone probably do
not lead to worse outcome. Our proposed guideline for surgical management of different scenarios
of soft tissue tumor with adjacent bone abutment/invasion can be the basis for objective mean to
plan the management of this subtype of soft tissue sarcoma. Larger size study is needed to expand
this guideline.
114
P-62
Efficacy of Pazopanib as a Second- or Third-line Treatment for Soft Tissue
Sarcoma at a Tertiary Cancer Center in Lebanon
Presenting Author Juliett Berro

Nour Abdul Halim, Said Saghieh, Ziad Salem, Fadi EL Karak, Fadi
Co-author(s)
Farhat
Country LB
Introduction:
Pazopanib is a Tyrosine Kinase Inhibitor that is used in advanced soft tissue sacromas (STS) following
chemotherapy failure. Pazopanib demonstrated promising targeted therapy in the early clinical
trials. However, no data exists concerning its efficacy in developing countries such as Lebanon.
This study aims to assess the patterns of pazopanib treatment and its efficacy, as well as the STS
subtypes most susceptible to Pazopanib treatment.
Methods:
This study is a multi-institution retrospective chart review. All patients 18 years and above diagnosed
with advanced STS and treated with Pazopanib as a second- or third-line treatment at 3 major
hospitals in Lebanon between January 1st 2014 and October 31st 2018 were included. Patient and
tumor characteristics were collected. Response was assessed and survival analysis was performed.
Results:
Around 700 patients diagnosed with soft tissue sarcoma were screened and only 20 patients took
pazopanib. Fifteen patients were included after excluding 3 patients diagnosed with liposarcoma,
and 2 patients diagnosed with bone sarcoma. The mean age was 48.6 [19-66] years. Common
histologic subtypes included undifferentiated/unclassified STS (n=5; 33.3%), leiyomyosarcoma
(n=4; 26.7%), synovial sarcoma (n=4; 26.7%), angiosarcoma (n=1; 6.7%), desmoid tumor/deep
fibromatosis (n=1; 6.7%). Response was observed in 2 (13.3%) patients, one of the patients was
diagnosed with undifferentiated/unclassified STS and the other one was diagnosed with synovial
sarcoma. Both showed stable disease. Median progression-free survival (PFS) and median overall
survival (OS) are not statistically significant 3 months (95% CI 0-6.67, p>0.05) and 20 months (95%
CI 15.1-28.7, p>0.05) for all subtypes, respectively.
Conclusions:
To our knowledge, this is the first study in the Middle East to assess the efficacy of pazopanib in
patients with soft tissue sarcoma. However, pazopanib did not demonstrate promising results in the
Lebanese population who had been pretreated for sarcoma.
115
P-63
Incidence and Survival Outcomes of Bone Sarcoma Subtypes in the Lebanese
Population
Presenting Author Rola El Sayed

Nour Abdul Halim, Juliett Berro, Fatima Shamseddine, Said
Co-author(s)
Saghieh, Amir Ibrahim
Country LB
Introduction:
Bone Sarcomas are a rare entity, with scarce research done in the Middle East. In this setting, we
aim at determining the number of patients diagnosed with bone sarcoma who presented to the
American University of Beirut Medical Center (AUBMC). This study will help shed light on bone
sarcomas and their most common subtypes.
Methods:
All patients 18 years old and above, diagnosed with bone sarcoma and treated at the American
University of Beirut Medical Center over the last 15 years are included. Baseline demographics,
pathological data, and survival data of each patient will be collected from the medical records
database.
Results:
Medical records of 228 patients were reviewed, and a total of 86 patients with bone sarcoma were
identified, and others excluded, men and women were equally affected, and the mean age of
diagnosis was 31. 4 subtypes were identified, 14 patients had chondrosarcoma, 41 patients had
osteosarcoma, 17 had Ewing, and 14 had pleomorphic sarcoma. In the osteosarcoma group, 5
patients had metastasis at diagnosis, and were treated differently. The majority of the patients had
sarcomas between 4.2-10 cm. Tumor location was divided between axial and appendicular, with
the majority being appendicular. A total of 11 patients had metastasis. The most common site of
metastasis was the lungs. A total of 17 patients were diagnosed with Ewing sarcoma, none of
the patients had metastasis at diagnosis. Among those 17 patients, 10 were females while 7 were
males. The mean ae at diagnosis was 25years. For 12 of the patients (70.6%) the location of the
tumor was appendicular and, and it was axial for 4 patients (23.5%). The most common tumor size
was between 4.2-10 cm. A total of 6 patients had metastasis to the lungs. 15 patients received
chemotherapy.
Conclusions:
Sarcoma is a term used to describe a large family of both bone and soft tissue growths. It is
extremely rare in adults and constitutes only 1% of all adult cancers. This study sheds the light on
bone sarcomas occurring in adults.
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116
P-64
Adaptive Radiotherapy in Patients Receiving Neoadjuvant Radiation for Soft
Tissue Sarcoma

Sara Mheid, Fawzi Abuhijla, Wafa Asha, Issa Mohamad, Abdullah
Co-author(s) Alrashdan, Samer alheet, Haitham Kana’an, Mohammad Abd Al-Ra-
heem, Abdelatif Almousa
Country JO
Introduction:
Contemporary neoadjuvant radiotherapy utilizes image guidance for precise treatment delivery.
Acquiring images during treatment provides information on patients’ position and anatomy,
moreover, it may depict changes in tumor size and shape. It has been suggested that soft tissue
sarcoma volumes change during neoadjuvant radiotherapy. The aim of this study is to evaluate tumor
volume changes during preoperative radiotherapy and to assess the role of adaptive radiation.
Methods:
Between 2016 and 2018, 23 patients aged ≥18 years with soft tissue sarcoma were treated at King
Hussein Cancer Center (KHCC). Patients and disease characteristics were retrospectively collected.
All patients received neoadjuvant radiation followed by surgical resection. The tumor volumes (cc)
were measured using Pinnacle planning system prior starting radiotherapy and during treatment,
the changes in volume and absolute differences were estimated. Moreover, patient’s position on
the machine was evaluated to assess setup offsets. The triggers for plan adaptation were 1> cm
expansion or unacceptable setup offsets.
Results:
The mean tumors volume at presentation was 810 cc (range, 55-4000). At last cone beam CT
(CBCT) the tumor volume had changed in 14 patients (61%); it was stable in nine patients (39%).
Disease regression documented in eight patients (35%), with median shrinkage of -20.5% (range,
-2 to -29%). While tumor progression observed in six cases (26%), the median change was 12.5%
(range, +10 to +25%).
Adaptive radiation was required in four patients (17%). For the remaining 19 cases (83%) the dose
distribution was adequate to cover target volumes.
Conclusions:
Change in soft tissue sarcoma volume during radiation is not uncommon, leading to inadequate
target coverage or unnecessary normal tissues irradiation. Image guidance should be used to
reduce setup errors and to detect differences in tumor volume. Image guidance and adaptive
radiation are paramount to ensure optimal radiation delivery.
117
P-65
Pediatric and Adult Experience in Management of Fibromatosis in A Single
Institution
Corresponding Author Ramiz Abu Hijleh
Presenting Author Rasha Deebajah
Co-author(s) None
Contact rdeebajah@khcc.jo
Country JO
Introduction:
Desmoid fibromatosis is a complex condition with many recognized treatments including active
observation, hormonal therapy, chemotherapy, radiotherapy and surgical resection. This study
compared a series of desmoid patients treated at a single institution .
Methods:
We reviewed clinical data of 52 patients from 2007 to 2017. Factors such as sex, age at presentation,
location, and lines of therapy were analyzed. We review the common presentation of desmoid
fibromatosis including the condition’s histopathological, clinical and radiological characteristics.
The local recurrence rate and recurrence-free survival were analyzed with these factors.
Results:
The patients in the present study 9 patient were pediatrics and 43 were adults. The median follow-
up time was 10 years. The most common symptom was a mass, the most common site was the
extremities. Fifty seven (57%) patients underwent resection.
Conclusions:
Multimodal approach provides favorable disease outcome, further large scale clinical trials are
required to further guide decision making.
.
Demo
118
P-66
Correlation of Radiologic and Pathologic Response in Patients Receiving
Neoadjuvant Radiotherapy for Soft Tissue Sarcoma

Sara Mheid, Fawzi Abuhijla, Wafa Asha, Issa Mohamad, Sameer
Co-author(s) Yaser, Ahmed Shehadeh, Samer Abdal, Abdelatif Almousa, Samer
Salah
Country JO
Introduction:
It is unknown if the radiologic response after neoadjuvant radiation (RT) in patients with soft tissue
sarcoma correlates with the histologic response or disease outcomes. The purpose of this study is
to evaluate radiographic and histologic responses in patients who received neoadjuvant RT, and to
evaluate the relation between these short-term surrogates.
Methods:
We sought to review consecutive patients with primary localized sarcoma, who were treated with
preoperative RT, between 2016 and 2018 at a single institution. All patients were required to have
initiated RT with the intention to be followed by curative surgical resection. Data on demographics
and disease characteristics were retrospectively collected, the tumor volume (cc) was calculated
before and after RT, pathology specimens were reviewed for percent of necrosis and status of
surgical margins.
Results:
Twenty-three patients with primary localized sarcoma received preoperative radiotherapy followed
by surgery. The tumor volume decreased after neoadjuvant RT in 10 cases (43%) to a maximum of
50% (range, -5 to -50%), while in eight patients (35%) the tumor grew in size to a maximum of 40%
(range, +10 to +40%). The tumor volume was stable in five patients (22%). Complete resection (R0)
was achieved in 18 cases (79%), microscopically involved margins (R1) were observed in 4 (17%),
and gross residual (R2) in one patient (4%). The median tumor necrosis was 40%. Five patients
(22%) demonstrated complete or near-complete pathologic response (≥ 95% necrosis). Pearson
correlation coefficient test revealed no correlation between radiologic and histologic responses
(-0.07). Major wound complication after surgery was observed in four patients.
Conclusions:
There was no correlation between radiologic and pathologic responses after neo-adjuvant RT.
Complete tumor necrosis was noticed in 22% of patients, larger studies are needed to test these
surrogates in a prospective fashion.
119
P-67
Coats Disease; Characteristics, Management Outcomes, and Scleral External
Drainage with AC-Maintainer for Stage 3B Disease
Corresponding Author Ahmad ElRimawi
Presenting Author Ahmad ElRimawi
Co-author(s) Yacoub A. Yousef
Affiliation Ibn Al-Haitham Hospital
Contact rimawi88@yahoo.com
Country JO
Introduction:
To report on the characteristics and outcome of management of coats disease, and to describe
a novel surgical technique for management of stage 3B with total retinal detachment by scleral
external drainage with AC-maintainer placement prior to the drainage without Pars Plana Vitrectomy
(PPV).
Methods:
A retrospective study of 26 eyes from 25 coats’ patients. Outcome measures included: demographics,
presentation, laterality, stage, treatment, and outcome.
Results:
The median age at diagnosis was 3.5 years. Twenty patients (80%) were males, and all except 1 girl
had unilateral disease. The presenting complaint was impaired vision in 13 (50%) eyes, leukocoria
in 6 (23%) eyes, and strabismus in 7 (27%) eyes. Based on the Shields classification; 3 (12%) eyes
were stage1, 9 (35%) eyes were stage2, 10 (38%) eyes were stage3, 2(8%) eyes were stage4, and 2
(8%) eyes were stage5. Primary management included cryotherapy (54%), laser photocoagulation
(27%), intravitreal Anti VEGF (23%), intravitreal steroids (23%), and surgical drainage (12%). The 3
eyes in stage3B (with total exudative RD) underwent subretinal fluid drainage with AC maintainer
(combined with laser photocoagulation and cryotherapy after flatting the retina), and all had the
retina reattached completely for 6 months follow up after the surgery. At mean follow up 21
months, 4 (15%) eyes were enucleated, 19 (73%) eyes had improvement or stabilization in visual
acuity, and all (100%) non-enucleated eyes had controlled intraocular pressure.
Conclusions:
Coats disease usually presents at advanced stage with poor visual prognosis, tailored and
individualized management for every case with close follow up are mandatory to avoid painful
glaucoma and enucleation. Subretinal fluid drainage with AC maintainer is a safe and useful
technique for repairing total RD in eyes with stage 3B coat’s disease.
120
P-68
Distinguished Features of Bladder/ Prostate Rhabdomyosarcoma King Hussein
Cancer Center Experience
Corresponding Author Taleb Ismael
Presenting Author Taleb Ismael

Zebin Al Zebin, Khalil Ghandour, Hadeel Halalsha, Rasha Deebaja,
Co-author(s) Abdulatif Al-Musa, Olfat Al Kodour, Mohammad Al Bohaisi, Iyad
Sultan
Contact tismael@khcc.jo
Country JO
Introduction:
Rhabdomyosarcoma (RMS) is a highly malignant mesenchymal tumor and is the most common
childhood soft-tissue sarcoma. Genitourinary RMS including Bladder/ Prostate makes up about
24% of RMS. Bladder and/or prostate RMS therapy before the early 1970s yielded poor survival rate.
Therapeutic approaches of that era usually involved radical or partial surgery; subsequent spread of
tumor because of poor local control and/or inadequate chemotherapy occurred frequently. Since
the early 1970s, large multi- and single-center prospective international studies began using risk-
based multimodality therapy involve surgery and chemotherapy, with and without radiation therapy.
Here in this retrospective study we are reporting King Hussein Cancer (KHCC) Experience.
Methods:
Files of all patients of Rhabdomyosarcoma patients treated at KHCC during the period from January
1, 2003 till August 31,2016 were retrospectively reviewed. Age at diagnosis, sex, date of diagnosed,
radiological and pathology reports, treatment methods and outcome were recorded.
Results:
Total of 161 patients were diagnosed to have RMS, of them 32(19.8%) patients having bladder/
prostate, of them 19 patients bladder(11 males, 8 females) and 13 prostate RMS. Median age 3years
(range 3m to 17y). Neurofibromatosis type 1 found in 4(30.7%) prostatic and one bladder(5.2%)
patients. Of the whole group One patient progressed and died before treatment, 2 patients lost
for follow up, 31 patients received chemotherapy and 28 patients received radiotherapy, 3
progressed and died before time of radiotherapy, surgery was done for 11 patients. After a median
follow up period of 2.9 years (range 3m to 13.2 y) , 21(70%) alive, 9(30%) died. Overall survival for
19 patients treated without surgery is 89.4%, and among 11 had surgery is 36.3%.
Conclusions:
Conservative treatment gives excellent results for bladder/ prostate RMS. Surgery is devastating and
may lead to increased chance of tumor recurrence. Neurofibromatosis looks to be a predisposing
condition for bladder/ prostate RMS.
.Demo
121
P-69
Intravitreal Chemotherapy for Retinoblastoma: The King Hussein Cancer Center
Experience
Corresponding Author Yacoub Yousef
Presenting Author Ibrahim Alnawaiseh

Amal M. Noureldin, Iyad Sultan, Rasha Deebajah, Maysa Al-Hus-
Co-author(s) saini, Reem AlJabari, Munir Shawagfeh, Mustafa Mehyar, Imad
Jaradat,
Contact i_nawaiseh@hotmail.com
Country JO
Introduction:
To evaluate our experience with intravitreal melphalan chemotherapy as a second-line regimen for
RB patients with refractory or recurrent vitreous seeds.
Methods:
A retrospective case series of 16 eyes from 16 patients with intraocular RB; 9 (56%) eyes with focal
vitreous seeds, and 7 (44%) eyes with diffuse vitreous seeds. All received intravitreal melphalan
chemotherapy using antireflux injection technique. Data included: demographics, stage at
diagnosis, treatment modalities, side effects, eye salvage, and survival.
Results:
The total number of injections was 64 (median, 3 injections per eye; range, 3-8), and the median
age at time of injection was 22 months (range, 9-63 months). Nine (56%) patients were males, and
13 (81%) patients had bilateral RB. Complete response was seen in 13 (81%) eyes; 9 (100%) eyes
of those with focal vitreous seeds, and 4 (57%) eyes of those with diffuse vitreous seeds (P= 0.062).
At a median follow-up of 18 months (range, 6- 48 months); eye salvage rate was 81%, local retinal
toxicity confined to site of injection was seen in 2/3 of the eyes, 2(12%) eyes had cataract, and none
of the patients had orbital recurrence, distant metastasis, or was dead.
Conclusions:
and Relevance: Intravitreal Melphalan is a promising modality for treatment of vitreous seeds, and
the dose of 20-30 µg of melphalan sounds to be safe and effective for refractory and recurrent
vitreous seeds.
122
P-70
How Critical is the Pathology Review of Pediatric Sarcoma Referred to A
Specialized Cancer Center
Corresponding Author Taleb Ismael
Presenting Author Taleb Ismael
Co-author(s) Iyad Sultan, Maher Al Sughayer, Marwa Al Shatti, Haytham Al Jbour
Contact tismael@khcc.jo
Country JO
Introduction:
Most pediatric soft tissue and bone sarcomas are rare. This rarity makes it more likely to label these
tumors with erroneous diagnoses that can affect significantly the plan of care and the ultimate
outcome of affected patients.
Methods:
In our center, all patients referred from other hospitals are required to have their pathology reviewed
by a board-certified pathologist. Difficult cases are discussed in the daily pathology meeting and
if necessary cases are sent for international consultation. In this retrospective study, we reviewed
medical records of all referred children under the age of 18years at time of referral, who were
diagnosis with bone or soft tissue sarcoma in other institutions. All patients who were referred
from January 2003 till December 2018 were reviewed. Major changes in pathology diagnoses were
considered if they potentially affected patients’ management or prognosis.
Results:
During the study period a total of 665 pediatric patients were diagnosed with sarcoma. Of these
410 patients had their diagnosis done outside, of those 72(17.2%) patients had pathology changed,
diagnosis of these patients were done in public, private or abroad laboratories. The following
referral diagnoses and percentages of patients with major changes were noticed: Ewing Sarcoma
(N=107, 22.4%), Osteosarcoma (N=68, 13.2%), Rhabdomyosarcoma (N=148, 9.4%) and other soft
tissue sarcomas (N=87, 28.7%).
Conclusions:
Major discrepancy in pathological diagnosis was noticed in a significant number of referred patients.
Central pathology review should be done for all pediatric sarcomas and building local expertise is
probably the most important element in establishing pediatric sarcoma care.
.Demo
123
P-71
Concomitant Intraocular Retinoblastoma and Choroidal Hemangioma in a 1-Year-
Old Boy
Corresponding Author Rasha Deebajah
Presenting Author Rasha Deebajah
Co-author(s) Yacoub Yousef
Contact rdeebajah@khcc.jo
Country JO
We report a case of concomitant choroidal hemangioma in an eye that harbored intraocular

retinoblastoma (RB) in a 1-year-old child. A 12-month-old boy presented with right white pupil
(Leukocoria). The initial clinical diagnosis was unilateral intraocular RB Group C. The eye was
treated initially by systemic chemotherapy combined with focal consolidation therapy followed by
I-125 plaque radiotherapy. Massive sub-retinal recurrence was seen 4 months later, and Magnetic
Resonance Imaging (MRI) showed extra-scleral invasion of the tumor, and therefore enucleation was
performed. Microscopic examination revealed a differentiated retinoblastoma associated at the
site of the base of the tumor with choroidal hemangioma with trans-scleral invasion. Orbit MRI was
repeated 3 months after the surgery, and there was no orbital tumor recurrence. We are reporting
a rare case of pathologically concomitant choroidal hemangioma with trans-scleral invasion in an
eye that harbored active recurrent intraocular RB. This trans-scleral extension of hemangioma was
misinterpreted by MRI as extraocular retinoblastoma and resulted in enucleation.
124
P-72
Plaque Therapy for Ocular Tumors, King Hussein Cancer Center Experience
Corresponding Author Imad Jaradat
Presenting Author Imad Jaradat
Co-author(s) Yacoub Yousef
Contact ijaradat@khcc.jo
Country JO
Introduction:
To evaluate the effectiveness of iodine-125 COMS plaque therapy for the treatment of ocular
tumors (Uveal melanoma, Retinoblastoma, hemangioma) at King Hussein Cancer Center, Jordan.
Methods:
Retrospective case series of eyes with ocular tumors treated by episcleral Iodine -125 COMS
radioactive plaque therapy. Main outcomes studies included demographic, tumor features, eye
salvage, visual outcome, metastasis, and mortality.
Results:
Between September 2008 and Jan 2017, 34 eyes for 34 patients had intraocular uveal melanoma,
six patients had retinoblastoma and four patients had hemangioma and treated by I-125 radioactive
plaque. The mean age at diagnosis was 48 years for melanoma and 32 for hemangioma and 3 for
retinoblastoma. The mean tumor thickness was 8mm for melanoma (range: 4-13 mm), and 6mm for
retinoblastoma and 5 mm for hemangioma.30 (90%) patients had medium or large size tumor. The
radioactive plaque size used was of 16 mm (range: 12-20mm).The mean apical dose was 83.5Gy for
melanoma (range 81-87), 42 Gy for retinoblastoma and 26 Gy for hemangioma.
At median follow up of two years range (1-9 years), eye salvage rate for melanoma patients was 90%.
Five (15%) patients had distant metastasis, and three (9%) were died of disease. Fifty percent of
patients had visual acuity better than 20/200 at last date of follow up. For retinoblastoma patients,
the control rate was 67 % (4/6) and the survival rate was 100% (6/6). Regarding hemangioma
patients, the outcome is excellent, all 4 patients survive with 100% globe preservation and have
good vision.
Conclusions:
Our preliminary results are encouraging and are comparable to that of other countries worldwide.
125
P-73
Central Nervous System Tumors in Adolescents and Young Adults: Epidemiological
Study from King Hussein Cancer Center
Co-author(s) Ghadeer Hayel AlMuhaisen
Country JO
Introduction:
Adolescents and young adults (AYA) age group lacks targeted epidemiologic studies that assess
the prevalence and outcome of tumors. We aim to provide deep analyses of the epidemiology of
central nervous system (CNS) tumors in AYA at King Hussein Cancer Center (KHCC).
Methods:
This is a retrospective study for all CNS tumors diagnosed in the AYA group patients diagnosed and
managed at KHCC in 2007-2016. Patients list was retrieved from the center’s cancer registry and
clinicopathologic data was reviewed individually from the patients’ records.
Results:
A total of 370 cases of primary CNS tumors were retrieved, with a median age of 28.5 years. Males
outnumbered females; 57.6% and 42.4%, respectively (p-value=0.91). Most tumors occurred in
the cerebrum (62.2 %, n=230), the frontal lobe was most commonly affected (29%). Gliomas were
the most common histologic category, comprising 58.9% (n= 218). High grade gliomas, including
glioblastoma multiforme and anaplastic astrocytoma, were the most common. Embryonal tumors
comprised the second most common group (16.8%, n=62). Medulloblastoma was the prototype of
embryonal tumors (91.9%; n=57) and these were diagnosed in the cerebellum. Gliomas tended to
affect older age group than embryonal tumors (p-value=0.002). On last available follow up, 29.5%
were lost to follow up, 36% were alive, and 34.6% were deceased. The median overall survival (OS)
was 47.6 months. Embryonal tumors had a better outcome than gliomas (median OS 76.3 vs. 30.3
months, respectively; p-value=0.001).
Conclusions:
High grade gliomas affecting the cerebrum were the most common tumors among AYA group, and
were associated with a less favorable outcome compared to embryonal tumors. More research is
needed to address this special age group.
126
P-74
Outcomes of Schwannoma Patients in a Middle Eastern Population; a Single
Institution Experience
Presenting Author Hazem Assi

Lara Hilal, Shadi Bsat, Maya Charafeddine, Juliett Berro, Rami
Co-author(s)
Morsi, Fadi Saadeh, Marwan Najjar
Country LB
Introduction:
Schwannomas are the most common type of peripheral nerve tumors. They most commonly arise
from the vestibular portion of the eighth cranial nerve, known as vestibular Schwannomas. The
treatment options for schwannoma include surgery, Radiation therapy (RT), and observation. Due
to the paucity of data on schwannoma in the Middle East, the aim of this study is to investigate the
epidemiology, prognostic factors, and outcomes of patients treated at the American University of
Beirut Medical Center (AUBMC).
Methods:
This is a single institution retrospective cohort study based on chart review of schwannoma cases
seen at AUBMC, a tertiary-care hospital, over a period of 10 years. Demographic data, treatment
modalities, outcomes, and complications were obtained. Descriptive statistics, Chi Square tests, and
Kaplan Meier Disease free survival curves were generated using IBM SPSS v.23. P<0.05 considered
significant.
Results:
68 patients had available data for analysis. The mean age at diagnosis was 49.5 years. 69% were
females and 31% males. 3% had history of Neurofibromatosis. Larger tumors (more than 2 cm)
were more likely to undergo surgery as the primary treatment and those in the range of 2-5 cm
were more significantly associated with having a partial resection. The type of treatment received,
whether observation, radiation, or surgery with or without adjuvant radiation was not significantly
associated with disease status (stable or progressive). Facial weakness was the only complication
significantly associated with the type of treatment, being more common in surgical patients. The
highest percentage was in the group who had radiation therapy upon progression after surgery.
With a median follow up of 4 years, progression free survival (PFS) was around 90%.
Conclusions:
Our Schwannoma data shows favorable PFS consistent with the literature. In our limited sample
size, surgery, radiation therapy, or a combination had no correlation with the progression of
disease. Facial weakness was significantly more common in the surgical group. We are currently
re-analyzing this schwannoma dataset to determine whether there is an association between facial
nerve complications and outcomes with the assistance of a head and neck surgeon as well as the
effect of intraoperative neuro-monitoring of the facial nerve.
127
P-75
Demographics and Outcomes of Meningioma Patients Treated at a Tertiary Care
Center in the Middle East
Presenting Author Shadi Bsat

Ibrahim Abu-Gheida, Lara Hilal, Fady Geara, Maya Charafeddine,
Co-author(s)
Marwan Najjar
Country LB
Introduction:
A meningioma is the most frequently diagnosed intracranial primary brain tumor. Many risk
and prognostic factors for meningiomas have been reported previously from various centers in
different parts of the world. To our knowledge, however, data from the Middle East is lacking.
Therefore, we aimed to study the demographics and outcomes of meningioma patients treated in
a multidisciplinary regional referral center in the Middle East.
Methods:
Those patients with pathological diagnoses of meningioma seen from January 2005 to December
2015 at the American University of Beirut Medical Center were included in this research. The data
for one hundred and ninety-five patients was analyzed. The baseline demographics and risk factors
were collected and reviewed retrospectively. The follow-ups and current disease statuses were
collected from the patients’ charts and imaging results, and they were updated with phone calls
made by a third party.
Results:
The means of the overall survival and progression free survival (PFS) for the entire cohort were 198
and 126 months, respectively. The residence area (city vs. countryside), occupation, alcohol use,
oral contraceptive use, family history of meningioma, previous head trauma, radiation exposure
for head/brain imaging, cell phone use, and finally, the tumor Ki-67 protein level did not correlate
with the survival outcomes. However, in the univariate analysis the meningioma grade and extent
of resection were significant predictors of the PFS. In the multivariate analysis, those who did
not receive radiotherapy had a risk of progression 4.39 times higher than those who underwent
radiotherapy.
Conclusions:
The findings in this cohort of Middle Eastern patients correlated with the reports from other
regions. Overall, an incomplete surgical resection, tumor grade, and recurrent disease were the
most important prognostic factors for the patients diagnosed with meningiomas.
.
Demo
128
P-76
Medical Research Information Seeking Behavior among Public
Corresponding Author Nedal Al Rawashdeh
Presenting Author Nedal Al Rawashdeh
Co-author(s) Rana Damsees, Majed Al Jeraisy, Eman Al Qasim, Ahmad Deeb
Contact na.08085@khcc.jo, rawashdehne@gmail.com
Country JO
Introduction:
Public are using various sources to update their information about the progress of the medical
knowledge. Information sources varies and can be considered reliable (based on scientific facts)
and unreliable sources. The extraction of such data can plays a major role in the patients believes
and behavior toward different types of diseases, as some of these sources might direct patient to
untrusted or unrealistic treatment options or can lead to misuse of medications as well as give false
hope of treatment. In this study we aimed to explore the medical research information seeking
behavior and level of trust toward such sources.
Methods:
Secondary data analysis was performed for a cross sectional survey study that was mainly conducted
to measure the level of the Saudi public knowledge and their attitude toward participation and the
conduction of clinical trials during al Janadriyah festival in 2016. Demographic data were reused in
addition to two variables that were not used previously and mainly were set to measure the source
of information and the level of trust among Saudi public.
Results:
930 subject participated in the study, 61.58% were males, 54.16 % between 18-30 years. The
major source of information was the internet with 34.1% and social media was only 8.7%. The
second most source of medical information was the healthcare workers with 15.7%, the least source
of information was the radio with only 2.1%. Scientific Journals is a source of medical research
information for only 8.6% of the public.
Conclusions:
There was a significant relationship between the sources of information the trust level. The vast
majority of the public used to trust different sources especially the healthcare workers. As getting
older, people tend to use sources of information other than internet or social media which considered
relatively modern sources of any kind of information. Scientists should use web-pages and social
media in order to reach the public more efficiently.
129
P-77
Decrease Waiting Time in the Adult Outpatient Chemotherapy Unit at King
Hussein Cancer Center
Corresponding Author Mohammad Mahmoud Dahoud
Presenting Author Mohammad Mahmoud Dahoud
Co-author(s) Aladeen Allouban, Mohammad al-khyait , Murad salahi
Contact betawi114@yahoo.com
Country JO
Introduction:
In the health care sector waiting time was found to be a global problem that encounters patients
when they visit most of the medical centres. This problem is considered as the primary source of
patient dissatisfaction and worker frustration.
Aim:
This study aimed to identify the main causes that lead to an increase the mean waiting time and
to reveal the main factors that help in decreasing it from the moments of patient check-in- to
treatment in the adult chemotherapy (CTx) unit.
Methods:
FOCUS-PDSA system was utilised to identify the most relevant factors that lead to increasing
waiting time in the CTx. Accordingly, the following factors were invented, redesigned, improved,
and studied in term of decreasing the waiting time. The booking process (utilization bed, booking
time), the nurses and pharmacy workflow during preparation of treatments (financial verifications,
starting preparation upon check of patient access (central), the assessment process for patient upon
arrival to CTx, patient awareness regarding the adherence with booking time, and the financial
coverage status to daily list of chemotherapy. The study assessed these factors in three waiting time
stations from the moments of patient check-in- to treatment in the adult CTx unit.
Results:
The data collected from the three stations showed the results as follow, in the first station from
arrival on appointment until assessment per minute (19.3 ± 2.5 to 7.3 ± 0.53, P-value 0.001), the
second station from assessment until request the treatment (17.4 ± 2.0 to 17.8 ± 1.2, P-value
0.866), and third station from request treatment until connecting the treatment (40.4 ± 1.2 to 32.6
± 0.47, P-value 0.001). These results showed that the waiting time was decreased significantly from
time appointment until connection treatment (14.9 ± 2.2 to 5.1± 0.64, P-value 0.001).
Conclusions:
It can be concluded that after applying these interventions, there was a significant decrease in
the mean patient waiting time. The reduction in waiting time was achieved by coordination and
cooperation from all involved departments and patients. Finally, this reduction improves patient
satisfaction and relieve worker frustration.
130
P-78
Cancer Tissue Banking Collaborative Research Effort between the Memorial
Sloan Kettering Cancer Center and the American University of Beirut

Mark Robson, Ayman Tawil, Victor Reuter, Roy Cambria, Nour Sa-
heb, Abdul Abdullah, Mariam Kanso, Ghina El Nounou, Chayma
Boussayoud, Christopher Kaufman, Joe-Max Wakim, Sandy Badson,
Co-author(s)
Roger Wilson, Collette Houston, Marija Drobnjak, Fuad Ziyadeh,
Ghazi Zaatari, Murray Brennan, Ali. K Abu-Alfa, and Ghassan K.
Abou-Alfa
Country LB
Introduction:
Tissue banking is becoming a key element for cancer care and research. Memorial Sloan-Kettering
Cancer Center (MSK) and the American University of Beirut Medical Center (AUBMC) have built a
joint tissue bank to serve as a repository and provide the material and data needed for high quality
joint research efforts.
Methods:
Patients 18 years of age and above were included in our ongoing project. Tissues collected were the
remaining tissue after all necessary diagnostic evaluation from any site in the body whether normal
or abnormal tissue, solid tissue or fluid. A core set of clinical information for each human biologic
specimen was collected. Demographic information collected include age, gender, ethnicity, and
diagnosis. Specimen information including the specimen type whether tissue or fluids, specimen
site, histology, tissue type, specimen size and handling were documented.
Results:
Of the 772 patients approached, 630 patients accepted to participate in the study and 142 refused
for various reasons. The tissue procured were from various organs like stomach, thyroid, breast,
colon. The most prevailing pathology was adenocarcinoma.
Conclusions:
This collaboration has been successful in terms of bio-banking fresh frozen tissues that will
consequently aid in the rapid evolution in personalized oncology and treatment selection.
.
Demo
131
P-79
Workflow Optimizing Radiology Reporting Time Following PACS Implementation

Abdullah Nofal, Rasha AbdelRahman, Sawsan Mutlaq, Mufeed Ghu-
Co-author(s) bar, Yasmeen Seidan, Asem Mansour, Dana Nashawati, Laith Abu
Hilal, Sawsan Munawer
Country JO
Introduction:
To present benefits of earlier access of radiology reports to clinicians and the effect on patient care
after the implementation of Picture Archiving and Communication System (PACS) in the radiology
department of a tertiary cancer center. The reporting times for CT and MRI exams requested from
emergency department are considered as Key Performance Indicators (KPI). These were substantially
below the set target before the implementation of PACS.
Methods:
The monthly on-time reporting for emergency CT and MRI exams KPI was calculated, over a 5-year
period. Comparative calculations were made a year before PACS initiation, during the implementation
period, and after the full integration of the system. The comparisons were made using Arena simulation
software mainly and the results were validated by control chart statistical tools commonly used in
quality improvement. The analysis was conducted on the system workflow and was validated by the
KPI, taking into consideration other important factors such as the growth in the number of cases. A
range of benefit measures were investigated by assessing the emergency room manager satisfaction
with the overall system, including the turnaround time and diagnostic value of PACS-based images.
Results:
Data analysis using Arena simulation output showed that the average percentage of on-time report
improved by 85% after implementing PACS. The report average time went by 85.6% and the difference
between request arriving time and report time decreased significantly by more than 85% and so did
the WIP average and the Queue for the signing off process. The average percentage of on-time report
went down to 42% during the introduction and integration of PACS spanning over 2.5 years; there
were several out of control months caused by assignable special causes. Significant improvement in
the on-time reporting KPI and reduced variation and in control process was noted only after the full
integration of the PACS, and electronic medical records systems where the rate went up to 96%.
Conclusions:
Although we faced some challenges during the transition to the PACS reporting system, the full
implementation of the PACS has played an important role in improving patient care by enabling
radiologists to decrease the reporting times and thus providing better quality of care through timely
critical information.
.
Demo
132
P-80
Mutational Analysis of the RB1 Gene and the Inheritance Patterns of
Retinoblastoma in Jordan
Corresponding Author Mustafa Mehyar
Presenting Author Mustafa Mehyar

Yacoub A. Yousef, Abdelghani Tbakhi. Maysa Al-Hussaini, Ibrahim
Co-author(s) AlNawaiseh, Ala Saab, Amal Afifi, Maysa Naji, Mona Mohammad,
Rasha Deebajah, Imad Jaradat, Iyad Sultan
Contact mustafamehyar@hotmail.com
Country JO
Retinoblastoma (RB) is a childhood cancer developing in the retina due to RB1 pathologic variant.
Herein we are evaluating the oncogenic mutations in the RB1 gene and the inheritance patterns of RB
in the Jordanian patients. In this prospective study, the peripheral blood of 50 retinoblastoma patients
was collected, genomic DNA was extracted, mutations were identified using Quantitative multiplex
PCR (QM-PCR), Allele-specific PCR, Next Generation Sequencing analysis, and Sanger sequencing.
In this cohort of 50 patients, 20(40%) patients had unilateral lRB and 30(60%) were males. Overall,
36(72%) patients had germline disease, 17(47%) of whom had the same RB1 pathologic variant
detected in one of the parents (inherited disease). In the bilateral group, all (100%) patients had
germline disease; 13(43%) of them had inherited mutation. In the unilateral group, 6(30%) had germline
disease, 4(20%) of them had inherited mutation. Nonsense mutation generating a stop codon and
producing a truncated non-functional protein was the most frequent detected type of mutations (n
= 15/36, 42%). Only one (2%) of the patients had mosaic mutation, and of the 17 inherited cases,
16(94%) had an unaffected carrier parent. In conclusion, in addition to all bilateral RB patients in our
cohort, 30% of unilateral cases showed germline mutation. Almost half (47%) of germline cases had
inherited disease from affected (6%) parent or unaffected carrier (94%). Therefore molecular screening
is critical for the genetic counseling regarding the risk for inherited RB in both unilateral and bilateral
cases including those with no family history.
133
P-81
Development of Competency-Based Residency Training Program in Radiation
Oncology; Our 15-Year Experience From A Developing Country
Corresponding Author Sondos Al Khatib
Presenting Author Sondos Al Khatib
Co-author(s) Jamal Khader, Abdellatif Al Mousa
Contact se.11035@khcc.jo
Country JO
Introduction:
For any comprehensive cancer care, a well-trained cancer professional staff is needed to assure best
oncology practice. Radiation Oncology service is an essential component of cancer care delivery
and therefore a well-trained specialists are needed. There has been lack in radiation oncologists
in Jordan and the region for decades, with only handful western trained radiation oncologists in
available in Jordan. Aim: We at King Hussein Cancer Center (KHCC), Jordan has established in
2004, a well-recognized & structured radiation oncology residency program, recognized by Jordan
Medical Council to assure the availability of such well-trained specialists for not only Jordan but the
region as well.
Methods:
Retrospective chart review, describes the Radiation oncology residency program in KHCC,
established in 2004, with a purpose to provide focused mentoring, training over 4 years period.
For more advanced training, an external rotation for 3 months was allowed at a well-reputed cancer
center in USA & UK as a part of residency program. A clinical curriculum was developed with the
help of our colleagues in western countries, which includes routine site-specific clinical rotations,
didactic lectures in clinical oncology, radiobiology, medical physics, statistics & basic research. Yearly
evaluation examination is being held, our residents are permitted to sit for the annual American
College of Radiologists (ACR) examination, as a Tool to pinch mark our residents and residency
program compared to peers in US in order to improve teaching and Identify weakness and work on.
So far, many well trained oncologists, not only from Jordan but from the region, have successfully
graduated from this program.
Conclusions:
By building a well-structured Radiation Oncology Residency Program within a developing country
with lack of radiation oncologists and resources & in collaboration with well-known programs in
developed countries, the obstacle of lack of such oncologists can be overcome.
134
P-82
Patients with Cancer on Other Side of the Stethoscope
Corresponding Author Thalia Arawi
Presenting Author Thalia Arawi and Zeid Founouni
Co-author(s) Zeid Founouni
Contact ta16@aub.edu.lb
Country LB
Modern medicine and the rapid development of medical technology imposes a new lens through
which members of the healthcare team tend to look at the patient, often focusing on the disease
rather than the illness.
This talk will highlight what truly happens on the other side of the stethoscope in an attempt at
shedding the light on how a closer attention to illness opens the road to healing.
135
Name Pref
Abdelatif Almousa O-50
Abdullah Obaid P-53
Abeer Al Rabayah O-36
Ahmad ElRimawi P-67
Ahmad Ishaq P-54
Ahmad Shehadeh O-42, P-57, P-60, P-61
Akram Al-Ibraheem O-6, O-9
Ali Al-Daghmi P-40
Ali Bazarbachi O-4
Ali Shamseddine P-28
Amal Al Omari O-28,O-30, O-43, O-45
Amal Al-Tabba' P-23, P-24
Arafat Tfayli O-10, O-25
Basil J. Ammori O-44, O49, P-14, P-32, P-33, P-35, P-39
Bassem Youssef O-48
Deborah Mukherji O-46, P-2
Deema Almomani P-56
Fadi Abu-Farsakh P-22
Feras Hawari P-49
Fawzi Abuhijla P-21, P-36, P-44
Gheyath Reaf Alnaim P-48
Hamza Ali AL-Quraan P-55
Hazem Assi O-16, O-19, O-23, O-51, P-20, P-62, P-63, P-74, P-75
Hikmat Abdel-Razeq O-12, O-18, O-20, O-22, O-33, O-34, P-3, P-7, P-11, P-25
Ibrahim Al-maayta P-15
Imad Jaradat P-72
Ismail Hamam P-50
136
Name Pref
Iyad Sultan O-37, P-59
Jean El-Cheikh O-3
Jeries Kort O-2
Kamal Al-rabi O-24
Kholoud AL-Qasem P-34
Lama Nazer O-31
Maher Sughayer P-5
Mahmoud Abu Dakka P-9
Mahmoud Al Masri O21, P-4, P-8, P-13, P-31
Mamoun Ahram O-8, O-17
Mayada Abu Shanap O-7
Maysa Al-Hussaini P-26, P-43, P-45, P-73
Mohamad Mohty O-5

Mohammad Mahmoud
P-77
Dahoud
Mohammad Ma'koseh P-16, P-18
Muhieddine Seoud O-47
Mustafa Mehyar P-80
Nagi El Saghir P-6
Nazmi Kamal P-19
Nedal Al Rawashdeh P-76
Nour Al Faqeer P-1
Ola Mashni P-52
Omar Shamieh O-35, P-51
Osama Abdalrahman P-17
Osama AlSmadi O-15
Ramiz Abu-Hijlih O-41, P-41, P-64, P-65, P-66
137
Name Pref
Rasha Deebajah P-71
Riad Abdel Jalil O-32
Rima Abdul-Khalek P-10
Rula Najjar O-1
Saif Aldeen AlRyalat P-27
Sally Temraz P-29
Samer Salah O-13, O-40, P-58
Sewar Salmany P-47
Sondos Al Khatib P-81
Suha Ghoul P-12, P-42, P-46, P-79
Taher Abu Hejleh O-26
Taleb Ismael P-68, P-70
Thalia Arawi P-82
Walid Faraj O-14, P-30, P-37, P-38, P-78
Wassim Abou-Kheir O-27, O-29
Yacoub Yousef O-38, O-39, P-69
Youssef H. Zeidan O-11
138
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1

Distinguished Researchers and Participants,

DAY 1: Friday; 22nd, March 2019

Time Topic Speaker

8:25 Welcome Remarks Dr. Asem Mansour

8:30-8:55 Acute lymphocytic leukemia Dr. Hagop Kantarjian

8:55-9:20 Acute Myeloid Leukemia Dr. FarhadRavandi

9:20-9:45 Acute Myeloid Leukemia in Elderly Dr. Amer Zeidan

10:00-10:25 Coffee Break & Poster View

10:25-10:50 Allogeneic Stem Cell Transplantation Dr.Ali Bazarbachi

10:50-11:15 Chronic Myeloid Leukemia Dr. Hagop Kantarjian

11:15-11:40 Myelodysplastic syndromes Dr. Amer Zeidan

11: 50- 1:10 Lunch and Jumah Prayers

1:10-1:35 The Highly Curable Leukemia's Dr. FarhadRavandi

1:35-2:00 Multiple Myeloma Dr. Sameer Yaser

2:00-2:25 Acute lymphocytic leukemia Dr. Hagop Kantarjian

2:25-2:50 Update on CAR-T Therapy Dr. Jean El-Cheikh

2:50- 3:00 Q&A

3:00-3:30 Coffee Break & Poster View

O-1; Comparable efficacy of peripheral stem cell mobilization using

O-2; safety and efficacy of 4 cycles of BrentuximabVedotinas

O-3; The role of Anti-thymocyte globulin with Thiotepa-

O-4; Imatinibmesylate is safe and effective in maintaining

O-5; Hematopoietic recovery and transfusion needs after

O-6; The value of interim FDG- PET/CT in assessing

O-7; Outcome of Relapsed Acute Lymphoblastic Leukemia in

4:55-5:00 Closing Remarks; Dr. Hagop Kantarjian

5:30- 6:30 Opening Ceremony

Time Hall-A/ Fourth Floor

Session-1/ Plenary Session

08:15-08:30 Welcome Remarks

O-8; Activation of androgen receptor induces epithelial - to

O-11; Postmastectomy Radiation Therapy: “No One Size Fits All”

O-12; Intravenous Ferric Carboxymaltose (FCM), without

O-13; Salvage chemotherapy using irinotecan and temozolamide

O-15; Modeling EGFR mutation detection for liquid biopsy

O-16; Diagnostic Performance of FDG-PET/ CT scan as Compared

10:30-11:00 Coffee Break & Poster View

Session-2/ Breast Session-3/ Lung

O-24; Effect of PD-L1

O-18; Genetic Counseling

O-19; Availability, Rate

O-20; Breast Cancer among

O-22; Amenorrhea and O-28; Prostate cancer (PC)

O-23; Fertility in Breast Cancer

13:00-14:00 Lunch and Poster View

Session-5/Supportive care Session-6/ Pediatrics

O-37; Differential Gene Expression

O-31; Predictors of Augmented O-38; The Impact Of

O-32; Impact of Using

O-33; Fertility Counseling and

O-40; Timing of local control

O-35; Decision Making O-41; Quality Assurance Rounds

O-36; Original filgrastim

15:30-16:00 Coffee Break and Poster View

Hall-A/ Fourth Floor

O-44; Laparoscopic versus open pancreaticoduodenectomy:

O-45; Knowledge, Attitudes and Practices (KAP) of

O-46; Female oncologists in the Middle East and

O-47; Cytoreduction and Hyperthermic intraperitoneal chemotherapy

O-48; Early Stage Oral Tongue Squamous Cell Carcinoma:

O-49; Laparoscopic versus open insertion of feeding gastrostomy tube

O-50; Clinical Characteristics and Treatment Outcome for Adult

O-51; Neuro-Onco-2; Prognostic Significance of O6-

17:45-18:00 Closing Remark; Dr. Hikmat Abdel-Razeq

Corresponding Author Rula Najjar

Presenting Author Rula Najjar