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El-Sayed S, Nelson N. Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and randomized trials. J Clin Oncol 1996; 14:838-47. [PMID: 8622032 DOI: 10.1200/jco.1996.14.3.838] [Citation(s) in RCA: 245] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Using the technique of meta-analysis, we aim to illustrate the potential benefit, or lack of it, in adding chemotherapy to locoregional definitive treatment in a prospective randomized setting. PATIENTS AND METHODS Mantel-Haenszel summary analyses were used to test 42 prospective and properly randomized trials for statistically significant differences in the proportion with side effects and in the proportion with response to treatment between the experimental treatment arm (including chemotherapy) and control arm (local definitive treatment only) of the study. Summarized estimates of relative risks of side effects and relative proportions of positive responses were obtained using the summarizing options in PROC FREQ in the SAS computer package. In 25 of 42 studies, sufficient survival information was available to estimate the effect of chemotherapy on the rate of dying per person per unit of time. RESULTS Chemotherapy, when added to local definitive treatment, was found to increase toxicity. This increase is statistically significant. The relative proportion of side effects was 2.17, with a 95% confidence interval of 1.84 to 2.56 and P less than .001. Addition of chemotherapy to local treatment has reduced the mortality rate for treated patients by 11% in the total group (all 25 studies), with a 95% confidence interval of 1% to 19%. This reduction means that at the time 50% of patients in the control arm were still alive, 54% of patients who received chemotherapy would be expected to be alive. Concurrent treatment (11 studies) has reduced the mortality rate by 22%, with a 95% confidence interval of 8% to 33%, which means that at the time 50% of patients in the control arm were still alive, 58% of patients who received chemotherapy would be expected to be alive. CONCLUSION Addition of chemotherapy to local definitive treatment has significantly increased the morbidity of treatment as well as the chance of initial tumor response and local control. A statistically significant improvement in survival was found for the simultaneous use of chemotherapy and local definitive treatment.
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Meta-Analysis |
29 |
245 |
2
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Croke JM, El-Sayed S. Multidisciplinary management of cancer patients: chasing a shadow or real value? An overview of the literature. ACTA ACUST UNITED AC 2012; 19:e232-8. [PMID: 22876151 DOI: 10.3747/co.19.944] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Multidisciplinary cancer conferences (mccs) are designed to optimize patient outcomes. It appears intuitive that mccs are essential to clinical decision-making and patient management; however, it is unclear whether that belief is supported by evidence. Our objectives were to assess the currently published literature addressing the impact of mccs on clinical decision-making and patient outcomes. METHODS Ovid medline was searched from 1950 to June 2010 using these keywords: "multidisciplinary/interdisciplinary/clinical meeting$/conference$/round$/team$," "decision making," "neoplasms$/cancer$/oncology/tumo(u)r conference$/board$/meeting$," "multidisciplinary/interdisciplinary cancer conference$/meeting$." All trials, guidelines, metaanalyses, reviews, and prospective and retrospective studies were included. RESULTS The keywords retrieved 595 abstracts, and 30 manuscripts were obtained. Most of the studies assessed the impact of mccs on clinical decision-making rather than on patient outcomes. CONCLUSIONS Available evidence supports the belief that mccs significantly influence clinical decision-making and treatment recommendations. In contrast, scant evidence suggests that mccs improve patient outcomes. Unfortunately, the current literature is substantially heterogeneous and therefore does not allow for firm conclusions.
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Journal Article |
13 |
80 |
3
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El-Sayed S, Nabid A, Shelley W, Hay J, Balogh J, Gelinas M, MacKenzie R, Read N, Berthelet E, Lau H, Epstein J, Delvecchio P, Ganguly PK, Wong F, Burns P, Tu D, Pater J. Prophylaxis of radiation-associated mucositis in conventionally treated patients with head and neck cancer: a double-blind, phase III, randomized, controlled trial evaluating the clinical efficacy of an antimicrobial lozenge using a validated mucositis scoring system. J Clin Oncol 2002; 20:3956-63. [PMID: 12351592 DOI: 10.1200/jco.2002.05.046] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Mucositis occurs in almost all patients treated with radiotherapy for head and neck cancer. The aim of this multicenter, double-blind, prospective, randomized trial was to evaluate the clinical efficacy of an economically viable antimicrobial lozenge (bacitracin, clotrimazole, and gentamicin [BcoG]) in the alleviation of radiation-induced mucositis in patients with head and neck cancer. PATIENTS AND METHODS One hundred thirty-seven eligible patients were randomized to treatment with either antimicrobial lozenge (69 patients) or placebo lozenge (68 patients). The primary end point of the study was the time to development of severe mucositis from the start of radiotherapy. Secondary end points included severity and duration of mucositis, pain measurement, radiation therapy interruption, and quality of life. Mucositis was scored using a validated mucositis scoring system. RESULTS Toxicity profiles were similar between the two arms of the study. The median time to development of severe mucositis from the start of radiotherapy was 3.61 weeks on BCoG and 3.96 weeks on placebo (P =.61). There were no statistically significant differences between the arms in the extent of severe mucositis as measured by physician, in oral toxicities as recorded by patients, or in radiotherapy delays. CONCLUSION This study was conducted on the basis of a pilot study that demonstrated the BCoG lozenge to be tolerable and microbiologically efficacious. A validated mucositis scoring system was used. However, in this group of patients treated with conventional radiotherapy, the lozenge did not impact significantly on the severity of mucositis. Whether such a lozenge would be beneficial in treatment situations where rate of severe mucositis is higher (ie, in patients treated with unconventional fractionation or with concomitant chemotherapy) is unknown.
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23 |
46 |
4
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El-Sayed S. Productivity of the Antarctic waters—A reappraisal. MARINE PHYTOPLANKTON AND PRODUCTIVITY 1984. [DOI: 10.1029/ln008p0019] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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41 |
41 |
5
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Elzayat M, El-Sayed S, Osman H, Amin M. X-ray diffraction and differential scanning calorimetry studies of a BaTiO3/polyvinylidene fluoride composites. POLYM ENG SCI 2012. [DOI: 10.1002/pen.23132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12 |
6
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Vickers M, Samson B, Colwell B, Cripps C, Jalink D, El-Sayed S, Chen E, Porter G, Goel R, Villeneuve J, Sundaresan S, Asselah J, Biagi J, Jonker D, Dawson L, Letourneau R, Rother M, Maroun J, Thirlwell M, Hussein M, Tehfe M, Perrin N, Michaud N, Hammad N, Champion P, Rajan R, Burkes R, Barrette S, Welch S, Yarom N, Asmis T. Eastern Canadian Colorectal Cancer Consensus Conference: setting the limits of resectable disease. ACTA ACUST UNITED AC 2011; 17:70-7. [PMID: 20651901 DOI: 10.3747/co.v17i3.610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Montreal, Quebec, October 22-24, 2009. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management colorectal cancer, such as the management of hepatic and pulmonary metastases, the role of monoclonal antibodies to the epidermal growth factor receptor, and the benefits and safety of chemotherapy in elderly patients. The management of gastrointestinal neuroendocrine tumours and gastric cancer are also discussed.
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Journal Article |
14 |
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7
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Amin A, El-Sayed S, Taher N, Sedki M, Nasr H. Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal function reserve estimation: is it a reliable predictive tool for assessment of preclinical renal involvement in scleroderma patients? Clin Rheumatol 2012; 31:961-6. [PMID: 22362258 DOI: 10.1007/s10067-012-1963-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/27/2012] [Accepted: 02/09/2012] [Indexed: 12/26/2022]
Abstract
Prognosis of systemic sclerosis (SSc) depends on internal organ involvement. We assessed the value of renal function reserve (RFR) for the detection of preclinical nephropathy in scleroderma. Thirty SSc patients with normal serum creatinine and 30 healthy controls were included. Medsger disease severity score, glomerular filtration rate (GFR), and microalbuminuria were measured. Tc-99m DTPA was utilized for GFR measurement at baseline and after oral protein overload (stimulated GFR). RFR was calculated as the percentile increase of stimulated GFR. SSc patients had lower means of baseline GFR (P=0.001), stimulated GFR (P=0.004), RFR (P=0.046), and higher microalbuminuria (P=0.009) than controls. According to baseline GFR, SSc patients showed three categories-normal baseline GFR (n=12), hyperfiltration GFR (n=3), and reduced baseline GFR (n=15). In the former category, RFR was normal in 6/12 patients and abnormal in the remainders (50%). Hyperfiltration patients and those with reduced baseline GFR showed abnormal RFR. A statistically significant negative association was found between microalbuminuria versus stimulated GFR and RFR (r= -0.5, P=0.007 and r= -0.45, P=0.013, respectively). The majority of SSc patients with abnormal RFR had disease duration of ≥48 months (60% vs. 20%, P=0.008). All SSc patients with pulmonary hypertension had abnormal RFR, while reduced baseline GFR was noted in only 60%. A significant negative correlation was found between reduced baseline GFR and cumulative dose of corticosteroids in SSc patients (r= -0.4, P=0.022). RFR estimation could be a useful predictive marker for preclinical renal involvement in SSc patients so that early prophylactic measures and therapy modifications could be considered.
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Journal Article |
13 |
7 |
8
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37 |
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9
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Atallah S, Al-Assaf H, Xu Y, El-Sayed S. Adrenocortical carcinoma: patterns of care and role of adjuvant radiation therapy-a population-based study and review of the literature. ACTA ACUST UNITED AC 2017; 24:e316-e322. [PMID: 28874901 DOI: 10.3747/co.24.3533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We reviewed the experience of a tertiary cancer centre in the management of adrenocortical carcinoma (acc) treated over 40 years. We also searched the literature for guidelines related to the treatment of acc and for evidence for adjuvant radiation therapy (rt). METHODS In a retrospective chart review, acc patients treated between January 1974 and December 2013 were identified, and patient demographics and tumour characteristics were extracted. Outcomes data, including dates and sites of failure, vital status, and cause of death, were collected. Overall survival was estimated using the Kaplan- Meier method. A medline search using PubMed, Ovid, and embase was used to review the literature about the role of rt and any available management guidelines for acc. RESULTS Of 81 patients identified during the chart review, 39 had confirmed acc. In 32 patients, surgical resection was performed, including in 2 patients with M1 disease. Of those 32 patients, 16 received adjuvant systemic treatment (mitotane or concurrent chemoradiation). Only 6 patients received adjuvant rt, of whom 3 are still alive (2 living with distant failure). At a median follow-up of 3.8 years, 28 patients had died (72%), 10 were living (26%), and 1 had been lost to follow-up. Of the 22 patients for whom failure data were available, 2 experienced local failure, and the rest, distant failure. CONCLUSIONS The current data are insufficient to make treatment recommendations. Use of collaborative databases and consensus about diagnostic and therapeutic guidelines are warranted for better identification of optimum management. Adjuvant rt could be a reasonable option for R1 disease, but further research is needed.
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Review |
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10
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Abdel-Razik HH, El-Sayed S, Hassen A. Dielectric properties of new fully conjugated 2H- and metal-pyrazinoporphyrazine network polymers. J Appl Polym Sci 2011. [DOI: 10.1002/app.34169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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14 |
4 |
11
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Kwok CB, Lam G, El-Sayed S. Suitability of using multileaf collimator (MLC) for photon field matching. Med Dosim 2004; 29:184-95. [PMID: 15324915 DOI: 10.1016/j.meddos.2004.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Revised: 03/19/2004] [Accepted: 04/05/2004] [Indexed: 11/16/2022]
Abstract
This study evaluated and presented the results on the suitability of using a Siemens double-focused multileaf collimator (MLC) for photon field matching. The study was conducted using film-based dosimetry for measurements and a Theraplan Plus (version 3.8) treatment planning system (TPS) for planning comparisons and additional field matching investigations. In this study, it was found that the double-focused MLC field matching closely resembled that of the independent jaws, with the exception that the MLC had a nonuniform match line-a--match line formed by a different size leaf pair gap--overlap at a different join-up position. In addition, it was found that the dose change varied linearly with the MLC leaf pair gap-overlap (from 3-mm gap to 3-mm overlap) by 11 +/- 1%/mm. Using intrafraction "feathering" of the junction, a reduction of the dose change from 11 +/- 1%/mm to 6.5 +/- 1%/mm occurred when the junction was moved once and from 11 +/- 1%/mm to 4 +/- 1%/mm when moved twice. Based on the results, the study suggested that MLC positioning error tolerances of +/-2 mm might be too large for photon field matching. On the other hand, a combination of reducing the tolerance to +/-1 mm and intrafraction junction moves (twice by +/-1 cm off matching axis) could reduce the maximum peak height--trough low at the junction to within a required range of -5 to +7% in planning target volume (PTV) dose heterogeneity.
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12
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Enein AA, El-Kharadely ME, El-Sayed S. A Technique for Homotransplantation of Canine Urinary Bladder. Urologia 1967. [DOI: 10.1177/039156036703400306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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58 |
2 |
13
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El-Sayed S, Hassan M, Ibrahim M, Elbassuoni E, Aziz N. Modified endogenous carbon monoxide production through modulation of heme oxygenase activity alters some aspects of the cold restraint stress response in male albino rats. Endocr Regul 2012; 46:205-15. [DOI: 10.4149/endo_2012_04_205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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2 |
14
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Hassen A, Moawed EA, Bahy R, El Basaty AB, El-Sayed S, Ali AI, Tayel A. Synergistic effects of thermally reduced graphene oxide/zinc oxide composite material on microbial infection for wound healing applications. Sci Rep 2024; 14:22942. [PMID: 39358395 PMCID: PMC11447095 DOI: 10.1038/s41598-024-73007-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024] Open
Abstract
Infections originating from pathogenic microorganisms can significantly impede the natural wound-healing process. To address this obstacle, innovative bio-active nanomaterials have been developed to enhance antibacterial capabilities. This study focuses on the preparation of nanocomposites from thermally reduced graphene oxide and zinc oxide (TRGO/ZnO). The hydrothermal method was employed to synthesize these nanocomposites, and their physicochemical properties were comprehensively characterized using X-ray diffraction analysis (XRD), High-resolution transmission electron microscopy (HR-TEM), Fourier-transform infrared (FT-IR), Raman spectroscopy, UV-vis, and field-emission scanning electron microscopy (FE-SEM) techniques. Subsequently, the potential of TRGO/ZnO nanocomposites as bio-active materials against wound infection-causing bacteria, including Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, was evaluated. Furthermore, the investigated samples show disrupted bacterial biofilm formation. A reactive oxygen species (ROS) assay was conducted to investigate the mechanism of nanocomposite inhibition against bacteria and for further in-vivo determination of antimicrobial activity. The MTT assay was performed to ensure the safety and biocompatibility of nanocomposite. The results suggest that TRGO/ZnO nanocomposites have the potential to serve as effective bio-active nanomaterials for combating pathogenic microorganisms present in wounds.
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research-article |
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15
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El-Sayed S, Symonds RP, Robertson AG, Paul J, McGarva J. Phase II trial of carboplatin and vinblastine in advanced squamous-cell carcinoma of the head and neck. Cancer Chemother Pharmacol 1990; 26:464-6. [PMID: 2225318 DOI: 10.1007/bf02994101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A chemotherapy regimen consisting of carboplatin and vinblastine was given to 30 patients with recurrent or previously untreated, locally advanced squamous carcinoma of the head and neck region. The main aim of the study was to assess the toxicity of this regimen, the feasibility of its outpatient administration and the tumour response. A total of ten patients (33%) achieved an objective response, including two who achieved a complete response. The combination offered useful palliation for patients with recurrent disease; it was well tolerated and can be given on an outpatient basis. This regimen could be combined with other active agents such as methotrexate or bleomycin.
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Clinical Trial |
35 |
2 |
16
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El-Sayed S, Hassan H, Abdel-Wahab A, Gebrael A. EFFECT OF GRAFTING ON THE CUCUMBER YIELD AND QUALITY UNDER HIGH AND LOW TEMPERATURES. ACTA ACUST UNITED AC 2014. [DOI: 10.21608/jpp.2014.53662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11 |
1 |
17
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Enein AA, El-Kharadely A, El-Sayed S. Experimental Orthotopic Urinary Bladder Homotransplantation. Urologia 1969. [DOI: 10.1177/039156036903600504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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56 |
1 |
18
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Atallah S, Thomas M, AL-Assaf H, Xu Y, El-Sayed S. One Center's Experience: Demographics, Treatment, and Outcome of Patients With Adrenocortical Carcinoma (ACC) Treated During the Past 40 Years. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Bhattacharya G, Ivars J, El-Sayed S, Eapen L, Haddad A, Gaudet M. Effect of Feeding Tube Strategy on Hospitalization Rates and Outcomes in Head and Neck Cancer Patients Treated with Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Atallah S, Thomas M, Al-Assaf H, El-Sayed S. 2235 Adrenocortical carcinoma (ACC), what is the optimum management? A report of single center experience. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Abd El-Ghafar I, El-Sayed S, Abd El-Monem M. Evaluation of the Efficacy of Surgically-Assisted Clear-Aligners in Orthodontic Tooth Movement Acceleration. AL-AZHAR ASSIUT DENTAL JOURNAL 2019; 2:177-183. [DOI: 10.21608/aadj.2019.76501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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22
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Tisseverasinghe S, El-Sayed S, Thomas M, Zhang T, Vanasse H, Gupta S. Outcome and Toxicity of Hypofractionated Conformal Radiation Therapy (HCRT) in Early Glottis Cancer: A Baseline for Comparison in the IMRT Era. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Song J, Yegendorf D, Eapen L, El-Sayed S, Gaudet M, Haddad A. Evaluation of Larynx Preservation on Patients with Locally Advanced Laryngeal Cancer in the Era of IMRT: Results from a Single Tertiary Cancer Center. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7 |
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24
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El-Sayed S, Busca I, AlHussain H, Broomfield J, Carty K. Patterns of Failure in Patients Treated With Intensity Modulated Radiation Therapy (IMRT) Using Helical Tomotherapy (HT) for Head-and-Neck Squamous Cell Carcinoma (HNSCC): Results of a Prospective Trial. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Tisseverasinghe S, El-Sayed S, Thomas M, Zhang T, Vanasse H, Gupta S. EP-1162: Outcomes and second malignancies after radiotherapy for early stage glottis cancers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31472-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7 |
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