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Background & Objective: Glioblastoma is the most common primary malignancy of the brain, the prognosis of which is poor. Immunotherapy with cancer/testis (CT) antigens is a novel therapeutic approach for glioblastoma. This study aimed to investigate the expression rate of MAGE-E1, GAGE, and SOX-6 in glioblastoma tumors using the method of immunohistochemistry (IHC). Methods: Expression of MAGE-E1, GAGE, and SOX-6 were determined by IHC in 50 paraffin blocks of glioblastoma. The results were compared between variables including age, gender, tumor location, and Karnofsky performance status (Kps) score. Survival analysis was also performed. Results: The expression levels of SOX-6, MAGE-E1, and GAGE were 82%, 78%, and 76%, respectively. The relationship between CT antigens and age, gender, and tumor location was not significant, while the association between MAGE-E1 expression and age was statistically significant (P=0.002). High expression levels of SOX-6 and MAGE-E1 were associated with low Kps scores (P=0.034 and P40 and Kps score

This study aimed to determine the association between cardiac dose distribution and strain and Tissue Imaging Doppler (TDI) echocardiographic indices during 1-year follow-up after Post-Mastectomy Radiotherapy (PMRT) in breast cancer patients. In this prospective cohort study, patients with left breast cancer candidate for PMRT were included. The patients treated radiation dose of 50 Gy in 25 fractions over 5 weeks. Before the radiotherapy, and 6 and 12 months after it, the patients underwent echocardiography using strain and TDI methods. The changes in echocardiographic indices and their association with cardiac radiation dose were evaluated. In this study, 31 patients with mean age of 36.6 ± 4.6 years old and the cumulative doses of doxorubicin to 237 ± 5 mg/m2 were participated. Correlation between cardiac dose during radiotherapy and changes in strain and TDI echocardiographic indices showed a significant inverse relation between minimum cardiac dose and 6-month TAPSE changes (p = 0.04, r = − 0.3), maximum cardiac dose and 6-month RV strain changes (p = 0.04, r = − 0.3) and 6 and 12-month S′ changes (p = 0.02, r = − 0.4 and p = 0.05, r = − 0.3), Cardiac V30 with 6 and 12-month E velocity changes (p = 0.05, r = − 0.3 and p = 0.02, r = − 0.4, respectively) and Heart V20 with 12-month E velocity changes (p = 0.04, r = − 0.3). Normal RV strain observed before starting the study in 12 patients (38.7%) was found to be abnormal after 6-month follow-up (p = 0.004). Results of this study showed that, PMRT was associated with left heart diastolic dysfunction and right heart systolic dysfunction especially in the first 6 months after radiotherapy.

Esophageal squamous cell carcinoma (ESCC) is among the leading causes of cancer related death. Despite extensive efforts in identifying valid cancer prognostic biomarkers, only a very small number of markers have been identified. Several genetic variants in the 9p21 region have been identified that are associated with the risk of multiple cancers. Here, we explored the association of two genetic variants in the 9p21 region, CDKN2A/B, rs10811661 and rs1333049 for the first time in 273 subjects with, or without ESCC. We observed that patients with ESCC had a higher frequency of a TT genotype for rs10811661 than individuals in the control group, and this polymorphism was also associated with tumor size. Moreover, a CC genotype for the rs1333049 polymorphism was associated with a reduced OS of patients with ESCC. In particular, patients with a CC (rs1333049) genotype had a significantly shorter OS (CC genotype: 34.5±8.9 months vs. CG+GG: 47.7±5.9 months; p value= 0.03). We have also shown the association of a novel genetic variant in CDKN2B gene with clinical outcome of ESCC patients. Further investigations are warranted in a larger population to explore the value of emerging markers as a risk stratification marker in ESCC. Key word: Esophageal squamous cell carcinoma, risk marker, CDKN2A/B, polymorphism

Squamous cell carcinoma (SCC) is the sixth most frequent malignant tumor of the head and neck region. Despite advances in therapeutic options over the last decades, the rate of mortality and morbidity has not been improved markedly. A small subset of cells, cancer stem cells (CSCs), with self-renewal properties have become a major focus of current cancer research. CD44 and p63 are identified as candidate stem cell markers in normal squamous epithelium and SCC. The role of these markers in oral squamous cell carcinoma (OSCC) is still debatable. The aim of this study was to evaluate immunohistochemical expression of these markers in OSCC samples and also correlates the expression of these markers with some clinicopathological parameters of prognostic significance including histological grading, TNM staging, overall survival (OS) rate as well as patients' age, gender, and tumor location. CD44 and p63 were expressed in all studied lesions with different degrees. Statistically significant difference was observed between CD44 and p63 expression with tumor grade and stage with higher expression in high grade and advanced OSCCs. No significant relationship was detected between markers immunoreactivity and patients age, gender, tumor location as well as OS. These markers can possibly advance our understanding of the initiating mechanisms and pathogenesis of OSCC and also result in novel therapeutic target in cancer treatment.

The DNA repair protein O6-Methylguanine-DNA methyltransferase (MGMT) is suggested to be associated with resistance to alkylating agents such as Temozolomide which is being used in treatment of patients with glioblastoma (GBM). Therefore, we evaluated the associations between MGMT promoter methylation and prognosis of patients with glioblastoma (GBM). Data were extracted from publications in Embase, PubMed, and the Cochrane Library. Data on overall survival (OS), progression-free survival (PFS), and MGMT methylation status were obtained and 4,097 subjects were enrolled. Data from 34 studies showed that MGMT methylated patients had better OS, compared to GBM unmethylated patients (pooled HRs, 0.494; 95%CI 0.412-0.591; p = 0.001). Meta-analysis of 10 eligible studies reporting on PFS, demonstrated that MGMT promoter methylation was not significantly associated with better PFS (pooled HRs, 0.653; 95%CI 0.414-1.030; p = 0.067). GBM patients with MGMT methylation were associated with longer overall survival, although this effect was not detected for PFS. Moreover, we performed further analysis in patients underwent a comprehensive imaging evaluation. This data showed a significant association with better OS and PFS, although further studies are warranted to assess the value of emerging marker in prospective setting in patients with glioblastoma as a risk stratification biomarker in clinical management of the patients.

Breast cancer is the second most common malignancy diagnosed in women, supporting the need for identification of novel prognostic and diagnostic biomarkers. Recently, microRNAs have emerged as molecular regulators that can have key roles in pathogenesis and progression of different malignancies, including breast cancer. Micro-RNAs can be circulated in body fluid, suggesting their values as non-invasive marker. There is growing body of evidence showing the aberrant activation of some known circulating miRNAs, for example let-151a, miR-21, miR-155, miR-,145 miR-18a, miR-16 as well as tissue specific-miRNAs, for example miR-182, miR-145, miR-21, miR-155/154, miR-203, miR-213, miR-7 in patients affected by breast cancer. In addition, there is growing body of evidences on the value of miRNAs to be associated with drug-resistance, suggesting their values as a potential approach to overcome chemo-resistance. Attuned with these facts, this review highlights recent preclinical and clinical investigation performed on tissue-specific miRNAs and circulating as novel promising biomarkers for detection of patients at early stages, prediction of prognosis, and monitoring of the patients in response to therapy.

Introduction: Melanoma-associated antigen 1 (MAGE1) expression in normal tissues is restricted to the testes, whilst being over-expressed in a number of human cancers. This feature of MAGE1 makes it a promising cancer biomarker. This study aimed to determine the expression of MAGE1 in esophageal squamous cell carcinoma (SCC) and its relationship with clinicopathological factors. Methods: This is a cross-sectional study conducted on pretreatment endoscopic tissue specimens of 43 patients with non-metastatic esophageal SCC, admitted to Omid Hospital, Mashhad, Iran, between 2011 and 2013. Out of 127 esophageal SCC patients who had already enrolled in a trial of trimodality therapy, we chose 43 patients whose paraffin blocks of endoscopic samples were accessible, which we then stained for MAGE1 expression by immunohistochemistry. Correlation of MAGE1expression and clinicopathological data (age, sex, stage, grade, and outcome) was assessed using SPSS 16 by T test, chi-square, and Pearson tests (p

Background and Purpose: The goal of this study is application of the proportional hazards model (PH) and accelerated failure time model (AFT), with consideration Weibull distribution, to determine the level of effectiveness of the factors affecting on the level of disease-free survival (DFS) of the patients with breast cancer. Materials and Methods: Based on the retrospective descriptive studies, 377 female patients with primary breast cancer that had been treated at oncology section (Omid Hospital) in Mashhad, Iran, were considered for participation in the study. Results: The median was 2 years and 10 months (mean 2 years and 4 months, interquartile range 3 years and 7 months, range 1-2920 days or 8 years). The average age of patients was 49.2 ± 11.5 (range 25-80 years). The rate of DFS determined with 52.5%. Base on the result of PHs Weibull model, the risk of the metastasis after surgery in the patients with invasive tumors to the skin and chest and positive lymph node was more than 2 times [hazard ratio (HR) = 2.53; confidence interval (CI): 1.26, 5.06] and (HR = 2.37 CI: 1.42, 3.98), respectively. Hormone therapy after surgery decreases the risk of the metastasis to 0.63% (HR = 0.63; CI: 0.41, 0.95). In the AFT model, characteristic tumor decelerated (γ < 1) the DFS time by a factor of 0.30 and 0.33, respectively. Furthermore, the hormonal therapy accelerated (γ > 1) the DFS time by factor of 1.8. Conclusion: In this study, the PH and AFT assumption have been satisfied by data and characteristics tumor and the hormonal therapy decrease and increases time until recurrence, respectively.

Background: Breast cancer is the first leading cause of cancer-related deaths in women. Ki-67 is being used for evaluation of the prognosis of patients with breast cancer. Objectives: The aim of the current study was to explore the association of the involvement of axillary lymph nodes status with the expression of Ki-67 in patients with breast cancer. Methods: A total of 449 patients were enrolled followed by evaluation of the association of Ki67 levels with demographic, pathologic, and survival data of patients, using Chi-square, logistic regression models, student t test and Mann-Whitney. Results: We observed a significant relationship between the expression level of Ki-67 and stage of tumor (P = 0.012), positive progesterone receptor (P = 0.003), and subtype pathologic features (P < 0.05). Also, a significant difference was detected between Her2 and expression level of Ki-67 (P = 0.015). Survival analysis showed the association for Ki-67 (P = 0.02), age (P = 0.005), stage of tumor (P < 0.05), lymph node involvement (P = 0.001), and the Her2 (P = 0.024) with clinical outcome (e.g., overall survival or disease free survival) of patients with breast cancer. Conclusions: The results of this study demonstrated that the overexpression of Ki-67 was associated with large tumors, progesterone receptor expression, and stage of tumor, but it was not related with lymph node involvement.

Aim: Esophageal cancer is the eighth most common cancer globally and the seventh most common cause of cancer-related deaths in men. Recent studies have shown that CYP450, family 1, subfamily B, polypeptide 1, which plays a role in the metabolism of xenobiotics, is associated with several cancers. Therefore, in the present study we investigated the association between a genetic variant, CYP1B1-rs1056836 gene, with the clinical characteristics of patients with squamous cell carcinoma of the esophagus (ESCC). Method: In this study, 117 patients with ESCC and 208 healthy controls were recruited. DNA was extracted and genotyped using real-time PCR-based TaqMan. Kaplan–Meier curves were utilized to assess overall and progression-free survival. To evaluate the relationship between clinicopathological data, genotypic frequencies, disease prognosis and survival, Pearson's χ2 and t-test were used. Logistic regression was utilized to assess the association between the risk of ESCC and genotypes. Results: The genotypic frequency for GG, GC and CC were 58.6, 29.8 and 11.5%, respectively, in the healthy subjects and 51.8, 36.14 and 12% in the ESCC group. An association between the GG genotype and stage of ESCC was found. Also, statistically significant results were not found for this variation and risk of ESCC. Conclusion: Our findings suggest a relationship between the CYP1B1-rs1056836 genetic polymorphism and clinical features of ESCC, supporting further studies in larger populations in different ethnic groups, taking into account potentially important environmental factors such as diet.

Background: Esophageal squamous cell carcinoma (ESCC) is a common malignancy in gastrointestinal tract. Objectives: This study was conducted to investigate the frequency of human epidermal growth factor receptor 2 (HER2), over-expression in patients with ESCC, and its correlation with pathologic response in cases undergoing neo-adjuvant, chemoradiation, and survival. Methods: In this cross sectional study, 68 patients with non-metastatic esophageal SCC, who had undergone neo-adjuvant chemotherapy containing cisplatin and 5FU in conjunction with radiotherapy between 2007 and 2014 were evaluated. HER2 expression assessed by Immunohistochemistry and HER2 score was also calculated for each specimen. Tumor response to neoadjuvant chemoradiotherapy was evaluated in surgical blocks according to tumor regression grading (TRG) system. Patients were followed up every 3 months in first 2 years and every 6 months afterwards. Results: The result of Hercep test was positive in 42.8% of cases, among whom 33.8% were 2+ and 8.8% were 3+. Her2 score was above 100 in 38.3%. Complete pathologic response was observed in 32.3%. There was no significant difference in the rate of complete response between patients with positive and negative HER-2 over-expression (P = 0.71). There was also no significant correlation between Her2 score among groups with favorable and unfavorable response to chemoradiation (P = 0.796 and 0.743). There was no difference in overall survival in Her2 positive and negative groups (3 years survival was 45 and 54 months, P = 0.32). Overall survival significantly reduced in patients with Her2 score above 100 (P = 0.045). Conclusions: Her2 positive in ESCC had no effect on tumors biologic behaviors and its response to chemoradiation. Although no correlation was observed between Her2 expression and survival; Her2 score above 100 was associated with shorter survival.

Introduction: Medulloblastoma is one of the most common malignancies in children. Common clinical symptoms of patients are related to the symptoms due to tumor in the posterior cranial fossa. Presentation of patients with symptoms related to metastatic tumors in the spinal canal are unusual. Case Presentation: We present a 6-year-old child with symptoms of lower back pain and Paraplegia as early symptoms of medulloblastom. The Magnetic Resonance Image (MRI) of spinal cord revealed multiple tumors in the spinal canal (initially diagnosed). A biopsy of the tumor was also performed. Then, whole CNS (Central Nervous System) imaging revealed tumor in the posterior cranial fossa. He had a dramatic improvement after treatment and returned to normal in all clinical signs. Four years have passed from his treatment and he is symptom free. Conclusions: Presentation of Medulloblastoma with widespread spinal canal drop metastases is rare. However, spinal drop metastasis should be considered to prevent a suboptimal management in child. These patients did not consider in aspect of the treatment outcome as hopeless.

Background and Aim: Squamous cell carcinoma (SCC) is the most common type of oral cancer, and it is important for it to be diagnosed in early stages. Researchers are interested in exploring the possibility of using biomarkers in the diagnosis of SCC in early stages. One of the detectable biomarkers in the serum is glutathione. Glutathione includes two forms: reduced form (or GSH) and oxidized form (or GSSG). The GSH/GSSG ratio tends to decrease in severe oxidative stress. The aim of this study was to assess the serum levels of GSH and GSSG as well as GSH/GSSG as total antioxidant capacity in patients with head and neck SCC (HNSCC) and to subsequently compare them with healthy controls. Materials and Methods: Twenty HNSCC patients as well as twenty healthy controls were included in the study. A blood sample of 5 ml was obtained from both the case and control groups. GSH, GSSG, and total antioxidant capacity were measured spectrophotometrically. Results: No significant difference in the level of GSSG was observed in the patients from the case and control groups (P = 0.796), whereas the level of GSH and GSH/GSSG was significantly lower in the case group (P = 0.002, P = 0.011, respectively). There was no significant relationship between the level of GSH, GSSG, and total antioxidant capacity, on the one hand, and the stage and grade of the tumor, on the other hand. Conclusion: Since the levels of GSH and GSH/GSSG were significantly lower in the case group, GSH/GSSG could be used as a prognostic factor for the early diagnosis of HNSCC.

Background: Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma. Materials and Methods: Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated. Results: One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. There were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%. In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confidence interval, 24.46-63.54). Conclusion: The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high. Key words: Esophageal carcinoma, neoadjuvant chemoradiation, survival

Background: Preoperative concurrent chemoradiotherapy may improve surgical results and patient survival rates in gastric adenocarcinomas. We aimed to assess tumor resectability and pathologic response rates in patients with locally advanced proximal gastric and esophagogastric junction adenocarcinomas by preoperative CRT and toxicity evaluation of treatment. Methods: The patients with proximal gastric or esophagogastric junction adenocarcinoma who had locally advanced disease on basis of endoscopic and imaging findings were candidates for preoperative concurrent chemoradiotherapy. Eligible patients underwent radiotherapy 45-50.4/1.8-2 Grays, five days in week concurrent with chemotherapy by 5-fluorouracil and leucovorin or capecitabine. 4 - 6 weeks after completion of this treatment, non-metastatic patients underwent surgery and all resected specimens evaluated for completeness of resection and pathologic response rate of tumor to preoperative treatment. The patients were followed for postoperative complications in a short time. Results: 35 out of 41 enrolled patients completed preoperative treatment without any mortality and significant toxicity. Ultimately, 22 patients underwent surgery. From these, 2 (9) had unresectable tumors, 2 (9) underwent incomplete resection and 18 (82) completely resected. In pathologic evaluations, 52 showed complete and partial pathologic responses and 48 showed no pathologic response to preoperative treatments. Male gender was significantly associated with tumor pathologic response (P value = 0.034). Postoperative complications were seen in only two patients. Conclusions: Preoperative concurrent chemoradiotherapy with 5 fluorouracil and leucovorin or capecitabine followed by surgery is a tolerable and safe treatment in patients with locally advanced proximal gastric and EGJ adenocarcinomas. It resulted in promising high rates of tumor resectability and pathologic response. © 2017, International Journal of Cancer Management.

Background: Immunohistochemistry (IHC) of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2) are important prognostic factors of breast cancer. However, discordance between IHC findings of primary tumor and ipsilateral metastatic lymph nodes (IMLNs) has been reported that might affect the criteria for adjuvant therapies in breast cancer in the future. Methods: Sample size of the current study was estimated 50 (Macnemar test). We performed IHC for ER, PR, and Her2 on IMLNs of 50 paraffin embedded blocks of breast cancer patients with regional lymphadenopathy during the period. All-red score 2 was regarded as negative and 3 as positive for ER/PR. Her2 results were classified to 1+ ( 0 and 1+), 2+, and 3+. We used SPSS 16 to insert and analyze the data. Results: Mean age of patients was 49 yrs, and mean tumor size was 4.8 ± 3.53 cm. Twenty-four samples were pN1, 17 pN2, and 9 pN3. ER and PR were positive in 50% and 52 % of tumoral samples and 78% and 76% of IMLNs, respectively (fisher exact test, P = 0.003 and P = 0.011, respectively). The discrepancy between IHC of primary tumor and IMLNs for ER, PR and Her2 was 32% (P = 0.000), 24% (P = 0.002), and 48%, respectively. Overall, 34 patients (68%) showed disagreement in at least one of their receptors. Conclusions: Discrepancy between IHC results of primary tumor and IMLNs was significant. Since metastatic clones in metastatic lymph nodes (MLNs) are potential sources of systemic metastasis, routine IHC on MLNs could play an important role in determining prognosis, indication for FISH, and finally, choosing adjuvant treatment.

Management of the central nervous system malignancies are among the evolving areasof research and clinical practice requiring a well-coordinated interdisciplinary approach.The neuro-oncology scientific club (NOSC) has tried to cross the links between variousdisciplines’ experts involved in brain tumor care in Iran since 2011. The NOSC’sstructured collaborative brain tumor registry (BTCR) and the support received from itssteering committee and provincial boards have been the key elements for its successand growth so far. This scientific community not only has helped to optimize brain tumorcare but provided interdisciplinary research opportunities to its members across Iran.Mashhad’s NOSC has been the pioneer in the above. During the 3 rd Mashhad’s NOSCmeeting held in November 21 st 2013, the interim results from some important localneuro-oncology studies were presented. Some potential opportunities to improve thecoordinated interdisciplinary brain tumor care within the province were discussed byneurosurgery, neuroradiology and radiation oncology faculty at this provincial NOSCmeeting. Clinical outcome, survival data and prognostic factors in adult and pediatricgliomas over the past several years in Mashhad, the association between methylguanine methyl transferase (MGMT) methylation status (determined by MSQP ormethylation specific quantitative polymerase chain reaction) where among the mainstudies outlined during this event. We realize that optimized brain tumor managementand productive research in neuro-oncology can only be achieved through an integratedapproach and strong team work. This is what the NOSC pursues.Keywords: Neuro-oncology; consensus development; brain tumor management;interdisciplinary; Mashhad; Iran.

BACKGROUND: Bone scan is a sensitive but not specific method for evaluation of bone metastases. However, the clinical data and the pattern of bone scan findings help the physician to narrow the diagnostic differentials. We tried to investigate the distribution of bone metastases in common cancers using bone scintigraphy. MATERIAL AND METHODS: 160 consecutive patients with malignancy (prostate cancer: 32, breast cancer: 107, lung can- cer: 8, and gastrointestinal cancers: 13) underwent bone scan. RESULTS: From the 160 patients, 58 patients (36.3%) had abnormal bone scans attributable to metastatic tumor. Bone metastases were found in 32.7%, 40.6%, 38.5% and 62.5% of patients with breast, prostate, GI and lung cancers, respectively (P = 0.35). The most frequently involved area was the spine, followed by ribs and pelvic bones. Spine was the most frequent site of bone metastases in breast and GI cancers. Except for the spine, common locations of bone metastases from breast cancer were ribs and sternum. In prostate cancer, the most frequent site were spine and pelvis, with similar incidences. In lung cancer, ribs followed by spine were most frequent sites of bone metastases. 97 (60.6%) of the cancer patients studied had symptoms of bone pain. The highest incidence was associated with metastatic lesions in bone scan (P = 0.004). Significant correlation between location of bone pain and evidence of bone metastasis in the same region was noticed in the pelvis (P = 0.001), skull (P = 0.04), sternum (P = 0.01), spine (P = 0.003) and femur (P < 0.001). CONCLUSIONS: Our results indicate that the spine and pelvis in prostate carcinoma and the spine, ribs and sternum in breast carcinoma as well as ribs and spine in lung cancer are most frequently invaded. Bone pain in the skull, sternum, lumbar ver- tebrae, pelvis and proximal portion of femurs are more important to keep in mind for metastatic bone involvement.

Esophageal cancer is the eighth most common type of cancer worldwide. For the treatment of which, surgical intervention alone or with neoadjuvant chemoradiotherapy or chemotherapy is recommended. In this study, we aimed to compare the benefits of neoadjuvant chemoradiotherapy versus postoperative chemoradiotherapy. We collected data regarding 325 patients admitted for esophageal cancer to Qaem Hospital, Mashhad, Iran, during 2006–2016. The participants were divided into two groups of neoadjuvant and postoperative adjuvant therapies. Chi-square, McNemar, Kaplan-Mayer, and multivariate regression tests were performed using SPSS. Gender, age, stage of the disease, tumor grade and location, disease histopathology, and the recurrence showed no significant differences between the two groups (P ˃ 0.05), but there was a significant association between the two types of treatment in terms of postoperative complications (P = 0.03). We followed up 147 patients postoperatively and found no significant differences between the groups (P ˃ 0.05). No conclusion can be drawn on whether there are any advantages in adjuvant chemoradiotherapy over neoadjuvant approaches. Further confirmatory trials, particularly randomized trials, are necessary before any recommendations can be made.

Background: High-grade astrocytomas are among the most common neuroepithelial brain tumors. Because of their highly malignant nature, in most cases, in addition to maximal resection, they also require adjuvant treatments, such as chemotherapy and radiotherapy. A common accompanying condition, which may occur with this type of clinical presentation, is cognitive disorders. These can be caused by the tumor itself, the treatment used or may be patient related. The aim of this study was to evaluate the level of cognitive ability in patients with astrocytoma compared to the normal population and evaluating the factors possibly affecting them. Methods: A case-control study was performed on 30 adults referred to Imam Reza and Omid hospitals, Mashhad, Iran, during year 2014. The studied patients had astrocytomas, for which they had performed surgery. All patients had also received radiotherapy. The control group consisted of 30 healthy individuals, among the patients’ family members, who were matched for age and gender with the patients. The tools used in this study were a checklist for demographic data, and the Farsi version of Addenbrook’s cognitive questionnaire. Data were entered in the SPSS 22 software and analyzed using the Student’s t test and Mann-Whitney test. P values of ≤ 0.05 were considered significant. Results: Normal cognitive disorders were seen in 33.3% and 80% of the patient and control groups, respectively. Mild cognitive disability was observed in 10% of both groups; and Alzheimer’s was observed in 56.7% and 10% of the patient and control groups, respectively. A statistically significant difference was found between cognitive function, age, and gender (P = 0.0001 in both). No meaningful difference, however, was observed between cognitive score and tumor location, chemotherapy, and the time, from which treatment had ended. Conclusion: With the high prevalence of cognitive disorders among patients with astrocytoma, one can conclude that the tumor itself and the surrounding factors affect the cognitive function of the patient. Results of this study showed that the type of treatment and some properties of the tumor, such as the tumor’s location, do not affect the patient’s cognitive capacity.

Background: Astrocytomas are the most common primary adult brain tumors. Objectives: In this study, we investigated the impact of some potential prognostic factors on survival in patients with low and high grade astrocytomas. Patients and Methods: This retrospective cohort study was performed on patients with brain astrocytoma who were referred to oncology departments, Omid and Ghaem hospitals, Mashhad University of Medical Sciences (2000 - 2011). Results: 415 patients with a median age of 43 and a male to female ratio of 252:163 (1.54) were recorded. Grade I to IV astrocytoma were found in 40 (9.6%), 88 (21.2%), 71 (17.1%) and 216 (52%) patients. With a median follow up time of 37 months for low grade and 13 months for high grade astrocytoma, the 5-year survival in grades I to IV was 92.1%, 69.1%, 49.2% and 9.6% respectively. In low grade astrocytomas, patients with grade I tumors, being ambulatory (5-year survival: 88% vs. 60.3%, P < 0.001) and performing optimal surgery (5-year survival 86% vs. 59.3%, P < 0.001) were associated with more favorable survival. In high grade astrocytomas, patients with grade III tumors, age < 50 (5-year survival 29.6% vs. 14.6%, P < 0.001), being ambulatory (5-year survival 39.4% vs. 10.5, P < 0.001), performing optimal surgery (5-year survival 46.1% vs. 4.3%, P < 0.001) and receiving chemotherapy (5-year survival 23.7% vs. 18.7%, P = 0.02) were associated with significantly higher overall survival. Conclusions: Performing optimal surgery and good performance status were associated with more favorable survival in both low and high grade astrocytomas. In high grade a strocytomas, patients younger than 43 and those who received chemotherapy had better overall survival.

Introduction: In oral cavity, the tongue is the most common site prone to development of squamous cell carcinoma (SCC). Considering malignant transformation as a cellular stress, the expression of heat shock proteins (HSPs) may be affected in this process. In this study we assessed the expression of HSP105 and HSP27 as two of the most interested stress proteins and investigated their relationship with grade and stage of the tongue SCC. Material and Methods: Fifty-six specimens including 31 early and 25 advanced tongue SCC were gathered. All specimens were graded histologically from I to III. Sixteen sections of normal oral mucosa were used as control group. The cellularity and intensity of HSP105 and HSP27 expression were studied immunohistochemically in both case and control groups. Results were expressed by histochemical score (HSCORE). Results: Significant differences were observed between expression of HSPs and stage of the disease. From early to advanced stage, the expression of HSP105 and HSP27 increased and decreased, respectively. There was no relationship between histological grade of lesion and HSCORE of HSP105 expression (P=0.5), although, HSP27 expression had reverse relationship with the SCC histological grade. Conclusion: HSP27 and HSP105 may be indicated for prognostic purposes in evaluation of tongue SCC. HSP 27 may be used for more accurate microscopic grading of tongue SCC. Increased expression of HSP105 in advanced stage may lead to using this protein for immunotherapy of tongue SCC. © Medicina Oral S. L.

Background: Pretreatment anxiety is one of the most common problems in patients undergoing radiotherapy, especially for the first time. There are limited and contradictory studies on the effect of multimedia as compared with common education methods. This study was intended to evaluate the effect of pretreatment multimedia on patient anxiety in the head and neck cancer radiotherapy setting. Methods: In a randomized clinical trial, 66 patients who resided in eastern Iran were recruited from three cancer treatment centers. The experimental group (n = 33) received a 20-minute multimedia presentation, while its print version of the same content was applied in the control group (n = 33). The study measure was evaluated by the Spielberger State-Trait Anxiety Inventory (STAI), which was answered by the participants at baseline after the visit by a cancer specialist deciding on radiotherapy and 2 weeks later prior to the starting of the treatment. Results: The findings indicated that statistically significant differences were observed in anxiety scores between the groups with multimedia as compared to the control (p = 0.009). Pamphlet-associated education led to a notably larger mean difference in anxiety score between the baseline score and two-week posttreatment score in the controls than multimedia version in the experimental group (p

Background: Pathological diagnosis of the brain tumors is very challenging. The current study aimed at evaluating the discordance between imaging data and pathologic diagnosis of patients with brain tumors. Methods: The current descriptive study retrospectively assessed the medical documents of patients referred to neuro-oncology clinics of Omid and Emam Reza hospitals affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from 2009 to 2010. The accordance of pathologic reports with imaging findings was studied and the smears were also reviewed in case of discordance. Result: Imaging/pathologic discordances were found in 11 out of 240 (4.5%) patients, which in 82% of the patients was associated with diagnosis change. Discussion: The current study showed that imaging/pathologic discordances existed and were accompanied by changes in management. Treatment approach and prognosis of patients with brain tumors substantially varies among the different subtypes and grades. Considering the limited sources in the developing countries such as Iran, reviewing the pathological findings of all patients is not practical. Therefore, it is suggested that 3 main diagnostic fields involved in the treatment of brain tumors (ie, neuro-oncology, neurosurgery, and pathology) should be familiar with all corresponding issues.

Introduction:: Pituitary adenomas have been the most common sellaturcica tumors. There have been many unusual types of pituitary tumors that might neglect by radiologists and clinicians. One of these tumors would be the malignant glioma. Case Presentation:: A 62-year-old male has complained from sudden frontal headache, nausea, vomiting, decreased vision, blurred vision and double vision. In skull radiographic, there was an expansion of sellaturcica and a lesion with clear border on T1; heterogeneous; iso - to hypotense; size about 3/5 × 2/5 cm with no surrounding edema that it has homogeneously attracted contrast Lesion, that shown a signal hypointensity on T2 with heterogeneous enhancement. In the coronal sections, the tumor expanded to the suprasellar region and optic chiasmatic that has compressed especially on the left side. Partial tumor resection has conducted. The surgery has done by a transsphenoidal approach. The pathologist has diagnosed a glioblastoma. This diagnosis has confirmed using immunohistochemistry technique. Conclusions:: There have been many unusual types of pituitary tumors that might neglect by radiologists and clinicians. One of these tumors would be the malignant glioma.

Characterizing a working-team concept in the practice of neuro-oncology requires continued interdisciplinary efforts. The Neuro-Oncology Scientific Club (NOSC) initiative is an interdisciplinary clinical forum which has been operational in Iran since 2011 attempting towards a connect-approach in the management of CNS malignancies. NOSC comprises nation-wide group of experts and pursues its mission through interval strategic meetings, tumor-boards, case-discussions as well as publishing neuro-oncology updates and newsletters. The most recent NOSC clinical forum in Mashhad (February 2016), put together insights from international practice guidelines, emerging evidence and expert opinions to draw a locally-adapted clinical pathway for glioma management in adults. As such, the expert panel concurred that following the clinical suspicion, conventional/functional neuroimaging are taken after which stereotactic biopsy would be taken to ensure pathological diagnosis. The specimen is then assessed for molecular markers. Patients will initially undergo baseline neuropsychological assessments and further brain-mapping measures for surgical planning. Stereotactic radiosurgery or safe maximal resection will be done for which the latter includes intraoperative recording through electrocorticography or somatosensory evoked-potentials where applicable. Post-operatively, the newly-diagnosed high-grade glioma (HGG) patients would undergo Stupp’s protocol of chemo-radiation and adjuvant chemotherapy with temozolomide (TMZ). Seizure control and optimized steroid use are to be considered. In recurrent HGG patients, those with the recursive partitioning analysis class V (RPA-V) would receive best supportive care, whereas patients with RPA class III/IV would either receive targeted/re-challenge therapy (anti-VEGF, TMZ re-challenge/metronomic dosing, radiosurgery, re-irradiation or TMZ+anti-VEGF) or enter the investigational setups including immunotherapy (PD-1 or IL4 receptor antagonists). In low-grade glioma (LGG) patients, watchful waiting may be recommended only in asymptomatic patients or those with minimal symptoms, while other patients require a planned treatment. Predictive and prognostic variables including 1p19q co-deletion, IDH-1 mutation and MGMT-methylation in anaplastic oligoastrocytoma or anaplastic oligodendroglioma patients would possibly help defining their preferred treatment plan including chemotherapy. On the other hand, as per the CATNON trial, TMZ can be considered for non-co-deleted anaplastic glioma patients.

Background For patients with lung metastases from soft-tissue sarcoma, pulmonary metastasectomy is considered to be the only chance of possible cure. In this survey, we analyzed some potential prognostic factors affecting the outcome in these patients. Patients and methods 34 patients who underwent pulmonary metastasectomy for soft-tissue sarcoma from April 1996 to April 2007, were enrolled in our study. The median follow-up period was 26 months. Survival curves, factors affecting the outcome, and treatment success rate were evaluated. Results Complete resection was achieved in 88.2% of patients. There was no perioperative mortality. The median overall survival and median disease-free survival were 42 and 27 months, respectively. Incomplete resection and bilateral lung metastases had significant adverse effects on overall survival. Shorter disease-free interval (Conclusion Complete resection is the most important defining factor of success rate and survival. Patients with bilateral lung metastases or a shorter disease-free interval have significantly lower success rates. Repeat metastasectomy is curative in many patients.

Background: Meningioma constitutes 20% of the intracranial neoplasms. Followed by surgery as the primary treatment for most patients, radiotherapy becomes indicated in high-grade tumors with incomplete surgical removal. We evaluated the prognostic factors and overall outcome in meningioma patients who underwent radiotherapy. Materials and Methods: In this retrospective analysis, data from all patients with documented diagnosis of meningioma who referred to the Omid and Ghaem Oncology Centers (Mashhad, Iran) from 2002 to 2013 were included. We calculated the overall survival rates using the Kaplan–Meier method and compared the survival curves between groups by the log-rank test. Results: Eighty-three patients with a median age of 50 years (ranging: 16–84) were included. Grade I, II, and III meningiomas were seen in 40 (48%), 31 (37%), and 12 (15%) patients, respectively. Radiation therapy was indicated due to tumor recurrence, incomplete excision, or tumor grade in 32, 8, and 43 patients, respectively. Tumor grade had a significant effect on the overall survival with a 3-year overall survival of 76.7%, 43.5%, and 13.3% in Grade I, II, and III, respectively (P < 0.001). Gender, age, and tumor location were not correlated with the overall survival. Moreover, patients with Grade II and III who underwent total resection had a significantly higher overall survival than those with subtotal resection or biopsy alone (5-year survival rates of 82% vs. 17.1%, respectively; P = 0.008). Conclusion: Tumor grade was the most important prognostic factor in meningioma patients undergoing radiation therapy. In patients with Grade II and III tumors, the extent of surgical resection is significantly correlated with the overall survival.

Ameloblastic fibrosarcoma (AFS) or ameloblastic sarcoma is an extremely rare odontogenic neoplasm. The authors report AFS in the maxillary sinus of a 4-month-old boy. The tumor was composed of odontogenic epithelium, resembling that of ameloblastoma, and a mesenchymal part exhibiting features of fibrosarcoma. We also found some areas with deposition of dentinoid material closely adjacent to the ameloblastic epithelium. Although AFS has occurred in a wide age range, this is the first report of this tumor in infancy with long-term follow-up.

Background Prostate cancer is the leading cause of cancer and the second cause of cancer-related death in men after lung cancer in the world. Differentiation of prostate adenocarcinoma from benign prostate lesions and hyperplasia sometimes cannot be done on the basis of morphological findings. As there is no basal cell layer in prostate adenocarcinoma, basal cell markers could help to differentiate prostate adenocarcioma from cancer mimickers. Methods We studied 98 prostate biopsies (40 adenocarcinoma and 58 benign lesions) for expression of basal cell markers. Findings P63 and 34βE12 were negative in all prostate adenocarcinoma specimens, but all benign prostate hyperplasia and high grade intraepithelial neoplasia cases expressed them. Interpretation Basal cell markers can help to distinguish prostate adenocarcioma from cancer mimickers.

Introduction Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in patients with locally advanced esophageal carcinoma. Method and material Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy (40 Gy/20 fractions) and chemotherapy (cisplatin 20 mg/m2 for 4 days plus 5-FU 700 mg/m2 24-hour infusion for 4 days on the first and the last week of radiation therapy). In patients with unsuitable hematological or general condition only one cycle of chemotherapy was prescribed. The patients underwent esophagectomy 3 to 4 weeks following radiation therapy. Pathologic response, overall survival rate, toxicity and feasibility were evaluated. Results 197 patients with a median age of 59 (range; 27-70) with a female to male ratio of 100/97 entered the protocol. 194 cases (98.5%) had esophageal SCC. Grades 3-4 of toxicity were as follows: neutropenia in 41 (21%) and esophagitis in 5 (2.5%) cases. There were 11 (5.6%) early death probably due to treatment related toxicities. The other reasons for not completing the protocol were as follows: toxicity in 6 (3%), refusing surgery in 35 (17.8%), improper general condition for surgery in 18 cases (9.1%). 127 cases (64.5%) completed the protocol among which 60 cases received 2 courses of chemotherapy. For patients who underwent surgery, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 47.2 % and median overall survival of 33 months. There were no significant difference in overall survival rates in patients receiving one or two cycles of chemotherapy (log-rank p = 0.64). Conclusion The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the toxicity rates were relatively high. prescribing two cycles of chemotherapy resulted in no significant improvement in survival rate as compared with those receiving one cycle. Disclosure All authors have declared no conflicts of interest.