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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.

Purpose In order to keep the acceptable level of the radiation oncology linear accelerators, it is necessary to apply a reliable quality assurance (QA) program. Materials and methods The QA protocols, published by authoritative organizations, such as the American Association of Physicists in Medicine (AAPM), determine the quality control (QC) tests which should be performed on the medical linear accelerators and the threshold levels for each test. The purpose of this study is to increase the accuracy and precision of the selected QC tests in order to increase the quality of treatment and also increase the speed of the tests to convince the crowded centers to start a reliable QA program. A new method has been developed for two of the QC tests; optical distance indicator (ODI) QC test as a daily test and gantry angle QC test as a monthly test. This method uses an image processing approach utilizing the snapshots taken by the CCD camera to measure the source to surface distance (SSD) and gantry angle. Results The new method of ODI QC test has an accuracy of 99.95% with a standard deviation of 0.061 cm and the new method for gantry angle QC has a precision of 0.43°. The automated proposed method which is used for both ODI and gantry angle QC tests, contains highly accurate and precise results which are objective and the human-caused errors have no effect on the results. Conclusion The results show that they are in the acceptable range for both of the QC tests, according to AAPM task group 142.

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.

Esophageal squamous cell carcinoma (ESCC) accounts for 80% of all esophageal cancers worldwide. It is the most common histological type of esophageal carcinoma in low-resource countries. ESCC is prevalent in Asian countries, accounting for more than 95% of esophageal cancers. The epidermal growth factor receptor (EGFR) is involved in cancer development, as its gene is often mutated and/or amplified in cancer cells. According to recent statistics, esophageal cancer is the eighth most common cancer in Iran.In this retrospective study, we assessed EGFR overexpression, using immunohistochemistry (IHC) in 68 patients with ESCC, undergoing neoadjuvant chemoradiotherapy and esophagectomy in 2011-2014. The treatment protocol included external beam radiotherapy (40 Gy), concomitant with cisplatin 20mg/m2 and 5- fluorouracil (5-FU) 1000 mg/m2 for 4 consecutive days during the first and fourth weeks of treatment. To compare the two groups (EGFR positive and negative) in terms of complete pathologic response, Chi-square test was performed using SPSS version 16.The median age of the patients was 59 years (range: 27-70 years), with a female-to-male ratio of 1.06. Overall, 70% of the subjects showed EGFR overexpression. Complete pathologic response to neoadjuvant treatment was significantly higher in EGFR-positive patients (40% vs. 15.8%, P = 0.05). In all cases, 1- and 3-year overall survival rates were 86.6% ± 4.1 and 48% ± 6.9, respectively. The 1- and 3-year disease free survival rates were calculated as 71.8% ± 5.4 and 44.3% ± 6.5, respectively. The overall survival rate was relatively higher in cases with EGFR overexpression, although the difference was not statistically significant (5-year survival rate: 47.9 ± 8.2 vs. 30.9 ± 13, P = 0.23).EGFR overexpression was reported in the majority of patients with ESCC in northeastern Iran. Moreover, EGFR overexpression was significantly associated with complete pathologic response.

Aims: In central nervous system (CNS) tumors, surgery combined with radiotherapy may cure many tumors. The basic technique in conventional radiotherapy is craniospinal radiotherapy; in this technique, spinal cord can be treated with electron or photon beams. This study was aimed to compare two radiotherapy techniques in craniospinal radiotherapy, (a) treatment of spine with a single photon beam and (b) with a combination of photon and electron beams. Materials and Methods: The two techniques were planned. In the first technique, both brain and spine were irradiated with 6 MV photon beams. In the second technique, brain was irradiated with 6 MV photon and spine with 18 MeV electron beams. To compensate the dose deficiency in lumbar area, an anterior field of 15 MV photon beam was also applied in the second technique. The dose to target volume and organ at risks (OARs) were measured by thermoluminescent dosimeter and compared with the corresponding values calculated by Isogray treatment planning system. Results: OARs including heart, mandible, thyroid, and lungs received lower dose from technique 2 compared with technique 1; kidneys were exceptions which received higher dose in the technique 2. Conclusions: The dose to thyroid, mandible, heart, and lungs were lower in technique 2, while kidneys received higher dose in technique 2. This was caused by using the anterior 15 MV photon beam. Based on these results, for children, instead of photon beam for treatment of spinal cord, it is wiser to use electron beam.

Objective(s): Prostate cancer is the world's leading cause of cancer and the second cause of cancer-related death in men after lung cancer. Differentiation of prostate adenocarcinoma from benign prostate lesions and hyperplasia sometimes cannot be done on the basis of morphologic findings. Considering the fact that in the prostate adenocarcinoma there is no basal cell layer, basal cell markers can help to differentiate prostate adenocarcinoma from cancer mimickers. Materials and Methods: We studied 98 prostate biopsy blocks (40 adenocarcinoma and 58 benign lesions) for basal cell marker expression. Results: p63 and 34βE12 were negative in all prostate adenocarcinoma specimens, but all benign prostate hyperplasia and high grade intraepithelial neoplasia cases expressed them. Conclusion: Basal cell markers can help to distinguish prostate adenocarcinoma from cancer mimickers.

BACKGROUND: Glioblastoma multiform (GBM, World Health Organization grade IV) is the most common and aggressive primary brain tumor.Immunotherapy is a promising therapeutic adjuvant in fighting against this cancer. Cancer/testis antigens (CTAs) are a group of tumor-associated antigens that are typically restricted to adult testis, but they are aberrantly expressed in several types of cancers, especially in advanced cancers with stem-like characteristics. These tumor-associated antigens are immunogenic in different cancers. Finding of frequently expressed CTAs in GBM can provide effective immunotherapeutic targets to use in translational researches on this cancer. The aim of this study was conduct an extensive expression analysis of ADAM29, HORMAD1, FTHL17 in GBM to determine whether these antigens can be appropriate target in immunotherapy of GBM. MATERIAL AND METHODS: Fifty pathologically confirmed GBM paraffin embedded tissue sample were conducted into this experiment. Total RNA was extracted from these samples and TaqMan based RealTime PCR technology was used to evaluation of HORMAD, ADAM29 and FTHL17 gene expression RESULTS: according to our results HORMAD1 is the most frequent expressed gene in these tissue samples. Forty-four percent of samples (22 out of 50 samples) expressed HORMAD1 in various levels. Either FTHL17 and ADAM29 were expressed in only one of samples.On the other hand, according to statistical studies of patients’ demographic findings and the expression of genes, HORMAD1 has had a much higher level of expression in glioblastoma samples than other genes, which, based on these results, we can consider this gene as a therapeutic target in immunotherapy. CONCLUSION: CT46/HORMAD1 is a single-copy gene on chromosome 1q21.3, A review of carcinoma showed that 31% of carcinomas express this antigen in high numbers. In 2006, the gene had a high expression in gastric cance. so far no precise and thorough study has been done on the existence (expression) of these gene in glioblastma samples,HORMAD1 can be a promising target in immunotherapy research targeting GBM.

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 Various infectious agents like Ebstein Barr Virus (EBV), HTLV-1 and Helicobacter pylori have known as etiologic factors in different sub-types of lymphoma. Although Hepatitis C virus (HCV) has not only been important for its hepatotropism and hepatitis development, but also in recent years its association with some forms of non- Hodgkin’s lymphoma (NHL), especially B cell NHL, has reported.In some countries, the rate of B cell NHL development in HCV infected patients was four times more than general population, and then association between HCV infection and B-NHL has proposed in many studies. Methods To assess this relationship in our geographic region, in a descriptive study; we have evaluated patients with B-NHL in an oncology center in northeast of Iran for HCV infection. Results Out of 128 B-NHL patients, HCV Antibody test (with third generation ELISA method) was positive in only one patient, which confirmed with Nested PCR technique. Then the frequency of HCV infection in our patients was 0.7%. Conclusion Respecting to the incidence of HCV infection in general population in Iran, which is between 0.5-1%, we couldn’t show higher prevalence of HCV infection in NHL patients than general population, and hence couldn’t confirm relation between HCV infection and B-NHL in our region.

Background Central Nervous System (CNS) tumors have accounted for approximately one fourth of all pediatric malignancies. CNS tumors have been the most common solid malignancies among the children. In this study, we have evaluated survival and prognostic factors in children with non-brain stem astrocytoma. Methods Children with non-brain stem astrocytoma, referring to radiation oncology centers of Ghaem and Omid hospitals of Mashhad, have included in this retrospective study, in years 2000-2010. Patients’ demographic data, past medical history, clinical symptoms, extent of tumor resection and treatment modality have recorded. Disease-free survival and overall survival have measured using Kaplan-Meier method. Results We studied 87 patients with male to female ratio of 44/43 (1.02), and median age of 10 yrs (range: 2-15 yrs). Tumor grade distribution was as follows: grade I: 20 (23%) subjects; grade II: 34 (39.1%) subjects; grade III: 20 (23%) subjects; and grade IV: 13 (14.9%) subjects. The median follow-up duration was 38 months (6 to 110), and 16 months (4 to 100) for patients with low- and high-grade tumors. The 2-year survival rates in grades I-IV were 100%, 84.7%, 60% and 10.8%, respectively. Tumor resection less than gross total and non-ambulation have associated with a significantly inferior survival in both groups multivariate analysis, with high- and low-grade tumors. Conclusion For all the cases of the pediatric non-brainstem astrocytoma, tumor grade had dramatic influences on their survival. Performing gross total resection was crucial for achieving favorable outcomes in both low-grade and high-grade cases. Moreover, according to the results, having major motor deficits has associated with lower survival.

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.

WNT/B-CATENIN signaling pathway is one of the key dysregulated pathways in different tumor types, which regulate the expression of several genes involved in cell proliferation, differentiation, and survival. This pathway is being modulated by sex-determining region Y-box (SOX) family genes. The functions of these genes are suggested as tumor suppressor or oncogene. SOX genes transcribe a group of transcription factors that play important roles in embryonic development and carcinogenesis. Among them, SOX15 is recently been identified as a novel tumor suppressor in pancreatic and esophagus cancers with a potential role in modulating Wnt/b-catenin signaling. This report summarizes the current knowledge about Wnt/b-catenin signaling pathway and its cross talk with SOX15 with particular emphasis on the value of SOX gene expression as prognostic or predictive biomarker in cancer.

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.

Background Anorectal melanoma is one of the rare but significant malignancies of the anorectal area. This malignancy currently accounts for 1% of all types of melanoma and less than 1% of all the anorectal area malignancies. Very rare cases of this disease have been reported worldwide.Anorectal melanoma is mostly diagnosed while treating other benign conditions of this area such as hemorrhoids with conventional modalities. Its treatment of choice has always been a controversial issue. Methods In this study, clinical pathology and outcome of 7 cases with anorectal melanoma referred to Omid Oncology Teaching Hospital during 2001-2011 were assessed. Results Out of seven cases, 2 patients had been diagnosed with hemorrhoids and undergone surgery and 2 other cases had been referred with the primary diagnosis of lymphoma. Initially, only in 3 cases melanoma was diagnosed in clinicopathology setting. Three cases of patients had distant metastases to the liver, lungs, omentum and mesentery, while the other 4 patients had advanced local disease. No patient had been diagnosed in the primary stages of the disease. The mean time duration between symptoms onset to diagnosis of disease had been 8 months. The median survival time was 5 months. Conclusion Rare anorectal melanoma and its similar manifestations to other common anorectal conditions can delay the diagnosis, therefore should be considered as an uncommon differential diagnosis. The disease's outcome is poor and most probably delay in the diagnosis has an important role in the treatment results.

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: Malignant melanoma (MM) usually present with metastases to unexpected regions of the body. Metastatic MM is a highly lethal condition, and the median survival in this setting is 6 to 7.5 months; however, few reports rarely describe long-term after chemotherapy.Case Report: We describe a 31-year-old man with MM, which got metastatic (to paranasal sinuses) after local and systemic therapy showed complete responses with long-term survival after endonasal endoscopic metastasectomy and radiotherapy of the nasal cavity, paranasal sinuses, and base of the skull.Conclusion: Although long-term survival is rare, few reports describe cases after chemotherapy. MM could be associated with metastasis to any regions and clinicians should be aware of its behavior and perform complete investigation in the presence of any suspicious symptoms, and this should be reinforced periodically. However, the survival is poor in the metastatic setting, and the treatment of choice is debatable, some patients may benefit from metastasectomy and local radiotherapy. [GMJ.2018;7:e860]

BACKGROUND: Astrocytoma is the most common primary tumor of CNS. Genetic alternations in glioma have increasing importance for classification puroposes. One of these genetic pathways is IDH1 mutation which has potential roles in diagnosis, prognosis and response to treatments. Our aim was to investigate IDH1 R132H and IDH1 R132S mutations by immunohistochemistry in brain astrocytomas. MATERIAL AND METHODS: IDH1 R132H and IDH1 R132S mutations were assessed by immunohistochemistry in 80 glioma patients from different histologic grades(20 patients from each grade),which are diagnosed in Ghaem and musa ibn jafar hospitals in mashhad,between 1388 and 1395.Then the results were compared with different factors such as,sex,gender and pattern of immunopositivity(negative,focal and diffuse).data results were analyzed by SPSS statistics. RESULTS: In our study the mean age was 16.9 years old in grade I,40 years in grade II,33.3 years in grade III and 54.5 years in grade IV,which correlation is most likely to be statistically significant.(P value0.05). CONCLUSION: The prevalence of IDH1 mutation is increased from grade II to grade IV,which may indicate that high grade gliomas are arising from low grade tumors, and also shows that pilocytic astrocytoma (grade I) has a different genetic pathway. Using immunohistochemistry is an easy and fast way to identify the IDH1 mutation, it could be use as first line for diagnosis the mutation, although it requires to confirm for its sensitivity and specificity in feature investigations in iran.also further studies is needed to evaluate the prognostic role of IDH1 mutation in Iranian people.According to the importance of IDH1 mutation in survival of the patients,we suggest that pathologists, clinicians and oncologists in our country should include this mutation for their diagnostic and therapeutic planes.

Background: Intracranial lesions of the pituitary gland are common pituitary adenomas, accounting for 6-10% of all symptomatic intracranial tumors. In this retrospective study, the clinicopathologic features and survival rate of pituitary adenomas were evaluated. Methods: The present retrospective study was conducted on 83 patients with pituitary adenomas, referring to radiation oncology departments of Ghaem and Omid Hospitals, Mashhad, Iran, over a period of 13 years (1999-2012). Data obtained from clinical records including clinical features, type of surgery (if performed), treatment modality, overall survival rate, and progression-free survival rate were analyzed. Results: Eighty-three patients including 44 males (53%) and 39 females (47%) participated in this study. The median age was 40 years (age range: 10-69 years). Chiasm compression was reported in 62 patients (74.4%), and 45.78% of the subjects suffered from headaches. Functional and non-functional adenomas were reported in 44 (53.01%) and 39 (46.99%) patients, respectively. In cases with functional and non-functional adenomas, the disease was controlled in 95 and 84.5% of the subjects for 3 years, respectively. Furthermore, 1- and 3-year survival rates for functional adenoma were 84.6 and 23%, respectively; the corresponding values were 90.9 and 22.7% in non-functional adenomas, respectively. Conclusion: In this study, a significant correlation between headache severity and type of adenoma was observed. So, application of surgery and radiotherapy together could be a highly effective approach for treating functional adenomas, although it is less efficient for the non-functional type.

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.

This aim of this study was to compare the doses received by critical cranial organs when three different radiation techniques were used to treat pituitary tumours. Cranial computed tomography scans of a RANDO phantom and 30 patients were used for pituitary macroadenoma radiotherapy treatment planning. For each slice, target volumes and other critical organs were contoured and three techniques were applied: (A) two parallel-opposed lateral fields, (B) two oblique fields (45°) in coronal plane and (C) two parallel-opposed lateral and anterior fields while the head was tilted 45° in the sagittal plane. The doses received by the target volume and the critical organs for each technique were calculated for all patients. Irradiation was repeated three times for each technique. Finally, the doses that reached the organs of interest resulting from these techniques were compared. The dose delivered to the temporal lobes was 105, 9 and 72 % of the prescribed dose using techniques A, B and C, respectively. The dose received by the cochlea was the lowest in technique C (27 % of prescribed dose) compared with techniques A (79 %) and B (48 %). All techniques delivered 100 % of the prescribed dose to the chiasma. Technique A increased the dose to temporal lobes and the cochlea to such an extent that they exceeded the tolerance dose. Technique B spared the temporal lobes better than technique C; however, technique C was preferred since the dose received by the cochlea in this case was the lowest of all techniques. None of the techniques spared the chiasma.

Minimal residual cancer cells may not be detected in surgical margins of oral squamous cell carcinoma (OSCC) with routine histological examination. Using molecular markers at surgical margins can be helpful. We attempted to evaluate the MMP-9 and E-cadherin expression in OSCC samples and tumor-free surgical margins and association with clinicopathological factors. We examined E-cadherin and MMP-9 expression in 58 OSCCs including 19 grade I, 21 grade II and 18 grade III with histological tumor-free surgical margins by immunohistochemistry. Specimens were also divided in two groups: 19 samples as an early and 39 as an advanced stage. For E-cadherin in OSCCs and surgical margins, significant difference was observed between poor and moderate tumor differentiation. Different stages of OSCC demonstrated significant differences with higher expression in early stage tumors. For surgical margins, 82.1% of advanced and 84.2% of early stage samples demonstrated immunoreactivity. Both OSCC samples and surgical margins demonstrated significant differences for MMP-9 between stages with higher immunoreactivity in advanced stage, whereas there were not differences between different grades in surgical margins. E-cadherin and MMP-9 expression at histologically negative surgical margins shows the significance of these markers for prognostic values in OSCC patients with E-cadherin being the preferred predictor.

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 Chemotherapy-induced amenorrhea is one of long term side effects of adjuvant chemotherapy in patients with breast cancer which may interfere with their future reproductive function. Although amenorrhea is well recognized, the actual incidence following taxanes remains uncertain. Methods In a cross sectional study, we identified breast cancer patients aged 45 years or younger who were treated with adjuvant anthracycline and taxane-based regimens at three different oncology departments from 2001-2008. Results One hundred and nineteen patients met all eligibility criteria and consented to participate in a regular follow up program. The median age at diagnosis was 33.5 years (range, 25-41). Seventy (58%) patients developed amenorrhea for at least 12 months following completion of treatment, and regular menses were maintained in another 49 (42%) patients. No statistically significant association was found between age and development of amenorrhea, although those who experienced cessation of menses were older. Conclusion Although taxane containing chemotherapy was associated with higher rate of amenorrhea compared to FAC, this was not statistically significant (P=0.11). Also, treatment with tamoxifen and Estrogen Receptor (ER) positive status was significantly correlated with chemotherapy induced amenorrhea.

Background The beginning of metastasis poorly affects the prognosis of breastcancer patients. Lung is the most frequent site of visceral metastasis, and the rate of recurrence is 10-30%. We have tried to find out if the routine Chest X Ray (CXR) could play a role for early detection of lung metastasis, during the prognosis of these patients. Methods The files of the breast cancer patients between 1996 to 2006 (1739 patients) have reviewed. Clinical characteristics of patients with pulmonary metastasis have recorded. Patients, who lacked imaging files or lacked an appropriate follow-up, have excluded. Data have analyzed by SPSS 11.5. The survival analyses have performed by using the Kaplan-Meier method. Results Fifty-six patients, median age 46, have entered into this retrospective study. Median tumor size was 4cm; median number of Lymphadenopathy (LAP) was 4. The intermediate grade has detected in 74% of patients. All patients have received adjuvant treatment. Median time from cancer diagnosis to pulmonary metastasis was 22 months. Pulmonary metastasis has detected by control CXR in77.4% and patients' symptoms in 22.6%. Forty eight patients have received chemotherapy in metastatic phase. In 28 patients (50%), other sites of metastasis (bone, liver, and brain) have discovered.The most frequent pattern of lung recurrence was pulmonary nodule (44.6%), followed by pleural effusion (28.6%). Median survival was 27.5; median survival from pulmonary metastasis was 8 m. Conclusion Early detection of pulmonary metastasis by CXR did not affect patients' endpoints. None of the probable prognostic factors have shown a significant effect on patients' outcome. Despite systemic treatment, survival after metastasis is low.

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.