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To provide a step-by-step approach to chemotherapy (CTx) in the novel coronavirus disease 2019 (COVID-19) era. The COVID-19 pandemic is the current global issue resulting in vast health implications. Amid the COVID-19 era, special attention must be paid to at-risk groups, including patients with cancer. To our knowledge, there is a paucity of data on the decision for CTx during the pandemic. We herein provide practical recommendations on the CTx of cancer patients over the pandemic based on our experience in an educational hospital. The decision on CTx should be considered to be individualized based on clinical findings. We hope that our experience provides a practical guide for clinical oncologists to deliver more effective cancer care over the COVID-19 pandemic.

Purpose Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. Methods In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. Results We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. Conclusion Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.

On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.

Aim:The aim of this study was to evaluate clinical efficacy and radiobiological outcome of intensity-modulated radiation therapy (IMRT) modalities using various collimator angles and non-coplanar fields for nasopharyngeal cancer (NPC).Materials and methods:A 70-Gy planning target volume dose was administered for 30 NPC patients referred for IMRT. Standard IMRT plans were constructed based on the target and organs at risk (OARs) volume; and dose constraints recommended by Radiation Therapy Oncology Group (RTOG). Using various collimator angles and non-coplanar fields, 11 different additional IMRT protocols were investigated. Homogeneity indexes (HIs) and conformation numbers (CNs) were calculated. Poisson and relative seriality models were utilised for estimating tumour control probability (TCP) and normal tissue complication probabilities (NTCPs), respectively.Results:Various collimator angles and non-coplanar fields had no significant effect on HI, CN and TCP, while significant effects were noted for some OARs, with a maximum mean dose (Dmax). No significant differences were observed among the calculated NTCPs of all the IMRT protocols. However, the protocol with 10° collimator angle (for five fields out of seven) and 8° couch angle had the lowest NTCP. Furthermore, the standard and some of non-coplanar IMRT protocols led to the reduction in OARs Dmax.Conclusions:Using appropriate standard/non-coplanar IMRT protocols for NPC treatment could potentially reduce the dose to the OARs and the probability of inducing secondary cancer in patients.

Background: Malignancy is a known risk factor of coronavirus disease 2019 (COVID-19) severe involvement. Information about this infection in patients with cancer is limited. Objectives: This study aimed at reporting the clinical and imaging characteristics of COVID-19 infection in patients with cancer. Methods: All the patients were known cases of a solid tumor with COVID-19 infection in one center, between February and May 2020. Clinical presentation and imaging involvement of COVID-19 infection in addition to cancer features were documented from medical records/patient interviews. Results: Thirty-one patients with solid tumors and COVID-19 involvement were included. The most prevalet presentation was fever, cough, and myalgia. Breast and gastrointestinal malignancies were the most common cancer types. The mortality rate was 22.5% and all deceased patients suffered from stage 4 of their underlying cancer disease. Lung computed tomography scan (CT scan) features in these patients were not different from the non-cancer patients with COVID-19. Conclusions: COVID-19 involvement in patients with cancer seems to be more severe with higher mortality rates especially in patients with other comorbidity and in metastatic cases. Treatment modifications during the pandemic era sound to be logical in decreasing the infection rate.

Background and objective: The second most common cancer in men after lung cancer is prostate cancer (PC). Previous studies assessed the association between food items or food groups and the risk of PC, but diet quality indices are unique approaches to study any relations between diet and disease. Our objective was to investigate the effect of healthy eating index (HEI-2010) and Mediterranean-Style Dietary Pattern Score (MSDPS) on PC risk. Methods: In this case-control study, we recruited 97 patients with MS and 205 control subjects . Dietary intake was evaluted using a valid and reliable food frequency questionnaire. The HEI and MSDPS were calculated. Logistic regression was used to evaluate the relationship between HEI and MSDP scores and PC risk after adjusting the confounders. Results: In comparison to controls, cases had lower score on HEI (61 vs. 70.07; P< 0.001), and higher score on MSDP (26.20 vs. 24.49; P= 0.44). After comparing the highest and the lowest tertile of HEI, we observed a significant decreasing trend in the risk of PC (p for trend

Background The outbreak of coronavirus disease 2019 (COVID-19) started in December 2020, and is a global problem now. There are several sets of established data regarding computed tomography (CT) findings in COVID-19 pneumonia with many differential diagnoses. During the early days of the pandemic, there was little data regarding lung CT features of COVID-19 in a cancer patient. In this paper, we described a rare case of simultaneous presentation of COVID-19 with pulmonary metastasis. Case presentation A Persian patient with a history of chondrosarcoma presented to our clinic during the COVID-19 pandemic with a new-onset cough. He had experienced no recurrence during previous follow-up visits. Chest CT scan revealed numerous bilateral small peripheral and perilymphatic pulmonary nodules, unilateral ground-glass patch, and nodular interlobular septal thickening. Biopsy of the pulmonary nodules established pulmonary metastasis of chondrosarcoma origin, and pharyngeal reverse transcription polymerase chain reaction (RT-PCR) was positive for COVID-19. Conclusion Pulmonary metastasis should be considered as a differential diagnosis of COVID-19 features in cancer patients in the pandemic era.

Background: Breast cancer is the most frequent cancer among women. In line with the survival improvement of patients with cancer, the issue of treatment-induced toxicities becomes more important. Objectives: This study aimed at evaluating acute radiation-induced cardiac damage. Methods: Between 2016 and 2019, women with histologically-confirmed early-stage left-sided breast cancer or ductal carcinoma in-situ (DCIS) without prior chemotherapy, who were candidates for adjuvant whole breast radiotherapy, entered the study. The radiation-induced cardiotoxicity was assessed, using a rise in high-sensitivity cardiac troponin I (hscTnI) over the radiotherapy. Likewise, the association between the percentage of heart receiving at least 25Gy (V25Gy) and the rise in hscTnI was evaluated as the secondary endpoint. Results: A total of 22 women were included in this study. Mean ± standard deviation (SD) hscTnI for the whole study population was 12 ± 2 ng/L before and 15 ± 2 ng/L after radiotherapy. The median (interquartile range [IQR]) V25Gy was 8.05% (6.95% - 8.95%). The difference between hscTnI levels before and after radiotherapy was significant (P = 0.001). There was no correlation between V25Gy and the rise in hscTnI (P = 0.18). Conclusions: hscTnI is a sensitive marker to detect early radiation-induced cardiotoxicity. There is no association between V25Gy and the rise in hscTnI over radiotherapy.

Background: To report the surgical outcomes of laparoscopic resection of large adnexal masses (≥10 cm). Methods: In this cross-sectional study, we enrolled 126 patients with large adnexal masses (≥10 cm), managed by laparoscopic surgery during 2013 to 2020. The rates of intraoperative complications, conversion to open surgery and incidence of cancer were assessed.Results: Mean mass size was 15.08±5.03 in all participants without significant difference based on the tumor type (P=.624). Mean age and operation time were higher in the malignant type compared to that of the benign type (PConclusion: Our study showed that large adnexal tumors can be operated by laparoscopic approach, while the most important factor for increased surgical complications and duration was malignancy.

Background: Prostate cancer (pCa) is the most frequently diagnosed visceral cancer among men. The main role of radical prostatectomy and external-beam radiation therapy (EBRT) in the management of patients with localized pCa has been established. Objectives: This study aims at comparing the clinical outcomes of hypofractionated versus conventional EBRT in the definitive management of patients with localized pCa. Methods: From 2013 to 2019, a consecutive series of patients with localized pCa was treated with conventional (74 Gy at 2 Gy fractions) or hypofractionated (70.2 Gy at 2.7 Gy fractions) radiotherapy schedules, using 3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT), respectively. The impact of the fractionation schedule on biochemical or clinical relapse-free survival (bc-RFS) and overall survival (OS) was assessed. Results: The median follow-up was 42 months (range: 8 - 81 months). Among 170 patients, 81 were treated with conventional and 89 with the hypofractionated schedule. The patient characteristics between groups were comparable. The mean bc-RFS of patients in conventional and hypofractionated groups was 34.9 and 35.4 months, respectively (confidence interval (CI) 95%: 34.5 - 35.7, P = 0.25). Accordingly, the mean OS of patients in conventional and hypofractionated groups was 34.6 and 38.6 months, respectively (CI 95%: 37.3 - 38.6, P = 0.04). The sub-analysis showed that the OS benefit of hypofractionated schedule was limited to intermediate- and high-risk groups with a trend toward significance (CI 95%: 0.02 - 1.46, P = 0.054). Conclusions: Hypofractionation had OS benefit over the conventional schedule for definitive radiotherapy of localized pCa. This benefit was limited to patients with intermediate- and high-risk pCa.

Aim To provide recommendations for the management of patients with cancer in the COVID-19 era. Background The current global pandemic of COVID-19 has severely impacted global healthcare systems. Several groups of people are considered high-risk for SARS-CoV-2 infection, including patients with cancer. Therefore, protocols for the better management of these patients during this viral pandemic are necessary. So far, several protocols have been presented regarding the management of patients with cancer during the COVID-19 pandemic. However, none of them points to a developing country with limited logistics and facilities. Methods In this review, we have provided a summary of recommendations on the management of patients with cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. Results We recommend that patients with cancer should be managed in an individualized manner during the COVID-19 pandemic. Conclusions Our recommendation provides a guide for oncology centers of developing countries for better management of cancer.

Background: Breast cancer is the most frequent diagnosed visceral cancer with 13400 new cases annually among Iranian women. Modified radical mastectomy (MRM) was the old standard surgical treatment in patients with breast cancer from 70 years ago and breast-conserving surgery (BCS) with adjuvant radiotherapy was the standard treatment from 30 years ago. Objectives: In this matched historical cohort study, we compared two types of therapy for breast carcinoma: breast-conserving therapy (BCT), and MRM. Methods: Medical records of 6000 patients with breast cancer from the database of Cancer Research Center of Shahid Beheshti University of Medical Sciences were reviewed and 1310 patients who had been treated by BCT (group A) or MRM (group B) were selected based on a time- stratified 1:1 between September 2002 and December 2014 as 10 baseline variables. By log-rank test analysis, their local recurrence (LR), disease free survival (DFS) and overall survival (OS) were evaluated and compared. Results: In groups A and B, the median age at the diagnosis time was 48.11 and 48.64 years old, respectively. Median follow-up time was 71 months since April 2015. 1.68% of patients in group A and 1.07% of patients in group B had local recurrence during the five years of follow up, (P = 0.173). In the group A and B, five years DFS were 87.94% and 80.46%, (P < 0.001) and five years OS were 89.31% and 83.02%, respectively (P = 0.041). Conclusions: The findings of this study showed that 5-year DFS and 5-year OS in BCT group were better than in the MRM group. Longer follow-up time of the patients to compare 10-year DFS and 10-year OS or even 20-year OS between two groups is recommended.

Background: Based on the literature review, the available information regarding late toxicities after intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) is limited to a few countries. Objectives: This study provides an opportunity to evaluate the delayed toxicities among Iranian patients with NPC that underwent IMRT. Methods: Between February 2016 and September 2018, 32 patients were treated with IMRT for NPC at Shohada-e Tajrish Hospital. The majority of them were in the advanced clinical stage and all received platinum-based induction and/or concurrent chemotherapy. Our typical prescription dose was 70.2 Gy to the gross tumor volume (GTV) in 2 Gy per fraction. Uninvolved regional lymph nodes received 59.4 Gy. Considering the minimum follow-up time of 6 months, we aimed mainly at evaluating the rate of delayed toxicities, including xerostomia, hearing loss, and eyeball damages. Toxicities were categorized based on either RTOG/EORTC or LENT/SOMA criteria. Results: The median follow-up time was 12 months (6 - 32 months). The occurrence rates of grade ≥ 2 xerostomia, grade ≥ 2 hearing loss, optic neuropathy, and retinopathy were 28%, 10%, 4%, and 7%, respectively. Based on the dose-volume histogram analysis, averages of mean doses to the parotid glands, submandibular glands, oral cavity, and cochlea were 32.3 Gy, 58.9 Gy, 41.8 Gy, and 44.9 Gy, respectively. Conclusions: Our experience of using IMRT in the treatment of NPC revealed equivalent toxicities (except for hearing loss) in comparison with high-experienced centers.

Background: Cancer-related fatigue (CRF) is experienced by 50% to 90% of cancer patients and can severely affect their quality of life and functional capacity. Several randomized trials have recommended various ways to alleviate the symptoms of CRF with or without recourse to medications. Objective: The aim of this study is to evaluate the effectiveness of processed honey and royal jelly on the symptoms of CRF in cancer patients who are undergoing hormone therapy, chemotherapy, chemo-radiation, or radiotherapy. Methods: Fifty-two participants from the patients who visited the oncology clinic of Shohada-e-Tajrish hospital in Tehran (Iran) between May 2013 and August 2014 were selected and divided into two groups. The study group (26 patients) received processed honey and royal jelly, while the control group received pure honey. Both groups were instructed to consume their 5mL supplement twice daily for 4 weeks. Both groups were assessed at the beginning of the study, after 2 weeks, and then at the end of 4 weeks of treatment. Fatigue was measured using a visual analogue fatigue scale (VAFS) and fatigue severity scale (FSS). The results were compared between the two arms of study, and equality of probability distributions was assessed using a Kolmogorov–Smirnov test. Results: The mean age of the 52 patients was 54.84. After two and four weeks of treatment with processed honey and royal jelly, VAFS and FSS due to treatment was better in the study group than in the control group, and the http://www.ephysician.ir Page 2476 differences were statistically significant (p

Background: Breast cancer is the most frequent diagnosed solid cancer with the incidence rate of 32 patients in 100,000 among Iranian women. Neo-adjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer, which was recently introduced for early stage disease to achieve breast preservation. Objectives: The aim of this study was to evaluate the rate of local recurrence, distant recurrence, breast cancer mortality, five years disease free survival (DFS) and five years overall survival (OS) in patients with breast cancer after NAC and to compare these factors with patients, who received adjuvant chemotherapy. Methods: In this cross sectional study, 188 patients with stage I to III breast cancer, who received NAC (group A), and 376 patients with breast cancer, who received adjuvant chemotherapy (group B), were selected and matched based on a time- stratified 2:1 approach between October 2002 and December 2014. Their clinical-pathological profile and survival study were compared. Results: The mean age of patients was 48.23 years in group A and 48.76 years in group B. The median follow-up time was 52 months. In group A and group B, 13.1% and 7.7% of the patients had local recurrence during the five years of follow up, respectively (P < 0.001). In group A and group B, five years PFS rate and five years OS rate was 66% and 70%, and 81.8% and 82.6%, respectively. According to log-rank test analysis, there was no significant difference between two groups as five years DFS and five years OS (P = 0.058 and P = 0.98, respectively). Conclusions: This study showed that higher frequency of local recurrence in NAC group than adjuvant chemotherapy group was not associated with any significant increase in distant recurrence or breast cancer mortality. Longer follow-up time of the patients to compare survival between two groups is recommended.

Patients with head and neck cancer after radiotherapy often suffer disability such as hearing disorders. In this study, the effect of radiotherapy (RT) on hearing function of patients with head and neck cancer after RT was determined according to the total dose delivered to specific parts of the auditory system. A total of 66 patients treated with primary or postoperative radiation therapy for various cancers in the head and neck region were selected. All patients had audiologic evaluation with pure tone audiometry for the frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz before and immediately after completion of treatment and again 3 months later. The cochlea dose volume histograms of the patients were derived from their computed-tomography-based treatment plans. At study's end, RT-induced auditory complications developed in 33% of patients. The greatest hearing loss (changes15 dB) occurred immediately after RT at frequencies of 3,000 (14.5%), 4,000 (12.9%), 6,000 (13.6%), and 8,000 Hz (10.6%), and after 3 months of follow-up, at 3,000 (6.8%), 4,000 (7.7%), 6,000 (10.7%), and 8,000 Hz (12.1%). Univariate and multivariate analyses indicated a positive relationship between dose delivered to the cochlea and hearing loss (p0.001, r = 0.484). An increased risk of hearing loss was present for patients receiving ≥40 Gy as their mean dose compared with those receiving30 Gy. We conclude that radiation dose has negative effects on the auditory system. This effect occurs more in high-frequency hearing. The received dose to the cochlea was the main cause of damage to hearing.

BACKGROUND: In adults, malignant glioma (high-grade glioma) is one of the most common brain tumors. In spite of different types of treatment, the outcome is still not likely to be favorable. The aim of this study was to determine the difference between survival rate in adult patients with high grade glioma treated by radiotherapy only and those treated by a combination of radiotherapy and nitrosurea-based chemotherapy. METHODS: This study was conducted using the records of 48 patients with grade 3 or 4 of glial brain tumor referred to the radiation-oncology ward of Shohada-e-Tajrish Hospital in Tehran, Iran from 2005 to 2012. The patients had undergone radiotherapy alone or adjuvant chemoradiation with nitrosourea. The median survival of patients after receiving the different types of treatment were evaluated using the Kaplan –Meier method and the log –rank exam. Data were analyzed using univariate analysis for median survival regarding to the patients’ age, gender, extent of surgery, Karnofsky performance status (KPS) with the Kaplan-Meier method, and the log-rank exam. We used the Cox-model for multivariate analysis. RESULTS: Records of 48 patients were studied (34 men and 14 women). The mean survival were 18 months for men and 15.2 months for women (P = 0.05). Around 58% (28 patients) were more than 50 years old, and 42% (20 patients) were less than 50, and mean survival for the two age groups were 13 and 20 months, respectively (P < 0.001). Then, the patients were divided into three groups according to the extent of surgery, i.e., excisional biopsy (11 patients), stereotactic biopsy (22 patients), and resection (15 patients), and the mean survival for the three groups were 14.7, 17.3, and 18.8 months, respectively. There was no significant statistical difference for mean survival between the three groups (P = 0.23). The KPS was greater than 70% in 23 patients and less than 70% in 21 patients, and the mean survival for the former and latter groups were 17.6 and 16 months, respectively (P = 0.67), four patients had unknown KPS. Twenty patients received only radiotherapy, and chemoradiation was done for 28 patients, and the mean survival for the former and latter patients were 14.5 and 19 months, respectively (P = 0.15). CONCLUSION: In this study, we concluded that age was the only effective factor in the survival of the patients and that chemotherapy had no significant effect on the survival of the patients.

Background: Breast cancer is the most frequent diagnosed solid cancer among Iranian females and it comprises 25% of all cancer new cases in women. Breast cancer is uncommon in very young women ( 35 years). However, extensive data from Iran is insufficient. Objectives: The aim of this study was to compare the clinical, pathological profile, and prognostic factors between patients with breast cancer with age ≤ 35 years and > 35 years at our institute. Methods: The medical records of 1,910 patients with breast cancer in the Shahid Beheshti University of Medical Sciences Cancer Research Center database were reviewed between September 2002 and December 2014. A total of 199 patients with breast cancer were identified as very young group (age ≤ 35 years) and 398 patients, as less young group (age > 35 years), were selected and matched based on a time-stratified 2:1 approach. Finally, 597 patients with breast cancer were selected for the study. Results: The 5-year progression free survival (PFS) rate was 66% in very young group and 91% in not very young group that were significantly lower in patients with age ≤ 35 years than patients with age > 35 years. Conclusions: We observed that very young women had worse outcome compared with not very young women. However, longer follow up of these patients is required for more mature data on these cancers.

BackgroundTriple negative breast cancer (TNBC) is characterized by negative result of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) in immunohistochemical (IHC) staining and an interesting topic of research today. Various studies have been reported in western countries on TNBC, all insisted of the poorer prognostic of TNBC than other subtypes of breast cancer. However extensive data from Iran is lacking.ObjectivesThe aim of this study was to analyze the clinical, pathological profile and survival of TNBC patients at our institute.MethodsMedical records of 1910 breast cancer patients in the Shahid Beheshti University of Medical Sciences cancer research center database with data on 180 patients of TNBC patients was collected between September 2002 and December 2014 and reviewed for clinicopathological profile and survival analysis.ResultsThe median age at diagnosis was 48 years. Fourteen patients (7.8 %) had stage I, 88 patients (48.9%) had stage II, 57 (31.7 %) had stage III, 8 (4.4%) patients had stage IV at first diagnosis and 13 patients (7.2%) with unknown stage. The median follow-up time was 41 months. 149 patients were without any with recurrences at the last follow up and 31 patients were with recurrence. Median interval for recurrence development was 39 months. Five years disease free survival (DFS) was 71%. Overall survival (OS) at 5 years for all patients was 56%. According to univariate cox regression 5-year DFS analysis, unfavorable prognostic factors in our study were as follows: grade III of tumor, positive LVI, presence of lymph node positive, stage II and stage III at diagnosis. According to multivariate cox regression 5-year OS analysis unfavorable prognostic factors were as follows: age: 40, grade III versus grade I of tumor, stage III at diagnosis versus Stage I, and visceral recurrence.ConclusionsWe observed that most clinical and pathological TNBC characteristics in Iranian patients are consistent with others findings in literature, such as younger age at diagnosis, high grade tumors, advanced stage at diagnosis, and short time of 5-year DFS and 5-year OS. Longer follow-up of these patients is required for more mature data on these cancers.

Background: Colorectal cancer is one major health problem and cancer-related cause of death in cancer patients in countries such as Iran where the most cases are diagnosed in advanced stages. Objectives: To evaluate the incidence and severity of toxic effects in colorectal cancer patients who have been treated with two different schedules of combination of oxaliplatin and bolus/infusional 5-fluorouracil with leucovorin (FOLFOX) and to compare them. Methods: Medical records of 458 patients with colorectal cancer treated with FOLFOX 4 and modified FOLFOX 6 regimen between 2005 and 2014 were reviewed. Data from 96 eligible patients were analyzed. Fifty-six patients (58.3%) received FOLFOX 4 and 40 patients (41.7%) received modified FOLFOX 6. Results: The study included 96 patients, 39 of whom were males (40.6%) and 57 of whom were females (59.4%). The median age was 62 years (range: 38 - 87 years). The follow up duration was between 16 - 109 months with a median of 62 months. There was a statistically significant incidence rate of grade ≥ 1 toxicity of diarrhea as gastrointestinal (GI) toxicity between FOLFOX 4 and modified FOLFOX 6 as the two regimens (P = 0.034), but there was not a statistically significant incidence rate of grade ≥ 1 toxicity of stomatitis as GI toxicity between the two regimens (P = 0.27). We observed a highly statistically significant incidence rate of grade ≥ 1 toxicity of neutropenia as hematologic toxicity between FOLFOX 4 and modified FOLFOX 6 as the two regimens (P < 0.001), but we did not observe any statistically significant differences of grade ≥ 1 of thrombocytopenia as hematologic toxicity between the two regimens (P = 0.063). There was a statistically significant incidence rate of grade ≥ 1 neurotoxicity between FOLFOX 4 and modified FOLFOX 6 as the two regimens (P = 0.017). Conclusions: We showed that in colorectal cancer patients treated with modified FOLFOX6. Some of hematological and non-hematological complications were more than FOLFOX4 and they can be concerned.

Patients with head and neck cancer after radiotherapy often suffer disability such as hearing disorders. In this study, the effect of radiotherapy (RT) on hearing function of patients with head and neck cancer after RT was determined according to the total dose delivered to specific parts of the auditory system. A total of 66 patients treated with primary or postoperative radiation therapy for various cancers in the head and neck region were selected. All patients had audiologic evaluation with pure tone audiometry for the frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz before and immediately after completion of treatment and again 3 months later. The cochlea dose volume histograms of the patients were derived from their computed-tomography-based treatment plans. At study's end, RT-induced auditory complications developed in 33% of patients. The greatest hearing loss (changes >15 dB) occurred immediately after RT at frequencies of 3,000 (14.5%), 4,000 (12.9%), 6,000 (13.6%), and 8,000 Hz (10.6%), and after 3 months of follow-up, at 3,000 (6.8%), 4,000 (7.7%), 6,000 (10.7%), and 8,000 Hz (12.1%). Univariate and multivariate analyses indicated a positive relationship between dose delivered to the cochlea and hearing loss (p < 0.001, r = 0.484). An increased risk of hearing loss was present for patients receiving ≥40 Gy as their mean dose compared with those receiving

Introduction:: Among the high grade cerebral gliomas, Glioblastoma multiform for instance, would be the main pattern of local recurrence causes clinical deterioration and deaths. This has observed 2 - 3 cm upon the initial lesion. During the period of 2 - 4 weeks post-surgery, remaining tumor cells have re-grown until radiochemotherapy has initiated. So it has seemed clear that improved local control could hopefully translate into improved survival. As a matter of fact, mass reduction has insufficiently achieved in almost every case of GBM as that the tumor cell number has not fallen below a “threshold” that tumor control might achieve by the host immune system. Intraoperative Radiation therapy has been one of those add-on therapies, which has performed during or directly after resection and cleared the tumor cavity from microscopically remaining cells. Although IORT has presented a novel and feasible principle, the method faced a number of technical and geometrical errors and limitations, which has decreased its potential in the reports of previous studies. Examples could be mentioned as incomplete target volume coverage that seemed as the greatest influence on survival, due to irradiation with an inadequate electron cone size, due to angle errors, or inadequately low energies. In contrast to the previously used forward-beaming electron cones, spherical irradiation sources were specifically attractive in brain tumor IORT, even in post resection cavities with normal complex shapes. Case Presentation:: We have been reporting 3 cases of high grade gliomas, one recurrent GBM, one primary glioma grade III, and the last one recurrent Rhabdoid GBM, which have been fulfilling our entrance criteria of IORT procedure, by using spherical applicators, which has been increasingly discussed in recent studies. Conclusions:: It was the first experience of intraoperative radiation therapy for cerebral malignant tumours in Iran. Finally, we had a brief overview on the past and present IORT strategies in the treatment of GBM.

Background: Cervical cancer remains to be a major health problem and cancer-related cause of death among women in developing countries such as Iran where the most cases are diagnosed in locally advanced stage. Objectives: This cross sectional-analytic study aims to report outcome 154 patients with carcinoma of cervix were treated with external beam radiation therapy (EBRT) and high-dose-rate (HDR) brachytherapy with cobalt 60 (Co-6o) remote after loading system. Patients and Methods: A total of 154 patients with the international federation of gynecologist and oncologist (FIGO) stages I-IVA with histopathologically confirmed carcinoma of cervix, followed by the radiation-oncology ward of Shohada-e-Tajrish Hospital in Tehran, Iran, between February 2008 and March 2015. They were completed their scheduled EBRT and HDR brachytherapy with Co-60 remote after loading system. Out of this, 132 patients completed their standard follow up protocol. They were analyzed for 3-year disease-free survival (DFS), 3-year overall survival (OS) incidence of acute and late complications for HDR brachytherapy. Results: Fourteen patients (9.1 %) were in stage I (FIGO classification), 8 (5.2%) were in stage IIA, 26 (16.9%) were in stage IIB, 100 (64.9%) were in stage III, and 6 (3.9 %) were in stage IVA. The follow up duration was between 6 - 60 months with a median of 38 months. Overall rectal and bladder treatment toxicity rates were 33.7%. The 3-year DFS rate was 85.7%, 70.7 %, 41% and 16.6% for stages I, II, III, IVA respectively. Favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm (after adjusting for the residual disease after radiation), no pelvic lymph node involvement and 1 week Gap between EBRT and HDR brachytherapy in 3-year DFS (P = 0.001, P = 0.012, P = 0.005, P = 0.005, respectively). The 3-year OS rate was 85.7%, 76.4%, 42%, and 33.3% for stages I, II, III, and IVA, respectively. Favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm, no pelvic lymph node involvement, 1 week gap between EBRT and HDR brachytherapy and no distant metastasis (during the follow up) in 3-year OS (P = 0.001, P = 0.002, P = 0.002, P = 0.002, P = 0.001, respectively). Conclusions: HDR brachytherapy with Co-60 remote after loading system was successful and it showed HDR brachytherapy in treating patients with carcinoma of cervix was effective after EBRT with acceptable rectal and bladder complications.

Background:: Radical prostatectomy is an established treatment modality for prostate cancer. Following radical prostatectomy, patients with positive surgical margins have increased risk of biochemical, and subsequently, clinical relapse. However, not all patients with positive margins will suffer disease recurrence. The aim of this study was to assess the factors that might predict the higher risk of disease recurrence in prostate cancer patients with positive surgical margins. Objectives:: The aim of this study was to assess the factors that might predict the higher risk of disease recurrence in prostate cancer patients with positive surgical margins. Patients and Methods:: From March 2009 till October 2013, seventy seven patients who had pathologically proven positive surgical margins after radical prostatectomy were followed and serum PSA levels were measured every three months. In case of biochemical failure, they were treated with salvage radiotherapy. Apart from pre-op and serial post-op PSA levels, number of positive margins based on anatomical classification of prostate, lymphovascular and perineural invasion, Gleason score and T-stage of the cancer were documented accurately. Results:: Fifty one patients (66.2%) had a single positive margin, while 26 (33.8%) had multiple positive margins. Among all 77 patients, 67 (87%) had biochemical failure. Cox regression analysis showed that among various parameters, only pre-op PSA>20ng/ml and having more than one positive margins were able to predict the likelihood of biochemical failure in the patients; while Gleason score, perineural invasion and lymphovascular invasion did not seem to have an important role in this regard. Conclusions:: Among patients with positive surgical margins after radical prostatectomy, those with pre-op PSA>20ng/ml or more than one positive margins are at greater risk of biochemical or/and clinical failure. In these patients, starting salvage radiotherapy after surgery might be considered as a logic option.

Breast cancer is a leading cause of morbidity and mortality in women worldwide. About 70 % of breast cancers are estrogen receptor (ER) positive. Blocking estrogen action by tamoxifen has been the treatment of choice in ER positive breast cancers for more than 30 years. In the past, several studies have revealed associations between gene copy number alterations and responsiveness to tamoxifen therapy, but so far no single gene copy number alteration could completely explain the response variation observed between individual breast cancer patients. Here, we set out to perform a simultaneous analysis of copy number alterations of several genes involved in the prognosis and response to therapy by multiplex ligation-dependent probe amplification (MLPA). A case–control study was designed encompassing 170 non-metastatic ER positive breast cancer patients (case group = 85, control group = 85). All patients in the control group had received standard adjuvant tamoxifen treatment for 5 years without any evidence of recurrence. Patients in the case group had experienced early recurrences while receiving tamoxifen treatment. 76 % of the patients of the case group and 73 % of the patients of the control group had received anthracycline-based adjuvant chemotherapy. Gene copy number alterations detected by MLPA in both groups were compared. Amplification of CCND1 (OR = 3.13; 95 % CI = 1.35 to 7.26; p = 0.006) and TOP2A (OR = 3.05; 95 % CI = 1.13 to 8.24; p = 0.022) were significantly more prevalent in the case group, compared to the control group. In a multivariate analysis CCND1 (p = 0.01) and TOP2A (p = 0.041) amplifications remained significant predictors of recurrence. Our results indicate that CCND1 amplification may serve as a useful biomarker for hormone responsiveness, and that TOP2A amplification may serve as a useful prognostic biomarker.

186Re-1-hydroxyethylidene-1,1-diphosphonate (HEDP) is an attractive radiopharmaceutical for the treatment of bone pain arising from skeletal metastatic lesions. Currently, 186Re-HEDP is most commonly used in European countries. The aim of this study was to investigate the palliative efficacy and adverse effects of 186Re-HEDP in patients with different types of cancers and skeletal bone pain. Methods: Nineteen (8 male, 11 female) patients with various cancers (breast, prostate, renal cell carcinoma, colon, and neuroendocrine tumors) and painful bone metastases were included in the study. A dose of 1,480–3,330 MBq (40–90 mCi) of 186Re-HEDP was administered intravenously. The patients’ level of pain relief was assessed by the Visual Analog Scale for 8 wk after treatment and by a weekly blood cell count to evaluate for hematologic toxicity. Results: The overall response rate was 89.5%, and the mean pain score assessed by the Visual Analog Scale was reduced from 9.1 to 5.3 after 1 wk (P = 0.003). No adverse effects were reported by patients during intravenous administration or for up to 24 h after administration. A flare reaction was seen in 63.2% of patients, mainly during days 1–3, and lasted for 2–4 d. There was no significant correlation between the response to therapy and the flare reactions (P > 0.05). The nadir of platelet reduction occurred at the fourth or fifth week and led to platelet infusion in only 4 patients with a low baseline platelet count and diffuse skeletal metastases. Bone marrow suppression occurred in patients receiving higher doses, but no clinical problems were seen except in 2 patients who required packed cell transfusion similar to their prior transfusions. Conclusion:186Re-HEDP is an effective radiopharmaceutical for the palliative treatment of metastatic bone pain and has minimal adverse effects.

Osteosarcoma is the most frequent primary malignancy of bone, and usually metastasizes to the lung and bones, while other sites are rare. In most reported cases, soft tissue metastasis of osteosarcoma is unusual, and only develops in the advanced stages of the disease, especially following multiple recurrences. We present a patient with recently diagnosed osteosarcoma of the right femur, showing abdominal wall metastasis diagnosed by technetium-99m-methylene diphosphonate (99m Tc-MDP) whole body bone scintigraphy and confirmed histologically. The present case highlights the importance of whole body imaging of patients with osteosarcoma for detecting unusual sites of metastasis, especially in soft tissue organs.

Oligodendrogliomas can be found anywhere oligodendrocytes exist; however, they mostly occur in frontal lobes. Although intra- and extra central nervous system dissemination of anaplastic oligodendroglioma is a well-known property of this tumour, low-grade oligodendroglioma with intracranial relapse is a very uncommon finding. In this case report, a 37-year-old man with grade II oligodendroglioma relapsed after 18 months with multiple parenchymal masses is presented.

Colorectal cancer is the fourth cause of cancer after stomach, bladder, prostate in men and second cause after breast in women in Iran. It is estimated that 4,000 new cases occur each year with 1,150 deaths annually. The present study aimed to determine survival of colorectal cancers in Iran in a national manner.The data from national cancer registry department of the Ministry of Health and Medical Education (MOH and ME) were used as the main source of incident colorectal cancer information in Iran from March 2000 to March 2005. One and five year survival proportions were 88% and 45% for females versus 86% and 39% for men. The median overall survival for colorectal cancer in Iran was 3.5 years with a 95 % confidence interval of 3.2-3.8 years. The worst survival status was found for patients less than 20 and more than 80 years old.The overall 5 year survival for colorectal cancer in Iran (41%) is comparable even with some developed countries but it is far from those with advanced health care systems, or community based screening programs. Thus at the policy level, application of an appropriate national cancer control program and management guidelines should be under consideration.

Objective: Pituitary function and hypopituitarism have not been well evaluated in adult patients with non-pituitary brain cancer. Methods: Thirty-one (31) patients treated with primary or postoperative radiotherapy (RT) for various cancers in the brain region without pre-existing hypothalamic pituitary (HP) disorder from other causes were prospectively evaluated. Serum samples were obtained from the patients to determine levels of growth hormone (GH), thyroid-stimulating hormone (TSH), and free thyroxine (FT4). Serum samples were measured before treatment, 3 and 6 months after completion of radiation therapy (RT). The hypothalamus-pituitary axis (HPA) and dose volume histograms (DVH) of the patients were derived from their computed tomography-based treatment plans. Results: Clinical hypopituitarism was not observed, but 83% of patients who tested for hypopituitarism demonstrated subclinical hypopituitarism after a median interval of 6 months. Subclinical GH and TSH deficiency were observed in 17 (54%) and 9 (29%) participants, respectively. Significant declines in TSH (p Conclusion: Radiation-induced hypopituitarism and central hypothyroidism are regarded as primary damage to the pituitary gland. Time after therapy is critical and so with time the incidence of growth hormone deficiency and thyroid stimulating hormone deficiency is likely to significantly increase and to no longer be subclinical. Neuronal cell death and degeneration because of the direct effects of radiation seem to play basic roles.