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Introduction: Post-irradiation mammary stromal sarcoma (MSS) is a rare condition, and it is worth learning new knowledge from each case. Case Presentation: We present the case report of a 59-year-old female with a medical history of breast cancer, who presented with an axillary mass on the same side. The patient was further evaluated and finally diagnosed with MSS with chondroid differentiation. Thereafter, she underwent neoadjuvant chemotherapy to facilitate the surgical resection of the tumor. However, she experienced local progression and lung metastasis during chemotherapy. Conclusions: MSS with chondroid differentiation was resistant to the standard chemotherapy regimens of sarcoma. Radiotherapy is a potential choice in the case of chemoresistant MSS. Further trials may reveal this notion.

Objectives: The COVID-19 outbreak is affecting people worldwide. Most of the infected patients suffering from respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiotherapy in patients with COVID-19 pneumonia. Methods: In this clinical trial, done in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (IL-6 and CRP) were recorded before and after irradiation.Results: Between 21 May 2020 and 24 June 2020, five patients received whole-lung irradiation. They followed for 5-7 days to evaluate response to treatment and toxicities. The clinical and paraclinical findings of four patients (except for patient #4 that get worst and died on day 3) improved on the first day of irradiation. Patient #3 opted-out the trial on the third day of irradiation. The mean time to discharge was 6 days for the other three patients. No acute radiation-induced toxicity was recorded.Conclusion: With a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia.

As of late 2019, the outbreak of novel coronavirus disease (COVID-19) -that started in China- has rapidly afflicted all over the world. The COVID-19 pandemic has challenged health-care facilities to provide optimal care. In this context, cancer care requires special attention because of its peculiar status by including patients who are commonly immunocompromised and treatments that are often highly toxic. In this review article, we have classified the main impacts of the COVID-19 pandemic on oncology practices -followed by their solutions- into ten categories, including impacts on (1) health care providers, (2) medical equipment, (3) access to medications, (4) treatment approaches, (5) patients' referral, (6) patients' accommodation, (7) patients' psychological health, (8) cancer research, (9) tumor board meetings, and (10) economic income of cancer centers. The effective identification and management of all these challenges will improve the standards of cancer care over the viral pandemic and can be a practical paradigm for possible future crises.br /.

Background: Breast cancer is the most frequent diagnosed visceral cancer with 13400 new cases annually in Iranian women. There are a few studies in the west countries that indicates that breast cancer patients with higher educational background had better prognosis than patients with lower education background.Objectives: In a retrospective single center study we compared educational background and its relationship to pathological stage and their treatment modalities among 3010 breast cancer patients.Methods: Medical records of 3010 patients with breast cancer from database at Cancer Research Center of the Shahid Beheshti University of Medical Sciences were reviewed and univariate logistic regression analysis was used for association between education background and its relationship to pathological breast cancer stage and treatment modalities. Results: The average age at diagnosis was 49.1 years ± 11.6 years. The proportion of breast cancer patients’ levels of education were 4.2 % illiterate, 7.8% primary school, 7.5% middle school, 21.8% high school and diploma, 18.6% university and above and 40.1% unspecified.Based on univariate logistic regression analysis, the illiterate group had 65.1% of early stage breast cancer (stage I and stage II), and the university and above group had 73.4% of early stage breast cancer (p-valueConclusions: The findings of this study showed that education background have a significant impact on pathological staging and the selection of treatment modalities.

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: Breast cancer (BC) is the most common cancer in Iranian women, with 13400 new cases annually. A few studies have reported that BC patients with a positive familial history had different prognoses and outcomes.Objectives: The aim of the present study was to evaluate and compare survival between familial breast cancer (FBC) patients and sporadic breast cancer (SBC) patients in Iranian women.Methods: In a longitudinal study, 1710 patients with complete medical records from the Cancer Research Center, database were extracted and divided into two groups: the FBC group (n=311) and the SBC group (n=1399). Then, five-year overall survival (OS) and five-year disease -free survival (DFS) for these two groups were evaluated and compared.Results: The FBC group and SBC group represented 18.22% % and 81.8% of all cases, with mean ages of 44.2 years and 47.7 years, respectively (p=0.0024). There were more advanced stage and positive lymph nodes, higher grade of tumor, more positive lymphovascular invasion and P53 status and higher degrees of negative progesterone receptor status in the FBC group than in the SBC group (p=0.0200, p=0.0001, p=0.0001, p=0.0386, p=0.0182 and p=0.0003, respectively). In the FBC group and SBC group, the five -year DFS was 81% and 86.5%, (p=0.0121), and the five -year OS was 71.1% and 76.5%, respectively (p=0.0401).Conclusions: The findings of this study showed that better five-year OS, five-year DFS and favorable prognostic factors in the SBT group than in the FBC group. The initial results might be helpful as better treatment modalities and careful follow-up in the FBC group.

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.

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.

Background: The treatment of lymph nodes engaged in breast cancer with radiotherapy leads to improved locoregional control and enhanced survival rates in patients after surgery. The aim of this study was to compare two treatment techniques, namely single anterior posterior (AP) supraclavicular field with plan depth and two anterior and posterior opposed (AP/PA) supraclavicular fields. In the study, we also examined the relationships between the depth of supraclavicular lymph nodes (SCLNs) and the diameter of the wall of the chest and body mass index (BMI). Methods: Forty patients with breast cancer were analyzed using computed tomography (CT) scans. In planning target volume (PTV), the SCLNs and axillary lymph nodes (AXLNs) were contoured, and, with the attention to PTV, supraclavicular (SC) depth was measured. The dosage that reached the aforementioned lymph nodes and the level of hot spots were investigated using two treatment methods, i.e., 1) AP/PA and 2) AP with three-dimensional (3D) planning. Each of these methods was analyzed using the program Isogray for the 6 MV compact accelerator, and the diameter of the wall of the chest was measured using the CT scan at the center of the SC field. Results: Placing the plan such that 95% of the target volume with 95% or greater of the prescribed dose of 50 Gy (V95) had ≥95% concordance in both treatment techniques. According to the PTV, the depth of SCLNs and the diameter of the wall of the chest were 3–7 and 12–21cm, respectively. Regression analysis showed that the mean SC depth (the mean Plan depth) and the mean diameter of the wall of the chest were related directly to BMI (p

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.

Introduction: We present a rare case of breast papillary carcinoma associated with intracystic component in a woman with a long history of autoimmune hypothyroidism and multiple sclerosis. Case Presentation: The patient was a 59-year-old woman presented with complaints of pain and swelling in her right breast. She was a known case of autoimmune hypothyroidism since 20 years and secondary progressive multiple sclerosis since 13 years ago. She had received frequent interferon, corticosteroid and cytotoxic therapy for her multiple sclerosis. On imaging studies, there were multiple large cystic-solid lesions in the right breast and with presumptive diagnosis of infectious collection or phyllodes tumor, she finally underwent simple mastectomy. On gross pathological evaluation, a large multi-loculated cyst filled with blood clots and necrotic debris was identified. In serial sections, a 7 cm solid tumoral mass with papillary projections protruding into the cyst cavity was seen. Although the gross appearance of the lesion resembled an angiosarcoma accompanied by cystic hemorrhagic necrosis, after the microscopic evaluation of the specimen, papillary breast carcinoma associated with intracyctic component was finally diagnosed. Conclusions: The aim of this study was to describe a rare variant of invasive breast cancer presenting with a large solid-cyctic mass in a woman with long standing autoimmune disorders.

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: Evidence about survival of the patients with nasopharyngeal cancer is scant in our region and the aim of the current study was to determine clinico-pathological factors influencing outcome of these patients. Methods: We reviewed all patients with a new diagnosis of nasopharyngeal carcinoma admitted between 2008 and 2014 to Jorjani cancer center, Tehran, Iran. Overall survival (OS) of the patients and their relation with demographic and clinico-pathological factors were analyzed. Results: Of 88 included patients, 56 were male and 32 were female with mean age of 46 years. With a median follow-up period of 31 months (range: 3 to 86 months), the overall survival of the whole patients and those without distant metastasis were 64% and 67% respectively. Tumor stage and presence or absence of distant metastasis at presentation were the only parameters that significantly influenced the patients’ OS. Conclusions: Our study provides some evidence on the outcome of Iranian patients with nasopharyngeal cancer and factors influencing it.

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.

Background Radiotherapy is the gold standard for treatment of prostrate cancer as it can cover an adequate area of tissues at risk for metastasis. Objectives We evaluated the Pelvic lymph node coverage of conventional radiotherapy fields based on bone and vessels landmarks using computed tomography (CT) simulation in patients with prostate cancer referred to Shohada-e-Tajrish hospital. Patients and methods In this cross sectional study, 40 patients with prostate cancer at the Stage T1c to T3b were studied. Pelvic lymph nodes were contoured by using pelvic vessels as surrogate markers. The distances were measured at different points of anterior-posterior (AP) and lateral fields and distances > 5 mm or more between the contoured nodes and the field borders. Results Mean and standard deviation of the aortic bifurcation from the superior border was 4.73 ± 1.16 cm, the distance of common iliac bifurcation from the superior border was 1.11 ± 1.25 cm, the mean (SD) distance of right external iliac from the lateral border of AP field was 2.06 ± 0.48 cm and for left external iliac artery was 1.90 ± 0.56 cm. The distance of the external iliac artery from the anterior border of the lateral field was 2.30 ± 0.74 cm. The distance of the external iliac artery from pelvic rim was 0.59 ± 0.59 cm, distance of bifurcation of iliac from sacroiliac joint was 0.82 ± 1.01 cm, the size of the pelvic rim was 12.30 ± 0.64 cm, sacral width was 8.29 ± 1.01 cm, anterior promontory symphysis distance was 12.02 ± 0.92 cm and posterior promontory symphysis distance was 10.98 ± 0.73 cm. Conclusions We observed that conventional radiotherapy using CT simulation based on bone and vessels landmarks provided adequate coverage of pelvic lymph nodes in our patients with prostate cancer.

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.