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Purpose This study aimed to investigate the efficacy of hydrocortisone enema in preventing radiation proctitis in patients with rectal cancer undergoing short-course radiotherapy (SCRT). Methods This phase II randomized controlled trial enrolled patients with newly diagnosed locally advanced rectal cancer (clinically staged T3–4 and/or N1–2M0). Participants received a median of 4 cycles of neoadjuvant chemotherapy (capecitabine plus oxaliplatin) followed by 3-dimensional conformal SCRT (25 Gy in 5 fractions). Patients were randomly assigned to receive either a hydrocortisone enema (n=50) or a placebo (n=51) once daily for 5 consecutive days during SCRT. The primary endpoint was the incidence and severity of acute proctitis. Results Of the 111 eligible patients, 101 were included in the study. Baseline characteristics, including sex, age, performance status, and tumor location, were comparable across the treatment arms. None of the patients experienced grade 4 acute gastrointestinal toxicity or had to discontinue treatment due to treatment-related adverse effects. Patients in the hydrocortisone arm experienced significantly less severe proctitis (P

Abstract Background Basal cell carcinoma is the most prevalent skin cancer, most characterized by local aggressiveness but with low metastatic potential, and bone metastasis is quite heterogeneous, thus the incidence profile is variable size from 0.0028% to 0.5%. We have this patient with an unusual example of basal cell carcinoma with bone metastases to add to the scarce report on this matter. Case description Here we document a 48-year-old Persian man with a background of being exposed to the sun for a long time. He was diagnosed with an ulcer on the cheek, which was clinically characterized and further confirmed by biopsy as morpheaform basal cell carcinoma. Following the first round of excision, multiple relapses eventually metastasized to the bone. The latter was found on follow-up radiologic scans. This case is characterized by the aggressive nature of the disease and the heterogeneity of basal cell carcinoma growth, thus challenging the conventional view of basal cell carcinoma behavior. Treatment included surgical excision of the primary lesion, which was treated with radiotherapy afterward. However, the skeleton improved slowly during follow-up, and palliative care was eventually pursued to control symptoms and improve quality of life. Conclusions This was a rare case of basal cell carcinoma metastasis to non-bone organs, which reminded us to consider basal cell carcinoma metastasis, especially in the case of atypical basal cell carcinoma. Therefore, risk-aware patient management is essential. Moreover, these findings highlight the role of further research into the mechanisms of basal cell carcinoma metastasis, leading to improved therapeutic strategies that may lead to potential improvements in patient outcomes.

Key Clinical Message Intracranial RDD is rare medical event mimicking different diagnoses. Although the surgical resection is the best treatment option, but radiation therapy can also achieves long‐term suboptimal outcomes. Abstract An 83‐year‐old male with a history of tension‐type headaches was evaluated. He was conscious with no focal neurological deficits. His brain MRI revealed an enhancable bifrontal tumor originating from falx cerebri and superior sagittal sinus dura. Due to the patient's preference and decline for gross total resection, she underwent a stereotactic biopsy. The pathology was positive for Rosai–Dorfman diseases. He received definitive targeted radiation with a total dose of 4500 cGy administered in 200 cGy daily fractions. His 4‐year follow‐up showed regional tumor control with excellent neurological outcome.

Abstract Background Intraoperative radiotherapy (IORT) is an alternative for external beam radiotherapy (EBRT) for early stage breast cancer (BC). Herein, we compared outcomes, postoperative and post‐radiation complications of IORT and EBRT. Methods We conducted a cohort study to compare complications of IORT and EBRT in patients. A checklist of the complications of IORT and EBRT, was used to assess and post‐radiation complications and outcomes. Results Overall, 264 women (121 in IORT and 143 in EBRT group) with a mean (SD) age of 55 ± 8.6 years analyzed in this study. The IORT group (quadrantectomy + SLNB + IORT) had more severe post‐operative pain compared to the EBRT group (quadrantectomy + SLNB) (OR = 1.929, 95% CI: 1.116–3.332). Other postoperative complications, including edema, erythema, seroma, hematoma, and wound complications were not significantly different between the IORT and EBRT groups. EBRT was associated with higher rates post‐radiation complications, including erythema (95.8% vs. 21.5%), skin dryness (30.8% vs. 12.4%), pruritus (26.6% vs. 17.4%), hyperpigmentation (48.3% vs. 9.9%), and telangiectasia (1.4% vs. 0.8%). Multivariate analysis showed that erythema, skin dryness and pruritus, and hyperpigmentation were more severe in the EBRT group, while breast induration was higher in the IORT group (OR = 4.109, 95% CI: 2.242–7.531). Excellent, good, and fair cosmetic outcome was seen in 11.2%, 72%, and 16.8% of the patients in the EBRT group and 29.8%, 63.6%, and 6.6% in the IORT group, respectively, suggesting that the cosmetic outcome was significantly better in the IORT group (P

Background: Glioblastoma is the most prevalent and aggressive adult glial tumor. Patients who receive standard treatment have a mean survival of 12-14 months. Zinc is a micronutrient that has shown to have anticancerous effects. In the in vitro studies zinc had antineoplastic effects on gliobalstoma cells.Method: This is a phase II randomized trial in which 60 patients in two groups were evaluated. The zinc group (29 patients) received zinc sulfate supplement 50 mg orally twice a day and the control group (31 patients) who were selected from historical case sreceived no supplements.Results: Mean overall survival in the case and control groups were 9.93 (± 3.29) and 9.0 (± 3.56) months. In the case and control groups, the mean disease-free survival were 9.62 (SD ± 3.37) and 8.26 (SD ± 3.47) months. These differences were not statistically significant. Although overall survival and recurrence-free survival in patients in the case group was higher than the control group, there was no statistically significant difference (P = 0.485).Conclusion: Zinc consumption was associated with better survival, but these differences were not statistically significant, necessitating further studies.

Background: Squamous cell carcinoma (SCC) is the most prevalent malignancy of the larynx. Non-squamous cell carcinomas of the larynx are rare and consist of different pathology types.Method: The present work is a retrospective study of non-SCC of the larynx in the south of Iran during a seven-year period.Results: Among 517 patients with laryngeal cancers, seven (0.13%) had non-SCC. The mean age was 59.1 (39-71) years, and six were male. The main complaint of two of the patients was neck mass, five cases had hoarseness, and one had dyspnea. One subject had both dyspnea and hoarseness. Out of three cases of neuroendocrine tumor, two had radical surgery and afterwards, radiotherapy (RT) was given for one of them. Both cases are well and disease-free. The other patient was a 58-year-old man and was treated with chemoradiation. He died due to brain metastasis following 12 months. Our patient with osteosarcoma is well controlled with surgery, chemotherapy, and RT. We had two male cases of adenoid cystic carcinoma who had undergone total laryngectomy and supraglottic laryngectomy. Both of them received RT (60 or 70 Gy dose) and both are well after 60 and 48 months. A 51-year-old patient with chondrosarcoma had undergone total laryngectomy, who was well after 36 months.Conclusion: Treatment of non-SCC of the larynx is an extrapolation from the treatment of the more common site of each pathology type. Further studies are needed to draw a firm conclusion.

Introduction: Salivary gland tumors are rare tumors that account for 3 to 4% of head and neck neoplasms. These tumors may arise from 6 major and numerous minor salivary glands. This study was designed to investigate the factors affecting the prognosis of salivary gland tumors. Methods: This study is a retrospective descriptive study in which the records of patients with salivary gland tumors referred to the Radiotherapy and Oncology Center of Namazi Hospital from 2005 to 2015 were reviewed. Results: 158 patients were included in this study with a mean age of 55.37 years. 49% of the patients were men. Adenoid Cystic Carcinoma was the most common histological type (30.57%) and Adenocarcinoma with a prevalence of 1.91% had the lowest prevalence rate in this study. 65.19% of salivary gland neoplasms in this study had parotid gland involvement and sublingual gland involvement had the lowest prevalence (3.8%). The results of survival analysis clearly illustrated that surgery, pathology type and stage was statistically significant in survival. Discussion: Clinical, pathological and therapeutic factors in people with malignant salivary gland neoplasms have a significant relationship with their survival. controversies on treatment and outcome continues.

Background: Breast cancer is among the most prevalent cancers in women. Radiotherapy is an important part in treatment of breast cancer, associated with some side-effects, including skin dermatitis. Dermatitis may be severe and impair quality of life. Multiple agents have been studied, but no standard treatment is yet available. Silicone based gel (StrataXRT) was promising in some studies in reducing skin inflammation and also radiotherapy-induced dermatitis. Method: This was a randomized trial on 100 women with breast cancer who had undergone quadrantectomy for breast cancer. They received StrataXRT gel or best supportive care during radiotherapy. Dermatitis area and grade of dermatitis were measured. Results: Regarding the mean size of radiation-induced dermatitis area, there was a significant difference between the intervention (36.88 cm2 ± 69.93) and control (83.83 cm2 ± 79.34) groups (P = 0.002). During radiotherapy, except in the fourth week, dermatitis was significantly more severe in the control group. Conclusion: It seems that StrataXRT is helpful in decreasing radiotherapy-induced dermatitis.

Abstract Background and objective We report our experiences with Intraoperative radiation therapy (IORT) among breast cancer (BC) patients in our region. Methods All patients who received radical IORT from April 2014 on to March 2020 were included in the study. Patient selection criteria included: Age equal or older than 45 years old; All cases of invasive carcinomas (in cases of lobular carcinomas only with MRI and confirmation); Patients who were 45–50 years old with a tumor size of 0–2 cm, 50–55 years old with a tumor size of

The current coronavirus pandemic (COVID-19), caused by SARS-CoV-2, has had devastating effects on the global health and economic system. The cellular and molecular mediators of both the innate and adaptive immune systems are critical in controlling SARS-CoV-2 infections. However, dysregulated inflammatory responses and imbalanced adaptive immunity may contribute to tissue destruction and pathogenesis of the disease. Important mechanisms in severe forms of COVID-19 include overproduction of inflammatory cytokines, impairment of type I IFN response, overactivation of neutrophils and macrophages, decreased frequencies of DC cells, NK cells and ILCs, complement activation, lymphopenia, Th1 and Treg hypoactivation, Th2 and Th17 hyperactivation, as well as decreased clonal diversity and dysregulated B lymphocyte function. Given the relationship between disease severity and an imbalanced immune system, scientists have been led to manipulate the immune system as a therapeutic approach. For example, anti-cytokine, cell, and IVIG therapies have received attention in the treatment of severe COVID-19. In this review, the role of immunity in the development and progression of COVID-19 is discussed, focusing on molecular and cellular aspects of the immune system in mild vs. severe forms of the disease. Moreover, some immune- based therapeutic approaches to COVID-19 are being investigated. Understanding key processes involved in the disease progression is critical in developing therapeutic agents and optimizing related strategies.

Abstract Idiopathic granulomatous mastitis (IGM) is a rare benign infectious disease of the breast, commonly presenting with a unilateral breast mass. Since GM's clinical presentation and imaging can be very similar to breast cancer, diagnosing GM can be challenging. So far, various reports have demonstrated the probable correlation and co‐occurrence of granulomatous mastitis and breast cancer. This report presents a 38‐year‐old female with invasive ductal carcinoma, previously diagnosed as IGM.

Glomus jugulare is known as a benign tumor that could involve in different parts of the body. The most prevalent site of involvement is head and neck area. This disease is rare and few of the cases are bilateral. However, in familial cases bilateral or multicenter lesions are even rarer, in which there is an autosomal dominant pattern of inheritance. The most efficient treatment is believed to be surgery or radiotherapy depending on the location and certain other factors, such as age and performance status. Sporadic bilateral lesion is rarely seen and most bilateral cases are familial. Herein, we reported a case of bilateral glomus jugulare of carotid with no history of this tumor in family or any other familial diseases. Our subject was a 67-year-old man. The diagnosis was made via Tru-cut biopsy. He was treated successfully by 3- dimensional conformal radiotherapy up to a dose of 60 Gy. The follow-up computed tomography scan revealed partial tumor responses. He had no family history of any systemic disease related to functional glomus jugulare, such as uncontrolled hypertention or mass in the neck. He also had no history of catecholeamine exceretion-related symptoms.

Background: The variety of neoadjuvant treatments concerning rectal cancer has led to acute complications. The present study aimed to evaluate and compare the acute complications of short-course (SC) and long-course (LC) radiotherapy. Method: We studied 100 patients suffering from rectal cancer, who referred to Nemazee Hospital before their surgery, in this cross-sectional study. The patients were divided into two categories: SC (25 grays radiotherapy at 5 fractions in 5 days) and LC (chemoradiotherapy with a dose of 45-50.4 grays in 25- 28 fraction in 5-6 weeks with concurrent Capecitabine (825 mg / m2) twice daily and five days a week). Subsequently, we evaluated them for acute complications in the SC group 10-14 days after the end of the treatment and in the LC group at intervals of the treatment, the end of it and 2 weeks afterwards. Results: In the LC group compared to the SC group, the percentage of patients with grade 1 diarrhea, grade 2 colitis and grade 1 cystitis at the end of the treatment was statistically different (p 0.05). Conclusion: This study implied that there were no significant differences regarding severe acute complication between the two groups.

We report a case of colon cancer with pancreatic and interesting heart metastasis several months prior to disseminated metastases. The case was a 59-year-old man with a cecal cancer (T4N2); he received chemotherapy with XELOX regimen and then radiotherapy up to a dose of 45 Gy. He was under close and regular follow-up. After 42 months, he developed jaundice and computed tomography (CT) scan showed an isolated mass in the pancreas. We performed Whipple’s operation and the pathology report was pancreatic metastasis. He received chemotherapy and was relatively well until his CEA rose again and the chest CT scan indicated cardiac metastasis. We resected the metastasis and administered chemotherapy. Unfortunately, the case developed brain metastasis and passed away. We searched the literature and found 15 cases of colon cancer and cardiac metastasis. We found no cases with metastasis from colon cancer to the left side. Although cardiac metastasis has a poor prognosis, it might be more prevalent than what is generally believed.

Primary rhabdomyosarcoma (RMS) of the kidney in an adult is rare, with only a few cases published in the literature. It is a mesenchymal tumor associated with an aggressive and rapid clinical progression course. We present a case of primary renal RMS in a 58-year-old female who presented with intermittent abdominal pain in the past year. The computed tomography (CT) scan revealed a 20×25×8 cm heterogeneous solid mass in the middle pole extended to the lower pole of the right kidney. Therefore, the patient underwent a right radical nephroureterectomy. Histopathology examination and immunohistochemistry studies confirmed the diagnosis of RMS with pleomorphic components. Postoperatively, the patient was discharged without any complications and was referred to an oncologist for chemotherapy. However, a follow-up CT scan in 2 months showed widespread liver metastasis and local recurrence. The patient received Gemcitabine and Docetaxel, but her condition worsened, and she passed away 5 months later. Primary renal RMS is rare in adults. In addition, liver metastasis is uncommon and poorly understood. Hence, we describe the clinicopathologic characteristics, including clinical follow-up of our case, focusing on the disease progression, treatment, and outcome.

The urinary bladder schwannoma is an extremely rare primary urologic tumor. Schwannoma arises from the Schwann´s cells in the nerve sheaths and is almost associated with von Recklinghausen´s disease. We report a case of schwannoma in a 35-year old female who presented with urinary frequency for 2 months with absence of evidence of von Recklinghausen disease and successfully treated with transurethral resection of bladder lesion (TUR_B). To the best of our knowledge, this represents only the 10th case of benign schwannoma of the urinary bladder in a patient without von Recklinghausen disease. We report a case of an isolated schwannoma of the urinary bladder, and also searched the English literature as we had access to bladder schwannoma.

Pineal region tumors are uncommon lesions in the central nervous system. Papillary tumor of the pineal region is recently recognized as a separate disease. Its incidence, treatment, and outcome are not well-defined. We have reported the case of a 6 yearold- boy with papillary tumor of the pineal region. He presented with headaches, nausea and vomiting and, after a biopsy, was referred for radiotherapy. The patient received 54 Gy irradiation to the pineal region followed by a chemotherapy regimen of cisplatin, vincristine, and lomostine. His tumor decreased slightly. After 4 years, the patient has remained well and attends school. He is under routine follow-up. We suggest radical radiotherapy as the main treatment for papillary tumors of the pineal region.

Most bladder tumors are epithelial in origin. Nonepithelial cancers are rarely located in the bladder. Sarcomas are the most common malignancies among nonepithelial cancers. Primary bladder lymphoma is rare and mostly low grade. Here, we have reported a case of diffuse large cell lymphoma of the bladder. The patient, a 64-year-old man, had urinary frequency for 18 months. Abdominal sonography indicated a thick bladder wall and transurethral biopsy showed diffuse large cell lymphoma. Immunohistochemistry (IHC) results showed that the tumor was positive for CD20, CD45, and Pax-5 and negative for BCL-2, cytokeratin, and S100. He had a normal bone marrow biopsy, abdominal, pelvic and chest CT scans. He had no B symptoms. The patient received 6 cycles of R-CHOP followed by radiotherapy (36 Gy) to the pelvis. Six months after treatment, the patient is well and has returned to work. We have searched PubMed for primary diffuse large cell lymphoma. Primary diffuse large cell lymphoma of the bladder is best treated according to treatment for diffuse large cell lymphoma of other sites, which includes chemotherapy and radiotherapy. As seen in our review, primary diffuse large cell lymphoma of the bladder has a similar clinical course to diffuse large cell lymphoma of other sites.

O presente estudo tem por objetivo relatar as características, fatores prognósticos e desfecho de tratamento de 18 casos de melanoma da mucosa nasossinusal e conduzir uma revisão da literatura. MÉTODO: Entre 1995 e 2005, 18 pacientes consecutivos diagnosticados com melanoma da mucosa do trato nasossinusal e tratados em nossa instituição. Para encontrar as principais casuísticas de estudos relacionados, conduzimos uma revisão da literatura em PubMed e Scopus. No total, encontramos 35 casuísticas, incluindo 1.077 pacientes com melanoma da mucosa nasossinusal. RESULTADOS: Encontramos 16 homens e 2 mulheres. A idade de apresentação foi 51-80 anos (mediana de 58 anos). Todos os pacientes sofreram excisão cirúrgica seguida de radioterapia com ou sem quimioterapia. A mediana de sobrevida foi de 15 meses e a sobrevida geral de 5 anos foi de 23%. Sob análise univariada, estadiamento e remissão completa após tratamento inicial foram importantes fatores prognósticos. Entretanto, sob análise multivariada, somente estágio da doença teve significância estatística. CONCLUSÃO: Melanoma nasossinusal é um tumor raro e agressivo com alto fracasso locorregional e distante e pobre desfecho de tratamento. Entretanto, em uma revisão da literatura, encontramos significativa melhora em termos de sobrevida de 5 anos para casuísticas recentes comparadas com casuísticas previamente relatadas.The present study aimed at reporting on the characteristics, prognostic factors and treatment outcomes of 18 cases of nasosinusal mucosa melanoma, and do a literature review on the subject. METHODS: between 1995 and 2005, 18 patients consecutively diagnosed with nasosinusal mucosa melanoma were managed in our institution. We reviewed the literature in PubMed and Scopus in order to find the main series from studies associated with this topic. We found a total of 35 series, involving 1,077 patients with nasosinusal mucosa melanoma. RESULTS: we found 16 men and 2 women, with age at presentation between 51 and 80 years (median of 58 years). All these patients were submitted to surgical excision followed by radiotherapy with or without chemotherapy. The survival median was 15 months, and the 5-year general survival had a percentage value of 23%. Considering our univariate analysis: tumor staging and complete remission after initial treatment were deemed relevant prognostic factors. Nonetheless, considering the multivariate analysis, only disease stage was statistically significant. CONCLUSION: nasosinusal melanoma is a rare and aggressive tumor, with high loco-regional and distant failure rates, and poor treatment outcomes. Notwithstanding, in a literature review we found significant improvements considering the 5-year survival for recent series when compared to previously reported ones.