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Objective: Esophageal cancer is a therapeutic challenge in most healthcare systems. Most patients present with locally advanced disease at diagnosis. Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced esophageal carcinoma. Since achieving a complete pathological response in postoperative specimens following neoadjuvant therapy is associated with improved patient survival, this study was designed to evaluate the pathologic response of localized or locally advanced esophageal carcinoma to induction chemotherapy followed by preoperative concurrent chemotherapy and hypofractionated radiotherapy (HFR). Methods: This single-arm clinical trial (IRCT20210623051676N1) evaluated patients with squamous cell carcinoma or adenocarcinoma of the esophagus, stage cT2-T4a N0 M0 or cT1-T4a N+ M0. Patients received 3-5 cycles of weekly induction chemotherapy with the paclitaxel (50 mg/m2) and carboplatin (AUC=2) regimen, followed by weekly concurrent CRT with the same chemotherapy regimen. The radiation dose was 40 Gy, delivered over 16 fractions, 5 days per week (2.5 Gray/fraction). Patients underwent surgery 4-6 weeks after completion of CRT. The surgical specimens were evaluated for pathological response. A p-value of < 0.05 was considered significant in all analyses. Results: Out of 54 patients enrolled in this study, 45 completed the neoadjuvant protocol. Of these 45 patients, 32 underwent surgery and were finally analyzed. The mean age of the patients was 59.9 ± 8.6 years (range, 37-75 years). The location of the tumor was in the mid-thoracic esophagus in most patients (21, 65.6%) and the most common histological type was SCC (29, 90.6%). The median number of induction and concurrent chemotherapy cycles was 5 (4.8 ± 1.3 course, range, 1-10) and 3 (2.6 ± 0.8 course, range, 0-4), respectively. Among 45 patients who completed the neoadjuvant protocol, the most common toxicities were grade 3 neutropenia (15.6%), acute renal failure (4.4%), and odynophagia (37.8%). Nearly two-thirds of the patients experienced complete or nearcomplete responses (71.9%, 23 patients). Partial response was reported in 6 patients (18.8%) and poor response in 3 patients (9.4%). Conclusion: Preoperative induction chemotherapy followed by HFR with concurrent chemotherapy has low toxicity and side effects, good tolerance, and significant efficacy in the treatment of patients with esophageal cancer. [ABSTRACT FROM AUTHOR]

Background: Uterine sarcomas (US) represent a rare and heterogeneous spectrum of tumors characterized by diverse clinical behaviors and tumor responses. This study aims to assess patient and tumor characteristics and oncologic outcomes. Method: This historical cohort study encompassed all patients with histologically confirmed diagnoses of the US who were referred to two oncology centers affiliated with Mashhad University of Medical Sciences (Iran) between March 2011 and April 2020. Data analyses were conducted using STATA version 14.02. Survival estimation was carried out utilizing the Kaplan-Meier method. The significance level was established at 0.05. Results: A total of 33 patients were included in this study, comprising 23 with US and 10 with carcinosarcoma (CS). The mean age was 49.3 years for CS and 62.4 years for US (P = 0.0001). Nearly all patients were overweight, with a mean body mass index of 27.1 (confidence interval: 25.6-28.7). The majority of patients were diagnosed at an early stage. The Federation of Gynecology and Obstetrics (FIGO) stage, patient's anemia, and surgical resection were identified as significant prognostic factors. The median overall survival was 50.88 ± 5.7 months. The survival rates at 2, 3, and 5 years were 75%, 56%, and 41%, respectively. No significant difference was observed between CS and US regarding overall and disease-free survival. Conclusion: Despite the typical early-stage diagnosis for US patients, the 5-year survival rate remains low. This study underscores the pivotal role of FIGO stage, tumor size, and surgical resection as vital prognostic factors for survival. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of bladder volume on the dosimetry of pelvic organs at risk (OARs) in patients treated with external beam radiation therapy. Twenty patients with locally advanced cervical cancer were selected. Two computed tomography-simulation scans were obtained, one with an empty bladder followed by one with a full bladder. The acquired images were transferred to the treatment planning system. Target and OARs were contoured in both images, and treatment plans were performed for each computed tomography image. The delivered doses to target and OARs were determined using dose–volume histograms. The mean dose of the bowel bag in the empty and full bladder were 35.06 ± 4.13 (Gy) and 31.59 ± 3.86 (Gy), respectively. Furthermore, the V 45 of the bowel bag in the empty bladder was 364.27 ± 154.39 (cc) and in the full bladder, it was 240.84 ± 129.66 (cc). The mean dose of the rectum in the empty and full bladder were 49.50 ± 1.95 (Gy) and 49.18 ± 1.03 (Gy), respectively. The rectal V 50 (%) was 52.82 ± 21.84 (%) in the empty bladder and 45.49 ± 29.55 (%) in the full bladder. The mean dose and V 45 of the bowel bag, also V 50 of the rectum, had significantly decreased in the full bladder status (p -value < 0.05). The results showed that the bladder volume significantly affected the delivered dose to the bowel bag and rectum. The average bowel bag V 45 and rectum V 50 in the full bladder were significantly decreased. Bladder distention is an effective method to improve the dosimetric parameters of pelvic OARs. [ABSTRACT FROM AUTHOR]

Background: A growing amount of data has indicated the possibility that tumor location may play a prognostic role in colon cancer. We set out to investigate the relationship between the location of colon cancer (right-sided vs. left-sided) and the patient's oncologic outcome. Methods: This retrospective cohort study included 654 colon cancer patients treated and followed up at Namazi and Faghihi hospitals in Shiraz and Imam Reza Hospital in Mashhad, Iran, between 2005 and 2014. The Cox regression multivariate analysis model was used to determine the most important independent predictors of oncologic outcomes. We analyzed the prognostic impact of the primary tumor location and other clinical, pathological, and treatment-related factors. Results: In the univariate analysis, the prognostic factors for disease-free survival (DFS) were the primary tumor stage (P<0.001), node stage (P<0.001), tumor grade (P=0.013), surgical margin status (P=0.001), lymphovascular invasion (LVI) (P<0.001), and perineural invasion (PNI) (P<0.001). Additionally, the prognostic factors for overall survival (OS) were the primary tumor stage (P<0.001), node stage (P<0.001), tumor grade (P=0.036), LVI (<0.001), PNI (P<0.001), and the mucinous type (P=0.042). In the multivariate analysis, LVI, T3-4 lesions, tumor grade II-III, and an advanced disease stage remained independent prognostic factors for DFS and OS. However, the colon cancer location was not a prognostic factor regarding DFS or OS. Conclusion: Our study indicates that the tumor location is not a significant prognostic factor for DFS and OS in colon cancer patients. [ABSTRACT FROM AUTHOR]

Objective(s): In this work, we propose an efficient preparation process for the synthesis of natural carbon quantum dots (NCQDs) by the usage of orange pericarp as the carbon natural resource, which is performed through hydrothermal treatment and top-down approaches. Materials and Methods: The structural, morphological, average size, and optical properties of synthesized NCQDs were investigated via dynamic light scattering (DLS), transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM), atomic force microscopy (AFM), field emission scanning electron microscope (FESEM), energy dispersive x-ray spectroscopy (EDX), ultraviolet-visible spectroscopy (UV-Vis), and fluorescence PL spectra. Results: The shape of obtained NCQDs was observed to be spherical in the results of TEM analysis with an average size of 6-7 nm which confirms NCQDs essence. The signs of a strong peak (absorption) at around 282 nm throughout the UV-vis spectrum have been detected. The provided FTIR spectroscopy confirmed the existence of functional groups above the NCQDs surface. Furthermore, the surface charge of -11 mV through the obtained zeta potential regarding the synthesized NCQDs has been identified. MTT assay on mouse colon carcinoma cells (C26) demonstrated the lack of any signs of toxicity in NCQDs. Conclusion: The obtained NCQDs contain high photo-stability, excellent PL activity, and efficient fluorescent emission based on excitation. The results of kinetic studies revealed the ability of NCQDs to inhibit trypsin activity in a non-competitive model, which qualifies them as potent inhibitors and quenchers of trypsin. It can be suggested that the synthesized NCQDs have the potential of functioning as a sustainable and eco-friendly source for various applications such as sensors for detecting Ca2+ and Zn2+ and trypsin biosensor for determining enzyme activity. [ABSTRACT FROM AUTHOR]

As a waste material, the amazing potential of cellulose nanocrystals (CNCs) isolated from Citrus medica L. pericarp in being a natural resource of lingo‐cellulosic products has never been investigated before. In the present study, an alkaline pretreatment and a two‐step bleaching procedure were applied to conduct the desired acid hydrolysis by the usage of 64% sulfuric acid at 50°C for 105 min. The extracted CNCs were distinguished through the means of transmission electron microscopy (TEM), field emission scanning electron microscopy (FESEM), X‐ray diffraction (XRD), atomic force microscopy (AFM), Fourier‐transform infrared (FTIR) spectroscopy, dynamic light scattering (DLS), zeta potential, and energy‐dispersive X‐ray spectroscopy (EDX). The elimination of peaks, which were accountable for the inducement of hemicelluloses and lignin, was confirmed by the FTIR results and were also validated by the outcomes of XRD that proved the gentle removal of non‐cellulosic components. The morphology and size of CNCs were indicated through the FESEM and TEM results. In addition, the spherical forms of synthesized CNCs were observed with a diameter of 46 nm throughout the FESEM images, while displaying a value of 42.54 nm as well due to TEM micrographs. The obtained zeta potential displayed a reasonable negative surface charge for CNCs. Furthermore, the cytotoxicity assessment of this product on fibroblast cells was performed to study their susceptibility for bio‐medical and cosmetic industrial applications, which resulted in the lack of exhibiting any cytotoxic effects. In conformity to the outcomes of TEM and FESEM, the results of AFM revealed a fine dispersion and spherical form of cellulose nanoparticles. The interaction between HMG‐CoA reductase and CNC was studied by the usage of multi‐spectroscopic methods and enzyme kinetics to explore the binding mechanism of HMG‐CoA reductase–CNC system. Reduced catalytic activity of the occurrence of changes in the secondary structure of HMG‐CoA reductase was as a result of interacting with CNC causing a reduction in its catalytic activity. [ABSTRACT FROM AUTHOR]

Background: Pre-operative chemoradiotherapy (NACRT) of patients with proximal gastric and esophagogastric junction (EGJ) adenocarcinoma may result in increased local control and improved patients' survival rate. This study aimed to investigate the effect of NACRT on resectability of tumor in patients with proximal gastric and EGJ adenocarcinoma. Methods: In this single-arm clinical trial, patients with locally advanced proximal gastric and EGJ adenocarcinoma were included. Two courses of paclitaxel/carboplatin chemotherapy alone followed by NACRT with a similar treatment regimen and a total radiation dose of 45-50.4/1.8-2 Grays were prescribed. After surgery, patients were evaluated for resection rate, pathologic response rate, and post-surgical complications. Results: A total of 61 patients with a mean age of 65.9 years participated. Grades 1 and 2 were the most prevalent side effects, with grade 3 being the worst grade and exhibiting as leukopenia (4.9%) and thrombocytopenia (1.6%). 25 (41%) patients underwent surgery after NACRT. Post-surgery complication was reported in 20% of cases (including 8% mortality and 12% morbidity). R0 and R2 resection was observed in 88% and 12% of cases, respectively. Complete pathologic-response was achieved in 24% of patients. Conclusion: Paclitaxel/carboplatin based neoadjuvant chemotherapy was associated with potential resectability and appropriate pathologic response in patients with locally advanced proximal gastric and EGJ adenocarcinoma. However, by reducing patient tolerance to complete courses of weekly chemotherapy, induction chemotherapy lowered the effectiveness of concurrent chemotherapy and radiotherapy (as a sensitizing agent). Hence, induction chemotherapy proved to be more unbeneficial causing delayed treatment and reducing concurrent chemoradiotherapy tolerance. [ABSTRACT FROM AUTHOR]

Background: The northeast of Iran is one of the endemic regions of human T-cell lymphotropic virus type-1 (HTLV-1). This study aimed to evaluate the relationship between nasopharyngeal carcinoma and HTLV-1 infection in northeast Iran, an endemic area for HTLV-1. Methods: In this case-control study, paraffin-embedded nasopharyngeal tissue samples of patients with definitive nasopharyngeal carcinoma were evaluated for the presence of the HTLV-1 genome by polymerase chain reaction retrospectively. Results: Thirty patients with nasopharyngeal carcinoma and 30 healthy people were evaluated. All participants were matched in terms of age and gender, and all were living in Mashhad. The HTLV-1 genome was detected in only one of the people in the healthy group. Conclusions: The HTLV-1 infection and nasopharyngeal carcinoma did not correlate significantly. [ABSTRACT FROM AUTHOR]

To compare the cosmetic outcome and acute cutaneous, cardiac, and pulmonary toxicity profile of accelerated hypofractionated and conventional whole breast radiotherapy (WBRT).This was a blocked randomized, clinical trial on women with early-stage node-negative invasive breast cancer after breast conservation surgery (BCS) with clear margins randomly assigned to receive WBRT either at a conventional dose of 50.0 grays (Gy) in 25 fractions (the conventional group) or at a dose of 42.5 Gy in 16 fractions (the hypofractionated group). Boost irradiation was permitted in both groups. Data were analyzed by SPSS V21.0 using Mann-Whitney U, independent-samples t- and Chi-Square/Fisher's exact tests at the level of P=0.05.The median follows up was 16 months. Forty-one patients in the conventional WBRT arm and 45 patients in the hypofractionated WBRT group were enrolled. No significant difference was observed in terms of left and right ventricle systolic dysfunction and diastolic dysfunction. Pulmonary function tests after 6 and 12 months follow up, were comparable in both groups (P=0.2). Skin toxicity during and after treatment was acceptable in both groups. Breast size change in the conventional and the hypofractionated WBRT groups was 14.3% and 7.1%, respectively (P=0.6). Excellent or good cosmetic outcome was similar in both groups. The results of our study support the use of accelerated hypofractionated WBRT in women with invasive breast cancer less than five cm and node-negative after breast-conserving surgery, which provides a more convenient shorter course of radiotherapy with a comparable cosmetic outcome and cutaneous, cardiac, and pulmonary toxicity profile. [ABSTRACT FROM AUTHOR]

Objective(s): Hepatocellular carcinoma (HCC) is one of the most significant health condition around the world. As the only curative therapies, liver transplantation and surgical resection are the clinical treatments of HCC. Due to the systemic toxicity and severe side effects of these treatments, it is vital to establish new therapeutic approaches. The present study aimed to compare cyclin D1 (CCN D1) gene expression in hepatocellular carcinoma cell line (HUH7) when it is treated with nanomicelle curcumin and sorafenib. The purpose was to identify toxicity risk and antioxidant activity of these drugs. Materials and Methods: The toxic dose (IC50) of nanomicelle curcumin and sorafenib were detected after treatment of HUH7 cell lines with different dose of mentioned agents followed by MTT assay. CCN D1 gene expression was evaluated using real-time PCR. Following the Tukey’s multiple comparison tests, statistical analysis is done through Student’s t-test or ANOVA. Results: The expression of the CCN D1 gene was statistically significant (P<0.001) at 289.31, 128 and 152.36 for sorafenib, nanomicelle curcumin and SNC (sorafenib-nanomicelle curcumin) respectively. The finding of this study revealed that, in comparison to sorafenib alone, the treatment of HUH7 with a nanomicelle curcumin IC50 dose, in combination with sorafenib, might down-regulate CCN D1 gene expression. Conclusion: The present research indicates that the treatment of the cell line with only nanomicelle curcumin results in the down-regulation of cyclin D1. To further decrease cyclin D1 expression, the co-delivery of curcumin and sorafenib appears to induce the apoptotic process. As a result, the effect of sorafenib cytotoxicity and CCN D1 gene expression decreases twofold. [ABSTRACT FROM AUTHOR]

The current treatment approaches for esophageal cancer are associated with poor survival, and there are ongoing efforts to find new and more effective therapeutic strategies. There are several reports on the antitumoral effects of low‐molecular‐weight heparins (LMWHs). We have assessed the possible survival benefit of LMWHs in esophageal malignancies. This was a randomized, single‐blind, multicenter, Phase II clinical trial on nonmetastatic esophageal cancer candidate for neoadjuvant chemoradiotherapy. Patients were randomly assigned to the chemoradiotherapy‐only arm or chemoradiotherapy plus enoxaparin arm using 1:1 allocation. Radiotherapy was delivered in 1.8‐Gy daily fractions to a dose of 50.4 Gy in both groups. Paclitaxel 50 mg/m2 and carboplatin (AUC 2) were administered weekly, concurrent with radiotherapy. In the intervention group, patients received enoxaparin (40 mg) and chemoradiation daily. 4–6 weeks after treatment, all patients underwent esophagectomy. After a median follow up of 7 months, estimated 1 year disease‐free survival (DFS) in the intervention group was 78.9% and was 70% in the control groups (p = 0.5). Toxicity from the experimental treatment was minimal, and there were no treatment‐related deaths. A pathologically complete response in intervention and control group was 64.8% and 62.5%, respectively (p = 0.9). There was a nonsignificant trend toward improved survival by the addition of enoxaparin to the concurrent chemoradiotherapy regimen. However, 1 y DFS of both groups were high as expected. A longer follow‐up and a larger sample size are required. Text and image files are complete and in correct format(s) for production [ABSTRACT FROM AUTHOR]

Radiation-induced dermatitis is one of the most common side effects of radiotherapy. Silymarin, a flavonoid extracted from the Silybum marianum, exhibits antioxidant and anti-inflammatory activities. The purpose of this study was to investigate the efficacy of silymarin gel in prevention of radiodermatitis in patients with breast cancer. During this randomized, double-blinded, placebo-controlled clinical trial, the preventive effect of silymarin 1% gel was assessed in comparison with placebo, on radiodermatitis occurrence. Forty patients randomly received silymarin gel or placebo formulation on chest wall skin following modified radical mastectomy, once daily starting at the first day of radiotherapy for 5 weeks. Radiodermatitis severity was assessed weekly based on Radiation Therapy Oncology Group (RTOG) and National Cancer Institute Common Terminology for Adverse Events (NCI-CTCAE) criteria radiodermatits grading scale for 5 weeks. The median NCI-CTCAE and RTOG scores were significantly lower in silymarin group at the end of the third to fifth weeks (p value < 0.05). The scores increased significantly in both placebo and silymarin groups during radiotherapy, but there was a delay in radiodermatitis development and progression in silymarin group. Prophylactic administration of silymarin gel could significantly reduce the severity of radiodermatitis and delay its occurrence after 5 weeks of application. [ABSTRACT FROM AUTHOR]

Background: The incidence of esophageal squamous cell carcinoma (ESCC) is increasing, causing catastrophic health burdens on communities. Curcumin has shown promise as a therapeutic agent in the treatment of colon, colorectal, pancreatic, and esophageal cancers but it has very poor bioavailability. The application of nano-carriers as drug delivery systems increases curcumin's bioavailability. Cyclin D1 is overexpressed in ESCC and curcumin may change its expression. Methods: In this study, the effect of SinaCurcumin®, a novel nano-micelle product containing 80 mg curcumin, on the growth of KYSE-30 cells and expression of cyclin D1, was investigated. Paclitaxel and Carboplatin served as reference drugs. Results: Nano-curcumin increased cell cytotoxicity, decreased IC50, and down-regulated of cyclin D1. However, treatment of cells with nano-curcumin might result in multidrug resistance. Conclusions: Nano-curcumin suppressed proliferation of KYSE-30 cells and expression of cyclin D1 although its use in combination with other chemotherapeutic agents requires further testing. [ABSTRACT FROM AUTHOR]

Background: Cancer is the third leading cause of death in Iran. Novel chemotherapeutic agents can lead to considerable improvements in cancer treatment, although using these agents requires special skills and experiences. The aim of this study was to evaluate the impact of a short course education on nurses' knowledge and attitude. Methods: Overall, 24 nurses participated in this short educational course, supervised by several clinical/radiation oncologists. During a two-week period, several protocols of chemotherapy, complications associated with chemotherapy, and the management of adverse outcomes was taught to the participants with a special emphasis on nursing considerations. Before the program and at the end of the course, the Multiple Choice Questionnaire (MCQ) and Direct Observation of Procedural Skills (DOPS) were used for evaluating the effectiveness of the program on the participants' knowledge. Changing their attitude was also evaluated by an author-made Questionnaire. The mean knowledge and attitude scores before and after the interventions were compared using paired t-test. Results: Overall, Four participants (16%) were male and 20 (83%) were female. The majority of the subjects (90%) worked at chemotherapy wards. Sixteen (66%) versus twenty two (91%) nurses achieved a minimum score of 70% on MCQ before and after the course, respectively (p=0.03). The mean scores before and after the course were 18.7-8.6 versus 26-11 for MCQ (p=0.03) and 30.3-10 versus 45.3-14 for DOPS (p=0.004). The mean of attitudes' score were 3.93-1.7 and 4.04-1.2 before and after the course, respectively, that showed a significant difference (p=0.01). Conclusions: Short educational courses about major subjects in oncology nursing could improve nurses' knowledge and attitude. [ABSTRACT FROM AUTHOR]

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

Background: The present study aimed to compare the rates of complete clinical and pathologic response to docetaxel, doxorubicin and cyclophosphamide (TAC) vs. 5-fluorouracil, doxorubicin and cyclophosphamide (FAC) as neoadjuvant chemotherapy in women with locally advanced breast cancer. Methods: One hundred women with pathologically confirmed newly diagnosed locally advanced (T3-T4 or N2-N3) breast cancer were randomly assigned to receive a median of four cycles of either 5-fluorouracil (600 mg/m2), doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) every three weeks or docetaxel (75 mg/m2), doxorubicin (50 mg/m2) and cyclophosphamide (500 mg/m2) every three weeks followed by modified radical mastectomy. Complete clinical and pathologic response rates and toxicity were the primary and secondary outcome measures of the study. Results: Median age for all patients was 43.4 years (range 25-63 years). Patients in the TAC arm achieved a higher clinical (16%) response rate than those in the FAC arm (4%, P=0.046). The pathologic response rate was also higher in the TAC arm compared to the FAC arm [TAC (20%) vs. FAC (6%), P=0.037]. Estrogen receptornegative status correlated with a higher clinical [TAC (19%) vs. FAC (4%), P=0.032] and pathologic [TAC (23%) vs. FAC (4%), P=0.011)] response rate in both arms. All patients generally tolerated treatment well, and treatment-related toxicities were manageable. Conclusion: Combined treatment with TAC led to higher rates of complete clinical and pathologic response with acceptable toxicity compared to FAC in patients with locally advanced breast cancer. However, further follow-up is needed to translate this response into improvements in survival. [ABSTRACT FROM AUTHOR]