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ABSTRACT Objectives Metastasis to the oral soft tissues and jaw is rare and accounts for 1%–3% of maxillofacial malignancies. These lesions usually occur in the context of an extensive malignant tumor with a poor prognosis. Materials and Methods Archived cases from the Oral and Maxillofacial Pathology Department of the Faculty of Dentistry and two hospital centers of Mashhad University of Medical Sciences were examined. Inclusion criteria were cases with available records of pathologically confirmed metastatic lesions of the oral cavity with or without diagnosed primary malignancy. Results Metastatic lesions in the oral cavity and jaw were found in 18 patients, including seven women and 11 men, with a mean age of 49.5 years. Metastatic lesions were more common in the jaw (66%) and particularly in the mandible (38%) than elsewhere. In the case of soft tissue metastases, the gingiva was more affected than other sites. The primary tumor was most commonly in the kidney in men and in the breast in women (36%–28%). In addition, the diagnosis of a metastatic lesion led to the detection of the primary tumor elsewhere in six out of 18 cases (33.3%). Conclusions Early diagnosis of the lesions is challenging, given the absence of specific signs or symptoms, which, in some cases, nonetheless resemble inflammatory, benign, reactive lesions. Therefore, dentists play a crucial role in diagnosing such lesions, as they lead to the discovery of hidden distant primary tumors. Biopsy should always be considered for suspicious lesions, even if the probability is very low.

Papillary tumor of the pineal region (PTPR) is an infrequent neoplasm arising from the ependymal cells of the sub-commissural organ. This tumor entity was incorporated into the World Health Organization (WHO) classification of central nervous system tumors in 2007. Given the propensity for local recurrence observed in PTPR cases and the documented instances of leptomeningeal seeding in previous case reports, it presents a substantial risk of significant morbidity. Due to its rarity, there is no established standard for its management. Surgical intervention constitutes the primary treatment modality, while the role of adjuvant radiotherapy remains ambiguous. In this case report, we present the clinical course of a 46-year-old male diagnosed with PTPR who underwent surgical resection followed by adjuvant radiotherapy. 14 months post-initial treatment, the patient manifested intracranial and spinal metastases in the form of leptomeningeal dissemination. Subsequently, systemic chemotherapy utilizing vincristine and carboplatin was initiated, and the patient exhibited no evidence of disease progression over the last six months.

ObjectiveEsophageal 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).MethodsThis 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.ResultsOut 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 near-complete responses (71.9%, 23 patients). Partial response was reported in 6 patients (18.8%) and poor response in 3 patients (9.4%).ConclusionPreoperative 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.Clinical trial registrationhttps://irct.behdasht.gov.ir/trial/59930, identifier NCT05745545.

Background: This study aimed cohort study aimed to evaluate the relationship between the depth of invasion (DOI) and the lymphocytic host response (LHR) in oral squamous cell carcinoma (OSCC) biopsies with various clinicopathological characteristics of the disease.Materials and Method: Eighty-seven OSCC biopsy samples were obtained and key patient data such as clinical stage, grading, nodal involvement, overall survival (OS), and disease-free survival (DFS) were collected. DOI was measured from the basement membrane to the deepest invasion point, classifying samples into low risk (DOI < 4 mm) and high risk (DOI > 4 mm) categories. Additionally, LHR in the DOI was categorized as mild, moderate, or severe. The Chi-squared and Fisher’s exact test and Kaplan-Meier analysis were used for data analysis. The significance level was set at 0.05.Results: The findings revealed that 43.7% of patients fell into the low-risk DOI category, while 56.3% were in the high-risk group. LHR levels varied, with 36.8% mild, 18.4% moderate, and 44.8% severe. Most patients were in stage IV (31%) and grade I (60.9%). A significant relationship was found between the high-risk DOI group and several factors: disease stage (p < 0.001), grading (p = 0.021), five-year OS (p=0.001), five-year DFS (p < 0.001), and lymph node involvement (p < 0.001). Moreover, a significant relationship existed between LHR and the disease stage (p = 0.003) and lymph node involvement (p = 0.001).Conclusion: Incorporating DOI into routine histopathological reports could be beneficial in predicting OSCC prognosis, especially in early stages. This underscores the importance of histopathological evaluations in OSCC treatment planning, highlighting the value of DOI and LHR in understanding the disease's clinicopathological aspects.

PurposeMaximum safe surgical resection followed by adjuvant chemoradiation and temozolomide chemotherapy is the current standard of care in the management of newly diagnosed high grade glioma. However, there are controversies about the optimal number of adjuvant temozolomide cycles. This study aimed to compare the survival benefits of 12 cycles against 6 cycles of adjuvant temozolomide adults with newly diagnosed high grade gliomas.MethodsAdult patients with newly diagnosed high grade gliomas, and a Karnofsky performance status>60%, were randomized to receive either 6 cycles or 12 cycles of adjuvant temozolomide. Patients were followed-up for assessment of overall survival (OS) and progression-free survival (PFS) by brain MRI every 3 months within the first year after treatment and then every six months.ResultsA total of 100 patients (6 cycles, 50; 12 cycles, 50) were entered. The rate of treatment completion in 6 cycles and 12 cycles groups were 91.3% and 55.1%, respectively. With a median follow-up of 26 months, the 12-, 24-, 36-, and 48-month OS rates in 6 cycles and 12 cycles groups were 81.3% vs 78.8%, 58.3% vs 49.8%, 47.6% vs 34.1%, and 47.6% vs 31.5%, respectively (p-value=.19). Median OS of 6 cycles and 12 cycles groups were 35 months (95% confidence interval (CI), 11.0 to 58.9) and 23 months (95%CI, 16.9 to 29.0). The 12-, 24-, 36-, and 48- month PFS rates in 6 cycles and 12 cycles groups were 70.8% vs 56.9%, 39.5% and 32.7%, 27.1% vs 28.8%, and 21.1% vs 28.8%, respectively (p=.88). The Median PFS of 6 cycles and 12 cycles groups was 18 months (95% CI, 14.8 to 21.1) and 16 (95% CI, 11.0 to 20.9) months.ConclusionPatients with newly diagnosed high grade gliomas treated with adjuvant temozolomide after maximum safe surgical resection and adjuvant chemoradiation do not benefit from extended adjuvant temozolomide beyond 6 cycles.Trial registrationProspectively registered with the Iranian Registry of Clinical Trials: IRCT20160706028815N3. Date registered: 18/03/14.

Background: Oral squamous cell carcinoma (OSCC) is the most common oral cavity cancer and may occur following oral epithelial dysplasia (OED). Cancer stem cells (CSCs) can self-renew and multi-directionally differentiate to promote tumorigenesis with high expression of cluster of differentiation (CD) 24 and CD44 markers. CSCs play a pivotal role in tumor development, drug resistance, and relapse after treatment. We aimed to evaluate the correlation between both marker expressions and clinicopathological indices in OED and OSCC patients. Materials and Methods: In this follow-up study, we could access 37 patients, including 12 OEDs and 25 OSCCs (Grade I: n = 9, Grade II: n = 8, and Grade III: n = 8). Data were analyzed using SPSS software (version 26) and log-rank tests, Fisher’s exact test, Chi-square, and one-way ANOVA. P < 0.05 was considered statistically significant. Results: There was no significant difference in the expression of CD24 and CD44 markers between the study groups (P > 0.05) and the expression of both markers and clinicopathological indices in the study groups (P > 0.05). The mean and standard deviation of overall survival (OS) were 54.46 ± 43.08 with a range of 6–193 months, and they were 8.24 ± 15.34 months with a range of 0–70 months for disease-free survival (DFS) in patients, respectively. The average of DFS in Grade I was significantly lower than the OED (P = 0.002) and Grade II (P = 0.039) groups. The OS average in the Grade I (P = 0.014) and Grade III (P = 0.004) groups was statistically lower than the OED group. Conclusion: Although more than half of the patients demonstrated high expression of both markers, there was no statistically significant difference between them and clinicopathological indices.

Brain glioblastoma multiforme with leptomeningeal metastasis is a rare medical condition. Although autopsy series have demonstrated a higher incidence of leptomeningeal metastasis, it is usually a late complication in the course of the disease. The disease progression is almost always rapid, resulting in a poor performance status and short survival. There is no single standard treatment but different individualized choices including chemotherapy (standard, anti-angiogenic, intrathecal, immunotherapy), and radiation have been utilized. In this manuscript, we report a male patient with glioblastoma multiforme of left prefrontal lobe that presented with concomitant cervical leptomeningeal metastasis. Because of poor performance, he received hypofractionated radiotherapy of brain and cervical spine which consisted of a total dose of 45 Gy in 10 fractions with 300c Gy per fraction and 30 Gy local boost to the areas of enhancement. Despite this treatment, there was no response and the patient died three days after the completion of the treatment.

[68Ga] Ga-labeled C-X-C motif receptor4 as a novel radio-ligand using PET/CT has been investigated for tracing various kinds of solid and hematopoietic malignancies in recent years. High-grade Glioma (WHO classification 2016 grade III and IV) shows elevated levels of CXCR4 ligand expression in the affected tumoral cells. Healthy and non-affected organ cells express low-level CXCR4 ligands density. We performed [68Ga] Ga-Pentixafor (Pars-Cixafor™) PET/CT in a patient with high-grade Glioma (anaplastic oligodendroglioma WHO grade III) with no other documented medical condition and history. In addition to the Pentixafor-avid tumor remnant in the PET/CT images, we observed mild symmetrical bilateral uptake in the fibro glandular tissue of the breasts and moderate CXCR4(Pentixafor) avidity in both adrenal glands without any discernable pathology and abnormal density changes in the CT component of the study. Attention should be paid to the interpreting [68Ga] Ga-Pentixafor PET/CT examination and its normal uptakes and variants.

Introduction: This study aims to investigate the effectiveness of mindfulness-based cognitive therapy in depression and serum cortisol levels in women with breast cancer and depressed women. Materials and Methods: In this clinical trial, 30 women with breast cancer who referred to Omid Hospital, Mashhad-Iran and 30 women with depression who referred to counseling clinics of Mashhad in 2020-2021 were selected by the convenience sampling method and were randomly assigned to four equal groups (2 experimental groups and 2 control groups). The experimental groups received mindfulness-based cognitive therapy during eight 90-120 minute sessions per week, while the control group did not receive any intervention. Research instruments included the Depression Inventory (BDI-II) and the blood samples to evaluate the cortisol levels. Data were analyzed through descriptive statistics, and the covariance analysis. Results: The results of depressed people demonstrated that mindfulness-based cognitive therapy is effective to reduce depression and serum cortisol levels within the normal laboratory range (P< 0.001). Further, the findings of breast cancer women indicated that mindfulness-based cognitive therapy reduced depression and increased serum cortisol from low to moderate levels within the normal laboratory range (P< 0.001). Conclusion: Mindfulness-based cognitive therapy can be effective in neurobiological mechanisms in addition to improving psychological symptoms in depressed individuals and cancer patients.

Introduction: Exquisite soft tissue contrast of magnetic resonance images (MRI) and the new combined radiotherapy system of MR-Linac have been the main impetus for applying MR imaging in radiotherapy. One limitation of MR-based radiotherapy is the geometric distortion of MR images that can generate errors in the contouring and dosimetry stages. This study aimed to evaluate and correct geometric distortion for radiotherapy applications. Material and Methods: A large field of view (FOV) phantom develop using Perspex sheets and 325 plastic pipes. The quantification and correction of MR images' system-related geometric distortion are conducted for HASTE protocol by MATLAB and 3D slicer software in phantom and patient images. The effect of MRI images geometrical distortion was evaluated for ten patients undergoing body radiotherapy treatment. CT images were used as a primary dataset to estimate the distortion map. Results: The phantom investigation results indicate that in radial distances of < 13 cm (or FOVs < 25 cm), the amount of distortion is under 2 mm. Still, at more considerable radial distances, distortion may increase up to about 3.5 cm. MR images of Patients with lateral (LAT) and anterior-posterior (AP) diameters of more than 38 cm and 25 cm respectively, need to be corrected for geometric distortion. Conclusion: MR images' geometric precision in large FOVs is not sufficient for MRI only treatment planning of radiotherapy and further corrections are required. The B-spline deformable registration method can correct the MR geometric distortion until an acceptable range of 2 mm for radiotherapy applications.

Background & Objective: The present study investigated the relationship between invasive front (IF) of tumors and clinicopathological parameters including stage, grade, nodal involvement, lymphocytic host response (LHR), recurrence, overall survival (OS), and disease-free survival (DFS).Methods: A total of 87 oral squamous cell carcinoma (OSCC) biopsies were evaluated. Clinical stage, grading, nodal involvement, time of recurrence, OS, and DFS were assessed. The number of tumor budding cells in the IF was measured by two pathologists with an optic microscope. IF was graded to low risk (5), according to the counting of tumor budding as a single cancer cell or cluster cells. Also, LHR was reported in the IF as mild, moderate, and severe.Results: IF was reported in 43.7% of patients as a low-risk group and 49.4% as a high-risk group. LHR was also mild in 31%, moderate in 25.3%, and severe in 43.7% of the patients. Most of the patients were in stage IV (31%) and grade 1 (60.9%). The high risk IF group had a significant statistical relationship with stage (P=0.001), grade (P=0.039), five years OS (P=0.03), five years DSF (P=0.01), and lymph node involvement (P=0.007). The relation between LHR and stage of disease was significant (P=0.034).Conclusion: Considering the important role of histopathological reports in the treatment plan of patients and the relationship between IF and clinical parameters, IF evaluation in routine histopathological examinations, especially in the early stages of OSCC, seems to be necessary.

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.

Background & Objectives: Glioblastoma is the most common primary malignancy of the brain, the prognosis of which is poor. Immunotherapy with cancer/testis (CT) antigens is a novel therapeutic approach for glioblastoma. This study aimed to investigate the expression rate of MAGE-E1, GAGE, and SOX-6 in glioblastoma tumors using the immunohistochemistry (IHC) method. Materials & Methods: Expression of MAGE-E1, GAGE, and SOX-6 were determined by IHC in 50 paraffin blocks of glioblastoma. The results were compared between variables including age, gender, tumor location, and Karnofsky performance status (Kps) score. Survival analysis was also performed. Results: The expression levels of SOX-6, MAGE-E1, and GAGE were 82%, 78%, and 76%, respectively. The relationship between CT antigens and age, gender, and tumor location was not significant, while the association between MAGE-E1 expression and age was statistically significant (p =0.002). High expression levels of SOX-6 and MAGE-E1 were associated with low Kps scores (p =0.034 and p 40 and Kps score p =0.005 and p =0.018, respectively). Expression of MAGE-E1 and GAGE was negatively associated with overall 2-year survival (p =0.001 and p =0.021, respectively). Conclusion: The expression of all the three CT antigens, especially MAGE-E1 and SOX-6, was high in patients with glioblastoma. It can be concluded that these markers are ideal targets for immunotherapy in these patients. MAGE-E1 and SOX-6 can be considered as important markers in determining the prognosis of glioblastoma.

Background:Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity. Despite some improvements in treatment, the survival rate is still very low, mainly due to the possible development of secondary malignancy or metastasis. Clinical and pathological features as well as molecular biomarkers might predict the recurrence. In recent years, many studies have been carried out on molecular biomarkers that can predict the prognosis of OSCC. One of these markers is the epidermal growth factor receptor (EGFR), which has led to different results. The aim of this study was to determine EGFR level in OSCC and to analyze its correlation with clinicopathological features. Methods: A total of 62 paraffin-embedded samples from OSCC patients treated in the oncology department of the Omid Hospital in the city of Mashhad, Iran were selected and EGFR staining was performed. The clinical and histopathological data were extracted from the medical records. Results: EGFR expression was positive in 98.4% of the cases. There was a significant difference between EGFR expression in the tumor and control cases in terms of cellularity and intensity (p˂0.001 and p=0.004, respectively). No statistically significant correlation was observed between EGFR and clinicopathological parameters. There was also no significant relationship between the cellularity and intensity expression of EGFR and patient survival (p=0.92 and p=0.42, respectively). Conclusion: In view of the high EGFR expression in squamous cell carcinoma, further studies on the role of EGFR in cell processes such as proliferation, angiogenesis and differentiation of the tumor are recommended.

Abstract Primary central nervous system lymphoma (PCNSL) is a rare form of non‐Hodgkin lymphoma. In this report, we present 11 cases of PCNSL which were treated with high‐dose MTX and WBI with a localized radiation boost to the tumor bed.

Introduction: The present study was conducted to implement a simple practical independent quality check of depth dose and isotropy of the Intrabeam™ therapeutic X-ray machine using radiochromic EBT2 film. Material and Methods: Theindependent quality check of 1.5, 3.5, and 5-cm spherical Intrabeam™ applicators was accomplished using particular EBT2 film cutting pieces with internal rounded edges in a water phantom. Prior to this measure, the film was calibrated at three distances from the 5-cm applicator in water to clarify the effects of beam spectrum and dose rate alteration on film response. To this end, three calibration curves were plotted. Results: The results of the one-way analysis of variance showed a critical difference between film pieces receiving equal doses at various distances (P

Background: The standard of care for glioblastoma is concurrent chemoradiotherapy and adjuvant chemotherapy with Temozolomide. In this trial, we have investigated the impact of MGMT promoter methylation on prognosis and benefit from Temozolomide based chemotherapy in a group of patients with glioblastoma in our region. Methods: This retrospective study included glioblastoma patients treated in our institute between 2006 and 2011. We used methylation specific PCR to detect methylation in the promoter region of the MGMT gene. The Kaplan-Meier technique was used to calculate overall survival from the time of diagnosis to the time of death. We utilized the log-rank test and Cox-regression model for univariate and multivariate analyses of potential prognostic factors. Results: There were 78 patient participants with a median age of 50 (range: 20 to 75) years and a male to female ratio of 56/22. All patients underwent minimal surgical resection which was considered as a biopsy. All patients received adjuvant radiotherapy with a median dose of 60 Gy (54-60 Gy) and 25 patients received concomitant Temozolomide. The MGMT promoter methylation was found in 19 (24.4%) patients and was relatively more frequent in men (28.6%) compared to women (13.6%; P=0.16).This genetic change was associated with a significantly higher 2-year survival in men (57.2%) compared to women (16.8%; P

Background: Melanoma is a neoplasm derived commonly from melanocytic cells of skin. Although coetaneous presentation of malignant melanoma is easily recognizable, the presentation of melanoma in other organs is so confusing. In particular, when it metastasizes to other organs, many bizarre figures and unusual organs may be involved. In this report, we present a case of primary duodenal malignant melanoma. Case Presentation: A 68-year-old man presented with a history of iron deficiency anemia. The upper gastrointestinal endoscopy showed a prominent papilla of duodenum along with an ulcerative lesion adjacent to second part of duodenum. Histopathologic evaluation showed a high-grade malignant neoplasm involving the bowel wall which was labeled for S100 protein and markers of melanocytic differentiation; Melan-A indicating the definitive diagnosis of malignant melanoma of the second portion of duodenal mucosa. Conclusions: In patients with a history of iron deficiency anemia, any GI symptom should be evaluated carefully. However, the diagnosis of primary GI melanomas in patients without any history of melanoma is possible. Full medical investigations are recommended in these patients with primary mucosal lesions.

Introduction: Esophageal squamous cell carcinoma is among the leading causes of cancer related deaths within gastrointestinal tumors. There is a growing body of evidence that shows an association between Epstein Barr virus infection and the development of malignancies such as B-cell non-Hodgkin’s lymphoma, Hodgkin’s disease, and Burkett’s lymphoma. However its potential association with esophageal squamous cell carcinoma is controversial. Therefore, in the present study, we have explored the association of Epstein Barr virus with pathological information and clinical outcomes of 108 esophageal squamous cell carcinoma patients. Methods: There were 48% female and 52% male patients with a mean age of 59.2±11.1 years who enrolled in this study. Patients had the following tumor stages: T1 (5.6%), T2 (21.3%), and T3 (71.3%). A total of 32.4% had lymph node metastases. In order to explore whether patient characteristics might influence clinical outcome, we analyzed data on progression-free survival and overall survival according to patients’ clinicopathologic features. Results: An association existed between tumor size, node and metastasis status, and stage with shorter overall and progression-free survival. We observed that 6.5% of patients had Epstein Barr virus. All patients infected with Epstein Barr virus had T2 and T3 disease. Conclusion: Our findings demonstrated the presence of Epstein Barr virus in 6.5% of Iranian patients and its potential link with tumor size. Additional studies in multicenter settings should be conducted to determine the association of Epstein Barr virus with development and progression of esophageal squamous cell carcinoma.

Introduction: Melanoma-associated antigen 1 (MAGE1) expression in normal tissues is restricted to the testes, whilst being over-expressed in a number of human cancers. This feature of MAGE1 makes it a promising cancer biomarker. This study aimed to determine the expression of MAGE1 in esophageal squamous cell carcinoma (SCC) and its relationship with clinicopathological factors. Methods: This is a cross-sectional study conducted on pretreatment endoscopic tissue specimens of 43 patients with non-metastatic esophageal SCC, admitted to Omid Hospital, Mashhad, Iran, between 2011 and 2013. Out of 127 esophageal SCC patients who had already enrolled in a trial of trimodality therapy, we chose 43 patients whose paraffin blocks of endoscopic samples were accessible, which we then stained for MAGE1 expression by immunohistochemistry. Correlation of MAGE1expression and clinicopathological data (age, sex, stage, grade, and outcome) was assessed using SPSS 16 by T test, chi-square, and Pearson tests (p

Background and Purpose: The goal of this study is application of the proportional hazards model (PH) and accelerated failure time model (AFT), with consideration Weibull distribution, to determine the level of effectiveness of the factors affecting on the level of disease-free survival (DFS) of the patients with breast cancer. Materials and Methods: Based on the retrospective descriptive studies, 377 female patients with primary breast cancer that had been treated at oncology section (Omid Hospital) in Mashhad, Iran, were considered for participation in the study. Results: The median was 2 years and 10 months (mean 2 years and 4 months, interquartile range 3 years and 7 months, range 1-2920 days or 8 years). The average age of patients was 49.2 ± 11.5 (range 25-80 years). The rate of DFS determined with 52.5%. Base on the result of PHs Weibull model, the risk of the metastasis after surgery in the patients with invasive tumors to the skin and chest and positive lymph node was more than 2 times [hazard ratio (HR) = 2.53; confidence interval (CI): 1.26, 5.06] and (HR = 2.37 CI: 1.42, 3.98), respectively. Hormone therapy after surgery decreases the risk of the metastasis to 0.63% (HR = 0.63; CI: 0.41, 0.95). In the AFT model, characteristic tumor decelerated (γ < 1) the DFS time by a factor of 0.30 and 0.33, respectively. Furthermore, the hormonal therapy accelerated (γ > 1) the DFS time by factor of 1.8. Conclusion: In this study, the PH and AFT assumption have been satisfied by data and characteristics tumor and the hormonal therapy decrease and increases time until recurrence, respectively.

Background: Pretreatment anxiety is one of the most common problems in patients undergoing radiotherapy, especially for the first time. There are limited and contradictory studies on the effect of multimedia as compared with common education methods. This study was intended to evaluate the effect of pretreatment multimedia on patient anxiety in the head and neck cancer radiotherapy setting. Methods: In a randomized clinical trial, 66 patients who resided in eastern Iran were recruited from three cancer treatment centers. The experimental group (n = 33) received a 20-minute multimedia presentation, while its print version of the same content was applied in the control group (n = 33). The study measure was evaluated by the Spielberger State-Trait Anxiety Inventory (STAI), which was answered by the participants at baseline after the visit by a cancer specialist deciding on radiotherapy and 2 weeks later prior to the starting of the treatment. Results: The findings indicated that statistically significant differences were observed in anxiety scores between the groups with multimedia as compared to the control (p = 0.009). Pamphlet-associated education led to a notably larger mean difference in anxiety score between the baseline score and two-week posttreatment score in the controls than multimedia version in the experimental group (p

Background: Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma. Materials and Methods: Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated. Results: One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. There were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%. In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confidence interval, 24.46-63.54). Conclusion: The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high.

In this research Glioblastoma has been studied as one of the most common brain tumors and a short review of the available therapeutic methods have presented including surgery, radiotherapy, chemotherapy and particularly adjuvant chemotherapy with temozolomide, as the most effective developed treatment. Moreover, MGMT gene promoter methylation has been introduced as an important predictive factor of treatment response to temozolamide. The different mechanisms of methylation and the availableliterature on its association with patient survival and disease recurrence have been summarized. Taken together, Glioblastoma is a tumor in which the MGMT gene expression can potentially deliver the highest amount of data in comparison to other tumors; as almost every related study has emphasized on the direct association between MGMT methylation and patient survival. Regarding this debate, the pseudoprogression pattern in Glioblastoma patients and the laboratory methods studying MGMT gene methylation have been examined. At the end of this review, the obstacles to its development have been briefly mentioned.

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

Esophageal squamous cell carcinoma (ESCC) is one of the most frequent malignancies, worldwide. It is important to find out what prognostic factors can facilitate diagnosis, optimize therapeutic decisions, and improve the survival of these patients. Despite improvements in surgical techniques combined with chemotherapy and/or radiotherapy, the novel therapies such as small molecule inhibitors of tyrosine kinases (TKIs) and humanized monoclonal antibodies (mAbs) are very much needed. On the other hand, neoadjuvant chemotherapy which may improve the outcome is accompanied by toxicity by destruction of normal cells. Side effects may be avoided by developing therapies that specifically target molecular characteristics of tumors. Epidermal growth factor receptor (EGFR) is one of tyrosine kinases receptors widely distributed in human epithelial cell membrane. Genetic polymorphisms in EGFR genes influence cell cycle progression, angiogenesis, apoptosis and metastasis. EGFR mutations are mostly observed in lung tumors; curiously they are more prevalent in Asian women diagnosed with adenocarcinoma. Also, esophageal SCC shows a relatively high incidence of EGFR (33%) and/or HER2 (31%) overexpression. Patients who carry these mutations in EGFR have been founded tending to have a better response to gefitinib, an EGFR-TKI, whereas patients with the wild-type genotype show a better response to conventional chemotherapy. Therefore, finding clinical characteristics and environmental interactions with EGFR can affect on investigations about novel anti-cancer therapies like monoclonal antibodies and gene therapy and studies which identify patients who may benefit from EGFR targeted therapies. Hence, it may be effective on the improvement of prognosis in these patients.

Purpose: To evaluate the correlation of Bcl-2 and Bax protein expressions with biochemical failure-free survival in patients with advanced or metastatic prostate carcinoma (PCa) undergoing androgen deprivation therapy. Materials and Methods: This retrospective study was performed on patients with locally advanced (≥ T3) or metastatic PCa, who were referred to Omid Hospital between years 2003 and 2007. All subjects had undergone androgen deprivation therapy. Samples were analyzed immunohistochemically for Bax and Bcl-2 expression. The H-score was calculated for each sample based on intensity and percentage of stained cells. H-score > 50 was considered positive. Results: Thirty-seven patients (13 metastatic and 24 locally advanced) were eligible for analysis. Thirty-six (97.3%) samples were positive for Bax and 26 (70.3%) for Bcl-2 expression. The median H-score for Bax and Bcl-2 was 200 (range, 40 to 300) and 85 (range, 0 to 220), respectively. While there was no correlation between Bax expression and Gleason score, high Bcl-2 expression (H-score > 85) was significantly associated with Gleason score > 7 (P = .004). The median time to progression in the advanced and metastatic groups was 22 (range, 10 to 37) months and 16 (range, 9 to 26) months, respectively. High Bcl-2 expression (P = .01) and prostate-specific antigen > 20 ng/mL (P = .01) were significant predictors of lower biochemical progression-free survival. Conclusion: High Bcl-2 expression was associated with higher Gleason scores and lower biochemical-free survival in patients with advanced PCa undergoing androgen deprivation therapy.

Introduction: Educating Patients diagnosed with cancer about their disease and treatment is a vital component of their nursing care. Management of treatment side effects and maintaining the quality of life could be achievable only by adequate and organized self-care education. With regards to the importance of the concept of cost-effectiveness in health care providing system, this study aimed to assess the effects of patient education on the quality of life in patients receiving chemotherapy and also to compare these effects between individual patient education and group education methods. Methods: One hundred and two patients with breast, esophagus and stomach cancer referred to Chemotherapy Unit in Omid hospital were randomly assined to two groups: Group teaching and Individual teaching methods. Fifty-one received three individual teaching sessions. Three group teaching sessions were conducted for the other fifty-one patients. All subjects were interviewed by the same interviewer three times (before the first chemotherapy, second and third session) using EORTC QLQ-C30 quality-of-life questionnaire. Results: The mean age of the two groups were 46/6± 3/9 and 48/7±1/32 in the individual and group teaching groups, respectivly. Using repeated measure test, we observed a significant difference in the quality of life scores over time between the two groups (p=0.02, F=3.7). However, this effect was only evident after the third chemotherapy course. Conclusion: Group teaching could maintain quality of life better than individual teaching over time. Health care providers could use these two methods interchangeably according to institute condition and the patients' needs and preferences.

Background:We assessed the effects of cisplatin-based chemotherapy, magnesium supplementation, probable contributory factors such as cisplatin cumulative dose and dose per cycle on serum magnesium levels. Methods:In this prospective randomized study, serum magnesium levels of 59 newly diagnosed adult patients receiving cisplatin-based chemotherapy were studied.The patients were randomly allocated to receive magnesium supplementation at a dose of 5 g IV per cycle (n=31) or to a control group (n=28). Serum magnesium levels

Background & Objective: Surgery and /or radiotherapy are major local treatments for esophageal carcinoma. The results of radiotherapy alone have been unsatisfactory. The purpose of this study was to evaluate the treatment outcome of definitive chemoradiotherapy for patients with esophageal SCC. Materials & Methods: This prospective histological descriptive study was done on 190 nonmetastatic esophageal SCC patients which received definitive chemoradiotherapy (55-64 Gy, Cisplatin 80-100 mg/m2 day 1-5FU 750-1000 mg/m2, 24h infusion days 1-4) with curative intent in cancer research center, Mashhad University of Medical Sciences between Jan 2000-Jan 2004. At least one course of chemotherapy was prescribed concurrently with radiotherapy. Results: There were 99 male and 91female patients with the median age of 65 (range, 25-87). The median radiation dose prescribed was 60 Gy (range, 55-64) and median chemotherapy courses was 4 (range, 1-8). With a median follow-up time of 12 months (range, 3-60), one, two and three-year survival rates were 67.8%, 48.7% and 36.3% respectively and median survival was 22 months. Reduction of symptoms was shown in 84% of patients with dysphagia. 109 patients remained disease free with a median follow-up of 14 months (range, 3-60), among which 34 were followed more than 24 months. We found 81 cases (42.6%) with treatment failure during the follow-up (34 locoregional failure, 14 distant metastases, 33 distant metastases accompanied with locoreginal failure). Conclusion: Although definitive chemoradiotherapy can result in long term disease free survival and even cure in a subset of patients with SCC of esophagus, locoregional failure and distant metastasis has remained the main causes of treatment failure.

Background: Meningioma constitutes 20% of the intracranial neoplasms. Followed by surgery as the primary treatment for most patients, radiotherapy becomes indicated in high-grade tumors with incomplete surgical removal. We evaluated the prognostic factors and overall outcome in meningioma patients who underwent radiotherapy. Materials and Methods: In this retrospective analysis, data from all patients with documented diagnosis of meningioma who referred to the Omid and Ghaem Oncology Centers (Mashhad, Iran) from 2002 to 2013 were included. We calculated the overall survival rates using the Kaplan–Meier method and compared the survival curves between groups by the log-rank test. Results: Eighty-three patients with a median age of 50 years (ranging: 16–84) were included. Grade I, II, and III meningiomas were seen in 40 (48%), 31 (37%), and 12 (15%) patients, respectively. Radiation therapy was indicated due to tumor recurrence, incomplete excision, or tumor grade in 32, 8, and 43 patients, respectively. Tumor grade had a significant effect on the overall survival with a 3-year overall survival of 76.7%, 43.5%, and 13.3% in Grade I, II, and III, respectively (P < 0.001). Gender, age, and tumor location were not correlated with the overall survival. Moreover, patients with Grade II and III who underwent total resection had a significantly higher overall survival than those with subtotal resection or biopsy alone (5-year survival rates of 82% vs. 17.1%, respectively; P = 0.008). Conclusion: Tumor grade was the most important prognostic factor in meningioma patients undergoing radiation therapy. In patients with Grade II and III tumors, the extent of surgical resection is significantly correlated with the overall survival.