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The aim of the study is to evaluate the overall accuracy of the surface-guided radiotherapy (SGRT) workflow through a comprehensive commissioning and quality assurance procedures and assess the potential benefits of deep-inspiration breath-hold (DIBH) radiotherapy as a cardiac and lung dose reduction approach for left-sided breast cancer irradiation.Accuracy and reproducibility of the optical surface scanner used for DIBH treatment were evaluated using different phantoms. Patient positioning accuracy and reproducibility of DIBH treatment were evaluated. Twenty patients were studied for treatment plan quality in target dose coverage and healthy organ sparing for the two different treatment techniques.Reproducibility tests for the surface scanner showed good stability within 1 mm in all directions. The maximum position variation between applied shifts on the couch and the scanner measured offsets is 1 mm in all directions. The clinical study of 200 fractions showed good agreement between the surface scanner and portal imaging with the isocenter position deviation of less than 3 mm in each lateral, longitudinal, and vertical direction. The standard deviation of the DIBH level showed a value of2 mm during all evaluated DIBHs. Compared to the free breathing (FB) technique, DIBH showed significant reduction of 48% for heart mean dose, 43% for heart V25, and 20% for ipsilateral lung V20.Surface-guided radiotherapy can be regarded as an accurate tool for patient positioning and monitoring in breast radiotherapy. DIBH treatment are considered to be effective techniques in heart and ipsilateral lung dose reductions for left breast radiotherapy.

The effects of saffron (Crocus sativus L.) on mood disorders have already been established. More recently, its anti-neoplastic effects have provoked a great attention. This study aims to assess the effects of crocin administration during doxorubicin-based chemotherapy of breast cancer on anxiety, depression, and chemotherapy toxicity profile. Seventy-two patients with non-metastatic Her2/neu positive or triple negative breast cancer were enrolled and randomly assigned to receive either 30 mg/day of crocin or placebo during chemotherapy [2:2]. Beck's Depression and Anxiety Inventories were used at baseline and end of the trial. In addition, the ECOG Common Toxicity Criteria were applied to assess chemotherapy side-effects. After the intervention, the degree of anxiety and depression decreased significantly in the crocin group (p = .001 for both) and increased significantly in the placebo-group (p = .006 and p = .036, respectively). There were significantly higher grade II-IV leukopenia (47.2% vs. 19.4%, p = .012) in the crocin group, and grade II-IV hypersensitivity-reaction (30.6% vs. 5.6%, p = .006) in addition to neurological disorders (66.7% vs. 41.7%, p = .03) in the placebo-group. The results indicate that using crocin during chemotherapy in patients with breast cancer has ameliorated anxiety and depression. Moreover, leucopenia increased whereas hypersensitivity reaction and neurological disorders decreased in the crocin group. In addition, a trend toward survival improvement was observed, which is going to be investigated on longer follow up.

Background: Prostate cancer is the second most common malignancy among Iranian men after stomach cancer. To understand the nature of the disease and plan and develop a population-based cancer registry, it is essential to recognize the clinical and pathological characteristics of the tumors, as well as treatment results. Objectives: The present study aimed to evaluate the clinical and pathological characteristics of prostate cancer and evaluate the routine practice, including treatment outline and results of treatment in six referral centers in Iran. Methods: This prospective observational pilot study recruited patients with prostate cancer between April 2015 and October 2015 at six referral centers in Iran. The participating physicians included consecutive patients according to inclusion criteria. Demographic, clinicopathologic, and treatment data were collected by the physicians using an electronic case report form (eCRF). The patients were followed for 18 months, and during this period, four visits were scheduled for each patient to collect the data. Results: A total number of 102 patients from six centers in five different cities of Iran were included in the study. Sixty-seven (65.7%) patients were diagnosed by needle biopsy as the first diagnostic method, 23 (22.5%) by radical prostatectomy, and 12 (11.8%) by open prostatectomy. Total at-risk times of patients for overall survival (OS) and progression-free survival (PFS) were 1480.9 and 1437 months, respectively. Median (IQR) values of OS and PFS were 18.2 (9.2 - 20.5) and 18.2 (6.8 - 20.4) months, respectively. Forty (39.2%) patients underwent surgery, 58 (56.8%) underwent radiotherapy, and 13 (12.7%) received chemotherapy. Twenty-nine (28.4%) patients experienced adverse events over the follow-up period. Eight deaths were reported that were unrelated to treatment adverse effects. Conclusions: This pilot registry could serve as a valuable tool for the development of a comprehensive nationwide registry for patients with prostate cancer in Iran.

Background: There are some hypotheses about radiation-sensitizing and radiation-protective effects of antioxidants. Saffron, dried stigmas of Crocus sativus L., is a precious medicinal plant that contains an impressive variety of plant compounds such as crocin, crocetin, and safranal that act as antioxidants. The present study examined the cytotoxic effects of saffron extracts with different polarity and their synergism or protective effects with radiation on a colorectal cancer cell line (HT-29) and normal human fibroblasts. Objectives: The aim was to find a natural agent to improve radiotherapy efficacy. Methods: HT-29 colorectal cancer cells and normal human fibroblasts were cultured in RPMI1640 medium, incubated with different concentrations of different saffron extracts (50-250 µg/ml), and then were exposed to a dose of 8 Gy of X-rays. The cytotoxicity effect was determined by the MTT assay. Results: Saffron extracts decreased cell viability in HT-29 colorectal cancer cells and normal human fibroblasts as a concentration-dependent manner. Combination radiotherapy with polar saffron extract in most doses showed synergistic effects on HT-29 cell death while it did not show any distinctive synergistic effect in normal cells. Semi-polar and non-Polar extracts just in low doses had synergistic effects on tumor cells. These two extracts did not show any protective effects on normal cells. Conclusions: Among the various saffron extracts, polar saffron extract and low doses of non-polar saffron extract in combination with radiation increase radiation sensitivity and cell death in tumor cells, while they do not increase radiation sensitivity in normal cells and even protect normal cells to some extent.

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.

PURPOSE Local recurrence is a common failure pattern in adenocarcinoma of the cecum. This study aimed to investigate the potential role of adjuvant radiation therapy on oncologic outcomes of patients with adenocarcinoma of the cecum. MATERIALS AND METHODS This retrospective study was carried out at three large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of 162 patients with adenocarcinoma of the cecum that were treated and followed up between 2000 and 2013. All the patients had undergone a right hemicolectomy and received chemotherapy with (n = 48) or without (n = 114) adjuvant radiation therapy. RESULTS The subjects were 65 females and 97 males with a median age of 56 years (range, 17 to 90 years) at diagnosis. The 5-year local control (LC), disease free survival (DFS), and overall survival (OS) rates were 72.7%, 57.2%, and 62.6% respectively. In a multivariate analysis, age, tumor stage, node stage, and adjuvant radiation therapy were determined to be independent prognostic factors. Age more than 55 years (hazard ratio [HR] = 1.0; 95% confidence interval [CI], 0.06-0.32; p = 0.003], T4 stage (HR = 6.8; 95% CI, 3.07-15.36; p < 0.001), node positive disease (HR = 4.2; 95% CI, 1.94-9.13; p < 0.001), and the absence of adjuvant radiation therapy (HR = 3.0; 95% CI, 1.39-6.46; p = 0.005) had a negative influence on OS. CONCLUSION Adjuvant radiation therapy significantly improves DFS and OS in patients with adenocarcinoma of the cecum.

Background: Deep inspiration breath-hold (DIBH) is known as a radiotherapy method for the treatment of patients with left-sided breast cancer. In this method, patient is under exposure only while he/she is at the end of a deep inspiration cycle and holds his/her breath. In this situation, the volume of the lung tissue is enhanced and the heart tissue is pushed away from the treating breast. Therefore, heart dose of these patients, using DIBH, experiences a considerable decline compared to free breathing treatment. There are a few commercialized systems for implementation of DIBH in invasive or noninvasive manners. Methods: We present a novel constructed noninvasive DIBH device relied on a manufacturing near-field laser distance meter. This in-house constructed system is composed of a CD22-100AM122 laser sensor combined with a data acquisition system for monitoring the breathing curve. Qt Creator (a cross-platform JavaScript, QML, and C++-integrated development environment that is part of the SDK for development of the Qt Graphical User Interface application framework) and Keil MDK-ARM (a programming software where users can write in C and C++ and assemble for ARM-based microcontrollers) are used for composing computer and microcontroller programs, respectively. Results: This system could be mounted in treatment or computed tomography (CT) room at suitable cost; it is also easy to use and needs a little training for personnel and patients. The system can assess the location of chest wall or abdomen in real time with high precision and frequency. The performance of CD22-100AM122 demonstrates promise for respiratory monitoring for its fast sampling rate as well as high precision. It can also deliver reasonable spatial and temporal accuracy. The patient observes his/her breathing waveform through a 7” 1024 × 600 liquid crystal display and gets some instructions during treatment and CT sessions by an exploited algorithm called “interaction scenario” in this study. The system is also noninvasive and well sustainable for patients. Conclusions: The constructed system has true real-time operation and is rapid enough for delivering clear contiguous monitoring. In addition, in this system, we have provided an interaction scenario option between patient and CT or Linac operator. In addition, the constructed system has the capability of sending triggers for turning on and off CT or Linac facilities. In this concern, the system has the superiority of combining a plenty of characteristics.

A 76-year-old man with castration-resistant prostate cancer and widespread skeletal metastases underwent 2 cycles of Lu-prostate-specific membrane antigen (PSMA) 617 therapy in our department. Whole-body Lu-PSMA scan after the first cycle showed diffuse skeletal PSMA-avid lesions, whereas no PSMA uptake was evident in the kidneys with minimal PSMA uptake by salivary glands (super scan). After 6 weeks, he received the second dose of Lu-PSMA and whole-body scan after the treatment showed remarkable resolution of skeletal metastases and normal PSMA uptake by the kidneys and salivary glands. To our best knowledge, this is the first case report of Lu-PSMA super scan.

A 73-year-old man with history of prostatic adenocarcinoma radical prostatectomy underwent 99mTc-MDP whole-body bone scan and subsequent 68Ga-labeled prostate-specific membrane antigen (PSMA) ligand PET/CT for restaging due to a gradual rise of prostate-specific antigen levels. Whole-body bone scan showed two focal zones of slightly increased uptake in the right fronto-parietal and temporal bones. 68Ga-PSMA PET/CT scan showed local recurrence in the prostatic bed and two foci of slightly increased uptake in the right temporal and fronto-parietal lobes. A brain CT scan, with IV contrast confirmed that foci of increased uptake in the temporal and parietal lobes were consistent with typical meningioma.

The role of post-mastectomy radiotherapy (PMRT) in the management of node-negative T1-T2 tumors remains unclear. Clinical decision-making is more complex when suboptimal numbers of nodes are examined. The minimum number of negative nodes required in omitting PMRT in these patients is unknown. This is a retrospective study of patients with T1-T2, node-negative tumors who had undergone modified radical mastectomy (MRM). Analyzed were the potential prognostic factors and the variables of taking chemotherapy, hormone therapy, PMRT, as well as the number of examined nodes in different cutoffs, from 0 to 9 nodes. Five hundred and three eligible patients were studied. The median follow-up was 60 months. The only prognostic factor was the variable of ≤3 vs. >3 nodes (P = 0.01). Other variables did not have a significant effect on the outcome. Analysis showed that without PMRT, the 5 and 10-year overall survival (OS) of 44 patients with ≤3 examined nodes were 76 and 63 %, respectively, and the 5- and 10-year OS rates of 155 patients with >3 examined nodes were 89 and 3 examined nodes were 92 and 88 %, respectively (P = 0.056). According to the results of the current study on node-negative T1-T2 breast cancer patients, PMRT can overcome the inferior outcome of a suboptimal dissection and improve OS and is therefore recommended as a cutoff point if less than 4 nodes have been examined.

Background In recent years, Mitoxantrone (MTX) has been introduced as a chemotherapy drug which also serves as a photosensitizer and radiosensitizer. Due to its serious side effects, there are limitations to the application of MTX so scientists are looking for solutions to overcome this problem. Hollow gold nanoparticles (HAuNP) have attracted growing attention due to their unique physical-chemical properties, such as biocompatibility, tunable plasmonic absorption peak ranging from visible to near infrared, high stability and various medical applications in imaging, drug delivery and combinational cancer treatments. In this paper, the combinational effect of photodynamic therapy (PDT) and chemotherapy of MTX conjugated to HAuNP is studied. Method After optimizing the synthesis of PEGylated HAuNP and preparing nanostructures conjugated with MTX, the characteristics of pharmacological agents including MTX, HAuNP, mPEG-HAuNP,and MTX-mPEG-HAuNP and their toxicity were determined at different concentrations on two cell lines of DFW and MCF7 derived from human melanoma and breast cancer, respectively. To select the optimal concentration for PDT, the cytotoxicity of agents was investigated at concentrations of 3, 6, 9 and 12 μM. Moreover, a LEDs system at 630 nm and power output of 3 W was used to apply PDT process. MTT test was used to determine cell survival 24 h after treatment. Several indexes were utilized for data comparison, such as therapeutic efficacy (TE), necessary concentration to kill 50% of cells (IC50), and necessary light exposure to induce 50% cell death (ED50). Results LED exposure alone did not cause significant cell death. For MTX-mPEG-HAuNP, at both cell lines, IC50 had the least exposure to dark condition with an exposure time of less than 9 min and this nanostructure had the smallest ED50 in each cell line at all concentrations. TE of MTX-mPEG-HAuNP at different exposures and concentrations was greater than 1 for the DFW cells. It was also true for concentrations greater than 6 μM with irradiation times longer than 3 min for MCF7 cells. Conclusion This is the first paper to use PEGylated hollow gold nanoparticles as the nanocarrier for MTX. The results indicated that MTX-mPEG-HAuNP improved the efficacy of PDT with Light Emission diode.

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. Key words: Esophageal carcinoma, neoadjuvant chemoradiation, survival

This study aimed to assess the impact of 3 anastomotic techniques after laparoscopic rectal cancer resection.In a cross-sectional study, the data of 155 patients who underwent surgery for rectal cancer were retrieved. An anastomosis was created between the left colon and anal canal with 3 different methods: coloanal anastomosis with protective ileostomy (group A), coloanal anastomosis without ostomy (group B), and delayed coloanal anastomosis (group C). The rates of anastomotic problems (leakage, peritonitis, and collection) were calculated for each treatment method. Multivariate analysis was used to verify the effect of anastomosis techniques.In 5 (3.2%) patients, peritonitis was observed in which 3 (9.7%) of them belonged to group B and 2 (4.1%) belonged to group C. In 9 (5.8%) patients, presacral collection and anastomotic leakage were observed; 4 (8.2%) patients belonged to group C, 4 (12.9%) patients to group B, and 1 (1.3%) patient to group A. Postoperative obstructions occurred in 5 (10.2%) patients of group C, 2 (6.5%) patients of group B, and 2 (2.7%) patients of group A. Rectovaginal fistula was detected in 2 patients from group B.Laparoscopic surgery of rectal cancer with transanal method is reliable and acceptable in terms of oncologic and surgical results. This study showed the best results in patients who had protective ostomy.

Background: Breast carcinoma is not a homogenous disease. It is divided into 5 pathological subtypes of luminal1, luminal2, strongly Her2 positive, basal like, and normal breast like. Basal like breast carcinoma that accounts for about 15% of all breast cancers has an aggressive clinical behavior with the features of high nuclear grade, negative estrogen receptor, progesterone receptor, and Her2 reactivity (triple negative). Objectives: We aimed at identifying the prevalence of basaloid phenotype among triple negative (TN) cases in our region via immunohistochemistry (IHC) staining using basaloid markers. Methods: We reviewed breast cancer patients in Omid and Imam Reza hospitals, Mashhad, Iran, between 2003 and 2007. We obtained the paraffin blocks from TN cases for immune-staining using cytokeratin 5/6 (CK5/6), cytokeratin 14 (CK14) and epidermal growth factor receptor1 (EGFR1) markers. Results: The incidence of TN disease among breast cancers was 21% (156/747). Based on IHC reactivity with at least one of the basaloid markers, from 59 available samples, 44 (75.4%) were basaloid. Conclusions: In our region, most triple negative tumors were basal like breast cancer (BLBC). Among these cases, most immune-reactivity was observed for EGFR1, followed by CK14 and CK5/6.

Management of the central nervous system malignancies are among the evolving areasof research and clinical practice requiring a well-coordinated interdisciplinary approach.The neuro-oncology scientific club (NOSC) has tried to cross the links between variousdisciplines’ experts involved in brain tumor care in Iran since 2011. The NOSC’sstructured collaborative brain tumor registry (BTCR) and the support received from itssteering committee and provincial boards have been the key elements for its successand growth so far. This scientific community not only has helped to optimize brain tumorcare but provided interdisciplinary research opportunities to its members across Iran.Mashhad’s NOSC has been the pioneer in the above. During the 3 rd Mashhad’s NOSCmeeting held in November 21 st 2013, the interim results from some important localneuro-oncology studies were presented. Some potential opportunities to improve thecoordinated interdisciplinary brain tumor care within the province were discussed byneurosurgery, neuroradiology and radiation oncology faculty at this provincial NOSCmeeting. Clinical outcome, survival data and prognostic factors in adult and pediatricgliomas over the past several years in Mashhad, the association between methylguanine methyl transferase (MGMT) methylation status (determined by MSQP ormethylation specific quantitative polymerase chain reaction) where among the mainstudies outlined during this event. We realize that optimized brain tumor managementand productive research in neuro-oncology can only be achieved through an integratedapproach and strong team work. This is what the NOSC pursues.Keywords: Neuro-oncology; consensus development; brain tumor management;interdisciplinary; Mashhad; Iran.

Introduction: Phyllodes tumor (PT) is not a common phenomenon and its coexistence with ductal carcinoma in situ (DCIS) is extremely rare. A few of these cases have been reported in the literatures. Case Presentation: We report a case of PT that a DCIS tumor has arisen from its epithelial component in a 26 year-old woman. The patient was referred to a surgeon with a palpable mass in her left breast. Ultrasonography failed to distinguish between fibroadenoma and PT. Excisional biopsy was performed for her and after pathologic study, the above - mentioned diagnosis was reported. Histologically stroma showed moderate cellularity with few mitoses. The epithelial component consisted of foci of ductal hyperplasia with comedo necrosis. After consultation with oncologists, simple mastectomy and reconstruction was performed for her. The patient was satisfied with the results. Conclusions: Diagnosis of DCIS within a PT before surgery is impossible and pathologist should confirm it. Different plans for their treatment have had good short term results.

Purpose Mucinous adenocarcinomas account for about 10% of all colorectal cancers. This study aimed to investigate the prognostic impact of mucinous histologic subtype on oncologic outcomes in patients with colorectal cancer. Methods This retrospective study was performed at two large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of patients with colorectal cancer who were treated and followed up between 2000 and 2013. Results Totally, 144 of 1,268 patients with a colorectal adenocarcinoma (11.4%) had mucinous histologic subtype. Statistically significant results found in this research are as follows: Mucinous histologic subtype tended to present in younger patients and to have larger tumor size, higher histologic grade, higher node stage, larger number of positive nodes, and higher rate of perineural invasion compared to nonmucinous histologic subtype. On the univariate analysis, mucinous subtype was a prognostic factor for disease-free and overall survival. On the multivariate analysis, primary tumor location, node stage and lymphatic-vascular invasion were independent prognostic factors for the local control rate. Rectal tumor location, higher disease stage, tumor grade II, and presence of lymphatic-vascular invasion had negative influences on disease-free survival, as did rectal tumor location, higher disease stage and presence of lymphatic-vascular invasion on overall survival. Conclusion Mucinous histologic subtype was associated with some adverse pathologic features in patients with colorectal cancer; however, it was not an independent prognostic factor for oncologic outcome.

No direct comparisons can be made in early stages of breast cancer, between the intravenous combinations of: cyclophosphamide, methotrexate, and fluorouracil; named modified versions of CMF with the classical oral version of CMF. Since these modifications have different dose intensities and densities, the outcomes for their subsequent treatments may be varied, and not produce the same results. Despite that, classical CMF has been commonly replaced with intravenous modifications. This study aimed to assess the results of treatment with two common intravenous modification of CMF chemotherapy; to represent the most effective and successful substitute of classical CMF. Five hundred patients in two groups were eligible to take part in the experiment. For two hundred and twenty-nine patients in the group CMF 1&8, chemotherapy was administered intravenously on days 1 and 8 every 28 days for six cycles consisting of: cyclophosphamide 600 mg/m2 , methotrexate 40 mg/m2 , fluorouracil 600 mg/m2 . In the group CMF 1 which consisted of 271 patients, chemotherapy was administered with all the same drugs and doses, however, it was only administered on day 1 and repeated at 21-day intervals for six cycles. Overall survival (OS), disease-free survival (DFS), the prognostic factors and other probable interventional factors were then compared between the two groups. The 5-year OS rate of 87.5% and 10-year OS rate of 82% in the group CMF 1&8 were statistically significantly better than 5-year OS of 84% and 10-year OS of 61.5% in the group CMF 1 (p = 0.01). The 5-year and 10-year DFS rates were 76% and 60% respectively, in the group CMF 1&8 compared with 77% and 54% respectively in the group CMF 1 (p = 0.8). Two groups were comparable regarding their distribution of different prognostic factors and other probable interventional factors. Considering 30% higher dose density of drugs in the protocol of CMF 1&8, the improving outcome can be related to the efficacy of dose-dense chemotherapy. Therefore, this intravenous modification is the better substitute of classical CMF.

Background: Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity. A relationship between the human papilloma virus (HPV) infection and the prognosis of oral cavity SCC (OCSCC) has been discussed before. Objectives: We investigated the prevalence rate of HPV status in patients with OCSCC, and its effects on clinicopathological characteristics of tumors and patients’ prognosis. Patients and Methods: Sections of formalin-fixed, paraffin-embedded tissue blocks from 114 histopathologically confirmed OCSCC cases were investigated in this study. Polymerase chain reaction (PCR) was applied to evaluate the HPV status in the samples. Results: Fifteen (13.16%) cases were identified as HPV positive. The detected viral subtypes in this study were the subtypes 6 and 11. The stage and especially lymph node stage was significantly higher in the HPV positive group compared to the HPV negative group (P = 0.04). Disease free survival (DFS) was remarkably lower in the HPV positive group compared to the HPV negative group (13.9 vs. 49.9 months, P = 0.02). Overall survival (OS) was also significantly inferior in the HPV positive group (15.7 vs. 49.6 months, P = 0.01). In the current study, no significant differences were observed between two groups in relation to the variables of age, gender, tumors site, tumor size, tumor grading and also the recurrence rate. Conclusions: The observed higher mortality rate among the HPV positive group indicates the poorer prognosis of this group in comparison with the HPV negative patients. The incidence rate of HPV infection was low in the studied samples; however, interaction of subtypes 6 and 11 of HPV in poorer prognosis of the patients and a carcinogenic role of HPV in OCSCC cannot be ruled out.

Background: Dihydropyrimidine dehydrogenase (DPD) is the initial enzyme in the catabolism of 5-fluorouracil (5-fu). Deficiency of this enzyme can lead to severe and lethal toxicity following the administration of 5FU or capecitabine. The aim of this study was to demonstrate the prevalence of the IVS14 + 1G > A mutation of the dihydropyrimidine dehydrogenase gene (DPYD) and important side effects of the adjuvant chemotherapy regimens in an ethnic Iranian group of colorectal cancer (CRC) patients. Methods: The research population included patients with colorectal cancer during the period of October 2011 to January 2013. Genomic DNA was isolated from blood cells of 109 patients. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was carried out to identify the frequency of the IVS14 + 1G > A mutation. The side effects of chemotherapy regimens containing 5-FU or capecitabine were recorded during 1-6 courses of chemotherapy. Results: The IVS14 + 1G > A mutation was not found in the population studied. Overall 28.4% of patients reported to have at least 1 grade 3 or 4 toxicity. Conclusions: We concluded that IVS14 + 1G > A mutation was rare in the population studied; however, a larger sample size may be required to determine the precise mutation frequency in this region.

Background: High-grade astrocytomas are among the most common neuroepithelial brain tumors. Because of their highly malignant nature, in most cases, in addition to maximal resection, they also require adjuvant treatments, such as chemotherapy and radiotherapy. A common accompanying condition, which may occur with this type of clinical presentation, is cognitive disorders. These can be caused by the tumor itself, the treatment used or may be patient related. The aim of this study was to evaluate the level of cognitive ability in patients with astrocytoma compared to the normal population and evaluating the factors possibly affecting them. Methods: A case-control study was performed on 30 adults referred to Imam Reza and Omid hospitals, Mashhad, Iran, during year 2014. The studied patients had astrocytomas, for which they had performed surgery. All patients had also received radiotherapy. The control group consisted of 30 healthy individuals, among the patients’ family members, who were matched for age and gender with the patients. The tools used in this study were a checklist for demographic data, and the Farsi version of Addenbrook’s cognitive questionnaire. Data were entered in the SPSS 22 software and analyzed using the Student’s t test and Mann-Whitney test. P values of ≤ 0.05 were considered significant. Results: Normal cognitive disorders were seen in 33.3% and 80% of the patient and control groups, respectively. Mild cognitive disability was observed in 10% of both groups; and Alzheimer’s was observed in 56.7% and 10% of the patient and control groups, respectively. A statistically significant difference was found between cognitive function, age, and gender (P = 0.0001 in both). No meaningful difference, however, was observed between cognitive score and tumor location, chemotherapy, and the time, from which treatment had ended. Conclusion: With the high prevalence of cognitive disorders among patients with astrocytoma, one can conclude that the tumor itself and the surrounding factors affect the cognitive function of the patient. Results of this study showed that the type of treatment and some properties of the tumor, such as the tumor’s location, do not affect the patient’s cognitive capacity.

Objective To survey the proportion of stages at the presentation of the disease without a screening program, among a population of breast cancer patients that is as a representative sample of the country in a distinct period. Materials and methods The population of the current study is found among the female breast cancer patients who were referred to oncology centers in northeastern Iran over a thirty-three-year period from 1980 to 2012. Results Four thousand patients were divided into three time periods consisting of 521 cases from 1980 to 1990, 1178 cases from 1991 to 2001, and 2302 cases from 2002 to 2012. While there was no difference in the proportions of T1 and T3 tumors, T2 tumors showed an increase ( P = 0.001) and T4 tumors a decrease ( P = 0.000) during these periods. There was no change in the proportion of stage I, however the proportion of stage II had risen ( P = 0.000), while that of stage III ( P = 0.002), and stage IV ( P = 0.000) had fallen. The study's urban and rural populations experienced a similar trend in this respect, with the exception that the rural population exhibited more striking changes during the study's recent years. Conclusion After a thirty-three-year follow up on breast cancer in northeastern Iran, it is obvious that this disease is now presented in its earlier stages even in the absence of a screening program. In spite of this, the proportion of T1 disease and those tumors are discovered by a screening program has not significantly changed.

The human multidrug resistance (MDR1) gene product P-glycoprotein is highly expressed in intestinal epithelial cells, where it constitutes a barrier against xenobiotics, bacterial toxins, drugs and other biologically active compounds, possibly carcinogens. In this study, an association of MDR1 gene polymorphism and the occurrence of colorectal cancer were evaluated. In this case-control-designed 118 unrelated colorectal cancer and 137 sex-and-ages matched healthy controls were enrolled. The C3435T MDR1 gene polymorphism was identified using the polymerase chain reaction-restriction fragment length polymorphism method. Significantly increased frequencies of the 3435T allele and the 3435TT were observed in patients with colorectal cancer compared with controls (P = 0.03; OR, 95% CI; 1.46 for 3435T allele and P = 0.003; OR, 95% CI; 2.2 for 3435TT genotype). In contrast, frequency of genotype TT was significantly higher in controls compared to colorectal cancer (P = 0.006; OR, 95% CI; 0.49 for TC genotype). In this study suggest that C3435T MDR1 polymorphism has an association with colorectal cancer. The results support that the presence of allele C results in decreased susceptibility to colorectal cancer.

The human multidrug resistance gene 1 (MDR1) encodes a plasma membrane, P-glycoprotein (Pgp), which functions as the transmembrane efflux pump for various structurally unrelated anticancer agents and toxins. Polymorphisms in the MDR1 gene may have an impact on the expression and function of Pgp, thereby influencing the susceptibility to various diseases, including cancer. Recently, a silent C3435T polymorphism in exon 26 of MDR1 has been reported to be associated with decreased expression of Pgp in TT genotype carriers and thus it may alter the physiological protective role of Pgp and influence disease risk. To evaluate the association of this polymorphism with breast cancer, 106 patients with breast cancer and 77 healthy controls were enrolled in this study. They were visited at two centers during a 1-year period (2006-2007). Data about the risk factors of breast cancer were collected using questionnaires. DNA of the whole-blood sample was extracted, and the polymorphic fragment was amplified by polymerase chain reaction using specific primers. The C3435T polymorphism was detected by the restriction fragment length polymorphism method. There were no significant differences in genotype (p = 0.744) and allele (p = 0.590) frequencies between patients and control subjects. Moreover, distribution of the breast cancer patients' risk factors was not different among CC, CT, and TT genotypes. Our results suggest that C3435T MDR1 polymorphism was not associated with the susceptibility to breast cancer in the population studied.

Objectives: Although Iran, and especially the northeast of the country, is known as one of the areas in the world where esophageal cancer is most prevalent, there is no information on the survival rate of patients affected with this disease in this region. To address this issue, we conducted a study comprehensive enough to provide as accurate an estimate as possible. Any finding related to survival of patients in this area may be considered representative of Iran. Methods: Esophageal cancer patients who were consecutively referred to the oncology centers of Omid and Imam Reza Hospitals from July 1997 to March 2004 were recruited for the study. Data collection included the demographical and clinical characteristics of patients in addition to treatment details. The median survival and overall survival rates, as well as the median event-free survival and event-free survival rates, were evaluated. Univariate and multivariate analyses were performed to detect any significant prognostic factors. Results: 1,568 patients were eligible. The Kaplan-Meier analysis indicates that median survival is 38 months (95% CI, 26.6–49.3), 5-year survival is 42% (38.76–46.16%), median event-free survival is 21 months (95% CI, 18.2–23.8) and 5-year event-free survival is 29.9% (27.07–32.67%). The univariate analysis indicates that age, gender, tumor histology, tumor location, body mass index and disease stage are significant predictors of overall survival. However, in the multivariate analysis, disease stage is the best prognostic factor. Conclusion: The prognosis of esophagus cancer in Iran is not as dismal as in other world regions. Our treatment outcome and survival rates are much higher than those reported especially in western countries.

Background: Small cell esophageal carcinoma (SCEC) is a highly aggressive and rare neoplasm. Objectives: This study aimed to report the characteristics, prognostic factors, and treatment outcomes of 22 patients with SCEC. Patients and Methods: This brief report was carried out by reviewing the medical records of 22 patients with newly histologically proven SCEC that were treated between 2000 and 2010 at 2 tertiary academic hospitals. All the potential prognostic variables, including the patients’ characteristics, tumor features, and treatment modalities were analyzed to establish their influence on the patients’ survival rates. Results: This study was conducted on 7 males and 15 females with a median age of 61 years. Dysphagia and weight loss were the most prevalent symptoms. According to the results, 14 patients (64%) had limited diseases and 8 cases (36%) had extensive diseases. In those with extensive diseases, liver, lung, and lymph nodes (LNs) were the most metastatic sites. Besides, most tumors were located in lower (50%) and middle (32%) part of the esophagus. Most patients (91%) were treated with sequential (55%) or concurrent (36%) chemoradiation (CRT). Surgical resection was also performed for 7 patients. Chemotherapy regimen consisted of cisplatin and etoposide in 14 patients (64%). The median follow up time was 12 months. The 1, 3, and 5-year overall survival rates were 27%, 14%, and 4%, respectively. Yet, no prognostic factors were found because of the small sample size of the study. Conclusions: Primary SCEC is a rare and highly aggressive tumor. However, prognosis is poor and long-term survival is exceptional. CRT could be an appropriate alternative to operation.

Objectives: Surgery has traditionally been the treatment of choice for patients with potentially resectable esophageal carcinoma. Recently, however, definitive chemoradiotherapy (CRT) has been suggested as a preferred treatment modality. In this study, CRT results with or without surgery are compared. Methods: A total of 986 patients of esophageal carcinoma were categorized into two groups depending on the treatment: surgery (675 patients) or CRT (311 patients). These two groups were compared based on age, sex, weight loss, tumor location and length, tumor shape, grade, stage, delay in receiving treatment, event-free survival (EFS) and overall survival (OS). Results: Patients in the CRT arm were significantly older (p = 0.01), had a more significant adenocarcinoma histology (p = 0.015), upper esophageal carcinoma (p = 0.0001) and more advanced stages of the disease (p = 0.0001). The median EFS for the surgery group was 24.5 months [95% confidence interval (CI), 17–32] versus 22.5 months (95% CI, 16.7–28.2) for the CRT arm (p = 0.56). The mean OS was 59.25 months (95% CI, 53.8–64.7) for the surgery group compared to 58.77 months (95% CI, 50.9–66.6) for the CRT group (p = 0.78). Conclusion: Definitive CRT is effective enough so as to consider omitting surgery and could be used as a standard treatment for patients with esophageal carcinoma.

Background: The allele frequency of the multidrug resistance 1 (MDR1) gene C3435T polymorphism differs with different ethnic populations, such as Asian, African, and Caucasian. This polymorphism has been reported to be associated with the increase of gastric cancer. Objectives: The objective of this study was to find out the association of gastric cancer incidence with MDR1 gene polymorphism in an ethnic Iranian population. Materials and Methods: In this study, 48 gastric cancer patients were diagnosed. Genomic DNA was extracted by a salting-out method. The MDR1 polymorphism was studied by a polymerase chain reaction (PCR)-restriction fragment length polymorphism method, using a standard method. Results: The polymorphic homozygote (T/T) genotype showed significantly an association with the incidence of gastric cancer compared with controls (P < 0.05). Conclusions: This study suggests that C3435T polymorphism of the MDR1 gene may be associated with gastric cancer in an ethnic Iranian population.

Stereotactic radiosurgery is a method for focused irradiation of intracranial lesions. Linac-based radiosurgery is currently performed by two techniques: couch mounted and pedestal mounted. In the first technique a device is required to affix the patient's head to the couch and neoreover to translate it accurately. Structure of such a device constructed by the authors plus acceptance test performed for evaluation is described in the article. A head docking device has been designed and constructed according to geometry of linac's couch and also desired functions. The device is cornpletely made from aluminum and consists of four major components: attachment bar, lower structure with four moveing accuracy mechanical stability and isocentric accuracy were assessed in the frame of acceptance test. Translating accuracy, mechanical stability and isocentric accuracy were found to be respectively: 1 mm, 1.64 mm and 3.2 mm with accuracy of 95%. According to AAPM report no. 54, a head docking device should translate head with an accuracy of 1 mm; this recommendation has been met. Moreover, we have demonstrated that the isocentric accuracy and mechanical stability of the device are sufficient that the device on confidently be used in stereotactic treatment.