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To define efficacy of pre-operative chemotherapy in down staging of advanced non-round cell soft tissue sarcomas. From Sep 2002 to Dec 2005, 70 patients were treated by Ifosfamid, MESNA, cisplatin, adriamycin, mitomycin and subsequent surgery. Postoperatively, patients received radiotherapy in cases of microscopically incomplete resection or local recurrence. The median age of the patients was 34 years and the median tumor size was 14 cm. According to AJCC classification 46 patients had stage 3 and 24 had stage 4 diseases. The most common subtypes were MFH and leiomyosarcoma. The most common sites of tumors were lower extremity and trunk. Toxicity grades three or higher consisted of nausea, Leucopenia and infection. About 50% of the patients received G-CSF. Response to chemotherapy was assessable in 63 patients; 9 patients achieved complete response and 16 showed partial response. Disease progressed in 8 and did not change in 37. The best response was seen with MFH, fibrosarcoma and synovial sarcoma. After chemotherapy seventy percent of patients underwent complete surgery. Disease relapsed in 41 patients and twenty two patients died of metastasis. Median survival of patients was 30 months. IMAP plus G-CSF is safe and effective as preoperative chemotherapy in some subtypes of sarcomas, although the metastasis problem has not been eliminated

Aim: In this study, these methods were used to estimate the treatment effect in patients with gastric cancer in the presence of noncompliance. Background: In medical sciences, simple and advanced methods are used to estimate treatment effects in the presence of noncompliance. Methods: This historical cohort study surveyed 178 patients with gastric cancer underwent chemotherapy alone (chemotherapy alone group) and 193 patients underwent surgery and chemotherapy (surgery plus chemotherapy group) from 2003 to 2007 at the Cancer Institute of Imam Khomeini Hospital (Tehran). Demographic and clinical characteristics were extracted from patients' hospital records. The survival of patients was calculated as being from diagnosis to death or to the end of the study. The treatment effect was estimated using three methods: treatment as a time-dependent covariate, IPCW, and Structural Nested Models using STATA and R software. Results: Fifty-six patients (31.5%) who underwent chemotherapy and 69 patients (35.8%) who underwent surgery and chemotherapy died by the end of the study. The hazard ratio in group I compared to group II was estimated between 1.5 to 2.07 times based on the simple analysis method. The modified hazard ratio was estimated to be 1.21 (95% CI: 1.11-1.32) based on the SNM method. Surgery plus chemotherapy is superior to chemotherapy alone, and it improves the overall survival (OS) rate of gastric cancer patients. Conclusion: Survival was improved in patients undergoing chemotherapy and surgery together compared to those undergoing chemotherapy alone. The results of the current study suggest that treatment effect can be estimated unbiasedly using the appropriate method. [ABSTRACT FROM AUTHOR]

Abstract Background Health related quality of life (HRQOL) is an important outcome after treatment for upper gastrointestinal carcinoma. This study aimed to compare HRQOL in patients with advanced gastric cancer (GC) receiving either a standard or an experimental treatment. Methods Seventy-one patients have been treated in Cancer Institute (Tehran, Iran) with docetaxel, cisplatin, 5 FU (TCF) or epirubicin, cisplatin, 5-FU (ECF) and were followed from Jan 2002 to Jan 2005. End points were response rate, HRQOL and survival. HRQOL was assessed using the EORCT QLQ-C30 at baseline and after the third cycle of chemotherapy. Results The baseline HRQOL scores were comparable between two groups. After treatment improvement was seen in a number of items and domains except for cognitive functioning, and diarrhoea. Pain decreased and physical functioning improved in both groups. However, only the TCF group showed statistically and clinically meaningful improvement in global QOL (P = 0.001). Surgical and pathologic response was better with TCF but there was no difference in survival rate between two groups. Conclusion Docetaxel based treatment (TCF) showed better palliation and improvement of global QOL as compared with epirubicin based treatment (ECF). However, it seems that regardless of treatment offered, effective chemotherapy was the most important factor affecting QOL in these patients.

Introduction: Febrile neutropenia (FN) is one of the dose-limiting adverse effects of chemotherapy. Granulocyte-Colony Stimulating Factors (G-CSFs) minimize the incidence of FN and reduce the risk of neutropenia complications. This study was conducted to address the prescription pattern of G-CSF for primary prophylaxis of FN during the first cycle of chemotherapy in solid tumors. Method: This prospective observational study was done to investigate the G-CSF prescription pattern in patients receiving the first cycle of chemotherapy for solid tumors and compare it with the NCCN guideline recommendations. Result: Based on the guideline, prophylactic G-CSF administration was indicated in 26 of the 96 patients (27.1%) and all of them received G-CSF. On the other hand, 70 patients (72.9%) did not meet the guideline criteria for prophylaxis, but 60 (62.5%) of them received G-CSF. Seven doses of pegfilgrastim and 165 doses of filgrastim were used inappropriately in the study population, which was associated with an economic burden of about 224.7 million IRR (5350 USD). Conclusion: Taken together, inconsistencies with the guideline were observed in this prospective evaluation, suggesting that submitting rationalized policies to decrease G-CSF prescription, especially in patients with a lower or intermediate FN risk, yields substantial cost savings. [ABSTRACT FROM AUTHOR]

Background: Because of the decreasing effect of metformin on insulin resistance, it has been suggested as an anti-obesity and anti-cancer drug. So, we aimed to study the effect of metformin therapy on tumor cell proliferation in non-diabetic breast cancer patients. Methods: We conducted a prospective clinical trial and studied the effect of metformin therapy on the level of Ki67 as a measure of tumor cell proliferation. Our primary endpoint was to evaluate the changes in Ki67. The intervention group consisted of 25 non-diabetic breast cancer patients with no indication for neoadjuvant chemotherapy. They were followed up from the time of biopsy to operation. Metformin (1500 mg/day) was prescribed in the intervention group from the date of diagnosis until the surgery (2.8 weeks). Controls were 20 early breast cancer patients who had been followed up with no prescription from biopsy until operation. Results: We could not find any statistically significant difference between the two groups regarding baseline clinical or tumor characteristics such as age, stage, grade, estrogen receptor, HER2 status or time, and type of surgery. However, the immunohistochemistry (IHS) study showed a decrease in median Ki67 from 35.14 to 29.6 in the intervention group (P-value= 0.02). While an increase from 24.5 to 30.6 was detected in the control group (P-value= 0.02). Both of these changes were statistically significant. Although mild gastrointestinal symptoms were seen in approximately 50% of cases, generally, patients tolerated metformin well. There was a correlation between the score of HOMA, a metabolic factor, and the changes in KI67. Conclusion: Metformin prescription in a short period of time between biopsy and definitive surgery leads to the inhibition of breast cancer cell growth. We found a relationship between metformin anti-proliferative effect and glucose and insulin metabolism. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common diagnosed female cancer. Breast cancer is also the leading cause of cancer death in females accounting for 13.7% of female cancer related mortality globally. Variable known prognostic factors such as histological tumor type, tumor size, nodal status, grade, age, and estrogen receptor (ER) status and the proliferation marker -- Ki-67 influence the type of treatment decision. The purpose of this present study is to investigate the association between Ki 67 expression with several clinicopathological variables and patients' outcome. Materials and Methods: This is a retrospective cohort study from September 2008 to March 2017; 165 newly diagnosed breast cancer patients were enrolled in the study. Ki67 levels were measured using immunohistochemistry and compared with clinicopathological variables. The relation of Ki67 expression with disease free survival (DFS) and overall survival (OS) was also analyzed. Results: The result of this study revealed that age, tumor size, menopausal status, and human epidermal growth factor receptor 2 (HER2) status had no effect on the patients' outcome. Patients with ER positive, progesterone receptor (PR)-positive, and HER2-negative tumors expressed a higher rate of Ki-67 (>10%) than patients with ER-negative, PR-negative, and HER2-positive tumors, respectively. However, we found that Ki-67 levels were not significantly increased statistically with ER, PR, and HER2 statuses. There was a statistically significant correlation between Ki-67 expression and with higher stages of the disease. Multivariate analysis showed that Ki-67 expression could not to be an independent prognostic factor for 5 year OS and DFS. Furthermore, p53 status was only prognostic factor for 5-year OS whereas higher stages of disease and p53 status were prognostic factors for 5-year DFS. Conclusion: Ki67 could not be an independent variable for prediction of breast cancer outcome. [ABSTRACT FROM AUTHOR]

According to the studies the rate of emergency departments use among cancer patients exceed those of general population; however, there are differences based on cancer type, initial treatments, socioeconomic status, disease stages, health insurance status and so on. Patients' symptoms and the severity of complications are varied as well. The emergency departments are actively involved in different stages of cancer management such as primary diagnosis, ongoing treatments and end-of-life period. Cancer patients usually have more serious complications and need more specialized cares at the end of life period, during chemotherapy and surgical treatments. Understanding the reasons for such visits could be useful in the development of dedicated interventions for preventing unnecessary emergency department visits, which is discussed in this mini-review. [ABSTRACT FROM AUTHOR]

Background: The authors selected European Organization for Research and Treatment (EORTC) C30 and EORTC QLQ CR29 to specify bowel, bladder, and sexual dysfunction of Iranian colorectal cancer patients. Methods: A sample of 100 patients with colorectal cancer attending Iran Cancer Institute from March 2012 to March 2013 at first-line chemotherapy in the adjuvant or palliative settings participated in the study. Patients responded to the study questionnaires at the beginning and after 3-4 cycles of chemotherapies. Responses to the core questionnaire (QLQ-C30) and the QLQ-CR29 were linearly converted into 0-100 scores, using the EORTC guidelines. Correlations between the QLQ-C30 and QLQ-CR29 were examined, using Pearson's product moment correlation in order to assess construct validity. Known groups' comparon examined the ability of EORCT-CR29 to dtinguh between subgroups of patients with and without a stoma. Sensitivity to changes over time was examined by the response to chemotherapy in palliative or neoadjuvant settings. Internal constency was measured using Cronbach's alpha coefficient with estimates of a magnitude of 0.7. Results: The mean age of patients was 53.6. Based on clinical and pathologic staging, 60% of the patients had presented while their cancer was in stage IV with dtant metastas at the time of referring to the clinic. Thirty-three percent of patients, almost all from rectal tumor group, had a permanent ostomy. In general, the correlation between the EORTC QLQ-C30 and QLQ-CR29 was in the expected directions, demonstrating that functional scales of both questionnaires had a positive correlation with each other while negative correlation was observed between functional and symptom subscales. In addition, the QLQ-CR29 differed considerably between patients with and without a stoma. The QLQ-CR29 results showed improved functioning scores after treatment and at the same time symptoms decreased. The Cronbach's alpha for the scales ranged from 0.48-0.77. Conclusion: In general, the Iranian version of the EORTC QLQ-CR29 worked well and now could be used in outcome studies in colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: Anti-cancer potential of silymarin has been shown in cell culture. However, no prospective clinical study has been conducted in this relation. Methods: In a randomized double blind pilot study, we compared effects of addition of standard chemotherapy along with silymarin (420mg/day) versus placebo on clinical response of advanced tumors after three cycles of cisplatin-based chemotherapy. Results: There was no significant difference in tumor size after three consecutive chemotherapy courses but a trend toward lower metastasis rate in chemotherapy + silymarin group. Concomitant use of silymarin and chemotherapy was very well tolerated but didn't significantly increase clinical response. Conclusion: Due to the trend towards significantly lower metastasis in silymarin group, further study with larger sample size is needed to better clarify probable role of adjunctive therapy with silymarin in patients with solid tumors. [ABSTRACT FROM AUTHOR]

Desmoids tumors, characterized by monoclonal proliferation of myofibroblasts, could occur in 5-10% of patients with familial adenomatous polyposis (FAP) as an extra-colonic manifestation of the disease. FAP can develop when there is a germ-line mutation in the adenomatous polyposis coli gene. Although mild or attenuated FAP may follow mutations in 5' extreme of the gene, it is more likely that 3' extreme mutations haveamore severe manifestation of thedisease. A 28-year-old woman was admitted to the Cancer Institute of Iran with an abdominal painful mass. She had strong family history of FAP and underwent prophylactic total colectomy. Pre-operative CT scans revealed a large mass. Microscopic observation showed diffuse fibroblast cell infiltration of the adjacent tissue structures. Peripheral blood DNA extraction followed by adenomatous polyposis coli gene exon by exon sequencing was performed to investigate the mutation in adenomatous polyposis coli gene. Analysis of DNA sequencing demonstrated a mutation of 4 bpdeletions at codon 1309-1310 of the exon 16 of adenomatous polyposis coli gene sequence which was repeated in 3 members of the family. Some of them had desmoid tumor without classical FAP history. Even when there is no familial history of adenomatous polyposis, the adenomatous polyposis coli gene mutation should be investigated in cases of familial desmoids tumors for a suitable prevention. The 3' extreme of the adenomatous polyposis coli gene is still the best likely location in such families. [ABSTRACT FROM AUTHOR]

Primary cardiac sarcomas are very rare and there is no consensus on management. Clinical presentation is usually late. Despite newer diagnostic technology, prognosis remains dismal. We report a case of right atrial sarcoma in a 28-year-old man who presented with acute cardiac tamponade. Emergency subxiphoid pericardial drainage stabilized the patient's critical condition. The lesion was advanced. Therefore, we only performed a suboptimal surgical resection. Despite planning for radiation, the patient's status deteriorated. Only palliative measures continued during the next four months before his death due to disseminated metastasis and progressive cardiopulmonary failure. [ABSTRACT FROM AUTHOR]

Introduction: Cisplatin is a widely used chemotherapeutic agent with a major side effect of nephrotoxicity. Delayed increase in serum creatinine after cisplatin injection makes serum creatinine not to be an ideal marker for early detection of cisplatin nephrotoxicity. Recently several new biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) have been proposed for early detection of acute kidney injury (AKI). This study assessed kinetic of urine NGAL-creatinine ratio in patients who received cisplatin-containing chemotherapy. Materials and Methods: Patients with a glomerular filtration rates greater than 45 mL/min who received cisplatin-containing chemotherapy were included. Urine creatinine and NGAL concentrations were measured before cisplatin infusion and 6, 24, 48, and 72 hours after cisplatin administration. To minimize hydration effects, urine NGAL levels were adjusted according to urine creatinine. Results: Twenty-four patients were assessed. According to the Acute Kidney Injury Network criteria, 2 patients (8%) experienced cisplatin-associated AKI. The median increases in urine NGAL-creatinine ratio  were 335% (interquartile range, 320% to 350%) in the patients with AKI and 100% (interquartile range, 73% to 190%) in those without AKI (P = .02) during the first 24 hours after cisplatin administration. A urine NGAL-creatinine ratio greater than 26.9 ng/mg 24 hours after cisplatin infusion had a sensitivity of 86% and a specificity of 50% to detect cisplatin-associated nephrotoxicity. Conclusions: Urine NGAL-creatinine ratio significantly increased in patients with cisplatin-associated AKI. Urine NGAL-creatinine ratio within the first 24 hours after cisplatin infusion may better predict cisplatin-associated nephrotoxicity than serum creatinine level. [ABSTRACT FROM AUTHOR]

To evaluate the effect of adding neoadjuvant chemotherapy to surgery and radiation therapy for locally advanced resectable oral cavity squamous cell carcinoma, 24 patients with T3 or T4a oral cavity squamous cell carcinoma were randomly assigned to surgery alone or Docetaxel, Cisplatin, and 5-FU (TPF) induction chemotherapy followed by surgery. All patients were planned to receive chemoradiotherapy after surgery. The primary end-points were organ preservation and progression-free-survival. SPSS version 17 was used for data analysis. Median follow-up was 16 months. The median age of the patients was 62 years old (23-75 years). Man/woman ratio was 1.13. The primary site of the tumor was the tongue in most patients (48%). No significant difference was observed between pathologic characteristics of the two groups. Chemotherapy group showed 16% complete pathologic response to TPF. No significant difference in organ preservation surgery or overall survival was detected. However, the patients in the chemotherapy group had longer progression-free-survival (P=0.014). Surgery followed by chemoradiotherapy with or without TPF induction results in similar survival time. However, progression-free-survival improves with the TPF induction chemotherapy. Studies with more patents and new strategies are recommended to evaluate organ preservation improvement and long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: With the aim of regenerating healthy tissues, different tissue engineering strategies pointed to extracellular matrix (ECM)-based scaffolds in tissue engineering and regenerative medicine and wound healing. It is a multidisciplinary science works to create biocompatible scaffolds with perfect physical parameters, mechanical integrity and high porosity to promote cell growth, migration and angiogenesis. With the increased incidence of obesity, subcutaneous adipose tissue is abundant and readily accessible. Liposuction surgeries yield from 100 mL to 3 L of lipoaspirate tissue. We present our prepared acellular ECM powders derived from human adipose tissue obtained from lipoaspirate, which contains large amounts of collagen suitable for induction of adipogenesis. Methods: The study had been carried out from December 2012 to March 2013 in Tissue Bank and Research Center in Imam Khomeini Hospital Tehran, Iran. Fresh human adipose tissue was obtained by liposuction of abdominal fat pad in a private Day Clinic. By using wasted material of liposuction, we obtained 100 to 200 cc fat tissue from each patient. After physical (freeze-thaw-slicing-manual massage) and chemical (enzymaticdetergent- acid digestion) treatment, an acellularized matrix was created from fat tissue. The final material lyophilized and ground to powder. We analyzed ultra structure and biochemical properties of obtained ECM powder by using electron microscopy, immunohistochemistry (IHC) examination and proteomic studies. Results: After mechanical and chemical process of decellularization, scanning electron micrographs of the samples showed smooth and contiguous collagenous components throughout the scaffold. IHC showed strong positive labeling for collagen IV and no evidence of nuclear material in the specimen. Separation of protein complex by Blue Native Polyacrylamide gel electrophoresis (BNPAGE) has proven type I collagen triple helices associate to form banded fibrils. RNA preparation and Gene Expression Analysis (RT-PCR) by using specific primers for laminin, fibronectin, collagen type I and IV, desmin, and actin showed strong staining of our fat tissue scaffold with collagen type I, fibronectin, collagen IV and laminin. Conclusion: The results show that our decellularization method produced an adipose ECM scaffold rich of collagen fibers, suitable and effective substrate for use in soft tissue engineering and regenerative medicine. [ABSTRACT FROM AUTHOR]

Introduction: McGill pain questionnaire (MPQ) is the most useful standard tools for pain assessment. Due to cultural differences, the questionnaire has been translated into several languages. We aimed to translate and adapt MPQ into Persian language and assess its reliability in Iranian cancer patients. Methods: The MPQ was translated by translation-base method with preserving the original structure. Subsequently we used Persian McGill Pain Questionnaire (P-MPQ) and interviewed 84 patients and repeated the interview after 24 hours in 30 patients. Results: Alpha coefficient of questionnaire (n=84) was 0.85 and the stability coefficient (n=30) in all areas (sensory, emotional, and other assessment) were more than 0.8. Stability coefficient was significant and reliable for all the MPQ subclasses. Conclusion: Adaptation and reliability of Persian-McGill Pain Questionnaire (P-MPQ) are enough for epidemiologic studies of chronic pain in cancer patients in Iran. [ABSTRACT FROM AUTHOR]

Background: Currently, autologous and allogeneic adipose tissues represent a ubiquitous source of material for fat reconstructive therapies. However, these approaches are limited, and often accompanied by a 40-60% reduction in graft volume following transplantation, limited proliferative capacity of mature adipocytes for ex vivo expansion, and extensive adipocyte damage encountered when harvested with conventional liposuction techniques. Recently, cell-based approaches utilizing adipogenic progenitor cells for fat tissue engineering have been developed and were reported to promote both short-term in vivo adipogenesis and to repair defect sites. The aim of this study was to isolate stem cells from fat tissue than examine the growth of stem cells by invitro tests. Methods: For human adipose stem cell isolation (hASC), subcutaneous adipose tissue sites were obtained from female subjects undergoing elective procedures. Tissues were washed 3-4 times in phosphate buffered saline (PBS) and suspended in an equal volume of PBS supplemented with 1% FCS and 0.1% collagenase type I. The tissue was placed in an agitated water bath at 37 1C. The supernatant containing mature adipocytes, was aspirated. Portions of the SVF were suspended in DMEM medium. hASCs were selected based on their ability to adhere to tissue culture plastic and subsequently expanded to 75-90% confluence. Adipose stem cells were isolated and cultured on DMEM. To assess mesenchymal origin of stem cells we used flow-cytomery technique as well as differentiation to osteocyte and chondrocyte lines. Results: The nature of the mesenchymal cells was confirmed by flow -cytometry techniques, based on the expression of CD90, CD105, CD166, and lack of expression of hematopoietic markers of CD34, CD31, and CD45. The successful differentiation of our stem cells to osteocyte, chondrocyte had been showed by specific Alizarin-Red and Toluidine-blue staining of cells. Conclusion: Although we have not the results of in vivo tests to support in vivo adipogenesis either alone or in combination with natural or synthetic matrix, the results showed that stem cells isolation from adipose tissue was successful, and we provided an environment for differentiation of stem cells. [ABSTRACT FROM AUTHOR]