Decision on Chemotherapy amidst COVID-19 Pandemic: A Review and a Practical Approach from Iran / 감염과화학요법

To provide a step-by-step approach to chemotherapy (CTx) in the novel coronavirus disease 2019 (COVID-19) era. The COVID-19 pandemic is the current global issue resulting in vast health implications. Amid the COVID-19 era, special attention must be paid to at-risk groups, including patients with cancer. To our knowledge, there is a paucity of data on the decision for CTx during the pandemic. We herein provide practical recommendations on the CTx of cancer patients over the pandemic based on our experience in an educational hospital. The decision on CTx should be considered to be individualized based on clinical findings. We hope that our experience provides a practical guide for clinical oncologists to deliver more effective cancer care over the COVID-19 pandemic.

Decision on Chemotherapy amidst COVID-19 Pandemic: A Review and a Practical Approach from Iran / 감염과화학요법

To provide a step-by-step approach to chemotherapy (CTx) in the novel coronavirus disease 2019 (COVID-19) era. The COVID-19 pandemic is the current global issue resulting in vast health implications. Amid the COVID-19 era, special attention must be paid to at-risk groups, including patients with cancer. To our knowledge, there is a paucity of data on the decision for CTx during the pandemic. We herein provide practical recommendations on the CTx of cancer patients over the pandemic based on our experience in an educational hospital. The decision on CTx should be considered to be individualized based on clinical findings. We hope that our experience provides a practical guide for clinical oncologists to deliver more effective cancer care over the COVID-19 pandemic.

Evaluation of survival and treatment toxicity with High-Dose-Rate Brachytherapy with cobalt 60 in Carcinoma of Cervix

Background: Cervical cancer remains to be a major health problem and cancer-related cause of death among women in developing countries such as Iran where the most cases are diagnosed in locally advanced stage

Objectives: This cross sectional-analytic study aims to report outcome 154 patients with carcinoma of cervix were treated with external beam radiation therapy [EBRT] and high-dose-rate [HDR] brachytherapy with cobalt 60 [Co-6o] remote after loading system

Patients and Methods: A total of 154 patients with the international federation of gynecologist and oncologist [FIGO] stages I-IVA with histopathologically confirmed carcinoma of cervix, followed by the radiation-oncology ward of Shohada-e-Tajrish Hospital in Tehran, Iran, between February 2008 and March 2015. They were completed their scheduled EBRT and HDR brachytherapy with Co-60 remote after loading system. Out of this, 132 patients completed their standard follow up protocol. They were analyzed for 3-year disease-free survival [DFS], 3-year overall survival [OS] incidence of acute and late complications for HDR brachytherapy

Results: Fourteen patients [9.1 %] were in stage I [FIGO classification], 8 [5.2%] were in stage IIA, 26 [16.9%] were in stage IIB, 100 [64.9%] were in stage III, and 6 [3.9 %] were in stage IVA. The follow up duration was between 6 - 60 months with a median of 38 months. Overall rectal and bladder treatment toxicity rates were 33.7%. The 3-year DFS rate was 85.7%, 70.7 %, 41% and 16.6% for stages I, II, III, IVA respectively. Favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm [after adjusting for the residual disease after radiation], no pelvic lymph node involvement and 1 week Gap between EBRT and HDR brachytherapy in 3-year DFS [P = 0.001, P = 0.012, P = 0.005, P = 0.005, respectively]. The 3-year OS rate was 85.7%, 76.4%, 42%, and 33.3% for stages I, II, III, and IVA, respectively. Favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm, no pelvic lymph node involvement, 1 week gap between EBRT and HDR brachytherapy and no distant metastasis [during the follow up] in 3-year OS [P = 0.001, P = 0.002, P = 0.002, P = 0.002, P = 0.001, respectively]

Conclusions: HDR brachytherapy with Co-60 remote after loading system was successful and it showed HDR brachytherapy in treating patients with carcinoma of cervix was effective after EBRT with acceptable rectal and bladder complications

First experience of intraoperative radiation therapy in cerebral high grade glioma in Iran: a report of three cases and literature review

Introduction: Among the high grade cerebral gliomas, Glioblastoma multiform for instance, would be the main pattern of local recurrence causes clinical deterioration and deaths. This has observed 2 - 3 cm upon the initial lesion. During the period of 2 - 4 weeks post-surgery, remaining tumor cells have re-grown until radiochemotherapy has initiated. So it has seemed clear that improved local control could hopefully translate into improved survival. As a matter of fact, mass reduction has insufficiently achieved in almost every case of GBM as that the tumor cell number has not fallen below a "threshold" that tumor control might achieve by the host immune system. Intraoperative Radiation therapy has been one of those add-on therapies, which has performed during or directly after resection and cleared the tumor cavity from microscopically remaining cells. Although IORT has presented a novel and feasible principle, the method faced a number of technical and geometrical errors and limitations, which has decreased its potential in the reports of previous studies. Examples could be mentioned as incomplete target volume coverage that seemed as the greatest influence on survival, due to irradiation with an inadequate electron cone size, due to angle errors, or inadequately low energies. In contrast to the previously used forward-beaming electron cones, spherical irradiation sources were specifically attractive in brain tumor IORT, even in post resection cavities with normal complex shapes

Case Presentation: We have been reporting 3 cases of high grade gliomas, one recurrent GBM, one primary glioma grade III, and the last one recurrent Rhabdoid GBM, which have been fulfilling our entrance criteria of IORT procedure, by using spherical applicators, which has been increasingly discussed in recent studies

Conclusions: It was the first experience of intraoperative radiation therapy for cerebral malignant tumours in Iran. Finally, we had a brief overview on the past and present IORT strategies in the treatment of GBM

Relation between HER-2 gene expression and gleason score in patients with Prostate Cancer

HER-2 is a proto-oncogene of the tyrosine kinase receptor family on chromosome 17. Overexpression of this gene affects the growth and prognosis of some tumors. This study was performed to evaluate the expression of the HER-2 gene in patients with prostate cancer and its relation with the Gleason score. Pathology specimens of all men with prostate cancer who had undergone radical prostatectomy without any supportive treatment were studied. The Gleason scores of the specimens and the expression of HER-2 gene were examined. The expression of HER-2 was scored between zero and 3+ in accordance with the Hercep Test method. Patients with scores of 2+ and 3+ were considered to be positive for HER-2 overexpression. Of 150 cancerous prostate specimens evaluated, 20 [13.3%] were positive for HER-2 gene overexpression. A weakly positive HeR-2 overexpression [2+] was seen in 15 of them [75%] and the remaining 5 [25%] were strongly positive. The Gleason score was not different between the HER-2-positive and HER-2-negative patients [P=.08]. Fourteen out of 97 patients [14.4%] with a Gleason score less than 7 and 6 out of 53 [11.3%] with scores of 7 or greater were positive for HER-2 overexpression. The frequency of HER-2 gene overexpression is not very high in our patients with prostate cancer, and we failed to show any association of HER-2 expression and the Gleason score