Evaluation of regional nodes irradiation during breast cancer radiotherapy

Background: The purpose of this study was to evaluate nodal irradiation with conventional three-field's technique. Materials and Methods: Fifty patients with breast cancer were enrolled in this study. Computed tomography scans in the supine treatment position were imported into a treatment planning system. Levels I-III axillary and supraclavicular nodes were identified and their depths to the anterior skin surface were measured. Two tangential fields and one anterior- posterior supraclavicular field were developed to treat all of the patients. Dose -volum histogram was evaluated for quality measurement. Results: The mean depths of the level I, II and III axillary and supraclavicular nodes varied widely [4.6, 5.7, 6.1 and 5.9 cm, respectively]. Complete coverage of level II was not achieved by tangential fields. In some patients the optimal dose was not prescribed. The median dose administered to level I, II and III was 42.6 Gy [10 to 53 Gy], 41.9 Gy [8.3 to 54 Gy] and 41.3 Gy [5 to 52 Gy], respectively. The median dose to supraclavicular nodes was 46.9 Gy [from 38 to 51 Gy].The mean regional nodal volumes included in the 95% isodose were 47, 48, 45.7, and 65.1 percent for level I-III and supraclavicular, respectively. Conclusion: As the depth of regional nodes varies widely, thus using a fixed calculation depth for dose prescription is not optimal. Careful depth measurement for each patient is necessary. Moreover, the use of conventional three- field technique is not optimal for all patients. At least in some patients, adding posterior axillary boost field is necessary, to optimize axillary coverage

[Survival in nonmetastatic gastric cancer patients]

Gastric carcinoma is the second most frequent cancer worldwide. Adjuvant treatment of gastric cancer varies worldwide; many differences have been observed in their clinical and pathological features, and survival rate. The aim of this study was to determine clinical and pathological features, and survival rate in a group of patients in south-east of Iran. Patient records and pathological reports of 82 consecutive patients, with nonmetastatic gastric cancer referring to the radiation oncology ward of Kerman Shafa Hospital since September 2003 to October 2011, were studied. Survival rate was estimated by the Kaplan-Meier method and differences in survival curves between the variables were determined by logrank test. The mean age of the subjects was 52 years and the male to female ratio was 1.8:1. Surgery with positive microscopic margin was performed in 19 patients [23.2%]. The number [%] of the patients with stage I, II, III, and IV were 7 [8.5%], 21 [25.6%], 35 [42.7%], and 19 [23.2%], respectively. The 2 years and 5 years survival rates were 22% and 53%, respectively. Only T, N, overall stage, and type of surgery had impact on the survival rate [P < 0.05], and the other variables had no significant roles. Gastric cancer continues to present in advanced stages, with poor prognosis. The findings of this study emphasize the need for employing policies for the early detection of gastric cancer

[ review on the efficacy of chemotherapy in locally advanced head and neck cancers]

Chemotherapy is utilized as a part of combined-modality programs to achieve organ preservation and improve survival in patients with locally advanced head and neck cancer. Combined-modality protocols can be used in three forms: a] neoadjuvant induction chemotherapy before definitive surgery or radiotherapy; b] concomitant chemoradiotherapy; and c] sequential therapy consisting of induction chemotherapy and chemoradiation. The aim of this article was to study the role of these methods in treatment of locoregionally advanced head and neck cancers. An extensive search was performed on PubMed using five key phrases of head and neck, carcinoma, neoadjuvant chemotherapy, induction chemotherapy, and adjuvant chemotherapy. The search results were limited to randomized trials and meta-analysis. Despite an improvement in organ preservation, induction treatment has no impact on survival. Chemoradiation provides higher survival and increased rate of organ preservation compared to radiation alone. Ongoing phase III comparisons of sequential therapy with chemoradiotherapy may help identify the superior approach. Although further studies in this field are required, taxane-based sequential therapy can be currently used as a reasonable alternative to chemoradiotherapy in patients with locally advanced head and neck cancers

[ effect of honey mouthwash on the prevention mucositis due to head and neck radiotherapy]

Mouthwash helps prevent and treat mucositis. The aim of this study was to investigate the effect of honey mouthwash in the prevention mucositis due to head and neck radiotherapy. In this clinical trial, single blind study, 80 patients with head and neck radiotherapy who attended in radiotherapy ward in Shafa Hospital, Kerman, 1389, was investigated. Applying simple sampling technique, the cases were selected and randomly divided into two groups of control and experiment. The experiment group [N=40] would gurgle 5 spoons of honey mouthwash after tooth brushing, and control group [40] used water as mouthwash. In this 14-day study, subjects' mouths were examined regarding mucositis, based on WHO grading scale on the 1st, 7th, and 14th days. Data were then analyzed applying SPSS, v.16 and employing Fisher exact test, and Mann-Whitney test. In the experiment group, in the units under study the severity of mucositis was mild in the first day [42.94] and lacking mucositis in both the 7th [62.84] and 14th [68.6%] days. In the control group, the severity was mild in the 1st day [29.5%] in the most units under study, and was mild and moderate in the 7th [29.4%] and 14th [32.4%] days, respectively. There was a significant difference between 2 groups regarding mucositis intensity in the first, seventh and fourteenth days [P<0.000]. Since mucositis can be easily prevented by using mouthwash, honey mouthwash can be applied to prevent mucositis and reduce its intensity in head and neck-radiotherapy units.

[Knowledge of patients with cancer towards their disease status]

Ethical issues arise in oncology more frequently than before. Informing patient of his/her disease status and prognosis is of utmost importance. The present study was designed to assess knowledge of patients with cancer towards their disease status in Kerman. For this study, 150 patients with cancer referring to the radiotherapy-oncology ward of Shafa hospital in Kerman were interviewed. We attempted to find out the following issues: Patients' knowledge towards their diagnosis, prognosis, etiology, duration and probable side effects of treatment. Then, the association between patients' knowledge and studied factors was determined. Of 150 patients, 53 [35.3%] were completely informed of their disease while 11 patients [7.3%] were aware of the prognosis. Totally, 63[42%], 16[10.7%] and 106[70.7%] of patients were aware of the disease complications, etiology and the treatment duration, respectively. 58 patients [38.7%] were involved in decision making about their treatment protocol. Patients' knowledge was associated with level of education, place and type of treatment [p < 0.05]. Iranian patients with cancer were not sufficiently informed of their disease status

[Concordance standards of breast cancer pathology reporting: with international a 4-year study in Kerman]

Accurate pathology reporting is important for treatment of malignancies including breast cancer. The aim of this study was to determine the concordance of the current reporting system with international cancer reporting guidelines. Pathology reports of 112 consecutive cases of invasive breast cancer who were treated by modified radical mastectomy and axillary lymph node dissection in different hospitals of Kerman city during 2001 to 2004 were studied. Adherence to the international guidelines for macroscopic and microscopic items were determined. Pathology reports were collected from pathology centers of Kerman University of Medical Sciences, social security organization and private laboratories. Rosai check list was considered as our standard reporting proforma. One hundred twelve cases met the inclusion criteria. The results of reporting of the prognostic criteria were as follow: Histologic type [100%], lymph node status [96.4%], tumor size [93.7%], tumor location [91.2%], histologic grade [87.5%], vascular invasion [85.7%], perineural invasion [83.9%], status of surgical margins [82.3%], calcification [75%], necrosis [74.1%], presence of insitu component [39.3%], tumor multicentricity [38.4%], extent of lymph node involvement [33%], extent of insitu component [23.2%] and level of lymph node involvement [0.8%]. In most reports the presence and extent of carcinoma insitu, level and extent of lymph node metastasis and tumor multicentricity have been ignored. Considering the pivotal role of these factors using a standard reporting protocol is suggested

[Sensitivity and Specificity of CA 15-3 in detection of breast cancer recurrence]

The value of CA15-3[cancer antigen 15-3] marker in early detection of breast cancer recurrence has been studied in several prospective trials. But the results of these studies are different. This may be due to variable cut- off points used for analysis, different intervals between CA15-3 measurements and the differences between patients population. This study was done to examine the predictive value, sensitivity and specificity of CA15-3 in detection of breast cancer recurrence in Iranian patients, using a commercial available ELISA assay with a cut-off value of 30 u/ml. For this purpose serial blood samples and clinical data of 133 female patients with breast cancer referring for adjuvant treatment to Radiation Oncology Department of Shiraz University of Medical Sciences from 1379 to 1382 were collected and for all cases of clinically suspected recurrence, routine methods were used for documentation. Mean age of patients was 45.6 years [SD 11] and mean time of follow up was 17.5 months. Recurrence was documented in 39 patients who were classified into 4 groups: patients with documented recurrence and early elevated marker [true positive,32 patients], patients with documented recurrence but no elevated marker[false negative, 7 patients], those without recurrence and normal marker [true negative,76 patients] and those without recurrence but elevated marker [false positive,18 patients]. According to these data sensitivity, specificity and positive and negative predictive values of CA15-3 were 82,80.85,64 and 91.5 percent respectively. CA15-3 with cut-off point of 30 u/ml has an adequate sensitivity and specificity for early detection of breast cancer recurrence in Iranian patients