Gastrointestinal tumor board: an evolving experience in Tehran Cancer Institute

Gastrointestinal [GI] cancers are a significant source of morbidity and mortality in Iran, with stomach adenocarcinoma as the most common cancer in men and the second common cancer in women. Also, some parts of Northern Iran have one of the highest incidences of esophageal cancer in the world. Multi-disciplinary organ-based joint clinics and tumor boards are a well-recognized necessity for modern treatment of cancer and are routinely utilized in developed countries, especially in major academic centres. But this concept is relatively new in developing countries, where cancer treatment centres are burdened by huge loads of patients and have to cope with a suboptimum availability of resources and facilities. Cancer Institute of Tehran University of Medical Sciences is the oldest and the only comprehensive cancer treatment centre in Iran, with a long tradition of a general tumor board for all cancers. But with the requirements of modern oncology, there has been a very welcome attention to sub-specialized organ-based tumor boards and joint clinics here in the past few years. Considering this, we started a multi-disciplinary tumor board for GI cancers in our institute in early 2010 as the first such endeavor here. We hereby review this 2-year evolving experience. The process of establishment of a GI tumor board, participations from different oncology disciplines and related specialties, the cancers presented and discussed in the 2 years of this tumor board, the general intents of treatment for the decisions made and the development of interest in this tumor board among the Tehran oncology community will be reviewed. The GI tumor board of Tehran Cancer Institute started its work in January 2010, with routine weekly sessions. A core group of 2 physicians from each surgical, radiation and medical oncology departments plus one gastroenterologist, GI pathologist and radiologist was formed, but participation from all interested physicians was encouraged. An electronic database was kept from the beginning. The number of patients presented in the tumor board increased from 4 in January 2010 to 16 in December 2011. Most patients were presented by radiation oncology department [38%] and then surgical [36%] and medical oncology [20%] departments. Physicians' participation also grew from an average of 8 each session to 12 in the same months, with a number of cancer specialists taking part from other university hospitals in Tehran. A total number of 225 patients were presented with a treatment decision made in this 2-year period. The majority of cases were colorectal [32%], stomach [23%], and esophageal [17%] cancers. The number of pancreatic [7%] and hepatobiliary [6%] cancers were much smaller. Most decisions were for a primary treatment [surgery or radiochemotherapy] and then a neoadjuvant approach. Tehran Cancer Institute's GI tumor board is one of the first multi-disciplinary organ-based tumor boards in Iran, and as such has made a successful start, establishing itself as a recognized body for clinical decisions and consultations in GI oncology. This experience is growing and evolving, with newer presentation and discussion formats and adapted guidelines for treatment of GI cancers in Iran sought

Rapid recovery of diabetes two months after discontinuation of tacrolimus [FK-506] in a single lung transplant patient

Post-transplant diabetes mellitus [PTDM], developing in almost one quarter of renal transplant patients within three years after the procedure, contributes to post-transplant morbidity and mortality by increasing the risk of infection and cardiovascular events. PTDM is considered a variant of diabetes mellitus [DM] type II and results in similar microvascular and macrovascular diabetic complications seen in non-transplant patients. In this article, we present a case of single lung transplant patient who developed PTDM with a severe DKA as the first manifestation of the disease. PTDM resolved rapidly after discontinuing tacrolimus

Achalasia as a potential predisposing factor for lung allograft rejection

Microaspiration secondary to gastroesophageal reflux has been postulated to be a predisposing factor for development of bronchiolitis obliterans syndrome after lung transplantation. Esophageal manometry and ambulatory pH monitoring have been suggested as a screening test in patients with end-stage lung disease. We report a single lung transplant patient who developed allograft rejection presumed to be due to underlying achalasia as the patient's clinical status and lung function improved markedly following the treatment of achalasia

Helicobacter pylori seroprevalence in patients with bronchiectasis

This study assessed Helicobacter pylori [HP] seroprevalence in bronchiectatic patients and determined whether there is a potential association between bronchiectasis and H.pylori infection or not. This study was conducted on forty consecutive patients [26 men, 14 women; mean age 48.90 +/- 16.67 years, range 21-86 years] with bronchiectasis diagnosed by clinical symptoms and high resolution CT-scan. Helicobacter pylori IgG serum levels were measured in serum by enzyme-linked immunosorbent assay. Forty healthy subjects [25 men, 15 women; mean age 55.50 +/- 11.91 years, range 16-77 years] were selected as controls with no history of cerebrovascular, ischemic heart or respiratory diseases. Control subjects were matched for age, gender and socioeconomic status. Significant differences were observed in the seroprevalence of H.pylori between the two groups, who had similar age, gender distribution and socioeconomic status [76.0% vs. 54.4%, p=0.001]. Similarly, H.pylori IgG levels were significantly higher in bronchiectatic patients than in control subjects attended the hospital with non-respiratory conditions [1.43 +/- 0.55 and 1.07 +/- 0.44 U/ml, respectively; p < 0.05]. The association between Hp infection and bronchiectasis was confirmed in this study. Additional studies with larger numbers of patients and randomized control studies should be undertaken to assess the relationship and impact of the H.pylori eradication on bronchiectasis