Rectal wall dose estimation in intracavitary brachytherapy: a preliminary comparison of an in-house rectal wire versus ICRU 38 recommendations

In intracavitary brachytherapy for gynecological cancers, various techniques are used to locate the anterior rectal wall nearest to the sources but there is no consensus on the best method to do so. This study aimed to compare a technique used routinely in some centers that employs a wire marker to locate the position of the maximum rectal dose point, versus the method recommended by the ICRU Report 38. In a preliminary prospective study on 34 intracavitary insertions for patients with cervical or endometrial cancer, treated at our center based on the Manchester system, the dose distributions were obtained from a treatment planning system following the input of scanned orthogonal anteroposterior and lateral radiographs. For each case, an in-house marked wire was inserted in the rectal lumen and the doses were calculated on several points along the wire seen on the radiographs, to obtain the maximum dose. For the same insertions, the ICRU method was also applied by considering the rectal wall hot spot as a point 0.5 cm posterior to the posterior vaginal wall [visualized on the radiographs by vaginal packing material containing contrast medium]. Averaged over all insertions, mean rectal wall hot spot dose calculated using the positional information obtained by the wire technique was lower by 28.6% than that given by the ICRU method [P < 0.001]. Our initial results add evidence to the suggestion that the wire technique underestimates the rectal wall hot spot dose significantly compared to the ICRU method

Drug-induced vasculitis in a breast cancer patient receiving chemotherapy

Introduction: Drug-induced vasculitis following chemotherapy has been rarely reported. We report such a case of drug-induced vasculitis following chemotherapy in a breast cancer patient

Report of the Case: A 52 year old woman with stage III breast cancer developed pathologically proven vasculitis presenting as bilateral severe erythema, edema and ulceration on both feet 10 days following the 4th cycle of adjuvant chemotherapy. Chemotherapy consisted of docetaxel, doxorubicin, and cyclophosphamide in each cycle that was preceded by premedication including dexamethasone, granisetron, and H1 and H2 blockers. Furthermore, filgrastim [5 micro g/kg] was administered following each cycle of chemotherapy during days 5-9. By discontinuing chemotherapy and starting high-dose intravenous methylprednisolone, vasculitis was resolved. The patient did not experience vasculitis following the re-challenge of chemotherapy excluding docetaxel and filgrastim

Conclusion: This case suggests that docetaxel and filgrastim might be added to the list of agents causing drug-induced vasculitis

Fine needle aspiration diagnosed skin metastasis in a young man with rectal cancer

Introduction: Although colon cancer is one of the most common human cancers, skin metastasis in this disease is rare and necessitates pathological confirmation

Report of the Case: Herein we present a 33 year old man with rectal cancer with ascites. Six cycles of Oxaliplatin based chemotherapy were given. The ascites improved. After three weeks, skin lesions appeared in the upper trunk, both chest wall and back, with extension to the anterior neck Fine Needle Aspiration from the lesions showed malignancy and second line chemotherapy was started. Although the skin lesions showed partial response, unfortunately, the patient died after the fourth chemotherapy injection

Conclusion: Skin metastasis in colorectal cancer, although rare, is a devastating sign, and a careful dermatologic examination should be included in these patients' follow up visits

Health related quality of life in breast cancer patients undergoing current chemotherapy protocols

Health related quality of life is one of the important concepts that nowadays is considered along with other quantitative criteria like life expectancy and survival in health service systems, but its significance is more obvious in degenerative diseases and long term treatments such as cancers. In this study we compared health related quality of life in breast cancer patients undergoing either Docetaxel -Adriamicine - Cyclophosphamide [TAG] or 5-FU- Adriamicine - Cyclophosphamide [FAC] regimens. This study was conducted in a double blind cohort design on 100 patients with positive - node breast cancer treated by TAG or FAC regimens. The international standard questionnaire [EORTC QLQ-C30] was used to evaluate health related quality of life at the start and end points of chemotherapy period. Data were analyzed by independent t-test at the significant level of 0.05. Results showed the same scores of quality of life at the first session of chemotherapy in both groups and in 4- month follow up, at the end of chemotherapy, mean score of quality of life in both groups decreased but it reduced more in TAG group. Chemotherapy regimens can decrease patients quality of life greatly. So reinforcing the relationship between patients and their families, society and treatment team in addition with using supportive methods and counseling groups can maintain the level of patients' quality of life greatly

phase II study of docetaxel, cisplatin and 5- fluorouracil [TPF] in patients with locally advanced head and neck carcinomas

The combination of cisplatin and 5-fluorouracil [PF] is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil [TPF] in patients with unresectable head and neck carcinomas. Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled. All patients received three cycle of induction chemotherapy with docetaxel [75mg/m[2]], cisplatin [40 mg/m[2]] [days 1-2/, and 5-FU [500 mg/m[2], days 1-3], repeated every 21 days. Following induction chemotherapy, all patients underwent concurrent chemoradiotherapy using weekly cisplatin [30 mg/m[2]] and a median total dose of 70 Gy was delivered. Clinical response rate and toxicity were the primary and secondary end-points of the study. There were 31 men and 15 women. All patients had non-metastatic stage IV [T2-3N2-3 or T4N0-3] of disease. Overall and complete response rates were 74% and 24% respectively. Advanced T4 classification was associated with poorer response rate [p value= 0.042]. The major [grade 3-4] treatment-related toxicities were myelosuppression [78%], anorexia [13%], diarrhea [7%], emesis [11%] and stomatitis/pharyngitis [24%]. In comparison with the data of historical published trials of the PF regimen, the TPF regimen was more effective. However, the TPF regimen appears to be associated with a higher incidence of major toxicities. Therefore, our limited findings support the TPF regimen as an alternative chemotherapeutic regimen for advanced head and neck carcinomas

Pancreatic cancer in Southern Iran

Pancreatic cancer is still a health problem worldwide. The present study aimed to report the clinical characteristics, prognostic factors and treatment outcomes of 55 cases of pancreatic cancer and the literature review and analysis. Between 1998 and 2008, 55 consecutive patients proven pathologically with adenocarcinoma of the pancreas and treated at our institution were enrolled. To find out the recent major series, a literature review was performed. We selected 35 major series including 257950 patients with pancreatic cancer for discussing the present study. Twenty-four patients [44%] had resectable disease, 19 [34%] had locally advanced disease, and 12 [22%] had metastatic disease. There were 22 women and 33 men ranging in age from 16 to 76 years, with a median age of 57 years at diagnosis. After a median follow-up of 15 months [range=2-104 months] for surviving patients, 14 patients were alive and without disease, 3 patients were alive with disease and 38 patients had died due to disease. The 5-year overall survival was 27%. In this study and by analyzing the large data collection of recent major reported series, we found that pancreatic cancer tended to present at advanced stage, with a high frequency of locoregional and distant failure and a poor outcome. More effective local and systemic treatment for improving overall survival is needed

Combined neoadjuvant chemotherapy and celecoxib in locally advanced breast cancer

Locally advanced breast cancer is a presentation form of cancer with poor prognosis. The optimal method of treatment for these cases remains unclear. In this trial, the role of low dose celecoxib combined with neoadjuvant chemotherapy in locally advanced breast cancer was evaluated. Fifty women with pathologically proven locally advanced breast cancer were enrolled. All patients received preoperative chemotherapy with CAF [Cyclophosphamide 600 mg/m[2], doxorubicin 60 mg/m[2], 5-FU 600 mg/m[2]] regimen. They were randomly assigned into two groups. The first group received oral celecoxib [100mg twice daily] concurrently with chemotherapy and the second group was offered placebo. Chemotherapy was administered every three weeks and celecoxib continued until one week before the surgery. The patients received an average of 3 months treatment. The size of breast mass was measured before each cycle of chemotherapy by a caliper. The pathologic response rate was the primary endpoint of the study. In this trial, 50 patients were eligible, of whom 44 were evaluable. There were 25 patients in the celecoxib group and 25 patients in the placebo arm. Two patients in each group developed metastasis during the treatment course and two patients in group one could not tolerate celecoxib and quit it, so they were excluded from the trial. There was no statistically significant difference in terms of partial or complete response [90.5% vs. 87.0%] between celecoxib and placebo groups. Histological type, grade and hormonal receptor were similar in the two groups. No significant association was observed between menstrual status, size of mass at presentation and response to celecoxib. This study suggests that the use of celecoxib with a dose of 100 mg twice daily combined with neoadjuvant chemotherapy does not improve response rate in locally advanced breast cancer

Effects of cisplatin on olfactory function in cancer patients receiving cisplatin-based chemotherapy

Although ototoxicity and neuropathy are common side effects of cisplatin, there is no evidence of altered olfactory function in cancer patients receiving cisplatin based chemotherapy. The purpose of this study was to investigate the effect of cisplatin on olfactory function. Fifty-eight patients [13 female, and 45 male with a mean age of 54 years] who needed to be treated with cisplatin based chemotherapy at our institution were enrolled in this study. Cisplatin with a dose of 70-100 mg/m2 was administered per cycle in different chemotherapy regimens. Olfactory function and audiometery were tested before beginning chemotherapy [as baseline]. Assessment of olfactory function also was carried out before each cycle of cisplatin and finally olfactory test and audiometery was performed at least 3 weeks after the last course of cisplatin based chemotherapy. of 58 patients enrolled in this study, seven patients died due to their cancer and 51 patients completed the planned chemotherapeutic treatment. The patients received cisplatin at a cumulative dose of 100-700 mg/m2 [mean cumulative dose: 380 mg/m2] during their chemotherapy treatment. Hearing impairment was documented in fourteen patients and four patients developed hyposmia and one patient anosmia that had no hearing loss. The test score changes were not statistically significant but there was a statistically significant correlation between drug dose and hearing loss [P=0.039]. The results of this study showed that cisplatin has no statistically significant effect on the sense of smell at doses which cause hearing impairment

[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

optimal time of adjuvant radiation therapy in locoregional breast cancer

The optimal time and sequence of adjuvant radiation therapy and chemotherapy after breast surgery is controversial. Radiation therapy is the most effective method for preventing locoregional recurrence following primary surgery for invasive breast cancer. Delay in radiation therapy after surgery can lead to increased local recurrence and delay in chemotherapy after surgery is associated with an increasing rate of failure in the systemic control of breast cancer. This study was undertaken to determine the optimal sequencing of adjuvant chemotherapy and radiotherapy for patients with locoregional breast cancer after modified radical mastectomy. Additionally, this study aimed at determining the possible effect of time of radiotherapy on local and distant cancer control and the overall survival in these patients. Over a 2.5 year period, 100 patients received chemotherapy and radiation therapy for a locoloregional breast cancer after modified radical mastectomy. The population was randomly divided into two equal groups based on the timing of radiation treatment. Fifty patients [Group I] began their radiation after completion of chemotherapy and about 21 weeks after surgery. Group II began their radiation therapy about 3 weeks after surgery in combination with chemotherapy. There was no statistically significant difference between the two groups with respect to nodal status, stage of breast cancer, age, sex and type of surgery performed. Comparison of local and distant failure and overall survival rate between the delayed radiation group [Group I], and early radiation group [Group II] was not significant. In patients who require both chemotherapy and radiation therapy for a localoregional breast cancer, a delay in the initiation of radiotherapy for completion of adjuvant chemotherapy appears safe and may be preferable in patients with high risk of dissemination

Glioblastoma multiforme 35 years after radiation therapy for tinea capitis

Although carcinogenesis is a well-known late side effect of ionizing radiation, development of malignant glioma in patients who have received low dose superficial radiation many years ago for the treatment of tinea capitis has been rarely reported. This is a case report of a patient with glioblastoma multiforme in the parietal lobe after treatment with superficial radiation for tinea capitis 35 years before referral. The patient was a 62- year- old lady who presented with left-sided weakness. Physical examination revealed decreased motor power in the left upper and lower extremities. CT-scan showed a ring-enhancing lesion in the right parietal lobe with peripheral edema. She underwent surgery and histological examination of the lesion was in favor of glioblastoma multiforme. She received post-operative radiotherapy [5400 CGY in 27 fractions] but after six months the tumor recurred. In patients with a history of previous radiation to the head and neck region, and who present with neurological disturbances, a complete evaluation to rule out the presence of a tumor is suggested