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

[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 and been studied in several prospective trials. But the results of these studies are different. This may be due to variable cutoff and points used for analysis, different intervals between CA15-3 measurements and the differences between patients and population. This study was done to examine the predictive value, sensitivity and specificity of `CA15-3 in detection of and breast cancer recurrence in Iranian patients, using a commercial available ELISA assay with a cut-off value of 30 u/ml. and For this purpose serial blood samples and clinical data of 133 female patients with breast cancer referring and for adjuvant treatment to Radiation Oncology Department of Shiraz University of Medical Sciences from 1379 to 1382 and 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 and documented in 39 patients who were classified into 4 groups: patients with documented recurrence and early elevated and marker [true positive,32 patients], patients with documented recurrence but no elevated marker[false negative, 7 and patients], those without recurrence and normal marker [true negative,76 patients] and those without recurrence but and elevated marker [false positive,18 patients]. According to these data sensitivity, specificity and positive and negative and 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 and breast cancer recurrence in Iranian patients

[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

Cord compression secondary to epidural extramedullary hematopoiesis in beta-thalassemia

Extramedullary hematopoiesis is a common occurrence in thalassemia and may rarely cause cord compression. Herein, a case of beta -thalassemia major with lower extrimity weakness and sensory deficit is presented. MRI revealed epidural extramedullary mass compressing the thoracic cord. Fine needle aspiration of the mass was performed under the guide of sonography and pathologic examination was in favor of extramedullary hematopoiesis. The patient received 1600 cGy 60Co radiation to the thoracic cord in 8 fractions. Three weeks after radiation, there was a complete resolution of the mass with total recovery of neurological deficits. Wherever beta - thalassemia is enedemic, extramedullary hematopoiesis as a cause of cord compression must be kept in mind and radiotherapy is to be considered the modality of choice in the therapeutic management