New methods for optical distance indicator and gantry angle quality control tests in medical linear accelerators: image processing by using a 3D phantom

PURPOSE: In order to keep the acceptable level of the radiation oncology linear accelerators, it is necessary to apply a reliable quality assurance (QA) program. MATERIALS AND METHODS: The QA protocols, published by authoritative organizations, such as the American Association of Physicists in Medicine (AAPM), determine the quality control (QC) tests which should be performed on the medical linear accelerators and the threshold levels for each test. The purpose of this study is to increase the accuracy and precision of the selected QC tests in order to increase the quality of treatment and also increase the speed of the tests to convince the crowded centers to start a reliable QA program. A new method has been developed for two of the QC tests; optical distance indicator (ODI) QC test as a daily test and gantry angle QC test as a monthly test. This method uses an image processing approach utilizing the snapshots taken by the CCD camera to measure the source to surface distance (SSD) and gantry angle. RESULTS: The new method of ODI QC test has an accuracy of 99.95% with a standard deviation of 0.061 cm and the new method for gantry angle QC has a precision of 0.43degrees. The automated proposed method which is used for both ODI and gantry angle QC tests, contains highly accurate and precise results which are objective and the human-caused errors have no effect on the results. CONCLUSION: The results show that they are in the acceptable range for both of the QC tests, according to AAPM task group 142.

comparison of 5-HT3 receptor antagonist and metoclopramide in the patients receiving chemotherapeutic regimens including CMF, CAF and CHOP

Chemotherapy- induced nausea and vomiting [CINV] occur frequently causing problems with an unacceptably high incidence that significantly affect patients' daily functioning and health-related quality of life. The present study was aimed to compare acute CINV for granisetron as 5-HT3 receptor antagonist and metoclopramide in the patients receiving chemotherapeutic regimens including cyclophosphamide and adriamycin. An attempt is made to examine whether it is possible to successfully replace granisetron with metoclopramide in control of acute CINV. A total of 137 patients with breast cancer [78.8%] and lymphoma [17.5%] from two oncology departments in the first course of chemotherapy were enrolled. They received granisetron 3mg/IV and dexamethasone 8mg for the first referring and in the second referring metoclopramid 30mg/IV and dexamethasone 8mg/IV thirty minutes before chemotherapy and metoclopramide 20mg/IV during chemotherapy. The patients recorded the incidence of chemotherapy induced nausea and vomiting [CINV] and other side effects including headache, extra pyramidal manifestations and delayed nausea. Median age of studied patients was 49 +/- 15 year. The patients who received granisetron and dexamethasone had less acute nausea [during the first 24 hours after chemotherapy] than those who received metoclopramide. Also our study showed that controlled CINV episodes in patients who received CMF regimen were better than the regimen including adriamycin [CAF, CHOP] into both granisetron [p=0.06] and metoclopramid [p=0.04]. The most common adverse event related to these drugs was extra pyramidal manifestations for 16 and 10 patients who had received granisetron and metoclopramide respectively. While the number of the patients who had sever delayed CINV [2-7 days after chemotherapy] episodes with granisetron [7 cases] was lower than those who took metoclopramide drug [14 cases]. The number of patients who experienced extrapyramidal manifestations in metoclopramide group was lower than granisetron group. There were not any significant clinically serious adverse events in any patients undergoing chemotherapy due to cancer. Thus, the safety profiles of granisetron and metoclopramide were comparable in this study. The patients who were treated with cyclophosphamide, and adriamycin, the efficacy of dexamethasone and metoclopramide in controlling acute nausea and vomiting nearly equaled to those of granisetron. Thus the present study supports the use of metoclopramide due to its lower cost and nearly the same efficacy and safety compared to granisetron in CMF regimen

Pituitary Glioblastoma: a case report

Introduction: Pituitary adenomas have been the most common sellaturcica tumors. There have been many unusual types of pituitary tumors that might neglect by radiologists and clinicians. One of these tumors would be the malignant glioma

Case Presentation: A 62-year-old male has complained from sudden frontal headache, nausea, vomiting, decreased vision, blurred vision and double vision. In skull radiographic, there was an expansion of sellaturcica and a lesion with clear border on T1; heterogeneous; iso - to hypotense; size about 3/5 × 2/5 cm with no surrounding edema that it has homogeneously attracted contrast Lesion, that shown a signal hypointensity on T2 with heterogeneous enhancement. In the coronal sections, the tumor expanded to the suprasellar region and optic chiasmatic that has compressed especially on the left side. Partial tumor resection has conducted. The surgery has done by a transsphenoidal approach. The pathologist has diagnosed a glioblastoma. This diagnosis has confirmed using immunohistochemistry technique

Conclusions: There have been many unusual types of pituitary tumors that might neglect by radiologists and clinicians. One of these tumors would be the malignant glioma

Treatment outcomes and prognostic factors in pediatric non-brainstem astrocytoma in north east of Iran

Central Nervous System [CNS] tumors have accounted for approximately one fourth of all pediatric malignancies. CNS tumors have been the most common solid malignancies among the children. In this study, we have evaluated survival and prognostic factors in children with non-brain stem astrocytoma. Children with non-brain stem astrocytoma, referring to radiation oncology centers of Ghaem and Omid hospitals of Mashhad, have included in this retrospective study, in years 2000-2010. Patients' demographic data, past medical history, clinical symptoms, extent of tumor resection and treatment modality have recorded. Disease-free survival and overall survival have measured using Kaplan-Meier method. We studied 87 patients with male to female ratio of 44/43 [1.02], and median age of 10 yrs [range: 2-15 yrs]. Tumor grade distribution was as follows: grade I: 20 [23%] subjects; grade II: 34 [39.1%] subjects; grade III: 20 [23%] subjects; and grade IV: 13 [14.9%] subjects. The median follow-up duration was 38 months [6 to 110], and 16 months [4 to 100] for patients with low- and high-grade tumors. The 2-year survival rates in grades I-IV were 100%, 84.7%, 60% and 10.8%, respectively. Tumor resection less than gross total and non-ambulation have associated with a significantly inferior survival in both groups multivariate analysis, with high- and low-grade tumors. For all the cases of the pediatric non-brainstem astrocytoma, tumor grade had dramatic influences on their survival. Performing gross total resection was crucial for achieving favorable outcomes in both low-grade and high-grade cases. Moreover, according to the results, having major motor deficits has associated with lower survival

Hepatitis-C infection incidence among the non-Hodgkin's B-cell lymphoma patients in the Northeast of Iran

Various infectious agents like Ebstein Barr Virus [EBV], HTLV-1 and Helicobacter pylori have known as etiologic factors in different sub-types of lymphoma. Although Hepatitis C virus [HCV] has not only been important for its hepatotropism and hepatitis development, but also in recent years its association with some forms of non- Hodgkin's lymphoma [NHL], especially B cell NHL, has reported. In some countries, the rate of B cell NHL development in HCV infected patients was four times more than general population, and then association between HCV infection and B-NHL has proposed in many studies. To assess this relationship in our geographic region, in a descriptive study; we have evaluated patients with B-NHL in an oncology center in northeast of Iran for HCV infection. Out of 128 B-NHL patients, HCV Antibody test [with third generation ELISA method] was positive in only one patient, which confirmed with Nested PCR technique. Then the frequency of HCV infection in our patients was 0.7%. Respecting to the incidence of HCV infection in general population in Iran, which is between 0.5-1%, we couldn't show higher prevalence of HCV infection in NHL patients than general population, and hence couldn't confirm relation between HCV infection and B-NHL in our region

Glioblastoma and the significance of mgmt gene methylation

In this research Glioblastoma has been studied as one of the most common brain tumors and a short review of the available therapeutic methods have presented including surgery, radiotherapy, chemotherapy and particularly adjuvant chemotherapy with temozolomide, as the most effective developed treatment. Moreover, MGMT gene promoter methylation has been introduced as an important predictive factor of treatment response to temozolamide. The different mechanisms of methylation and the available literature on its association with patient survival and disease recurrence have been summarized. Taken together, Glioblastoma is a tumor in which the MGMT gene expression can potentially deliver the highest amount of data in comparison to other tumors; as almost every related study has emphasized on the direct association between MGMT methylation and patient survival. Regarding this debate, the pseudoprogression pattern in Glioblastoma patients and the laboratory methods studying MGMT gene methylation have been examined. At the end of this review, the obstacles to its development have been briefly mentioned

Esophageal cancer and the importance of epidermal growth factor [EGFR]

Esophageal squamous cell carcinoma [ESCC] is one of the most frequent malignancies, worldwide. It is important to find out what prognostic factors can facilitate diagnosis, optimize therapeutic decisions, and improve the survival of these patients. Despite improvements in surgical techniques combined with chemotherapy and/or radiotherapy, the novel therapies such as small molecule inhibitors of tyrosine kinases [TKIs] and humanized monoclonal antibodies [mAbs] are very much needed. On the other hand, neoadjuvant chemotherapy which may improve the outcome is accompanied by toxicity by destruction of normal cells. Side effects may be avoided by developing therapies that specifically target molecular characteristics of tumors. Epidermal growth factor receptor [EGFR] is one of tyrosine kinases receptors widely distributed in human epithelial cell membrane. Genetic polymorphisms in EGFR genes influence cell cycle progression, angiogenesis, apoptosis and metastasis. EGFR mutations are mostly observed in lung tumors; curiously they are more prevalent in Asian women diagnosed with adenocarcinoma. Also, esophageal SCC shows a relatively high incidence of EGFR [33%] and/or HER2 [31%] overexpression. Patients who carry these mutations in EGFR have been founded tending to have a better response to gefitinib, an EGFR-TKI, whereas patients with the wild-type genotype show a better response to conventional chemotherapy. Therefore, finding clinical characteristics and environmental interactions with EGFR can affect on investigations about novel anti-cancer therapies like monoclonal antibodies and gene therapy and studies which identify patients who may benefit from EGFR targeted therapies. Hence, it may be effective on the improvement of prognosis in these patients

Incidence of chemotherapy-induced amenorrhea after adjuvant chemotherapy with taxane and anthracyclines in young patients with breast cancer

Chemotherapy-induced amenorrhea is one of long term side effects of adjuvant chemotherapy in patients with breast cancer which may interfere with their future reproductive function. Although amenorrhea is well recognized, the actual incidence following taxanes remains uncertain. In a cross sectional study, we identified breast cancer patients aged 45 years or younger who were treated with adjuvant anthracycline and taxane-based regimens at three different oncology departments from 2001-2008. One hundred and nineteen patients met all eligibility criteria and consented to participate in a regular follow up program. The median age at diagnosis was 33.5 years [range, 25-41]. Seventy [58%] patients developed amenorrhea for at least 12 months following completion of treatment, and regular menses were maintained in another 49 [42%] patients. No statistically significant association was found between age and development of amenorrhea, although those who experienced cessation of menses were older. Although taxane containing chemotherapy was associated with higher rate of amenorrhea compared to FAC, this was not statistically significant [P=0.11]. Also, treatment with tamoxifen and Estrogen Receptor [ER] positive status was significantly correlated with chemotherapy induced amenorrhea

effect of surveillance on the outcome of breast cancer patients

The beginning of metastasis poorly affects the prognosis of breast cancer patients. Lung is the most frequent site of visceral metastasis, and the rate of recurrence is 10-30%. We have tried to find out if the routine Chest X Ray [CXR] could play a role for early detection of lung metastasis, during the prognosis of these patients. The files of the breast cancer patients between 1996 to 2006 [1739 patients] have reviewed. Clinical characteristics of patients with pulmonary metastasis have recorded. Patients, who lacked imaging files or lacked an appropriate follow-up, have excluded. Data have analyzed by SPSS 11.5. The survival analyses have performed by using the Kaplan-Meier method. Fifty-six patients, median age 46, have entered into this retrospective study. Median tumor size was 4cm; median number of Lymphadenopathy [LAP] was 4. The intermediate grade has detected in 74% of patients. All patients have received adjuvant treatment. Median time from cancer diagnosis to pulmonary metastasis was 22 months. Pulmonary metastasis has detected by control CXR in 77.4% and patients' symptoms in 22.6%. Forty eight patients have received chemotherapy in metastatic phase. In 28 patients [50%], other sites of metastasis [bone, liver, and brain] have discovered. The most frequent pattern of lung recurrence was pulmonary nodule [44.6%], followed by pleural effusion [28.6%]. Median survival was 27.5; median survival from pulmonary metastasis was 8 m; Early detection of pulmonary metastasis by CXR did not affect patients' endpoints. None of the probable prognostic factors have shown a significant effect on patients' outcome. Despite systemic treatment, survival after metastasis is low

Anorectal melanoma: a 10-year study in the north-east of Iran

Anorectal melanoma is one of the rare but significant malignancies of the anorectal area. This malignancy currently accounts for 1% of all types of melanoma and less than 1% of all the anorectal area malignancies. Very rare cases of this disease have been reported worldwide. Anorectal melanoma is mostly diagnosed while treating other benign conditions of this area such as hemorrhoids with conventional modalities. Its treatment of choice has always been a controversial issue. In this study, clinical pathology and outcome of 7 cases with anorectal melanoma referred to Omid Oncology Teaching Hospital during 2001-2011 were assessed. Out of seven cases, 2 patients had been diagnosed with hemorrhoids and undergone surgery and 2 other cases had been referred with the primary diagnosis of lymphoma. Initially, only in 3 cases melanoma was diagnosed in clinico-pathology setting. Three cases of patients had distant metastases to the liver, lungs, omentum and mesentery, while the other 4 patients had advanced local disease. No patient had been diagnosed in the primary stages of the disease. The mean time duration between symptoms onset to diagnosis of disease had been 8 months. The median survival time was 5 months. Rare anorectal melanoma and its similar manifestations to other common anorectal conditions can delay the diagnosis, therefore should be considered as an uncommon differential diagnosis. The disease's outcome is poor and most probably delay in the diagnosis has an important role in the treatment results.

Treatment of esophageal carcinoma by pre-operative chemo-radiotherapy modality

Combined modality treatments have been proposed for improving survival in patients with esophageal carcinoma. In this study, we evaluated the results of neoadjuvant radiotherapy and chemotherapy followed by surgery in patients with esophageal Squamous Cell Carcinoma [SCC]. Between September 2001 and September 2006, 75 patients with Operable esophageal SCC underwent neoadjuvant radiotherapy [30 Gray/10 fractions in 34 or 40 Gray/20 fractions in 41 cases] followed by trans-hiatal esophagectomy at Omid Hospital, Mashhad, Iran. A total of 42 patients received at least 3 courses of chemotherapy containing cisplatin and 5FU. Complete response to neoadjuvant treatment was found in 5 cases [6.7%]. With a median follow up time of 13 months, 21 cases [28%] experienced recurrence including 9 locoregional recurrences, 9 distant metastasis and 3 concomitant local and distant failure. Period of 3-year survivals for all patients was 62.2%. There was no significant difference in survival between patients treated with either radiotherapy protocols [p=0.37]. Patients who received at least 3 courses of chemotherapy had relatively better survival compared with those receiving less than three courses or no chemotherapy [p=0.09]. In comparison with patients having grade III tumors, patients with grade I and II tumors had significantly better survival rate [p=0.05]. Major treatment complications included leukopenia in 13 [17%], anemia in 6 [8%], Thrombocytopenia in 2 [3%], postsurgical fistula in 2 [3%] and anastomosis stricture in 8 [11%] patients. In this study, neoadjuvant chemoradiotherapy and surgery achieved satisfactory survival and acceptable incidence of complications for patients with esophageal SCC and we recommend further investigation in this regard