Current approaches in intensification of long-course chemoradiotherapy in locally advanced rectal cancer: a review

Rectal cancer is one of the most prevalent cancers in the world. In many countries, the current standard of care is long-course chemoradiation (CRT), followed by total mesorectal excision. Some efforts have been made by intensifying radiation or chemotherapy components of the neoadjuvant therapy to further decrease the local recurrence and augment surgery’s feasibility and improve the oncological outcomes. This paper reviews recent intensified neoadjuvant interventions in locally advanced rectal cancer (LARC) in terms of efficacy and treatment-related toxicity. Many maneuvers have been made so far to improve the oncological outcomes of rectal cancer with intensified neoadjuvant long-course CRT. Some of these approaches seem compelling and deserve further study, while some have just increased the treatment-related toxicities without evident benefits. Those endeavors with greater pathological complete response than the standard of care may make us await the long-term results on survival rates and chronic treatment-related toxicity. After introduction of neoadjuvant CRT for LARC there have been many efforts to improve its outcomes. Here, this study gathered most of these efforts that intensified the neoadjuvant therapy with some being promising and some being futile.

Current approaches in intensification of long-course chemoradiotherapy in locally advanced rectal cancer: a review

Rectal cancer is one of the most prevalent cancers in the world. In many countries, the current standard of care is long-course chemoradiation (CRT), followed by total mesorectal excision. Some efforts have been made by intensifying radiation or chemotherapy components of the neoadjuvant therapy to further decrease the local recurrence and augment surgery’s feasibility and improve the oncological outcomes. This paper reviews recent intensified neoadjuvant interventions in locally advanced rectal cancer (LARC) in terms of efficacy and treatment-related toxicity. Many maneuvers have been made so far to improve the oncological outcomes of rectal cancer with intensified neoadjuvant long-course CRT. Some of these approaches seem compelling and deserve further study, while some have just increased the treatment-related toxicities without evident benefits. Those endeavors with greater pathological complete response than the standard of care may make us await the long-term results on survival rates and chronic treatment-related toxicity. After introduction of neoadjuvant CRT for LARC there have been many efforts to improve its outcomes. Here, this study gathered most of these efforts that intensified the neoadjuvant therapy with some being promising and some being futile.

Short-course versus long-course neoadjuvant chemoradiotherapy in patients with rectal cancer: preliminary results of a randomized controlled trial

Purpose@#Colorectal cancer is becoming an increasing concern in the middle-aged population of Iran. This study aimed to compare the preliminary results of short-course and long-course neoadjuvant chemoradiotherapy treatment for rectal cancer patients. @*Materials and Methods@#Patients in group I received three-dimensional conformational radiotherapy with a dose of 25 Gy/5 fractions in 1 week plus concurrent XELOX regimen (capecitabine 625 mg/m2 from day 1–5 twice daily and oxaliplatin 50 mg/m2 on day 1 once daily). Patients in group II received a total dose of 50–50.4 Gy/25–28 fractions for 5 to 5.5 weeks plus capecitabine 825 mg/m2 twice daily. Both groups underwent delayed surgery at least 8 weeks after radiotherapy completion. The pathological response was assessed with tumor regression grade. @*Results@#In this preliminary report on complications and pathological response, 66 patients were randomized into study groups. Mean duration of radiotherapy in the two groups was 5 ± 1 days (range, 5 to 8 days) and 38 ± 6 days (range, 30 to 58 days). The median follow-up was 18 months. Pathological complete response was achieved in 32.3% and 23.1% of patients in the short-course and long-course groups, respectively (p = 0.558). Overall, acute grade 3 or higher treatment-related toxicities occurred in 24.2% and 22.2% of patients in group I and II, respectively (p = 0.551). No acute grade 4 or 5 adverse events were observed in either group. Within one month of surgery, no significant difference was seen regarding grade ≥3 postoperative complications (p = 0.333). @*Conclusion@#For patients with rectal cancer located 5 cm above the anal verge, short-course radiotherapy with concurrent and consolidation chemotherapy and delayed surgery is not different in terms of acute toxicity, postoperative morbidity, complete resection, and pathological response compared to long-course chemoradiotherapy.

Preoperative short course radiotherapy with concurrent and consolidation chemotherapies followed by delayed surgery in locally advanced rectal cancer: preliminary results

PURPOSE: This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery. MATERIALS AND METHODS: In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin. Total mesorectal excision was done at least 8 weeks after the last fraction of radiotherapy. Primary outcome was complete pathologic response and secondary outcomes were treatment related complications. RESULTS: Thirty-three patients completed the planned preoperative chemoradiation and 26 of them underwent surgery (24 low anterior resection and 2 abdominoperineal resection). Acute proctitis grades 2 and 3 were seen in 11 (33.3%) and 7 (21.2%) patients, respectively. There were no grades 3 and 4 subacute hematologic and non-hematologic (genitourinary and peripheral neuropathy) toxicities and perioperative morbidities such as anastomose leakage. Grade 2 or higher late toxicities were observed among 29.6% of the patients. Complete pathologic response was achieved in 8 (30.8%) patients who underwent surgery. The 3-year overall survival and local control rates were 65% and 94%, respectively. CONCLUSION: This study showed that SRT combined with concurrent and consolidation chemotherapies followed by delayed surgery is not only feasible and tolerable without significant toxicity but also, associated with promising complete pathologic response rates.

Ultrasound accuracy in determining the tumor depth for boost field radiotherapy in breast cancer in comparison with CT scan plus clips

Background: There are miscellaneous methods of boost field determination with different levels of accuracy. One of the important parameters in boost field planning is the tumor bed depth, as it is important for determining electron energy

Objectives: The purpose of present research was the determination of ultrasound accuracy to estimate the appropriate depth for the tumor bed

Patients and Methods: Patients who were undergone breast conservative surgery with placing of 5 clips in the tumor bed [lower, upper, medial, lateral, and posterior] were included. The depth and location of the tumor bed were determined using ultrasonography. The optimum field boost was planned with an appropriate 2.5 cm margin. After putting the marker on the field boost, the CT simulation was done and then the obtained depth of the ultrasound report and that of the CT scan-clips were compared

Results: Twenty five patients were included. The average depth reported by the ultrasound was about 18 mm +/- 3 mm [range 10-26 mm], and the average obtained from the CT scan-clips was about 48 mm +/- 13 mm [range 24-80 mm], [P Value = 0.001]. In almost all cases, the depth obtained from the ultrasound was less than that obtained from the CT scan- clips

Conclusions: Ultrasound is not an accurate method to determine the appropriate depth and field for determination of breast field boost. Thus, it is better not to use ultrasound to estimate the tumor cavity depth; the CT scan images with surgical clips should be used instead

Triple-negative breast cancer survival in Iranian patients

This study focused on triple-negative breast cancer [TNBC] that is characterized by the lack of expression of estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER-2]. The primary goal of this study was to describe the relation between triple-negative receptor status and survival. This is the first study about triple-negative breast cancer in our community of the 1541 patients diagnosed with breast cancer between 2002 and 2007 at the Cancer Institute [Tehran, Iran]. 107 patients were identified as TNBC and 107 patients were randomly selected as non-TNB. HER-2, ER and PR status were assessed by immunohistochemistry [IHC]. Analyses of their collected data were performed retrospectively and then clinical and pathologic parameters were compared between two groups. In multivariate analysis, a significantly decreased overall survival was observed for patients with TNBC compared with non-TNBC [55.7 months versus 60.7 mounts; 95%CI: 51.1-60.3 and 57.9-63.5 for TNBC and non-TNBC respectively, P=0.0008]. The 2- and 5-year estimates for overall survival were 69.8% and 62.3% for TNBC, and 90% and 83% for non-TNBC, respectively. During the study period, 36 [33.6%] patient of TNBC and 14 [13.1%] of non-TNBC presented local recurrence. Significantly decreased disease-free survival was also observed for patients with TNBC compared with non-TNBC [P=0.0004]. The 2- and 5-year estimates for disease-free survival were 68% and 63% for TNBC; and 89% and 82% for non-TNBC, respectively. Significantly decreased distant metastasis free survival was also observed for patients with TNBC compared with non-TNBC [54.4 mounts versus 61.7 mounts; 95%CI: 49.8-59.0 and 59.1-64.4 for TNBC and non-TNBC respectively, P=0.0004]. Triple negative breast cancer has a biologic aggressive behavior and poor prognosis. Therefore aggressive treatment and regular follow-up in early stage of diagnosis can be a significant impact on their prognosis.

[Ranking of Imam Khomeini educational hospital wards]

Objective: The aims of this study are scoring the educational wards of Imam Hospital complex, comparison of different wards according to educational, research and treatment scores and finally improvement of hospital's curriculum

Methods: For assessing the educational performance a questionnaire was filled by the wards' directors. Another questionnaire was filled by faculty members in order to evaluating the research situation of the ward. Customers' satisfaction was assessed through questionnaires which were filled by residents, interns, students and patients. Data were analyzed using SPSS-13

Results: In educational sector, pediatric ward has the first rank, infection ward the second rank. In the research sector infection ward the first and the pediatric ward have the second rank. Training customers have the most satisfaction of general ward and Patient had more satisfaction of surgery ward [3 and 4 surgery ward].With 47% score to training sector, 28% to research sector and 25%to satisfaction, the infection ward has the first rank, pediatric ward second rank and orthopedic ward the third rank of Imam Khomeini complex

Conclusion: In Imam Khomeini complex survey of wards ranking, the infection ward has the first rank pediatric ward second rank and orthopedic ward the third rank in overall survey

[Dosimetric comparison of various radiotherapeutic treatment plans using cobalt-60 and linac for prostate cancer]

This study was designed to evaluate dosimetric parameters such as rectal dose, bladder dose, integral dose [ID], homogeneity index [HI] and conformity index [CI] in various treatment plans for prostate cancer. Pelvic computed tomography [CT] scans of 27 patients were acquired and transferred to the RTDosePLAN treatment planning system. For each patient, 8 conventional plans [3, 4, 5 and 6 fields] were planned for the cobalt-60 photon energy. Subsequently, the same plans were performed for 6 MY and 18 MY photon energies. By increasing the energy of the beam relative to the cobalt-60 energy, the D[mean] values for rectum and bladder were reduced from 3% to 4% and 4% to 6%, respectively, the dose received by the whole of the bladder volume decreased by 26% for 6 MV and by 58% for 18 MV. Increasing the photon beam energy decreased CI to 7% and 10% ID was decreased by l0% and 20% and D[max] was decreased by 3% and 4% respectively. A six-field treatment plan in comparison to the other plans offers the minimum dose to critical organs and sufficient dose to the prostate. Increasing the photon energy improves the treatment parameters of the bladder and the PTV