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

Evaluation of emotional distress in breast cancer patients

Cancer has been known as a class of dangerous diseases which cause tremendous physical and emotional problems to both patients and their families. In spite of medical advances, cancer is still considered to be equal with death and pain. This study aims to analyze the emotional distress and the causes in breast cancer patients. This study was a quantitative study which tries to analyze the emotional distress in 82 breast cancer patients referred to the Radiotherapy and Oncology Department of Razi Hospital in Rasht, northern Iran. In this study, the emotional distress is analyzed based on a standard questionnaire which contains demographic information, distress thermometer, and a section devoted to the probable causes. Among the 82 patients that participated in this study, 32 patients [39%] suffered from severe emotional distress which had a statistically significant relationship [p<0.009] with the functional status of the patients. Taking care of children, fear, anxiety, difficulties of taking bath and wearing clothes, family problems, fever and nasal dryness are the most common issued related to emotional distress. Emotional distress can affect the quality of life of breast cancer patients. Therefore, oncology specialists should utilize mental health services to improve their patients' mental health as well as to control the consequences of the disease

prognostic role of tumor marker CA-125 in B-cell non-Hodgkin's lymphoma

B-cell non-Hodgkin's lymphoma [NHL] is a common malignancy of lymphoid tissues. Different types of NHL show various behaviors, prognoses, and responses to treatment. Evaluation of disease activity in NHL can be helpful in managing and even increasing the patient's survey. In total, 121 patients [76 males and 45 females], and their age range were 18-53 years, were evaluated in this study. The mean level of serum carbohydrate antigen 125 [CA-125] was 89.3 +/- 18.5 u/ml, ranging from 27 to 135 u/ml. There were significant differences in International Prognostic Index [IPI] score [p=0.002], stage of the disease [p=0.006], mortality rate [p=0.02], and relapse rate [p=0.04] between patients with serum CA-125 level <35 u/ml and patients with CA-125 level >35 u/ml. CA-125 seems to be a useful and reliable tumor marker for monitoring a patient with NHL. It might be the time to consider CA-125 in staging, prognostic scoring, or decision making about NHL treatment

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

Vulvar carcinoma in pregnant women aged less than 40 years: case report

Invasive squamous cell carcinoma of the vulva is primarily a disease of postmenopausal women and thus is rarely associated with pregnancy. We have reported on a young woman under 40 years old with vulvar carcinoma, which occurred during the pregnancy but optimal treatment was delayed to the postpartum period. This 37-year-old woman was diagnosed with 3x3 cm vulvar lesion, 2 weeks after cesarean section, subsequent biopsy revealed squamous cell carcinoma. She had a history of an ulcer on her left labia minor at the third month of the pregnancy. She was treated by a modified radical vulvectomy and bilateral groin lymphadenectomy. She did not receive any additional treatments. Now after two years, she has had no recurrence of the disease. This case emphasizes on the need to consider malignancy as a differential diagnosis in vulvar lesions of pregnant young women

Comparison of hormone receptor status in primary and recurrent breast cancer

Systematic treatments such as hormone and chemotherapy are selected according to tumor characteristic after major therapeutic approaches such as surgery. This study attempted to analyze and compare the status of Estrogen Receptor [ER] and Progesterone Receptor [PR] in primary and recurrent sites of breast cancer in patients. We reviewed all medical records of breast cancer women who were treated between January 1995 and December 2008. One hundred eighty two out of 2241 patients [8.12%] had a metastatic breast cancer. Amongst them 48 patients had tumor and biopsy-driven samples, however 13 samples were destroyed and only 35 samples were investigated in this study, therefore 35 malignant biopsy specimens of breast cancer patients were examined by immunohistochemistry essay for ER and PR. Binominal proportional test and Chi square test were conducted to determine the significant correlation between positive cases of hormone receptors among primary and metastases sites. Hormone Receptor in the primary tumor [HR1] of 9 patients [25.7%] was positive [ER1 and/or PR1] and in the recurrent areas [HR2] of 8 patients [22.9%] was positive [either ER2 or PR2 positive]. Kappa coefficients of diagnostic agreement in primary and recurrent cases were 0.077 and 0.125 for estrogen and progesterone, respectively which indicated that the amount of coefficient of agreement is not considerable between primary and recurrent sites. The current study indicated that receptor status in recurrent tumors did not pose predictable value based on the analysis of hormone receptors in primary stage, so it is not an appropriate basis to set up therapeutic protocol in the metastatic patients. Therefore, tissue sampling and hormone receptor reanalyzing of metastatic sites should be considered in these cases