Dynamic anthropomorphic thorax phantom for quality assurance of motion management in radiotherapy.

Background and purpose: Motion management techniques are important to spare the healthy tissue adequately. However, they are complex and need dedicated quality assurance. The aim of this study was to create a dynamic phantom designed for quality assurance and to replicate a patient's size, anatomy, and tissue density. Materials and methods: A computed tomography (CT) scan of a cancer patient was used to create molds for the lungs, heart, ribs, and vertebral column via additive manufacturing. A pump system and software were developed to simulate respiratory dynamics. The extent of respiratory motion was quantified using a 4DCT scan. End-to-end tests were conducted to evaluate two motion management techniques for lung stereotactic body radiotherapy (SBRT). Results: The chest wall moved between 4 mm and 13 mm anteriorly and 2 mm to 7 mm laterally during the breathing. The diaphragm exhibited superior-inferior movement ranging from 5 mm to 16 mm in the left lung and 10 mm to 36 mm in the right lung. The left lung tumor displaced ± 7 mm superior-inferiorly and anterior-posteriorly. The CT numbers were for lung: -716 ± 108 HU (phantom) and -713 ± 70 HU (patient); bone: 460 ± 20 HU (phantom) and 458 ± 206 HU (patient); soft tissue: 92 ± 9 HU (phantom) and 60 ± 25 HU (patient). The end-to-end testing showed an excellent agreement between the measured and the calculated dose for ion chamber and film dosimetry. Conclusions: The phantom is recommended for quality assurance, evaluating the institution's specific planning and motion management strategies either through end-to-end testing or as an external audit phantom.

Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Concurrent Use of Crocin During Chemoradiation for Esophageal Squamous Cell Carcinoma.

Crocin is the major active carotenoid of saffron (Crocus sativus L.). Its pluripotent effects have led to a growing body of literature investigating its antitumor properties as well as its diverse potentials for mood stabilization, normal tissue protection, and inflammation reduction; However, there is a gap in clinical trials testing this substance in cancer patients. In this randomized, double-blind, placebo-controlled clinical trial, patients with newly diagnosed esophageal squamous cell carcinoma were randomly assigned to either 30 mg/day of crocin or placebo, prescribed during the neoadjuvant chemo-radiotherapy. The primary endpoints were pathological response and toxicity, and secondary endpoints were depression and anxiety levels and survival analysis.

Erratum to: Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran.

[This corrects the article DOI: 10.5603/RPOR.a2022.0103.].

The cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancers.

PURPOSE: Intensity-modulated radiotherapy is developed as a replacement for 3-dimensional conformal radiation therapy. Considering the difference in costs and effectiveness of these interventions, the aim of this study was to compare the cost effectiveness of intensity-modulated radiation therapy and three-dimensional conformal radiotherapy in the treatment of head and neck cancer in east of Iran. METHODS: A Markov model including six states based on xerostomia and dysphagia was developed to estimate the incremental cost effectiveness ratio from the perspective of societal. Cost and quality of life data were collected from 97 respondents via a checklist and EuroQol-5Dimension questionnaire. The robustness of results was examined by deterministic and probabilistic sensitivity analysis. All analysis were conducted with Treeage software. RESULTS: The results of this study showed that the cost and quality adjusted life years for 3-dimensional conformal radiation therapy were 9209.76 and 3.63 respectively. However, the cost and quality adjusted life years for intensity-modulated radiotherapy were 12562.90 and 3.17 respectively. Therefore, 3-dimensional conformal radiation therapy produced 0.45 more quality adjusted life years than intensity-modulated radiotherapy and saved $3353. According to the incremental cost effectiveness ratio, 3-dimensional conformal radiation therapy as compared to intensity-modulated radiotherapy saved $7367.27 per quality adjusted life years. These results confirmed by sensitivity analysis. CONCLUSION: This study concluded that in the treatment of head and neck cancer, the 3-dimensional conformal radiation therapy method appears to be cost-effective when compared with intensity-modulated radiotherapy.

A dose planning study for cardiac and lung dose sparing techniques in left breast cancer radiotherapy: Can free breathing helical tomotherapy be considered as an alternative for deep inspiration breath hold?

Purpose: To investigate the possibility to be able to offer left sided breast cancer patients, not suitable for DIBH, an organ at risk saving treatment. Materials and Methods: Twenty patients receiving radiotherapy for left breast cancer in DIBH were enrolled in the study. Planning CT scans were acquired in the same supine treatment position in FB and DIBH. 3DCRT_DIBH plans were designed and optimized using two parallel opposed tangent beams (with some additional segments) for the breast and chest wall and anterior-posterior fields for regional lymph nodes irradiation. Additionally, FB helical tomotherapy plans were optimized to minimize heart and lung dose. All forty plans were optimized with at least 95% of the total CTV covered by the 95% of prescribed dose of 50 Gy in 25 fractions. Results: HT_FB plans showed significantly better dose homogeneity and conformity compared to the 3DCRT_DIBH specially for regional nodal irradiation. The heart mean dose was almost comparable in 3DCRT_DIBH and HT_FB while the volume (%) of the heart receiving 25 Gy had a statistically significant reduction from 7.90 ± 3.33 in 3DCRT_DIBH to 0.88 ± 0.66 in HT_FB. HT_FB was also more effective in left descending artery (LAD) mean dose reduction about 100% from 30.83 ± 9.2 Gy to 9.7 ± 3.1. The ipsilateral lung volume receiving 20 Gy has a further reduction of 43 % in HT_FB compared with 3DCRT_DIBH. For low dose comparison, 3DCRT_DIBH was superior for contralateral organ sparing compared to the HT_FB due to the limited angle for dose delivery. Conclusion: For patients who cannot be a candidate for DIBH for any reason, HT in free breathing may be a good alternative and provides heart and ipsilateral lung dose sparing, however with the cost of increased dose to contralateral breast and lung.

Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran.

Background: The aim of the study is to evaluate the overall accuracy of the surface-guided radiotherapy (SGRT) workflow through a comprehensive commissioning and quality assurance procedures and assess the potential benefits of deep-inspiration breath-hold (DIBH) radiotherapy as a cardiac and lung dose reduction approach for left-sided breast cancer irradiation. Materials and methods: Accuracy and reproducibility of the optical surface scanner used for DIBH treatment were evaluated using different phantoms. Patient positioning accuracy and reproducibility of DIBH treatment were evaluated. Twenty patients were studied for treatment plan quality in target dose coverage and healthy organ sparing for the two different treatment techniques. Results: Reproducibility tests for the surface scanner showed good stability within 1 mm in all directions. The maximum position variation between applied shifts on the couch and the scanner measured offsets is 1 mm in all directions. The clinical study of 200 fractions showed good agreement between the surface scanner and portal imaging with the isocenter position deviation of less than 3 mm in each lateral, longitudinal, and vertical direction. The standard deviation of the DIBH level showed a value of < 2 mm during all evaluated DIBHs. Compared to the free breathing (FB) technique, DIBH showed significant reduction of 48% for heart mean dose, 43% for heart V25, and 20% for ipsilateral lung V20. Conclusion: Surface-guided radiotherapy can be regarded as an accurate tool for patient positioning and monitoring in breast radiotherapy. DIBH treatment are considered to be effective techniques in heart and ipsilateral lung dose reductions for left breast radiotherapy.

Diagnosis of an occult gastric adenocarcinoma by oral manifestations (acanthosis nigricans): A case report.

BACKGROUND: Acanthosis nigricans (AN) is a condition with an important characteristics of symmetrical areas of thickened skin with grayish brown hyperpigmentation. The mucosa may show a papillomatous surface, with or without hyperpigmentation. Lips and sites at risk of trauma may be affected and palmoplantar keratosis might also be present. In some rare cases, acanthosis nigricans presents as a sign of internal neoplasia, mostly a gastrointestinal cancer, and is called malignant acanthosis nigricans (MAN). CASE PRESENTATION: In this study, a 55-year-old female Iranian patient with malignant acanthosis nigricans (MAN) is reported. She was seeking esthetic treatment for her oral and perioral regions. The peculiarity of this case is simultaneous skin manifestation consistent with MAN, "tripe palms" (TP) and Leser-Trélat (LT) sign and mucosal changes in the oral cavity such as papillomatosis and roughened surfaces of the lips, hard palate and buccal mucosa. These changes harbored gastric adenocarcinoma stage T3 N3, but the patient was asymptomatic except for pruritis. CONCLUSION: There is an urgent need to suspect a correlation between oral and skin changes and the possibility of an internal neoplasia, therefore it is of utmost importance to refer these patients for early diagnosis of the underlying disease. This would improve the prognosis and lessen the consequences to a great extent.

Effects of a polyherbal formulation on the quality of life and survival of patients with common upper gastrointestinal cancers: A randomized placebo-controlled trial.

OBJECTIVE: Previous clinical trials have suggested that herbal medicines can improve the quality of life (QOL) and survival of cancer patients. This study was aimed to evaluate the effects of a polyherbal compound (PHC, formulated as syrup) consisting of Allium sativum, Curcuma longa, Panax ginseng, and Camellia sinensis on the quality of life (QOL) and survival in patients with upper gastrointestinal cancers. MATERIALS AND METHODS: A randomized placebo-controlled trial was carried out on patients with esophageal or gastric cancer who had finished their oncological treatments. The patients were randomly assigned to PHC (n=20) or placebo (n=20) group. The PHC group was treated with the PHC for 12 weeks, while the placebo group received 70% sucrose syrup. The QOL was assessed at baseline and after 12 weeks. The patients were followed for up to 24 months to determine overall survival. RESULTS: PHC significantly improved cancer-related symptoms, physical performance, and psychological and social functions of the patients (p<0.05 for all cases). Death occurred in 33 and 22% of cases in the placebo and PHC group, respectively. The mean survival time was 16.8 months (95% CI: 12.8-20.9) in the placebo group and 21.4 months (95% CI: 19.1-23.6) in the PHC group but the difference was not statistically significant. CONCLUSION: The PHC improved cancer-related symptoms, physical performance, and psychological and social functions in patients with gastrointestinal cancers. It seems that this herbal compound has the potential to be used as a supplement in the management of cancer.

Amelioration of anxiety, depression, and chemotherapy related toxicity after crocin administration during chemotherapy of breast cancer: A double blind, randomized clinical trial.

The effects of saffron (Crocus sativus L.) on mood disorders have already been established. More recently, its anti-neoplastic effects have provoked a great attention. This study aims to assess the effects of crocin administration during doxorubicin-based chemotherapy of breast cancer on anxiety, depression, and chemotherapy toxicity profile. Seventy-two patients with non-metastatic Her2/neu positive or triple negative breast cancer were enrolled and randomly assigned to receive either 30 mg/day of crocin or placebo during chemotherapy [2:2]. Beck's Depression and Anxiety Inventories were used at baseline and end of the trial. In addition, the ECOG Common Toxicity Criteria were applied to assess chemotherapy side-effects. After the intervention, the degree of anxiety and depression decreased significantly in the crocin group (p = .001 for both) and increased significantly in the placebo-group (p = .006 and p = .036, respectively). There were significantly higher grade II-IV leukopenia (47.2% vs. 19.4%, p = .012) in the crocin group, and grade II-IV hypersensitivity-reaction (30.6% vs. 5.6%, p = .006) in addition to neurological disorders (66.7% vs. 41.7%, p = .03) in the placebo-group. The results indicate that using crocin during chemotherapy in patients with breast cancer has ameliorated anxiety and depression. Moreover, leucopenia increased whereas hypersensitivity reaction and neurological disorders decreased in the crocin group. In addition, a trend toward survival improvement was observed, which is going to be investigated on longer follow up.

Pegylated hollow gold-mitoxantrone nanoparticles combining photodynamic therapy and chemotherapy of cancer cells.

BACKGROUND: In recent years, Mitoxantrone (MTX) has been introduced as a chemotherapy drug which also serves as a photosensitizer and radiosensitizer. Due to its serious side effects, there are limitations to the application of MTX so scientists are looking for solutions to overcome this problem. Hollow gold nanoparticles (HAuNP) have attracted growing attention due to their unique physical-chemical properties, such as biocompatibility, tunable plasmonic absorption peak ranging from visible to near infrared, high stability and various medical applications in imaging, drug delivery and combinational cancer treatments. In this paper, the combinational effect of photodynamic therapy (PDT) and chemotherapy of MTX conjugated to HAuNP is studied. METHOD: After optimizing the synthesis of PEGylated HAuNP and preparing nanostructures conjugated with MTX, the characteristics of pharmacological agents including MTX, HAuNP, mPEG-HAuNP,and MTX-mPEG-HAuNP and their toxicity were determined at different concentrations on two cell lines of DFW and MCF7 derived from human melanoma and breast cancer, respectively. To select the optimal concentration for PDT, the cytotoxicity of agents was investigated at concentrations of 3, 6, 9 and 12 µM. Moreover, a LEDs system at 630 nm and power output of 3 W was used to apply PDT process. MTT test was used to determine cell survival 24 h after treatment. Several indexes were utilized for data comparison, such as therapeutic efficacy (TE), necessary concentration to kill 50% of cells (IC50), and necessary light exposure to induce 50% cell death (ED50). RESULTS: LED exposure alone did not cause significant cell death. For MTX-mPEG-HAuNP, at both cell lines, IC50 had the least exposure to dark condition with an exposure time of less than 9 min and this nanostructure had the smallest ED50 in each cell line at all concentrations. TE of MTX-mPEG-HAuNP at different exposures and concentrations was greater than 1 for the DFW cells. It was also true for concentrations greater than 6 µM with irradiation times longer than 3 min for MCF7 cells. CONCLUSION: This is the first paper to use PEGylated hollow gold nanoparticles as the nanocarrier for MTX. The results indicated that MTX-mPEG-HAuNP improved the efficacy of PDT with Light Emission diode.

Prognostic significance of adjuvant radiation therapy in adenocarcinoma of the cecum.

PURPOSE: Local recurrence is a common failure pattern in adenocarcinoma of the cecum. This study aimed to investigate the potential role of adjuvant radiation therapy on oncologic outcomes of patients with adenocarcinoma of the cecum. MATERIALS AND METHODS: This retrospective study was carried out at three large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of 162 patients with adenocarcinoma of the cecum that were treated and followed up between 2000 and 2013. All the patients had undergone a right hemicolectomy and received chemotherapy with (n = 48) or without (n = 114) adjuvant radiation therapy. RESULTS: The subjects were 65 females and 97 males with a median age of 56 years (range, 17 to 90 years) at diagnosis. The 5-year local control (LC), disease free survival (DFS), and overall survival (OS) rates were 72.7%, 57.2%, and 62.6% respectively. In a multivariate analysis, age, tumor stage, node stage, and adjuvant radiation therapy were determined to be independent prognostic factors. Age more than 55 years (hazard ratio [HR] = 1.0; 95% confidence interval [CI], 0.06-0.32; p = 0.003], T4 stage (HR = 6.8; 95% CI, 3.07-15.36; p < 0.001), node positive disease (HR = 4.2; 95% CI, 1.94-9.13; p < 0.001), and the absence of adjuvant radiation therapy (HR = 3.0; 95% CI, 1.39-6.46; p = 0.005) had a negative influence on OS. CONCLUSION: Adjuvant radiation therapy significantly improves DFS and OS in patients with adenocarcinoma of the cecum.

177Lu-Prostate-Specific Membrane Antigen Super Scan and Good Response Even After 1 Cycle of Radioligand Therapy.

A 76-year-old man with castration-resistant prostate cancer and widespread skeletal metastases underwent 2 cycles of Lu-prostate-specific membrane antigen (PSMA) 617 therapy in our department. Whole-body Lu-PSMA scan after the first cycle showed diffuse skeletal PSMA-avid lesions, whereas no PSMA uptake was evident in the kidneys with minimal PSMA uptake by salivary glands (super scan). After 6 weeks, he received the second dose of Lu-PSMA and whole-body scan after the treatment showed remarkable resolution of skeletal metastases and normal PSMA uptake by the kidneys and salivary glands. To our best knowledge, this is the first case report of Lu-PSMA super scan.

Design and Construction of A Laser-Based Respiratory Gating System For Implementation of Deep Inspiration Breathe Hold Technique in Radiotherapy Clinics.

BACKGROUND: Deep inspiration breath-hold (DIBH) is known as a radiotherapy method for the treatment of patients with left-sided breast cancer. In this method, patient is under exposure only while he/she is at the end of a deep inspiration cycle and holds his/her breath. In this situation, the volume of the lung tissue is enhanced and the heart tissue is pushed away from the treating breast. Therefore, heart dose of these patients, using DIBH, experiences a considerable decline compared to free breathing treatment. There are a few commercialized systems for implementation of DIBH in invasive or noninvasive manners. METHODS: We present a novel constructed noninvasive DIBH device relied on a manufacturing near-field laser distance meter. This in-house constructed system is composed of a CD22-100AM122 laser sensor combined with a data acquisition system for monitoring the breathing curve. Qt Creator (a cross-platform JavaScript, QML, and C++-integrated development environment that is part of the SDK for development of the Qt Graphical User Interface application framework) and Keil MDK-ARM (a programming software where users can write in C and C++ and assemble for ARM-based microcontrollers) are used for composing computer and microcontroller programs, respectively. RESULTS: This system could be mounted in treatment or computed tomography (CT) room at suitable cost; it is also easy to use and needs a little training for personnel and patients. The system can assess the location of chest wall or abdomen in real time with high precision and frequency. The performance of CD22-100AM122 demonstrates promise for respiratory monitoring for its fast sampling rate as well as high precision. It can also deliver reasonable spatial and temporal accuracy. The patient observes his/her breathing waveform through a 7" 1024 × 600 liquid crystal display and gets some instructions during treatment and CT sessions by an exploited algorithm called "interaction scenario" in this study. The system is also noninvasive and well sustainable for patients. CONCLUSIONS: The constructed system has true real-time operation and is rapid enough for delivering clear contiguous monitoring. In addition, in this system, we have provided an interaction scenario option between patient and CT or Linac operator. In addition, the constructed system has the capability of sending triggers for turning on and off CT or Linac facilities. In this concern, the system has the superiority of combining a plenty of characteristics.

Three Anastomotic Techniques Following Laparoscopic Rectal Cancer Resection: Our Experience in 155 Patients.

PURPOSE: This study aimed to assess the impact of 3 anastomotic techniques after laparoscopic rectal cancer resection. METHODS: In a cross-sectional study, the data of 155 patients who underwent surgery for rectal cancer were retrieved. An anastomosis was created between the left colon and anal canal with 3 different methods: coloanal anastomosis with protective ileostomy (group A), coloanal anastomosis without ostomy (group B), and delayed coloanal anastomosis (group C). The rates of anastomotic problems (leakage, peritonitis, and collection) were calculated for each treatment method. Multivariate analysis was used to verify the effect of anastomosis techniques. RESULTS: In 5 (3.2%) patients, peritonitis was observed in which 3 (9.7%) of them belonged to group B and 2 (4.1%) belonged to group C. In 9 (5.8%) patients, presacral collection and anastomotic leakage were observed; 4 (8.2%) patients belonged to group C, 4 (12.9%) patients to group B, and 1 (1.3%) patient to group A. Postoperative obstructions occurred in 5 (10.2%) patients of group C, 2 (6.5%) patients of group B, and 2 (2.7%) patients of group A. Rectovaginal fistula was detected in 2 patients from group B. CONCLUSIONS: Laparoscopic surgery of rectal cancer with transanal method is reliable and acceptable in terms of oncologic and surgical results. This study showed the best results in patients who had protective ostomy.

Prognostic Significance of Mucinous Histologic Subtype on Oncologic Outcomes in Patients With Colorectal Cancer.

PURPOSE: Mucinous adenocarcinomas account for about 10% of all colorectal cancers. This study aimed to investigate the prognostic impact of mucinous histologic subtype on oncologic outcomes in patients with colorectal cancer. METHODS: This retrospective study was performed at two large tertiary university hospitals. We analyzed the characteristics, prognostic factors, and survival of patients with colorectal cancer who were treated and followed up between 2000 and 2013. RESULTS: Totally, 144 of 1,268 patients with a colorectal adenocarcinoma (11.4%) had mucinous histologic subtype. Statistically significant results found in this research are as follows: Mucinous histologic subtype tended to present in younger patients and to have larger tumor size, higher histologic grade, higher node stage, larger number of positive nodes, and higher rate of perineural invasion compared to nonmucinous histologic subtype. On the univariate analysis, mucinous subtype was a prognostic factor for disease-free and overall survival. On the multivariate analysis, primary tumor location, node stage and lymphatic-vascular invasion were independent prognostic factors for the local control rate. Rectal tumor location, higher disease stage, tumor grade II, and presence of lymphatic-vascular invasion had negative influences on disease-free survival, as did rectal tumor location, higher disease stage and presence of lymphatic-vascular invasion on overall survival. CONCLUSION: Mucinous histologic subtype was associated with some adverse pathologic features in patients with colorectal cancer; however, it was not an independent prognostic factor for oncologic outcome.

Evaluation of the Prevalence Rate and the Prognostic Effect of Human Papilloma Virus Infection in a Group of Patients With Oral Cavity Squamous Cell Carcinoma.

BACKGROUND: Squamous cell carcinoma (SCC) is the most common malignancy of the oral cavity. A relationship between the human papilloma virus (HPV) infection and the prognosis of oral cavity SCC (OCSCC) has been discussed before. OBJECTIVES: We investigated the prevalence rate of HPV status in patients with OCSCC, and its effects on clinicopathological characteristics of tumors and patients' prognosis. PATIENTS AND METHODS: Sections of formalin-fixed, paraffin-embedded tissue blocks from 114 histopathologically confirmed OCSCC cases were investigated in this study. Polymerase chain reaction (PCR) was applied to evaluate the HPV status in the samples. RESULTS: Fifteen (13.16%) cases were identified as HPV positive. The detected viral subtypes in this study were the subtypes 6 and 11. The stage and especially lymph node stage was significantly higher in the HPV positive group compared to the HPV negative group (P = 0.04). Disease free survival (DFS) was remarkably lower in the HPV positive group compared to the HPV negative group (13.9 vs. 49.9 months, P = 0.02). Overall survival (OS) was also significantly inferior in the HPV positive group (15.7 vs. 49.6 months, P = 0.01). In the current study, no significant differences were observed between two groups in relation to the variables of age, gender, tumors site, tumor size, tumor grading and also the recurrence rate. CONCLUSIONS: The observed higher mortality rate among the HPV positive group indicates the poorer prognosis of this group in comparison with the HPV negative patients. The incidence rate of HPV infection was low in the studied samples; however, interaction of subtypes 6 and 11 of HPV in poorer prognosis of the patients and a carcinogenic role of HPV in OCSCC cannot be ruled out.

The Results of Chemotherapy with Two Variants of Intravenous CMF in Patients with Early Stage Breast Carcinoma; Does Dose Density Matter?

No direct comparisons can be made in early stages of breast cancer, between the intravenous combinations of: cyclophosphamide, methotrexate, and fluorouracil; named modified versions of CMF with the classical oral version of CMF. Since these modifications have different dose intensities and densities, the outcomes for their subsequent treatments may be varied, and not produce the same results. Despite that, classical CMF has been commonly replaced with intravenous modifications. This study aimed to assess the results of treatment with two common intravenous modification of CMF chemotherapy; to represent the most effective and successful substitute of classical CMF. Five hundred patients in two groups were eligible to take part in the experiment. For two hundred and twenty-nine patients in the group CMF 1&8, chemotherapy was administered intravenously on days 1 and 8 every 28 days for six cycles consisting of: cyclophosphamide 600 mg/m2 , methotrexate 40 mg/m2 , fluorouracil 600 mg/m2 . In the group CMF 1 which consisted of 271 patients, chemotherapy was administered with all the same drugs and doses, however, it was only administered on day 1 and repeated at 21-day intervals for six cycles. Overall survival (OS), disease-free survival (DFS), the prognostic factors and other probable interventional factors were then compared between the two groups. The 5-year OS rate of 87.5% and 10-year OS rate of 82% in the group CMF 1&8 were statistically significantly better than 5-year OS of 84% and 10-year OS of 61.5% in the group CMF 1 (p = 0.01). The 5-year and 10-year DFS rates were 76% and 60% respectively, in the group CMF 1&8 compared with 77% and 54% respectively in the group CMF 1 (p = 0.8). Two groups were comparable regarding their distribution of different prognostic factors and other probable interventional factors. Considering 30% higher dose density of drugs in the protocol of CMF 1&8, the improving outcome can be related to the efficacy of dose-dense chemotherapy. Therefore, this intravenous modification is the better substitute of classical CMF.

Changing pattern in the clinical presentation of breast cancer in the absence of a screening program over a period of thirty-three years in Iran.

OBJECTIVE: To survey the proportion of stages at the presentation of the disease without a screening program, among a population of breast cancer patients that is as a representative sample of the country in a distinct period. MATERIALS AND METHODS: The population of the current study is found among the female breast cancer patients who were referred to oncology centers in northeastern Iran over a thirty-three-year period from 1980 to 2012. RESULTS: Four thousand patients were divided into three time periods consisting of 521 cases from 1980 to 1990, 1178 cases from 1991 to 2001, and 2302 cases from 2002 to 2012. While there was no difference in the proportions of T1 and T3 tumors, T2 tumors showed an increase (P = 0.001) and T4 tumors a decrease (P = 0.000) during these periods. There was no change in the proportion of stage I, however the proportion of stage II had risen (P = 0.000), while that of stage III (P = 0.002), and stage IV (P = 0.000) had fallen. The study's urban and rural populations experienced a similar trend in this respect, with the exception that the rural population exhibited more striking changes during the study's recent years. CONCLUSION: After a thirty-three-year follow up on breast cancer in northeastern Iran, it is obvious that this disease is now presented in its earlier stages even in the absence of a screening program. In spite of this, the proportion of T1 disease and those tumors are discovered by a screening program has not significantly changed.

A clinical trial of neoadjuvant concurrent chemoradiotherapy followed by resection for esophageal carcinoma.

BACKGROUND: Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma. MATERIALS AND METHODS: Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated. RESULTS: One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. There were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%. In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confidence interval, 24.46-63.54). CONCLUSION: The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high.