Binary Logistic Regression Modeling of Voice Impairment and Voice Assessment in Iranian Patients with Nonlaryngeal Head-and-Neck Cancers after Chemoradiation Therapy: Objective and Subjective Voice Evaluation.

Background: Laryngeal damages after chemoradiation therapy (RT) in nonlaryngeal head-and-neck cancers (HNCs) can cause voice disorders and finally reduce the patient's quality of life (QOL). The aim of this study was to evaluate voice and predict laryngeal damages using statistical binary logistic regression (BLR) models in patients with nonlaryngeal HNCs. Methods: This cross-section experimental study was performed on seventy patients (46 males, 24 females) with an average age of 50.43 ± 16.54 years, with nonlaryngeal HNCs and eighty individuals with assumed normal voices. Subjective and objective voice assessment was carried out in three stages including before, at the end, and 6 months after treatment. Eventually, the Enter method of the BLR was used to measure the odds ratio of independent variables. Results: In objective evaluation, the acoustic parameters except for F0 increased significantly (P < 0.001) at the end treatment stage and decreased 6 months after treatment. The same trend can be seen in the subjective evaluations, whereas none of the values returned to pretreatment levels. Statistical models of BLR showed that chemotherapy (P < 0.05), mean laryngeal dose (P < 0.05), V50 Gy (P = 0.002), and gender (P = 0.008) had the greatest effect on incidence laryngeal damages. The model based on acoustic analysis had the highest percentage accuracy of 84.3%, sensitivity of 87.2%, and the area under the curve of 0.927. Conclusions: Voice evaluation and the use of BLR models to determine important factors were the optimum methods to reduce laryngeal damages and maintain the patient's QOL.

Recurrent malignant ovarian adenocarcinoma with central nervous system metastasis successfully treated with paclitaxel, carboplatin, capecitabine, and gemcitabine.

Ovarian carcinoma is a common malignancy with a grim prognosis and a high mortality rate. Here, we report a rare case of an Iranian woman with four episodes of recurrent metastatic ovarian carcinoma. She was initially diagnosed with stage IVa high-grade serous ovarian adenocarcinoma (HGSOC), treated with paclitaxel-carboplatin and capecitabine, followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Two years later, she developed cerebellar metastasis and received whole-brain radiotherapy and paclitaxel-carboplatin. Eighteen months later, she had peritoneal metastasis and had sequential gemcitabine-carboplatin-paclitaxel. One year later, she had splenic metastasis, treated with splenectomy and adjuvant carboplatin and nano-albumin bond paclitaxel. The patient remains in remission until now, 11 months after completing the most recent regimen. This report emphasizes the potential to successfully use chemoradiotherapy with sequential courses of platinum-based agents in patients with recurrent metastatic HGSOC.

Successful treatment of recurrent esophageal squamous cell carcinoma with muscle metastasis using capecitabine and cetuximab.

Esophageal cancer (EC) is a relatively rare malignancy in the United States, although it is associated with high morbidity and mortality. More than 90% of EC cancer-related mortality is due to distant metastasis, most commonly to the liver, lungs, bone, and brain. Although EC has a high tendency for random dissemination, it rarely metastasizes to the muscles and soft tissue. Here, we report a rare case of a patient with recurrent esophageal squamous cell carcinoma metastasis to his left thigh musculature, initially suspected to be a soft tissue sarcoma on magnetic resonance imaging. The patient did not tolerate standard chemotherapy with epirubicin, oxaliplatin, and capecitabine and was subsequently successfully treated with neoadjuvant radiotherapy, surgery, and adjuvant chemotherapy with capecitabine and cetuximab for 2 years and capecitabine alone for 1 year.

The Relationship between Lung and Heart Two-Dimensional Parameters and Three-Dimensional Dose-Volume Data in Adjuvant Radiotherapy for Breast Cancer.

Background: Two-dimensional (2D) radiographic parameters have been used to estimate the amount of heart and lung irradiated for minimizing heart and lung complications in breast cancer patients. The aim of this study was to investigate the correlation between traditionally used 2D radiographic and dose-volume parameters during adjuvant radiotherapy of breast cancer. Methods: In this cross-sectional study, we analyzed 121 female patients treated with breast-conserving surgery (BCS) or modified radical mastectomy (MRM) and 3D conformal radiotherapy (3DCRT) using two-field radiotherapy (2FRT) or three-field radiotherapy (3FRT) technique. All patients underwent computed tomography (CT)-planning. Two-D parameters, including central lung distance (CLD), maximum lung depth (MLD), maximum heart length (MHL), maximum heart distance (MHD), and chest wall separation (CWS), were measured using digitally reconstructed radiographs (DRR) and CT images. DVHs for lung, heart, and target were created. The Pearson correlation test was used to evaluate the correlation between 2D radiographic and dose-volume parameters. Results: There was a correlation between CLD and ipsilateral lung V5-20Gy and Dmean and between MLD and ipsilateral lung V5-20Gy. In 2FRT, only moderate correlation between CLD and ipsilateral lung V20Gy (r = 0.453, P = 0.003) and between MLD and ipsilateral lung V20Gy (r = 0.593, P <0.001) were observed. Poor correlation of MHL and heart V25Gy (r = 0.409, P = 0.007) was seen only in 3FRT. There was a correlation between MHD and heart dose-volume data, with a strong correlation between MHD and heart V5-25Gy and Dmean (r = 0.875-0.934, P<0.001) in the 2FRT group. No correlation between CWS and breast Dmax was found. Conclusion: There was a correlation between 2D parameters (i.e., CLD, MLD, and MHD) and the heart and lung dose-volume parameters during adjuvant breast radiotherapy. Although CLD was correlated to ipsilateral lung V5-20Gy and Dmean, the correlation between CLD and ipsilateral lung V20Gy was greater than other dose-volume parameters. MHD provided a close estimation of heart dose-volume parameters.

Common data elements of breast cancer for research databases: A systematic review.

BACKGROUND: Common Data Elements (CDEs) are data-metadata descriptors used to collect research study data. CDEs facilitate the collection, processing, and sharing of breast cancer data. This study intended to explore the CDEs of breast cancer for research databases and primary care systems. METHODS: This study was conducted using systematic search and review. This systematic literature review covered PubMed, Scopus, Science Direct, SID, ISC, Web of Science, and Google Scholar search engine. It included studies in English language with accessible full-text from the beginning of 2007 to September 2019. RESULTS: Reviewing 25 studies revealed that 52 percent of studies were carried out in the US and most studies were conducted between 2013 and 2015. The most domains for using CDEs were: Pathology Report and Registry. The CDEs of breast cancer for research databases were categorized into three categories namely clinical, research, and non-clinical and indicate the importance of these data elements. Most of the studies focused on creating and deploying clinical CDEs as physical examination, clinical history and pathology data. CONCLUSION: The integration of biomedical and clinical data relevant to breast cancer enhances the power of research variable analysis and statistical analysis, thereby facilitating improved knowledge of effective therapeutic interventions. Also CDEs used to collect, store, and retrieve patient data in various health setting such as primary care and research databases.

Radiosurgery for glomus jugulare tumors: experience treating 16 patients in Iran.

OBJECT: Glomus jugulare tumors (GJT) have traditionally been treated by surgery or fractionated external-beam radiotherapy. The aim of this retrospective study was to determine the tumor control rate, clinical outcome, and short-term complications of stereotactic radiosurgery in subsets of patients who are poor candidates for these procedures, based on age, medical problems, tumor size, or prior treatment failure. METHODS: The Leksell Gamma Knife was used to treat 16 patients harboring symptomatic, residual, recurrent, or unresectable GJTs. The age of the patients ranged from 12 to 77 years (median 46.5 years). Gamma Knife surgery (GKS) was performed as primary treatment in five patients (31.3%). Microsurgery preceded radiosurgery in 10 patients (62.5%) and fractionated radiotherapy in three patients (18.8%). The median tumor volume was 9.8 cm3 (range 1.7-20.6 cm3). The median marginal dose applied to a mean isodose volume of 50% (range 37-70%) was 18 Gy (range 14-20 Gy). Neurological follow-up examinations revealed improved clinical status in 10 patients (62.5%), a stable neurological status in six (37.5%), and no complications. After radiosurgery, follow-up imaging was conducted in 14 patients; the median interval from GKS to the last follow up was 18.5 months (range 4-28 months). Tumor size had decreased in six patients (42.9%), and the volume remained unchanged in the remaining eight (57.1%). None of the tumors increased in volume during the observation period. CONCLUSIONS: According to the authors' experience, GKS represents a useful therapeutic option to control symptoms and may be safely conducted in patients with primary or recurrent GJTs with no death and no acute morbidity. Because of the tumor's naturally slow growth rate, however, long-term follow-up data are needed to establish a cure rate after radiosurgery.