Abstract Background: Breast cancer (BC) is the most common cancer in Iranian women, with 13400 new cases annually. A few studies have reported that BC patients with a positive familial history had different prognoses and outcomes.Objectives: The aim of the present study was to evaluate and compare survival between familial breast cancer (FBC) patients and sporadic breast cancer (SBC) patients in Iranian women.Methods: In a longitudinal study, 1710 patients with complete medical records from the Cancer Research Center, database were extracted and divided into two groups: the FBC group (n=311) and the SBC group (n=1399). Then, five-year overall survival (OS) and five-year disease -free survival (DFS) for these two groups were evaluated and compared.Results: The FBC group and SBC group represented 18.22% % and 81.8% of all cases, with mean ages of 44.2 years and 47.7 years, respectively (p=0.0024). There were more advanced stage and positive lymph nodes, higher grade of tumor, more positive lymphovascular invasion and P53 status and higher degrees of negative progesterone receptor status in the FBC group than in the SBC group (p=0.0200, p=0.0001, p=0.0001, p=0.0386, p=0.0182 and p=0.0003, respectively). In the FBC group and SBC group, the five -year DFS was 81% and 86.5%, (p=0.0121), and the five -year OS was 71.1% and 76.5%, respectively (p=0.0401).Conclusions: The findings of this study showed that better five-year OS, five-year DFS and favorable prognostic factors in the SBT group than in the FBC group. The initial results might be helpful as better treatment modalities and careful follow-up in the FBC group.
As of late 2019, the outbreak of novel coronavirus disease (COVID-19) –that started in China– has rapidly afflicted all over the world. The COVID-19 pandemic has challenged health-care facilities to provide optimal care. In this context, cancer care requires special attention because of its peculiar status by including patients who are commonly immunocompromised and treatments that are often highly toxic. In this review article, we have classified the main impacts of the COVID-19 pandemic on oncology practices –followed by their solutions– into ten categories, including impacts on (1) health care providers, (2) medical equipment, (3) access to medications, (4) treatment approaches, (5) patients' referral, (6) patients' accommodation, (7) patients' psychological health, (8) cancer research, (9) tumor board meetings, and (10) economic income of cancer centers. The effective identification and management of all these challenges will improve the standards of cancer care over the viral pandemic and can be a practical paradigm for possible future crises.
Background: Based on the literature review, the available information regarding late toxicities after intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) is limited to a few countries. Objectives: This study provides an opportunity to evaluate the delayed toxicities among Iranian patients with NPC that underwent IMRT. Methods: Between February 2016 and September 2018, 32 patients were treated with IMRT for NPC at Shohada-e Tajrish Hospital. The majority of them were in the advanced clinical stage and all received platinum-based induction and/or concurrent chemotherapy. Our typical prescription dose was 70.2 Gy to the gross tumor volume (GTV) in 2 Gy per fraction. Uninvolved regional lymph nodes received 59.4 Gy. Considering the minimum follow-up time of 6 months, we aimed mainly at evaluating the rate of delayed toxicities, including xerostomia, hearing loss, and eyeball damages. Toxicities were categorized based on either RTOG/EORTC or LENT/SOMA criteria. Results: The median follow-up time was 12 months (6 - 32 months). The occurrence rates of grade ⥠2 xerostomia, grade ⥠2 hearing loss, optic neuropathy, and retinopathy were 28%, 10%, 4%, and 7%, respectively. Based on the dose-volume histogram analysis, averages of mean doses to the parotid glands, submandibular glands, oral cavity, and cochlea were 32.3 Gy, 58.9 Gy, 41.8 Gy, and 44.9 Gy, respectively. Conclusions: Our experience of using IMRT in the treatment of NPC revealed equivalent toxicities (except for hearing loss) in comparison with high-experienced centers.
Background: The aim of this study was to evaluate and analyze disease-free survival (DFS) and overall survival (OS) after intensity-modulated radiotherapy (IMRT) for Iranian patients with nasopharyngeal carcinoma (NC). Methods: In this historical cohort study, 65 non-metastatic patients treated for NC with IMRT were selected and reviewed at the Shohadai-e-Tajrish Hospital between October 2017 and October 2019. Chemotherapy was given either as induction, concurrent, or adjuvant therapy in all cases. Three years of DFS and OS were calculated according to Kaplan-Meier and compared with the Pearson Correlation Test. Results: The mean age of patients was 43.38 years. The three-year DFS and OS rates were 95.72%, 92.32%, 72.73%, 73.26%, and 100%, 84.61%, 90.90%, and 79.41% in stage I, II, III, and IV patients, respectively (P = 0.119, P = 0.155). The total three-year DFS rate and the total three-year OS rate were 76.47% and 84.60% in all cases. Based on the Pearson Correlation Test, it was a significant correlation between the duration of IMRT time and three-year DFS (correlation=0.138, P = 0.017) and the number of concurrent cycles of chemotherapy with IMRT (correlation=0.375, P = 0.002). It was not a significant correlation between total time duration, MRI response, induction chemotherapy, age, sex, and the three-year DFS. There was a significant correlation between total time duration and three-year OS (correlation=0.263, P = 0.040) and the number of concurrent cycles of chemotherapy with IMRT and three-year OS (correlation=0.334, P = 0.007). It was not a significant correlation between the duration of IMRT time, MRI response, induction chemotherapy, age, sex, and the three-year OS. Conclusions: Our findings showed that IMRT with concurrent chemo-radiotherapy has the three-year DFS and OS, which were comparable with the other published results. We emphasize the number of concurrent cycles of chemotherapy with IMRT, which have an important role in both three-year DFS and OS. The duration of IMRT time has also an important role in the three-year DFS but not in the three-year OS. A longer follow-up for the patients to evaluate 10-year DFS and OS is recommended.
Abstract Objectives: The COVID-19 outbreak is affecting people worldwide. Most of the infected patients suffering from respiratory involvement that may progress to acute respiratory distress syndrome. This pilot study aimed to evaluate the clinical efficacy of low-dose whole-lung radiotherapy in patients with COVID-19 pneumonia. Methods: In this clinical trial, done in Iran, we enrolled patients with COVID-19 who were older than 60 years and hospitalized to receive supplementary oxygen for their documented pneumonia. Participants were treated with whole-lung irradiation in a single fraction of 0.5 Gy plus national protocol for the management of COVID-19. Vital signs (including blood oxygenation and body temperature) and laboratory findings (IL-6 and CRP) were recorded before and after irradiation. Results: Between 21 May 2020 and 24 June 2020, five patients received whole-lung irradiation. They followed for 5-7 days to evaluate response to treatment and toxicities. The clinical and paraclinical findings of four patients (except for patient #4 that get worst and died on day 3) improved on the first day of irradiation. Patient #3 opted-out the trial on the third day of irradiation. The mean time to discharge was 6 days for the other three patients. No acute radiation-induced toxicity was recorded. Conclusion: With a response rate of 80%, whole-lung irradiation in a single fraction of 0.5 Gy had encouraging results in oxygen-dependent patients with COVID-19 pneumonia.
Background: Triple negative breast cancer (TNBC) is characterized by negative result of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) in immunohistochemical (IHC) staining and an interesting topic of research today. Various studies have been reported in western countries on TNBC, all insisted of the poorer prognostic of TNBC than other subtypes of breast cancer. However extensive data from Iran is lacking. Objectives: The aim of this study was to analyze the clinical, pathological profile and survival of TNBC patients at our institute. Methods: Medical records of 1910 breast cancer patients in the Shahid Beheshti University of Medical Sciences cancer research center database with data on 180 patients of TNBC patients was collected between September 2002 and December 2014 and reviewed for clinicopathological profile and survival analysis. Results: The median age at diagnosis was 48 years. Fourteen patients (7.8 %) had stage I, 88 patients (48.9%) had stage II, 57 (31.7 %) had stage III, 8 (4.4%) patients had stage IV at first diagnosis and 13 patients (7.2%) with unknown stage. The median follow-up time was 41 months. 149 patients were without any with recurrences at the last follow up and 31 patients were with recurrence. Median interval for recurrence development was 39 months. Five years disease free survival (DFS) was 71%. Overall survival (OS) at 5 years for all patients was 56%. According to univariate cox regression 5-year DFS analysis, unfavorable prognostic factors in our study were as follows: grade III of tumor, positive LVI, presence of lymph node positive, stage II and stage III at diagnosis. According to multivariate cox regression 5-year OS analysis unfavorable prognostic factors were as follows: age: 40, grade III versus grade I of tumor, stage III at diagnosis versus Stage I, and visceral recurrence. Conclusions: We observed that most clinical and pathological TNBC characteristics in Iranian patients are consistent with others findings in literature, such as younger age at diagnosis, high grade tumors, advanced stage at diagnosis, and short time of 5-year DFS and 5-year OS. Longer follow-up of these patients is required for more mature data on these cancers.
Cervical cancer remains to be a major health problem and cancer-related cause of death among women in developing countries such as Iran where the most cases are diagnosed in locally advanced stage.This cross sectional-analytic study aims to report outcome 154 patients with carcinoma of cervix were treated with external beam radiation therapy (EBRT) and high-dose-rate (HDR) brachytherapy with cobalt 60 (Co-6o) remote after loading system.A total of 154 patients with the international federation of gynecologist and oncologist (FIGO) stages I-IVA with histopathologically confirmed carcinoma of cervix, followed by the radiation-oncology ward of Shohada-e-Tajrish Hospital in Tehran, Iran, between February 2008 and March 2015. They were completed their scheduled EBRT and HDR brachytherapy with Co-60 remote after loading system. Out of this, 132 patients completed their standard follow up protocol. They were analyzed for 3-year disease-free survival (DFS), 3-year overall survival (OS) incidence of acute and late complications for HDR brachytherapy.Fourteen patients (9.1 %) were in stage I (FIGO classification), 8 (5.2%) were in stage IIA, 26 (16.9%) were in stage IIB, 100 (64.9%) were in stage III, and 6 (3.9 %) were in stage IVA. The follow up duration was between 6 - 60 months with a median of 38 months. Overall rectal and bladder treatment toxicity rates were 33.7%. The 3-year DFS rate was 85.7%, 70.7 %, 41% and 16.6% for stages I, II, III, IVA respectively. Favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm (after adjusting for the residual disease after radiation), no pelvic lymph node involvement and 1 week Gap between EBRT and HDR brachytherapy in 3-year DFS (P = 0.001, P = 0.012, P = 0.005, P = 0.005, respectively). The 3-year OS rate was 85.7%, 76.4%, 42%, and 33.3% for stages I, II, III, and IVA, respectively. Favorable prognostic factors in univariate and multivariate analysis were early stage, tumor size < 4 cm, no pelvic lymph node involvement, 1 week gap between EBRT and HDR brachytherapy and no distant metastasis (during the follow up) in 3-year OS (P = 0.001, P = 0.002, P = 0.002, P = 0.002, P = 0.001, respectively).HDR brachytherapy with Co-60 remote after loading system was successful and it showed HDR brachytherapy in treating patients with carcinoma of cervix was effective after EBRT with acceptable rectal and bladder complications.
Background: Breast cancer is the most frequent diagnosed solid cancer among Iranian females and it comprises 25% of all cancer new cases in women. Breast cancer is uncommon in very young women (< 35 years), only accounting for fewer than 4% in Western countries. However, it is more common in Asian countries. Various studies have been reported in western countries on very young women; most of them insisted on the poorer outcomes of very young women instead of not very young women (age > 35 years). However, extensive data from Iran is insufficient. Objectives: The aim of this study was to compare the clinical, pathological profile, and prognostic factors between patients with breast cancer with age ≤ 35 years and > 35 years at our institute. Methods: The medical records of 1,910 patients with breast cancer in the Shahid Beheshti University of Medical Sciences Cancer Research Center database were reviewed between September 2002 and December 2014. A total of 199 patients with breast cancer were identified as very young group (age ≤ 35 years) and 398 patients, as less young group (age > 35 years), were selected and matched based on a time-stratified 2:1 approach. Finally, 597 patients with breast cancer were selected for the study. Results: The 5-year progression free survival (PFS) rate was 66% in very young group and 91% in not very young group that were significantly lower in patients with age ≤ 35 years than patients with age > 35 years. Conclusions: We observed that very young women had worse outcome compared with not very young women. However, longer follow up of these patients is required for more mature data on these cancers.
Radiotherapy is the gold standard for treatment of prostrate cancer as it can cover an adequate area of tissues at risk for metastasis.We evaluated the Pelvic lymph node coverage of conventional radiotherapy fields based on bone and vessels landmarks using computed tomography (CT) simulation in patients with prostate cancer referred to Shohada-e-Tajrish hospital.In this cross sectional study, 40 patients with prostate cancer at the Stage T1c to T3b were studied. Pelvic lymph nodes were contoured by using pelvic vessels as surrogate markers. The distances were measured at different points of anterior-posterior (AP) and lateral fields and distances > 5 mm or more between the contoured nodes and the field borders.Mean and standard deviation of the aortic bifurcation from the superior border was 4.73 ± 1.16 cm, the distance of common iliac bifurcation from the superior border was 1.11 ± 1.25 cm, the mean (SD) distance of right external iliac from the lateral border of AP field was 2.06 ± 0.48 cm and for left external iliac artery was 1.90 ± 0.56 cm. The distance of the external iliac artery from the anterior border of the lateral field was 2.30 ± 0.74 cm. The distance of the external iliac artery from pelvic rim was 0.59 ± 0.59 cm, distance of bifurcation of iliac from sacroiliac joint was 0.82 ± 1.01 cm, the size of the pelvic rim was 12.30 ± 0.64 cm, sacral width was 8.29 ± 1.01 cm, anterior promontory symphysis distance was 12.02 ± 0.92 cm and posterior promontory symphysis distance was 10.98 ± 0.73 cm.We observed that conventional radiotherapy using CT simulation based on bone and vessels landmarks provided adequate coverage of pelvic lymph nodes in our patients with prostate cancer.
Introduction: Post-irradiation mammary stromal sarcoma (MSS) is a rare condition, and it is worth learning new knowledge from each case. Case Presentation: We present the case report of a 59-year-old female with a medical history of breast cancer, who presented with an axillary mass on the same side. The patient was further evaluated and finally diagnosed with MSS with chondroid differentiation. Thereafter, she underwent neoadjuvant chemotherapy to facilitate the surgical resection of the tumor. However, she experienced local progression and lung metastasis during chemotherapy. Conclusions: MSS with chondroid differentiation was resistant to the standard chemotherapy regimens of sarcoma. Radiotherapy is a potential choice in the case of chemoresistant MSS. Further trials may reveal this notion.
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