International Journal of Cancer Management
Year:2014 | Volume:7 | Issue:2|Papers Count:11

Radiation therapy (RT) is an integral part of cancer treatment for local control, in International Atomic Energy Agency (IAEA) report cancer cure is related to surgery, by 49%, radiation therapy as a single treatment or adjuvant by 40%, chemotherapy as a single or with other treatment by 11%. For local management surgery and RT are two main accepted procedures.From the first day of X-Ray discovery the scientific community used it as intra operation or external depending on facilities and available accepted status to treat the cases.The Electron and Proton are other ionized radiation material in RT departments. Nowadays mobile machines are available in the operating rooms to treat the cases with X-Ray or Electron, and because of that some new problems are raising up. Radical and or boost dose of RT are acceptable management, for many cases of abdominal malignancies such as cardia, stomach, pancreas, rectum and retroperitoneal cancers, sarcoma in particular in the retropritoneum and extremities. There is no doubt that IORT in these cases are efficient and acceptable in cancer management but in Breast Cancer there is a different situation.Nowadays, RT after Breast Conserving Surgery (BCS) is essential part of treatment that in conventional manner, it is used after surgery and chemotherapy with at least 120 days delay. Whole Breast Radiation (WBR) and boost dose are modalities of treatment with at least 30 days engagement. In IORT, these two are done in few minutes (Electron) or half an hour (photon). Because of such differences, IORT is going to be standard of care for selected cases of breast cancer.There is two important trial called Targit and Eliot using X-Ray and Electron as Boost and/or Radical dose. There is some question about selecting cases for radical dose, to have appropriate outcomes. In two trials all cases less than 50 years old, with early stage breast cancer, tumor size less than 4 cm and node negative, good biological markers(ER, PR positive and Her-2 negative) and appropriate pathological features (Grade 1 and no vascular invasion) were suitable cases for radical RT. Radical IORT for the others are questionable and needs more investigation to use it, here in my country we create a new protocol called IRIORT. In IRIORT, the cases older than 40 years old, with tumor size less than 4cm, node negative are eligible for radical dose of IORT. So we hope that with a suitable period, our data as a new experience will be available to be judged in scientific communities.IORT is an acceptable RT treatment for whole cases now and in the future as a part of cancer management with other procedures such as external radiation, brachytherapy, and more.

Background: Esophageal cancer is often diagnosed in the last stages where the chance of patient's survival is very low. The aim of this systematic review was presentation of valid estimation of survival in patients with esophageal cancer in different regions of Iran.Methods: A systematic review was carried out based on the reliable domestic medical databases including: SID, Magiran, Irandoc and Iranmedex as well as reliable foreign databases like PubMed and Scopus using "Cancer", "Esophagus", "survival" "Neoplasms" and "Longevity" as keywords. Then all the reviewed articles and dissertations which met the entry criteria were analyzed. The data were analyzed by using meta-analysis method (random model) and by means of STATA software application version 11.1.Results: In 18 studies the total numbers of 2932 people were analyzed. The one year survival rate in Iran is estimated at 47 percent (95% CI: 34-61) and the five year survival rate is estimated at 12% (95% CI: 8-16). The two, three and four year survival rates were 31% (95% CI: 18-44), 22% (95% CI: 13-31) and 21% (95% CI: 4-38), respectively.Conclusion: According to the findings one year survival rate for esophageal cancer in Iran is almost four times higher than its five year survival rate. Moreover the five year survival rate in Iran is less than many other countries.

Background: Patients which have diagnosed with a cancer, have a life time risk for developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Cancer victims could survive longer due to settling treatment modalities, and then would likely develop a new metachronous malignancy.This article aims to report our observed trend of increasing, in prevalence of both synchronous and metachronous second primary malignancy, among the cancer victims, and to review the relevant literature.Methods: A hospital based retrospective gathering of prospective data, among the patients that have diagnosed with second de novo malignancy.The study has conducted over a 4 years period from 2009 to 2012. All patients that have diagnosed with a histologically proven second malignancy as per Warren and Gates criteria have included. Various details which have regarded site, age at presentation, sex, synchronous or metachronous, treatment have recorded.Results: Among 41 cases of multiple primary malignancies that have observed, 8 were synchronous (19.51%) and 33 were metachronous (80.49%). Out of 41 patients, 25 (60.98%) were females and 16 (39.02%) were males. The most common sites of primary tumor were head and neck cancers that have followed by gynecological cancers, breast cancer, lung cancer, esophageal cancer, and then the others. Among the second malignancy, the most common site was breast and gastrointestinal tract that have followed by lung and gynecological cancers. Out of the total number of cases with double location, 14 tumors (34.15%) have belonged to the breast, out of which 5 (12.20%) have represented first locations and 7 (17.07%) have been second locations. Both locations have belonged to the breast in 2 patients (4.9%). In 5 cases (12.20%), there were associations of breast-cervix and in 6 cases (14.63%), there were association of lung-head & neck cancers.Conclusion: The incidence of multiple primary malignancies has not been rare at all. Screening procedures have especially been useful for the early detection of associated tumors, whereas careful monitoring of patients has treated for primary cancer, and then a good communication between patients and medical care team would certify not only an early detection for secondary tumors, but only finally & subsequently, an appropriate management.

Background: In this study we have evaluated the prognostic impact of Metastatic Lymph node Ratio (MLR) in gastric cancer patients whose have undergone curative surgical resection.Methods: A total of 121 patients with gastric adenocarcinoma undergoing curative surgical resection (R0) in our institutions between 2003 and 2010 have been included in this study. MLR has classified into 3 groups as follows: MLR0; 0, MLR1; >0-0.33 and MLR2; 0.34-1. We have used Kaplan-Meier method to calculate survival rates and log rank test to compare survival curves between groups. Cox proportional hazards model has utilized for multivariate analysis.Results: The median age of patients was 65 (range; 32 to 89) with a male to female ratio of 91/30 (3.03). 88 patients have undergone total gastrectomy (72.5%) and 33 subtotal gastrectomy (27.5%). With a median total retrieved lymph node of 11 (range; 6 to 44), the MLR0 to MLR2 has calculated in 28(23.1%), 31(25.6%) and 62 (51.2%) patients respectively. MLR2 (>0.33) has significantly associated with higher Tumor stage (T1-T2: 18.7% vs. T3: 56.2%, p=0.002). With a median follow up time of 12 months (range; 2-88), the 3-year survival in patients with MLR0, MLR1 and MLR2 was 75.1%, 54.8% and 9.5% respectively (p value<0.001). Tumor location (p<0.01), tumor stage (p<0.01) and lymph node stage (p<0.001) were also significant predictor of survival. MLR has also significant correlated with survival in 91 patients with less than 15 obtained lymph nodes (p<0.001). Cox-regression multivariate analysis has shown MLR as the most important and independent predictor of survival (p<0.001).Conclusion: MLR with cutoff point of 0.33 could be used as an independent prognostic factor in gastric cancer patients whose have undergone curative surgical resection. This factor could effectively predict survival even in cases with insufficient (<15) retrieved lymph nodes.

Background: The aim of this study was to investigate the epidemiological aspects of malignant tumors of head and neck in southeast of Iran, with a view toward analyzing the age, gender and site distribution and histological types.Methods: All cases with malignant tumor of the head and neck region from 1999 to 2009 were retrieved from the records of cancer registry center of Kerman University of medical sciences and all pathology laboratories of Kerman province.Results: A total of 1604 cases were recruited during the study period. The mean age of patients was 53.03 years (standard deviation: 17.18, range: 2 to 95 years). Patients with a diagnosis of carcinoma were older than those with sarcoma and lymphoma (p<0.01). 18.4% of patients were below the age of 41 years. The overall male to female ratio was 2.74:1. Larynx was the most commonly affected site (46.76%) followed by oral cavity (15.9%). Squamous cell carcinoma was the most common diagnoses (77.5%), followed by lymphoma (9.4%).Conclusion: The higher incidence of laryngeal cancer in the head and neck region in southeast of Iran is in agreement with findings of the other parts of Iran. Also, occurrence of head and neck cancer under 41 year olds is greater than what is reported for some countries.

Background: Glioblastoma Multiforme (GBM) or grade IV astrocytoma is the most common and lethal adult malignant brain tumor. Several of the molecular alterations detected in gliomas may have diagnostic and/or prognostic implications. Proteomics has been widely applied in various areas of science, ranging from the deciphering of molecular pathogen nests of discuses.Methods: In this study proteins were extracted from the tumor and normal brain tissues and then the protein purity was evaluated by Bradford test and spectrophotometry. In this study, proteins were separated by 2-Dimensional Gel (2DG) electrophoresis method and the spots were then analyzed and compared using statistical data and specific software. Protein clustering analysis was performed on the list of proteins deemed significantly altered in glioblastoma tumors (t-test and one-way ANOVA; P<0.05).Results: The 2D gel showed totally 876 spots. We reported, 172 spots were exhibited differently in expression level (fold>2) for glioblastoma. On each analytical 2D gel, an average of 876 spots was observed. In this study, 188 spots exhibited up regulation of expression level, whereas the remaining 232 spots were decreased in glioblastoma tumor relative to normal tissue. Results demonstrate that functional clustering (up and down regulated) and Principal Component Analysis (PCA) has considerable merits in aiding the interpretation of proteomic data.Conclusion: 2D gel electrophoresis is the core of proteomics which permitted the separation of thousands of proteins. High resolution 2DE can resolve up to 5,000 proteins simultaneously. Using cluster analysis, we can also form groups of related variables, similar to what is practiced in factor analysis.

Background: 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.Methods: 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.Results: 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.Conclusion: 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.

Background: Oral cancer has emerged as a significant cause of global public health concern. If a cancerous lesion is diagnosed in primary stages, the survival rate would be higher. Thus, the aim of this study was to evaluate knowledge, attitude and practice of general dentist regarding oral cancer in Sari, Iran.Methods: This cross sectional analytical study was performed on general dentists of Sari, Iran. The dentists were given a questionnaire including demographic characteristics of the dentists and questions about knowledge, attitude and practice regarding oral cancer. Data were subjected to SPSS 18.0. Quantitative data were reported as mean (±SD) and qualitative data were shown as percent. Kolmogorov- Smirnoff sample test, t-test (p<0.07 was considered statistically significant)’ equivalent nonparametric test and Spearman’s rho test was used for statistical analysis.Results: Total mean score of knowledge, mean score of females and mean score of males was 20.88±8.53, 20.96±7.62 and 20.71±10.43, respectively. Age and sex had no correlation with score of knowledge.Conclusion: Dentists of Sari do not have enough knowledge about oral cancer.

Rabies is a fatal neurological infection caused by rabies virus. The deadly rabies virus could enter into human body via the wound that has caused by mammal bite. Since rabies is a fatal disease without existing effective treatment, the best way is prevention. The widely examined preventive method for rabies is the use of post exposure rabies vaccination. In this specific case report, the author has presented an interesting case report of post exposure rabies vaccination in a pediatric patient with acute myeloid leukemia during the chemotherapy course.

The deadly Schwannomas, as uncommon subtype of soft tissue tumors originate from peripheral nerve sheaths. Retro peritoneum is an uncommon site for these tumors.Here we present the clinical feature and therapeutic implication of a 38 year old man affected by recurrent retroperitoneal schwannoma who admitted to emergency ward following abdominal pain. Computed Tomorgraphic Scan showed a solid well-differentiated heterogeneous mass, 8.5´6 cm size in portahepatis beneath liver and right periumbilical. On laboratory tests Cancer Antigen 19-9 and Cancer Embryonic Antigen were in normal range. In surgery, a 7´8cm round mass was discovered at juxta renal juxta duodenal retro peritoneum, It was completely adhered to second part of duodenum with no signs of infiltration of the liver and right kidney, unable to simply being enucleated, curative resection was performed by classical whipple procedure. The patient`s hospitalization course was uneventful and on the second week he was discharged from the hospital with complete recovery.Due to the high recurrent rate of retroperitoneal Schwannomas even in benign circumstances, radical resection would be the treatment of choice.

To The Editor:Cancer has emerged as a major public health concern owing to its magnitude, worldwide distribution, and impact on the quality of life, financial burden on the patient/family/society/ health care delivery system, and associated mortality [1]. Recent estimates have revealed that in the year 2012, almost 14.1 million new cancer cases have been reported and 8.2 million cancer deaths have occurred [2]. However, the issue of concern is that around 57% of the new cancer cases and 65% of the reported mortalities are from developing nations [2, 3].