[Show abstract][Hide abstract] ABSTRACT: Purpose:
Despite advances in rectal cancer treatment over the last decade, local control and risk of late side effects due to external beam radiation therapy (EBRT) remain as concerns. The present study aimed to investigate the efficacy and the safety of low-dose-rate endorectal brachytherapy (LDRBT) as a boost to neoadjuvant chemoradiation for use in treating locally advanced distal rectal adenocarcinomas.
This phase-II clinical trial included 34 patients (as the study arm) with newly diagnosed, locally advanced (clinical T3-T4 and/or N1/N2, M0) lower rectal cancer. For comparative analysis, 102 matched patients (as the historical control arm) with rectal cancer were also selected. All the patients were treated with LDRBT (15 Gy in 3 fractions) and concurrent chemoradiation (45-50.4 Gy). Concurrent chemotherapy consisted of oxaliplatin 130 mg/m(2) intravenously on day 1 plus oral capecitabine 825 mg/m(2) twice daily during LDRBT and EBRT.
The study results revealed a significant differences between the study arm and the control arm in terms in the pathologic tumor size (2.1 cm vs. 3.6 cm, P = 0.001), the pathologic tumor stage (35% T3-4 vs. 65% T3-4, P = 0.003), and the pathologic complete response (29.4% vs. 11.7%, P < 0.028). Moreover, a significantly higher dose of EBRT (P = 0.041) was found in the control arm, and a longer time to surgery was observed in the study arm (P < 0.001). The higher rate of treatment-related toxicities, such as mild proctitis and anemia, in the study arm was tolerable and easily manageable.
A boost of LDRBT can optimize the pathologic complete response, with acceptable toxicities, in patients with distal rectal cancer.
Annals of Coloproctology 09/2015; 31(4):123-130. DOI:10.3393/ac.2015.31.4.123
[Show abstract][Hide abstract] ABSTRACT: Background: In intracavitary brachytherapy for gynecological cancers, various techniques are used to locate the anterior rectal wall nearest to the sources but there is no consensus on the best method to do so. This study aimed to compare a technique used routinely in some centers that employs a wire marker to locate the position of the maximum rectal dose point, versus the method recommended by the ICRU Report 38. Materials and Methods: In a preliminary prospective study on 34 intracavitary insertions for patients with cervical or endometrial cancer, treated at our center based on the Manchester system, the dose distributions were obtained from a treatment planning system following the input of scanned orthogonal anteroposterior and lateral radiographs. For each case, an in-house marked wire was inserted in the rectal lumen and the doses were calculated on several points along the wire seen on the radiographs, to obtain the maximum dose. For the same insertions, the ICRU method was also applied by considering the rectal wall hot spot as a point 0.5 cm posterior to the posterior vaginal wall (visualized on the radiographs by vaginal packing material containing contrast medium). Results: Averaged over all insertions, mean rectal wall hot spot dose calculated using the positional information obtained by the wire technique was lower by 28.6% than that given by the ICRU method (P < 0.001). Conclusion: Our initial results add evidence to the suggestion that the wire technique underestimates the rectal wall hot spot dose significantly compared to the ICRU method.
Iranian journal of radiation research (IJRR) 01/2015; 12(4):369-372. · 0.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Thymomas are rare epithelial tumors arising from thymus gland. This study aims at investigating the clinical presentation, prognostic factors and treatment outcome of forty five patients with thymoma and thymic carcinoma.
Methods: Forty-five patients being histologically diagnosed with thymoma or thymic carcinoma that were treated and followed-up at a tertiary academic hospital during January 1987 and December 2008 were selected for the present study. Twelve patients were solely treated with surgery, 14 with surgery followed by adjuvant radiotherapy, 12 with sequential combined treatment of surgery, radiotherapy and/or chemotherapy and 7 with non-surgical approach including radiotherapy and/or chemotherapy. Tumors were classified based on the new World Health Organization (WHO) histological classification.
Results: There were 18 women and 27 men with a median age of 43 years. Twelve patients (26.7%) had stage I, 7 (17.8%) had stage II, 23 (51%) had stage III and 2 (4.5%) had stage IV disease. Tumors types were categorized as type A (n=4), type AB (n=10), type B1 (n=9), type B2 (n=10), type B3 (n=5) and type C (n=7). In univariate analysis for overall survival, disease stage (P=0.001), tumor size (P=0.017) and the extent of surgical resection (P<0.001) were prognostic factors. Regarding the multivariate analysis, only the extent of the surgical resection (P<0.001) was the independent prognostic factor and non-surgical treatment had a negative influence on the survival. The 5-year and 10-year overall survival rates were 70.8% and 62.9%, respectively.
Conclusion: Complete surgical resection is the most important prognostic factor in patients with thymic epithelial tumors.
Iranian Journal of Medical Sciences 07/2014; 39(4):341-9.
[Show abstract][Hide abstract] ABSTRACT: Paratesticular sarcomas have happened rarely. Due to the infrequency of this malignant disease and its diverse histopathologic subtypes, no standard treatment would be available. Multiple treatments have reported in literature with different results. We have reported a 55 years old man with a 30 years history of paratesticular mass. After multiple operations, radical orchiectomy has revealed liposarcoma. The patient has been receiving 50 Gy radiation to the scrotum and inguinal area. After 18 months follow up, the patient was well and disease free. He has shown good response to surgery and radiotherapy, so we have reported the disease and its clinical course.
Iranian Journal of Cancer Prevention 05/2014; 7(4):239-43.
[Show abstract][Hide abstract] ABSTRACT: Background: This two-arm, randomized clinical study aimed to compare efficacy between topical Alpha ointment and topical hydrocortisone cream (1%) in the healing of radiation-induced dermatitis in breast cancer patients.
Methods: The inclusion criteria comprised newly pathologically proven, locally advanced breast cancer (treated with modified radical mastectomy followed by sequential adjuvant treatments, including chest wall radiotherapy [45-50.4 Gy]) and grade 2 and/or 3 chest wall dermatitis. The exclusion criteria were comprised of any underlying disease or medications interfering with the wound healing process, previous history of chest wall radiotherapy, and concurrent use of chemotherapy. Sixty eligible patients were randomly assigned to use either topical Alpha ointment (study arm, n=30) or topical hydrocortisone cream (1%) (control arm, n=30) immediately after receiving a total dose of 45-50 Gy chest wall radiotherapy.
Results: The mean radiation dose was 49.1 Gy in the control arm and 48.8 Gy in the study arm. The mean dermatitis area was 13.54 cm2 in the control arm and 17.02 cm2 in the study arm. Topical Alpha ointment was more effective on the healing of radiation-induced dermatitis than was topical hydrocortisone cream (1%) (P=0.001). This effect was significant in the second week (P=0.007). In addition, Alpha ointment decreased the patients’ complaints such as pain (P<0.001), pruritus (P=0.009), and discharge (P=0.010) effectively and meaningfully.
Conclusion: Topical Alpha ointment was more effective on the healing of radiation-induced dermatitis than was topical hydrocortisone cream (1%) in our patients with breast cancer.
Trial Registration Numbers: IRCT201206099979N1, ACTRN12612000837820
Iranian Journal of Medical Sciences 12/2013; 38(4):293-300.
[Show abstract][Hide abstract] ABSTRACT: Introduction. This study aimed to report the characteristics, prognostic factors,
and treatment outcomes of 54 patients with primary gastric lymphoma.
Materials and Methods. This retrospective study was carried out by reviewing the
medical records of 54 adult patients diagnosed at a tertiary academic hospital. All the patients were treated with curative intent. Forty-four patients
(81.5%) underwent gastrectomy followed by adjuvant chemotherapy and/or radiotherapy,
whereas 10 ones (18.5%) were treated with chemotherapy alone or with radiotherapy.
Results. The study was conducted on 25 males and 29
females with the median age of 50 years. Diffuse large B-cell lymphoma
(DLCL) (67%) and Mucosa Associated Lymphoid Tissue (MALT) lymphoma (26%) were
the most common histologic types. Besides, 36 (59%), 16 (30%), 5 (9%),
and 1 (2%) patients were in stages I, II, III, and IV, respectively. The 5-year
disease-free survival and overall survival were 64.7% and 67%, respectively.
In univariate analysis for overall survival, International Prognostic Index (IPI) (), the WHO performance status (), Ann Arbor stage (), age (), and LDH serum level () were the prognostic factors. Conclusion. Gastric lymphoma tends to present in early stage of the disease and has a favorable outcome.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate local control and survival rates following abdominoperineal resection (APR) compared with low anterior resection (LAR) in lower and middle rectal cancer.
In this retrospective study, 153 patients with newly histologically proven rectal adenocarcinoma located at low and middle third that were treated between 2004 and 2010 at a tertiary hospital. The tumors were pathologically staged according to the 7th edition of the American Joint Committee on Cancer (AJCC) staging system. Surgery was applied for 138 (90%) of the patients, of which 96 (70%) underwent LAR and 42 were (30%) treated with APR. Total mesorectal excision was performed for all patients. In addition, 125 patients (82%) received concurrent (neoadjuvant, adjuvant or palliative) pelvic chemoradiation, and 134 patients (88%) received neoadjuvant, adjuvant or concurrent chemotherapy. Patients' follow-up ranged from 4 to 156 (median 37) months.
Of 153 patients, 89 were men and 64 were women with a median age of 57years. One patient (0.7%) was stage 0, 15 (9.8%) stage I, 63 (41.2%) stage II, 51 (33.3%) stage III and 23 (15%) stage IV. There was a significant difference between LAR and APR in terms of tumor distance from anal verge, disease stage and combined modality therapy used. However, there was no significant difference regarding 5-year local control, disease free and overall survival rates between LAR and APR.
LAR can provide comparable local control, disease free and overall survival rates compared with APR in eligible patients with lower and middle rectal cancer.
Journal of the Egyptian National Cancer Institute 09/2013; 25(3):151-60. DOI:10.1016/j.jnci.2013.06.001
[Show abstract][Hide abstract] ABSTRACT: This study aimed to report the characteristics, prognostic factors and treatment outcome of 223 patients with glioblastoma multiforme (GBM).
This retrospective study was carried out by reviewing the medical records of 223 adult patients diagnosed at a tertiary academic hospital between 1990 and 2008. Patients' follow up ranged from 1 to 69months (median 11months). Surgery was attempted in all patients in whom complete resection in 15 patients (7%), subtotal resection in 77 patients (34%), partial resection in 73 patients (33%) and biopsy alone in 58 patients (26%) were done. In addition, we performed a literature review of PubMed to find out and analyze major related series. In all, we collected and analyzed the data of 33 major series including more than 11,000 patients with GBM.
There were 141 men and 82 women. The median progression free- and overall survival were 6 (95% CI=5.711-8.289) and 11 (95% CI=9.304-12.696) months respectively. In univariate analysis for overall survival, age (P=0.003), tumor size (P<0.013), performance status (P<0.001), the extent of surgical resection (P=0.009), dose of radiation (P<0.001), and adjuvant chemotherapy (P<0.001) were prognostic factors. However, in multivariate analysis, only radiation dose, extent of surgical resection, and adjuvant chemotherapy were independent prognostic factors for overall survival.
The prognosis of adult patients with GBM remains poor; however, complete surgical resection and adjuvant treatments improve progression-free and overall survival.
Journal of the Egyptian National Cancer Institute 03/2013; 25(1):21-30. DOI:10.1016/j.jnci.2012.11.001
[Show abstract][Hide abstract] ABSTRACT: Background
Breast cancer is the most common cancer and the leading cause of cancer death among the women worldwide. The risk of local and distant recurrence is the highest during the first two years following the initial treatment. Very late relapse (after 12 years) is uncommon in breast cancer survivors.
Herein, we report the characteristics and outcomes of 6 such cases of breast cancer.
The mean age of the patients was 40.1 years (range 30-57) and the mean disease free survival was 19.6 years.
Late relapse is not so common in breast cancer but can occur in any stage. Therefore, we suggest life-time follow up for every patient with breast cancer.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Since the advent of magnetic resonance imaging, metal artifacts have posed an important diagnostic problem in different fields of medicine. However, this has not been systematically studied in patients undergoing surgery for brain tumors. OBJECTIVE: This study was planned to assess whether metal artifacts can occur in patients undergoing brain surgery without metallic implants. METHODS: Of 40 individuals who could be included because of having a pre- and postoperative MRI and a postoperative computed tomography (CT) scan or a conventional skull X-ray for the detection of metallic artifacts, 26 patients agreed to participate in this study and gave informed consent. RESULTS: Twenty-six subjects, 12 males and 14 females, with an age range of 12 to 54 years, were included in the study. Four patients were found to have gross metal particles in their postoperative brain CTs and were excluded. Of the remaining 22 subjects, 7 patients (31.8%) had metallic artifacts. CONCLUSION: Our study showed that simple bone drilling or chiseling during surgical manipulation of skull bones may result in separation of very tiny metal particles which can remain in the surgical site and cause artifacts in postoperative MRIs. This finding appeared to be independent of factors such as age, sex, tumor/incision site, tumor size, pathologic tumor type, total radiation dose, operation-MRI time interval and sequence of MRI.
Magnetic Resonance Imaging 01/2013; 31(5). DOI:10.1016/j.mri.2012.11.001 · 2.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: IntroductionThis phase II clinical trial aimed to investigate the efficacy and safety of induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF regimen) followed by concurrent chemoradiation in patients with locally advanced nasopharyngeal carcinoma.Methods
Eligible patients were aged 15–70 years and had to have newly diagnosed locally advanced NPC (T3–T4 and/or N2–N3, M0), Karnofsky Performance Status (KPS) ⩾70, and normal or adequate kidney, liver, cardiovascular, and bone marrow functions. All patients were assigned to receive 3 cycles of induction chemotherapy in an outpatient setting every 3 weeks with TPF regimen (docetaxel 75 mg/m2 for day 1, cisplatin 75 mg/m2 for day 1, 5-FU 750 mg/m2/day with 8-h infusion on days 1–3) followed by 7 weeks of concurrent chemoradiation (70 Gy) with weekly cisplatin 30 mg/m2.ResultsOverall, 74 courses of induction chemotherapy were administered. After induction chemotherapy, overall response rate was 84%. However, only one patient achieved a pathologic complete response. At the end of concurrent chemoradiation, 24 patients (96%) achieved clinical and pathologic complete response at both nasopharynx and regional nodes and one (4%) had persistent disease. Treatment-related toxicities were common but manageable. Grade 1–2 anemia was the most hematologic toxicity being detected in 51 cycles (68.9%) of induction chemotherapy. Four patients developed uncomplicated, culture-negative febrile neutropenia. There was no treatment-related death.Conclusion
Induction chemotherapy with TPF regimen followed by concurrent chemoradiation is highly effective with manageable toxicity in patients with locally advanced nasopharyngeal carcinoma.
[Show abstract][Hide abstract] ABSTRACT: Glioblastoma multiforme (GBM) is the most common astrocytoma in adults and has a poor prognosis, with a median survival of about 12 months. But, it is rare in children. We report our experience on the pediatric population (20 years or younger) with GBM.
Twenty-three patients with GBM who were treated at our hospital during 1990-2008 were evaluated.
The mean age was 15.2 years, and the majority of them (14/23) were male. All had received radiotherapy and some had also received chemotherapy. The mean survival was 16.0 months. Two cases survived more than 5 years. Age, radiation dose and performance status were significantly related to survival.
GBM in pediatric patients were not very common in our center, and prognosis was unfavorable.
Indian journal of medical and paediatric oncology 07/2012; 33(3):155-60. DOI:10.4103/0971-5851.103142
[Show abstract][Hide abstract] ABSTRACT: This is the first study that aimed to determine the efficacy and safety of concurrent chemoradiation with weekly cisplatin ± celecoxib 100 mg twice daily in locally advanced undifferentiated nasopharyngeal carcinoma.
Eligible patients had newly diagnosed locally advanced (T3-T4, and/or N2-N3, M0) undifferentiated nasopharyngeal carcinoma, no prior therapy, Karnofsky performance status ≥ 70, and normal organ function. The patients were assigned to receive 7 weeks concurrent chemoradiation (70 Gy) with weekly cisplatin 30 mg/m 2 with either celecoxib 100 mg twice daily, (study group, n = 26) or placebo (control group, n = 27) followed by adjuvant combined chemotherapy with cisplatin 70 mg/m 2 on day 1 plus 5-fluorouracil 750 mg/m 2 /d with 8-h infusion on days 1-3, 3-weekly for 3 cycles.
Overall clinical response rate was 100% in both groups. Complete and partial clinical response rates were 64% and 36% in the study group and 44% and 56% in the control group, respectively (P > 0.25). The addition of celecoxib to concurrent chemoradiation was associated with improved 2-year locoregional control rate from 84% to 100% (P = 0.039).
The addition of celecoxib 100 mg twice daily to concurrent chemoradiation improved 2-year locoregional control rate.
Journal of cancer research and therapeutics 10/2011; 7(4):442-7. DOI:10.4103/0973-1482.92013 · 0.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
The combination of cisplatin and 5-fluorouracil (PF) is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with unresectable head and neck carcinomas.
Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled. All patients received three cycles of induction chemotherapy with docetaxel (75 mg/m(2)), cisplatin (40 mg/m(2)) (days 1-2), and 5-FU (500 mg/m(2), days 1-3), repeated every 21 days. Following induction chemotherapy, all patients underwent concurrent chemoradiotherapy using weekly cisplatin (30 mg/m(2)) and a median total dose of 70 Gy was delivered. Clinical response rate and toxicity were the primary and secondary end-points of the study.
There were 31 men and 15 women. All patients had non-metastatic stage IV (T2-3N2-3 or T4N0-3) of disease. Overall and complete response rates were 74% and 24% respectively. Advanced T4 classification was associated with poorer response rate (p value=0.042). The major (grade 3-4) treatment-related toxicities were myelosuppression (78%), anorexia (13%), diarrhea (7%), emesis (11%) and stomatitis/pharyngitis (24%).
In comparison with the data of historical published trials of the PF regimen, the TPF regimen was more effective. However, the TPF regimen appears to be associated with a higher incidence of major toxicities. Therefore, our limited findings support the TPF regimen as an alternative chemotherapeutic regimen for advanced head and neck carcinomas.