Investigating the level of vitamin D receptor gene expression in two tumoral and healthy breast tissues in breast cancer patients and its association with prognostic factors.

BACKGROUND: Breast cancer is one of the most common cancers known among women. This study aimed to investigate the level of vitamin D receptor gene expression in two tumoral and healthy breast tissues in breast cancer patients and its association with prognostic factors. METHODS: This descriptive cross-sectional study was conducted in 2022 on 50 patients with high suspicion of breast cancer who were candidates for mastectomy and lumpectomy in a learning hospital. From the patients, two tissue samples were prepared, and there was a total of 100 samples. The samples were subjected to H/E staining and evaluated by a pathologist. The presence or absence of malignancy in each sample was confirmed by two pathologists, and HER2/ER/PR indices were determined. Descriptive and analytical statistical methods and SPSS version 22 software were used. RESULTS: The average age of the patients was 51.60 ± 11.22 years old, and the average tumor size was 3.17 ± 1.28. Most tumors were grade 2 (48%). The expression of HER2, ER, and PR was positive in 24, 64, and 54%, respectively. The largest number of cases were in stage 2A. The expression level of vitamin D receptor (VDR) gene in healthy tissue (2.08 ± 1.01) was higher than tumoral tissue (0.25 ± 1.38) (P = 0.001). In tumoral and healthy tissue, VDR expression was not significant according to tumor grade, HER2, ER, PR, LVI, LN, disease stage, age, and tumor size. CONCLUSIONS: The expression level of VDR in healthy tissue was significantly higher than tumoral tissue. However, there was no significant relationship between VDR and tumor grade, HER2, ER, PR, LVI, LN, disease stage, age, and tumor size.

The Validity and Reliability of the Persian Version of the Xerostomia Inventory Questionnaire.

Statement of the Problem: Reduced saliva production or changes in the quality of saliva are major causes of xerostomia as a perceptual disease. Purpose: This study aimed to measure validity and reliability of the Persian version of the xerostomia inventory (XI) questionnaire. Materials and Method: This cross-sectional study was performed in Kerman in 2021. The sample size for this study was 100 people. To test the discriminant validity of XI, 50 healthy people (control group) and 50 people undergoing or recovering from laryngeal radiation (xerostomia group) were chosen. Cronbach's alpha coefficient was used to determine internal consistency, and the intra-cluster correlation (ICC) coefficient was used to determine test-retest reliability after two weeks. To evaluate the concurrent validity, the relationship between the total score of the questionnaire and the golden question, which was defined as "How often do you have dry mouth?" was measured. Results: Cronbach's alpha and ICC coefficient for the total XI score were 0.84 and 0.95, respectively. The mean ages of patients in the radiotherapy group and the healthy participants were 59±7.5 and 41.1±6.6 years, respectively. Participants who were having or had had laryngeal radiotherapy had a significantly higher mean total XI score than healthy individuals (p< 0.001). Conclusion: The Persian version of the Xerostomia Inventory is a valid and reliable tool for assessing xerostomia.

Sequential Chemotherapy Followed by Radiotherapy Versus Concurrent Chemo-Radiation in Muscle Invasive Bladder Cancer.

Bladder cancer is diagnosed at older age compared to all other known cancer types. Radical cystectomy after neoadjuvant chemotherapy or tri-modality treatment (consist of TURB, concurrent chemo-radiation) are the standard treatments. Many of the patients cannot receive tri-modality treatment (concurrent chemo-radiation) because of medical comorbidities. The present study assessed the results of sequential use of chemotherapy and radiotherapy versus concurrent use of them in 266 muscle invasive bladder cancer patients. The results showed similar overall survival but lower disease-free survival in the sequential group. Recurrence rate was higher in the concurrent group. The results showed that sequential use of chemotherapy and radiotherapy provides comparable results to concurrent use of them and provides better results than less than tri-modality treatments.

Radiotherapy Improves the Disability in Patients with Secondary Progressive Multiple Sclerosis.

Background: Multiple sclerosis (MS) as a complex neurological abnormality is marked with loss of myelin and axons due to chronic inflammatory and autoimmune responses. The modulatory properties of the low dose radiation (LDR) on inflammatory and immune responses have well known. Objective: The current research aimed to assess the impacts of LDR on the disability in patients suffering from MS. Material and Methods: This experimental pilot study was done on 10 patients with secondary progressive multiple sclerosis (SPMS). After magnetic resonance imaging, the SPMS patients were treated by LDR at a daily dose of 2 Gray for 5 consecutive days (totally 10 Gray dose) using a linear accelerator. The extent of the disability was evaluated one week after the completion of radiotherapy using expanded disability status scale (EDSS). Results: After receiving radiotherapy, the patients had a feeling of wellbeing of some sort. The mean of EDSS was significantly reduced after radiotherapy compared with before irradiation (7.4±0.45 vs 6.35±1.18; P<0.017). EDSS more decreased in younger SPMS patients (P=0.0001), and in the women after LDR (P=0.027). Conclusion: Radiotherapy can reduce fatigue and EDSS in patients with SPMS. The age and gender of patients may influence the LDR efficacy.

The Patients' Characteristics And Non-Surgical Treatment Results For Hypopharyngeal Cancer In Southeast Of Iran: A 13-Year Study.

BACKGROUND: Various modalities have been used to treat hypopharyngeal cancer. Non- surgical modalities include radiotherapy alone, sequential chemoradiation and concomitant chemoradiation or bio radiation. This study was conducted to evaluate the primary non-surgical treatment. METHODS: A total number of 67 patients treated from March 2009 to January 2022 were enrolled in this study. The 2-year and 5-year survival rates were estimated using the Kaplan-Meier method. Log-rank test was used to compare the survival outcomes according to various factors. To define independent prognostic factors, we used Cox regression analysis. RESULTS: The mean age of the patients was 56.2 years, and 55.2% of them were male. These patients were treated by radiation alone (9 patients) or induction chemotherapy followed by either radiation (4 patients), chemoradiation (33 patients), or bio-radiation (21 patients). The mean follow-up time was 18.12 months. The 2-year and 5-year overall survival rates were estimated to be 43% and 18%, respectively. Multivariate analysis showed that T stage, N stage, and treatment modality had a statically significant relationship with overall survival. CONCLUSIONS: The results of non-surgical treatment for hypopharyngeal cancer are not satisfactory. More studies are needed to investigate the role of salvage surgery.

Comparative Study of Extremely Low-Frequency Electromagnetic Field, Radiation, and Temozolomide Administration in Spheroid and Monolayer Forms of the Glioblastoma Cell Line (T98).

BACKGROUND: Glioblastoma is the most common primary malignant tumor of the central nervous system. The patient's median survival rate is 13.5 months, so it is necessary to explore new therapeutic approaches. OBJECTIVE: Extremely low-frequency electromagnetic field (EMF) has been explored as a noninvasive cancer treatment. This study applied the EMF with previous conventional chemoradiotherapy for glioblastoma. METHODS: In this study, we evaluated the cytotoxic effects of EMF (50 Hz, 100 G), temozolomide (TMZ), and radiation (Rad) on gene expression of T98 glioma cell lines in monolayer and spheroid cell cultures. RESULTS: Treatment with Rad and EMF significantly increased apoptosis-related gene expression compared to the control group in monolayers and spheroids (p<0.001). The expression of apoptotic-related genes in monolayers was higher than the similar spheroid groups (p<0.001). We found that treatment with TMZ and EMF could increase the gene expression of the autophagy cascade markers compared to the control group (p<0.001). Autophagy-related gene expression in spheroids was higher than in the similar monolayer group (p<0.001). We demonstrated that coadministration of EMF, TMZ, and Rad significantly reduced cell cycle and drug resistance gene expression in monolayers and spheroids (p<0.001) compared to the control group. CONCLUSION: The combinational use of TMZ, Rad and, EMF showed the highest antitumor activity by inducing apoptosis and autophagy signaling pathways and inhibiting cell cycle and drug resistance gene expression. Furthermore, EMF increased TMZ or radiation efficiency.

Opium use and risk of lung cancer: A multicenter case-control study in Iran.

Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicenter case-control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic regression analyses to estimate the odds ratios (OR) and 95% confidence intervals (CI) and measured the association between opium use and the risk of lung cancer. The ORs were adjusted for the residential place, age, gender, socioeconomic status, cigarettes, and water pipe smoking. We found a 3.6-fold risk of lung cancer for regular opium users compared to never users (95% CI: 2.9, 4.6). There was a strong dose-response association between a cumulative count of opium use and lung cancer risk. The OR for regular opium use was higher for small cell carcinoma than in other histology (8.3, 95% CI: 4.8, 14.4). The OR of developing lung cancer among opium users was higher in females (7.4, 95% CI: 3.8, 14.5) than in males (3.3, 95% CI: 2.6, 4.2). The OR for users of both opium and tobacco was 13.4 (95% CI: 10.2, 17.7) compared to nonusers of anything. The risk of developing lung cancer is higher in regular opium users, and these results strengthen the conclusions on the carcinogenicity of opium. The association is stronger for small cell carcinoma cases than in other histology.

Non-Surgical Treatment Prognosis For Laryngeal Cancer Based On American Joint Committee On Cancer Staging And T And N Integer Score.

Background: The American Joint Committee on Cancer (AJCC) system is the most acceptable staging method. In this study, an attempt has been made to evaluate the survival rate of laryngeal cancer based on the AJCC and T and N integer scores (TANIS). Methods: In this prospective cohort study, from March 2004 to March 2021, laryngeal cancer patients who were considered for non-surgical treatment were included. Radiation alone was considered for T1-T2 lesions without nodal involvement. Sequential or concomitant chemoradiation (based on physician choice) was considered for locoregionally advanced patients (T3/T4 or node positive). The 2-year, 5-year and 10-year overall survival (OS) and progression-free survival (PFS) rates were estimated using Kaplan-Meier method. Cox -Regression method was used for covariates analysis. Results: The 2-year, 5-year and 10-year overall survival (OS) rates in all patients were estimated to be 82%, 70% and 41%, respectively. The 2-year, 5-year and 10-year progression-free survival (PFS) rates in all patients were estimated to be 78%, 59% and 41%, respectively. The 5-year OS rates for stages I, II, III, IVa, and IVb were 83, 84, 51, 12, and 19 percent, respectively. The 5-year OS rates for TANIS 1, 2, and 3 were 85, 62 and 53 percent, respectively. Based on multivariate analysis, the group stage (p=0.001), TANIS group (p=0.003) and tumour subsite. (p=0.006) were independently effective in survival rates. Conclusion: TANIS-3 can simply predict the prognosis of non-surgically treated laryngeal cancers. The separation of different prognostic groups by TANIS is better than the AJCC system. More extensive studies are necessary to confirm this.

Induction Chemotherapy Followed by either Chemoradiotherapy or Bioradiotherapy in Laryngeal Cancer.

OBJECTIVE: In loco regionally advanced head and neck cancer, the superiority of concomitant cetuximab with radiation over radiation alone has been proven previously. But comparison between chemo radiation and bioradiation has not been well studied. METHODS: Between October 2013 and August 2017, 38 patients with locoregionally advanced laryngeal cancer and more than 50% response to 3 cycles of  induction chemotherapy (docetaxel and cisplatin: both with a dose of 75 mg/m2 on the first day  and 5-flurouracil: 750 mg/m2 during  days 1to 3; repeated every 21 days) were selected to receive either carboplatin (18 patients, AUC 1.5 , weekly) or cetuximab (20 patients, with loading dose of 400 mg/m2 and weekly dose of  250 mg/m2) with radiation. A Kaplan-Meier analysis was used to calculate progression free survival and overall survival rates. The log-rank test was used to compare overall survival between treatment groups. RESULTS: The median follow up time was 36 months. The 2-year organ preservation rate of 78.9% was achieved. The 3- year progression-free survival rates of 65.2%, 72.7% and 58.2% were observed for all patients, carboplatin group and cetuximab group, respectively (p=0.4). The 3-year estimates of overall survival were 67.8%, 69.2 %, and 66.3 % for all patients, carboplatin group and cetuximab group, respectively (p=0.47). Concomitant carboplatin was discontinued in 3 patients due to toxicity Conclusion: Concomitant cetuximab is a reasonable alternative to concomitant chemotherapy. But the difference in treatment outcome between bioradiation and chemoradiation remains to be defined.
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Is opium use associated with an increased risk of lung cancer? A case-control study.

BACKGROUND: In recent years, lung cancer (LC) incidence has increased in Iran. The use of opium and its derivatives (O&D) has increased as well. This study aimed to investigate the association between the use of O&D and LC incidence. METHODS: In this case-control study conducted in Kerman, Iran; 140 patients with lung cancer and 280 healthy controls matched by age, sex, and place of residence were included. Data, including O&D use, cigarette smoking, alcohol use, and diet, were collected using a structured questionnaire. The relation between the use of O&D and LC was evaluated using conditional logistic regression adjusted for tobacco smoking, education, daily intake of fruit, vegetables, red meat, and hydrogenated fats. RESULTS: Opium ever-use was associated with an increased risk of LC (Adjusted Odds Ratio (AOR) =5.95, 95% CI: 1.87-18.92). Participants were divided into low and high use groups based on the median of opium use in the control group. A significant dose-response relation was observed between the amount of daily O&D use and LC; and the relation was stronger in high users (AOR low users = 3.81% CI: 1.13-12.77 and OR high users = 9.36, 95% CI: 2.05-42.72). Also, LC was higher among participants starting the use of O&D at younger ages (≤ 41 years old vs never users AOR = 8.64, 95% CI: 1.90-39.18) compared to those who started at an older age (> 41 years old vs never users, AOR = 4.71, 95% CI: 1.38-16.08). The association between opium, and lung cancer among non-smokers was OR: 6.50 (95% CI: 2.89 to 14.64). CONCLUSION: The results of this study show that opium use is probably a dose related risk factor for lung cancer.

Opium Use and Head and Neck Cancers: A Matched Case-Control Study in Iran.

BACKGROUND: Head and Neck (H and N) cancers include malignant tumors of the nasal cavity, pharynx, paranasal sinuses, oral cavity, larynx and salivary glands. Opium use might be related to these cancers. The aim of this study was to investigate the relation between Opium and its Derivatives (O and D) use and the incidence of H and N cancers. METHODS: In this case-control study conducted in Kerman, 140 patients with HandN cancers and 280 healthy controls (matched for age, gender, and place of residence) were included. Information about their use of O and D, cigarette smoking, alcohol and diet were collected using a structured questionnaire. Conditional logistic regression was used to investigate the relation between variables. RESULTS: The use of opioids was associated with an increased risk of H and N cancers (Adjusted OR: 8.13; CI: 4.08-16.2). A significant dose-response relation between O and D use was observed, with high use Adjusted OR=8.91; 95% CI: 4.03-19.65 and low use Adjusted OR=6.52; 95% CI: 3.18- 13.36. This dose-response association was stronger in patients with laryngeal cancer and opioids use, with high use Adjusted OR = 11.17; 95% CI=4.48-28.09 and low use Adjusted OR = 9.46; 95% CI= 3.97- 22.52. CONCLUSION: The results show that opium use can be considered as an important risk factor for H and N cancers. Also in Iran, opium seems to play a more important role than cigarette smoking.

Epidemiological characteristics of head and neck cancers in southeast of iran.

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.

Survival following non surgical treatments for oral cancer: a single institutional result.

AIM: To report the results of radiotherapy with or without chemotherapy in the patients with oral cancer. METHODS: Over the 2003-2009 periods, a total number of 69 patients with squamous cell carcinoma of the oral cavity that refused surgery or had unresectable tumor were enrolled in this study. A total dose of 60 to 70 Gy (2 Gy per day) was given to the primary tumor and clinically positive nodes. In the patients with locoregionally advanced disease (57 patients with T3, T4 lesions and/ or N+) induction chemotherapy following by concomitant chemoradiation was used. Induction chemotherapy consisted of 3 cycles of Cisplatin and 5-Flourouracil with or without Docetaxel. Weekly cisplatin was used in concomitant protocol. Kaplan-Meier method was used to calculate overall survival. Log-rank test and Cox regression model were used for comparison purposes. RESULTS: Median follow-up was 32 months. The mean age of the patients was 59.2 years. The overall response rate after induction chemotherapy was 68.4%. Actuarial overall survival rates after 2 and 3 years were 38% and 26%, respectively. Clinical stage emerged as the only independent predictor of survival. CONCLUSION: Outcome of the patients with oral cancer is poor. Presenting with an advanced stage lesion contributed to this result. The role of chemotherapy in advanced cases remains to be defined.

Sequential chemoradiotherapy in advanced laryngeal cancer: an institutional experience.

AIM: The objective of this study was to determine the efficacy of sequential chemoradiation for larynx preservation. METHODS: Between October 2002 and December 2007, 76 patients with T3, T4 and N+ laryngeal cancer who had refused a laryngectomy or had unresectable disease (medically or surgically) enrolled in this study. The chemotherapy consisted of three cycles of docetaxel (75 mg/m(2) on day 1), cisplatin (75 mg/m(2) on day 1) and 5-flurouracil (5-FU) (750 mg/m(2) by infusion on days 1-3). All patients were assigned to receive radiotherapy (70 Gy to primary site). The Kaplan-Meier method was used to obtain survival outcomes. RESULTS: The median follow up was 36 months. A chemotherapy clinical response (complete and partial) was observed in 51 patients (67.1%). The 2-year laryngeal preservation rate was 75%. Actuarial progression-free survival rates of 71% and 67% were observed at 2 and 3 years, respectively. Actuarial overall survival rates were 83% and 71% at 2 and 3 years, respectively. Disease progression was seen in 26 patients (34.2%). Grade 3 and 4 neutropenia occurred in 39 (51.3%) patients. CONCLUSION: Sequential chemotherapy with docetaxel, cisplatin and 5-flurouracil followed by radiation may be an alternative to a laryngectomy in patients with advanced laryngeal cancer.