The 30-year incremental pattern of breast cancer: A study in the northern of Iran.

Background: Rapid economic progress and cultural-social changes have led to lifestyle changes and increased risk of breast cancer all around the world, including Iran. This study aims to investigate the 30-year incremental pattern of breast cancer in patients of Shahid Rajaei Radiation Therapy Center in Babolsar, North of Iran.||. Methods: In this cross-sectional study, the data were retrospectively extracted from the physical and electronic files of patients diagnosed with breast cancer from 1992 to 2021 every 5 year by census method, during the study, overall, 1326 patients' information out of 6199 patients was analyzed using SPSSV.22 software at the level of p-value ≤ 0.05. Results: The average age of patients was 49.84 ± 11.26 years, which has been increasing over the years of study. 6143(99.13%) patients were women, the mean and standard deviation of their BMI was 29.63 ± 6.00, the number of patients with stage 1 is increasing, and patients with stage 3 is decreasing. 871(65.70%) people went through Radical Mastectomy (MRM), 261(19.68%) people experienced metastasis. There was a statistically significant relation between the type of surgery, stage of cancer, metastasis, and local recurrence within the years of study (p<0.001). Conclusion: Breast cancer and the age of getting it have increased in recent years. However, advanced stages as well as metastasis and local recurrence have decreased during the investigated years. Therefore, it is recommended to continuously warn women about the risk factors and develop suitable disease screening programs and implement them effectively.

Efficacy of sesame oil versus placebo in the management of acute radiation-induced dermatitis in breast cancer patients: A double-blind randomized clinical trial.

AIM: Considering the anti-inflammatory and positive effects of sesame oil in treating skin diseases, the present research aimed to study its therapeutic effects on acute radiotherapy dermatitis in such patients. METHODS: Forty women with breast cancer during radiotherapy (for 5 weeks) were randomly grouped into two categories: sesame oil (20 patients) and placebo (20 patients). After each radiotherapy session, they were asked to use 3cc of the ointment on the treating field and continue the treatment until the end. They were examined weekly according to the staging criteria of the radiation therapy oncology group. RESULTS: No significant difference was observed in the first 3 weeks. In the fourth week, dermatitis grade 0 was 35%, grade 1 was 65%, and grade 2 was 0% in the intervention (case) group, while in the control group, they were 10%, 75%, and 15%, respectively. This difference was statistically significant (p = 0.046). Also, in the fifth week in the case group, dermatitis grade 0 was 25%, grade 1 was 70%, and grade 2 was 5%, while in the control group, they were 0%, 80%, and 20%, respectively. This difference was also statistically significant (p = 0.032). CONCLUSION: Based on the findings, sesame oil, as a cheap and available herbal treatment, may be utilized in treating acute dermatitis caused by radiotherapy. However, an investigation with a larger sample size in several centers should be conducted to examine sesame oil effects in treating acute radio dermatitis more comprehensively.

Body composition and serum levels of matrix metalloproteinase-9, adiponectin and AMP-activated protein kinase in breast cancer survivors.

Background: Available data suggest that obesity is related to changes in the several adipocyte-derived proteins levels, which are involved in cancer recurrence. The purpose of this work was to investigate the correlation between obesity with metalloproteinase-9 (MMP-9), adiponectin and adiponectin and AMP-activated protein kinase (AMPK) levels by comparing serum levels of MMP-9, AMPK in normal weight and obese breast cancer survivors. Materials and Methods: In this cross-sectional study, 30 normal weight breast cancer survivors (body mass index [BMI] 18.5-25 kg/m2) and 30 obese breast cancer survivors (BMI ≥30 kg/m2) were investigated. Anthropometric parameters and serum levels of MMP-9, adiponectin, and AMPK were compared between the two groups. Results: No differences were detected in the serum levels of MMP-9, adiponectin, and AMPK in obese patients and normal weight patients (P > 0.05). There were no correlations between MMP-9, adiponectin, and AMPK levels with anthropometric measurements in two groups (P > 0.05). Conclusion: We found that there was a lack of correlation between obesity measures and serum levels of MMP-9, adiponectin, and AMPK. In breast cancer survivors, it seems that circulating levels of adiponectin, AMPK, and MMP-9 do not change in obesity state.

Recove® burn ointment for managing acute radiodermatitis in patients with breast cancer: A double blind randomized controlled trial.

Background: Radiodermatitis is the most common complication of radiotherapy. There is no gold standard for managing the radiodermatitis. This study aimed to evaluate the effect of topical Recove® burn ointment; basically compounded of sesame oil, camphor, and zinc oxide; in preventing acute radiodermatitis. Methods: This double blind RCT (IRCT No.: 201204047136N2) was performed on 71 patients that referred for radiotherapy after mastectomy to Shahid Rajaee Hospital (Babolsar-Iran) during 2013-2017. Patients were allocated into 2 groups; 34 in control group and 37 in Recove® group. Patients applied the ointment 2 times a day, before every radiation therapy session for 5 weeks. The radiation oncologist assessed the severity of dermatitis weekly for 5 weeks and graded it from 0 to 4 according to the RTOG criteria. Results: Baseline characteristics including age, and BMI had no significant difference between groups. The Recover group patients experienced significantly less severe dermatitis compared to the controls (p<0.001). None of the patients in Recove® group encountered more than grade 2 of RTOG criteria, however, in the control group, 4 (12.9%) patients experienced grade 3 of RTOG and 3 (9.7%) patients developed grade 4 of RTOG at the end of the 5th week. Conclusion: Our results indicate that Recove® ointment significantly reduces the severity of acute radiodermatitis.

Association of social support, spirituality with psychological factors in Iranian breast cancer survivors: An evidence from a cross-sectional study.

AIMS: The aim of this study was to explore the protective role of social support and spirituality in the prevention of depression, anxiety and fatigue severity. DESIGN: In a cross-sectional study, 305 women of breast cancer survivors were recruited in the study. METHODS: The participants answered a self-reported the hospital anxiety and depression scale, fatigue severity scale (FSS), social support and spiritual health questionnaires. The data were analysed using a multiple linear regression model to estimate the adjusted regression coefficients. RESULTS: A greater proportion of patients had moderate depression (62.9%) and moderate anxiety (67.3%). The higher level of social support was significantly associated with a lesser degree of depression (ß=-0.05, p = .001) and anxiety (ß=-0.04, p = .001), but there had been no association with the severity of fatigue score, while the association of spiritual health with depression and anxiety was not independently significant. This study highlights the importance of perceived social support in the prevention of depression and anxiety.

A case report of prostate adenocarcinoma with leptomeningeal carcinomatosis and intracerebral metastasis.

Despite the fact that prostate cancer is the most prevalent cancer in men, metastases to the central nervous system including leptomeningeal involvement by prostate carcinoma is a rare event. The prognosis of metastatic prostate cancer is very poor due to lack of CNS penetrating therapeutic agents.

Molecular identification and antifungal susceptibility testing of Candida species isolated from oral lesions in patients with head and neck cancer undergoing radiotherapy.

BACKGROUND AND PURPOSE: Radiation therapy in patients with head and neck malignancies predisposes them to oral Candida colonization and infection due to damage of oral mucosa and destruction of the salivary gland. This study aimed to determine the prevalence of oropharyngeal candidiasis (OPC) in patients with head and neck cancer (HNC) undergoing radiotherapy (RT), identify the yeasts isolated from them, and determine their antifungal susceptibility. MATERIALS AND METHODS: This cross-sectional study was conducted from December 2018 to June 2019 at two referral radiotherapy centers in northern Iran. Yeast strains that were isolated from patients with HNC were identified using conventional and molecular methods. The in vitro activities of eight common antifungal drugs against 55 isolates were investigated according to the guidelines of the Clinical and Laboratory Standard Institute (M27-A3 and M27-S4) broth microdilution document. RESULTS: Among 59 patients receiving RT, the prevalence of OPC was 21 (35.59%) and 15 (25.42%) patients were diagnosed with colonization. The mean age of the patients was 55.32±13.3 years (within the range of 27-87 years). In this study, the pseudomembranous form was reported as the most clinical type of OPC. Candida albicans with the frequency of 60% was the most common type of Candida spp. that was observed in this study, although non-albicans Candida spp., such as C. glabrata (27.27%), C. tropicalis (5.45%), C. parapsilosis (3.63%), C. krusei (1.83%), and C. kefyr (1.83%) were also isolated. Considering the low minimum inhibitory concentration range of amphotericin B, compared to fluconazole, administration of this agent is a more suitable antifungal drug for extensive oral candidiasis in these patients. Among azoles, clotrimazole had low efficacy and several studied isolates (65.5%) showed resistance. CONCLUSION: Correct diagnosis as well as determining drug sensitivity and risk factors are the effective steps in reducing the complications related to oral candidiasis in people undergoing RT.

Focus on the expected quality of reporting in SBRT/radiosurgery prospective studies: how far have we come in 30 years?

OBJECTIVES: We aimed at describing and assessing the quality of reporting in all published prospective trials about radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). METHODS: The Medline database was searched for. The reporting of study design, patients' and radiotherapy characteristics, previous and concurrent cancer treatments, acute and late toxicities and assessment of quality of life were collected. RESULTS: 114 articles - published between 1989 and 2019 - were analysed. 21 trials were randomised (18.4%). Randomisation information was unavailable in 59.6% of the publications. Data about randomisation, ITT analysis and whether the study was multicentre or not, had been significantly less reported during the 2010-2019 publication period than before (respectively 29.4% vs 57.4% (p < 0.001), 20.6% vs 57.4% (p < 0.001), 48.5% vs 68.1% (p < 0.001). 89.5% of the articles reported the number of included patients. Information about radiation total dose was available in 86% of cases and dose per fraction in 78.1%. Regarding the method of dose prescription, the prescription isodose was the most reported information (58.8%). The reporting of radiotherapy characteristics did not improve during the 2010 s-2019s. Acute and late high-grade toxicity was reported in 37.7 and 30.7%, respectively. Their reporting decreased in recent period, especially for all-grade late toxicities (p = 0.044). CONCLUSION: It seems necessary to meet stricter specifications to improve the quality of reporting. ADVANCES IN KNOWLEDGE: Our work results in one of the rare analyses of radiosurgery and SBRT publications. Literature must include necessary information to first, ensure treatments can be compared and reproduced and secondly, to permit to decide on new standards of care.

CDK 4/6 inhibitors combined with radiotherapy: A review of literature.

Cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) namely palbociclib, ribociclib and abemaciclib were granted approval by the European Medicines Agency (EMA) between 2017 and 2018. They are currently prescribed in combination with hormone therapy to treat hormone receptor positive, HER2 negative metastatic or locally advanced breast cancer. Their combination with radiotherapy raises safety concerns as preclinical data enlightened their possible synergistic effect. Moreover, data about toxicity when combining CDK4/6i with radiotherapy are scarce. This review of literature focused on the use of CDK4/6i combined with radiotherapy. It aimed at listing every published data about such combination so as to understand its possible resulting toxicity in metastatic breast cancer.

The effect of aqueous and ethanolic extract of Iranian propolis on Candida Albicans isolated from the mouth of patients with colorectal malignancy undergone chemotherapy: An in-vitro study.

BACKGROUND: Candidiasis is one of the most common fungal infections in immunosuppressed patients. The condition is usually treated with local and systemic antifungal agents. Given the antifungal properties of propolis, it appears this natural resin material can be effective in treating this infection. The aim of the present in vitro study was to compare the effect of Iranian propolis with those of routine antifungal agents on Candida species isolated from the oral candida lesions of patients with cancer, who had undergone chemotherapy, and a standard strain of Candida albicans. METHODS: A total of 23 samples were collected from the oral cavities of patients with colorectal cancer, who had undergone chemotherapy with 5-fu. The fungal species were determined based on the results of culture in C. albicans chromagar medium, formation of the germ tube and formation of vesicles. The MIC of aqueous extract propolis (AEP) and ethanolic extract of propolis (EEP) and amphotericin B (AMP-B), fluconazole (FL) and nystatin (NYS) were compared. RESULTS: A total of 23 oral C. albicans samples were isolated. The MICs of FL and AMP- B were similar and less than those of EEP, AEP and NYS (P<0.001). In addition, the MIC of AEP was higher than EEP (P<0.001). The MIC of AMP- B on the strains isolated from the patients was more than that of the standard strain (P=0.012). CONCLUSION: The aqueous and ethanolic extracts of Iranian propolis exhibited antifungal activity, with a greater effect of the EEP compared to the AEP.

Analysis of quality of life in breast cancer survivors using structural equation modelling: the role of spirituality, social support and psychological well-being.

BACKGROUND: To explore and characterize the inter-relationship between psychological well-being, spirituality, social support, comorbidity, demographic and lifestyle factors and quality of life (QoL). METHODS: This cross-sectional study was conducted with 305 breast cancer survivors in northern Iran in 2017. The demographic and socio-economic data and physical activity were measured with a standard questionnaire. The standard European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL scale, a system-of-belief inventory questionnaire, the social support scale, the short form of the Hospital Anxiety and Depression Scale and the fatigue severity scale (FSS) were used in data collection. In structural equation modelling analysis, we used the maximum likelihood procedure to estimate the direct and indirect effects of relevant factors on QoL. RESULTS: The median age (quartile 1 [Q1], quartile 3 [Q3]) of patients was 50 y (43, 55). The psychological factors designated by anxiety, depression and FSS had a negative significant direct effect on QoL (ß=-0.62). Spirituality has a positive direct effect (ß=0.089) but a negligible indirect effect (ß=0.020) on QoL, while the direct association of social support was almost negligible. CONCLUSIONS: The findings emphasized the unifying structure of the determinants of QoL and the mediating negative association of psychological factors with QoL. Thus the supportive education efforts should focus on improving psychological well-being along with standard treatment in breast cancer survivors.

A 25-year trend in gastrointestinal cancers in northern Iran (1991-2016).

BACKGROUND: Identifying the incidence of cancer helps in planning and prioritizing resources for its screening, prevention, treatment and diagnosis. This study aimed at investigating a 25-year trend in gastrointestinal cancer in northern Iran during 1991-2016. METHODS: This research was a trend analysis. The study population was one thousand five hundred and thirty-five cancer patients referring to Shahid Rajai Hospital in Babolsar, northern Iran, as the only center for radiotherapy in the North of Iran, during 1991-2016. SPSS version 22 was used for entering data and t-test, ᵡ2 and ANOVA were used for analyzing data in the significant level of ≤0.05. RESULTS: The highest incidence of stomach cancer was 111 (35%) in 2011 and the lowest incidence was 44 (16.3%) in 1996, The highest frequency of esophageal cancer was reported 137(56.1%) cases in 1991 and the lowest frequency was 78 (26.3%) cases in 2016, while the highest incidence of colorectal cancer was 109 (36.7%) cases in 2016 and its lowest frequency was 32 (16.3%) in 1996. There was also a significant difference in the frequency of gastrointestinal cancers in different studied years (p <0.001). CONCLUSION: The trends in the incidence of stomach and colorectal cancers in northern Iran were increasing while esophageal cancer was decreasing.

Infertility as a risk factor for breast cancer: Results from a hospital-based case-control study.

CONTEXT: Breast cancer is the most common cancer in women worldwide and its prevalence is increasing. AIMS: The aim of this study was to investigate the extent to which a history of infertility can present as risk factors for breast cancer. SETTINGS AND DESIGN: This was a hospital-based case-control study. SUBJECTS AND METHODS: In this study, 1177 women with breast cancer were participated for assessing the risk for this cancer. The control was 1204 women with self-reported free-cancer history who were matched in terms of age and residence. STATISTICAL ANALYSIS USED: Using logistic regression, it was examined whether infertility is a risk factor of case-control status in addition to marriage age, menarche age, body mass index, number of pregnancies, family history of breast cancer, and previous oral contraceptive use. The data were considered significant at P ≤ 0.05. RESULTS: Infertility history was reported in 12.5% (n = 147) of the cases and 5.8% (n = 70) of the controls. Infertility history was a relevant risk for case-control study in addition to other risk factors (odds ratio: 2.43; 95% confidence interval, 3.34-1.77). CONCLUSIONS: This study found that infertility may be as the main risk factor for breast cancer in Iranian women, therefore, doing breast screening in women who have one or more risk factors, must receive more emphasis.

Immunohistochemical expression of TWIST in oral squamous cell carcinoma and its correlation with clinicopathologic factors.

BACKGROUND AND OBJECTIVES: TWIST is a transcription factor that plays a key role in the development of primary tumor to metastatic stage of cancer. It is an inhibitor of E-cadherin in epithelial-to-mesenchymal transformation process (epithelial-mesenchymal transition). Few studies are available on the use of TWIST as a goal in molecular-targeted therapy. The aim of this study was to evaluate of TWIST expression in oral squamous cell carcinoma (OSCC) and its correlation with clinicopathologic factors. MATERIALS AND METHODS: In this cross-sectional study, immunohistochemical staining was for TWIST performed on 30 paraffin-embedded blocks of OSCC. Furthermore, thirty paraffin-embedded blocks of normal oral mucosa with minimum inflammation from the clinical and histopathologic aspects were selected. Staining intensity and percentage of stained cells from nuclear and cytoplasmic aspects were ranked in epithelial cells. TWIST expression and correlation with clinicopathologic factors were analyzed using Cox regression and Chi-square tests. RESULTS: TWIST expression in OSCC was significantly increased compared to oral normal mucosa. Nuclear expression of TWIST in OSCC was significantly associated with clinical stage (P = 0.01) and lymph node metastasis (P = 0.007). Cytoplasmic expression of TWIST in OSCC was not associated with any clinicopathological factors. CONCLUSION: The results support the role of TWIST in carcinogenesis, development of OSCC, and its metastasis to lymph nodes.

HLA-G Expression is Associated with an Unfavorable Prognosis of Oral Squamous Cell Carcinoma

Background: HLA-G, a major histocompatibility complex of non-classical class Ib, plays a key role in the development of the primary tumors to metastatic stages. The aim of this study was to investigate HLA-G expression in oral squamous cell carcinomas and its relationship with clinicopathological factors. Methods: After immunohistochemical staining for HLA-G with 63 formalin fixed and paraffin embedded blocks (33 oral squamous cell carcinoma and 30 normal oral mucosa samples), staining intensity, percentage of stained cells and final immunoreactivity score were evaluated, along with other variables. Results: Staining intensity, percentage of stained cells and final immunoreactivity scores in oral squamous cell carcinomas were higher than those in normal oral mucosa (all P=0.001). The staining intensity in the parenchyma of squamous cell carcinoma cells was significantly associated with the clinical tumor stage (P=0.022) and the group with lymphatic metastasis exhibited a higher staining percentage (P=0.026). Staining intensity and immunoreactivity score (IRS) exhibited a significant but inverse correlation with survival rate (P=0.004 and P=0.018, respectively) and a significant direct relationship with clinical stage (P=0.001 and P=0.001). Conclusion: The results supported a role of HLA-G in development of oral squamous cell carcinomas and metastasis to lymph nodes. It might be useful in molecular-targeted therapy.

Alterations in serum levels of trace element in patients with breast cancer before and after chemotherapy.

BACKGROUND: Breast cancer is the most common serious disease around the world. The trace elements have a vital role in the metabolism and chemotherapy may change the level of metal ions. Due to the ambiguity of the existence in this regard, the study examined the trace element serum levels in women with breast cancer before and after chemotherapy . METHODS: Sixty patients were studied undergoing specialist. First sampling was taken before chemotherapy (after 4 weeks of surgery) and second sampling was taken after the completion of 3 courses of chemotherapy, approximately 9 weeks after the first chemotherapy. The patients took Adriamycin 60mg/m2 Cytoxan 600mg/m2. Serum zinc and iron levels were measured using standard spectrophotometric method. Measurement of serum copper was done by atomic absorption spectroscopy. RESULTS: Serum zinc and iron levels in women after chemotherapy significantly decreased (p<0.001), however, the serum level of copper increased but was not significant (P=0.676). CONCLUSIONS: Our findings demonstrate significant decrease in zinc and iron levels in breast cancer patients after 3 courses of Adriamycin and Cytoxan chemotherapy. Prescribing zinc supplements can be useful after chemotherapy.

A stochastic mathematical model of avascular tumor growth patterns and its treatment by means of noises.

Due to the rate increase in cancer incidence, many researchers in different fields have been conducting studies on cancer-related phenomena. Most studies are conducted to focus on cellular and molecular aspects of cancerous diseases and treatment strategies. Physicists have been using mathematical modeling and simulation to explain the growth pattern of tumors. Although most published studies in this area still have not gained the needed maturity for "treating cancer", research has helped with the statistical laws of growth, predation and proliferation of cancer cells. In this review, a brief explanation of mathematical models for tumor growth is presented, followed by a discussion on treatment simulations, introducing white noise as one of the clinical remedies in the original model.

Three cycles of AC chemotherapy regimen increased oxidative stress in breast cancer patients: A clinical hint.

BACKGROUND: Recent studies have suggested the importance of oxidant/antioxidant status in initiation and progression of breast cancer. The aim of this study was to evaluate oxidative stress markers in breast cancer patients before and after 3 cycles of chemotherapy with adriamycin and cytoxan (AC). Also, in this study the effect of age and the stage of disease on oxidative stress markers were compared and evaluated. METHODS: This study included 60 women with newly diagnosed stage II-III breast cancer who underwent chemotherapy with AC as the therapy-first strategy after surgery. Serum samples were obtained before treatment and after the third chemotherapy. Then, serum total antioxidant status (TAS) and malondialdehyde (MDA) as lipid peroxidation marker were analyzed. Moreover, the effects of the subject's age and clinical disease stage were investigated. RESULTS: A concurrent significant increase in MDA (p<0.001) and a significant decrease in TAS (p<0.001) were also observed after 3 cycles of AC chemotherapy. In addition, some changes were found in the status of oxidative stress markers which were associated with age and clinical disease stage. CONCLUSION: Our data indicated that chemotherapy with AC increase the oxidative stress in breast cancer patients. The present study indicated that higher stages of the breast cancer are associated with significant increases of oxidative stress markers.

Astrocyte Elevated Gene 1 (AEG-1): A Promising Candidate for Molecular Targeted Therapy in Oral Squamous Cell Carcinomas

Background: Astrocyte elevated gene 1 (AEG-1), also known as metadherin, is an oncogene which is overexpressed in various types of cancer, playing important roles in invasion, metastasis, angiogenesis and chemotherapy resistance. Hence it might be used as a therapeutic target. The aim of this study was to evaluate the expression of AEG-1 as a novel molecular marker in oral squamous cell carcinomas and establish correlations with clinicopathologic factors. Materials and Methods: Thirty formalin fixed paraffin-embedded blocks of OSCC cases and 30 samples of normal oral mucosa with minimal inflammation were selected and stained immunohistochemically for AEG-1. Staining intensity and percentage of stained cells were scored according to nuclear and cytoplasmic staining of epithelial cells. Relationship between immunoreactivity and clinicopathologic factors were examined by T-test and Mann-Whitney. Results: AEG-1 expression in OSCCs was greater than in normal oral mucosa (P<0.05). However, nuclear and cytoplasmic expression of AEG-1 was not associated with any of the clinicopathologic factors, age and gender of patients, tumor location, smoking history, tumor staging and grading, metastasis to lymph nodes and distant metastasis ( P>0.05). Conclusion: The current results support some role of AEG-1 in genesis of oral squamous cell carcinomas.