Combination of neoadjuvant and adjuvant chemotherapy with FOLFOX compared with adjuvant chemotherapy in management of locally advanced rectal cancers: a randomized trial of a promising therapeutic approach.

BACKGROUND: Colorectal cancer (CRC) is a significant malignancy with widespread implications. Despite progress in surgical interventions for rectal cancer, improvements in overall prognosis remain disproportionate. Standard preoperative chemoradiation, while established as the standard treatment for the majority of rectal cancers, exhibits limited effectiveness in enhancing disease-free survival (DFS) and mitigating distant metastases, particularly in cases of locally advanced rectal cancer (LARC). METHODS: This randomised clinical trial assessed 286 patients with LARC in two paralleled groups. Group A underwent six courses of neoadjuvant MFOLFOX chemotherapy, chemoradiation, surgery, and six adjuvant chemotherapy cycles. Group B received concurrent chemoradiation, surgery, and twelve adjuvant chemotherapy cycles. Patient evaluations were achieved at multiple stages of treatment and follow-up. RESULTS: Group A had significantly lower local recurrence (11.64%) than Group B (21.74%, P = 0.025). The distant metastasis rate in Group A (8.90%) was lower than in Group B (20.29%) but was not significant (p = 0.143). More patients in Group A experienced downstaging (80.82% vs. 60.87%, p < 0.001). Specifically, 72.60% demonstrated downstaging of tumour invasion and 54.79% downstaging of lymph node involvement, compared to 57.25% and 41.30% in Group B (p = 0.009 and p = 0.025, respectively) as well as higher pCR rate (26.03% vs. 15.25%, p = 0.030) and three-year DFS rate (82.19% vs. 71.01%, p = 0.035) in group A compare to group B. CONCLUSION: This innovative strategy for LARC showed promising results with lower local recurrence and higher rates of downstaging and pCR. Treatment side effects were similar in both groups but less frequent in Group A. Anaemia was the most common haematological side effect (A: 58%, B: 68%), and peripheral sensory neuropathy was the most common non-haematological complication (A: 63%, B: 64%). These findings suggest this regimen could be a valuable therapeutic approach for LARC. TRIAL REGISTRATION: This trial was registered on 2023-12-08 within the IRCT.IR database under the number IRCT20210308050628N1.

Breast percent density changes in digital mammography pre- and post-radiotherapy.

INTRODUCTION: Breast cancer (BC), the most frequently diagnosed malignancy among women worldwide, presents a public health challenge and affects mortality rates. Breast-conserving therapy (BCT) is a common treatment, but the risk from residual disease necessitates radiotherapy. Digital mammography monitors treatment response by identifying post-operative and radiotherapy tissue alterations, but accurate assessment of mammographic density remains a challenge. This study used OpenBreast to measure percent density (PD), offering insights into changes in mammographic density before and after BCT with radiation therapy. METHODS: This retrospective analysis included 92 female patients with BC who underwent BCT, chemotherapy, and radiotherapy, excluding those who received hormonal therapy or bilateral BCT. Percent/percentage density measurements were extracted using OpenBreast, an automated software that applies computational techniques to density analyses. Data were analysed at baseline, 3 months, and 15 months post-treatment using standardised mean difference (SMD) with Cohen's d, chi-square, and paired sample t-tests. The predictive power of PD changes for BC was measured based on the receiver operating characteristic (ROC) curve analysis. RESULTS: The mean age was 53.2 years. There were no significant differences in PD between the periods. Standardised mean difference analysis revealed no significant changes in the SMD for PD before treatment compared with 3- and 15-months post-treatment. Although PD increased numerically after radiotherapy, ROC analysis revealed optimal sensitivity at 15 months post-treatment for detecting changes in breast density. CONCLUSIONS: This study utilised an automated breast density segmentation tool to assess the changes in mammographic density before and after BC treatment. No significant differences in the density were observed during the short-term follow-up period. However, the results suggest that quantitative density assessment could be valuable for long-term monitoring of treatment effects. The study underscores the necessity for larger and longitudinal studies to accurately measure and validate the effectiveness of quantitative methods in clinical BC management.

Circulating-tumour DNA methylation of HAND1 gene: a promising biomarker in early detection of colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) is one of the significant global health concerns with an increase in cases. Regular screening tests are crucial for early detection as it is often asymptomatic in the initial stages. Liquid biopsies, a non-invasive approach that examines biomarkers in biofluids, offer a promising future in diagnosing and screening cancer. Circulating-tumour DNA (ctDNA) is the genetic material in biofluids released into the circulatory system by cells. ctDNA is a promising marker for monitoring patients since cancer cells display distinct DNA methylation patterns compared to normal cells. The potential of our research to contribute to early detection and improved patient outcomes is significant. AIMS: The primary objective of this research project was to explore the HAND1 methylation levels in plasma ctDNA as a potential biomarker for diagnosing CRC and evaluate the methylation level of the well-established gene SPET9 to compare it with the methylation level of HAND1. MATERIALS AND METHODS: Plasma samples were collected from 30 CRC patients and 15 healthy individuals, with CRC samples obtained pre-treatment. ctDNA was extracted and treated with bisulfite for methylation status assessment. Quantitative methylation-specific PCR (qMS-PCR) was performed for HAND1 and SEPT9, using ß-actin (ACTB gene) as a reference. The study aims to evaluate the potential of these genes as diagnostic biomarkers for CRC, contributing to early detection and improved patient outcomes. RESULTS: Our study yielded significant results: 90% of CRC patients (27 out of 30) had hypermethylation in the SEPT9 gene, and 83% (25 out of 30) exhibited hypermethylation in the HAND1 gene. The methylation levels of both genes were significantly higher in CRC patients than in healthy donors. These findings underscore the potential of SEPT9 and HAND1 methylation as promising biomarkers for diagnosing CRC, potentially leading to early detection and improved patient outcomes. CONCLUSION: These findings highlight the potential of SEPT9 and HAND1 methylation as promising biomarkers for diagnosing CRC. However, further research and validation studies are needed to confirm these findings and to explore their clinical utility in CRC diagnosis and management.

Epigenteic Alteration of DOK7 Gene CpG Island in Blood Leukocyte of Patients with Gastric Cancer and Intestinal Methaplasia.

Background: Intestinal metaplasia (IM) is a benign lesion with no serious concern for patients' health. On the other hand, gastric cancer (GC) is a malignant lesion that has to be differentially diagnosed from benign intestinal metaplasia. Epigenetic modifications have been suggested to play an important role in cancer initiation and development, and they have been investigated as a reliable biomarker tool even for early cancer diagnosis. Whole blood leucocytes (WBC) are potentially the most accessible tissue for cancer early diagnosis, especially for GC, which is hard to diagnose in the early stage. Objective: This study aims to investigate the methylation status of DOK7 gene CpG island in blood leukocytes of patients with IM and GC compared to normal control groups. Material and Method: DNA was extracted from the whole blood of 30 IM patients, 30 GC patients, and 34 normal controls samples, and MSRE-PCR was utilized to evaluate the loci methylation status. Results: Significant hypermethylation of DOK7 gene CpG has been observed in GC 88.1 % (p < 0.001) and IM 66.0 % (p = 0.03) in comparison to the normal control group 56.8%. A cutoff upper than 84.5 % of hypermethylation is considered as a presence of gastric cancer malignant lesions. Conclusions: This is the first reported on hypermethylation in DOK7 CPG in blood leukocytes of patients with GC and IM and establishing a laboratory blood based test that may be useful as a novel biomarker test in the early diagnosis and screaning of GC and IM.

Consequences of aberrated DNA methylation in Colon Adenocarcinoma: a bioinformatic-based multi-approach.

INTRODUCTION: The biology of colorectal cancer (CRC) is remained to be elucidated. Numerous genetic and epigenetic modifications are in concert to create and progress CRC. DNA methylation as a principal epigenetic factor has gained increased attention and could be utilized for biological studies. This study aims to find novel methylated and downregulated genes with a focus on HAND2 in CRC and decipher the biological consequences. MATERIAL AND METHOD: Data on DNA methylation from GEO and SMART databases and the expression GEPIA2 database were downloaded. Afterward, a set of hypermethylated and downregulated genes in CRC was chosen by overlapping genes. Consequently, HAND2 was selected as a key gene for further investigation and confirmed with cell lines methylation and expression data. The functions of HAND2 were further analyzed using gene ontology analyses and the protein-protein interaction network. RESULTS: The methylation (p < 0.01) and expression (p < 0.01) of HAND2 are significantly varied in CRC compared to normal control. The correlation analysis (Pearson's correlation coefficient = -0.44, p = 6.6e-14) conveys that HAND2 significantly downregulated and has a reverse correlation with the methylation status of CpG islands. The biological process analysis of HAND2 target genes conveyed that disruption in HAND2 expression could dysregulate ERK1 and ERK2 signaling pathways. CONCLUSION: Together, the findings showed that DNA hypermethylation of HAND2 was critical evidence in CRC. Further validation and prospective studies are needed to utilize HAND2 methylation as a promising biomarker.

A Randomized, Controlled, Parallel-Group, Trial on the Effects of Melatonin on Fatigue Associated with Breast Cancer and Its Adjuvant Treatments.

OBJECTIVE: Fatigue associated with malignant conditions and their treatments is a disabling condition. This trial assessed the anti-fatigue effects of melatonin coadministration during adjuvant treatment of patients with the breast cancer. MATERIAL AND METHODS: Patients with breast cancer were randomly assigned to receive melatonin or placebo during adjuvant chemotherapy and radiotherapy. Thirty-seven patients were randomly enrolled in each group. The mean ages of patients in the intervention and control groups were 50.47 ± 10.79 and 46.05 ± 10.55 years, respectively (P = .223). The intervention group received oral melatonin (18 mg/day) from 1 week before until 1 month after the adjuvant radiotherapy. The level of fatigue was assessed before and after intervention using Brief Fatigue Inventory (BFI) in both groups. To analyze data, the Student's t-test and the Chi-square test were used at a significance level of P ≤ .05. RESULTS: The BFI score was similar before the intervention in both groups, however, after the intervention, it was significantly lower in the melatonin group (P < .001). Moreover, the frequency of severe fatigue in the melatonin group was significantly lower than in the placebo group after intervention (42.1% vs 83.3%, P < .001). CONCLUSION: Coadministration of melatonin during adjuvant chemotherapy and radiotherapy of women with breast cancer decreased the levels of fatigue associated with the malignant condition and its treatments.

Clinicopathologic characteristics of male breast cancer: a report of 21 cases in radiotherapy center of hamedan, iran.

BACKGROUND: Male breast cancer accounts for less than 1% of all cancer in men and only around 1% of all diagnosed breast cancer. Despite a significant raise in the last 25 years, it still remains a rare disease. MATERIALS AND METHODS: We conducted a retrospective study from 2004-2011 with 21 male breast cancer patients. We aimed to analyze the epidemiologic data (age, personal and family history), tumor characteristics (size, histological type, location, TNM stage, receptors), surgery, adjuvant chemotherapy and radiation therapy, hormonal therapy and survival (relapse, follow up, death) who reffered to our center with breast cancer. RESULTS: The median age was 49.2±14.2 years (range 30-83 years). A family history of breast cancer was noted in four cases. The main clinical complaint was a retroareolar mass in 85.7%of patients (n=18). Histologically, 85.7% (n=18)were invasive ductal carcinoma and 4.7% (n=1) had ductal carcinoma in situ and 9.4% (n=2) had mixed histology including invasive medullary and ductal carcinoma. Hormonal therapy was delivered to 16 cases (76.1%) due to ER or PR positivity. During median follow up of 30 months (3-84 month), distant metastases were evident in 4 cases (19%). During the follow-up period, only one patient died due to metastatic disease. The mean time to recurrence detection was 30 months. CONCLUSIONS: The percentage of cases of male breast cancer is very low compared to breast cancer in females, explaining why very few investigations have been conducted in Iran. Limited coverage in the literature make gender-specific findings difficult so future research of this entity involving multi-institutional cooperation and longer follow up is essential to provide new insights about the biological and clinical factors of this rare cancer.