Exploring the combined impact of cisplatin and copper-cysteamine nanoparticles through Chemoradiation: An in-vitro study.

Copper-Cysteamine nanoparticles (Cu-Cy NPs) have emerged as promising radiosensitizers in cancer treatment. This study aims to investigate the combined therapeutic effect of these nanoparticles and cisplatin using a clinical linear accelerator to enhance the efficacy of chemoradiation therapy for cervical cancer. Following successful synthesis and characterization of Cu-Cy NPs, the cytotoxicity effect of these nanoparticles and cisplatin in various concentrations was evaluated on HeLa cancer cells, individually and in combination. Additionally, the radiobiological effects of these agents were investigated under a 6MV linear accelerator. At a concentration of 25 mg/L, Cu-Cy NPs displayed no significant cytotoxicity toward HeLa cancer cells. However, when combined with 2Gy X-ray irradiation at this concentration, the nanoparticles demonstrated a potent radiosensitizing effect. Notably, cell viability and migration rate in the combination group (Cu-Cy NPs + cisplatin + radiation) were significantly reduced compared to the radiation-alone group. Additionally, the combination treatment induced a significantly higher rate of apoptosis compared to the radiation-alone group. Overall, Cu-Cy NPs exhibited a significant dose-dependent synergistic enhancement of radiation efficacy when combined with cisplatin under X-ray exposure, and may provide a promising approach to improve the therapeutic effect of conventional radiation therapy.

Risk factors and survival of triple-negative breast cancer among breast cancer patients: Ten-year cross-sectional study in the southwestern Iranian population.

Background: Breast cancer results from genetic and epigenetic mutations, contributing significantly to cancer-related morbidity and mortality. This study aimed to determine the prevalence and survival rates of triple-negative breast cancer (TNBC) among breast cancer patients in southwestern Iran over a ten-year period. Methods: This retrospective cross-sectional study aims to assess prognostic factors associated with survival in women diagnosed with breast cancer in Iran's southwestern region over a ten-year period (2007-2017). Data were collected from patients who visited the Clinical Oncology Department at Golestan Hospital in Ahvaz (the breast cancer center of the Southwestern country). The study enrolled women diagnosed with TNBC using a census method and data from medical records. The primary outcome (survival rates) and secondary outcomes (demographic data, diagnostic stages, and three receptors estrogen receptors [ER], progesterone receptor [PR], human epidermal growth factor receptor 2 [HER2] status) were collected. Results: Breast cancer was diagnosed in 2641 women over ten years; TNBC was diagnosed in 227 individuals (8.59%). Statistical analysis revealed a significant correlation between negative ER status and TNBC (p > 0.05). Furthermore, the prevalence of TNBC differed significantly from that of other types of breast cancer (p = 0.0001). The variables of age, HER2, PR, and TNBC grade did not differ significantly (p > 0.05). The overall disease-free survival rate over 5 years was 88.1%, while the rate for individuals without recurrence was 77.97%. Conclusion: This study highlights a differentially low incidence of TNBC in the southwestern part of Iran when compared to other regions; genetic or epigenetic influences may explain this discrepancy. ER-negative status is a crucial prognostic indicator in diagnosing TNBC. The incidence of this disease is expected to rise by 100% in 2 years and 77.97% in 5 years.

Evaluating the Gray Level Co-Occurrence Matrix-Based Texture Features of Magnetic Resonance Images for Glioblastoma Multiform Patients' Treatment Response Assessment.

Background: Medical images of cancer patients are usually evaluated qualitatively by clinical specialists which makes the accuracy of the diagnosis subjective and related to the skills of clinicians. Quantitative methods based on the textural feature analysis may be useful to facilitate such evaluations. This study aimed to analyze the gray level co-occurrence matrix (GLCM)-based texture features extracted from T1-axial magnetic resonance (MR) images of glioblastoma multiform (GBM) patients to determine the distinctive features specific to treatment response or disease progression. Methods: 20 GLCM-based texture features, in addition to mean, standard deviation, entropy, RMS, kurtosis, and skewness were extracted from step I MR images (obtained 72 h after surgery) and step II MR images (obtained three months later). Responded and not responded patients to treatment were classified manually based on the radiological evaluation of step II images. Extracted texture features from Step I and Step II images were analyzed to determine the distinctive features for each group of responsive or progressive diseases. MATLAB 2020 was applied to feature extraction. SPSS version 26 was used for the statistical analysis. P value < 0.05 was considered statistically significant. Results: Despite no statistically significant differences between Step I texture features for two considered groups, almost all step II extracted GLCM-based texture features in addition to entropy M and skewness were significantly different between responsive and progressive disease groups. Conclusions: GLCM-based texture features extracted from MR images of GBM patients can be used with automatic algorithms for the expeditious prediction or interpretation of response to the treatment quantitatively besides qualitative evaluations.

Therapeutic and prophylactic effects of radiation therapy in the management of recurrent granulation tissue induced tracheal stenosis: a review on the role of Endobronchial brachytherapy and external beam radiation therapy.

PURPOSE: Granulation tissue-induced tracheal stenosis (mainly secondary to intubation or lung transplantation) is one of the most common etiologies of benign airway obstructions. Recurrence rates after standard treatment options (surgical resection and/or endobronchial interventions) can inadvertently worsen the stricture through the stimulation of more granulation tissue generation (via increased fibroblast activity and roliferation). Low-dose radiotherapy could be a promising tool to prevent granulation tissue formation after surgery and/or endobronchial interventions regarding its established role in the treatment of keloids or hypertrophic scars, two benign diseases with similar a pathophysiology to tracheal stenosis. This study reviews case reports and small series that used endobronchial brachytherapy (EBBT) or external beam radiotherapy (EBRT) for the management of refractory granulation tissue-induced tracheal stenosis after surgery and/or endobronchial interventions. METHODS AND MATERIALS: Case reports and series (published up to October 2022) that reported outcomes of patients with recurrent granulation tissue-induced tracheal stenosis (after surgery and/or endobronchial interventions) treated by EBBT or EBRT (in definitive or prophylactic settings) were eligible. RESULTS: Sixteen studies (EBBT: nine studies including 69 patients, EBRT: seven studies including 32 patients) were reviewed. The pooled success rate across all studies was 74% and 97% for EBBT and EBRT, respectively. CONCLUSIONS: Radiation therapy appears to be effective in the management of selected patients with recurrent/refractory tracheal stenosis. Response to this treatment is usually good, but further studies with a larger number of patients and long-term followup are necessary to determine the optimal technique, dose, and timing of radiation therapy, late complications, the durability of response, and criteria for patient selection.

Cross-Cultural Adaptation and Validation of the Speech Handicap Index into Persian.

PURPOSE: The aim of the present study was to adapt and validate the Speech Handicap Index (SHI) into the Persian language. PATIENTS AND METHODS: The original published English version of the SHI was translated into Persian using the translation protocol and guidelines of the International Quality of Life Assessment. One hundred participants with oral and oropharyngeal cancer and 40 healthy participants completed the Persian SHI. Forty participants of the patient group completed the Persian SHI a second time after a 2-weeks period to evaluate test-retest reliability. Content validity (content validity index and content validity ratio), internal consistency (Cronbach α coefficient), test-retest reliability (intraclass correlations), and construct validity (confirmatory factor analysis) were examined. Control group and patient group values were compared to determine the clinical validity. RESULTS: A significant discrimination coefficient was found across all items, and the content and clinical validity were found to be acceptable. The Persian SHI showed a high internal consistency and test-retest reliability. The construct validity was within the acceptable range. CONCLUSIONS: The P-SHI is considered to be a valid and reliable questionnaire for speech assessment in Persian-speaking patients with head and neck cancer.

Role of non-absorbable oral antibiotics in bowel preparation for intracavitary brachytherapy: effects of rifaximin on rectal dosimetric parameters during vaginal cuff brachytherapy.

PURPOSE: Brachytherapy is a major tool for dose escalation in gynecological cancer treatment. Control of rectal repletion is particularly challenging; it can impact dose received by this organ at risk and there are reported toxicities. The use of methods, such as enema and bowel preparation, to reduce rectal volume is a difficult process for patients, and its repeatability requires patients' cooperation. Due to the effect of antibiotics on reducing intestinal gases, this study was conducted to measure the effect of adding rifaximin to bowel preparation on rectal dose-volume histogram (DVH) parameters. MATERIAL AND METHODS: In this prospective interventional study, 24 patients with cervical and endometrial cancer were treated with adjuvant high-dose-rate (HDR) brachytherapy. Both first and second sessions of brachytherapy were performed with bowel preparation, before and after the administration of rifaximin, respectively. The rectum was contoured as an organ at risk, and DVH parameters were recorded and compared in both sessions using magnetic resonance imaging (MRI)-based 3D treatment planning system. RESULTS: Rifaximin consumption reduced the rectal volume (p = 0.01), but had no significant correlation with other DVH parameters, especially D2cc (p = 0.599). Moreover, rectal volume had no significant correlation with DVH parameters (all p-values ≤ 0.05). CONCLUSIONS: Even though the addition of rifaximin to bowel preparation significantly reduced rectal volume, no significant difference was observed in DVH parameters. Therefore, it is recommended that adjuvant vaginal cuff HDR brachytherapy should be performed without the use of rifaximin, until further researches' validate its effects.

Accuracy Evaluation of EPL and ETAR Algorithms in the Treatment Planning Systems using CIRS Thorax Phantom.

BACKGROUND: It is recommended for each set of radiation data and algorithm that subtle deliberation is done regarding dose calculation accuracy. Knowing the errors in dose calculation for each treatment plan will result in an accurate estimate of the actual dose achieved by the tumor. OBJECTIVE: This study aims to evaluate the equivalent path length (EPL) and equivalent tissue air ratio (ETAR) algorithms in radiation dose calculation. MATERIAL AND METHODS: In this experimental study, the TEC-DOC 1583 guideline was used. Measurements and calculations were obtained for each algorithm at specific points in thorax CIRS phantom for 6 and 18 MVs and results were compared. RESULTS: In the EPL, calculations were in agreement with measurements for 27 points and differences between them ranged from 0.1% to 10.4% at 6 MV. The calculations were in agreement with measurements for 21 points and differences between them ranged from 0.4% to 13% at 18 MV. In ETAR, calculations were also in consistent with measurements for 21 points, and differences between them ranged from 0.1% to 9% at 6 MV. Moreover, for 18 MV, the calculations were in agreement with measurements for 17 points and differences between them ranged from 0% to 11%. CONCLUSION: For the EPL algorithm, more dose points were in consistent with acceptance criteria. The errors in the ETAR were 1% to 2% less than the EPL. The greatest calculation error occurs in low-density lung tissue with inhomogeneities or in high-density bone. Errors were larger in shallow depths. The error in higher energy was more than low energy beam.

The Effect of Pain Self-Management Education on Pain Severity and Quality of Life in Metastatic Cancer Patients.

OBJECTIVE: Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches. METHODS: This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests. RESULTS: It was observed that after the intervention, the trend of pain severity during weeks 1-7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001). CONCLUSIONS: Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.

Investigating the Dosimetric Characteristics of Microbeam Radiation Treatment.

BACKGROUND: High-radiation therapeutic gain could be achieved by the modern technique of microbeam radiation treatment (MRT). The aim of this study was to investigate the dosimetric properties of MRT. METHODS: The EGSnrc Monte Carlo (MC) code system was used to transport photons and electrons in MRT. The mono-energetic beams (1 cm × 1 cm array) of 50, 100, and 150 keV and the spectrum photon beam (European Synchrotron Radiation Facility [ESRF]) were modeled to transport through multislit collimators with the aperture's widths of 25 and 50 µm and the center-to-center (c-t-c) distance between two adjacent microbeams (MBs) of 200 µm. The calculated phase spaces at the upper surface of water phantom (1 cm × 1 cm) were implemented in DOSXYZnrc code to calculate the percentage depth dose (PDD), the dose profile curves (in depths of 0-1, 1-2, and 3-4 cm), and the peak-to-valley dose ratios (PVDRs). RESULTS: The PDD, dose profile curves, and PVDRs were calculated for different effective parameters. The more flatness of lateral dose profile was obtained for the ESRF spectrum MB. With constant c-t-c distance, an increase in the MB size increased the peak and valley dose; simultaneously, the PVDR was larger for the 25 µm MB (33.5) compared to 50 µm MB (21.9) beam, due to the decreased scattering photons followed to the lower overlapping of the adjacent MBs. An increase in the depth decreased the PVDRs (i.e., 54.9 in depth of 0-1 cm). CONCLUSION: Our MC model of MRT successfully calculated the effect of dosimetric parameters including photon's energy, beam width, and depth to estimate the dose distribution.

The IFN-Ɣ + 874 A/T polymorphism is associated with malignant breast cancer in a population from the southwest of Iran.

OBJECTIVE: Breast cancer (BC) is one of the most common diseases in women globally, with an increasing number of deaths associated with it. Recently the role of polymorphisms in the genes encoding cytokines and immune cells has been demonstrated. This study aimed to evaluate the association of IFN-Ɣ + 874 A/T polymorphism with BC clinical symptoms. RESULTS: The study included 88 women with BC and 88 healthy women who had no history of cancer and were matched for age and sex. Allele-specific oligonucleotide-polymerase chain reaction technique was used to investigate the IFN-Ɣ polymorphism. Clinical data were obtained from the patients' records. Our results showed that the frequencies of genotypes in the BC patients were not significantly different from the control subjects. However, in the patients, the AT genotype was associated with the risk of malignant BC. The age at BC diagnosis was not different in patients with AA and AT genotypes; however, it was significantly earlier in HER2 negative subjects (p = 0.002). Given the higher frequency of AT in malignant BC patients, our results confirm the association of the IFN-Ɣ polymorphism with the disease's progression to a malignant state.

Evaluation of rectal volume correlation with dosimetric parameters during optimized intracavitary high-dose-rate brachytherapy in cervical cancer.

PURPOSE: Brachytherapy (BRT) is a cornerstone in cervical cancer treatment, with the ultimate goal to maximize the tumor dose while sparing organs at risk (OARs), such as rectum. Several studies evaluated the effect of rectal volume on rectal doses, but the results are inconsistent. This study aimed to evaluate the rectal volume and dose-volume histogram (DVH) relationship in high-dose-rate (HDR) brachytherapy in locally advanced cervical cancer. MATERIAL AND METHODS: Planning computed tomography of 65 patients who underwent HDR brachytherapy boost as a component of definitive radiotherapy from March 2016 to February 2018 were reviewed. OARs and target volume were re-delineated by a single physician to decrease interobserver variation. Two sets of plan were generated; in the first set, the dose was prescribed to point A with Manchester system loading pattern, while in the second set, the dose was prescribed to high-risk clinical target volume (HR-CTV) D90 with inverse planning optimization. The DVH values for rectum, sigmoid, and HR-CTV were generated and correlated with rectal or sigmoidal volume variation. RESULTS: Dose to 2cc (D2cc), 1cc (D1cc), and 0.1cc (D0.1cc) of rectum and sigmoid showed a significant decrease in optimization vs. point A planning (p < 0.0001). HR-CTV D90 coverage was significantly higher in optimization vs. point A planning (p = 0.041). Rectal volume showed a significant correlation with D2cc (rs, 0.302, p = 0.014), D1cc (rs, 0.310, p = 0.012), and D0.1cc (rs, 0.283, p = 0.02) of rectum in optimization planning. CONCLUSIONS: Larger rectal volumes are associated with higher rectal dose parameters during HDR brachytherapy using inverse planning optimization. This method spares OAR, while producing reasonable HR-CTV D90. Prospective studies are needed to find appropriate technique of rectal volume reduction.

Optimization of the photoneutron target geometry for e-accelerator based BNCT.

BACKGROUND AND AIM: Today, electron accelerators are taken into consideration as photoneutron sources. Therefore, for maximum production of epithermal neutron flux, designing a photoneutron target is of significant importance. In this paper, the effect of thickness and geometric shape of a photoneutron target on neutron output were investigated. METHODS: In this study, a pencil photon source with 13, 15, 18, 20 and 25 MeV energies and a diameter of 2 mm was investigated using Monte Carlo simulation method using MCNP code. To optimize the design of the photoneutron target, the tungsten target with various geometries and thicknesses was investigated. RESULTS: The maximum neutron flux produced for all target geometries and thicknesses occurred at neutron energy peak of around 0.46 MeV. As the thickness increased to 2 cm, neutron flux increased and then a decreasing trend was observed. For various geometrical shapes, the determining factor in photoneutron output was the effective target thickness in the photon interaction path that increased by the increase in the area of interaction. Another factor was the angle of the photon's incidence with the target surface that resulted in a significant decrease in photoneutron output in cone-shaped targets. CONCLUSION: Three factors including the total neutron flux, neutrons energy spectrum, and convergence of neutrons plays an important role in the selection of geometry and shape of the target that should be investigated considering beam shaping assembly (BSA) shape.

A Rare Case of Craniopharyngioma in the Temporal Lobe.

Herein, we report on a rare case of craniopharyngioma arising in the left temporal lobe with no prior history of head trauma or surgery. There was a solid-cystic mass in the left temporal lobe on MR images. To the best of our knowledge, this is the second case of a craniopharyngioma occurring in the temporal lobe.

Analytical Consideration of Surface Dose and Kerma for Megavoltage Photon Beams in Clinical Radiation Therapy.

BACKGROUND: In radiation therapy, estimation of surface doses is clinically important. This study aimed to obtain an analytical relationship to determine the skin surface dose, kerma and the depth of maximum dose, with energies of 6 and 18 megavoltage (MV). MATERIALS AND METHODS: To obtain the dose on the surface of skin, using the relationship between dose and kerma and solving differential equations governing the two quantities, a general relationship of dose changes relative to the depth was obtained. By dosimetry all the standard square fields of 5x5cm to 40x40cm, an equation similar to response to differential equations of the dose and kerma were fitted on the measurements for any field size and energy. Applying two conditions: a) equality of the area under dose distribution and kerma changes in versus depth in 6 and 18 MV, b) equality of the kerma and dose at x=dmax and using these results, coefficients of the obtained analytical relationship were determined. By putting the depth of zero in the relation, amount of PDD and kerma on the surface of the skin, could be obtained. RESULTS: Using the MATLAB software, an exponential binomial function with R-Square >0.9953 was determined for any field size and depth in two energy modes 6 and 18MV, the surface PDD and kerma was obtained and both of them increase due to the increase of the field, but they reduce due to increased energy and from the obtained relation, depth of maximum dose can be determined. CONCLUSIONS: Using this analytical formula, one can find the skin surface dose, kerma and thickness of the buildup region.

Radiation sensitization with sodium nitrite in patients with brain metastases: a pilot randomized controlled trial.

Systemic administration of nitrite anion seems to be a practical way to produce local burst of nitric oxide, a hypoxic cell radiosensitizer in solid tumors. This randomized controlled pilot study assessed radiologic objective response rate (ORR) in patients suffered from brain metastases treated by whole-brain radiotherapy (WBRT) concurrent with intravenous infusion of sodium nitrite versus WBRT alone. Twenty patients were randomized into the following groups: Ten patients treated by WBRT (30 Gy in ten fractions over 2 weeks) concomitant with 2-hour intravenous infusion of sodium nitrite (267 µg/kg/h) before each fraction of radiation (WBRT + SN arm) and ten patients received the same schedule of WBRT, alone (control arm). ORR was measured according to response evaluation criteria in solid tumors (RECIST version 1.1). There were four radiologic objective responses in WBRT + SN arm compared with three in the control group without significant statistical difference (P = 1.00). In contrast, age ≤ 65 years (P = 0.05) and presence of extra-cranial metastases (P = 0.01) were predictor factors of ORR. In conclusion, intravenous infusion of sodium nitrite with this dose and schedule to patients with brain metastases concurrent with radiotherapy did not show any major benefit in terms of radiologic response.