PErspective and current status of Radiotherapy Service in IRan (PERSIR)-1 study: assessment of current external beam radiotherapy facilities, staff and techniques compared to the international guidelines.

BACKGROUND AND PURPOSE: Radiotherapy (RT) is an essential treatment modality against cancer and becoming even more in demand due to the anticipated increase in cancer incidence. Due to the rapid development of RT technologies amid financial challenges, we aimed to assess the available RT facilities and the issues with achieving health equity based on current equipment compared to the previous reports from Iran. MATERIALS AND METHODS: A survey arranged by the Iran Cancer Institute's Radiation Oncology Research Center (RORC) was sent to all of the country's radiotherapy centers in 2022. Four components were retrieved: the reimbursement type, equipment, human resources, and patient load. To calculate the radiotherapy utilization rate (RUR), the Lancet Commission was used. The findings were compared with the previous national data. RESULTS: Seventy-six active radiotherapy centers with 123 Linear accelerators (LINACs) were identified. The centers have been directed in three ways. 10 (20 LINACs), 36 (50 LINACs), and 30 centers (53 LINACs) were charity-, private-, and public-based, respectively. Four provinces had no centers. There was no active intraoperative radiotherapy machine despite its availability in 4 centers. One orthovoltage X-ray machine was active and 14 brachytherapy devices were treating patients. There were 344, 252, and 419 active radiation oncologists, medical physicists, and radiation therapy technologists, respectively. The ratio of LINAC and radiation oncologists to one million populations was 1.68 and 4.10, respectively. Since 2017, 35±5 radiation oncology residents have been trained each year. CONCLUSION: There has been a notable growth in RT facilities since the previous reports and Iran's situation is currently acceptable among LMICs. However, there is an urgent need to improve the distribution of the RT infrastructure and provide more facilities that can deliver advanced techniques.

A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression.

BACKGROUND: Fear of progression (FOP) is a common and significant concern among cancer patients, encompassing worries about cancer progression during active treatment. Elevated levels of FOP can be dysfunctional. This study aims to assess the efficacy of an Acceptance and Commitment Therapy (ACT)-based intervention on FOP, anxiety sensitivity (AS), and quality of life (QOL) in breast cancer patients. METHODS: A clinical trial was conducted involving 80 stage I-III active-treatment breast cancer patients with a score greater than 34 on the Fear of Progression Questionnaire-Short Form scale. These patients were randomly assigned in a 1:1 ratio to either an intervention group, which received weekly 70-min sessions of 5-ACT-bsed group-therapy, or a control group that received usual treatment. Variables including FOP, AS, QOL, and ACT-related factors were assessed using ASQ, QLQ-C30, Cognitive Fusion Questionnaire, and Acceptance and Action Questionnaire-II at three time points: baseline, post-intervention, and 3-month follow-up. The efficacy of the intervention was evaluated using mixed model analysis across all time-points. RESULTS: The fidelity and acceptability of the ACT-based manual were confirmed using significant methods. A significant reduction in FOP was observed only in the ACT group at post-intervention (P-valueACT < 0.001; Cohen dACT = 1.099). Furthermore, the ACT group demonstrated a more significant reduction in FOP at follow-up. Furthermore, all secondary and ACT-related variables, except for the physical symptoms subscale, showed significant improvement in the ACT group compared to the control group. CONCLUSIONS: Our ACT-based manual showed promise for reducing FOP, AS, and improving QOL, and ACT-related variables in breast cancer patients 3 months following the intervention.

Duloxetine to prevent neuropathy in breast cancer patients under paclitaxel chemotherapy (a double-blind randomized trial).

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) is one of the major side effects and main reasons for affecting quality of life and dose reduction or even discontinuation of treatment in breast cancer patients. One of the most widely prescribed chemotherapies is the "taxanes." Considering that duloxetine has been used in treating neuropathies in recent years, this study aimed to investigate its effectiveness in preventing taxane-related neuropathy. MATERIAL AND METHODS: This is a randomized controlled trial on 47 patients: 24 received a placebo and 23 received duloxetine at 30 mg daily in the first week following the injection of paclitaxel and 60 mg during the second week in each chemotherapy cycle. Patients objective (nerve conduction velocity (NCV) values) and subjective symptoms (visual analog scale including; neuropathy, paresthesia, pain, cold sensitivity, and numbness), the grades of the patients' neuropathy (calculated according to Common Terminology Criteria for Adverse Events (CTCAE) v.5), and the presence of complications, before and after each chemotherapy cycle, were recorded. RESULTS: The placebo group experienced significantly higher occurrences of new neuropathy (8/23 in duloxetine vs 16/24 in placebo, P = 0.029) in NCV by tibial nerve latency (- 0.28% vs 19.87%, P = 0.006), tibial amplitude (4.40% vs - 10.88%, P = 0.049), and median nerve latency (8.72% vs 31.16%, P = 0.039); administration of duloxetine significantly reduced the scores of neuropathies (P < 0.001), pain (P = 0.027), during chemotherapy, and 6 weeks later; however, no significant effect was observed on paresthesia, numbness, cold sensitivity, and other NCV measurements. CONCLUSIONS: Paclitaxel can cause neuropathy, lasting for a long time. Our study showed duloxetine is potentially an effective medication that can prevent subjective and objective neuropathy.

A novel panel of blood-based microRNAs capable of discrimination between benign breast disease and breast cancer at early stages.

Breast cancer (BC) as a leading cause of cancer death among women, exhibits a wide range of genetic heterogeneity in affected individuals. Satisfactory management of BC depends on early diagnosis and proper monitoring of patients' response to therapy. In this study, we aimed to assess the relation between the expression patterns of blood-based microRNAs (miRNAs) with demographic characteristics of the patients with BC in an attempt to find novel diagnostic markers for BC with acceptable precision in clinical applications. To this end, we performed comprehensive statistical analysis of the data of the Cancer Genome Atlas (TCGA) database and the blood miRNome dataset (GSE31309). As a result, 21 miRNAs were selected for experimental verification by quantitative RT-PCR on blood samples of 70 BC patients and 60 normal individuals (without any lesions or benign breast diseases). Statistical one-way ANOVA revealed no significant difference in the blood levels of the selected miRNAs in BC patients compared to any lesions or benign breast diseases. However, the multi-marker panel consisting of hsa-miR-106b-5p, -126-3p, -140-3p, -193a-5p, and -10b-5p could detect early-stages of BC with 0.79 sensitivity, 0.86 specificity and 0.82 accuracy. Furthermore, this multi-marker panel showed the potential of detecting benign breast diseases from BC patients with 0.67 sensitivity, 0.80 specificity, and 0.74 accuracy. In conclusion, these data indicate that the present panel might be considered an asset in detecting benign breast disease and BC.

Measuring inequalities in the selected indicators of National Health Accounts from 2008 to 2016: evidence from Iran.

BACKGROUND: Increase in total health expenditures is one of the main challenges of health systems worldwide, and its inequality is considered as a concern in global arena especially developing countries. This study aims to measure inequality in the distribution of selected indicators of national health accounts across the Iranian provinces. METHODS: In this study, the data on health financing agents from provincial health accounts from 2008 to 2016 were collected. Gini coefficient (GC) was used to measure inequality. The population and the number of service providers in each province were the bases to measure the GC. The Coefficient of Variation (CV) and the Rate Ratio (RR) were used to determine the dispersion and variation across the provinces. Disparity index was employed to measure the average deviation of the out-of-pocket (OOP) proportion from the desired OOP proportion presented in national development plans (NDPs) of Iran. RESULTS: The distribution of resources using both bases were unequal, especially in OOP, with the highest rate over the years studied, ranging from 0.50 to 0.59. The inequality in public resources was lower, with Health Insurance Organization dropping from 0.42 to 0.40 over the years. CV and RR also confirmed the inequality in health resources distribution. In the years 2014 and 2015, the lowest and highest levels were 0.22 and 0.39, respectively. The values of disparity index for OOP had a fluctuating trend ranging from 37.01 to 65.85%. CONCLUSION: Inequality in the distribution of public health expenditures was moderate to high. Moreover, inequality in private health expenditures was higher than public one. Distribution of OOP spent by households at provincial level showed a high inequality. It is suggested that inequality measures to be considered in NDPs to illustrate how resources are distributed at the geographical level. NHA framework can help to provide robust evidence base for policymaking.

The protective effect of vitamin D on ovarian reserve and anti-mullerian hormone in patients undergoing chemotherapy for breast cancer, a randomized phase ΙΙ clinical trial.

BACKGROUND: Reduced ovarian reserve is among the crucial long-term side effects of using chemotherapy agents in breast cancer, yielding early ovarian failure. On the other hand, vitamin D is an essential factor in protecting the follicles and an important predictive factor for successful IVF therapy. AIM: The aim of this study is evaluation of vitamin D as a agent that can reduce fertility complications of chemotherapy specially in young women. METHODS: Breast cancer patients undergoing chemotherapy at two cancer institutes were enrolled in this study. The case group received 1000 IU of calcitriol, and the AMH level was measured at the baseline, after chemotherapy, and six months after chemotherapy. The primary end point was improvement in the AMH level after six months of chemotherapy. the secondary endpoint was to evaluate the predictive factors of AMH level decline during chemotherapy. RESULTS: Between 2018 and 2019, 18 and 15 patients were enrolled in the case and control groups, respectively. The mean AMH level (ngr/ml) of the patients in the case and control group were 3.16 and 2.37 ng/mL, respectively (p-value = .16). These levels were 0.387 and 0.19 after six months (p-value = .38). The AMH rise immediately after chemotherapy cycles to six months after chemotherapy, in the case and control groups were 0.86 and 0.44 ng/mL, respectively, which was slightly higher in the case group but not statistically significant between two groups (p-value = .054). CONCLUSION: Despite a minimal rise in the AMH level after six months of chemotherapy, the study could not demonstrate any protective effect of vitamin D on patients' ovarian reserve undergoing chemotherapy for breast cancer. Further larger studies are needed to evaluate the effect of vitamin D supplements on ovarian reserve beside optimal dose and duration.

Examining the impact of the device used for contouring in saving time and increasing the ease of contouring patients in radiotherapy treatment.

INTRODUCTION/BACKGROUND: This study was designed to investigate the amount of time saved and the degree of contour difficulty between the two methods of contouring, mouse/keyboard, versus touch screen/stylus in radiotherapy. METHODS: Each of 94 patients consisting of 26 breast cancer cases, 24 lymph nodes cases, 25 rectal cancer cases, and 19 heart cases has been contoured twice. One with a mouse/keyboard, and the next one with the touch screen/stylus. Three radiation oncologists participated in this study. Contouring information including measured time, estimated time spent, volume of contour performed and organ contoured are recorded. To evaluate the differences between the contouring methods, the results regarding target volume and time to completion were analyzed using two-way robust ANOVA. Ease of use and contouring difficulty were compared for differences in distribution of the response choices between the groups using Pearson chi-square test. RESULTS: In this study, 94 clinical cases were studied. The average time required for contouring with the touch screen/stylus method was half the time needed for contouring patients with the mouse/keyboard method. The reduction in the time in breast cancer cases was the highest (48.2%) and the lowest in head and neck cancer cases (32.4%). In comparing the contoured volumes, no significant difference was observed between the two methods. the mean estimated time reported by the radiation oncologist in the mouse/keyboard method was 5.6 minutes longer and, in the touch screen/stylus method, was 3.9 minutes less than the actual measured time. CONCLUSIONS: All the measured and analyzed variables show the superiority of contouring with the touch screen/stylus method and reduced the time required for patient contouring by an average of 50%.

Short- and long-term survival of esophageal cancer patients treated at the Cancer Institute of Iran.

INTRODUCTION: Little data is available on the prognosis of esophageal cancer (EC) in Iran. We studied the short- and long-term survival of EC patients treated at the Cancer Institute of Iran. METHODS: 619 patients were followed who had been operated in the years 1997-2006. The 1-month to 5-year survival rates of EC and hazard ratios (HR) for different prognostic factors were estimated. RESULTS: Median survival was 11.5 months and 5-year survival was 10%. Patients at the advanced stage had a 2.1-fold higher risk of mortality compared to the early stage (95% CI 1.2-3.4). One-month mortality decreased from 12.2 in 1997-1999 to 9.1% in 2003-2006. In the first month, patients who were diagnosed in 2003-2006 had a significantly (60%) lower HR compared to 1997-1999 (HR = 0.4, 95% CI 0.1-0.9). In addition, patients with cardiopulmonary complications had an 11.7-fold higher HR compared to patients without complications (95% CI 4.7-29.3). CONCLUSIONS: The 5-year survival rate for operated EC patients was considerably low in Iran. Cardiopulmonary complications were the strong prognostic factors for first-month mortality. We suggest improving the pre- and postoperative care of EC to control these complications. Regular monitoring of patient survival is recommended to evaluate the effect of this intervention.

Comparison of Morbidity, Mortality, and Costs of VAP Patients with Non-VAP Patients in the Tertiary Referral Hospital of Kerman, Iran.

Background: Ventilator-associated pneumonia is the most common type of nosocomial infection in ICUs. Hence, this study shall focus on the morbidity, mortality, and costs associated with this infection among ICU patients. Materials and Methods: The current research is a prospective descriptive-analytical study. The study population included patients admitted to the Tertiary Referral Hospital of Kerman University of Medical Sciences who were enrolled in the study according to inclusion criteria and demographic characteristics data, length of stay in ICU and general wards, and direct and indirect medical expenses such as unemployment and rehabilitation cost, etc. Results: Nine of the 144 patients studied died. (4 in the Ventilator-Associated Pneumonia (VAP) group and 5 in the non-VAP group). Among them, the prevalence of Acinetobacter Baumannii was significantly higher than other bacteria (P-Value=0.001). The duration of hospitalization in the ICU (18±9 vs. 9.5±6 days) and recovery time (21.6±9 9.6 vs. 13.2±7 days) were higher in the VAP group (P-Value<0.05). Moreover, the duration of hospitalization in the general ward was 15.4±8 days in the VAP group and 10.6±6 days in the non-VAP group (P-Value<0.05). The cost of treatment in the VAP group ($7952.28) was significantly higher than in the non-infected group ($4400.98). The average rehabilitation cost in the VAP group was $2571.42 and in the non-affected group was $1530.88. The financial loss due to the delay in work starting was $482 in the non-VAP group which was significantly less than the VAP group ($792). Conclusion: Having VAP can significantly increase mortality, length of stay in the ICU as well as increase direct and indirect costs for patients.

Complication and response assessment of high-dose-rate endorectal brachytherapy boost in neo-adjuvant chemoradiotherapy of locally advanced rectal cancer with long-term outcomes.

Purpose: To identify efficacy, complication, and pathologic response of high-dose-rate endorectal brachytherapy (HDR-BRT) boost in neo-adjuvant chemoradiotherapy (nCRT) of locally advanced rectal cancer. Material and methods: Forty-four patients who met eligibility criteria were included in this non-randomized comparative study. Control group was recruited retrospectively. nCRT (50.40 Gy/28 fr. plus capecitabine 825 mg/m2 twice daily) was administered to both groups before surgery. In the case group, HDR-BRT (8 Gy/2 fr.) was supplemented after chemoradiation. Surgery was done 6-8 weeks after completion of neo-adjuvant therapy. Pathologic complete response (pCR) was the study's primary endpoint. Results: From 44 patients in the case and control groups, pCR was 11 (50%) and 8 (36.4%), respectively (p = 0.27). According to Ryan's grading system, tumor regression grade (TRG) TRG1, TRG2, and TRG3 were 16 (72.7%), 2 (9.1%), and 4 (18.2%) in the case, and 10 (45.5%), 7 (31.8%), and 5 (22.7%) in the control group (p = 0.118). T down-staging was found in 19 (86.4%) and 13 (59.1%) patients in the case and control groups, respectively. No grade > 2 toxicity was identified in both the groups. Organ preservation was achieved in 42.8% and 15.3% in the case and control arm (p = 0.192). In the case group, 8-year overall survival (OS) and disease-free survival (DFS) were 89% (95% CI: 73-100%) and 78% (95% CI: 58-98%), respectively. Our study did not reach median OS and median DFS. Conclusions: Treatment schedule was well-tolerated, and neo-adjuvant HDR-BRT could achieve better T down-staging as a boost comparing with nCRT, without significant complication. However, the optimal dose and fractions in the context of HDR-BRT boost needs further studies.

Frequency of HER2 Expression, MMR Deficiency, and PI3KCA Mutation in Pretreated Surgical Specimens of Patients with Esophageal Squamous Cell Carcinoma in Iran Cancer Institute.

Background & Objective: Iran is located in the esophageal cancer geographical belt. As multiple genetic alterations are responsible for the molecular pathogenesis of esophageal squamous cell cancer (ESCC), the role and frequency of HER2 expression, MMR deficiency, and PI3KCA mutation are not well defined. Methods: We carried out HER2/neu expression, dMMR/MSI high, and PI3KCA mutation analysis in specimens of patients with ESCC. We accessed archival tissue blocks related to specimens of 68 ESCC cases at the time of surgery following neoadjuvant chemoradiation. These patients underwent surgery during 2013-2018 at the Cancer Institute of Iran affiliated with the Tehran University of Medical Sciences in Tehran. Results: None of the patients showed HER2 expression, dMMR/MSI high, or PI3K mutations. Conclusion: dMMR/MSI-H and PI3KCA mutation and HER2 expression may not be reliable andfrequent targets for systemic therapy in patients with esophageal SCC.

A systematic approach introduced novel targets in rectal cancer by considering miRNA/mRNA interactions in response to radiotherapy.

BACKGROUND: The discovery of miRNA/mRNA interactions in several biological samples prompted the researchers to explore new biomarkers in tumors. OBJECTIVE: We aimed to investigate the interactions of miRNA/mRNA in response to radiotherapy in the plasma samples of rectal cancer patients. METHODS: Five microarray datasets related to cancerous and non-cancerous individuals were first used to construct networks. The databases of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were applied to analyze pathway enrichment. The plasma samples were then collected from 55 patients with recently diagnosed rectal cancer and 10 healthy subjects. For radiotherapy courses, the patients have consecutively received 30 sessions of local radiation for six weeks. At last, the expression of selected genes and miRNAs was experimentally measured before and after radiotherapy by qPCR, and the protein levels of the target genes were measured by ELISA assay. We evaluated the therapeutic responses based on the tumor regression grade of the Dworak classification. RESULTS: We identified 5 up-regulated and 5 down-regulated miRNAs and 8 up-regulated and 3 down-regulated genes of the databases. There was a significant increase in tumor suppressor miRNAs, including miR-101-3p, miR-145-5p, miR-26a-5p, miR-34a-5p, and a significant decrease in oncomiRs, including miR-221-3p and miR-17-5p, after radiotherapy compared to the pre-treatment. Moreover, the up-regulated miR-17-5p and miR-221-5p and the down-regulated miR-101-3p and miR-145-5p were directly related to rectal cancer through the interaction with the Wnt, RAS, PI3K, and TGF-ß signaling pathways. An analysis of receiver operating characteristics showed that miRNAs 221, 17, and 23 were response-related in locally advanced rectal cancer patients. CONCLUSIONS: It seems that monitoring the miRNA/mRNA interactions during radiotherapy can be an appropriate diagnostic tool to track the recovery process and respond to standard therapies.

Detection of the Early Cardiotoxic Effects of Doxorubicin-Containing Chemotherapy Regimens in Patients with Breast Cancer through Novel Cardiac Magnetic Resonance Imaging: A Short-term Follow-up.

OBJECTIVES: Many patients with breast cancer (BC) require cardiotoxic anthracycline-based chemotherapy. We intended to assess the early cardiotoxic effects of doxorubicin utilizing cardiac magnetic resonance (CMR) imaging. MATERIAL AND METHODS: Forty-nine patients including 21 otherwise healthy females with BC at a mean age (±SD) of 47.62 ± 9.07 years and 28 normal controls at a mean age (±SD) of 45.18 ± 4.29 years were recruited. They underwent CMR and transthoracic echocardiography at baseline and 7 days after four biweekly cycles of doxorubicin and cyclophosphamide. Biventricular functional, volumetric, global strain, and tissue characterization findings were analyzed and compared with those of 28 controls. RESULTS: In post-chemotherapy CMR, 4 patients (19.04%), three symptomatic and one asymptomatic, exhibited evidence of doxorubicin cardiotoxicity. Significant differences in biventricular ejection fraction, left ventricular end-systolic volume index, and all 3D global strain values were noted after chemotherapy in comparison with the baseline (all P < 0.05). More than half of the study population showed a significant change in all right ventricular global strain values. One patient (4.76%) exhibited evidence of diffuse myocardial edema in post-chemotherapy CMR, and 3 patients (14.28%) showed myocardial fibrosis. The study participants were clinically followed up for 4-10 months (mean = 7 months). Overall, 8 patients (38.09%) complained of dyspnea on exertion and fatigue on follow-up. None of the CMR markers was associated with the development of symptoms. CONCLUSION: Our investigation revealed striking changes in CMR parameters in the follow-up of BC patients treated with cardiotoxic chemotherapy. These exclusive CMR features assist in the early initiation of preventive cardiac strategies.

Primitive Neuroectodermal Tumour Invading the Inferior Vena Cava.

In the present report, we describe our experience with a 44-year-old male with abnormal retroperitoneal primitive neuroectodermal tumours (PNETs) in our hospital, who was operated on with a spindle cell neoplasm diagnosis. LEARNING POINTS: Appropriate treatment is a crucial challenge in patients with PNETs due to late referral.The differential diagnoses were malignant pheochromocytoma, paraganglioma and retroperitoneal sarcoma.Physicians should keep in mind that the patient could be simultaneously suffering from sarcoma and a retroperitoneal PNET.

Transhiatal versus Left Transthoracic Esophagectomy for Gastroesophageal Junction Cancer; The Impact of Surgical Approach on Postoperative Complications.

BACKGROUND Esophagectomy is the mainstay of treatment for esophageal cancer. Although different surgical approaches have been described, choosing the most appropriate technique is still on debate. We compared the complications of transhiatal esophagectomy (THE) versus left transthoracic esophagectomy (LTE) among a group of Iranian patients with gastroesophageal junction cancer. METHODS This was a retrospective study between 2011 and 2013 on 40 patients with gastroesophageal cancer. 23 patients underwent THE and the others underwent LTE. 30-day postoperative mortality, complications, duration of hospital stay, and number of dissected lymph nodes were studied. RESULTS 37.5% of the patients had squamous cell carcinoma. No mortality was seen. Totally, 10 patients suffered from complications. Cardiac and pulmonary complications occurred in eight and six patients, respectively. No patients suffered from vocal cord injuries and anastomotic leakage. The mean duration of postoperative hospital stay was 11.82 ± 3.8 days, and the mean number of dissected lymph nodes was 8.2 ± 3.9. No significant difference was seen between the two groups (p > 0.05). CONCLUSION Choosing between the approaches for resection of gastroesophageal cancer may not impact the complications and mortality rates. We propose that LTE approach could be used safely in comparison with THE, and that selecting between THE and LTE may be based on the surgeon's preference and experience.

Iranian Cancer Patients Perceptions of Barriers to Participation in Decision-Making: Potential Impact on Patient-Centered Care.

OBJECTIVE: The purpose of this study was to explore perceptions about barriers to decision-making in Iranian patients with cancer about their care. METHODS: Utilizing a qualitative approach, semi-structured interviews were conducted with 15 cancer patients. RESULTS: Data analysis revealed four central categories reflecting patient perceptions about barriers that included medical dominance (uninformed decision-making, perceived inability to disagree secondary to despair, and patient objectification), healthcare system mistrust (physician, nurse, and medical center facility and equipment), healthcare system characteristics (services and facilities' limitations, poor communication, healthcare setting compulsion), and cultural barriers (feeling unfamiliar, insecurity in an unfamiliar environment, language barriers, limited attention to religious beliefs). CONCLUSIONS: Barriers may impact the perceived ability of Iranian patients' with cancer ability to participate in decision-making regarding their care. Such barriers contain the potential to disrupt patient-centered care. Perceptions about barriers articulated by patients are modifiable. While some Iranian healthcare systems may have problematic challenges, targeted allocation of resources and education of healthcare providers convey strong possibilities to enhance patient-centered care.

Outcomes of Definitive Chemoradiotherapy for Cervical and Upper Thoracic Esophageal Cancers: a Single-Institution Experience of a Rare Cancer.

PURPOSE: Upper esophageal carcinomas are uncommon but confer a poor prognosis. However, there is scarcity of data regarding outcomes of definitive chemoradiotherapy for cervical and upper thoracic esophageal squamous cell carcinoma in Iran. METHODS: In this retrospective cohort study, we analyzed data of patients with squamous cell carcinoma of cervical and upper thoracic esophagus (at 16 to 25 cm from incisors) treated by definitive chemoradiotherapy in our institution between 2007 and 2015. The primary outcome was overall survival and secondary endpoints were predictors of overall survival. RESULTS: From 2007 to 2015, 40 patients were entered to final analysis. The mean age of patients was 59.7 ± 14.3 (range 24-85 years). Sixteen (40%) were node-positive. The median follow-up time was 15.3 months. Twenty-seven patients (67.5%) died during post treatment period. Thirty-five percent and 25% of patients suffered from local and distant recurrences, respectively. The actuarial median overall survival was 19.2 (CI 95% 14.2-24.2) months. The 1- and 2-year overall survival rates were 76 and 38%, respectively. The overall survival was higher among patients who were younger than 50 years, of female gender, had stage II tumor, grades I to II, who received induction chemotherapy, and whom treated with doses < 60 Gy. However, none of the differences was statistically significant. CONCLUSIONS: Cervical and upper thoracic esophageal squamous cell carcinomas are associated with bad outcome. Studies with bigger sample sizes are required to define best treatment strategies.

Outcomes of Neoadjuvant Chemoradiation in Patients with Gastro-esophageal Junction Adenocarcinoma: a Retrospective Cohort Study in Iran.

PURPOSE: The optimal treatment for locally advanced GEJ and cardia adenocarcinoma is controversial. Several studies have shown that treating these patients with neoadjuvant chemoradiotherapy followed by surgery leads to survival benefits, and there are also studies that have declared conflicting results. It seems that there is still room for discussion. We calculated the survival rates and pathologic responses in our patients with characteristics which we mentioned above. METHODS: Patients with locally advanced, non-metastatic GEJ and cardia adenocarcinomas (only patients with Siewert's type I and II), who were referred to Imam Khomeini hospital (Institute of cancer) between 2005 and 2014 and received neoadjuvant chemoradiation and underwent surgery were enrolled in this retrospective cohort study. Evaluations were done every 3 months. RESULTS: Thirty-two patients enrolled in this study. Median follow up time was 23 months (Reverse Kaplan-Meier method). The rates of 1-year survival, 2-year survival, 3-year survival, 4-year survival, and 5-year survival were 75%, 52%, 52%, 37%, and 37%, respectively. No local recurrences occurred among patients; however, four patients experienced distal recurrence in the following locations: two cases (6.3%) in the liver, one case (3.1%) in the lung, and one case (3.1%) in the peritoneum. The rate of complete pathologic response (T0N0) was 21.9%. CONCLUSIONS: Neoadjuvant chemoradiation in patients with locally advanced GEJ and cardia adenocarcinoma will lead to a survival benefit.

High-dose-rate brachytherapy in treatment of non-melanoma skin cancer of head and neck region: preliminary results of a prospective single institution study.

PURPOSE: Skin cancers are the most common human malignancy with increasing incidence. Currently, surgery is standard of care treatment for non-melanoma skin cancers. However, brachytherapy is a growing modality in the management of skin cancers. Therefore, we aimed to assess the outcome of patients with non-melanoma skin cancers treated by high-dose-rate (HDR) brachytherapy with surface mold technique. MATERIAL AND METHODS: In this prospective study, we recruited patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin who were candidates for definitive or adjuvant brachytherapy during 2013-2014. Alginate was used for making the individualized surface molds for each patient. Patients were treated with afterloading radionuclide HDR brachytherapy machine, with a total dose of 30-52 Gy in 10-13 fractions. Participants were followed for 2 years for radiation toxicity, cosmetic results, and local failures. RESULTS: A total of 60 patients (66.7% male; median age, 71 years) were included, of which 42 (70.0%) underwent definitive radiotherapy. Seventy-five percent of lesions were BCC. The mean total dose was 39.6 ± 5.4 Gy. Of patients in definitive group, 40/42 (95.2%) experienced complete clinical response after 3 months. The recurrence rate was 2/18 (11.11%) and 1/42 (2.38%) in adjuvant and definitive groups, respectively. The percentage of grade 3-4 acute (3-month post-treatment) and late toxicities (2 years post-treatment) was 6.7% and 0%, respectively. The cosmetic results were good/excellent in 96.2% of patients after 2 years of follow-up. CONCLUSIONS: With appropriate patient selection and choosing as lowest dose per fraction as possible, HDR brachytherapy with customized surface molds yields good oncological and cosmetic results for the treatment of localized skin BCC and SCC.