مهدی سیلانیان طوسی

Breast cancer is the most common type of cancer in women. 35% of breast cancer is reported in women older than 70 years. This study was performed with aim to evaluate the clinical characteristics of breast cancer among women above 70 years.
In this multi-central, retrospective and descriptive study, 2723 files of women with breast cancer referred to Mashhad Omid hospital and Reza Radiation oncology centre from 2001 to 2012 were evaluated. All the necessary data about age, family history, tumour pathology, clinical stage of tumour, hormone receptor status, Her2 protein status, type of surgery and type of adjuvant therapy ( radiotherapy, chemotherapy, hormone therapy ) were extracted from these files. Data was analysed with SPSS software (version 16). P The most common pathology was invasive ductal carcinoma (89.4%). 106 cases (65.8%) had positive estrogen receptor, 79 (9.8%) positive progesterone receptor and 89 (64.49%) negative Her2. Most patients (71.4%) had undergone modified radical mastectomy. The most common clinical stage was IIB (33.54%).
The most common type of breast cancer in women above 70 years is invasive ductal carcinoma and the most common stage of disease is IIB. Most patients are positive estrogen receptor and negative HER2. Therefore, it is recommended to pay more attention to their specific clinical characteristics in choosing their treatment approach.

Combined modality treatments have been proposed for improving survival in patients with esophageal carcinoma. In this study, we evaluated the results of neoadjuvant radiotherapy and chemotherapy followed by surgery in patients with esophageal Squamous Cell Carcinoma (SCC). Between September 2001 and September 2006, 75 patients with Operable esophageal SCC underwent neoadjuvant radiotherapy (30 Gray/10 fractions in 34 or 40 Gray/20 fractions in 41 cases) followed by trans-hiatal esophagectomy at Omid Hospital, Mashhad, Iran. A total of 42 patients received at least 3 courses of chemotherapy containing cisplatin and 5FU. Complete response to neoadjuvant treatment was found in 5 cases (6.7%). With a median follow up time of 13 months, 21 cases (28%) experienced recurrence including 9 locoregional recurrences, 9 distant metastasis and 3 concomitant local and distant failure. Period of 3-year survivals for all patients was 62.2%. There was no significant difference in survival between patients treated with either radiotherapy protocols (p=0.37). Patients who received at least 3 courses of chemotherapy had relatively better survival compared with those receiving less than three courses or no chemotherapy (p=0.09). In comparison with patients having grade III tumors, patients with grade I & II tumors had significantly better survival rate (p=0.05). Major treatment complications included leukopenia in 13 (17%), anemia in 6 (8%), Thrombocytopenia in 2 (3%), postsurgical fistula in 2 (3%) and anastomosis stricture in 8 (11%) patients. In this study, neoadjuvant chemoradiotherapy and surgery achieved satisfactory survival and acceptable incidence of complications for patients with esophageal SCC and we recommend further investigation in this regard.

Colorectal carcinoma accounts for nearly 10% of all incident cancers. The stage of the disease is the most important prognostic factor. The main purpose of this study was to evaluate the effect of some presumed prognostic factors on the survival rate of patients with nonmetastatic rectal adenocarcinoma. In this retrospective cohort study, 76 patients (m/f:40/36) with nonmetastatic rectal adenocarcinoma whome were referred to oncology department of Omid Hospital between 2001-06 were evaluated. All patients underwent surgical resection and those with T3-T4 and/or lymph node involvement received adjuvant radiotherapy and chemotherapy. Disease free survival was assessed from the date of diagnosis to the date of recurrence using Kaplan-Meyer method. Log-rank test was used to compare survival curves between groups. Multivariate analysis was performed using stepwise backward Cox Proportional Regression method. Stages 1, 2 and 3 were detected in 4, 34 and 38 cases. 48 patients had well differentiated tumors. 11 cases presented with obstruction. With a median follow up time of 18 months, 17 patients experienced recurrence. For all cases 3-year survival rate was 68.2%. The 3-year survival rate was significantly better for stage 1,2 compared to stage 3, patient without obstruction compared to those presented with obstruction, cases older than 50 compared to younger patients and patients with well differentiated tumor compared to moderately or poor differentiated tumors (P<0.05). The gender and the site of tumor had not significant effects on survival. In multivariate analysis only stage of the disease remained significant predictor of survival (p<0.05). This study confirmed that the stage of the disease is the most important predictor of survival. Although younger ages (<50), moderately or poorly differentiated tumor and presence of obstruction at diagnosis were associated with decreased survival in univariate calculations, they lost their significance in multivariate analysis.

Pleural malignant mesothelioma is an uncommon but extremely invasive tumor which originates from mesothelial cells and usually occures after prolonged exposure to asbestos. The aim of this study was to clinicopathologically evaluation of 40 patients with pleural malignant mesothelioma and the main factors influencing their prognosis. In this study patients with definitive diagnosis, who had been followed up for at least three years were studied based on gender, age presenting symptoms, and clinicopathological patterns.

Host genetic and environmental factors are involved in development of gastric cancer. Tumor necrosis factor (TNF)-α| has a key role in Helicobacter pylori-induced gastritis. We analyzed the association between TNF-α polymorphism and the risk of gastric cancer in an Iranian population residing in northeastern Iran.In a case-control study, the genotyping was carried out by PCR-RFLP in 108 patients with gastric cancer and 100 randomly-selected healthy individuals. The polymorphic sites studied include promoter region of TNF-α at position 308 (G-A transition). H. pylori infection was determined by ELISA assay in 100 patients.The frequencies of TNF-α 308 GG, AG and AA genotypes were 67%, 29% and 4% for controls and 75.9%, 13.2% and 10.2% for patients. AG genotype significantly reduced the risk of gastric carcinoma (p=0.008). There was no association between TNF-α 308 polymorphisms and the risk of diffuse type gastric carcinoma. Carriers of AG genotype wereassociated with a decreased risk of intestinal type gastric carcinoma (OR=0.25, 95% CI: 0.08-0.7). With stratification of patients according to H. pylori infection status, there were no significant differences in the frequencies of genotypes between those with H. pylori-negative gastric carcinoma and controls. However, the frequency of AG genotype was significantly higher among controls than H. pylori-positive cases (OR=0.230, 95% CI: 0.06-0.8). In contrast, AA genotype was significantly more frequent among H. pylori-positive cases compared to the controls (OR=4.1, CI: 1.04-16.4).Our results suggest an association between TNF-α 308 polymorphism and the risk of gastric cancer in Iranians. The effect is prominent among H. pylori-infected patients and intestinal type of gastric carcinoma.

Surgery and /or radiotherapy are major local treatments for esophageal carcinoma. The results of radiotherapy alone have been unsatisfactory. The purpose of this study was to evaluate the treatment outcome of definitive chemoradiotherapy for patients with esophageal SCC. This prospective histological descriptive study was done on 190 nonmetastatic esophageal SCC patients which received definitive chemoradiotherapy (55-64 Gy, Cisplatin 80-100 mg/m2 day 1-5FU 750-1000 mg/m2, 24h infusion days 1-4) with curative intent in cancer research center, Mashhad University of Medical Sciences between Jan 2000-Jan 2004. At least one course of chemotherapy was prescribed concurrently with radiotherapy. There were 99 male and 91female patients with the median age of 65 (range, 25-87). The median radiation dose prescribed was 60 Gy (range, 55-64) and median chemotherapy courses was 4 (range, 1-8). With a median follow-up time of 12 months (range, 3-60), one, two and three-year survival rates were 67.8%, 48.7% and 36.3% respectively and median survival was 22 months. Reduction of symptoms was shown in 84% of patients with dysphagia. 109 patients remained disease free with a median follow-up of 14 months (range, 3-60), among which 34 were followed more than 24 months. We found 81 cases (42.6%) with treatment failure during the follow-up (34 locoregional failure, 14 distant metastases, 33 distant metastases accompanied with locoreginal failure). Although definitive chemoradiotherapy can result in long term disease free survival and even cure in a subset of patients with SCC of esophagus, locoregional failure and distant metastasis has remained the main causes of treatment failure.

The proper treatment for early-stage Hodgkin’s disease is controversial. The purpose of this study was to evaluate the therapeutic outcomes of various treatment strategies in supradiaphragmatic clinical early-stage Hodgkin’s disease. This retrospective study reviewed the medical records of 105 eligible patients (49 stage I, 59 stage II) who were treated at radiotherapy- oncology departments of Qaem and Omid hospitals in Mashhad (Iran) from April 1995 to April 2000. 26 patients had B symptoms and 5 had large mediastinal mass. Treatment of patients consisted of chemotherapy alone (43 cases), radiotherapy alone (46 cases, 40 mantle and 6 Total nodal irradiation) and combined modality (16 cases). Survival rates were calculated by Kaplan- Meier model. Log-rank test was used to compare the survival profile between groups. The median age of patients was 25 years with a male to female ratio of 1.56: 1. In comparison with radiotherapy only group, Primary chemotherapy and combined modality groups had significantly more cases with unfavorable factors such as B symptoms, Large mediastinal mass, ESR>40 and stage II. For chemotherapy, combined modality and radiotherapy groups the 5-year progression free survival was 72.5%, 82.5% and 56.2% (P<0.05) and the 5-year disease specific survival was 82.9%, 91.6% and 82.5% respectively. Despite having more cases with unfavorable factors, patients who underwent chemotherapy or combined treatment had lower relapse rates compared to radiotherapy only group. However, there was not a significant difference in 5-year disease specific survival rates between these groups.

Neurofibromatosis 1 (NF1) is a relatively common autosomal dominant condition. Among the complications of the disease, such as neurological disorders, hypertension and skeletal deformities, malignancy is the most serious one and is the main cause of early death in these patients. Review of cases of NF-1 associated with malignancies.Patents and In a retrospective, descriptive study, 17 patients with malignancy and NF1 disease referred to oncology department of Qaem and Omid Hospitals (Mashhad) in a 10-year-period between 1993 and 2003 were reviewed. 11 patients were male and 6 were female. The median age of patients was 23 years. We observed 9 cases with malignant peripheral nerve sheath tumors, 4 with CNS malignancies, 2 with rhabdomyosarcoma and one case with breast carcinoma. Regarding the importance of early diagnosis of these malignancies, and especially considering the young age of involved patients, it is logical to plot a schedule to examine the NF1 patients periodically. Physicians who are in contact with these patients should educate them to be aware of any suspicious signs and symptoms of malignancy.