فهرست مطالب

Middle East Journal of Cancer - Volume:9 Issue: 3, 2018
  • Volume:9 Issue: 3, 2018
  • تاریخ انتشار: 1397/04/12
  • تعداد عناوین: 13
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  • Abbas Rezaianzadeh, Ali Mohammad Mokhtari *, Soheil Hassanipour, Ahmad Maghsoudi, Seyedeh Leila Dehghani, Milad Nazarzadeh, Najmeh Maharlouei Pages 171-178
    Background
    Cancer is the leading cause of morbidity and mortality worldwide. Among gynecological cancers, ovarian cancer is the first cause of cancer-related deaths. However, only a few studies have evaluated the age-standardized incidence rate of ovarian cancer in Iranian women. Therefore, the present study aims to systematically review the age-standardized incidence rate of ovarian cancer in Iran.
    Methods
    We systematically reviewed the literature that pertained to the incidence rate of ovarian cancer among Iranian women. In May 2016, we performed searches of national scientific databases that included SID, Magiran, IranMedex, and IranDoc. Searches of international databases included PubMed, Scopus, and ScienceDirect. The retrieved studies were then assessed according to the study’s inclusion criteria.
    Results
    In this review, we included 14 from 115 articles obtained through searching national and international databases, grey literature, and hand searching. Based on the random effects model, the age-standardized incidence rate of ovarian cancer was 3.19 (95% CI: 2.78-3.59).
    Conclusion
    The study results indicated that the age-standardized incidence rate of ovarian cancer was considerably low in Iran. The registration methodology normally used by cancer registries has probably led to an underestimation of the incidence rate of ovarian cancer among Iranian women. Thus, we recommend the establishment of cancer registries that cover a broader population.
    Keywords: Ovarian neoplasm, Incidence, Iran, Systematic review, Meta-analysis
  • Kazem Anvari, Mehdi Seilanian Toussi *, Hossein Ayatollahi, Gholamreza Bahadorkhan, Mohammadreza Ghavam Nasiri, Mitra Fazl Ersi Pages 179-185
    Background
    The standard of care for glioblastoma is concurrent chemoradiotherapy and adjuvant chemotherapy with Temozolomide. In this trial, we have investigated the impact of MGMT promoter methylation on prognosis and benefit from Temozolomide based chemotherapy in a group of patients with glioblastoma in our region.
    Methods
    This retrospective study included glioblastoma patients treated in our institute between 2006 and 2011. We used methylation specific PCR to detect methylation in the promoter region of the MGMT gene. The Kaplan-Meier technique was used to calculate overall survival from the time of diagnosis to the time of death. We utilized the log-rank test and Cox-regression model for univariate and multivariate analyses of potential prognostic factors.
    Results
    There were 78 patient participants with a median age of 50 (range: 20 to 75) years and a male to female ratio of 56/22. All patients underwent minimal surgical resection which was considered as a biopsy. All patients received adjuvant radiotherapy with a median dose of 60 Gy (54-60 Gy) and 25 patients received concomitant Temozolomide. The MGMT promoter methylation was found in 19 (24.4%) patients and was relatively more frequent in men (28.6%) compared to women (13.6%; P=0.16).This genetic change was associated with a significantly higher 2-year survival in men (57.2%) compared to women (16.8%; P
    Conclusion
    In our series, MGMT promoter methylation was a significant independent prognostic factor. The finding of sex as an independent prognostic factor would need further validation.
    Keywords: Glioblastoma, MGMT gene, Promoter, Methylation
  • Ehsan Rafeemanesh, Ali Taghizadekermani, Mohammad Khajedaluee, Fatemeh Ahmadi * Pages 186-194
    Background
    Breast cancer is the most common cancer in females. At present, evidence exists to support an association of breast cancer with several risk factors such as occupational risk factors. The aim of this study is to further characterize potential associations between breast cancer risk and occupation.
    Methods
    In this case-control study, we reviewed records from 965 histologically confirmed breast cancer cases. From these, 104 employed women were chosen. The control group consisted of 112 age-matched employed women. Required data were gathered through in-person interviews and medical records reviews. Occupations were classified into four categories: teachers, administrative/clerical workers, healthcare workers, and miscellaneous jobs. Data analysis was performed using the chi-square, t-test, and logistic regression model.
    Results
    A higher proportion of cases (60.6%) were teachers. Physical activity, smoking, and family history of cancer significantly differed between the case and control groups. After adjustment for potential confounders, we found that teachers had a higher risk for breast cancer compared to other occupations (P
    Conclusion
    The teaching profession can be an important risk factor for breast cancer. Emphasis on early screening programs seems necessary. According to the high percent of female teachers, we recommend a detailed evaluation of exposures in this occupation.
    Keywords: Breast cancer, Risk factors, Occupation
  • Mohammad S. Makoseh *, Rami A. Al-Wardat, Murad Y. Salam, Samer H. Salah Pages 195-201
    Background
    Limited data exists to support the benefit from second-line chemotherapy in patients with metastatic urothelial carcinoma. Factors that predict survival following progression after first-line platinum-based regimens in patients treated outside clinical trials are not clear. This study intends to evaluate different prognostic factors and the impact of second-line chemotherapy on survival.
    Methods
    We retrospectively reviewed patients with metastatic urothelial carcinoma who experienced disease progression following first-line platinum-based regimens for metastases. These patients received treatment and follow up visits at a single institution. The effect of demographic, disease characteristics, and second-line therapy on overall survival was examined through univariate and multivariate cox-regression analyses.
    Results
    There were 64 patients included. A total of 27 (42%) patients did not receive second-line chemotherapy because of poor Eastern Cooperative Oncology Group performance status, 20 (31%) received combination chemotherapy (platinum-based in 17), and 17 (27%) received a single agent chemotherapy. The median overall survival from the date of documented progression after first-line therapy was 5.0 months. In multivariate analysis, a correlation existed between poor overall survival and performance status of ≥1 (HR: 5.74, 95% CI: 1.4- 45.57, P=0.036), no second-line chemotherapy (HR: 2.72, 95% CI: 1.39-5.31, P=0.003), and ≥2 metastatic sites (HR: 5.19, 95% CI: 1.74-15.44, P
    Conclusion
    A significant proportion of patients with metastatic urothelial carcinoma were not eligible for second-line chemotherapy because of poor performance status. Use of second-line chemotherapy, Eastern Cooperative Oncology Group performance status, and number of metastatic sites were important determinants of survival.
    Keywords: Urothelial neoplasms, Prognosis, Chemotherapy, Performance status, Metastatic sites
  • Mohammad Reza Bordbar, Sezaneh Haghpanah, Nader Shakibazad, Tahereh Zarei * Pages 202-207
    Background
    Folate and vitamin B12 have a number of biologic roles that make them important in hematological disorders and malignancy. In the present study, we have assessed serum folate and vitamin B12 levels and their associated variables in patients with leukemia, lymphoma, and solid tumors.
    Methods
    This cross-section study investigated 98 patients (57 with leukemia, 16 lymphoma, and 25 solid tumors) between April 2015 and March 2016 in Southern Iran. Complete blood counts and serum levels of folate, vitamin B12, lactate dehydrogenase, and homocysteine were measured. Clinical characteristics of the patients were also gathered from their medical records.
    Results
    Patients had the following mean serum levels: serum folate (12.27±6.69 ng/ml), vitamin B12 (331.81±183.22 pg/ml), and homocysteine (11.74±26.67 μmole/L). Vitamin B12 showed a significant negative correlation with homocysteine levels (r= -0.223, P=0.043). Overall, there were 21(21.9%) vitamin B12 and 9 (9.8%) folate deficient patients. Vitamin B12 patients had a longer remission time (time from off therapy until study entry) of 18±16.97 months compared to those with normal vitamin B12 levels (8.81±8.08 months, P=025). However, logistic regression analysis showed that only mean corpuscular volume had a significant correlation with vitamin B12 deficiency (B= -0.105, odds ratio=0.9, 95% CI: 0.819-0.990, P=0.03). None of the variables showed significant correlation with folate deficiency (P>0.05).
    Conclusion
    Vitamin B12 and folate deficiency are frequently seen in survivors of childhood malignancy, mainly due to the effects of chemotherapy. These vitamins have important roles in hematopoiesis, as well as development and maintenance of the nervous system; therefore, timely detection of their deficiencies is of utmost importance. It is highly recommended to check the serum levels of these vitamins in children who successfully survive their cancer treatments
    Keywords: Malignancy, Pediatric cancer, Folate, Vitamin B12
  • Elahe Ramezanzade Tabriz *, Reza Mohammadi, Golam Reza Roshandel, Razieh Talebi, Mehdi Khorshidi Pages 208-216
    Background
    Coping strategies affect patients’ perceptions of pain severity, their ability to tolerate pain, duration of daily activities, and emotions. This study aims to determine the relationship between pain coping and unpleasant emotions, and religious coping in cancer patients.
    Methods
    This was a cross-sectional survey study. Sampling was conducted from June to December 2016. During that period, 363 cancer patients referred to Omid Hospital in Mashhad city, Iran and 22 Bahman Hospital in Neyshabur city, Iran. Data collection tools included a demographic questionnaire, religious coping scale, pain severity scale, Coping Strategies Questionnaire, and Depression Anxiety Stress Scale. The dataset was analyzed using descriptive and inferential statistics that included chi-square and one-way ANOVA with SPSS v.16 software.
    Results
    The majority of cancer patients (231; 63.6%) used the strategy of praying and hoping as their coping mechanisms. There was a significant difference between religious coping and pain coping strategies (P=0.02). Patients with mild depression most frequently used the praying and hoping strategy, whereas those with moderate depression more frequently used the catastrophic strategy (P>0.05).
    Conclusion
    Designing and performing educational programs for coping with pain can be an effective solution for patients to improve their pain management, as well as control and cope with their illness. These programs would help increase patient quality of life and disease self-management, as well as decreasing psychological and communication problems.
    Keywords: Pain coping strategies, Anxiety, Stress, Depression, Religious coping
  • Muhammad Waqar *, Muhammad Shahban, Quratulain Soomro, Muhammad Nawaz Abro Pages 217-222
    Background
    Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah (NORIN) is a newly established full-fledged healthcare facility for diagnosis, treatment, and research of all cancer types in rural areas of Sindh, Pakistan. Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah began its radiotherapy services in January 2012. We have conducted this study to assess cancer patients who registered in the Radiotherapy Department and received external beam radiotherapy at this institute in Pakistan.
    Methods
    We gathered institution-based data on cancer incidence distributed according to gender, age, district, tumor location, and stage of cancer when patients registered in the Radiotherapy Department of the Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah. In total, we included 2116 patients in this study from 2012 to 2016 who received irradiation administered by a cobalt-60 machine.
    Results
    The most common cancers were located in the head and neck region in males and breast in females. Most patients presented to the Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah with disease stages III and IV. Data from patients treated by external beam radiotherapy has indicated that most were 40-85 years of age. The Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah is located in Nawabshah District. Therefore, most patients who presented to this institution were residents of Nawabshah and neighboring districts.
    Conclusion
    Late stage diagnosis, lack of awareness, and low socio-economic status in rural areas of Sindh is of tremendous concern. The establishment of a cancer detection campaign and initiation of a cancer control program is vital for an efficient fight against cancer.
    Keywords: Stages, Rural area, External beam radiotherapy, Socio-economic status, Head, neck cancer
  • Hasan Jalaeikhoo, Morteza Sharifzadeh, Mohsen Rajaeinejad, Manoutchehr Keyhani, Mohammad Zokaasadi * Pages 223-227
    Background
    Neutrophil to lymphocyte ratio was initially used as a low cost prognostic marker in a group of solid tumors and subsequently hypothesized to have a role in multiple myeloma. This retrospective analysis aimed to report the prognostic importance of the neutrophil to lymphocyte ratio in multiple myeloma.
    Methods
    Between November 2003 and February 2016, we included 175 patients from two centers in this study. CBC differentials were primarily checked by a Sysmex analyzer in both centers. In one center, differentials were rechecked by light microscopy. Analysis of survival was performed using a Kaplan-Meier estimate and we assessed the effects of prognostic factors by Cox proportional hazards model.
    Results
    Patients had a mean age of 63.22±10.89 years. Although mean lymphocyte percent did not differ between the two centers, mean neutrophil percent and mean neutrophil to lymphocyte ratio were higher at the center that manually checked the CBC differentials. After adjustments for age and gender, we noted that the hazard ratio for elevated neutrophil to lymphocyte ratio when stratified for the centers was 1.07 (95% CI: 1.01–1.15, P=0.034).
    Conclusion
    A precisely checked neutrophil to lymphocyte ratio could act as a potentially inexpensive, accessible prognostic factor for multiple myeloma patients.
    Keywords: Multiple myeloma, Neutrophil to lymphocyte ratio, Survival analysis, Prognosis
  • Manjusha Nair *, Rajeev Kavalakara Raghavan, Anil Prahladan, Anita Mathews, Kusumakumary Parukkutty Pages 228-234
    Background
    Treatment of childhood brain tumours requires coordinated efforts by multiple specialities - neurosurgery, neuroradiology, neuropathology, oncology, and radiotherapy. The outcome is worse in developing countries compared to developed countries because of deficiencies in proper registry, failure of timely diagnosis, lack of availability and co-ordination of multiple specialists required for comprehensive management and high abandonment rates.
    Method
    The pediatric neuro-oncology program was initiated in collaboration with the neighbouring neurosurgery institution as a step towards improving care for pediatric brain tumor patients in our hospital. Epidemiology, treatment and followup of brain tumours in children aged 1-14 years attending the pediatric oncology department were studied. Patients received multimodality treatment with surgery, radiotherapy and chemotherapy by specialists in both centres. The study period was from January 2008 to December 2012.
    Results
    There were 375 pediatric brain tumour patients during the study period. 166 patients (44.2%) had supratentorial tumors and 209 (55.73%) had infratentorial tumors. 42.6% of tumours were high-grade and 53.6% were low grade. The commonest histopathological tumour type was astrocytoma (48.8%) followed by medullobastoma (24.5%). 287 (76.5%) patients underwent surgery, 216 (57.6%) patients received radiotherapy, 97 (25.8%) patients received chemotherapy and 94 (25%) required follow-up only. Patient follow-up rates improved from 37.2% to 82.6% and treatment abandonment decreased from 35.8% to 14.8% over these years.
    Conclusions
    Impact of the pediatric neuro-oncology program in our hospital has made it possible to provide comprehensive multidisciplinary treatment in a co-ordinated manner, describe the epidemiology of pediatric brain tumors, reduce treatment abandonment, and improve the follow-up of pediatric brain tumour patients.
    Keywords: Pediatric brain tumor, Neuro-Oncology, India
  • Kamyar Mansori, Salman Khazaei, Fatemeh Khosravi Shadmani, Shiva Mansouri Hanis, Ensiyeh Jenabi, Mokhtar Soheylizad, Mohadeseh Sani, Erfan Ayubi Pages 235-242
    Objective
    Cervical cancer (CC) is the third most common cancer in women after breast and colorectal cancers and is one of the leading causes of cancer death among women in the world. The aim this study is associations of cervix cancer incidence and mortality rates with Human Development Index (HDI).
    Methods
    The Information of the incidence and mortality rates of CC obtained from the GLOBOCAN cancer project in year 2012 and data for the HDI 2013 obtained from the World Bank database. The linear regression models were used for assessment of the HDI effect on CC occurrence rates. Inequality in the age-specific incidence and mortality rates (ASR) of CC according to the HDI were assessed by using concentration index.
    Results
    The results of this study that incidence and mortality rates of CC were very higher in regions with low & median HDI as compared to regions that had very high & high HDI, indeed Death and incidence from CC were more concentrated in low HDI countries. There was significant negative association between cervix cancer incidence and mortality rates with all the components of HDI including life expectancy (B= -0.98, P
    Conclusion
    It seems CC significant public health problem in countries with low HDI and requires the implementation of prevention programs and screening for early detection and treatment.
    Keywords: Human Development Index, Cervical cancer, Correlation, GLOBOCAN Cancer Project
  • Nahid Nafissi, Maryam Khayamzadeh*, Zahra Zeinali, Davood Pazooki, Mostafa Hosseini, Mohammad Esmaeil Akbari Pages 243-251
    Background
    Breast cancer is the most prevalent cancer among females worldwide. This study compares the results of the most cited published Iranian studies and studies from other Middle East countries on breast cancer with data from the Ministry of Health and Medical Education and approximately 2000 cases from the Cancer Research Center of Shahid Beheshti Medical University of Iran.
    Methods
    Data from the Cancer Registry System of the Ministry of Health and Medical Education and the Cancer Research Center were obtained in addition to data from other published Iranian articles to increase the accuracy of incidence, prevalence, disease burden, risk factors, clinical staging, clinical pathology, biological markers, clinical subtypes, and survival rate of breast cancer in the last decade and compare the epidemiological data with other areas of the world.
    Results
    Overall, breast cancer was the most common cancer in Iran. The agestandardized rate for breast cancer was 33.21 per 100,000 according to the latest national databases. The mortality rate for breast cancer has not changed in the past 30 years in Iran. The age-standardized rate for mortality was 14.2 per 100,000 with a mean age of 49.84 years. The most common cancer in Iran is invasive ductal carcinoma. In our last review, 65.5%-70.5% of cases were in the early stages (1 and 2) and less than 30% were in the advanced stages. The five-year overall survival rate was estimated at 72% in women and 60% in men. The stage and number of positive lymph nodes significantly affected the survival rate. In the Gulf Cooperation Council, ASR of the Kingdom of Saudi Arabia was (12.9), Bahrain (46.4), Kuwait (44.3), Qatar (35.5), United Arab Emirates (19.2), and Oman (14.4) per 100,000.
    Conclusion
    Our study shows that epidemiology and histopathology of cancer is different with other neighborhood countries and is multi-dimension and needs multicenter involvement from government authorities, clinicians and scientists.
    Keywords: Breast cancer, Epidemiology, Biomarker, Pathology, Iran
  • Mahmoud Khaled Al Hamarsheh *, Majd Mrayyan Pages 253-258
    Euthanasia has initiated a debate in many countries on whether ending a patient's life intentionally who suffers from a terminal stage cancer should be lawful or not. This topic has recently gained much attention. This controversial issue was raised because of the few existing countries that have passed legislation. This argumentative essay defends the author's position regarding euthanasia in oncology patients and reviews both opponents and proponents point of views, taking into consideration the legal and ethical perspectives regarding euthanasia. The current authors are against all types of euthanasia, and do not support the legislation of euthanasia in Jordan. The authors, in their defence against legalizing euthanasia, provide four main arguments (religion, slippery slope, reliance, and palliative care) as an opposition stand to persuade readers with their position. A suggestion has been made throughout several recommendations in an effort to resolve the furthermost important ethical and legal debates around euthanasia. The authors conclude that there is no agreement on whether euthanasia should be legislated or not. The opposing side has reasoned that it was contrary to religious jurisprudence and against established basic public taboo. Alternatively, the proponent side reasoned that the patient's autonomy for decision-making had to be respected, which would allow euthanasia to give the patients a means to end suffering and pain.
    Keywords: Assisted dying, Cancer, Ethics, Euthanasia, Law
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