فهرست مطالب

  • Volume:16 Issue: 1, Dec 2023
  • تاریخ انتشار: 1401/12/24
  • تعداد عناوین: 42
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  • Hamidreza Azizifarsani, Shayesteh Khorasanizadeh, Nour Mohammad Arefian, Faranak Behnaz, Afsaneh Sadat Makeh, Arash Tafrishinejad * Page 1
    Introduction

    Brachial plexus injury (BPI) is not acommoncomplication of surgery and anesthesia, whichmayhappen with varied mechanisms like over-abduction, no appropriate positioning, and upper limb stretching. The overall prognosis of BPIs iscommonly satisfactory, but the poor function of the upper limb may not be fully recovered in all cases and may end in the permanent sequel in serious injuries.

    Case Presentation

    This study reported a woman with breast cancer. She developed a right brachial plexopathy following a modified radical mastectomy. Upon conservative treatment, full recovery was achieved and normal function of the right upper limb was observed 3 months following the operation.

    Conclusions

    The arm’s extremely abnormal positioning during intraoperative manipulation and axillary retraction or hyper abduction can lead to BPI. Nerve injury can occur even in diabetic patients, whose blood glucose is well controlled and have no other risk factors. If the nerve structure is intact, spontaneous recovery can be expected with conservative management.

    Keywords: Anesthesia, General, Mastectomy, Brachial Plexus Neuropathy, Lymph Node Dissection
  • Ahmadreza Mirbolook, Mirbahador Athari, Nima Mohseni Kabir, Bardia Hajikarimloo, Masoud Saberi, Mojtaba Baroutkoub * Page 2
    Introduction

    Intramedullary ependymoma (IE) is adults’ mostcommon intramedullary spinal tumor. Tumors usually extend one to eight segments in the cervical region. In this case report, wereported a patient with massive IE spanning from the fourth ventricle to the T4 segment of the spinal cord, which surgically treated with laminectomy from occiput to T4

    Case Presentation

    A 42-year-old man who is a known case of IE with progressive upper extremities paraesthesia and gait disturbance. Four years ago he refused surgery and presented with dysphagia. The patient’s MRI demonstrated an intramedullary spinal cord tumor extending from the fourth ventricle to T4.

    Conclusions

    massive spinal ependymoma is a rare, benign, slow-growing tumor, and patients present symptoms years before diagnosis. Upon confirmation of the diagnosis, the tumor must be surgically removed.

    Keywords: Brain Tumor, Ependymoma, Paresthesia
  • Azadeh Rakhshan, _ Afshin Moradi, Elham Masoudi * Page 3
    Background

    Skin cancer is the most common cancer in Iran. Given the importance of early diagnosis in treating early tumors, knowledge of the demographic and pathological findings of the disease is helpful.

    Objectives

    The aim of present study was to investigate the incidence, trend and risk factors of melanoma in Iranian childhood and adolescents.

    Methods

    The present retrospective study was performed between 2005 and 2013 on registered data in the National Cancer Registry System, Iran. The age group studied was patients 18 years or younger. Data included demographic status, risk factors, clinical and histopathological characteristics, and stage.

    Results

    The results showed that 8 (57.1%) of 14 patients were males. The mean age of the study population was 8.71 ± 6.02 years (range, 1-15 years). Ten (71.4%) patients were of Fars ethnic groups. In terms of tumor invasiveness, 13 (92.9%) patients were invasive and one (7.1%) patient was in situ. The growth phase of melanoma was vertical in 13 (92.9%) patients and radial phase in one (7.1%) patient. In terms of lymph node metastasis, it was observed in only one patient. Surgical treatment was performed on all patients. Melanoma histology was nodular in 3 patients and unspecified or unregistered in the rest. The most area of the tumor was in the head/neck and lower limbs.

    Conclusions

    According to the results, regardless of the differences in the specific coverage of the Iranian people, the distribution and statistical characteristics of malignant melanoma in Iran are almost similar to other countries in the world. Wider studies are recommended to confirm the findings of the present study.

    Keywords: Melanoma, Childhood, Adolescence, Iran, Cancer
  • Mahmoud Beheshti Monfared, Hamid Ghaderi, Zahra Ansari Aval *, Manouchehr Hekmat, S. Adeleh Mirjafari, Reza Beheshtimonfared Page 4
    Introduction

    With the improvements in neoplasm treatments and the increased survival of patients with neoplastic diseases, we have entered a new era of having to deal with the complications of senile patients. The issue of bone fusion or the side effects of its delay, such as malunion or infections, are among the concerns for any surgery in patients whose bone marrow is affected by treatment orwhosebonemarrowbloodflowis impaired. The left internalmammary artery (LIMA) is used for coronary artery bypass graft (CABG) surgery with its 2 - 3 times longer lifespan compared to saphenous vein grafts, but its harvest from the sternum affects the sternum blood flow and the outcome of its use is still not identified in patients undergoing bone marrow transplant. This case report is the first report on this issue.

    Case Presentation

    A 60-year-old man with diffuse large B cell lymphoma who had undergone bone marrow transplant a year before had then developed chest pain, which was diagnosed as vessel disease; he was selected for CABG surgery. The LIMA was harvested during the surgery and the left anterior descending artery (LAD) was anastomosed. The saphenous vein graft was also anastomosed to the diagonal artery, obtuse marginatus (OM), posterior descending artery (PDA), and posterior left ventricle (PLV). After the surgery, the patient was followed up for six months, during which time no specific incidents occurred and no sternum-related complications were observed either.

    Conclusions

    In this case report, the use of LIMA in a patient who had undergone a bone marrow transplant and CABG surgery was not associated with any increase in sternum-related complications.

    Keywords: Bone Marrow Transplant, Coronary Artery Bypass Graft, Left Internal Mammary Graft
  • Seyed Amir Miratashi Yazdi, Elham Nazar *, Mojgan Deilamani Page 5
    Background

    P21 protein is a cyclin-dependent kinase inhibitor and has a crucial function as a cell cycle regulator in malignant tissues. Thus, its association with aggressive characteristics of malignant lesions is suggested.

    Objectives

    We evaluated the expression level of P21 in gastric cancers and its association with the histopathological findings of cancer.

    Methods

    This cross-sectional study was performed on gastric adenocarcinomas from radical gastrectomy. The histopathological examination was assessed by Hematoxylin & Eosin. The immunohistochemistry technique was then used to assess the expression of the P21 marker.

    Results

    P21 positivity was revealed in 28 specimens of the cancerous lesions with an overall prevalence of 70.0% in our population. There was no association between P21 positivity and tumor-related characteristics, including tumor location, type, grade and stage, as well as the size of the cancerous lesion. P21 positivity could not be related to perineural or lymphovascular invasion of the tumor (P-value > 0.05).

    Conclusions

    In our population, the expression of P21 may not be prognostic or predict tumor biological behavior among patients with gastric adenocarcinomas.

    Keywords: P21, Gastric Adenocarcinoma, Prognosis, Behavior
  • Hamid Barghbani, Narjes Heshmatifar, Neda Mahdavifar, Batol Keykhosravi, MojganAnsari * Page 6
    Background

    Informal caregivers provide long-term support and care for cancer patients and they do not receive enough support from the family and the health system; as a result, they suffer from a lot of caregiver burden.

    Objectives

    In the current study, we investigated the effect of the Benson relaxation technique on caregiver burden in informal caregivers of cancer patients.

    Methods

    This randomized clinical trial with a control group was conducted on 113 caregivers, who scored X  48 from the Novak and Guest caregiver burden inventory. They were randomly divided into intervention group (n = 57) and control group (n = 56). The intervention group performed Benson relaxation twice a day for 20 minutes each time for 1 month. The control group did not receive any intervention. Then, after 1 month, Novak and Guest caregiver burden questionnaire was completed by both groups. The conceptual framework for this study was based on the general system theory modified by Ludwig Von Bertalanffy.

    Results

    The mean score of the total caregiver burden before the intervention in the intervention and control groups was 71.16 ± 14.42 and 74.47 ± 15.16, respectively. After the intervention, the mean score of the total care burden in the intervention and control groups changed to 57.21 ± 14.66 and 75.47 ± 13.94, respectively. Data analysis shows a significant decrease in the intervention group (P = 0.000).

    Conclusions

    The results showed that the Benson relaxation technique as a cheap and non-pharmacological method effectively reduces the caregiver burden in informal caregivers of cancer patients.

    Keywords: Benson’s Relaxation, Caregiver Burden, Informal Caregivers, Cancer
  • Amir Reza Abedi, Ahmad R Mafi, Seyed Yasin Tabatabaeimehr, Hoormehr Nozari, Farzad Allameh * Page 7
    Background

    Prostate cancer is one of the most common cancers worldwide. The proper management of this cancer during the coronavirus disease 2019 (COVID-19) or similar outbreaks could be a serious challenge. Proper timing of surgery, radiotherapy, and other medical modalities are essential in providing the most effective treatment.

    Objectives

    This systematic review aimed at evaluating the proper management of prostate cancer during the COVID-19 outbreak.

    Methods

    This study was conducted from 2019 to 2022. An internet search was conducted using the keywords: Diagnosis, management, radical prostatectomy, radiotherapy, hormone ablation therapy, chemotherapy and prostate cancer, and COVID-19. The visited databases included PubMed, Scopus, Web of Sciences, Google Scholar, and Scientific Information Database. The review was performed based on the preferred reporting items for a systematic review and meta-analyses (PRISMA) guidelines.

    Results

    Postponing the biopsy for up to three months and adopting of non-invasive diagnostic methods were likely reasonable during the COVID-19 pandemic. Patients with cancer weremoreprone to severe injuries and weremorelikely to have serious complications. Surgery, radiation therapy, brachytherapy, palliative radiation, hormone ablation therapy, and chemotherapy were among the pre-institutional treatments that had to be performed according to medical protocols as well as health and professional guidelines.

    Conclusions

    It was recommended that the prostate cancer screening should not be performed for asymptomatic men during the COVID-19 outbreak. It was also suggested that the treatment should be performed in the shortest possible time and in the safest way.

    Keywords: Coronavirus Infection, Diagnosis, Pandemic, Prostate Cancer
  • Ghasem Miri-Aliabad *, Hamid Dahmardeh Page 8
    Introduction

    The coronavirus disease 2019 (COVID-19) mainly causes pulmonary disease. However, extrapulmonary manifestations, which affect the gastrointestinal tract and hepatobiliary system, have been reported.

    Case Presentation

    Here we reported a 4-year-old boy with acute lymphoblastic leukemia and abdominal pain who had acute necrotic pancreatitis secondary to COVID-19.

    Conclusions

    According to the COVID-19 epidemic, if drug-induced pancreatitis is ruled out, viral causes, especially COVID-19, should be considered.

    Keywords: Acute Pancreatitis, COVID-19, Acute Lymphoblastic Leukemia, Children
  • Mahsa Konani, Mohammad Pourhoseini, Mehrdad Hashemi, _ Maliheh Entezari *, Sepideh Khaleghi Page 9
    Background

    The utilization of molecular techniques in detecting cancer has resulted in an improved prediction of outcomes. Oral squamous cell carcinoma (OSCC) is a prevalent illness that is frequently detected in its late stages. Therefore, finding molecular biomarkers that lead to the early detection of OSCC is of great importance.

    Objectives

    This study aimed at evaluating the expression levels of long non-coding RNA (LncRNA) gastric carcinoma highly expressed transcript 1 (GHET1) and lncRNA ZXF2 in OSCC patients and their relationship with clinical pathology variables due to biomarker discovery and early diagnosis of OSCC.

    Methods

    Tissue sampling was performed after selecting 30 OSCC patients and 30 healthy individuals from Emam-Khomeini Hospital, Tehran, Iran. Then, RNA extraction and cDNA synthesis were performed from these samples, using the relevant kits and their quantity and quality were measured, using nanodrop and agarose gel electrophoresis, respectively. For molecular biomarker identification and validation, real-time PCR (RT-PCR) was utilized to assess the expression of lncRNA GHET1 and lncRNA ZXF2. Data analysis was done, using GraphPad prism V.8 software.

    Results

    The results showed that the expressions of both lncRNA GHET1 and lncRNA ZXF2 in OSCC tumor tissue increased compared to normal tissue (P < 0.0001). Receiver operating characteristic (ROC) analysis indicated that lncRNA GHET1 and lncRNA ZXF2 have the capability to be employed as biomarkers for OSCC detection. However, no significant relationship was observed between lncRNA GHET1 and lncRNA ZXF2 expressions with clinicopathological variables such as tumor stage and grade as well as patients’ age.

    Conclusions

    LncRNA GHET1 and lncRNA ZXF2 have the potential to be used as biomarkers in the early detection of OSCC and evaluating their expression in clinical settings are recommended. The use of these biomarkers in the early detection of OSCC can prevent the high mortality rate of OSCC patients. In the current study, the important role of the studied lncRNAs in OSCC diagnosis was shown. However, further studies are needed to confirm this.

    Keywords: Oral Squamous Cell, LncRNA, Real-time PCR
  • Setareh Akhavan, Azamsadat Mousavi, Shahrzad Sheikh Hassani, Narges Zamani, Elahe Rezayof, Zohreh Torabi * Page 10
    Background

    Cervical cancer is prevalent cancer among women that correct diagnosis has very important role in its treatment.

    Objectives

    The aim of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in comparison with surgical staging. Also, we compared the accuracy of physical examination with surgical pathology.

    Methods

    This retrospective cross-sectional study was performed on women who had cervical cancer from the start of 2017 to the end of 2021. Age, tumor pathology report (squamous cell carcinoma, clear cell carcinoma, adenocarcinoma, and small cell carcinoma), stage of the tumor, involvement of vagina, uterine, and parametrium, cervical stroma invasion, mass size, pelvic and abductor lymph node metastasis were extracted from the patient’s data and all were evaluated. The pathology report was considered as the gold standard.

    Results

    Eighty women with cervical cancer were evaluated and the mean age was 47.3 years. There was a statistically significant difference between the different prevalence of disease stages (P-value = 0.035) and also stage diagnosis between the three methods (P-value = 0.0004). The diagnostic accuracy of physical examination and MRI in terms of vaginal involvement, parametrium involvement, and uterine involvement were 97.5% and 98.7%; 98.7% and 96.2%; 94.9% and 93.6%; respectively.

    Conclusions

    Magnetic resonance imaging is a good method for the assessment of the clinical staging of cervical cancer and its accuracy is more than 94% in the diagnosis of different parts of cervical cancer involvement.

    Keywords: Uterine Cervical Neoplasms, Neoplasms, Magnetic Resonance Imaging, Physical Examination
  • Amna Amin Sethi, Nisar Ahmed Shar * Page 11
    Background

    Liver cancer accounts for more than 700,000 deaths each year making it the third leading cause of cancer-related deaths worldwide. Late diagnosis of the disease is the reason behind most deaths. Driver mutations are genetic alterations in tumor cells, which are responsible for the development of liver cancer; therefore, the identification of genetic biomarkers is necessary for the prediction and early diagnosis of liver cancer.

    Objectives

    The main objective of this study is to identify pathogenic alleles that may act as potential biomarkers for the prediction of liver cancer. It also identifies the role of novel genes in liver cancer that are not known to cause the disease.

    Methods

    The mutation data of non-coding variants were downloaded from the catalogue of somatic mutations in cancer (COSMIC) databases. Different bioinformatics tools were, then, used to retrieve mutations in liver cancer. The genetic alterations in hepatocellular carcinoma (HCC) were analyzed.

    Results

    The present study successfully identified pathogenic alleles (consistent mutations) along with a set of novel genes that might be involved in the development of liver cancer. It identified non-coding mutations near human genes and transcription factor binding sites of HepG2 cells. This study also identified mutations near the genes that are involved in the Ras/MAFK signaling pathway of the Hepatitis B virus.

    Conclusions

    The pathogenic alleles identified in this study may provide targeted therapy for the treatment of liver cancer. The identification of novel genes may help to understand the progression of liver cancer at the molecular level. The identified driver mutations may act as potential biomarkers and therapeutic targets for early prediction and treatment of liver cancer.

    Keywords: Liver Cancer, Driver Mutations, Consistent Mutations, Transcription Factors, HepG2 Cells, Biomarkers
  • Ali Dehghani Nazhvani, Ali Farhadi, Parisa Badiee, Haleh Keshvari, Mohammad Javad Ashraf, Fatemeh Pakdel, Golnoush Farzinnia * Page 12
    Background

    There are diverse lesions originating from the paranasal sinuses and nasal cavity. Tobacco use, alcohol consumption, and malnutrition have been identified to play a role in the development of head and neck carcinomas. Recently, fungi and viruses have been recognized as potential causes of nasal cavity and paranasal tumors.

    Objectives

    This study aimed at specifying the prevalence of Aspergillus andhumanpapillomavirus (HPV) infections in the epithelial tumors of nasal cavity and paranasal sinuses.

    Methods

    In this cross-sectional study, 57 paraffin-embedded tissue samples of malignant and benign lesions of the paranasal sinuses and nasal cavity were evaluated for the presence of Aspergillus and HPV DNA by nested polymerase chain reaction (nPCR) technique with specific primers.

    Results

    Despite the absence of angular hyphae (acute angle) of the fungus on histopathological slides, overall, 10 (17.54%) out of 57 paraffin-embeddedsamples were found to be positive for Aspergillus species. However, HPV-DNAwas not found in any of the samples.

    Conclusions

    Our data suggest that fungal infections (especially aspergillosis) as an etiological factor can be contributed to the development of sinonasal cancer and, therefore, they should be considered in the management of patients with sinonasal cancer. In addition, PCR can provide an alternative to culture-dependent identification methods.

    Keywords: Aspergillus, Human Papillomavirus, Nasal Cavity, Nested PCR, Paranasal Sinuses
  • Ebrahim Zabihi, _ Mobina Zamani, Alexis Vallard, Nicolas Magne, Dariush Moslemi * Page 13
    Background

    Acute radiodermatitis (ARD) is a common side effect of breast cancer radiotherapy. It includes erythema, burning sensation, swelling, epilation, desquamation, ulceration, or necrosis. So far, there has been no consensus about the best practice in preventing /treating ARD.

    Objectives

    This is the first study to assess the efficacy of topical phenytoin in the prevention and treatment of ARD.

    Methods

    This prospective randomized double-blind trial was a placebo-controlled study. A total of 70 patients with breast cancer were included. They were referred for breast radiotherapy after radical mastectomy. Patients were randomly assigned to either the topical phenytoin or placebo group. Both ointments were applied twice and daily on affected areas of the chest. Acute radiodermatitis was evaluated every week, for 5 weeks, during radiotherapy. A blinded-to-treatment physician used the “(radiation therapy oncology group) RTOG dermatitis scoring” to do so.

    Results

    During the first 3 weeks, ARD was neither severe (RTOG < 2) nor statistically different between the two treatment groups (P > 0.05). However, after the 3rd week, the ARD score was lower in phenytoin group than in the placebo group (P < 0.05).

    Conclusions

    Phenytoin topical ointment could postpone the occurrence and/or decrease the severity of ARDin patients with breast cancer.

    Keywords: Phenytoin, Radiodermatitis, Breast Cancer
  • Shiva Shabani, _ Parvaneh Cheraghi, Haniyeh Ghaffari-Nazari, Abbas Hajifathali * Page 14
    Background

    Coronavirus disease 2019 (COVID-19) is a devastating viral pandemic infecting millions of people with a wide range of symptoms from fever to death. It has been suggested that immunocompromised patients are at a higher risk of severe disease, poor clinical outcomes, and mortality. However, these patients’ risk factors and COVID-19-related outcomes are not well characterized.

    Objectives

    We evaluated the COVID-19-related outcomes among immunocompromised patients ranging from solid tumors, hematological malignancies, and HIV to autoimmune disease and transplant recipients who received immunosuppressive agents. We also aimed at finding risk factors related to mortality among immunocompromised patients with COVID-19.

    Methods

    This cross-sectional study was conducted in Khansari Hospital, Iran between March and November 2021. We included immunocompromised patients with nasal swab positive SARS-CoV-2 polymerase chain reaction (PCR) results in the study. Patient outcomes, including hospitalization ward and the mortality rate, were assessed till three months after COVID-19 infection were evaluated in all patients. Moreover, the relation between risk factors and the rate of the mortality rate was analyzed in immunocompromised patients with COVID-19.

    Results

    A total number of 74 immunocompromised patients with solid tumors, hematologic malignancies, autoimmunediseases, acquired immunodeficiencies, and solid-organ transplant recipients were included in the study. Results indicated that the male gender and ICU hospitalization significantly increase the mortality risk. Surprisingly, chemotherapy is associated with a lower risk of mortality.

    Conclusions

    Identifying the risk factors can improve the decision-making on cancer patients’ management during the COVID- 19 infection. A further large cohort of patients would be required to identify risk factors relating to poor clinical outcomes and mortality rates in immunocompromised patients with COVID-19.

    Keywords: Coronavirus Disease-2019, Immunocompromised Patients, Immunosuppressed Patients, Cancer, Mortality
  • Mahsa Matbouei, Majid Samsami *, Mohsen Soleimani Page 15
    Background

    Cancer recurrence is an important care challenge for breast cancer survivors. It is necessary to understand and identify the barriers and facilitators that affect the decision to start retreatment by those facing breast cancer recurrence compared to factors affecting their decision to start the initial treatment, which is different.

    Objectives

    This study is part of a qualitative study with a grounded theory approach, which was conducted to explain the facilitating and inhibiting factors affecting the decision to start retreatment in survivors of breast cancer recurrence, using a qualitative content analysis method.

    Methods

    This study was conducted based on the experiences of 16 patients with breast cancer recurrence and 2 oncologists to confirm the findings of the effective inhibiting and facilitating factors in patients’ decisions to start retreatment for breast cancer recurrence in one of the hospitals in Tehran, Iran. The samples were selected, using the purposeful sampling method trying to have maximum diversity. Data were collected through in-depth semi-structured telephone interviews from November 2020 to November 2021 and analyzed, using the conventional content analysis method following the Elo and Kyngas method, which includes 3 phases, including the preparation phase, the organizing phase, and the reporting phase. Credibility, transferability, dependability, confirmability, and authenticity were used for determining the trustworthiness of data.

    Results

    Both groups of inhibiting and facilitating factors were divided into 5 categories, including individual factors, social factors, family factors, illness characteristics, and treatment-related factors. Also, each category included sub-categories in two groups of inhibiting and facilitating factors affecting the decision to start treatment again.

    Conclusions

    Based on the results of the present study, it is necessary to increase the awareness of patients with breast cancer by the treatment staff about the possibility of recurrence and to know the factors influencing their decision-making process to start retreatment. Nurses should play the role of advisors, educators, and supporters of the patients in this field.

    Keywords: Breast Cancer, Qualitative Research, Decision-making, Recurrence
  • Elham Bastani, Fariba Shokri * Page 16

    Context:

     Lung cancer (LC) is one of the common diseases in the pulmonary system, which is defined as the uncontrolled growth of cells in the lung tissue.

    Objectives

    The present investigation was conducted with the aim of the prevalence of LC in Iran by meta-analysis method.

    Methods

    In this meta-analysis study, the articles that were conducted to determine age-standardized incidence rates (ASRs) in the field of LC were included in the study. The inclusion criteria included determining the number of ASRs in Iranian LC patients, reporting the sample size in men and women groups, and publishing articles between 2000 and January 2023. Data were analyzed, using CMA software.

    Results

    In this meta-analysis study, 889 articles were found in the initial search, and after the final search, 23 articles were included in the meta-analysis stage. Out of the 22 final articles, the prevalence of LC was 3.7% (95% CI, 2.6 - 5.3) in women and 7.1% (95% CI, 5.7 - 9) in males.

    Conclusions

    Considering that the incidence rate of LC in this study was high, it is essential to carry out necessary preventive interventions in this field.

    Keywords: Lung Cancer, Iran, Systematic Review, Meta-analysis
  • Fatemeh Keshmiri Nasrabadi, Sussan Rahimzade *, Mohammad Esmaeil Akbari Page 17
    Background

    Cancer disease is considered one of the basic health problems in the world, which threatens the health of human life. It causes numerous personal, family and social damages in physical, psychological, and social dimensions.

    Objectives

    The present study aimed at investigating health literacy and cognitive dysfunction on the quality of life of cancer survivors to make better decisions for the daily functioning, quality of life, and work capacity of cancer survivors so that their lives can be spent with more peace and less stress.

    Methods

    With a descriptive correlational design, 350 cancer survivors of the Cancer Research Center of Shahid Beheshti University of Medical Sciences (Shohaday Tajrish Hospital) from September to November 2021, who had been treated for at least one year, volunteered online and in person. Cognitive failure (Broadbent et al., 1982), cancer health literacy test (Dumenci et al., 2014), and quality of life of adults surviving cancer (Avis et al, 2005).

    Results

    Pearson correlation showed a negative relationship between cognitive dysfunction and quality of life; so, path analysis showed that 25% of the quality of life is explained by cognitive dysfunction, but cancer health literacy was not correlated with the quality of life of cancer survivors.

    Conclusions

    According to the findings, the optimization of cognitive functions after treatment was emphasized to increase the quality of life of cancer survivors.

    Keywords: Health Literacy, Cognitive Dysfunction, Quality of Life, Cancer Survivors
  • Farshid Farhan, Sepideh Sehat Kashani, Farnaz Amouzegar-Hashemi, Peiman Haddad, Mohammad Babaei, Ebrahim Esmati, Reza Ghalehtaki, Mansoureh Nabavi, Fatemeh Jafari * Page 18
    Background

    Internal mammary lymph nodes (IMNs) are a potential site of metastasis for breast cancer. Targeting IMNs as part of a comprehensive regional nodal irradiation comes at the cost of higher unwanted doses to critical nearby organs at risk. Thus, the efficacy and safety of different radiotherapy techniques for the coverage of this area remain elusive.

    Objectives

    We present a dosimetric comparison between partially wide tangents (PWT) and direct photon/electron (P/E) portals in terms of target volume coverage and normal tissue sparing.

    Methods

    Patients with left-sided breast cancer, who were referred to our clinic for post-lumpectomy or post-mastectomy radiotherapy, underwent computed tomography (CT) simulation. The left breast and IMNs, heart, lung, right breast, and esophagus were contoured. Dosimetric comparisons were based on dose-volume histograms (DVHs) generated for all of the aforementioned organs. A subgroup analysis was also performed based on patients’ type of surgical treatment.

    Results

    A total of 30 patients (10 with breast conserving surgery and 20 with modified radical mastectomy) were included. The P/E plan provided a higher coverage of the left breast (P-value of CTV V105%: < 0.001) and IMNs with a P-value of 0.087 regarding the mean dose received by IMNs, and also less volume of the heart (P-value of Heart V30Gy: 0.021), and lungs (P-value of Lung V20Gy: 0.003) were irradiated. However, these advantages came at the cost of a higher dose to the esophagus and right breast and more hotspots compared to the PWT technique.

    Conclusions

    The P/E technique had advantages regarding target volume coverage and toxicity regardless of the type of surgery. Based on the results of this study, overall, the P/E portal is superior to the PWT for radiotherapy of breast cancer with internal mammary node inclusion. However, the appropriate treatment plan should be decided on a case-by-case basis.

    Keywords: Breast Cancer, Internal Mammary Lymph Nodes, Radiation Therapy
  • Jalaluddin Khoshnevis, _ Mohammad Esmaeil Akbari, Mohammadreza Kalantar Motamed, Afshin Moradi, Mohammad Ebrahimi, Meysam Jirabadi, Terifeh Dashti, Afsaneh Sadat Makeh, Maryam Karami *, Farid Moradian Page 19
    Background

    Esophageal cancer is an invasive tumor with rapid growth and a poor prognosis. The annual incidence of esophageal cancer in the United States is 6 per 100 000 men and 1.6 per 100 000 women. This is different in the case of Iran, and the number of patients in the country is higher than in other countries. In this evaluation, the researchers present the experience with open Transhiatal Esophagectomy (Orringer) technique outcomes.

    Objectives

    This study aimed at evaluating the Orringer technique and its complications in patients with esophageal cancer for 25 years at the Cancer Research Center of Shahid Beheshti University of Medical Sciences.

    Methods

    This is a descriptive study conducted from the beginning of 1988 to 2016. In this study, 114 patients with a mean age of 55 years and a gender classification of 60% male and 40% female were evaluated.

    Results

    After resection, more than 98% of patients were in the T3 N1 - N3 stage. There were 4 mortalities: 2 were due to descending aorta tearing, 1 was due to tracheobronchial tearing, and 1 was pneumonia From 40 cases of pleural effusion, only 5 cases (12.5%) needed a thoracotomy tube. Only 2 patients needed intervention from 30 patients with dysphagia; 1 case was relieved by balloon dilatation and the other needed a free jejunal flap. Five-year survivals were 30% and 20% versus 48% and 23% in the neoadjuvant and non-neoadjuvant groups, respectively.

    conclusions

    The present studyandother experiencesshowedthat non-radical surgery such as the Orringer technique is acceptable and compassable compared to radical surgery in 3 fields.

    Keywords: Esophageal Cancer, Orringer Technique, Complications
  • Maryam Ghobadi, Haniyeh Bashi Zadeh Fakhar *, Babak Shaghaghi Page 20
    Background

    The genotypic distribution of human papillomavirus (HPV) needs to be determined with detail as it is an important issue when it comes to public health and preparing vaccines since the HPV type may be different in various areas.

    Objectives

    This study aimed at reporting the frequency of HPV types among women in Sari in the north of Iran.

    Methods

    From 2018 October to 2019 April, 50 sterile swabs of vaginal and cervical discharge of women with genital warts, which were performed by a gynecologist, were examined to determine the prevalence of HPV genotyping by using polymerase chain reaction (PCR).

    Results

    From 50 vaginal swab samples of patients with genital warts, the frequency distribution of types of HPV in women with genital warts included 5 patients (10.0%) with 2 high-risk serotypes as simultaneous serotypes 4% (16, 18), 4% (18, 35), 2% (66, 67), 1 patient (2%) HPV 33, 1 patient (2%) HPV 34, 1 patient (2%) 1 patient (2%) HPV 35, 2 patients (4%) HPV 66, 1 patient (2%) HPV 67, and 1 patient (2%) HPV 68.

    Conclusions

    Since HPV genotype varies in diverse areas, these results can be used for screening, management, and vaccination of the target population against the common types of virus in Sari.

    Keywords: Prevalence, Human Papillomavirus, GenitalWarts, Genotyping, PCR
  • Mahnaz Akbari, Alireza Negahi, Najmeh Dabbagh, Amir Hossein Salimi Kordasiabi, SabaZarean Shahraki, Mohammad Esmaeil Akbari Page 21
    Background

    Idiopathic Granulomatous Mastitis (IGM) is a benign disease; it can clinically and radiologically mimic the symptoms of breast cancer.

    Objectives

    Due to the rare and limited number of studies in Iran, this study was designed and conducted to evaluate patients’ clinical characteristics and treatment management with IGM.

    Methods

    In this cross-sectional and retrospective descriptive-analytic study, we studied the medical records of 293 patients with IGM, such as demographic information, characteristics of breast lesions, type of treatment, complications, and their outcome, which were recorded in the Cancer Research Centers of Shahid Beheshti University of Medical Sciences (SBMU) from 2010 to 2019. The patients were contacted by telephone to visit clinically or collect additional information. Data were analyzed by SPSS software version 24.

    Results

    The mean age of patients was 39.21 (ST = 8.29) years. Breast involvement in 236 cases (80.5%) was unilateral, and in 50 cases (17.1%), the involvement was Pere pri-Areola. The most common type of treatment was conservative therapy (analgesia + drainage) (178 cases, 60.8%), which was the primary treatment in our study; 66 patients (22.5%) received antibiotic therapy + analgesia + drainage, and 41(14%) cases received corticosteroid in addition to this treatment. Totally, 132 cases (79.5%) were completely cured with the performed treatments, 17 cases (5.8%) had a recurrence of symptoms, and 14.7% of the patients were still receiving treatment. Recurrence after 1 year in patients who had a longer duration of disease (more than 12 months) was higher than in those who had a shorter period (less than 12 months) (15.3% vs. 5.1%, P = 0.004). Also, the highest recurrence rate was in the group receiving corticosteroids compared to the group receiving the usual treatment and usual treatment plus antibiotics. This relationship was statistically significant (22.0% vs. 9 % and 6.1%, respectively, P = 0.032). Complications (scar or breast skin color change) were significantly higher in patients without a pregnancy history than in patients who had pregnancy (50.0% vs. 22.8%, P = 0.030). Also, these complications were significantly higher in patients who had a longer duration of disease (more than 12 months) than in shorter periods of disease (less than 12 months) (31.4% vs. 17.3%, P = 0.005).

    Conclusions

    The results of our study and its comparison with the results of other studies still emphasize the uncertainty of the etiology of IGM disease and its treatment, but to some extent, our study has shown that conservative treatment (drainage with analgesic drugs) is one of the best treatment options. Also, corticosteroid therapy is associated with a higher recurrence rate, but in some cases is necessary and recommended in many studies.

    Keywords: Idiopathic Granulomatous Mastitis, Disease, Breast
  • Elaheh Mohammadali, Reza Safaralizadeh *, Arash Poursheikhani, _ Tooraj Asvadi, Shahram Teimourian, Behzad Baradaran Page 22
    Background

    In recent decades, many long non-coding RNAs (lncRNAs) have been reported to play a prominent role in tumorigenesis and the progression of human cancers, including gastric cancer (GC), a leading cause of cancer death in Iranian men and women. Studies have demonstrated that thymopoietin antisense transcript 1 (TMPO-AS1) was upregulated in different cancers by acting as an oncogenic lncRNA.

    Objectives

    This study aimed to evaluate the expression of lncRNA TMPO-AS1 in Iranian patients with GC.

    Methods

    In order to conduct the present study, 40 gastric tumor samples and 40 marginal noncancerous counterparts were collected. The characteristics of patients’ samples were recorded, and the TMPO-AS1 expression levels were evaluated by qRT-PCR analysis. The Cancer Genome Atlas (TCGA) data for TMPO-AS1 were used and analyzed through GEPIA and TANRIC online tools. Receiver operating characteristic (ROC) curve analysis was used to estimate the diagnostic value. Student t-test, one-way ANOVA, and chisquare test were accomplished via SPSS software.

    Results

    Our data demonstrated that TMPO-AS1 was overexpressed in cancerous tissues compared to adjacent nonmalignant ones (P = 0.0076). None of the demographic and clinicopathological data were associated with TMPO-AS1 expression levels. The TCGA data demonstrated that TMPO-AS1 was upregulated in GC tissues in comparison to adjacent nonmalignant ones (P = 0.001). ROC curve analysis suggested that TMPO-AS1 expression levels could discriminate GC tumor tissues from normal ones (AUC = 0.699, P = 0.001).

    Conclusions

    Altogether, in our study, we demonstrated that lncRNA TMPO-AS1 may be considered a biomarker in Iranian patients with GC. However, further investigations are required to confirm the potential application of this lncRNA in diagnosis, prognosis, and therapeutic applications of GC.

    Keywords: Gastric Cancer, Gene Expression, LncRNA, TMPO-AS1, In Silico
  • Afsoon Taghavi, Atieh Khorsand, Malihe Saberafsharian, Reza Sahabi, Mozhdeh Beiraghdar, Mitra Hosseinpour, Sara Zahedifard, Hadi Hajizadeh Fallah, Reza Maghsoodi, SarehSalarinejad, Parto Nasri, Hamid Reza Eftekhari, Zahra Sadeghzadeh, Masoumeh Hosseini, Arsham Moradi, Leila Bahari Khasraghi * Page 23
    Background

    Gastric cancer is one of the most common cancers among Iranian men and women.

    Objectives

    The aim here was to investigate different histopathologic types and features of this cancer in association with selected prognostic variables.

    Methods

    A retrospective cross-sectional study was performed to reevaluate the pathologic samples of 100 cases of gastric cancer referred to Shohadaye Tajrish Hospital, Tehran, Iran from 2017 to 2022.

    Results

    We evaluated 100 cases of gastric cancer in this study. They had a mean age of 62.4 ± 13.44 years old (range 28 - 84 years) and were mostly men (n = 66, 66 %). On histopathologic evaluation, tubular carcinoma was the most common type (n = 45, 45%). We found a statistically significant correlation between the histologic type and perineural invasion (P-value = 0.024), lymphovascular invasion (P-value < 0.001), tumoral involvement of surgical margin (P-value = 0.012 ), infiltration depth of the primary tumor (pT) (P-value = 0.049) , number of metastatic lymph nodes (pN) (P-value = < 0.001) , tumor location in the antrum (P-value=0.033) and body (P-value = 0.013) , and tumor size (P-value = 0.002 and P-value = 0.031 in small and large size groups respectively).

    Conclusions

    According to the findings, histologic type of gastric cancer correlates with perineural invasion, lymphovascular invasion, tumoral involvement of the surgical margin, pT, pN, and tumor location and size.

    Keywords: Gastric Cancer, Perineural Invasion, Lymphovascular Invasion, Surgical Margin, WHO Classification System, TNMStaging System
  • Fatemeh Safi *, Mohammad Hasanian, Masoud Fazeli, Masoumeh Sofian, Edris Bahrami, Mersad Mehrnahad Page 24
    Background

    The present study evaluated purified protein derivative (PPD) changes based on mediastinal lymph node density.

    Methods

    This cross-sectional observational studywasperformedon130 patientswhowere referred toValiasrandAmirAl-Momenin Hospitals in Arak, Iran for a CT scan for non-infectious and non-tumor reasons. The gender of the patients was recorded, and they then underwent non-contrast CT, and their mediastinal lymph node density was measured and recorded based on the Hounsfield units. Patients were evaluated for changes in the tuberculin test. The induration diameter obtained from the tuberculin test was recorded for each individual. Data analysis was then carried out using SPSS software ver. 20.

    Results

    There was a positive correlation between mediastinal lymph node density and tuberculin test induration diameter, so larger induration diameter in the tuberculin test results in increasing lymph node density result (r = 0.416, P < 0.001). There was a negative correlation between mediastinal lymph node density and age, i.e., mediastinal lymph node density decreased with increasing age (P < 0.001, r = -0.616). Lymph node density was higher in men than in women (P = 0.022).

    Conclusions

    There is a positive correlation between the mediastinal lymph node density and the tuberculin test induration diameter, and the tuberculin test induration diameter increases with increasing lymph node density. There is a negative correlation between the mediastinal lymph node density and age, i.e., the mediastinal lymph node density decreases with increasing age. Lymph node density was also higher in men than in women. Therefore, the results can help ensure an earlier diagnosis of pulmonary tuberculosis, and measuring the mediastinal lymph node density is recommended.

    Keywords: Tuberculin Test, Lymph Nodes, Mediastinal
  • Maryam Jafarpour, Ali Moeini *, Niloofar Maryami, Azin Nahvijou ORCID, Ayoub Mohammadian Page 25
    Background

     The algorithmic classification of infected and healthy individuals by gene expression has been a topic of interest to researchers in numerous domains, including cancer. Several studies have presented numerous solutions, such as neural networks and support vector machines (SVMs), to classify a diverse range of cancer cases. Such classifications have provided some degrees of accuracy, which highly depend on optimization approaches and suitable kernels.

    Objectives

     This study aimed at proposing a method to classify cancer-prone and healthy cases under breast cancer and colorectal cancer (CRC), using machine learning methods efficiently, increasing the accuracy of the classification process.

    Methods

     This study presented an algorithm to diagnose individuals prone to breast cancer and CRC. The novelty of this algorithm lies in its suitable kernel and the feature extraction approach. By the application of this algorithm, this study first identified the genes closely associated with these types of cancers and, then, tried to find individuals susceptible to the concerned cancers using SVM. The present study highlighted the indirect gene expressions associated with these cancers, which might show health status complications for the patients. To this end, the algorithm consists of SVMs in conjunction with the k-fold method for validation.

    Results

     The results confirmed the superior performance of this approach, compared to the common neural networks. The algorithm’s identification accuracy values were 98.077% and 99.806% for breast cancer and CRC, respectively. The graphic representation of the cause-effect relationships was also provided to help researchers better understand the trend of cancer or other types of diseases.

    Conclusions

     The feature extraction method highly affects the accuracy of the classification. In addition, relying on indirect disease-triggering genes’ expressions highlights a cause-effect relationship between genes and diseases. Such relationships can form Markov models in the clinical domain leading to treatment paths and prediction of patient outcomes.

    Keywords: Machine Learning, Support Vector Machine, Gene Expression, Breast Cancer, Colorectal Cancer, Classification
  • Moslem Arian, MohammadSaeed Khanjani, Abbas Ebadi *, Seyyed Jalal Younesi, Manoochehr Azkhosh, Samaneh Hosseinzadeh Page 26

    Context: 

    Existential guilt is an important concept in cancer patients. However, the literature shows that the components of this concept are not well defined and specified. Hence, this study aimed at enhancing understanding of the characteristics of existential guilt and its differentiation from other similar concepts in the field of cancer.

    Evidence Acquisition: 

    Focusing on cancer patients, Walker & Avant's approach was followed to clarify and analyze the concept of existential guilt. So, Web of Sciences (ISI), PubMed, ProQuest, Scopus, PsycINFO databases, and Google Scholar were searched, using 'existential guilt', 'guilt', and 'cancer' keywords to identify relevant studies with no time limitation. After screening and evaluation, 58 articles were identified, of which 26 were analyzed.

    Results

     Initially, definitions, characteristics, antecedents, and consequences of the existential guilt concept were introduced. Then, a case model was explained to create a more clarified understanding of the concept and, eventually, some implications for the approach to cancer patients were proposed.

    Conclusions

     The existence of different definitions and separate research pathways about the concept of existential guilt may indicate a sense of scatteredness. However, as shown in this study, one can come to a widely accepted understanding as well as a differential understanding of this concept; this clarification can, in turn, result in efficient and comprehensive psychological attention to cancer patients. Indeed, this concept analysis can pave the way for clinical interventions, operationalization, and research on this topic and population

    Keywords: Cancer, Concept Analysis, Existential Guilt, Palliative Care
  • Mohsen Sobhani, Ebrahim Salehifar *, Parisa Moradimajd, Ehsan Zaboli, Monireh Mohsenzadegan, Hamidreza Samaee Page 27

    Context:

     One of the most common cancers in men is prostate cancer, which can lead to death. Immune checkpoint inhibitors (ICIs) are drugs that have been proposed in recent years as proposed treatments for prostate cancer.

    Objectives

     The aim of this study was to review the efficacy and tolerability of ICIs in these patients.
    Data Sources: From January 1, 1990, to January 1, 2022, using the keywords in checkpoint inhibitors, prostate cancer, efficacy, and tolerability, systematically reviewed databases such as PubMed, ClinicalTrial.gov, Web of Science, Scopus, Cochrane Library, ScienceDirect and Google Scholar based on the protocol registered in Prospero were identified as CRD42021252562.

    Results

     Out of 690 studies found, 43 studies were reviewed for evaluation in terms of inclusion criteria, and finally 6 studies were included in the design. In the analysis of selected studies, 1 800 patients were studied, and the range of sample size was from 23 to 799. According to the results of the meta-analysis, there was no significant difference in death risk compared to ICI + radiotherapy with radiotherapy + placebo (HR: 0.96, 95% CI: 0.74, 1.23, P = 0.74). Combined results from 2 clinical trials demonstrated that the risk of death in the radiotherapy + ICI group was less than in the group just treated with radiotherapy (HR: 0.69, 95% CI: 0.61, 0.77, (P < 0.001), 0.77, P < 0.001). To evaluate tolerability, the results showed a non-significant difference between the groups considering the overall prevalence of treatment-related side effects (RR: 1.59, 95% CI: 0.75, 3.39, I2 = 98%).

    Conclusions

     The present meta-analysis showed that the use of safety checkpoint inhibitors has been associated with improved survival without progression, but their effect on increasing overall survival has not been confirmed.

    Keywords: Immune Checkpoint Inhibitors, Prostate Cancer, Efficacy, Tolerability
  • Mia Elhidsi *, Jamal Zaini, Dicky Soehardiman, Prasenohadi Pradono, Menaldi Rasmin Page 28

    Context: 

    The accuracy of narrow-band imaging (NBI) is a technology imaging for the assessment of lung cancer.

    Objectives

     We aimed at summarizing the diagnostic profile of NBI for the early diagnosis of airway cancer lesions.

    Methods

     We used PubMed, Scopus, and EMBASE databases to search for eligible studies published up to October 2022. Eligible studies have investigated the diagnostic profile of bronchoscopy NBI for the early diagnosis of lung cancer. The index test was NBI bronchoscopy, and the reference test was the histopathological results of lung cancer based on the World Health Organization (WHO) classification. In eligible studies, the detected lesions were confirmed by histopathology. We extracted true positive (TP), true negative (TN), false positive (FP), and false negative (FN) from the eligible studies to calculate the diagnostic profile of NBI. the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) assessment was used as a tool to assess the risk of bias. A random-effects model was used to pool the summary receiver operating characteristic curve, specificity, and sensitivity.

    Results

     Five studies were included, involving 1267 subjects with 1850 biopsy specimens. The overall pooled sensitivity and specificity for NBI bronchoscopy for the early detection of airway cancer lesions were 98% (95% confidence interval [CI]: 89% - 100%) and 77% (95% CI: 62% - 88%), respectively. All I2 values for sensitivity and specificity were 35.93% and 85%, respectively, with a P-value of 0.001. The positive LR was 4.35 (95% CI: 2.51 - 7.54, P < 0.001), and the negative LR was 0.03 (95% CI: 0.01 - 0.14, P = 0.006). The area under the receiver operating characteristic curve was 0.95 (95% CI: 0.92 - 0.96).

    Conclusions

     Narrow-band imaging bronchoscopy can be used as a diagnostic modality for the early diagnosis of airway cancer lesions with good diagnostic accuracy.
    Keywords

    Keywords: Bronchoscopy, Lung Cancer, Narrow Band Imaging
  • MohammadReza Nowroozi, Erfan Amini, Ehsan Mosa Farkhani, Ali Nowroozi, Mohsen Ayati, Seyed Ali Momeni Page 29
    Background

     Bladder cancer is one of the most common cancers worldwide and also in Iran. Understanding of bladder cancer epidemiology is of great value for policymakers and assists in the prevention and early detection of the disease.

    Objectives

     The aim of the present study was to report national and subnational incidence trends of bladder cancer in Iran between 2003 and 2015.

    Methods

     This study investigated the age-standardized incidence rates (ASIRs) per annum of bladder cancer from 2003 to 2015 in Iran using the data from the cancer registration system of the Ministry of Health and Medical Education of Iran. The crude incidence rates were calculated by dividing incident cases by the country and province population, which were provided by the Statistic Center of Iran. Age standardization was performed using the WHO standard population, and ASIRs were compared by age, sex, and province.

    Results

     The ASIR of bladder cancer increased from 8.35 in 2003 to 13.57 in 2015 in men. The ASIR of bladder cancer also showed a mild increase in females, 2.12 in 2003 versus 2.86 in 2015. The province of Yazd had the highest rate of bladder cancer in men, and West Azerbaijan had the highest rate for women (15.13 and 7.79 per 100,000), while Sistan va Baluchestan and Ilam had the lowest ASIRs for men and women (3.01 and 0.96 per 100,000, respectively).

    Conclusions

     The increasing trend of bladder cancer incidence in Iran, despite the clear decreasing global trend accompanying to ongoing aging of the population highlights the diseases as a potential health problem in the upcoming years in Iran. Therefore, it is necessary for health organizations to implement effective research and control programs in the country to prevent further increases in disease burden.

    Keywords: Urinary Bladder Neoplasms, Epidemiology, Incidence, Time Series, Iran
  • Ali Tayebi, Fatemeh Karkhaneh, Ghazaleh Donyadideh, Faranak Olamaeian, MohammadJavad Ashoori, Mansour Bahahrdoust * Page 30
    Background

     Colorectal cancer (CC) is one of the most important causes of death due to cancer in the world. The association of blood groups with CC in many races has been reported in previous studies. So far, no study has evaluated the relationship between blood group type, tumor location, and polyp type.

    Objectives

     This study aimed at evaluating the association of the ABO blood group and CC, tumor location, and polyp type.

    Methods

     In this case-control study, 802 subjects (401 cases and 401 controls), who underwent surgery at our medical centers between 2014 and 2021, were included. The case group was selected from the hospital records of patients with CC, and the controls were selected from non-cancer patients who were admitted to the same centers for reasons other than cancer. Patients’ demographic characteristics and clinical and pathology findings were extracted from the medical profile, and blood group information was extracted from the blood bank. Multivariate logistic regression analysis was used for the predictive variables of CC.

    Results

     The risk of CC in patients with blood type A was significantly higher than non-A. While the risk of developing CC in patients with blood type O was significantly lower than non-O O. The risk of developing neoplastic polyps was significantly higher in patients with blood type A compared to non-A. The results of multivariate analysis showed that ABO blood type A (OR Adju: 1.66) and O (OR Adju: 0.78) and neoplastic polyp type (OR Adju: 1.36) were associated with CC.

    Conclusions

     The results of this study showed that ABO blood group type was significantly related to CC and polyp type.

    Keywords: ABO Blood Group, Colorectal Cancer, Intestinal Polyps
  • Maryam Kalantari Khandani, Samira Azghandi, Zahra Siavashpour, Afshin Rakhsha, Amir Shahram Yousefi Kashi *, Arian Yousefi Kashi Page 31
    Background

     The aim of this study was to evaluate and analyze disease-free survival (DFS) and overall survival (OS) after intensity-modulated radiotherapy (IMRT) for Iranian patients with nasopharyngeal carcinoma (NC).

    Methods

     In this historical cohort study, 65 non-metastatic patients treated for NC with IMRT were selected and reviewed at the Shohadai-e-Tajrish Hospital between October 2017 and October 2019. Chemotherapy was given either as induction, concurrent, or adjuvant therapy in all cases. Three years of DFS and OS were calculated according to Kaplan-Meier and compared with the Pearson Correlation Test.

    Results

     The mean age of patients was 43.38 years. The three-year DFS and OS rates were 95.72%, 92.32%, 72.73%, 73.26%, and 100%, 84.61%, 90.90%, and 79.41% in stage I, II, III, and IV patients, respectively (P = 0.119, P = 0.155). The total three-year DFS rate and the total three-year OS rate were 76.47% and 84.60% in all cases. Based on the Pearson Correlation Test, it was a significant correlation between the duration of IMRT time and three-year DFS (correlation=0.138, P = 0.017) and the number of concurrent cycles of chemotherapy with IMRT (correlation=0.375, P = 0.002). It was not a significant correlation between total time duration, MRI response, induction chemotherapy, age, sex, and the three-year DFS. There was a significant correlation between total time duration and three-year OS (correlation=0.263, P = 0.040) and the number of concurrent cycles of chemotherapy with IMRT and three-year OS (correlation=0.334, P = 0.007). It was not a significant correlation between the duration of IMRT time, MRI response, induction chemotherapy, age, sex, and the three-year OS.

    Conclusions

     Our findings showed that IMRT with concurrent chemo-radiotherapy has the three-year DFS and OS, which were comparable with the other published results. We emphasize the number of concurrent cycles of chemotherapy with IMRT, which have an important role in both three-year DFS and OS. The duration of IMRT time has also an important role in the three-year DFS but not in the three-year OS. A longer follow-up for the patients to evaluate 10-year DFS and OS is recommended.

    Keywords: Nasopharyngeal Carcinoma, Intensity Modulated Radiotherapy, disease-Free Survival, Overall Survival
  • Ehsan Khadivi, Negar Moghaddas *, Hamidreza Rasti Boroujeni, Bashir Rasoulian, Mohammadreza Afzalzadeh, Maryam Emadzadeh Page 32
    Background

     Despite the high prevalence of head and neck cancers in Iran, no studies have been conducted to investigate the relationship between vitamin D levels and these cancers. Many Iranians suffer from vitamin D deficiency, which underscores the importance of conducting these studies in Iran.

    Objectives

     This study aims at investigating the relationship between vitamin D levels and laryngeal cancer.

    Methods

     This 1: 1 matched case-control study included 216 patients in Mashhad, Iran, who had not consumed vitamin D supplements for 3-months before study onset. Participants were grouped in 2 categories; the case group, which consisted of patients with laryngeal cancer whose squamous cell carcinoma was confirmed pathologically for the first time (new cases), and the control group, which consisted of individuals who did not have any cancer at the time of the study, confirmed by indirect laryngoscopy, and were identical to the patient group in terms of other risk factors for laryngeal cancer (smoking and alcohol abuse). First, the relevant checklist (including age, occupation, consumption of tobacco, alcohol use, etc., history of contact with mustard gas, wood, stone, metal, and cement industry, as well as history of reflux in the individual and cancer in relatives) was completed for all case and control group members. After taking blood samples, they were evaluated for serum levels of vitamin D3. Data were analyzed using chi-square, Mann-Whitney U or independent sample t-tests. Logistic regression was also used to determine the relation between vitamin D level and laryngeal cancer.

    Results

     Mean age, sex and risk factors of laryngeal cancer were not significantly different between the two groups. Vitamin D level was significantly lower in patients with laryngeal cancer compared to control group (16.02 ± 3.62 ng/mL vs 25.19 ± 3.40 (P < 0.001)). Logistic regression analysis showed that vitamin D level is independently related to laryngeal cancer and has a protective effect on this neoplasm (OR = 0.54, 95%CI: 0.46 - 0.63, P < 0.001).

    Conclusions

     A lower vitamin D level may be related to laryngeal cancer. However, the role of vitamin D deficiency as a risk factor for head and neck cancers and whether the treatment of this condition could prevent the incidence of such cancers is a matter of future investigations.

    Keywords: Vitamin D, Laryngeal Cancer, Squamous Cell Carcinoma
  • Nahid Nafissi, Ayoub Bagheri *, Hamed Vaseghi, Leyla Shojaee, Mina Zolnouri, Stefano Pompei Page 33
    Background

     Breast cancer is still a major contributing factor to the burden of the disease worldwide. A single-stage implant-based reconstruction (IBR) lowers tissue morbidity, thus increasing overall aesthetic outcome and patient satisfaction.

    Objectives

     Because of the high price of ADM and the lack of insurance coverage in Iran, we aimed at examining the results of using TIGR® mesh in patients with breast cancer.

    Methods

     This quasi-experimental study was conducted in Iran (Tehran) from 2016 to 2018. About 140 eligible patients with breast cancer were included and their information was collected and analyzed prospectively during the 3 years that they were referred to the surgery center in Tehran. The reconstruction was performed, as either direct-single staged, implant + TIGR MESH, or delayed-multistage. Patient satisfaction was calculated after 1 year of follow-up, using Body Checking Questionnaire (BCQ) by applying the VAS scale. All statistical analyses were performed at a 95% significance level, using SPSS statistical software version. (Evidence-based medicine level: Level III, a prospective cohort).

    Results

     The results of our study showed slightly more short-term complications than other studies due to the surgical team’s first experience in the surgery. Complications were infection (7.1%), epidermal necrosis (15.9%), and severe capsular contracture (14.2%). Seven patients (6.2%) had full-thickness skin necrosis, and the prosthesis was finally removed. The use of the TIGR Mesh did not increase the rate of complications, and only 5 implant losses in this group and 2 in the tissue expander group were reported. The levels of patients’ satisfaction in IBR and delayed-multistage groups were 44.4% and 12.7%, respectively.

    Conclusions

     Our results showed that placement of TIGR MESH for lower pole support during IBR does not increase the complication rate. Additionally, patients’ satisfaction levels increased compared to traditional methods of reconstruction.

    Keywords: Breast Implantation, Breast Reconstruction, Mastectomy, Complications, Tissue Expander
  • Shadi Nouri *, Navid Mirhosseini, Nazanin Naghibi, Mohammad Hasanian Page 34
    Background

     Hematologic malignancies are the fifth most common malignancies worldwide. Pulmonary symptoms are among the patient’s common complaints. Early diagnosis based on patient symptoms, laboratory testing, and imaging may lead to an appropriate therapeutic approach.

    Objectives

     To evaluate thoracic computed tomography (CT) scan findings in known cases of hematologic malignancy with acute respiratory symptoms.

    Methods

     A cross-sectional study was conducted on 200 patients with hematologic malignancies admitted to Khansari cancer center for acute pulmonary symptoms, from December 2019 to May 2020. Collected data included demographic data, physical examination, laboratory tests and findings of thoracic CT images. Descriptive analysis and chi-Square test were performed to analyze the data using SPSS version 20.

    Results

     Non-Hodgkin lymphoma was the most common malignancy, accounting for 48% of total cases. The most common radiological findings included atelectasis (49%), followed by pleural effusion (42%), mediastinal lymphadenopathy (38.5%), consolidation (37%), and ground-glass opacities (33.5%). Mediastinal lymphadenopathy was more prevalent in patients diagnosed with lymphoma. Among pulmonary pathologies, pneumonia was the most prevalent disease (41.5%), followed by small airway disease (13.5%), mediastinal lymphadenopathy (12.5%), chronic pulmonary disease (6.5%), and pulmonary metastasis (6%). Normal thoracic CT scan was detected in 20% of participants. Overall assessment of clinical symptoms, laboratory tests, and imaging findings did not lead to the diagnosis of acute lung involvement in 5.5% of study participants, because complete clinical data were not available in some participants.

    Conclusions

     Assessment of the most common thoracic imaging findings in patients diagnosed with hematologic malignancies, may help make better diagnosis and planning of a rapid therapeutic approach.

    Keywords: Hematologic Malignancy, Acute Pulmonary Symptoms, Computed Tomography, Chest
  • Zeynab Moradian Haft Cheshmeh, Mohsen Asadi-Lari *, Ali Motlagh, Afshin Ostovar Page 35
    Background

     Breast cancer (BC) is a leading cause of cancer-related deaths among women worldwide, and its incidence has increased in Iran over recent years.

    Objectives

     In this study, we aimed at assessing the completeness of BC pathology reports in the population-based cancer registration system and perform a spatial analysis of the incidence of this cancer in Iran in 2016 to help policymakers develop targeted interventions.

    Methods

     We conducted a retrospective descriptive analysis, using secondary data from the Integrated Cancer Information Management System, and obtained 13789 BC pathology reports from all provinces in Iran in 2016. Pathology data, including tumor type, tumor site, tumor size, pathologic T stage, pathologic N stage, and tumor grade were examined for completeness by age group.

    Results

     Pathology reports from 4000 women with BC in 2016 from across all provinces of Iran were selected for this study. The completeness of tumor type, tumor site, tumor size, pathologic T stage, pathologic N stage, and tumor grade increased with aging. In addition, the completeness of pathology reports varied across different variables. Accordingly, the tumor grade and pathologic T stage had the highest and lowest completeness rates (100 % versus 27.4%), respectively. Spatial analysis revealed significant high-risk areas for BC incidence, including Isfahan, Markazi, Chaharmahal and Bakhtiari, and Kohgiluyeh and Boyer-Ahmad provinces in central Iran. In contrast, North Khorasan was identified as a low-risk area.

    Conclusions

     Considering the incompleteness of the pathology report in most of the tumor variables in the BC registry, we recognize the gaps to improve pathology data. To ensure effective interventions for BC control, tailored preventive measures are needed, particularly for high-risk areas. Continuous evaluation and data completion, including standard cellular pathology reports, are necessary for accurate BC control in Iran.

    Keywords: Completeness, Pathology Report, Breast Cancer, Incidence, Spatial Analysis, Iran
  • Hossein Karami, Mahyar Ghafoori, Reza Dashti * Page 36
    Background

     Prostate cancer (PC) is one of the most common cancers worldwide. Recently, multiparametric magnetic resonance imaging (mpMRI) has been used to diagnose PC in suspected patients. Prostate Imaging Reporting & Data System (PI-RADS) was developed and applied as a criterion for detecting lesions suspicious of PC. Various studies have been conducted to determine the negative predictive value of non-suspicious mpMRI (PI-RADS 1 or 2). However, the results of these studies have been limited and different.

    Objectives

     This study was conducted to determine the PC rate in patients with PI-RADS 2 lesions in mpMRI and the factors related to clinically significant prostate cancer (CsPC) diagnosis in these lesions.

    Methods

     By referring to the archive department of Shahada-e-Tajrish, Rasul-e-Akram, Treata, and Payambaran hospitals, among the patients suspected of PC who underwent biopsy and had elevated prostate-specific antigen (PSA) serum levels, the prostate biopsy samples of 330 patients were consecutively included in the study. Frequency of samples diagnosed with PC and its histological characteristics, including mass location, Gleason score (GS), Gleason group (GG), percentage of G4 and G5 cells, sample size, percentage of involvement of sample with cancer tissue, and invasion to the surrounding tissues were examined. Adenocarcinoma samples were divided into low-risk, intermediate-to-high-risk groups based on D'Amico criteria and the relationship between age, PSA total (PSAt), PSA density (PSAd), prostate volume, and the presence of a PI-RADS 3 or 4 lesion at the same time with the rate of diagnosed CsPCs were reviewed.

    Results

     The data from 709 tissue samples were collected, among which 249 were from the right inner part, 249 were from the left inner part, and 211 biopsy samples were from the peripheral portion of the prostate. Among these, 390 tissue samples in mpMRI studies were PI-RADS 2, and 319 were PI-RADS 3 or 4. The mean age of the patients was 64.78 ± 37.55. The mean PSAd, PSAt, and prostate volume were 0.15 ± 0.11, 8.73 ± 6.43, and 61.18 ± 25.76, respectively. Seventy-five samples were diagnosed with adenocarcinoma, of which 48% are in PI-RADS group 2, and 52% are in PI-RADS group 3 - 4 (P-value = 0.263). Comparing the histological characteristics of adenocarcinoma samples between the two groups showed that only the amount of GG was significantly higher in the samples with PI-RADS 3 and 4 (P-value = 0.035). Adenocarcinomas diagnosed in 72.2% of cases in PI-RADS 2 samples and 84.6% of PI-RADS 3 and 4 samples were clinically significant, and no significant difference was seen between the two groups (P-value = 0.38). The amount of PSAt in PI-RADS 2 adenocarcinoma samples was significantly higher in clinically significant carcinomas than in low-risk carcinomas (P-value = 0.045).

    Conclusions

     The results of the present study showed that PI-RADS 2 lesions should be considered for biopsy when there is clinical suspicion of PC. PSA levels can effectively determine the need for biopsy in PI-RADS 2 lesions.

    Keywords: mpMRI, PI-RADS, MRI-Targeted Biopsy, Prostate Cancer
  • Babak Arjmand, Mostafa Rezaei-Tavirani, Maryam Hamzeloo-Moghadam, Zahra Razzaghi *, Majid Rezaei-Tavirani Page 37
    Background

     The radiation resistance process is a major problem in radiotherapy. Proteomics is a useful method to determine the molecular mechanism of biological and medical events. Protein-protein interaction (PPI) network is a suitable method for proteomics data interpretation.

    Objectives

     Assessment of proteomics data about the radiation resistance process in human cell lines via PPI network analysis is the aim of this study.

    Methods

     Proteomic data were extracted from literature and the differentially expressed proteins (DEPs) were included in the PPI network via the STRING database by Cytoscape software. The network was analyzed and the central nodes were introduced. The central nodes were assessed via action map analysis and gene ontology enrichment.

    Results

     Among the 251 queried DEPs, 171 individuals were included in the PPI network. Epidermal growth factor receptor (EGFR), fibronectin (FN1), CD44 antigen (CD44), prostaglandin G/H synthase 2 (PTGS2), CD44 antigen (CD44), prostaglandin G/H synthase 2 (PTGS2), NF-kappa-B inhibitor alpha (NFKBIA), Kelch-like ECH-associated protein 1 (KEAP1), cathepsin D (CTSD), D-3-phosphoglycerate dehydrogenase (PHGD), and 5-nucleotidase (NT5E) were introduced as the critical DEPs. Eight groups of biological terms were attributed to the introduced critical DEPs. EGFR, FN1, CD44, and PTGS2 were discriminated among the critical DEPs as the key dysregulated proteins.

    Conclusions

     The results indicate that EGFR, FN1, CD44, and PTGS2 are the four essential proteins that are involved in radiation resistance in the radioresistant cells.

    Keywords: Radiotherapy, Radioresistant, Network Analysis, Proteomics, Gene Ontology
  • Nasser Malekpour, MohammadHossein Ehsani *, Samira Adhami, Sara Besharat Page 38
    Background

     Colon cancer is the most common gastrointestinal malignancy worldwide and accounts for more than half of all gastrointestinal tumors, with over 1 million new cases and 500 000 deaths per year.

    Objectives

     The purpose of our study was to compare the outcomes of laparoscopic surgery and open surgery for colon cancer surgery by evaluating the lymph nodes. It is crucial to remove an adequate number of lymph nodes, as a more extensive nodal removal has been associated with higher survival rates and fewer relapses.

    Methods

     This prospective study was conducted on 120 patients (57 females and 63 males) with colon cancer, who were registered and analyzed in our unit from 2019 to 2021. Of these patients, 78 underwent open surgery and 42 underwent laparoscopic surgery. A checklist comprising 8 variables including postoperative pain, length of hospital stay, site infection during the first 30 days, number of lymph nodes removed in pathology, hemoglobin drop, anastomotic leak, urinary tract injury, and time of operation was completed for all patients. SPSS version 21 software was used for data analysis, and a P-value less than 0.05 was considered significant.

    Results

     The age of the patients was between 30 to 60 years. The variables of site infection during the first 30 days (P = 0.7), anastomotic leak complication (P = 0.5), urinary tract injury (P = 0.02), and number of lymph nodes removed (P = 0.13) were not statistically significant between the two groups of laparoscopic surgery and open surgery. However, the variables of duration of operation (P < 0.05), decrease in hemoglobin of postoperative patients compared to preoperative (P < 0.05), severe postoperative pain (P < 0.05), and number of days of hospital stay (P < 0.05) between the groups of laparoscopic surgery and open surgery were statistically significant.

    Conclusions

     Our experience suggests that laparoscopic colectomy is a safe and feasible procedure with better short-term outcomes and comparable oncological efficacy to the open approach.

    Keywords: Laparoscopic Colectomy, Open Colectomy, Lymph Node Evaluation, Colon Cancer
  • Suma Surya, Dinesh Kumar Sathanantham *, Sreeramulu P N, Srinivasan Doraiswamy Page 39
    Introduction

     Thyroid lymphomas are a rare finding among thyroid malignancies, and Chronic Lymphocytic B-cell (CLL-B) type of thyroid lymphoma is even more infrequent. Lymphomas compose only 2% of thyroid malignancies, with primary thyroid lymphomas constituting only 2.5% of all lymphomas. Chronic lymphocytic B-cell (CLL-B) type of thyroid lymphoma (CLL-B) is is exceptionally rare, with only 4% of cases ever reported worldwide.

    Case Presentation

     A 55-year-old female presented with a complaint of swelling over the anterior part of neck. She had a pre-existing diagnosis of CLL, fine needle aspiration biopsy (FNAB)of the swelling revealed lymphocytic proliferation, classified as Bethesda grade II. The patients was in a euthyroid state and a ‘core-needle’ biopsy was performed to confirm the diagnosis of lymphocytic infiltration of the thyroid. The patient was managed conservatively and is currently under regular follow-up.

    Conclusions

     The occurrence of thyroid swelling in CLL is a rare phenomenon, and confirming the diagnosis through biopsy is recommended. Surgeons should be cautious not to be deceived by the rarity of the swelling and avoid unnecessary surgical interventions. Conservative management has been the prevailing approach in the literature. This case report serves to support this conservative approach and contributes to the existing literature on Thyroid lymphoma due to CLL.

    Keywords: CLL, Chronic Lymphocytic Lymphoma, Thyroid Swelling, Lymphocytic Infiltration
  • Soroor Fathi, Bahareh Aminnejad Kavkani, Soheila Shekari, Samaneh Mirzaei Dahka, Naeemeh Hassanpour Ardekanizadeh, Golsa Khalatbari Mohseni Page 40

    Context: 

    Advanced cancer is one of the most complicated conditions for both patients and their relatives. This study aimed at investigating the challenges of home parenteral nutrition (HPN) in patients with advanced cancer.

    Evidence Acquisition:

     In this study, all articles published in English from 2000 to 2022 on dietary support for HPN in patients with advanced cancer were collected from several databases, including Medline, Scopus, and Google Scholar, using related keywords such as “advanced cancer” and “home parenteral nutrition”.

    Results

     The different issues of HPN were examined for different dimensions such as HPN during palliative care, deciding HPN, patients’ safety, supportive environment, and health literacy. Regarding ethical issues on HPN, 4 principles including charity, autonomy, harmlessness, and justice should be considered in patients with advanced cancer. Considering recent findings on the beneficial effects of nutrients in patients with advanced cancer, there may be a need to revise the guidelines related to parenteral nutrition support in these patients.

    Conclusions

     Different challenges should be especially considered in adopting appropriate approaches in the field of HPN in patients with advanced cancer. More longitudinal studies in this field are needed.

    Keywords: Ethics, Home Parenteral Nutrition, Cancer, Autonomy
  • Valiollah Mehrzad, Mahshid Mehdizadeh, Sayeh Parkhideh, Azita Rafiee, Noorodin Jamshidian * Page 41
    Background

     Multiple myeloma (MM) management includes primary chemotherapy, followed by autologous bone marrow transplantation (ABMT) if the bone marrow gets cleared of cancerous cells. In some cases disease relapse may occur if complete clearance is not achieved. Transplantation was primarily performed through the bone marrow; however, peripheral blood has become more favored due to its safety and convenient collection in case of appropriate bone marrow mobilization which is a challenging issue.

    Objectives

     The current study was aimed to investigate the effectiveness of desipramine application for bone marrow mobilization in multiple myeloma (MM) who were candidate for autologous bone marrow transplantation (ABMT).

    Methods

     The current randomized clinical trial involved 122 MM patients who were candidate for ABMT. The participants were divided into two intervention groups: the first group (n = 63) received G-CSF only treatment, while the second group (n = 59) received a similar G-CSF treatment plus desipramine. The first group received 30 microgram intravenous G-CSF for five days and the second one was treated with G-CSF with similar pattern in combination with daily 100 mg desipramine initiated within three days before G-CSF treatment and continued until the last dose of G-CSF. CD34+ cells and complete blood cells and differentiation were assessed by the end of the interventions.

    Results

     The findings of the study show that the number of CD34+ cells, white blood cells (WBC) and platelet (PLT) count were remarkably higher among the patients receiving the combination therapy compared to the G-CSF only treated group (P-value < 0.001) within 5 days after the interventions; however, no significant differences were observed between the two groups when considering the stage of the disease and the frequency of chemotherapy sessions (P-value > 0.05).

    Conclusions

     Desipramine application led to significantly increased levels of CD34+ cells as the representatives of bone marrow mobilization. Besides, the patients treated with this regimen had higher serum levels of WBC and PLT; however, the disease stage and the number of chemotherapy sessions did not affect the response to the treatment.

    Keywords: Multiple Myeloma, Bone Marrow Transplantation, Granulocyte Colony-Stimulating Factor, Desipramine
  • Reza Negarandeh, Zahra Yazdani *, Rebecca Lehto, Marzieh Lashkari Page 42
    Background

     With advances in healthcare options for the medical management of breast cancer, treatment decision-making has become more complex.

    Objectives

     Guided by self-efficacy theory, the study investigated the impact of a question prompt list (QPL) on decision-making outcomes among women with breast cancer in Iran who were post-surgery.

    Methods

     A randomized controlled trial was conducted at a comprehensive cancer center in Tehran, Iran. Fifty patients were randomized to either a QPL with usual care (n = 25) or to a usual care (n = 25) condition. Data were collected pre- and post-treatment utilizing: 9-item Shared Decision-Making Questionnaire; Decision Self-efficacy Scale; and the Control Preferences Scale. Utilizing SPSS 26 software, descriptive, Shapiro-Wilk test, independent t-test, Fisher's Exact test, and Mann-Whitney U test were used.

    Results

     No differences between the usual care and QPL groups on major study constructs were found (P > 0.05).

    Conclusions

     The QPL did not impact various decision-making outcomes among women with breast cancer post-surgery. Cross-cultural research is needed with larger samples to further examine the impact of decision aids such as QPL on decision-making outcomes for women with breast cancer.

    Keywords: Cancer, Iran, Patient Preference, Question Prompt List, Self-efficacy, Shared-Decision Making