Basic and Clinical Cancer Research
Volume:2 Issue: 1, Winter 2010

Each cell is a representative unit of the human body with all of its genetic specialties. Identification of genes responsible for specific types of tumors provides a new insight into the cause, diagnosis, treatment and prognosis of different kinds of cancers. Scientific and technological advances in genomics, proteomics and bioinformatics demand a large number of tumors, and also require access to collections of well- preserved and well-characterized tumor tissue, accompanied by high quality clinical data, family history and pedigree. The Tumor Bank is a collection of surgical tissues that are critical to clinical diagnostic requirements linked with their clinical data specifically to support a range of research studies.Various kinds of therapies should not test on patients directly, but on the live cells, as in-vitro studies first. Detection of tumor markers or creation of vaccine for a tumor is possible as well, with regards to the cell’s special proteins and antigens.TechnologyHaving donors’ informed consent, their samples are preserved within 30 minutes of post- resection. Tissues are verified by pathologists and are subject to a scrutinizing audit process, in order to ensure tissue integrity and data completion. Tissue specimens are labeled with a bar code, entered into the inventory, frozen and stored at -180°C. The patient’s identity is removed from the clinical information, and stored in a secure central database. The material includes blood, normal tissue, pre-neoplastic lesions and tumor tissues. They are processed into frozen tissue and paraffin blocks accompanied by the histology, pathology, clinical data, pedigree, treatment and outcome data related to the patient. ConclusionRecognizing the need for tumor tissue and resource data bank, the Cancer Institute of Tehran University of Medical Sciences has created a Tumor Bank by making high quality tissues and accompanying clinical data available to cancer researchers, and industrial scientists and will help accelerate the identification of new drug targets, prediction of response to therapy and developments aimed at individualized therapy.

In October 2008, professor Olof Nyren, a distinguished researcher, from the department of epidemiology and biostatistics, Karolinska Institute, paid a visit to the Cancer Research Center (CRC) of the Iran Cancer Institute. Professor Nyren is a leading Scientist in clinical epidemiology with the main interest in etiological research on cancer, particularly esophageal and stomach cancer. Professor Nyren is currently member of the Nobel Commi Hee in physiology of medicine. He is also Member of “International Agency for Research on Cancer (IARC) working group on the evaluation of carcinogenic risks to humans, surgical implants and other foreign bodies”, “Editorial board of Annals of Cancer Research and Therapy”, “Editorial board of Clinical Gastroenterology and Hepatology”. National Cancer Institute (NCI, USA) round table conference on future research strategies in upper GI cancer (2002).Our collaboration with professor Nyren started since 2001, when a joint project was launched between Karolinska Institute and CRC in order to evaluate quality of Tehran Population-Based Cancer Registry and, conduct a migrant study among Iranian immigrants in Sweden. In addition, we had opportunity to enjoy listening to his lecture “Evaluation of Scientific paper”, a memorable event hosted by Medical Student Research Center of TUMS. Professor Nyren, further, visited Pasteur Institute and Digestive Disease Research Center of TUMS and discussed their ongoing studies on stomach an esophageal cancers in Iran.Upon the memorable visit by professor Nyren, we discussed our opportunities and limitations for cancer epidemiology in Iran. I strongly believe that implementation of the valuable thoughts emerged during this visit will inflate quality of our future works in Iran.

Studies in developed countries have shown that abdominal sonography is useful for follow-up of breast cancer patients. The aim of this study was to evaluate usefulness of abdominal sonography for the follow-up of patients with breast cancer in Iran. Additionally, we assessed the value of regional lymph node sonography in patients with breast cancer. Retrospectively, abdominal ultrasound examination reports of 330 patients with breast cancer who were referred to cancer institute radiology department were reviewed. Abdominal sonography revealed liver metastases in 10% of patients. Multiple liver metastases found in 7.9% of patients, Single liver metastases found in 2.1% of patients. Hypoecho and hyperecho lesions within liver observed in 8.5% and 2.1% of patients, respectively. Ascites was present in 2.4%. Para aortic Adenopathy was found in 1.2% of patients. Spleen and Kidney Involvement were not reported. Although abdominal Lymphadenopathy was rare, correlation between age and abdominal lymphadenopathy was significant in our study. The incidence of echogen regions increased when the timebetween ‘Diagnosis’ and “Sonography Exam” increased. Because sonography considers as a non-invasive, rapid, inexpensive and accurate method; it is suggested for follow-up evaluations of patients with breast cancer in Iran.

Aversectin C consists of avermectin groups. Avermectin has been reported to block secretion of the tumor necrosis factor. For investigation of its effect, different concentrations of Aversetin C consist 0.1, 0.25, 1, 5, 10, 20, 50, 100, and 500 μg/ml were studied on the growth of converted cells in Chinese hamster. It was shown for the first time that Aversectin C possesses a pronounced antitumoral function. When added at non-toxic doses, it could significantly suppress cell growth. Interestingly, at high concentration of Aversectin C, cell membrane was destroyed and cell fragments were seen in the culture media. Cell death in high concentration closely resembled apoptosis phenomenon. Aversectin C suppresses growth of the transformed (cancerous) cells, and this suppression has cumulative effects

The efficacy and toxicity of a chemotherapy protocol consisting of Gemcitabine, 5-FU and Leucovorin in patients with different stages of pancreatic cancer was evaluated. Fifty-one chemo-naїve patients with different stages of pancreatic cancer were treated with a chemotherapy protocol consisting of Gemcitabine 1000 mg/m2 on the first day, 5-FU 450 mg/m2 and Leucovorin 100 mg/m2 on days 1-3. The treatment was repeated every 2 weeks. Fourteen of our patients (male:female 9:5) received this protocol as their adjuvant chemotherapy after surgical treatment. Thirty-seven other patients with advanced pancreatic cancer (male:female 27:10) (67.6% stage IVb) were enrolled. With a mean time follow-up of 25 months in the adjuvant group, all the patients were alive and disease free. For the others, in an intention-to-treat analysis, seven (18.9%) partial responses were objectively achieved (95% CI: 8.33 to 29). fourteen (37.8%) patients had stable disease and 16 (43.2%) experienced progressive disease. The median response time was 3 months (ranged 1.5–7.0). Overall mean survival time was 6.5 months (ranged 1.0–15.5). The response to chemotherapy revealed no significant difference in two genders (P=0.971). No cases of grade III/IV toxicities were seen in any of our patients. The combination of Gemcitabine with 5-FU and Leucovorin is an active and well-tolerated regimen in patients with all stages of pancreatic cancer, meriting further evaluation in prospective randomized studies. This combination may be considered a valuable alternative to Gemcitabine alone

Thyroid cancer comprises about 1% of all malignancies and accounts for up to 1% of all cancer deaths. Radioactive iodine is utilized to treat some papillary, mixed papillary-follicular and follicular carcinomas. In these patients, because of the absence of thyroid tissue, the range of absorption of iodine and time of decreasing the exposure rate to standard limits differs from other patients with extra pathologies. In this study we tried to measure the biologic half-life of 131I in patients with thyroid cancer and the effects of different variables like age, sex, histological subtypes, and residual disease on the biologic half-life of 131I. We evaluated 29 patients with differentiated thyroid cancer who referred to radiation and oncology department of Jorjani hospital, Tehran, Iran. Patients were treated with 131I dosing between 100-150 mci and the exposure rate in patients, just after prescribing 131I, were regularly estimated by portable dose rate meter. We observed wide range of biologic half-life of 131I in patients and no variable had significant effects on biologic half-life of 131I. It seems that all patients should repeatedly undergo dosimetry until the range of radiation reaches to normal

Esophageal carcinoma is an aggressive disease with a high incidence of locoregional recurrence. This study was designed to determine the feasibility and toxicity of chemotherapy, external beam radiation therapy (EBRT), and esophageal moderate dose rate (MDR) intraluminal brachytherapy (ILBT) in a potentially curable group of patients with squamous cell carcinoma of the esophagus. This study was considered important to determine the median survival time, local control, and late toxicity associated with this treatment regimen (MDR-ILBT). Between 2004 and 2007, 16 patients with esophageal cancer in the middle and lower third of esophagus were treated with 50.4 Grays (Gy) of external beam radiation (28 fractions given over 5.5 weeks) concurrently with cisplatin and 5-Fluoro Uracil, followed by MDR brachytherapy of 5 Gy during week 7. Chemotherapy was given during weeks 1, 5, 9, and 13, with cisplatin 75 mg/m2 on day 1 and 5-FU 750 mg/m2/day during days 1-4. All 16 patients had squamous histology. 14 patients (87.5%) completed external beam radiation plus at least two courses of chemotherapy, whereas two patients (12.5%) were able to complete EBRT without chemotherapy. The 2-year local recurrence-free survival rates were 71%. The 1-year and 2-year actuarial survival rates of all cases were 79.5% and 61.8%, respectively. Life-threatening toxicity or treatment-related deaths did not occur. There were no fistulas but there were two esophageal strictures. Local control and survival and adverse effects were determined with RTOG criteria. The addition of MDR-ILBT to chemoradiation did not have severe late complications and it improved local control. Therefore, it is a promising boost therapy after EBRT.

The public health has been always concerned of the immediate environment of human as causal factors for different diseases and health outcomes. Epidemiology, as one of the fundamental basis of public health, is concerned of how diseases are distributed in terms of geographical, chronological, and human population characteristics and employees the descriptive nature of such spread to draw conclusion on the etiology of health or disease utcome for further policy making on prevention of disease or promotion of health. In this paper, we present the importance of GIS technology in epidemiology from both descriptive and etiologic standpoints and elaborate how this technology can stand in the forefront of disease and health outcome measures in the coming decades. The paper will address the history of geo-related health and disease issues. The mapping tool as a traditionally strong resource in the public health will be explored. The advances in Information Technology and one of its best utilized offshoot, GIS, in Health and disease will be discussed. How the huge repository of generated or ever generating geo-related data and information is utilized to address etiology of diseases or to help public health authorities in making informed policy making decisions are explored. The utilizationof GIS technology in diseases with intermittent host such as malaria, yellow fever, or other parasitic diseases has already been well established. The GIS technology and its utilization in chronic and degenerative diseases such as cancer, diabetes, and aging are under development and new frontiers are discovering. The limitation of GIS technology in addressing host environment interaction in micro-environment (at the molecular biology and tissue pathogenicity level) and gene–environment interaction (at the individual level) will further be discussed. We then distress on the efficient use of GIS both in the etiologic investigation of diseases and health events as well as the utilization of the GIS technology as a administrative tool in the help of public health authorities and policy makers in strategic management of health of a community or emergency management of man-made or technological disasters (e.g., wars) or naturally occurring disasters (e.g., earthquake and floods).

Advanced uterine cervical cancer is usually treated with concurrent Cisplatin and external radiotherapy and then low dose rate of intracavitary brachytherapy (ICBRT). In this prospective clinical trial we evaluated the efficacy of concurrent Cisplatin and medium dose rate (MDR-ICBRT). Patients with locally advanced cervical cancer (stage IB2-IVA) who were candidates for radical radiotherapy recruited in this study. They were treated with chemoradiation by external radiotherapy and MDR-ICBRT by 24 Gy in two fractions concurrently with 35 mg/m2 Cisplatin from October 2007 to May 2008. Response rate, local control and acute and late effects of treatment were evaluated using WHO scale. Forty patients with uterine cervical carcinoma were enrolled in this study. Nine patients did not return for follow-up and were excluded. Therefore, we assessed response rate, acute and late effects in 31 cases. The median time of follow-up was 13 months (4-20 months). Most of the patients (29 cases) were in stage IIB of cervical tumor. Twelve months overall survival was 78% and 22 cases were disease free. Local tumor recurrence was noted in two patients. One patient developed bone metastasis and six deceased because of tumor progression. Acute effects were abdominal pain in 23%, cystitis in 19%, vaginitis in 18%, and proctitis in 15% of cases. There were grade 1 and 2 leucopenia in 85% and %15 and grade 1 and 2 anemia in 95 % and 5% of the cases, respectively; there were no grade 3-4 acute toxicities. Late effects were cystitis in 24%, proctitis in 12%, abdominal pain in 4%, and rectal fistula in 3% of cases. In this study, the efficacy of concurrent Cisplatin and MDR-ICBRT in advanced cervical tumors was assessed. Acute effects specially hematological and renal toxicities, subjective complaints and response rate were acceptable. Although evaluation of rectal and bladder late effects were not completed because of the short period of follow-up, it seems that sub-acute effects (seen in 6-20 months after therapy) were acceptable.

This study investigates the antiproliferative activity of ethanol and acetic acid on tumoral cells C11-B11 from Chinese hamster. Different concentrations of ethanol (ET) and acetic acid (AA) were applied in two experiments: 0 – Control; 0.001% AA; 0.005% AA; 0.01% AA; 0.05% AA; 2% ET; 2% ET + 0.05% AA; 0.05% AA, 2% ET + 0.1% AA, 0.1% AA. Proliferation and growth of cells general and stationary life spans were determined. According to the results, some concentrations of ethanol and acetic acid can inhibit growth and proliferation of cancerous cells. 2% ET increased general and stationary life span by 1.33 and 1.49 respectively. The effect of 0.05% AA alone was the similar to combination of 0.05% AA with 2% E and fixed the cells. Life span Increasing in the culture medium could be applied to gerontology and is hypothesis for increasing life span in humans and animals. Since some concentrations of acetic acid and ethanol could eradicate cancerous cells, this approach could be applied in oncology too.

The cancer Institute has recently investigating on economic aspects of cancer. This paper reports the preliminary results which aim to estimate the indirect cost of cancer in patients. To estimate the indirect cost of cancer, a questionnaire was developed which included questions about demographic data, histological type of cancer, and the direct cost1 and expenses that patients incur during last year of their present visit or since the first time of diagnosis of cancer (if it was less than one year). Patients were interviewed by a trained social worker, when they referred to outpatient clinic of the cancer institute. Data about transportation costs, expenses and indirect costs gathered from patients. Sixty patients were recruited. The annual average of indirect costs of breast and bladder cancers estimated $11027 and $16935 per patient, respectively. The average number of referring to medical care facility was 8.66 for breast cancer and 5.8 for bladder cancer. Our study estimated expenses which indirectly related to disease for cancer patients. Further studies warranted to accurately estimate the indirect and direct costs of cancer.

We report two non-smoker Iranian patients presenting with massive pleural effusion and multiple lung nodules and diagnosed lung adenocarcinoma. Patients received oral erlotinib 150mg/day.Within three months of medication, both patients showed complete clinical and radiologic response. This response was maintained for 2 years in first patient and continued for 9 months, the time of this report, in the second case. Erlotinib was well tolerated.Nevertheless grade 2-3 rash and grade 1 diarrhea were the only significant toxicities. Both of the patients was able to conduct daily activities throughout their erlotinib therapy. A subgroup of patients with lung adnocarcinoma who have never been smoker may be good candidates for Therapy with erlotinib as first line