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On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.

Peripheral neuropathy is a dose-limiting adverse effect of oxaliplatin. The aim of this study was to evaluate the efficacy and safety of duloxetine in the prevention of oxaliplatin-induced peripheral neuropathy (OIPN).Cancer patients receiving oxaliplatin based chemotherapy were randomized into two arms. Duloxetine 60 mg capsule was given in the first 14 days of each chemotherapy cycle to one arm and placebo was similarly given to another. We compared the two arms based on the incidence of neuropathy and the results of the nerve conduction study (NCS). Grade of complained neuropathy was recorded according to Common Terminology Criteria for Adverse Events (CTCAE).Thirty-two patients mostly rectal cancer (90.6%) were randomized to duloxetine and placebo arms. Highest grade of neuropathy in each cycle was not significantly different between the two groups. Six weeks after treatment incidence of neuropathy of any grade was 52.9 in duloxetine arm compared to 76.9% in placebo arm (P: 0.26). Patients in the duloxetine arm had a lower percentage of chemotherapy cycles (mean) in which they reported distal paresthesia (51% vs. 84%, P = 0.01) and throat discomfort (37% vs. 69%, P = 0.01). Results of NCS were mostly comparable between the two arms except for the velocity in two of the examined nerve which was significantly higher in duloxetine group. Duloxetine was safe and well-tolerated.Although a definite conclusion might be difficult to draw but administering duloxetine for 14 days in each chemotherapy cycle could not decrease the incidence of acute OIPN based on CTCAE grading system.

Introduction:In the recent years, some publications (mainly from one group of authors) have dealt with the effectiveness of proton–boron fusion therapy (PBFT). This theory is based on the Q-value of three produced α particles in the reaction of protons with boron (11B). They claim that this reaction significantly increases the absorbed dose in the target volume. However, the current study would re-evaluate their method to show if PBFT is really effective.Methods and materials:A parallel 80-MeV proton beam was irradiated on a water medium in a cubic boron uptake region (BUR). The two-dimensional dose distribution and percentage depth dose of protons, alphas and all particles were calculated using tally F6 and mesh-tallies by Monte Carlo N Particle Transport code.Results:The results not only showed that the dose enhancement in BUR is neglectable but also the higher density of BUR in comparison with water led to decrement of dose in this region. Because of low cross section of boron for proton beam (Conclusions:The physical aspects and the simulation results did not show any effectiveness of the PBFT for proton therapy dose enhancement.

Background To compare iodine-125 (125I) with ruthenium-106 (106Ru) episcleral plaque radiation therapy in terms of the effectiveness and non-inferiority for choroidal melanoma treatment. Objective To report the non-inferiority of new made iodine-125 (125I) compared with ruthenium-106 (106Ru) episcleral plaque radiation. Patients and methods A retrospective, non-randomized comparative case series. In this series the patients treated with 125I and 106Ru episcleral plaques for choroidal melanoma between September 2013 and August 2017 at Farabi Hospital are compared. Local control of choroidal melanomas after 125I and 106Ru plaques implantation and vision changes are the main outcome measures. Results A total of 35 patients were identified (125I = 15, 106Ru = 20). No significant difference between two groups in visual acuity, diameter and thickness changes were observed after treatment. Multivariate linear regression (MLR) analysis showed that final diameter was only, independently and significantly, correlated with the pre-treatment diameter of the tumor (β = 0.59, 95% confidence interval [CI]: 0.29, 1.34, P = 0.003). The same MLR analysis for the final thickness and visual acuity, after adjusting for age and sex showed no significant difference between two groups. A single patient treated with 106Ru had local tumor recurrence with no one in the 125I group. No statistical difference in the rate of ocular complications was observed. Conclusion The treatment with our 125I plaques is as effective as 106Ru plaques in controlling choroidal melanoma tumor and preserving the vision during the two and half year of follow-up. The complication rates are alike. It means that the effectiveness of 125I is not only comparable to 106Ru but also superior when the outcome of the interest is the thickness of the tumors.

IntroductionPeripheral neuropathy is a dose-limiting adverse effect of oxaliplatin. The aim of this study was to evaluate the efficacy and safety of duloxetine in the prevention of oxaliplatin-induced peripheral neuropathy (OIPN).MethodCancer patients receiving oxaliplatin chemotherapy were randomized into two arms. Duloxetine 60 mg capsule was given in the first 14 days of each chemotherapy cycle to one arm and placebo was similarly given to another arm. We compared the two arms based on the incidence of neuropathy and the results of the nerve conduction study.ResultsThirty two patients were randomized to duloxetine and placebo arms. Most of the patients had rectal cancer (90.6%). Compared with the placebo arm, patients in the duloxetine arm had a lower percentage of chemotherapy cycles (mean) in which they reported distal paresthesia (84% vs. 51%, P = 0.01) and throat discomfort (69% vs. 37%, P = 0.01). There was no difference in the percentage of cycles in which patients reported cold-induced dysesthesia. Highest grade of neuropathy in each cycle was not significantly different between the two arms. Six weeks after the last cycle of chemotherapy, nerve conduction velocity was significantly higher in duloxetine arm compared to the placebo arm in the deep peroneal nerve and tibial nerve. Duloxetine was safe and well-tolerated.ConclusionIn spite of small sample size, results of this study suggests potential efficacy of duloxetine in the prevention of OIPN, as indicated by objective measures of neurotoxicity and some patient-reported symptoms.

In radiotherapy with electron or photon beams, if the produced photon energy is higher than ~7 MeV, neutrons may be produced through photoneutron interaction, exposing not only the patient but the personnel outside the room, by passing through the walls or skyshine. This exposure to photoneutron induced doses can be detrimental to people's health. In this study, deposited energy and fluences at different points inside and outside the room have been examined by the MCNP code for a Siemens Artiste in a bunker. Different thicknesses of the roof have been investigated for examining the skyshine. In addition, two layouts of room door were compared in term of ambient dose equivalent (ADE) leakage. The deposited energy and fluence distributions were obtained in the head of linac and the bunker. In the main hall of the room the fast neutrons were prevailing, but within the maze and at the corners, the neutron spectrum has been shifted into thermal and epithermal neutrons ( The findings had a good coincidence with literatures, despite the differences in the room size and linacs models. These characteristics make also possible to calculate the deposited energy distribution and particle spectra for other settings. In addition, the optimum roof thickness calculating can lead to economic and practical effectiveness.

Objective: The aim of this study was to evaluate the effects of individual or combined use of two antioxidants, melatonin and famotidine on radiation induced apoptosis in leukocytes from breast cancer (BC) patients. Materials and Methods: In this experimental study, the DPPH assay was used to determine the appropriate doses of melatonin and famotidine for treatment of BC and control leukocytes. The leukocytes were cultured in complete RPMI- 1640 medium and treated with either agent for two hours. Cells were exposed to 4 Gy gamma rays generated from a Co-60 source at a dose rate of 0.85 Gy for 48 hours before harvesting. The cells were placed on slides and the neutral comet assay was performed. A total of 500 cells were stained with ethidium bromide and assessed for the amount of apoptosis under a fluorescent microscope x400 magnification. Results: We observed significantly more apoptosis following radiation alone in the leukocytes from BC patients compared with normal individuals (P0.05). However, when combined with radiation, there was a decreased frequency of apoptosis in leukocytes of both normal and BC patients (P

Background To compare iodine-125 (125I) with ruthenium-106 (106Ru) episcleral plaque radiation therapy in terms of the effectiveness and non-inferiority for choroidal melanoma treatment. Objective To report the non-inferiority of new made iodine-125 (125I) compared with ruthenium-106 (106Ru) episcleral plaque radiation. Patients and Methods A retrospective, non-randomized comparative case series. In this series the patients treated with 125I and 106Ru episcleral plaques for choroidal melanoma between September 2013 and August 2017 at Farabi Hospital are compared. Local control of choroidal melanomas after 125I and 106Ru plaques implantation and vision changes are the main outcome measures. Results A total of 35 patients were identified (125I = 15, 106Ru = 20). No significant difference between two groups in visual acuity, diameter and thickness changes were observed after treatment. Multivariate linear regression (MLR) analysis showed that final diameter was only, independently and significantly, correlated with the pre-treatment diameter of the tumor (β = 0.59, 95% confidence interval [CI]: 0.29, 1.34, P = 0.003). The same MLR analysis for the final thickness and visual acuity, after adjusting for age and sex showed no significant difference between two groups. A single patient treated with 106Ru had local tumor recurrence with no one in the 125I group. No statistical difference in the rate of ocular complications was observed. Conclusion The treatment with our 125I plaques is as effective as 106Ru plaques in controlling choroidal melanoma tumor and preserving the vision during the two and half year of follow-up. The complication rates are alike. It means that the effectiveness of 125I is not only comparable to 106Ru but also superior when the outcome of the interest is the thickness of the tumors.

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

Background: Brain tumor is one of the most common tumors. A successful treatment might be achieved with an early identification. Pathological investigation as the gold standard method for tumor identification has some limitations. Noninvasive assessment of tumor specifications may be possible using perfusion-weighted magnetic resonance imaging (MRI). Cerebral blood volume (CBV) and cerebral blood flow (CBF) could be calculated based on dynamic contrast-enhanced MRI (DCE-MRI) in addition to dynamic susceptibility contrast MRI (DSC-MRI) modality. Each category of the cerebral hemodynamic and permeability indices revealed the specific tumor characteristics and their collection could help for better identification of the tumor. Some mathematical methods were developed to determine both cerebral hemodynamic and permeability indices based on a single-dose DCE perfusion MRI. There are only a few studies available on the comparison of DSC- and DCE-derived cerebral hemodynamic indices such as CBF and CBV. Aim: The objective of the study was to validate first-pass perfusion parameters derived from T1-based DCE method in comparison to the routine T2*-based DSC protocol. Materials and Methods: Twenty-nine patients with brain tumor underwent DCE- and DSC-MRIs to evaluate the agreement between DSC- and DCE-derived cerebral hemodynamic parameters. Agreement between DSC- and DCE-derived cerebral hemodynamic indices was determined using the statistical method described by Bland and Altman. The reliability between DSC- and DCE-derived cerebral hemodynamic indices was measured using the intraclass correlation analysis. Results: The achieved magnitudes for DCE-derived CBV (gray matter [GM]: 5.01 ± 1.40 mL/100 g vs. white matter [WM]: 1.84 ± 0.74 mL/100 g) and DCE-derived CBF (GM: 60.53 ± 12.70 mL/100 g/min vs. WM: 32.00 ± 6.00 mL/100 g/min) were in good agreement with other studies. The intraclass correlation coefficients showed that the cerebral hemodynamic indices could accurately be estimated based on the DCE-MRI using a single-compartment model (>0.87), and DCE-derived cerebral hemodynamic indices are significantly similar to the magnitudes achieved based on the DSC-MRI (P < 0.001). Furthermore, an acceptable agreement was observed between DSC- and DCE-derived cerebral hemodynamic indices. Conclusion: Based on the measurement of the cerebral hemodynamic and blood–brain barrier permeability using DCE-MRI, a more comprehensive collection of the physiological parameters cloud be achieved for tumor evaluations.

We report occurrence of a rare case of Giant Cell Tumor (GCT), in a 28-year old woman, arising from anterior arc of right 6th rib during pregnancy. It progressed rapidly during breast-feeding period, mimicking malignant bone tumor at delayed presentation.

Context: Low energy electron beam has been being used widely for superficial cancer treatments. In the current study a design for production of very low energy electron beam, by different thickness of Perspex spoilers, is presented that may be used for skin cancer. Aims: MCNPX Monte Carlo code was used for modeling and simulations in the current study. An energy spoiler Perspex was modeled for degrading 4 MeV electron beam of Varian 2300 CD Linac. Materials and Methods: The thicknesses of 3, 7, and 10 mm were applied before electron applicator at a distance of 42 cm from phantom surface. Dosimetric properties of new electron beams including Rp, Dmax, E0, as well as the penumbra of the beam were investigated. Results: For the 3 mm spoiler, the superficial beam output decreased to 77%, and the Dmax, R90, R50, and RP were shifted to the depths of 4, 6, 9, and 12 mm, respectively. While for 10 mm filter the results were 5.2, 3.0 and 5.0 mm for R90, R50, and Rp, respectively. In addition, the surface dose was 93% and the Dmax was shifted to the depth of 1mm for the 10mm Perspex spoiler slab. Conclusions: The presented beam provides a novel surface dose, Dmax, and RP which can be applicable for treatment of skin cancers with minimum dose to the beyond normal tissues.

A 38 years old male worker presented with an advanced left side retroperitoneal mass, with metastatic involvement of 11th Thoracic Vertebra (T11) and resultant paraparesia and paresthesia . The histopathologic examination and immunohistochemical analysis confirmed the diagnosis of paraganglioma. Decompression laminectomy and fixation of involved vertebra resulted to considerable symptomatic relief. Due to unresectability at presentation, chemotherapy with palliative intent performed, and resulted to mild response. Palliative debulking performed after chemotherapy and resulted to better quality of patient's life during next 8 months. Remaining mass at pelvic area increased in size and patient received (131)I-MIBG therapy, 8 months post-operatively. A second debulking surgery, as well as other palliative measures will be considered for future.

A 23-year-old lady presented with abdominal fullness and distension as well as large abdominal masses in physical exam. Upon ultrasonographic evaluation, two large space occupying lesions anterior to kidneys, with no clear distinction from renal tissue, as well as bilateral hydronephrosis were found. The findings were confirmed by MRI. Histopathological analysis of renal masses and lymph nodes showed proliferation of histiocytes mixed with occasional multinucleated giant cells, immunostaining of which was positive for S-100 and CD68. We present renal scintigraphy features of this rare case of renal sinus histiocytosis with massive intraabdominal lymphadenopathy (Rosai-Dorfman disease).

Recurrence of cervical cancer is one of the important and plausible discussions in oncology especially in patients with advanced stages. The purpose of this study was to introduce probability invasive cervical carcinoma recurrence as well as determining characteristics and the prognostic factors of this entity. A retrospective study was designed to identify risk factors and pattern of uterine cervical carcinoma recurrence evaluating the outcome of 36 registered patients. Recurrence was defined based on clinical or para-clinical documentation over at least 6 months after complete remission following surgery or radiotherapy. Treatment consisted of a radiosurgical combination and exclusive radiotherapy. Mean age in selected patients is 54.8 ± 12.0 years. The pathological reports of primary diagnosis are squamous cell carcinoma in 94.44 % and adenocarcinoma in remaining patients. Mean duration of recurrence among patients is 2.75 ± 1.5 years after the initial treatment. Metrorrhagia is mostly revealing symptom which patients present in recurrent episode. Usually, the recurrence of cervical cancer is presented in pelvic cavity locally. Marginal involvement is documented in 50 % of cases and lymph node in 33.3 % of patients with recurrent episode being involved. Most important prognostic factors are improper treatment (16.66 % of cases) after initial diagnosis. Prognostic factors such as selection of appropriate method for treatment are an important point for reducing the rate of recurrence. Moreover, warning patients about symptoms and frequent episodes of follow up is necessary for early diagnosis of recurrence.