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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 radio-therapy, 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. [ABSTRACT FROM AUTHOR]

Purpose: 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). Method: 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). Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Introduction: The present study aimed to investigate the interaction of the common lncRNA-miRNA-mRNA network involved in signaling pathways in different stages of prostate cancer (PCa) by using bioinformatics and experimental methods. Methods: Seventy subjects included sixty PCa patients in Local, Locally Advanced, Biochemical Relapse, Metastatic, and Benign stages, and ten healthy subjects were entered into the current study. The mRNAs with significant expression differences were first found using the GEO database. The candidate hub genes were then identified by analyzing Cytohubba and MCODE software. Cytoscape, GO Term, and KEGG software determined hub genes and critical pathways. The expression of candidate lncRNAs, miRNAs, and mRNAs was then assessed using Real-Time PCR and ELISA techniques. Results: 4 lncRNAs, 5 miRNAs, and 15 common target genes were detected in PCa patients compared with the healthy group. Unlike the tumor suppressors, the expression levels of common onco-lncRNAs, oncomiRNAs, and oncogenes showed a considerable increase in patients with advanced stages; Biochemical Relapse and Metastatic, in comparison to the primary stages; Local and Locally Advanced. Additionally, their expression levels significantly increased with a higher Gleason score than a lower one. Conclusion: Identifying a common lncRNA-miRNA-mRNA network associated with prostate cancer may be clinically valuable as potential predictive biomarkers. They can also serve as novel therapeutic targets for PCa patients. [ABSTRACT FROM AUTHOR]

Background and Objectives: The non-surgical treatment outcome of gastroesophageal junction (GEJ) adenocarcinoma remains to be defined. We aimed to assess the outcomes of definitive chemoradiation (CRT) of GEJ tumors. Methods: This retrospective cohort study was entirely carried out in the radiation oncology ward of Cancer Institute of Iran. We included patients with adenocarcinoma histology whose tumors had involved the gastro-esophageal junction and underwent chemoradiotherapy without surgery. In the final analysis, we evaluated 50 patients with non-metastatic adenocarcinoma of GEJ (Siewert's type I and II) from 2008 to 2017. The primary outcome was overall survival; secondary outcomes were progression-free survival and local and distal metastasis. Results: The reasons for not undergoing surgery in order of frequency from highest to lowest were patient refusal or medical unfitness for surgery, tumor unresectability or progress at the time of operation and incident metastasis in pre-op restaging, and. The 1-year, 2-year, and 3-year overall survival rates were 53%, 26%, and 12%, respectively. The 1-year, 2-year, and 3-year progression-free survival rates were 44%, 18%, and 10%, respectively. In the multivariate analysis, the only independent predictor of survival was a distant failure (P=0.031). Conclusion: Although the outcomes of non-surgical treatments are disappointing in GEJ adenocarcinomas, a few patients may experience long-term survival using definitive CRT. This option should be discussed with all patients who are not candidates for surgery. [ABSTRACT FROM AUTHOR]

Background & Objective: Iran is located in the esophageal cancer geographical belt. As multiple genetic alterations are responsible for the molecular pathogenesis of esophageal squamous cell cancer (ESCC), the role and frequency of HER2 expression, MMR deficiency, and PI3KCA mutation are not well defined. Methods: We carried out HER2/neu expression, dMMR/MSI high, and PI3KCA mutation analysis in specimens of patients with ESCC. We accessed archival tissue blocks related to specimens of 68 ESCC cases at the time of surgery following neoadjuvant chemoradiation. These patients underwent surgery during 2013-2018 at the Cancer Institute of Iran affiliated with the Tehran University of Medical Sciences in Tehran. Results: None of the patients showed HER2 expression, dMMR/MSI high, or PI3K mutations. Conclusion: dMMR/MSI-H and PI3KCA mutation and HER2 expression may not be reliable andfrequent targets for systemic therapy in patients with esophageal SCC. [ABSTRACT FROM AUTHOR]

Background: Adenoid cystic carcinomas is a rare tumor occurring in major salivary glands. Despite definitive treatment, these aggressive cancers often recur and metastasize with no known effective chemotherapy regimen. The present study aimed to evaluate the recurrence and survival rates of head-and-neck adenoid cystic carcinoma and assess the prognostic factors related to the patients' local recurrence and survival. Method: A retrospective study was conducted on 54 patients with adenoid cystic carcinoma. Demographic data, operative factors of patients before, during, and after surgery were reviewed and finally calculated using the Kaplan-Meier method. Results: Among the 54 patients, 61.1% were female, and 38.9% were male with an average age of46.00 ± 14.52 years. The survival rate at 12, 24, 36, 60, 84, 100 and 120 months post-surgery were 100, 93.3, 84.4, 48.9, 24.4, 20.0 and 13.3%, respectively. Both the marital status (P = 0.002) and the type of surgery (P = 0.045) were significantly related to the overall survival of the patients, and the local recurrence significantly correlated with overall survival (P = 0.027). Conclusion: According to the findings, marital status, type of surgery, metastases, histological staging, and local recurrence rate were related to the overall survival of the patients. Hence, it is of utmost importance to pay attention to these factors in health centers. It is recommended to opt for case-control and prospective studies with more samples for further investigation in the future. [ABSTRACT FROM AUTHOR]

Background: Hypopharyngeal carcinoma (HPC) is a rare head and neck cancer which poses many therapeutic challenges. There is limited evidence regarding the outcomes of HPC treatment in Iran. Method: In this retrospective cohort study, we evaluated patients treated with chemoradiation or radiation alone, between 2007 and 2016 in the radiation oncology ward of the cancer institute affiliated to Tehran University of Medical Sciences. The design of the study was reviewed and approved by the local institutional review board (code: 86100142). All patients underwent definitive radiotherapy with or without concurrent or sequential chemotherapy. We assessed the two-year overall survival (OS) as the primary outcome. The progression-free survival (PFS) was our secondary outcome. Results: We studied 40 patients whose median age was 58 years. 37 patients were stage 3 or 4, while the most common stage was T3N1-2, observed in 35% of the cases. The most common site of involvement was pyriform sinus (47.5%). The twoyear OS rate was 29%. The two-year PFS was 22%. In the univariate analysis, N0-1 vs. N 2-3 and stage 2 vs. stage 3-4 were significant predictors of OS. In addition, distant metastasis had almost a significant association with lower OS. Conclusion: The outcome of locally advanced HPC was not promising using 3DCRT alone. It is necessary to implement dramatic changes in the management of these patients to achieve better outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Post-surgery radiation can reduce the risk of loco-regional relapse in high-intermediate-risk endometrial cancer. High-dose-rate vaginal cuff brachytherapy (HDR-BRT) is an acceptable method of radiation in majority of endometrial cancer cases. Although 2D planning is frequently used for treatment based on physical examination without any imaging, measurement of the dose received by organs-at-risk (OARs) is not possible. Therefore, the present study was the first to compare dose delivered to target and OARs in 2D vs. 3D planning in patients treated with cobalt-60 source. Material and methods: In this study, organs including vagina wall, bladder, rectum, and sigmoid were contoured on computed tomography (CT) scan images of 37 endometrial cancer patients, and doses delivered to organs were recorded. Statistics, such as D90, D99, V100, V150, V200, D0.1cc, D1cc, and D2cc were determined. Results: D90 and D99 were lower in 3D treatment planning in comparison with 2D. Although V100 was more in 3D planning, V150 and V200 were less. Analyzing D0.1cc, D1cc, and D2cc of OARs revealed that doses given to rectum, sigmoid, and bladder were less in 3D planning compared to 2D. Conclusions: Comparison of 2D and 3D planning results showed that 3D planning could deliver an appropriate dose to the target while sparing more OARs. [ABSTRACT FROM AUTHOR]

Follicular dendritic cell sarcoma responded dramatically to chemotherapy with gemcitabine and docetaxel. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare pelvic lymph nodes coverage in Digital Reconstructed Radiography (DRR) based on bony landmarks and 3D planning based on contouring in external beam radiation of cervical cancer patients. Material and Methods: The study was carried out on 43 cervical cancer patients who were referred to Cancer Institute of Iran. We used RT Dose Plan software available in our department to define the treatment plan and field sizes. Images of patients were transported to RT dose plan software for planning. The Box treatment field (4 perpendicular fields) with or without additional brachytherapy was considered. The Dose Volume Histogram (DVH) and isodose curves were surveyed for acceptable tumour coverage. The study participants were assigned to two types of planning including planning based on anatomical markers (Conventional, DRR) and planning by considering the actual position of lymph nodes based on CT simulation images (CT). Results: The mean age of participants was 51 years. In the AP/PA field, the mean difference of superior, right, and left lateral borders was -2.31, -0.29, and -0.029, respectively. On the other hand, the mean difference of inferior border was estimated 1.87. Further, in the lateral field, the mean difference of DDR and CT approaches for anterior and posterior borders was 0.89 and 0.164, respectively. Conclusion: It seems CT simulation and use of contouring provide a better vision to pelvic lymph nodes and leads to wider coverage through reducing the possibility of ignoring treated areas. Nevertheless, more studies are required. [ABSTRACT FROM AUTHOR]