Role of Intralesional Bleomycin in the Treatment of Complicated Hemangiomas: Prospective Clinical Study

BACKGROUND: Hemangioma is the most common tumor of infancy. Although it has a basically benign nature and usually spontaneously regresses, a small percentage (5%) have complications that need treatment. Many different therapeutic modalities can be used in this tumor. OBJECTIVE: To investigate the effect of a new method of treatment (intralesional bleomycin injection) in complicated hemangiomas. MATERIALS AND METHODS: In the Department of Radiation Oncology at Nemazee Hospital in Shiraz, Iran, from April 1992 to October 1998, 32 patients with complicated hemangioma were treated with four to six courses of direct injection of bleomycin into the lesion. RESULTS: After a minimum follow-up of 6 years, there was 70 to 100% regression in 18 patients, 50 to 70% in 7 cases, and less than 50% reduction in 7 patients. CONCLUSION: Intralesional injection of bleomycin is an easy, safe, and effective therapeutic modality in complicated cutaneous hemangiomas.     

Radiation-induced chondrosarcoma of the maxilla 7-year after combined chemoradiation for tonsillar lymphoma

Radiation-induced sarcoma is a rare complication of radiation therapy. We report a case of radiation-induced chondrosarcoma of the maxilla. An 80-year-old Persian woman developed radiation-induced chondrosarcoma of the left maxilla 7 years after combined chemotherapy and external beam radiation therapy for the Ann Arbor stage IE malignant lymphoma of the right tonsil. She underwent suboptimal tumour resection and died due to extensive locoregional disease 8 months later. An English language literature search of Medline using the terms chondrosarcoma, radiation-induced sarcoma and maxilla revealed only one earlier reported case. We describe the clinical and pathological features of this case and review the literature on radiation-induced sarcomas.     

Role of external irradiation in high-risk resected colon cancer

BACKGROUND / AIM: The best therapeutic modality for colon cancer "one of the most common malignancies of human being" is surgical resection of primary tumor. Adjuvant chemotherapy can help surgery to have a higher control and survival rate in high-risk resected patients, but the role of radiation therapy is the place of debate. This study was carried out to evaluate the possible role of adjuvant radiotherapy in such cases. MATERIALS AND METHODS: This retrospective trial evaluated 65 eligible patients with surgically resected high-risk colon carcinoma (serosal and/or lymph node involvement), from May 1986 to February 2000. The patients were categorized into two groups. The first group was treated with chemotherapy alone and the other with chemo-radiotherapy. Chemotherapy included 5.FU 500 mg/m2sub/5days for 6-8 courses and radiotherapy consisted 45-55 Gy with 1.5-2 Gy/fraction. Minimum follow-up was 36 months. RESULTS: Mean event-free survival was 140 and 101 months in chemotherapy and combined-therapy groups, respectively (P = 0.099). Local recurrence rate was detected as 9.7% in the chemotherapy arm and 23.5% in the combined-therapy arm (P > 0.1). Treatment-related morbidity and mortality has been significantly higher in the radiation arm (P CONCLUSION: Postoperative external radiation as adjuvant treatment does not improve local control of the patients with colon carcinoma.     

Surface area: a better predictor of disease severity than the height and volume of the barium column in patients with primary achalasia

OBJECTIVE: Subjective assessment of primary achalasia is not accurate. We aimed to study the utility of surface area of barium retention in the objective assessment of these patients. METHODS: Subjective and objective esophageal functions of 99 patients with primary achalasia were evaluated initially and 43 of them were reevaluated 1 month after balloon dilation. RESULTS: Before dilation: Ninety-nine patients were enrolled. Forty-one of them were male. The mean age was 37.5+/-15.3 years. The mean score, resting lower esophageal sphincter pressure, height, surface and volume of barium retention at 5 min were 8.03+/-3.1, 59.1+/-20 mmHg, 9.9+/-4.9 cm, and 23.6+/-13.9 cm and 53.2+/-47.7 cm, respectively. Surface area at 5 min had best correlation and predictive value for resting lower esophageal sphincter pressure. After dilation: Forty-three of 99 patients were reevaluated after balloon dilation. The mean age was 36.8+/-13.6 years. Seventeen of them were male. Mean score, resting lower esophageal sphincter pressure, height, surface area and volume of barium retention at 5 min dropped significantly after dilation. Surface area at 5 min had best correlation and predictive value for lower esophageal sphincter pressure. CONCLUSIONS: Surface area of barium retention at 5 min is an accurate objective tool to assess patients with primary achalasia. It is cheap and easy to perform; therefore, it could be used more frequently in postdilation follow-up.     

The 12-item medical outcomes study short form health survey version 2.0 (SF-12v2): a population-based validation study from Tehran,Iran

Background  

The SF-12v2 is the improved version of the SF-12v1. This study aimed to validate the SF-12v2 in Iran.     

The efficacy and safety of neoadjuvant chemotherapy?+/??letrozole in postmenopausal women with locally advanced breast cancer: a randomized phase III clinical trial

This two-arm randomized clinical study aimed to evaluate the efficacy and safety of neoadjuvant concurrent chemotherapy and letrozole in postmenopausal women with locally advanced breast carcinoma. One hundred and one postmenopausal women aged 50-83 years with pathologically proven locally advanced (clinical stage T3, T4 and/or N2, N3) breast cancer were randomly assigned to receive neoadjuvant chemotherapy alone (control arm, n = 51) or neoadjuvant chemotherapy concurrent with letrozole 2.5 mg (study arm, n = 50). Chemotherapy consisted of a median 4 (range 3-5) cycles of intravenous 5-fluorouracil 600 mg/m(2), doxorubicin 60 mg/m(2), and cyclophosphamide 600 mg/m(2), every three weeks. All patients subsequently underwent modified radical mastectomy approximately two weeks after the last cycle of chemotherapy. Pathologic complete response rates were 25.5% and 10.2% in the study and the control group, respectively (P = 0.049). Similarly, clinical complete response rates were 27.6% and 10.2% in the study and the control group, respectively (P = 0.037). In the subgroup analysis of hormone receptor-positive cases, the complete response rates were more prominent in study group compared with control group. Common treatment-related side effects such as nausea, vomiting, bone marrow suppression, and mucositis were similar in both groups, but hot flush was more prevalent in study group compared with control group (P = 0.023). The addition of letrozole concurrently with neoadjuvant chemotherapy provides a higher clinical and pathologic response rates with acceptable toxicity compared with chemotherapy alone in postmenopausal women with locally advanced sensitive breast cancer.     

Anxiety and depression in patients with gastrointestinal cancer: does knowledge of cancer diagnosis matter?

Background  

Gastrointestinal cancer is the first leading cause of cancer related deaths in men and the second among women in Iran. An investigation was carried out to examine anxiety and depression in this group of patients and to investigate whether the knowledge of cancer diagnosis affect their psychological distress.     

Haplotype analysis of XRCC1 (at codons 194 and 399) and breast cancer risk, a case–control study

DNA in most cells is regularly damaged by endogenous and exogenous mutagens. Among DNA repair systems, the base excision repair pathway is responsible for the repair of oxidative DNA damage and single-strand breaks. The X-ray repair cross-complementation group 1 (XRCC1) protein plays an important role in base excision repair. Several polymorphisms in the XRCC1 gene have been described, including Arg194Trp (db SNP rs. 1799782). Since it has been suggested that the XRCC1 codon 194 polymorphism might be associated with significant alterations in the DNA repair capacity, the present study was undertaken. Blood samples from 186 females with breast cancer and 187 age- and sex-matched healthy individuals were collected. The genotypes were determined using a polymerase chain reaction-restriction fragment length polymorphism method. Allele frequency of 194Trp was low in both cancer patients and controls (0.0968 and 0.0802, respectively) and exhibited a similar distribution within both groups (odd ratio = 1.22, 95% confidence interval: 0.74–2.04, P = 0.426). The association between Arg194Trp polymorphism and breast cancer risk was not significant neither in Trp/Trp (P = 1.0) nor Arg/Trp (P = 0.273) genotypes compared with the Arg/Arg genotype. The close physical proximity of the polymorphisms at codons 194 and 399 of XRCC1 place them in linkage disequilibrium (patients: D′ = 0.8386, P < 0.001; controls: D′ = 1.0, P < 0.001). However, no significant difference between frequencies of the four types of haplotypes among cases and controls (P > 0.05) was noted.     

The porphyrin-fullerene nanoparticles to promote the ATP overproduction in myocardium: 25Mg2+-magnetic isotope effect

This is a first case ever reported on the fullerene-based low toxic nanocationite particles (porphyrin adducts of cyclohexyl fullerene-C(60)) designed for targeted delivery of the paramagnetic magnesium stable isotope to the heart muscle providing a sharp clinical effect close to about 80% recovery of the tissue hypoxia symptoms in less than 24 h after a single injection (0.03-0.1 LD(50)). A whole principle of this therapy is novel: (25)Mg(2+)-magnetic isotope effect selectively stimulates the ATP overproduction in the oxygen-depleted cells due to (25)Mg(2+) released by the nanoparticles. Being membranotropic cationites, these "smart nanoparticles" release the overactivating paramagnetic cations only in response to the metabolic acidic shift. The resulting positive changes in the heart cell energy metabolism may help to prevent and/or treat the local myocardial hypoxic disorders and, hence, protect the heart muscle from a serious damage in a vast variety of the hypoxia-caused clinical situations including both doxorubicin and 1-methylnicotineamide cardiotoxic side effects. Both pharmacokinetics and pharmacodynamics of the drug proposed make it suitable for safe and efficient administration in either single or multi-injection (acute or chronic) therapeutic schemes.     

Primary localized stages I and II non-Hodgkin’s lymphoma of the nasopharynx: a retrospective 17-year single institutional experience

The aim of this retrospective study was to define the natural history, clinicopathological findings, prognostic factors, and treatment outcome of 43 patients with localized stages I and II primary non-Hodgkin’s lymphoma (NHL) of the nasopharynx, followed up in a single institution over a 17-year period. Forty-three (13 women and 30 men) consecutive patients with localized stages I (N = 12) and II (N = 31) primary nasopharyngeal NHL were treated in our institution between 1990 and 2007. The pathologic reports were classified according to the International Working Formulation (N = 22) or Revised European-American Lymphoma classification (N = 21). The vast majority of patients (88%) were managed with a sequential combination of chemotherapy and radiation therapy. Chemotherapy mainly consisted of 4–8 (median 6) cycles of CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisolone). Involved-field radiation therapy with a median dose of 44 Gy was delivered to the primary site and entire cervical lymph nodes. The median age of the patients was 53 years (range, 6 to 86 years). The majority of the patients (70%) had high-grade histology. B-cell types represented 67% of the cases, among which diffuse large B cell was the most common histological subtype. After a median follow-up of 70 months, the 5-year disease-free survival and overall survival were 58.8% and 70.6%, respectively. In multivariate analysis, age less than or equal to 30 years (hazard ratio (HR) = 5.32, 95% confidence interval (CI) = 1.69–16.76), elevated serum lactate dehydrogenase level (HR = 3.69, 95% CI = 1.43–9.51), and modified International Prognostic Index with more than or equal to two risk factors (HR = 17.99, 95% CI = 2.32–139.30) retained statistical significance. Our limited data suggest that primary nasopharyngeal NHL tends to have aggressive histology and unfavorable clinical course with poor outcome, despite a considerably localized disease at the time of presentation and high frequency of complete initial response rates. Combined modality therapy should be considered for the majority of patients with primary localized nasopharyngeal NHL.