International Journal of Cancer Management

In Collaboration with Cancer Research Center (CRC), SBMU

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International Journal of Cancer Management (IJCM) publishes peer-reviewed original studies and reviews on cancer etiology, epidemiology and risk factors, novel approach to cancer management including prevention, diagnosis, surgery, radiotherapy, medical oncology, and issues regarding cancer survivorship and palliative care. The scope spans the spectrum of cancer research from the laboratory to the clinic, with special emphasis on translational cancer research that bridge the laboratory and clinic. We also consider original case reports that expand clinical cancer knowledge and convey important best practice messages.

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Recent Submissions

Now showing 1 - 20 of 1108
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    Ten-year Experience of Reconstructive Techniques After Resection of Hypopharyngeal Squamous Cell Carcinoma (SCC): Changing Trend from Gastric Pull up to Free Flaps
    (Brieflands, 2024-12-31) Sanaz Karimi Dardashti; Mohammad Shirkhoda; Amirsina Sharifi; Amirmohsen Jalaeefar
    Background: Hypo-pharyngeal squamous cell carcinoma (H-SCC) is a rare type of head and neck malignancy often necessitating extensive surgical resection and subsequent reconstruction. Objectives: This study presented a 10-year retrospective analysis of reconstructive surgeries following the resection of H-SCC. Methods: A cross-sectional study was conducted on H-SCC patients who underwent reconstructive surgery after either laryngopharyngoesophagectomy (13 cases, 42%) or pharyngolaryngectomy (18 cases, 58%). Various reconstructive techniques were employed, including gastric pull up (12 cases, 39%), pectoralis major myo-cutaneous flap (PMMCF) (11 cases, 35%), and free flaps such as jejunum (2 cases, 6%), ileocecal (2 cases, 6%), or antero-lateral thigh (ALT) (4 cases, 13%). Results: The study included 31 patients with a mean age of 56.26 ± 3.98 years, predominantly male (64%). Smoking habit was observed in 22 (71%) patients. The total complication rate was 48% including 2 (6%) cases of flap loss, 2 (6%) cases of cervical anastomosis leak, 1 (3%) case of hematoma, 2 (6%) cases of neck wound infection, 5 (16%) cases of pneumonia, and 3 (10%) cases of pleural effusion, with a mortality rate of 16%. GPU and PMMCF had total number of post operative complications of 12 and 6, respectively. ALT flap, jejunal flap and ileocecal flap had 3, 2 and 1 total complications, respectively. Severe stenosis at cervical anastomosis was found in 4 (13%) patients after GPU and not other techniques. Conclusions: Advances in microvascular anatomy knowledge have led to the evolution of reconstructive techniques. The study suggests that in upcoming years, the free flap techniques hold promise as a preferred method for hypo-pharyngeal reconstruction.
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    Predictive Value of Pre-treatment Hematological Parameters for Response to Definitive Chemoradiation in Locally Advanced Cervical Cancer: A Prospective Study
    (Brieflands, 2024-12-31) Kambiz Novin; Pedram Fadavi; Nafiseh Mortazavi; Amir Mohammad Arefpour; Hamidreza Dehghan; Mohadeseh Shahin; Somayeh Mohammad Taheri
    Background: More than 90% of cervical cancers are related to chronic inflammation caused by HPV. Several studies have shown that laboratory hematological parameters can detect the severity of systemic inflammation. Objectives: Our current cohort study investigated the predictive role of pretreatment hematological parameters for response to definitive chemoradiotherapy in patients with locally advanced cervical cancer (LACC). Methods: Prospectively, patients with LACC who candidates for definitive chemoradiation at Shohadaye Haftom-e-Tir are and Firozgar Hospitals (Tehran, Iran) were included in our study between April 2021 and December 2022. Hematological parameters were obtained from the blood sample test and peripheral blood smear before treatment. All patients diagnosed in stage IB to IVA received a similar treatment protocol and follow-up. Patients were divided into complete clinical (CR) and non-complete clinical responses (Non-CR). Leukocyte, Lymphocyte, neutrophil, platelet, hemoglobin (Hb), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), were documented and then compared between two groups of responders. We used receiver operating characteristic (ROC) analysis to investigate the predictive value of these hematological parameters. Results: Out of 34 patients who met the inclusion criteria, 25 (73/5%) patients were complete responders and 9 (26.5%) were non-complete responders. The average number of neutrophils, leukocytes, and NLR was significantly higher among Non-complete responders. Hemoglobin in patients with non-complete responses was significantly lower than that of the other group of responders. Receiver operating characteristic curve analysis showed that the optimized cut-off values for pretreatment Hb and NLR were 11 and 2.1, respectively. Neutrophil-to-lymphocyte ratio cut-off point > 2.1 is significantly associated with larger tumor size, low Hb, high platelet, and high leukocyte. Conclusions: hematological markers such as NLR can be a simple and inexpensive predictive factor to evaluate therapeutic response to chemoradiation in LACC patients.
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    Pathologic Response Rates in Patients with Gastric Cancer Following FLOT Neoadjuvant Chemotherapy
    (Brieflands, 2024-12-31) Samaneh Sajjadi; Mostafa Kamandi; Abolghasem Allahyari; Sajjad Ataei Azimi; Alireza Baari; Niloufar Valizadeh; Farbod Hatami
    Background: Gastric adenocarcinoma is among the most prevalent cancers associated with a high mortality rate. The multidrug neoadjuvant chemotherapy administered before and after surgery has attracted attention as a beneficial standard of care for managing this malignancy. Objectives: This study assessed the pathologic response of patients with gastric cancer who were treated with fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT). Methods: Patients with pathologically confirmed gastric adenocarcinoma without distant metastases were enrolled in this retrospective cohort study conducted at Imam Reza and Ghaem hospitals in Mashhad. Data regarding demographics, tumor status, treatment toxicity, and pathology results were collected using a predesigned questionnaire after four cycles of FLOT neoadjuvant chemotherapy. SPSS-26.0 was utilized to analyze the data, and a significance level of P < 0.05 was applied. Results: We evaluated data from 53 cases with a mean age of 51.1 ± 9.7 years. Diffuse adenocarcinoma was the most common finding in histology (54.7%). Pathologic complete response was observed in 16 (30.2%) patients. Most (69.8%) patients received only 7 out of 8 planned cycles. Concerning surgical margin, 46 (86.8%) patients achieved R0 tumor resection. Pathologic complete response was not significantly linked with age (P = 0.91), sex (P = 0.65), performance status (P = 0.2), tumor histology (P = 0.14), tumor grading (P = 0.07), tumor location (P = 0.8), and the number of neoadjuvant chemotherapy cycles (P = 0.9). Conclusions: Our findings demonstrated the relative clinical efficacy of neoadjuvant chemotherapy with the FLOT regimen administered before and after surgery. However, due to chemotherapy-related side effects, patients may not adhere to all eight prescribed cycles of chemotherapy.
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    Weekly Afatinib in the Treatment of Advanced Non-small Cell Lung Cancer with Egfr-G719c Mutation Followed by Lobectomy: A Case Report
    (Brieflands, 2024-12-31) Dung Xuan Ho; Long Thien Phan; Hung Manh Vuong; Kha Nguyen Dang
    Introduction: Lung cancer stands as the leading cause of cancer-related deaths worldwide. Over the past three decades, the advent of tyrosine kinase inhibitors (TKIs) has marked a significant turning point in the treatment of non-small cell lung cancer (NSCLC) harboring EGFR mutations. Notably, high response rates have been notably observed in cases with exon 19 deletions (Del19) and Exon 21 substitution L858R mutations. Conversely, the G719X mutation on exon 18 is less prevalent, with variable sensitivity across different generations of TKIs. Afatinib, a second-generation inhibitor, gained FDA approval for the initial treatment of EGFR-mutant metastatic NSCLC in 2013, though its role remains incompletely understood within a multidisciplinary treatment framework, particularly in combination with surgery. However, the standard daily dose of 40mg Afatinib has demonstrated poor tolerability, often resulting in adverse events such as diarrhea and skin toxicity, leading to treatment discontinuation. A recent strategy involving a weekly dose of 280mg Afatinib has shown promising outcomes and a reduced risk of adverse events. Case Presentation: This case report highlights a 50 - year-old female diagnosed with stage IVa right lung adenocarcinoma metastasizing to the left lung (cT3N0M1a), revealing the rare EGFR-G719C (exon18) mutation. Following this diagnosis, the patient underwent open lobectomy. Nine months post-surgery, a treatment approach involving 280mg weekly Afatinib was initiated. Subsequently, the patient was closely monitored for 16 months with no signs of recurrence. Conclusions: EGFR G719C exhibits sensitivity to Afatinib, endorsing the use of Afatinib with fewer adverse events compared to the traditional daily dosage. Our case further advocates for collaborative strategies between medical oncologists and surgeons in the management of advanced-stage NSCLC.
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    Acrylic Cranioplasty for Cranial Defects Following Meningioma Surgery: A Case Series
    (Brieflands, 2024-12-31) Khamim Thohari; Salmon Charles P. T. Siahaan; Natalia Yuwono; Areta Idarto; Rafi Daffa Dzaky
    Background: Meningiomas are the most prevalent primary intracranial tumors, which are treated with surgical resection. This procedure may result in cranial defects, leading to significant functional and aesthetic impairments. Lately, acrylic cranioplasty has emerged as a promising technique for repairing these defects. Objectives: The current retrospective review investigated patients, who underwent reconstructive cranioplasty following meningioma surgery between November 2021 and March 2023. Methods: Thirteen patients, who underwent cranioplasty surgery to repair extensive skull defects following meningioma surgery, were included as subjects. Eleven patients were female and all of them had a history of using progesterone contraception for 10 to 30 years. Two patients were male and had comorbid diabetes mellitus. Patients’ ages varied between 39 and 59 years old. The interval between craniectomy and cranioplasty was about 45 days. The material used for cranioplasty was polymethyl methacrylate prostheses. It started with a CT scan to determine the location and size of the skull defect. We reconstructed the defect, using computer-aided design and computer-aided manufacturing (CAD/CAM) to produce a prosthesis that was specific to each patient. This 3D-printed prosthesis was designed to manufacture a mold, which was sterilized and intraoperatively used. Results: We conducted post-operative surgery follow-up for up to 3 months. After 1 month of post-operative surgery follow-up, 2 out of our 13 patients developed cerebrospinal fluid leakage. Conclusions: Acrylic cranioplasty using CAD/CAM technology and 3D printing has shown potential for producing patient-specific implants to repair extensive skull defects. However, careful monitoring for post-operative complications is essential.
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    A Report of Pediatric Langerhans Cell Histiocytosis in a Hospital-Based Study
    (Brieflands, 2024-12-31) Javad Sabery Nejad; Ali Ebrahim Ahmadi; Maryam Tashvighi; Narjes Mehrvar; Azim Mehrvar
    Background: The reports of Iranian Pediatric Langerhans Cell Histiocytosis (LCH) are rare and there is no specific survival rate for those cases. Objectives: This study was designed as a hospital-based project for evaluating the epidemiological data and survival rates of the mentioned patients. Methods: This was a cross-sectional descriptive study that enrolled patients younger than 15 years old with approved LCH malignancy. Data was gathered based on a unique questionnaire and analyzed by SPSS Software version 25. Results: There were 32 cases (male/female ratio = 0.88) who were categorized as high risk (n = 18), moderate (n = 9) and low risk (n = 5), respectively. The mean age of patients was 5.1 years and the common chief complaint in them was bone pain, with the skeleton site of involvement. The 5-years overall and event-free survival rates were 93.3% and 72.9%, respectively. Conclusions: The suggestion is to provide a national registry for pediatric LCH followed by designing future projects around affective genes on the treatment response of the mentioned patients. In that way, we can improve the survival rate of these patients and decrease mortality.
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    CAR-NK Cells as Promising Immune Therapeutics: Platforms and Current Progress
    (Brieflands, 2024-12-31) Maryam Samareh Salavati; Shirin Tavakoli; Shima Tavoosi; Masoume Nodehi; Amir Hossein Baghsheikhi; Mohammad Vaezi; Javad Verdi; Soheila Rahgozar; Maryam Barkhordar; Mohamad Ahmadvand
    Context: Adoptive T-cell therapy with chimeric antigen receptor (CAR) has shown tremendous progress in hematological cancers. However, some obstacles, such as high price tag, cytokine release syndrome, inability to penetrate solid tumors, and manufacturing complexity limit the wide application of this therapy. Natural killer (NK) cells can kill target cells via mechanisms similar to those of CD8+ cytotoxic T cells; therefore, CAR-NK cell therapy is a promising strategy for cancer treatment. Evidence Acquisition: In this manuscript, all articles published in English regarding CAR-NKs and their application for the treatment of different types of cancers were collected from several databases, including PubMed, Scopus, and Google Scholar, using related keywords such as "Cancer, CAR construction, NK cells, and CAR-NK cells". Results: Compared with CAR-T cells, CAR-NK cells have several advantages, including less toxicity, a high potential opportunity for universal off-the-shelf manufacturing, increased infiltration into solid tumors, overcoming resistant tumor microenvironment, and absence of graft-versus-host disease (GVHD). Conclusions: In this review, we discuss NK cell biology, the source of CAR-NK cells, CAR structure, advances, challenges, and ways to overcome these challenges in CAR-NK cell therapy. Furthermore, we have summarized and highlighted some preclinical and clinical studies in this field.
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    A Rare Case of Struma Ovarii in Afghanistan
    (Brieflands, 2024-12-31) Romal Seddiqui; Azizullah Mohammadi; Mohammad Behroz Noori; Abdul Shokor Shirpor; Aziz Rahman Rasib
    Introduction: Struma ovarii is a rare ovarian tumor characterized by containing either entirely or predominantly thyroid tissue (> 50%). It accounts for less than 1% of all ovarian tumors and approximately 3% of ovarian teratomas. The condition was first described by Von Klden in 1895. Case Presentation: In this report, we described a 50-year-old Afghan menopausal woman who referred to our hospital with a 5-month history of weight loss, anorexia, hyperthyroidism, abdominal distension and sinus tachycardia. Abdominal radiological findings revealed left adnexal large multilocular cystic lesion and the patient’s CA-125 serum level was high. Preoperatively, the clinicians suggested a diagnosis of ovarian cancer based on the symptoms, radiological findings and high level of CA-125 serum. However, postoperatively, histopathological examination revealed the lesion to be a benign struma ovarii. Conclusions: Association of struma ovarii with CA-125 and hyperthyroidism is an extremely rare case and are usually misdiagnosed preoperatively due to nonspecific clinical manifestations, and indistinguishable imaging studies, and should be kept in the differential diagnosis of all ovarian cystic lesions. An exact diagnosis is only made by postoperative histopathological examination, and complete surgical resection of the lesion is considered the optimal treatment.
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    Evaluation of Sensitivity and Specificity of Ultrasound-Guided FNA of Suspicious Axillary Lymph Nodes in Patients with Breast Cancer
    (Brieflands, 2024-12-31) Farzaneh Khoroushi; Hashem Neshati; Seyed Ali Alamdaran; Bita Abbasi; Lida Jarahi
    Background: The axillary lymph node status in breast cancer is a major prognostic factor in survival and establishing a personalized treatment scheme. The ultrasound-guided fine needle aspiration (US-FNA) is a method for taking a lymph node sample. It allows physicians to decide how to manage the axilla. Objectives: This study was conducted to investigate the sensitivity of the US-FNA technique on suspicious axillary lymph nodes with a thickness of 3 to 6 mm in breast cancer patients. Methods: In a cross-sectional study, all the patients were subjected to preoperative ultrasound evaluation of the axilla to determine the presence of lymph nodes suspicious of malignancy. In cases where the suspicious lymph node cortex size was between 3 and 6 mm, US-FNA was performed. After surgery, the frozen section of the biopsy sample was examined histologically and compared with fine needle aspiration (FNA) cytology results. Results: A total of 102 patients were examined in the study. FNA test results indicated that 46 subjects had axillary malignant tissue, and benign cases summed 56. Also, the final results of frozen section surgical histopathology identified 46.1% of patients with involved lymph nodes. The sensitivity and specificity of FNA were 93.62% and 96.36%, respectively. Also, the overall diagnostic accuracy was 95.1%. Conclusions: This study showed that the sensitivity, specificity, and accuracy were more than 90% for the ultrasound-guided FNA test in identifying involved lymph nodes in patients with breast cancer. Therefore, the results of this test can be considered clinically reliable. However, there is still a need to examine the sensitivity and specificity of this method in identifying lymph node involvement.
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    Investigating the Risk Factors Affecting the Survival Rate of Breast Cancer Patients Using Cured Model Based on Defective Distribution
    (Brieflands, 2024-12-31) Solmaz Taheri; Mohammad Esmaeil Akbari; Ali Akbar Khadem Maboudi; Ahmadreza Baghestani
    Background: The analysis methods for breast cancer (BC) data have also advanced alongside medical advancements in the treatment of the disease. Objectives: This study tried to investigate the factors affecting the survival rate of BC patients using the cured model based on Kumaraswamy's defective distribution. Methods: A retrospective study collected data on 2 574 BC patients between September 2013 and September 2020, including demographic, clinicopathological, and biological characteristics. The best model for predicting cure was chosen based on AIC. Results: The selected cure model revealed that age (P = 0.046), tumor histologic grade (P = 0.0.38), tumor size (P = 0.0.41), HER2 status (P = 0.001), KI67 levels (P = 0.027), P53 status (P = 0.029), and hormone therapy (P = 0.039) were significant variables. The estimated cured rate of this data was 0.82. Conclusions: Considering that the advanced cured model has the highest accuracy in identifying the factors affecting the survival rate of BC patients and more risk factors have become significant in this model, it is recommended to pay special attention to patients aged over 60 with poorly differentiated historical grade, T3 tumor size, HER2 positive status, KI67 levels below 20%, negative P53 status, and no hormone therapy received in the process of disease prognosis.
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    Survival Prediction in Patients with Colorectal Cancer Using Artificial Neural Network and Cox Regression
    (Brieflands, 2020-01-15) Samaneh Sabouri; Habibollah Esmaily; Soodabeh Shahidsales; Mahdi Emadi
    Background: Colorectal cancer (CRC) is the third prevalent cancer worldwide, and it includes 10% of all cancer mortality. In Iran, men and women have the third and the fourth incidence rate of CRC, respectively. Survival analysis methods deal with data that measure the time until an event occurs. Artificial neural networks (ANN) and Cox regression are methods for survival analysis. Objectives: The current study was designated to determine related factors to CRC patients’ survival using ANN and Cox regression. Methods: In this historical cohort, information of patients who were diagnosed with CRC in Omid Hospital of Mashhad was collected. A total of 157 subjects were investigated from 2006 to 2011 and were followed up until 2016. In ANN, data were divided into two groups of training and testing, and the best neural network architecture was determined based on the area under the ROC curve (AUC). Cox regression model was also fitted and the accuracy of these two models in survival prediction was compared by AUC. Results: The mean and standard deviation of age was 56.4 ± 14.6 years. The three-, five- and seven-year survival rates of patients were 0.67, 0.62, and 0.58, respectively. Using test dataset, the area under curve was estimated 0.759 for the chosen model in ANN and 0.544 for Cox regression model. Conclusions: In this study, ANN is an appropriate approach for predicting CRC patients’ survival which was superior to Cox regression. Thus, it is recommended for predicting and also determining the influence of risk factors on patients’ survival.
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    A Study of Relationship Between Breast Cancer Mortality Rate and Human Development Index: Global Trend Analysis from 1990 to 2017
    (Brieflands, 2020-08-19) Zahra Zolghadr; Masoud Salehi; Afsaneh Dehnad; Farid Zayeri
    Background: Female breast cancer is known as one of the top five cancers in terms of mortality. Regarding contradictory reports about the mortality trend of this cancer and its association with the socio-economic status of the world countries, we aimed at assessing the global trend of female breast cancer mortality rate and investigate the relationship between its mortality rate and development status. Methods: The breast cancer Age Standardized Mortality Rate (ASMR) per 100,000 and Human Development Index (HDI) for 179 world countries were extracted, respectively from the Global Burden of Disease (GBD) 2017 study and the United Nations Development Programme (UNDP) database, for the period 1990 to 2017. The marginal modeling methodology was employed to analyze the global trend of ASMR and examine the relationship between ASMR and HDI. Results: The results showed a slightly constant curve for the global trend of breast cancer ASMR from 1990 to 2017 (around 17 per 100,000). Moreover, it was indicated that the ASMR is strongly related to development status. While countries with higher levels of HDI have experienced a declining trend of breast cancer mortality rate, countries with lower HDI levels experienced an ascending trend at this period. Conclusions: In general, the findings showed that mortality due to breast cancer is still a major health problem in total world countries. Hence, more efforts should be made to screen the patients in the early stages of the disease and promote the level of care, especially in countries with lower levels of economic development.
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    Evaluation of Risk Factors for Pediatric Cancers in the West of Iran
    (Brieflands, 2021-06-30) Borhan Moradveisi; Jamal Amiri; Siamak Derakhshan; Daem Roshani; Farideh Elahimanesh
    Background: Occurrence of pediatric cancers is affected by maternal, environmental, and hereditary/genetic factors. Objectives: The purpose of this study was to evaluate the correlation between background radiation, ultrasound and other possible risk factors for pediatric cancers incidence indicators. Methods: In a cross-sectional study during 2 years, 103 patients under 14 years were studied. A total of 13 environmental, maternal and hereditary/genetic risk factors were studied, and the study was performed by using a questionnaire, measurement of background radiation, and statistical data. Incidence in the studied sample size at city (ISSSC) and incidence in the studied sample size at area (ISSSA) indicators were defined. Results: The mean age of patients was (6.31 ± 3.22) including 54 (52.4%) males and 49 (47.6%) females. History of repeated ultrasound before gender determination (RUBGD) and repeated ultrasound during pregnancy (RUDP) were statistically higher in solid tumors group. Toxic substances (TS) and pediatric medical ionizing radiation (PMIR) was higher in hematologic malignancies. Statistically significant association were found between of cancer types and Family history of leukemia (FHL), Family history of solid tumors (FHST), Abortion history (AH), Maternal smoking during pregnancy (MSDP), Children’s residence place (CRP), and background radiation (BR) variables. No statistically significant association was found between cancer types and maternal pregnancy age (MPA), IVF baby, and maternal ionizing radiation exposure (MIRE) variables. Conclusions: Pediatric cancers are multifactorial diseases. Increased background radiation is correlated with an increased incidence of all pediatric malignancies. It seems that increasing ultrasound scans might increase the risk of solid tumors in children.
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    Oncological Assistance in the Emergency Room Setting: The Role of a Dedicated Oncology Unit
    (Brieflands, 2021-07-31) Antonio Faiella; Livia Onofrio; Filomena Liccardi; Fiorella Paladino; Martina Chiurazzi; Ferdinando Riccardi; Bruno Chiurazzi
    Background: The appearance of symptoms that may be related to the worsening of the disease, as well as the toxicity of chemotherapy treatment or an acute complication, are the most frequent reasons for access to the emergency room (ER) for patients with cancer. To date, the Italian territorial health services, as well as local preventive medicine, are unable to provide adequate management of patients with cancer and, for this reason, diagnostic delays and inappropriate hospitalization in the oncology departments have occurred; moreover, it has been observed that many patients receive the first diagnosis of cancer directly in the ER, where the experience in the oncology field is often inadequate. Objectives: Cardarelli Hospital, in Naples, started twenty-two month Experimental Oncological Emergency Service, under the supervision of its own Oncology Department, with the double main objectives of encouraging de-hospitalization and improving diagnostic and therapeutic performance. Methods: We have developed a methodological protocol for patients’ admission to the ER, assuming that the host physician transfers patients with suspected cancer to a new hospital figure, the ER oncologist, who acts as supervisor and coordinator. The first consultation was carried out together with one or more specialists, identified by the supervisor. Based on their characteristics, the patients were divided into 4 categories: (1) Patients with a known diagnosis of cancer and already undergoing anticancer treatments; (2) patients who show complications due to ongoing cancer treatments; (3) patients who no longer respond to anticancer treatments due to the worsening of the disease; (4) patients who are first diagnosed with cancer in the ER. Each individual cohort of patients was directed towards what we have called diagnostic-therapeutic assistance paths (PDTA), specific protocols for each type of patient, which allowed us to reduce the time to diagnosis. Results: According to the data, the average hospitalization time for patients with lung cancer who followed the study was 10 days, compared to 16 days for patients who did not undergo cancer screening in the ER. Another relevant result demonstrated the improvement in the quality and efficiency of medical services by including first aid in the management of cancer patients regards de-hospitalization. In fact, thanks to the experimental protocol we applied, we were able to de-hospitalize 484 patients directly from the ER, which are over 34% of the total. Conclusions: Close integration between hospital medical fields and territorial medicine could improve the quality of cancer treatment and the efficiency of health services management. All of this without affecting the costs of public healthcare because of the considerable improvement in performance which allowed important savings.
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    Factors Related to Nurses and Physicians’ Knowledge and Attitudes Towards Palliative Care
    (Brieflands, 2022-02-28) Hadis Ashrafizadeh; Leila Khanali Mojen; Salman Barasteh; Mohammad Esmaeil Akbari; Samira Beiranvand; Azam Shirinabadi Farahani; Azam Eshaghian Dorcheh; Maryam Karami; Fatemeh Khademi; Tahereh Alsadat Khoubbin Khoshnazar; Eric Krakauer; Maryam Rassouli
    Background: Changes in the course of diseases, their treatment, and care provision result in the need for a specific type of care known as palliative care. Medical staff’s knowledge and awareness of palliative care is important in this regard. Objectives: This study aims to examine the caregivers’ knowledge and awareness of palliative care and to determine the related predictors. Methods: In this cross-sectional study, 277 subjects were selected from among the caregivers working in the selected teaching hospitals in Iran through non-randomized sampling method. The subjects were asked to fill the online questionnaire which consisted of 3 sections including demographic data, knowledge, and attitude toward palliative care. Descriptive, inferential statistics, correlation and regression analyses were performed. Results: The mean scores of care providers’ attitude and knowledge were 140.90 ± 11.56 and 19.36 ± 2.73 respectively. There was a significant relationships between some variables such as working place, education level, age, palliative care-related working experience, and the necessity to pass training courses and the mean scores of attitude and knowledge. Conclusions: Since palliative care providers’ level of knowledge and attitude were reported to be moderate, training courses at different levels in the form of clinical courses should be offered with the aim of improving care providers’ skills and scientific abilities. It is essential to include the related topics in the curricula of academic programs.
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    Parasagittal Fibroblastic Meningioma in Accompaniment with Scalp Basal Cell Carcinoma: Report of a Case
    (Brieflands, 2022-12-31) Sara Zandpazandi; Mohammadreza Shahmohammadi; Mehdi Farokhi
    Introduction: Accompaniment of meningioma with other tumors especially cerebral tumors is quite rare. In some institutes, cases of simultaneous meningioma and glioma are seen and reported previously. Case Presentation: We reported a meningioma with the accompaniment of scalp basal cell carcinoma (BCC) with no signs and symptoms of Gorlin syndrome and no history of radiation. Conclusions: Expression of some adjacent cancerous lesions might have a local cancerous induction effect.
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    Massive Intramedullary Ependymoma: A Case Report
    (Brieflands, 2023-12-31) Ahmadreza Mirbolook; Mirbahador Athari; Nima Mohseni Kabir; Bardia Hajikarimloo; Masoud Saberi; Mojtaba Baroutkoub
    Introduction: Intramedullary ependymoma (IE) is adults' most common intramedullary spinal tumor. Tumors usually extend one to eight segments in the cervical region. In this case report, we reported 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.
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    Comparison of 3D-Conformal Planning Using Partially Wide Tangents and Direct Photon/Electron Portals for Breast Radiotherapy with Internal Mammary Nodes Inclusion: A Dosimetric Analysis
    (Brieflands, 2023-12-31) Farshid Farhan; Sepideh Sehat Kashani; Farnaz Amouzegar-Hashemi; Peiman Haddad; Mohammad Babaei; Ebrahim Esmati; Reza Ghalehtaki; Mansoureh Nabavi; Fatemeh Jafari
    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.
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    Topical Phenytoin Versus Placebo in the Management of Acute Radiation-Induced Dermatitis in Patients with Breast Cancer: A Double-Blind Randomized Controlled Trial
    (Brieflands, 2023-12-31) Ebrahim Zabihi; Mobina Zamani; Alexis Vallard; Nicolas Magne; Dariush Moslemi
    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 breast conservative surgery. 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 ARD in patients with breast cancer.
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    Outcomes and Complications of Double Roux Loop Reconstruction in Pancreaticoduodenectomy: A Single Center Experience
    (Brieflands, 2019-06-30) Abolfazl Afsharfard; Barmak Gholizadeh; Behzad Azimi; Mohammad Amin Shahrbaf; Adel Zeinalpour
    Background: pancreaticoduodenectomy is associated with higher morbidity and mortality rates. The leak of activated pancreatic enzymes can cause several complications which could be life threatening. One of the suggested methods, which can prevent complications, is double Roux anastomosis technique. Objectives: The aim of this study was to evaluate the outcomes and complications of double Roux anastomosis method. Methods: In this prospective study, patients who underwent pancreaticoduodenectomy with double Roux anastomosis were evaluated from 2013 to 2017. The outcomes and complications such as mortality rate, pancreatic leak or fistula, bile leakage, and abscess formation were evaluated. Results: A total of 12 patients were evaluated. The mean age was 53.08 ± 13.43 (19 - 70). Seven of them were male and five were female. Indications of surgery in the patients were periampullary cancer (6 patients), pancreatic head cancer (4 patients), distal cholangiocarcinoma (1 patient) and duodenal trauma (1 patient). There was no mortality, no pancreatic leak or fistula, no hemorrhage, and no abscess in any of the patient. There was one case of the biliary leakage, which was managed expectantly. Conclusions: The results of this study showed that use of separate double Roux, one for the pancreas and the other one for the stomach and bile duct reduces complications and mortality. Although this method requires more anastomosis and the operating time is prolonged, but ultimate outcome of the patient has great effects.