Reports of Radiotherapy and Oncology

In Collaboration with ISCO


Reports of Radiotherapy and Oncology (RRO) is an international, specialized, peer-reviewed journal in all areas of oncology. The journal welcomes the submission of manuscripts that meet the general criteria of significance and scientific excellence in all fields of cancer and will publish:

  • Original articles in basic and applied research
  • Case studies
  • Critical reviews, surveys, opinions, commentaries, and essays


Recent Submissions

Now showing 1 - 20 of 91
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    Status of Axillary Staging in Patients with Breast Cancer and Its Impact on the Management of Patients
    (Brieflands, 2024-12-31) Alaleh Alaleh; Danial Fazilat-Panah; Babak PeyroShabany; Seyed Alireza Javadinia; Pejman Porouhan
    Background: Breast cancer is most common in women, and symptoms and treatment depend on ethnicity, screening, and drug availability. The current standard for breast surgery is breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). However, performing axillary lymph node dissection (ALND) and the number of lymph nodes examined to determine the N stage has been insufficient in many patients, with a maximum of 10 lymph nodes assessed in patients undergoing ALND. This limitation leads to inadequate estimation and ultimately affects treatment choices. Objectives: This study examined the status of axillary staging in patients with breast cancer and its impact on management. Methods: This retrospective longitudinal cohort study included 272 breast cancer patients at Sabzevar University of Medical Sciences, Sabzevar, Iran, from 2015 to 2019. Data regarding laterality, mass location, histology, grade, in situ status, lymphovascular invasion, perineural invasion, necrosis, and AJCC TNM staging were collected. Results: Most patients were at stage two (54.1%), and the median size of the primary breast tumor was 1.3 cm (range 1 - 14 cm, mean 3.7 ± 2.1 cm). The median number of dissected lymph nodes was 8 (range 1 - 37, mean 8.3 ± 5.8); however, no lymph nodes were examined pathologically in 23% (n = 63) of patients despite undergoing ALND. Additionally, in 38.2% of patients undergoing ALND, less than 10 lymph nodes were examined, which is considered inadequate for accurate axillary staging. Conclusions: The rates of inadequate lymph node staging were considerable in our patients, resulting in overtreatment.
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    Eighth International Congress and Eighteenth Annual Congress of Clinical Oncology
    (Brieflands, 2024-04-30) Yasha Makhdoumi; Ali Ghanbari Motlagh; Seyed Mohammad Hosseini
    This article does not have an abstract.
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    Assessing the Accuracy of a Computer-Aided Detection System for Suspected Malignant Breast Lesions Using Magnetic Resonance Imaging
    (Brieflands, 2024-12-31) Maryam Farghadani; Maryam Riahonejad; Atoosa Adibi; maryam lashkarblock; Zahra Naderi Beni
    Background: Mammograms often reveal breast microcalcifications, necessitating invasive procedures to ascertain whether they are cancerous or benign. Objectives: Although many microcalcifications are linked to noncancerous conditions, this study sought to investigate the efficacy of a computer-aided detection (CAD) system using breast MRI in distinguishing between benign and malignant breast anomalies. Methods: This cross-sectional study included forty patients with mammographically suspicious microcalcifications who underwent stereotactically-guided biopsies at our institution over two years. Prior to the biopsy, these patients received a breast MRI within eight weeks. Surgical interventions were carried out for cases identified as malignant or of uncertain malignant potential. The study aimed to determine diagnostic benchmarks by comparing the breast imaging reporting and database system (BI-RADS) category assignments from initial mammography screenings and breast MRI reports to the pathology findings. Results: Histopathology reports showed that of the total cases, 23 were benign, and 17 were malignant. Breast MRI exhibited a sensitivity of 88.8%, specificity of 54.5%, a positive predictive value of 58.5%, and a negative predictive value of 94.1%. Further analysis using CAD demonstrated sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 50.0%, 59.0%, and 100%, respectively. Conclusions: Utilizing breast MRI with the support of CAD, radiologists could significantly enhance their capability to differentiate between benign and malignant mammographic microcalcifications. This innovative diagnostic approach has the potential to decrease the necessity for unnecessary breast biopsies.
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    High Dose-Rate Brachytherapy in Recurrent High-Risk Head and Neck Cancer
    (Brieflands, 2019-12-31) Tanvir Pasha; Siddanna Rudrappa Palled; Rahul Loni; Shwetha Bondel; Purushottam Chavan; Ashok Shenoy; Thimmaiah Naveen; V Lokesh
    Background: Thirty to fifty percent of HNSCC patients treated with chemoradiation therapy present with recurrence and can be treated with maximum debulking surgery combined with re-irradiation. Re-irradiation can be done using external beam radiation therapy (EBRT) or brachytherapy. The advantage of brachytherapy over EBRT is that owing to rapid dose falls off, a higher dose can be delivered to the target area sparing normal tissue. Hence, we evaluated toxicity and outcomes [overall survival (OS) and disease-free survival (DFS)] in high-risk (HR) recurrent HNSCC patients undergoing re-irradiation using interstitial brachytherapy following surgery. Objectives: To evaluate toxicity and outcomes of re-irradiation using Interstitial High Dose-Rate Brachytherapy (HDR-BRT) in high-risk Head and Neck Squamous Cell Carcinoma (HNSCC) patients. Methods: Ten biopsy-proven recurrent HNSCC patients treated with primary chemoradiation therapy who had the HR of the second recurrence at nodal disease were evaluated. All patients underwent surgery followed by the intraoperative placement of catheters in a single plane, at 10 - 12 mm apart and fixed with stay sutures. The CT simulation was done on the 5th - 7th postoperative day. Volumetric optimization was done with a 5-mm dwell position. The dose of 30 Gy/10 Fractions, 3 Gy/Fraction, two fractions per day, 6 hours apart after 5 days was planned. Results: The DFS and OS for the entire cohort in 1 and 2 years were 60% and 40%, respectively. One patient had carotid blowout where the disease was stuck to the carotid vessel. No other significant acute or late toxicity was noted. Conclusions: The HDR-interstitial brachytherapy in the recurrent HR, HNSCC with the intraoperative placement of catheters at tumor bed provides reasonably good local control without significant acute or late toxicity.
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    Investigation of Simultaneous Photons and Electrons Beam by Monte Carlo Code
    (Brieflands, 2015-06-28) Navid Khaledi; Azim Arbabi; Dariush Sardari; Mohammad Mohammadi; Ahmad Ameri
    Background:: Depending on the location and depth of tumor, the electron or photon beams might be used for treatment. Electron beam have some advantages over photon beam for treatment of shallow tumors to spare the normal tissues beyond of the tumor. In the other hand, the photon beam are used for deep targets treatment. Both of these beams have some limitations, for example, the dependency of penumbra with depth, and the lack of lateral equilibrium for small electron beam fields. Objectives:: In this study, improvement of the penumbra and Dmax changes will be investigated. Also the effects of cut-outs on the beam parameters prepared as well. Patients and Methods:: In first, we simulated the conventional head configuration of Varian 2300 for 16 MeV electron, and the results approved by benchmarking the percent depth dose (PDD) and profile of the simulation and measurement. In the next step, a perforated Lead (Pb) sheet with 1 mm thickness placed at the top of the applicator holder tray. This layer producing bremsstrahlung x-ray and a part of the electrons passing through the holes, in result, we have a simultaneous mixed electron and photon beam. For making the irradiation field uniform, a layer of steel placed after the Pb layer. The simulation was performed for 10 × 10, and 4 × 4 cm2 field size. Results:: The measured R50 and RP for 10 × 10 cm2 field were 6.5 and 7.8 cm, respectively. The photon percentage for 1 mm thickness with 0.2, 0.3, and 0.5 cm holes diameter Lead layer target was about 33%, 32%, and 28% and for 2 mm targets punched with 0.2, 0.3, and 0.5 cm holes, the x-ray percentages were 43%, 41%, and 35%. Conclusions:: This study showed the advantages of mixing the electron and photon beam by reduction of pure electron’s penumbra dependency with the depth, especially for small fields, also decreasing of dramatic changes of PDD curve with irradiation field size.
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    Fine Needle Aspiration Diagnosed Skin Metastasis in a Young Man with Rectal Cancer
    (Brieflands, 2013-12-01) Hamid Nasrolahi; Bita Geramizadeh; Leila MoaddabShoar; Seyed Hasan Hamedi; Mohammad MohammadianPanah; Shapour Omidvari; Mansour Ansari; Niloofar Ahmadloo; Ahmad Mosalaei
    Introduction: Although colon cancer is one of the most common human cancers, skin metastasis in this disease is rare and necessitates pathological confirmation.
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    Vinorelbine and Docetaxel Combination as the First Line Treatment in Patients with Metastatic Breast Cancer: Results of a Multi-centric Phase II Trial in Iran
    (Brieflands, 2013-09-01) Ahamad Ameri; Behrouz Shahrad; Abollah Fazlalizadeh; Hossein Madani; Ahmad Mousavizadeh; Shiva Moghadam
    Introduction: We conducted a multi-centric phase II study to evaluate the tumor response and safety of the combination of vinorelbin and docetaxel in treatment of metastatic breast cancer patients.
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    Radiation Therapy: Past, Present and the Future
    (Brieflands, 2013-09-01) Azim Arbabi
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    Choriocarcinoma Metastatic to the Kidney Presenting With Prolonged Amenorrhea and Flank Pain
    (Brieflands, 2015-09-30) Fariba Behnamfar; Fereshteh Mohammadizadeh; Leila Hashemi; Somayeh Sheikhalian
    Introduction:: Gestational choriocarcinoma usually occurs following an intrauterine pregnancy. We report a case of metastatic choriocarcinoma to the left kidney and lungs with long term intermittent amenorrhea and vaginal bleeding after a normal vaginal delivery. Case presentation:: A 43-year-old rural woman presented with prolonged amenorrhea. Her last delivery was three years ago. She also complained of hematuria and left flank pain. Serum β-hCG level was considerably high. She underwent endometrial curettage. Pathologic examination of endometrial curettage specimen revealed choriocarcinoma. Ultrasound revealed enlarged uterus involved by an irregular mass with heterogenous echo pattern and extensive myometrial invasion. A mass with similar echo pattern was also evident in the left kidney. Computerized tomography confirmed the intrauterine mass and involvement of the left kidney. On chest X-ray, metastatic nodules were seen in both lungs and in the left retrocardiac space. The patient underwent 10 courses of chemotherapy (8 treatment courses and 2 courses for consolidation) with EMA-CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovine). Following the fifth course of chemotherapy, she became pancytopenic and febrile. This condition was successfully managed with G-CSF, leukovorin and antibiotics. The patient is now well and still under the chemotherapy. Her serum β-hCG level has fallen to negative (3 IU/mL). Conclusions:: Gestational trophoblastic diseases should be considered in the differential diagnosis of prolonged amenorrhea in patients of reproductive age with a history of prior pregnancy. Moreover, symptoms related to metastatic involvement such as hematuria and flank pain may be among the first clinical manifestations of choriocarcinoma.
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    Prognostic Significance of Thrombocytosis in Patients with Locally Advanced Cervical Carcinoma Treated with Chemoradiotherapy
    (Brieflands, 2018-12-31) Nanda Ramanand; Shamsundar Sunkappa Dayashankara; Aradhana Katke; Thejaswini Boraiah
    Background: The outcome of chemoradiotherapy in patients with locally advanced cervical carcinoma is highly variable and depends on various prognostic factors. Objectives: The aim of this study is to evaluate the prevalence and prognostic significance of thrombocytosis in this group of the patients referred to our institution. Methods: Between January 2008 and December 2012, 195 patients with locally advanced cervical carcinoma (International Federation of Gynecology and Obstetrics (FIGO) stages of IIB-IIIB), treated with external beam radiotherapy (EBRT) to a dose of 45 Gy in 25 fractions along with concurrent chemotherapy (cisplatin 40 mg/m2), followed by HDR brachytherapy EQD2 of 30 Gy. The platelet counts were recorded pre-treatment and during treatment in all the patients. Results: Among the 195 patients, 101 (51.5%) belonged to stage IIB and 94 (48.5%) to stage IIIB. Thrombocytosis (platelet count > 400 × 109/liter) was seen in 31 (15.8%) patients. The overall survival in thrombocytosis group is 41%, which is significantly less than the overall survival of the non-thrombocytosis group, which is 62%. Conclusions: Thrombocytosis is not a frequent finding in patients with locally advanced cervical carcinoma in our population; however, when it is present, it is associated with poor outcome in terms of survival.
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    Correlation of Magnetic Resonance Spectroscopy Changes in Hippocampal and Perihippocampal Regions and Neuro-Psychologic Evaluation with Various Clinical Factors Following Whole Brain Radiotherapy in Brain Metastasis
    (Brieflands, 2019-11-04) Thimmaiah Naveen; Uday Krishna AS; Vezokhoto Phesao; Pasha Tanvir; V. Lokesh
    Objectives: To study the correlation of magnetic resonance spectroscopy (MRS) changes in hippocampal and perihippocampal regions and neuro-psychologic evaluation with various clinical factors following whole brain radiotherapy in brain metastasis. Methods: A total of 33 patients with newly diagnosed brain metastasis, referred to our Department of Radiation Oncology were recruited after a prior informed written consent. All patients underwent baseline clinical/neurological evaluation, detailed MMSE examination, gadolinium enhanced MRI along with MRS (for ratio of Choline: NAA = CNI) from the bilateral hippocampal and perihippocampal areas. All patients then underwent WBRT by two opposing lateral portals on a linear accelerator to a dose of 30 gray in 10 fractions delivered over 2 weeks. Serial evaluations along with MRS and MMSE score were done at 1st, 3rd and 6 months after WBRT. The trends of CNI and MMSE scores at last follow-up were correlated with various clinical factors. Results: Our cohort had 33 patients, predominantly women (M:F, 12:21) with a median age of 47 years, median KPS (Karnofsky performance status) of 80, mean RPA (recursive partitioning analysis) class 2, primary histology (lung, breast, GI, Gy, GU, MUO (metastasis of unknown origin): 10, 11, 2, 4, 4, 2). Median survival of the cohort was 4 months. At the end of 14 months of follow-up 30% of the patients were alive with a mean KPS of 70. Trend in the CNI values with time showed that, KPS (P = 0.079), RPA class (P = 0.079), primary diagnosis site (P = 0.049), number of brain metastasis (P = 0.045) showed statistical significance in terms of change in mean value of CNI value at last follow-up. Site of primary (lung/breast vs. others, P = 0.02) and number of metastasis (solitary/oligo vs. multiple, P = 0.02) showed significant correlation with decline in CNI. The KPS at presentation (< 70 or > 70, P = 0.04); RPA class (class II or higher, P = 0.04); Site of primary (lung/breast vs. others, P = 0.01), presence of extracranial disease (yes or no, P = 0.045), number of metastasis (solitary/oligo vs. multiple, P = 0.06), Size of the largest metastatic lesion (< or > 4 cm, P = 0.02) showed significant correlation with decline in MMSE at last follow-up. Conclusions: Cognitive functioning after WBRT is influenced by a number of factors; patient related, systemic disease burden and local tumor load. Local disease control has significant impact on preservation of neurocognition. The trend in the CNI index and MMSE scores at last follow-up correlated with various factors and can be used as a guide to aid in patient selection for hippocampus- avoidance WBRT.
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    Rhabdomyosarcoma in Uterine Cervix: A 30-Year-Old Tunisian Woman Case Report
    (Brieflands, 2022-12-31) Alia Mousli; Emna Boudhina; Ines Lasmar; Fadoua Bouguerra; Yosr Zenzri; Rim Abidi; Chiraz Nasr; Amel Mezlini
    Introduction: Rhabdomyosarcoma (RMS) is a rare and aggressive mesenchymal tumor arising from skeletal muscle cells. Although it is predominantly seen in children, it can also affect adults. RMS typically presents as a rapidly growing mass in the head and neck region, genitourinary tract, or extremities. Among these sites, cervical RMS is exceedingly rare and has only been reported in a handful of cases. Case Presentation: In this report, we present a case of cervical RMS in a 30-year-old woman diagnosed and treated at the Salah Azaiez Institute. We describe the clinical presentation, imaging findings, histopathological characteristics, and treatment modalities used in this patient's management. Additionally, we review the existing literature on cervical RMS to highlight the rarity of this entity and the challenges in its diagnosis and management. A 30-year-old woman with no pathological history suddenly presented with a cervical polyp with no other symptoms. On gynecological examination, a polypoid mass measuring 3 cm developed in the lower lip of the cervix. A surgery consisting of the cervical polyp removal was performed, showing at macroscopy several polypoid fragments measuring up to 1.5 cm, microscopically non-characterizable. Gynecologists opted for conization. Definitive histology concluded with an embryonic RMS with spindle cells (desmin+, myogenin+) of the uterine cervix with microscopically involved margins, resulting in the amputation of the whole cervix. The pelvic MRI showed no residual mass. The PET-CT did not find any hypermetabolic site. The tumor was classified as IA IRSG (Intergroup Rhabdomyosarcoma Study Group) favorable group (T1a according to the TNM classification), corresponding to the low risk of recurrence subgroup. Multidisciplinary reunion decided to treat with adjuvant chemotherapy based on 4 cycles of Doxorubicin and Ifosfamide and did not retain the indication of postoperative radiation therapy. Conclusions: Given the rarity of RMS in adults and the absence of standardized protocols for managing these tumors, a multidisciplinary decision is essential, and case reports remain highly relevant.
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    Meningeal Carcinomatosis in Bladder Transitional Cell Carcinoma
    (Brieflands, 2013-06-01) Ali Akhavan; Fariba Binesh; Fazlollah Ghannadi
    Meningeal carcinomatosis is a rare event in bladder transitional cell carcinoma. In this report, we present a man with transitional cell carcinoma who developed brain metastasis followed by spinal and leptomeningeal involvement.
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    Seroepidemiological Study of Epstein-Barr Virus in Patients with Head and Neck Tumors at Shahid Rajaee Hospital in Babolsar, Iran
    (Brieflands, 2020-12-31) Dariush Moslemi; Ali Bijani; Amrollah Mostafazadeh; Hamid Safiri; Akram Mohammadi Nokhandani; Mohammad Moslemi; Masoume Karimi
    Background: Epstein-Barr virus (EBV) is a herpes virus, which is the cause of infectious mononucleosis. Seroepidemiological studies show that more than 95% of adults in the world are infected with this virus. This virus is a modifying virus that is associated with some malignancies such as Burkitt lymphoma, tumors in HIV-infected patients, Hodgkin's lymphoma, head and neck tumors, and T-cell lymphoma. Objectives: This study aimed to determine the prevalence of EBV and its relation to the type of cancer in patients with head and neck tumors, which were treated in the years 2015 to 2016 at Shahid Rajaee Radiation Hospital in Babolsar. Methods: During one year, all patients with head and neck tumors were monitored, and finally, a total of 37 patients who had pathologically confirmed diagnoses were entered into the study after obtaining written informed consent. In this descriptive study, specific anti-EBV viral capsid antigen (VCA) immunoglobulin M (IgM) and IgG antibodies were evaluated using enzyme-linked immunosorbent assay (ELISA). Also, other patients' information was obtained from their records. Results: The mean age of the patients was 59 years, and the number of men (70.23%) was higher than that of women (29.77%). Regarding the histopathology information and the frequency of tumors, most of the patients had squamous cell carcinoma (SCC) (73%) in the sites of the nasopharynx (27.02%) and pharynx (18.91%). The results of the ELISA test showed that IgG antibodies were positive in most of the patients (86.5 %). About the relation between the sites of the tumors and the IgG antibody, all patients (100%) with nasopharyngeal, tongue, and lips cancers were positive while they were the least in pharyngeal cancer (5.4%). Conclusions: This study showed that a significant number of patients with head and neck tumors (86.5%) were infected with this virus, which indicates that EBV as a carcinogenic agent in head and neck tumors has a high prevalence in our society and requires preventive and therapeutic actions.
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    Radiation-induced Hypothyroidism in Survivors of Head-and-Neck and Breast Cancers After 3-Dimensional Radiation Therapy: Dose-Response Models and Clinical-Dosimetric Predictors
    (Brieflands, 2020-12-31) Aysan Mohammad Namdar; Homayoun Sadeghi-Bazargani; Mohammad Mohammadzadeh; Asghar Mesbahi
    Background: The prediction of normal tissue complications in treatment planning plays a critical role in radiation therapy of cancer. Objectives: The aim of the current study was to evaluate mathematical models and clinical-dosimetric variables for prediction of radiation-induced hypothyroidism (RHT) in patients with head-and-neck cancer (HNC) and breast cancer (BC). Methods: Clinical and dose-volume data from 62 patients treated with three-dimensional conformal radiation therapy were prospectively analyzed in terms of HNCs and BC. Thyroid function assessment was monitored by the level of thyroid hormones from patients’ serum samples. Cox semi-parametric regression models were used to predict the risk of RHT. Model performance and model ranking were evaluated in accordance with the area under the receiver operating characteristic curve (AUC) and Akaike’s information criterion (AIC), respectively. Results: Out of 62 patients, 17 persons developed RHT at a median follow-up of 11.4 months after radiation therapy. Thyroid volumes above the cut-off points of 14.2 cc and 11.4 cc showed a decrease in RHT risk for patients with HNC and BC, respectively. Moreover, the thyroid mean dose above the cut-off points of 53 and 27 Gy increased the risk of RHT for patients with HNC and BC, respectively. Simple and Multiple Cox regression analyses of the complete dataset revealed that thyroid volume and thyroid mean dose were the strongest predictors of RHT. According to AUC, Boomsma’s model, and the generalized equivalent-uniform-dose (EUD) model in the HNC dataset outperformed the BC dataset. Conclusions: The probability of RHT rises with an increase in the mean dose to the thyroid gland; however, it decreases with increasing thyroid gland volume. Regarding the AUC analysis, gEUD model showed an acceptable predictive performance; however, the logistic Boomsma’s model was somehow more effective in predicting RHT on the HNC dataset. Cella’s model revealed a relatively acceptable prediction of RHT on the BC dataset.
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    Primary Histiocytic Sarcoma, an Extremely Rare Neoplasm: Report of a Case Presenting as a Skin Lesion
    (Brieflands, 2020-08-09) Mohsen Esfandbod; Bahareh Shateri Amiri; Alireza Ghanadan; Reza Taslimi; Farid Kosari
    Histiocytic sarcoma (HS) is a very rare neoplasm of hematopoietic origin characterized by the proliferation of malignant cells that have the morphological and immunohistochemical features of mature tissue histiocytes, with only a few cases reported. Most patients with symptoms of the unilateral or multichannel disease are more involved with the intestines, skin, and soft tissues, palpable mass lesions, and compressions of adjacent organs, such as intestinal obstruction, or constitutional symptoms (e.g., fever and weight loss). In this study, we reported a 56-year-old man with a six-month history of a cutaneous plaque lesion on the left arm’s posterior surface. He underwent skin lesion biopsy, histopathologic examination, and immunohistochemistry that was compatible with histiocytic sarcoma. Since surgical resection not deemed appropriate, our patient underwent aggressive multiagent chemotherapy with six cycles of ICE (ifosfamide, mesna, carboplatin, and etoposide) regimen and radiotherapy. After the completion of chemoradiotherapy, the skin lesion was completely disappeared. The patient is currently coming to us for the follow-up without any recurrence of the disease.
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    Study of Lymphedema Risk Factors among Patients with Invasive Breast Cancer after the Initial Treatment
    (Brieflands, 2013-06-01) Hamid Saedi; Ali Taghizadeh Kermani; Monavar Afzal Aghaee; Taher Mottaghi; Shiva Moghadam
    Introduction: Upper limbs lymphedema is one of the rather common and debilitating sequels of breast cancer treatment. The incidence of this sequel has been reported in different sources to be from 25% to 38%. The purpose of this study was to evaluate the incidence and the risk factors of lymphedema following invasive breast carcinoma treatment.
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    Low Dose Radiotherapy for COVID-19 Pneumonia: A New Perspective for an Old Horizon
    (Brieflands, 2020-08-15) Ahmad Ameri; Nazanin Rahnama; Farzad Taghizadeh-Hesary
    This article does not have an abstract.
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    Examining the Outcome of Osteosarcoma: 10-Year Experience in a Referral Center South of Iran
    (Brieflands, 2021-12-31) Saeed Solooki; Yaser Mansoori; Mohammad Hadi Gerami; Seyed Arman Moein; Jamshid Jamali
    Background: Osteosarcoma is a primary and malignant bone tumor. Currently, using neoadjuvant chemotherapy, surgery, and appropriate adjuvant chemotherapy, long-term survival of more than 70% can be expected for patients affected by this disease. Therefore, the combination of different treatment methods increases the chances of saving the limb. Objectives: In this study we intend to share our 10-year experience in the management of osteosarcoma in Shiraz as the referral center of south of Iran. Methods: In this retrospective cohort study, 56 patients with osteosarcoma who were referred to Chamran and Namazi hospitals between 2008 and 2017, were included. Age, sex, site of involvement, presence of metastasis, treatment procedure, treatment outcomes, and survival time were studied. Kaplan-Meier method was used for survival analysis. Log rank test was applied for comparison of survival time according to sex. SPSS software version 25 (SPSS Inc., Chicago, US) was used for statistical analysis. Significance level considered P-value less than 0.05. Results: Among these patients, 33 were men 23 were women, with an average of 10 to 68 years old. In our study, distal femur was the most common site for osteosarcoma. Moreover, 44.6% of the patients undergone amputation. The best treatment results are in patients who received neoadjuvant chemotherapy followed by surgery. Finally, 77% of patients had a 2-year survival rate, and 57% had a 5-year survival rate. Conclusions: There has been a significant advancement in the treatment of osteosarcoma. A multifaceted approach to this disease, including surgery and chemotherapy has increased the possibility of better prognosis for this disease. Early diagnosis and appropriate treatment in the form of neoadjuvant chemotherapy, surgery with appropriate margin removal, and adjuvant chemotherapy are suggested for this tumor.
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    High-dose MRI-Guided Adaptive Radiation Therapy for Locally Recurrent Pancreatic Cancer
    (Brieflands, 2021-12-31) Yukihiro Hama; Etsuko Tate
    Introduction: The prognosis of recurrent pancreatic cancer is poor even after curative resection. There have been no reports of MRI-guided radiation therapy for locally recurrent pancreatic cancer after curative resection and chemotherapy. Case Presentation: A 66-year-old man with pancreatic cancer was referred to our institution for local recurrence after failure of surgical resection and second-line chemotherapy. He did not want to undergo further chemotherapy, so high-dose MRI-guided adaptive radiation therapy was performed in daily doses of 2.5 Gy to a total dose of 70 Gy over a period of 5.5 weeks. Three months after radiation therapy, the recurrent tumors disappeared and his CA19-9 level was within normal range without chemotherapy. There were no adverse events during treatment and three months of follow-up. Conclusions: High-dose MRI-guided adaptive radiation therapy may be safe and useful for locally recurrent pancreatic cancer.