International Journal of Cancer Management

In Collaboration with Cancer Research Center (CRC), SBMU


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.

Peer Review Policy:

1) Double-Blind Peer Review System

2) Open Peer Review (since Aug 2019), Show List of All Published Reviewers' Comments


Recent Submissions

Now showing 1 - 20 of 1115
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    Microvessel Density Assessment and Related Factors in Patients with Endometrial Cancer: A Cross-Sectional Study
    (Brieflands, 2024-12-31) Maryam Talayeh; Rezvan Beheshti Roory; Noushin Afsahr Moghaddam; Salman Khazaei; Maryam Hosseini; Mliheh Arab; Farah Farzaneh; Fatemeh Hadi; Fatemeh Amiri
    Background: Studying microvessel density (MVD) as an angiogenesis indicator enhances insights into tumor diversity, predicting invasive or metastatic tendencies. It assists in tailoring treatment approaches based on angiogenesis expression in different tumors. Objectives: This study aimed at assessing MVD using the CD31 marker and its associated factors in individuals with endometrial malignancies. Methods: This cross-sectional study involved 118 patients with endometrial cancer (EC) at Imam Hussein Educational and Medical Center, Tehran, Iran spanning from 2018 to 2023. Data, gathered from patient medical files using a researcher-made checklist, included a quantitative assessment of angiogenesis using the CD31 endothelial marker for MVD. Linear regression models were utilized to identify predictors of MVD-CD31 in patients with EC. Results: Patients had a mean age of 57.35 ± 11.16 years. The overall mean MVD-CD31 was 157.06 ± 94.31 (range, 32 - 385). Those with over 50% invasion depth exhibited a higher MVD-CD31 (79.59 units) compared to those with no invasion depth (P = 0.003). Higher MVD-CD31 levels were also associated with lymph node involvement and metastasis to other organs (P < 0.001). In comparison to grade 1 tumors, grade 2 tumors showed elevated MVD-CD31 (mean difference: 64.85, P = 0.007). Clear cell carcinoma tumor type had significantly higher MVD-CD31 than low-grade endometrioid carcinoma (mean difference: 225.84, P = 0.005). Conclusions: Our results suggest that some tumor characteristics such as invasion depth, lymph node involvement, tumor grade, and tumor type may play a role in angiogenesis in patients with EC. These findings suggest that tumor features play a crucial role in modulating angiogenesis in EC.
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    Challenges of Truth-telling to Patients and Their Families: A Qualitative Study
    (Brieflands, 2024-12-31) Soore Khaki; Mohammad Ali Hosseini; Farahnaz Mohammadi-shahboulaghi; Gülbeyaz Can; Masoud Fallahi-Khoshknab
    Background: The issue of truth-telling by healthcare providers is critically important, and it has legal and ethical implications. Objectives: This study was conducted to investigate the perceptions and preferences of patients, families, and healthcare providers related to truth disclosure to identify barriers to this important aspect of communication. Methods: A total of 27 participants (4 patients, 7 family members, 4 physicians, and 12 nurses) were recruited by purposeful sampling. Data were collected through in-depth, semi-structured interviews and analyzed by qualitative thematic analysis. Results: Three main themes and eight sub-themes emerged from the data: (1) truth shock: Patient inability to face the truth, family inability to handle the truth; (2) secrecy during treatment and recovery: Withholding critical information from patients and families; family confusion about the patient’s condition; families preventing truth disclosure to the patient; family fear of the truth’s impact on the patient; and (3) patient's right to information: Lack of patient awareness of their rights; the importance of informing patients about their condition. Conclusions: The findings of this study suggest that healthcare providers can deliver bad news to patients and their families more effectively and satisfyingly using an approach based on culture, patient preferences, and ethical values
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    Assessing Analgesic Adherence and Influencing Factors in Saudi Cancer Patients
    (Brieflands, 2024-12-31) Taghreed Algthami; Waleed Kattan
    Background: As cancer incidences rise within the Saudi population, effective pain management remains a critical component of oncological care. Analgesic adherence is vital for managing cancer-related pain, yet it is often inadequately addressed in clinical practice, leading to diminished quality of life of patients. Objectives: This study aimed to assess the level of adherence to analgesic medications among Saudi cancer patients and to identify demographic and health-related factors that may influence adherence. Methods: In a cross-sectional study at King Abdulaziz Medical City, 132 oncology patients were sampled randomly. Data were collected through an online survey incorporating demographic queries and the Morisky Medication Adherence Scale (MMAS-8). SPSS 26 facilitated the statistical analysis, with descriptive statistics and Spearman’s Rho tests determining the significance of the findings. Results: Among participants, 52.2% were married, 51.5% were unemployed, and 80.4% reported substantial social support. Health insurance was prevalent among 79.5% of patients. Low adherence was observed in 94.6% of patients, with only 0.8% showing high adherence. The primary reasons for non-adherence included forgetting (54.5%) and fear of side effects (38.6%). Age and the number of medications were significantly correlated with adherence levels, highlighting the multifactorial nature of medication adherence in this patient population. Conclusions: The research highlights a concerning level of low adherence to analgesics among Saudi oncology patients, suggesting an urgent need for targeted interventions. Strategies to improve adherence should focus on education regarding the importance of pain management and addressing patients' concerns about medication side effects and dependency, as well as personalized medication management plans to accommodate the complexities of handling multiple medications. These findings are instrumental for oncology healthcare providers to optimize pain management strategies and enhance patient outcomes.
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    Continued Increase in Incidence of Kidney Cancer in Iran and its 31 Provinces
    (Brieflands, 2024-12-31) Mohammad Reza Nowroozi; Ehsan Mosa Farkhani; Kiavash Hushmandi; Erfan Amini; Seyed Ali Momeni; Seyed Hassan Inanloo; Laleh Sharifi; Saied Bokaie
    Background: Kidney cancer in adults includes malignant tumors originating from the parenchyma and pelvis and is the most lethal urogenital cancer. Available data in Iran indicate that the incidence and pattern of this cancer are changing. Objectives: Our study aimed to present an updated incidence rate of kidney cancer in Iran and its 31 provinces and their trends, and climate zones distribution of the disease. Methods: In this study, the age standard incidence rate (ASIR) of kidney cancer based on provinces, age groups, and gender has been calculated using the available data in the national cancer registration system of the Ministry of Health from 2003 to 2016. Results: Overall ASIR of kidney cancer was 1.28 per 100,000 from 2003 to 2016. ASIR of this cancer in men has increased from 0.96 in 2003 to 3.66 in 2016 and similarly, reached from 0.61 in 2003 to 2.24 in 2016 in Iran. Fars, Yazd, Tehran and Isfahan provinces had the highest ASIR in Iran. Hot climate zones are associated with a higher incidence of kidney cancer while moderate climate is linked to lower incidence rates in Iran. Conclusions: Although the incidence rate of kidney cancer in Iran and its provinces is low, the increasing trend is concerning particularly among men. Therefore, it is crucial to develop cost-effective screening tests and implement control and prevention programs in the high-incidence provinces.
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    Research Progress of Idiopathic Pulmonary Fibrosis Complicated with Lung Cancer
    (Brieflands, 2024-12-31) Hao Ruan; Zihui Zhang; Jiao Tian; Mingjiang Li; Ting Xiao
    Context: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic interstitial disease with unknown cause and pathogenesis. Idiopathic pulmonary fibrosis patients are more likely to be concomitant with lung cancer (LC) than normal older smoking men. Currently, there is no unified expert consensus on the diagnosis and treatment of IPF combined with lung cancer (IPF-LC) patients. Evidence Acquisition: We performed a computerized search of PubMed database with keywords: idiopathic pulmonary fibrosis complicated with LC and therapy. Results: Idiopathic pulmonary fibrosis is an independent risk factor for LC, and there are similar genetic mutations, epigenetic changes, and signaling pathways between IPF and LC. acute exacerbation of IPF (AE-IPF) poses a significant challenge in the treatment of IPF-LC patients, as surgery, chemotherapy, and targeted therapy may all trigger AE-IPF leading to patient death. The clinical benefits of anti-fibrotic therapy drugs such as nintedanib or combined therapy targeting lung fibrosis and LC are expected to outweigh adverse reactions. Conclusions: Combination therapy may be an effective strategy for treating IPF-LC in the future, and there is an urgent need to develop appropriate preclinical animal models and conduct more clinical studies to find safe and effective new strategies for treating IPF-LC.
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    Two-Stage Radical Cystoprostatectomy in a Complicated Patient: A Case Report
    (Brieflands, 2024-12-31) Mohammad Soleimani; Farzad Allameh; Navid Masoumi; Seyyed Ali Hojjati; Amir Alinejad Khorram
    Introduction: Radical cystectomy plays the main role in the treatment of muscle-invasive and high-grade bladder cancers; however, it still has significant rates of perioperative complications and mortality. The risk of complications is higher in elderly patients with multiple comorbidities. In certain patients, due to simultaneous comorbidities, it becomes challenging to perform long-term orthotopic radical cystectomy surgery. Case Presentation: In this article, we analyzed a 61-year-old man who was a candidate for radical cystectomy surgery due to muscle-invasive bladder cancer. However, due to simultaneous comorbidities and the lengthy surgery time, it was not feasible to perform orthotopic surgery in a single stage. Consequently, the patient's surgery was carried out in two separate stages. Conclusions: Conducting a radical cystectomy in two stages may aid in minimizing surgical complications, thus enabling patients to benefit from the advantages of urinary diversion through an orthotopic neobladder.
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    Out-of-pocket Health Expenditure and Factors Affecting Them in Breast Cancer Patients in Iran
    (Brieflands, 2024-12-31) Esmaeil Alizadeh; Leila Manzouri; Maryam Seyednezhad; Mohammad Akbari; Mohammad Moradi-joo
    Background: Breast cancer (BC) is the most common type of cancer among Iranian women. The cost of breast cancer treatment is high, and many families struggle to afford it. Objectives: This study was conducted with the aim of determining the out-of-pocket (OOP) health expenditure and factors affecting it in BC patients in Shahid Jalil Hospital affiliated to Yasuj University of Medical Sciences, Iran. Methods: This study was conducted in a cross-sectional descriptive-analytical way. Based on the inclusion criteria, the health expenditure of 82 patients with BC were collected. The data was gathered from Shahid Jalil Hospital, affiliated with Yasuj University of Medical Sciences. It includes inpatient and outpatient information from the Iran Health Insurance Organization, as well as patient-declared costs in 2022. The study data analyzed using descriptive statistics methods including frequency, percentage, mean and standard deviation, and stepwise linear regression to investigate the effect of variables on the amount of OOP health expenditure in SPSS 21 software. Results: The OOP expenses for BC patients accounted for 32.89% of the total direct medical expenses. Of the OOP costs, 47.18% were attributed to drug expenses, 16.19% to laboratory costs, 11.74% to imaging expenses, 11.20% to visit costs, 8.40% to hospitalization expenses, 2.84% to doctor’s services, and 2.45% to physical therapy-related expenses. Factors such as age, place of residence, occupation, education, and household income were among the factors that had a significant effect on OOP payments (P < 0.05). Marital status, housing situation, and social coverage had no significant effect on patients' OOP payments (P > 0.05). Conclusions: BC patients incur a lot of expenses, and about 32.89% of these expenses are OOP payments. It is essential for insurance organizations to increase their coverage, while also requiring additional support from the government for patients with breast cancer in obtaining necessary medication and medical supplies.
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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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    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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    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.