Waitlist mortality of young patients with biliary atresia:Impact of allocation policy and living donor liver transplantation

Patients with biliary atresia (BA) below 2 years of age in need of a transplantation largely rely on partial grafts from deceased donors (deceased donor liver transplantation [DDLT]) or living donors (living donor liver transplantation [LDLT]). Because of high waitlist mortality in especially young patients with BA, the Eurotransplant Liver Intestine Advisory Committee (ELIAC) has further prioritized patients with BA listed before their second birthday for allocation of a deceased donor liver since 2014. We evaluated whether this Eurotransplant (ET) allocation prioritization changed the waitlist mortality of young patients with BA. We used a pre-post cohort study design with the implementation of the new allocation rule between the two periods. Participants were patients with BA younger than 2 years who were listed for liver transplantation in the ET database between 2001 and 2018. Competing risk analyses were performed to assess waitlist mortality in the first 2 years after listing. We analyzed a total of 1055 patients with BA, of which 882 had been listed in the preimplementation phase (PRE) and 173 in the postimplementation phase (POST). Waitlist mortality decreased from 6.7% in PRE to 2.3% in POST (p = 0.03). Interestingly, the proportion of young patients with BA undergoing DDLT decreased from 32% to 18% after ET allocation prioritization (p = 0.001), whereas LDLT increased from 55% to 74% (p = 0.001). The proportional increase in LDLT decreased the median waitlist duration of transplanted patients from 1.5 months in PRE to 0.85 months in POST (p = 0.003). Since 2014, waitlist mortality in young patients with BA has strongly decreased in the ET region. Rather than associated with prioritized allocation of deceased donor organs, the decreased waitlist mortality was related to a higher proportion of patients undergoing LDLT.</p

Fluoride doping into SiO2-MgO-CaO bioactive glass nanoparticles: bioactivity, biodegradation and biocompatibility assessments

In this research, for the first time, the structure, bioactivity, biodegradation and biocompatibility of SiO2-MgO-CaO glasses doped with different levels of fluoride were studied. The glassy powder samples were synthesized by a coprecipitation method followed by calcination at 500 °C, where amorphicity and fluoride incorporation were verified by X-ray diffraction and Raman spectroscopy, respectively. The in vitro biomineralization and biodegradation of the samples were also investigated by electron microscopy, Raman spectroscopy and inductively coupled plasma optical emission spectrometry. These assessments revealed that there is an optimum level of fluoride doping to meet the highest bioactivity. Remarkably, the same level of incorporation presented the foremost biocompatibility with respect to osteoblast-like MG-63 human cells, as realized by the MTT assay and cell attachment studies

Concurrent Chemoradiation With Weekly Gemcitabine and Cisplatin in Locally Advanced Cervical Cancer

Background: More than 80 years, the standard treatment of locally advanced cervical cancer was radiotherapy. However, based on several phase III randomized clinical trials in the past decade, concurrent cisplatin-based chemoradiotherapy is the current standard of treatment for this disease. Gemcitabine has potent radiosensitizing properties in preclinical and clinical trials, so it can be utilized simultaneously with radiation.Methods: Thirty Women with untreated invasive squamous-cell carcinoma of the cervix of stage IIB to stage IVA were enrolled in the study in Radiation Oncology department of Imam Khomeini Hospital in Tehran from September 2009 to September 2010. Sixty mg/m2 gemcitabine followed by 35 mg/m2 cisplatin were concurrently administered with radiotherapy to the whole pelvic region on day one of each treatment week for five weeks One and three months after treatment, patients underwent a complete physical examination and MRI to determine the response to treatment.Results: The mean age of the participants was 58.13±11.83 (29-78) years. After 3 months of treatment, 73.3% had complete and 26.7% had partial response to treatment. Grade 3 anemia was seen in 10%, grade 3 thrombocytopenia in 3.3% and grade 3 leukopenia in 10% of the patients.Conclusion: According to the positive results of this study in stage IIB, further phase II and III clinical trials are suggested to evaluate the role of chemoradiation by gemcitabine in advanced cervical cancers

Comparison of pelvic lymph node coverage in conventional radiotherapy based on boney landmarks versus contouring radiotherapy in cervical cancer patients

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

Management policies of breast cancer surgery, chemotherapy and radiotherapy during COVID-19 outbreak in Iran

Objective: Introducing a modified guideline to save medical and human resources during COVID-19, and suggesting modifications to cancer treatment procedures during COVID-19 with the aim of reducing patients’ exposures to medical centers. Materials and Methods: Breast cancer management protocols were discussed among our colleagues in Cancer Institute of Tehran University of Medical Sciences through interactive applications (WhatsApp and Skype). We have provided the consensus of all opinions under relevant headings. Our recommendations will be modified as pandemic severity changes. Results: Surgery is restricted to patients whose survival is likely to be compromised if surgery is not performed. As for systemic therapy, we prefer to prescribe less toxic regimens and choose tri-weekly cycles instead of bi-weekly or weekly ones. In the case of radiotherapy, hypofractionated schedules are preferred schedules. Conclusions: COVID-19 pandemic put cancer patients, physicians, and health care systems in a challenging situation. All our colleagues agreed to choose less invasive and minimal interventions at this time because it is imperative to spare medical resources and workforce, and decrease patients’ contact with medical environments. We know that some of our suggestions may interfere with standard and routine practice, but our recommendations will be changed when COVID-19 pandemic severity changes

Neoadjuvant chemotherapy of epirobicin, oxaliplatin, capecitabine regimen in patients with advanced gastric cancer: a two year study

Background: Gastric cancer is an important health problem across the world. Chemotherapy in combination with local treatment is the standard treatment for locally advanced gastroesophageal junction (EGJ) cancers. The purpose of this study was to evaluate response and tolerability to neoadjuvant regimen combining epirobicin, oxaliplatin and capecitabin (EOX) in locoregionally advanced gastric cancer.Methods: We recruited 28 patients with histologically confirmed advanced gastric or EGJ adenocarcinoma in this study performed in the Cancer Institute of Imam Khomeini Hospital in Tehran, Iran in 2010-2011. Staging workup included chest and abdominal computed tomography (CT) scans, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), measurement of carcinoembryonic antigen (CEA), complete blood cell count (CBC), and liver and renal function tests. After three treatment cycles with EOX regimen, we evaluated response to the neoadjuvant chemotherapy by performing endoscopic ultrasonography (EUS) and chest and abdominal CT scans.Results: The mean age of the patients was 56.64±11.08 years (ranging from 37 to 78 years). Most patients were classified as having stage III (98.8%) cancer before chemotherapy while most were classified as stage II (57.14%) after the treatment. Only 28.5% of tumors were resectable before chemotherapy, but 82.1% of them were resectable upon the treatment. 75% of tumors were downstaged after chemotherapy.Conclusion: Regarding the acceptable response and downstaging of tumors and low toxicity of EOX regimen in locoregionally advanced gastric cancer, evaluation of this regimen as a neoadjuvant chemotherapy in larger phase III clinical trials in Iranian patients would be both necessary and logical

3-Dimentional radiotherapy versus conventional treatment plans for gastric cancer

&quot;n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The current standard of adjuvant management for gastric cancer after curative resection based on the results of intergroup 0116 is concurrent chemoradiation. Current guidelines for designing these challenging fields still include two-dimensional simulation with simple AP-PA parallel opposed design. However, the implementation of radiotherapy (RT) remains a concern. Our objective was to compare three-dimensional (3D) techniques to the more commonly used AP-PA technique.&quot;n&quot;nMethods: A total of 24 patients with stages II-IV adenocarcinoma of the stomach were treated with adjuvant postoperative chemoradiation with simple AP-PA technique, using Cobalt-60. Total radiation dose was 50.4Gy. Landmark-based fields were simulated to assess PTV coverage. For each patient, three additional radiotherapy treatment plans were generated using three-dimensional (3D) technique. The four treatment plans were then compared for target volume coverage and dose to normal tissues (liver, spinal cord, kidneys) using dose volume histogram (DVH) analysis.&quot;n&quot;nResults: The three-dimensional planning techniques provided 10% superior PTV coverage compared to conventional AP-PA fields (p&amp;lt;0.001). Comparative DVHs for the right kidney, left kidney and spinal cord demonstrate lower radiation doses using the 3D planning techniques (p&amp;lt;0.0001), the liver dose is higher (p=0.03), but is still well below liver tolerance.&quot;n&quot;nConclusion: Despite the department protocol using conventional planning, 3D radiotherapy provides 10% superior PTV coverage. It is associated with reduced radiation doses to the kidneys and spinal cord compared to AP-PA techniques with the potential to reduce treatment toxicity

Efficacy of gabapentin for the prevention of paclitaxel induced peripheral neuropathy: A randomized placebo controlled clinical trial

Neuropathy is a dose limiting side effect of taxanes which may impact the quality of life and treatment outcomes. This randomized placebo-controlled double-blinded clinical trial was carried out to assess the efficacy of gabapentin in preventing chemotherapy induced neuropathy. Women with breast cancer were randomized into two groups of paclitaxel chemotherapy with gabapentin 300 mg/three times a day orally or placebo for 2 weeks started at day 1 of each paclitaxel cycle. Two groups were compared based on the relative frequency of neuropathy and change in nerve conducting velocity (NCV). Twenty women were assigned to each study arm. The majority of the neuropathy in gabapentin group was grade 1 in all of the four cycles with no event of �grade 3 neuropathy in this group. Compared to the placebo, the rate of 2nd and 3rd grade neuropathy was significantly lower in the gabapentin group (P = 0.000). The change in NCV after four cycles of paclitaxel was significantly lower in the gabapentin group compared to the placebo group (17.7 vs 61.0 decline in NCV for sural and 21.9 vs 62.5 declines in NCV for peroneal nerve). Gabapentin given with paclitaxel is effective in the prevention of intermediate and high grade neuropathies both objectively and subjectively. © 2019 Wiley Periodicals, Inc

Neuroendocrine carcinoma of the tongue

Neuroendocrine carcinoma usually originates from lung. Few data exist in the literature regarding neuroendocrine carcinoma of the tongue. Patient data including history, surgical procedure, histology, and radiology investigations were collected and summarized. A 40-year-old woman was referred after partial glossectomy. Squamous mucosa with neoplasm and cells with round nuclei and light cytoplasm was reported in the tongue biopsy. Immunohistochemistry (IHC) staining was positive for cytokeratin, neuron specific enolase, synaptophysin and chromogranin and negative for leukocyte common antigen. This case showed a high proliferative activity (Ki-67 labeling index were 60). These IHC findings were in favor of poorly differentiated neuroendocrine carcinoma. After surgery, she received chemotherapy and chemoradiation. The diagnosis of neuroendocrine tumors in the present case is based on immunohistochemical markers and cellular shapes. Postoperative chemoradiotherapy is a critical element of therapy for head and neck high-grade neuroendocrine carcinomas, our patient received this treatment after surgery

A systematic approach introduced novel targets in rectal cancer by considering miRNA/mRNA interactions in response to radiotherapy

Background: The discovery of miRNA/mRNA interactions in several biological samples prompted the researchers to explore new biomarkers in tumors. Objective: We aimed to investigate the interactions of miRNA/mRNA in response to radiotherapy in the plasma samples of rectal cancer patients. Methods: Five microarray datasets related to cancerous and non-cancerous individuals were first used to construct networks. The databases of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were applied to analyze pathway enrichment. The plasma samples were then collected from 55 patients with recently diagnosed rectal cancer and 10 healthy subjects. For radiotherapy courses, the patients have consecutively received 30 sessions of local radiation for six weeks. At last, the expression of selected genes and miRNAs was experimentally measured before and after radiotherapy by qPCR, and the protein levels of the target genes were measured by ELISA assay. We evaluated the therapeutic responses based on the tumor regression grade of the Dworak classification. Results: We identified 5 up-regulated and 5 down-regulated miRNAs and 8 up-regulated and 3 down-regulated genes of the databases. There was a significant increase in tumor suppressor miRNAs, including miR-101-3p, miR-145-5p, miR-26a-5p, miR-34a-5p, and a significant decrease in oncomiRs, including miR-221-3p and miR-17-5p, after radiotherapy compared to the pre-treatment. Moreover, the up-regulated miR-17-5p and miR-221-5p and the down-regulated miR-101-3p and miR-145-5p were directly related to rectal cancer through the interaction with the Wnt, RAS, PI3K, and TGF-β signaling pathways. An analysis of receiver operating characteristics showed that miRNAs 221, 17, and 23 were response-related in locally advanced rectal cancer patients. ConclusionS: It seems that monitoring the miRNA/mRNA interactions during radiotherapy can be an appropriate diagnostic tool to track the recovery process and respond to standard therapies. © 2022 - IOS Press. All rights reserved