Is sentinel node mapping possible in surgically removed ectopic axillary breast cancer? A case report

We reported a 24-year-old female patient with the history of ectopic axillary breast cancer which was removed surgically. Sentinel node mapping was performed for lymphatic axillary staging of this patient with two injections of the 99m-Tc-phytate in both ends of the surgical scar. Lymphoscintigraphy showed an axillary sentinel node which was harvested during surgery and was not pathologically involved. Our case showed that sentinel node mapping is possible for ectopic axillary breast cancer patients even after excisional biopsy of the index lesion

Long term follow up of recurrent uterine cervical cancer: A Case Report

Background and Aim: Carcinoma of the uterine cervix is a significant cause of mortality because of malignancy in women. Radiotherapy is a major treatment modality for invasive cervical cancer with good treatment outcome in early-stage patients. However, substantial treatment failures still occur in the advanced-stage patients. In this case report a long term follow up of a 58 years old woman with stage II cervical squamous cell carcinoma (SCC), who was considered inoperable due to her general condition, cardiac poor function and ischemic heart disease (IHD) has been reported. After full dose external radiotherapy the patient became disease free till 6 years and after local recurrence, she was treated successfully with total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) as well as adjuvant chemotherapy with favorable results during a long term follow up of 14 years. It is concluded that long term favorable outcome may be achieved by intensive radiotherapy of uterine cervix SCC and probable recurrence could be managed successfully by surgical excision

Surgeons’ Errors in the Management of Patients with Cervical Cancer

Background and Aim: Generally, in patients with cervical cancer, careful preliminary evaluation is necessary for avoiding improper surgical procedures and making effective clinical decisions for treatment. The aim of this study was to determine surgeons’ errors, which necessitate a combination of surgery and radiotherapy for cervical cancer patients.    Methods: In this retrospective study, medical records of all cervical cancer patients, undergoing hysterectomy at tumor clinics of Ghaem and Omid hospitals, were collected from 1988 to 2008. In total, the medical records of 93 subjects with postoperative radiotherapy were examined. All records were assessed in terms of surgeons’ errors, patients’ follow-up after radiotherapy, rate of disease recurrence, and mortality rate. In addition, survival factors were recorded and assessed, and cumulative 3- and 5-year disease-free survival (DFS) rates as well as overall survival (OS) rate were determined by Kaplan–Meier test. Results: The overall rate of surgeons’ errors was 41%. The most common surgical error was improper surgical care due to surgeon’s lack of knowledge about the cervical cancer treatment. The 3-year DFS rates were 86% and 64% in cases without surgeon’s error and those affected by surgeon's error, respectively. In addition, the 5-year DFS rate was 53% in the non-affected group and 47% in cases affected by surgeon's error (P=0.05).      Conclusion: Pre-treatment evaluation as well as proper treatment is necessary for the prevention of adverse effects, caused by inappropriate surgical interventions. It is suggested that more time and attention be allocated to the improvement of surgical outcomes

A retrospective analysis of rectal and bladder dose for gynecological brachytherapy treatments with GZP6 HDR afterloading system

AimThe aim of this work is to evaluate rectal and bladder dose for the patients treated for gynecological cancers.BackgroundThe GZP6 high dose rate brachytherapy system has been recently introduced to a number of radiation therapy departments in Iran, for treatment of various tumor sites such as cervix and vagina.Materials and methodsOur analysis was based on dose measurements for 40 insertions in 28 patients, treated by a GZP6 unit between June 2009 and November 2010. Treatments consisted of combined teletherapy and intracavitary brachytherapy. In vivo dosimetry was performed with TLD-400 chips and TLD-100 microcubes in the rectum and bladder.ResultsThe average of maximum rectal and bladder dose values were found to be 7.62[[ce:hsp sp="0.25"/]]Gy (range 1.72–18.55[[ce:hsp sp="0.25"/]]Gy) and 5.17[[ce:hsp sp="0.25"/]]Gy (range 0.72–15.85[[ce:hsp sp="0.25"/]]Gy), respectively. It has been recommended by the ICRU that the maximum dose to the rectum and bladder in intracavitary treatment of vaginal or cervical cancer should be lower than 80% of the prescribed dose to point A in the Manchester system. In this study, of the total number of 40 insertions, maximum rectal dose in 29 insertions (72.5% of treatment sessions) and maximum bladder dose in 18 insertions (45% of treatments sessions) were higher than 80% of the prescribed dose to the point of dose prescription.ConclusionIn vivo dosimetry for patients undergoing treatment by GZP6 brachytherapy system can be used for evaluation of the quality of brachytherapy treatments by this system. This information could be used as a base for developing the strategy for treatment of patients treated with GZP6 system

A clinical trial of neoadjuvant concurrent chemoradiotherapy followed by resection for esophageal carcinoma

Background: Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma. Materials and Methods: Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated. Results: One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. There were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%. In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confidence interval, 24.46-63.54). Conclusion: The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high