Comparing the dosimetric characteristics of the electron beam from dedicated intraoperative and conventional radiotherapy accelerators

The specific design of the mobile dedicated intraoperative radiotherapy (IORT) accelerators and different electron beam collimation system can change the dosimetric characteristics of electron beam with respect to the conventional accelerators. The aim of this study is to measure and compare the dosimetric characteristics of electron beam produced by intraoperative and conventional radiotherapy accelerators. To this end, percentage depth dose along clinical axis (PDD), transverse dose profile (TDP), and output factor of LIAC IORT and Varian 2100C/D conventional radiotherapy accelerators were measured and compared. TDPs were recorded at depth of maximum dose. The results of this work showed that depths of maximum dose, R90, R50, and RP for LIAC beam are lower than those of Varian beam. Furthermore, for all energies, surface doses related to the LIAC beam are substantially higher than those of Varian beam. The symmetry and flatness of LIAC beam profiles are more desirable compared to the Varian ones. Contrary to Varian accelerator, output factor of LIAC beam substantially increases with a decrease in the size of the applicator. Dosimetric characteristics of beveled IORT applicators along clinical axis were different from those of the flat ones. From these results, it can be concluded that dosimetric characteristics of intraoperative electron beam are substantially different from those of conventional clinical electron beam. The dosimetric characteristics of the LIAC electron beam make it a useful tool for intraoperative radiotherapy purposes

The relationship of reproductive risk factors and histologic patterns with molecular subtypes of breast cancer

Background: The close link between molecular subtypes and different histological types of breast cancer has recently been taken into consideration. Objectives: The present study aimed at evaluating the reproductive risk factors in relation to molecular subtypes and histological features of breast cancer in a large group of Iranian patients. Methods: This historical cohort study was conducted on 1988 women diagnosed as different subtypes of breast cancers recruited in 2011 to 2016 from cancer research center in Shahid Beheshti University of Medical Sciences, Iran. Data on molecular markers were obtained from hospital files obtaining originally from immunohistochemical staining technique. Based on the pathological reports in hospital recorded files, the histological patterns of the cancer was also determined. The patients were followed for 5 years to assess the 5-year survival and compared the survival across the different molecular subtypes. Results: The highest mean age was found for the group with HER2-overexpression and the lowest for those with luminal A (P = 0.045). The most and the least tumor size was revealed in triple negative group and luminal A group, respectively (P = 0.035). The mean number of lymph nodes involved in breast cancer was significantly higher in luminal B subtypes compared to luminal A and triple negative subtypes (P = 0.004). The tumor stages III-IV were found in 31.6 of patients with luminal A subtype, 42.2 in patients with luminal B, 34.3 in patients with HER2 overexpression, and 26.0 in those with triple negative subtype (P = 0.006). The histological patterns of the tumor were powerfully different in terms of the molecular subtypes of tumor so that luminal A subtype was found more in ILC pattern, luminal B subtype was found more in DCIS pattern, HER2-overexpression subtype was revealed more in DCIS pattern, and triple negative subtype was found more in IDC pattern. Based on the long-term survival analysis, 5-year survival was found to be 98.3 in luminal A group, 98.3 in luminal B group, 100 in HER2 overexpression, and 98.1 in triple negative with no difference between different molecular subtypes. The lowest 5-year survival was found in the patients aged higher than 30 years at first pregnancy and live birth with triple negative subtype (survival rate of 75.0). The long-term survival was adversely associated with the tumor stage but independent to tumor molecular subtypes. Conclusions: Age at first live birth, tumor size, lymph node involvement, tumor stage, and histological pattern of breast cancer are linked to its molecular subtype. The lower long-term survival of breast cancer can be predicted by advanced age (especially in triple negative subtype) and by higher tumor stage independent to molecular subtype. © 2018, Cancer Research Center (CRC), Shahid Beheshti University of Medical Sciences

Investigating the health of resection margins for conducting intra operative radiotherapy during breast conservative surgery

To conduct radiotherapy during operation in treating the breast cancer through breast conservative surgery method, we must ensure the healthiness of resection margins during the operation. Then, electron ray is flashed to the surrounding tissues in order to reduce the chance of the presence of any microscopic cancer cells. The present research studies the ability of Frozen in diagnosing the health or involvement of margins during the operation and seeks to compare the results of Frozen with the results of gold standard (permanent pathology) diagnostic method in patients suffering from breast cancer who have undergone breast conservative surgery and Intra-operative radiotherapy. In this observational study conducted in the form of a retrospective research, some 496 patients suffering from breast cancer who have undergone breast conservative surgery were selected through the convenience sampling method and the results of breast margin pathologies conducted through Permanent and Frozen section were compared against one another so that we may find the sensitivities and specifications of the Frozen sections in comparison with the Permanent method. In the Frozen and Permanent methods, the margins had a freedom degree of 83.1 and 98 respectively. The sensitivity and peculiarity of the Frozen section as compared to the Permanent method were 80 and 84 respectively, however the negative predictive value was 99.5. A significant relationship was observed here based on chi square test. The level of accuracy was 84.3, and the pseudo negative weas 0.5. The compliance level of the Permanent and Frozen diagnostic methods was 84.3. It is therefore concluded that the Frozen section has a good degree of compliance in determining the state of margin of the removed cancerous lump in breast conservative surgeries and false negative reports have been issued for 0.5 of the cases. Thus, it is recommended to use the Frozen section before radiotherapy to determine the freedom of margins. � 2016, Oriental Scientific Publishing Company. All rights reserved

Prognostic factors of recurrence (Early and late) and death in breast cancer patients in Iranian women

Background: Breast cancer treatment success depends upon prolonging survival with effective treatment, and constant monitoring of recurrence. Survival rate can well be improved by better understanding of prognostic factors, preventive measures, and effective treatments together with follow-up and post-treatment care. Objectives: This study is aimed to know prognostic factors effective in recurrence and death in Iranian breast cancer patients. Methods: This is a retrospective study conducted by reviewing data acquired from 1604 female breast cancer patients who were admitted to Cancer Research Center at Shahid Beheshti University of Medical Sciences between October, 1982 and March, 2014. During the follow-up, after diagnosis, 313 patients experienced recurrence then were classified into two groups: early recurrence, less than 1 year and late recurrence after 5 years. We analyzed prognostic factors of recurrence in each groups and evaluated effective factors of death in this patients. Results: Median age of patients at diagnosis was 50 years. Median follow up time was 4.33 years (range: 0.005-24.9 years). Of these patients, 210 (67.09 ) and 76 (24.28), developed distant and loco -regional recurrence. Among 313 patients, 62 (21/60) and 69 (24/04) had early and late recurrence. In the univariate analysis, tumor grade, stage of disease, ER and PR status, axillary lymph node involvement and lymph vascular invasion were the prognostic factors affecting recurrence in patients, but in the multivariate analysis, ER/PR statuswasthemostimportant independent prognostic factor affecting the early recurrenceandstage of disease were prognostic factors in late recurrence. In all of the recurrent patients, 56.86 (178 individuals) survived and 43.13 (135 individuals) died at the end of follow-up period. The most important factors of death were histologic grade, disease free survival time, site of recurrence and age of disease. Conclusions: Biologic marker, estrogen and progesterone receptors status, had most influence in early recurrence, unlike late recurrence, stage of disease had a more important role. However, lymph vascular invasion has been an effective factor either in early or late recurrence. As a result of studying effective factors in death of these patients, recurrence site, DFS, pathologic grade and patients� age at the time of recurrence came to be effective. Knowing more about affecting factors on recurrence and the death of patients with recurrence, one can try to enhance survival and quality of life in patients by adopting more effective treatments. © 2016, Iranian Journal of Cancer Prevention

Dietary carbohydrate promotes cell survival in cancer via the up-regulation of fat mass and obesity-associated gene expression level

Cancer cells are mainly dependent on glycolysis for their growth and survival. Dietary carbohydrates play a critical role in the growth and proliferation of cancer and a low-carbohydrate diet may help slow down the growth of tumours. However, the exact mechanisms behind this effect are unclear. This review study aimed to investigate the effect of fat mass and obesity-associated (FTO) gene in the association between dietary carbohydrates and cancer. This study was carried out using keywords such as polymorphism and/or cancer and/or dietary carbohydrate and/or FTO gene. PubMed and Science Direct databases were used to collect all related articles published from 1990 to 2018. Recent studies showed that the level of FTO gene expression in cancer cells is dramatically increased and may play a role in the growth of these cells through the regulation of the cellular metabolic pathways, including the phosphoinositide 3-kinases/protein kinaseB (PI3K/AKT) signaling pathway. Dietary carbohydrate may influence the FTO gene expression by eliminating the inhibitory effect of adenosine monophosphate-activated protein kinase (AMPK) on the FTO gene expression. This review summarised what has been recently discovered about the effects of dietary carbohydrate on cancer cells and tried to determine the mediating role of the FTO gene in these effects. © Penerbit Universiti Sains Malaysia

Dopamine receptor gene (DRD1-DRD5) expression changes as stress factors associated with breast cancer

Breast cancer is the most common cancer among females worldwide and a most prevalent malignancy in Iranian women. Chronic stress may make an important contribution to cancer, especially in the breast. Numerous studies showed roles of neurotransmitters in the occurrence and progression of cancers which are mediated by their various types of receptors. This study was conducted to evaluate alterations in the expression profile of dopamine receptor genes in peripheral blood mononuclear cells (PBMC) as stress factors in breast cancer patients and the human breast cancer cell line (MCF-7). Peripheral blood samples were obtained from 30 patients and 30 healthy individuals. Total mRNA was extracted from PBMC and MCF-7 cells and RT-PCR was performed to confirm the presence of five dopamine receptors (DRD1-DRD5). Expression changes of dopamine receptor genes were evaluated by real time PCR. We observed that DRD2-DRD4 in PBMCs of breast cancer patients were increased compared to healthy individuals. In addition, all dopamine receptor subtypes but DRD1 were expressed in MCF-7 cells. Therefore, alterations of these receptors as stress factorsshould be assessed for selecting appropriate drugs such as D2-like agonists for treatment of breast cancer after performing complimentary tests. Determining the expression profile of dopamine receptor genes thus seems promising

Expression of EMSY, a novel BRCA2-link protein, is associated with lymph node metastasis and increased tumor size in breast carcinomas

Background: The EMSY gene encodes a BRCA2-binding partner protein that represses the DNA repair function of BRCA2 in non-hereditary breast cancer. Although amplification of EMSY gene has been proposed to have prognostic value in breast cancer, no data have been available concerning EMSY tissue expression patterns and its associations with clinicopathological features. Materials and Methods: In the current study, we examined the expression and localization pattern of EMSY protein by immunohistochemistry and assessed its prognostic value in a well-characterized series of 116 unselected breast carcinomas with a mean follow up of 47 months using tissue microarray technique. Results: Immunohistochemical expression of EMSY protein was detected in 76 of primary breast tumors, localized in nuclear (18), cytoplasmic (35) or both cytoplasmic and nuclear sites (23). Univariate analysis revealed a significant positive association between EMSY expression and lymph node metastasis (p value=0.045) and larger tumor size (p value=0.027), as well as a non-significant relation with increased risk of recurrence (p value=0.088), whereas no association with patients' survival (log rank test, p value=0.482), tumor grade or type was observed. Conclusions: Herein, we demonstrated for the first time the immunostaining pattern of EMSY protein in breast tumors. Our data imply that EMSY protein may have impact on clinicipathological parameters and could be considered as a potential target for breast cancer treatment

Epidemiology and histopathology of breast cancer in iran versus other middle eastern countries

Background: Breast cancer is the most prevalent cancer among females worldwide. This study compares the results of the most cited published Iranian studies and studies from other Middle East countries on breast cancer with data from the Ministry of Health and Medical Education and approximately 2000 cases from the Cancer Research Center of Shahid Beheshti Medical University of Iran. Methods: Data from the Cancer Registry System of the Ministry of Health and Medical Education and the Cancer Research Center were obtained in addition to data from other published Iranian articles to increase the accuracy of incidence, prevalence, disease burden, risk factors, clinical staging, clinical pathology, biological markers, clinical subtypes, and survival rate of breast cancer in the last decade and compare the epidemiological data with other areas of the world. Results: Overall, breast cancer was the most common cancer in Iran. The age-standardized rate for breast cancer was 33.21 per 100,000 according to the latest national databases. The mortality rate for breast cancer has not changed in the past 30 years in Iran. The age-standardized rate for mortality was 14.2 per 100,000 with a mean age of 49.84 years. The most common cancer in Iran is invasive ductal carcinoma. In our last review, 65.5-70.5 of cases were in the early stages (1 and 2) and less than 30 were in the advanced stages. The five-year overall survival rate was estimated at 72 in women and 60 in men. The stage and number of positive lymph nodes significantly affected the survival rate. In the Gulf Cooperation Council, ASR of the Kingdom of Saudi Arabia was (12.9), Bahrain (46.4), Kuwait (44.3), Qatar (35.5), United Arab Emirates (19.2), and Oman (14.4) per 100,000. Conclusion: Our study shows that epidemiology and histopathology of cancer is different with other neighborhood countries and is multi-dimension and needs multi-center involvement from government authorities, clinicians and scientists. © 2018, Shiraz University of Medical Sciences. All rights reserved

Cyclooxygenase enzyme and PGE2 expression in patients with functional and non-functional pituitary adenomas

Background: Pituitary adenomas as multifactorial intracranial neoplasms impose a massive burden of morbidity on patients and characterizing the molecular mechanism underlying their pathogenesis has received considerable attention. Despite the appealing role of cyclooxygenase enzymes and their bioactive lipid products in cancer pathogenesis, their relevance to pituitary adenoma pathogenesis is debated and yet to be determined. Thus, the current study perused this relevance. Methods: The expression level of the isoforms of cyclooxygenase (COX-1 and COX-2) was evaluated in hormone-secreting and in-active pituitary adenoma tumors and normal pituitary tissues through Real-Time PCR. The level of PGE2, as the main product of enzymes, was assessed using enzyme immunoassay kits in patients and healthy subjects. Results: The results of the current study demonstrated that COX-1 and COX-2 expression levels were increased in pituitary tumors including non-functional pituitary adenoma (NFPA), acromegaly, Cushing's disease and prolactinoma compared with normal pituitary tissues. A significant expression level of COX-2 was observed in NFPA compared with the other pituitary tumors. Furthermore, the COX-2 expression level was significantly increased in macroadenoma and invasive tumors. The level of PGE2 was consistent with COX enzymes enhanced in pituitary adenoma tumors compared with healthy pituitary tissue. A significant elevation in the PGE2 level was detected in NFPA compared with hormone-secreting pituitary tumors. Additionally, the PGE2 level was increased in macroadenoma compared with microadenoma and in invasive compared with non-invasive pituitary tumors. The diagnostic values of cyclooxygenase isoforms and PGE2 were considerable between patients and healthy groups; however, COX-2 revealed more value in distinguishing endocrinologically active and non-active pituitary tumors. Conclusions: Data from the current study provides expression patterns of COX-1, COX-2 and PGE2 in prevalent pituitary tumors and their association with patients' clinical features which may open up new molecular targets for early diagnosis/follow up of pituitary tumor growth. © 2020 The Author(s)