Clinical management of metastatic melanoma suffered historically from a lack of effective targeted and immunotherapies due to short-lived clinical responses. Recent advances in our understanding of tumor-immune signaling pathways, discovery of immunosuppressive checkpoints, and subsequent development of antibodies that target these checkpoints reverses the situation to some extent. Two antibodies ipilimumab and nivolumab gained Food and Drug administration approval for the treatment of metastatic melanoma and target two major immunosuppressive checkpoints cytotoxic T lymphocyte antigen and programmed cell death protein 1 (PD-1), respectively. Nivolumab binds to PD-1, prevents PD-1 interaction with ligand Programmed death ligand 1 (PD-L1), and thus releases the T-cell exhaustion events (such as T cell apoptosis, decrease in T cell proliferation, etc.) leading to buildup of potent tumor-specific immune response. Successful Phase I–III results with remarkable antitumor activity and safety led to approval of nivolumab against ipilimumab refractory metastatic melanoma. Nivolumab therapy is exciting in that it not only provides substantial benefit but also provides durable responses. This review focuses on the evolution of immunotherapy leading to nivolumab approval and its potential in treating melanoma either alone or in combination with other therapies.

Context: Intraoperative consultation frozen section (FS) provides a surgeon background and management plan for surgery. Surgeons' and pathologists' coordination between each other including their departments' cooperation for FS management is very important. The role of FS in the intraoperative consultation is important. It is always advisable to consult an experienced histopathologist specially trained for CNS lesions for intraoperative consultation. Aims: Frozen section (FS) diagnosis provides surgeons, physicians, and pathologists a provisional diagnosis to plan out their management plan. By this study, we intended to evaluate the importance of intraoperative consultation-FS diagnosis in central nervous system (CNS) lesions. In this study, the diagnostic accuracy and the various limitations of using FS of CNS tumors were determined. Subjects and Methods: In this study, we analyzed retrospectively, the results of FS and final diagnoses of all CNS tumors were made at our institute for the duration of 1 year from July 2014 to June 2015. Ethical Standards: We all authors state that all human studies have been approved by the Institutional Ethics Committee. We all authors also gave our informed consent before their inclusion in the study. Details that might disclose the identity of the subjects under study have been omitted. Results: We studied 252 cases of age group from 1 to 76 years. Out of which, 155 (61.50%) cases had complete concordance between FS and final diagnosis, 77 (30.5%) cases had a partial concordance, and 20 cases (8.0%) were discordant. Considering the concordant and partially concordant cases, the accuracy rate was 92.0%, sensitivity was 93.42%, specificity was 91.66%, and positive and negative predictive values were 94.66% and 59.45%, respectively. Conclusions: A Kappa agreement score of 0.75 (substantial agreement score) showed high concordance for FS results with the permanent section. We came to the final conclusion that high sensitivity and specificity were seen with FS diagnosis in the CNS tumors.

Background and Objective: c-Jun an activator protein-1 transcription factor component is activated by a variety of extracellular stimuli. Overexpression of c-Jun has been implicated in the pathogenesis of several types of cancer including oral cancer. The aim of this study was to correlate the expression of c-Jun in the normal buccal mucosa (NM), oral submucous fibrosis (OSMF), severe epithelial dysplasia (ED), and well-differentiated squamous cell carcinoma (WDSCC). Subjects and Methods: Qualitative and quantitative expression of c-Jun was evaluated in a total of 60 histopathologically diagnosed cases, 15 each of NM, OSMF, ED, and WDSCC. The percentage of positive cells (Nuclear labeling index [nLI]) was considered for quantitative assessment and grading of staining for qualitative assessment. Results: The average nLI of c-Jun expression in NM, OSMF, ED, and WDSCC was 35.02%, 35.61%, 89.09%, and 83.31%, respectively. A statistical significant difference was found in c-Jun expression quantitatively between NM and ED (P = 0.000), NM and WDSCC (P = 0.000), OSMF and ED (P = 0.000), OSMF and WDSCC (P = 0.000), and ED and WDSCC (P = 0.021). Qualitatively, statistical significant difference was seen in an intense c-Jun expression between OSMF and ED (P = 0.000), OSMF and WDSCC (P = 0.032), and ED and WDSCC (P = 0.011). Conclusion: The overexpression of c-Jun in ED and WDSCC reveals its role in early carcinogenesis as evidenced in this study. Therefore, c-Jun might act in different mechanisms and pathways which lead to a malignant transformation in oral lesions.

Introduction: The relation between Behçet's disease (BD) and breast cancer (BC) is unclear. Our purpose is to investigate whether BD has an important effect on BC or vice versa. Patients and Methods: A total of 12 female BC patients with a diagnosis of BD were identified from a cohort including 5050 BC patients. The demographic data of the selected patients including previous chemotherapy (CT), radiotherapy (RT), hormonal therapy (HT), drugs used for BD, history of thrombotic events, and overall survival were examined. Results: The rate of BD in the entire cohort was found to be 0.25% (12/4800), and all had early BC at the time of BC diagnosis, with a median age of 47 years (range: 38–51). All patients underwent curative surgery for BC. In the adjuvant setting, CT, RT, and HT were administered in 11 (91%), 10 (83.4%), and 9 (75%) patients, respectively. All patients received acetylsalicylic acid and colchicine for BD. No serious adverse event associated with BC and/or BD was observed. Clinical symptoms in 11 patients with BD were observed to be improved following the BC treatment. Only one patient developed disease progression and then expired. Conclusion: Unlike the natural behavior of BD, which is well-defined to have an increased risk of thrombosis, BC patients with BD in this study did not have any adverse event. However, due to small sample size, it is difficult to drive any definite conclusion regarding the relation between these two pathologies.

Purpose: The study aims to estimate the differences in vaginal surface, bladder, and rectal doses when adjuvant intracavitary brachytherapy is carried out with ovoids or with vaginal cylinders, in postoperative carcinoma endometrium and to assess the difference in variability in organs at risk (OAR) doses and thereby the reproducibility of application in subsequent sittings. Materials and Methods: Fifteen patients each received vaginal brachytherapy with ovoid and cylindrical applicators. The dose received by 0.1 cc, 1.0 cc, 2.0 cc, 5.0 cc, and 10.0 cc volumes of the OAR, namely, bladder, and rectum were analyzed using independent t-test. Interfractional variation in dose to OAR was evaluated using a two-way repeated ANOVA test. The dose received by the upper 2 cm of vagina was assessed using volume receiving 100% (V₁₀₀) and dose received by 100% (D₁₀₀) for documenting dose distribution to the target volume. Results: The mean dose to rectum and bladder were significantly lesser with ovoids (P < 0.0001). This difference was seen in all volumes analyzed. V₁₀₀ (99.05% vs. 67.7%, P < 0.0001) and D₁₀₀ (95.70% vs. 53.08%, P < 0.0001) were significantly better with cylinders compared to ovoids. There was no statistically significant interfractional variation between sittings with either applicator. Conclusion: The two applicators studied have different dosimetric properties conferring specific advantages and disadvantages as far as dose to OARs and target is concerned. Both applicators provide good reproducibility. The choice of applicator would ultimately depend on the clinical outcomes of these dosimetric differences which need to be prospectively analyzed.

Background: Parotid-sparing intensity-modulated radiotherapy (IMRT) effectively reduces xerostomia in head-and-neck cancer (HNC). Changes in the salivary output at 1 year were studied and correlation with quality of life (QOL) changes in patients of locally advanced HNC (LAHNC) was drawn. Materials and Methods: Between October 2009 and October 2011, 20 patients of LAHNC were treated with IMRT using simultaneous integrated boost technique. High-risk clinical target volume (CTV) was given a dose of 66 Gy/30 fr, intermediate-risk CTV 60 Gy/30 fr, and low-risk CTV 54 Gy/30 fr. The saliva flow rate was estimated for 5 min at rest (unstimulated) and after using lemon drops (stimulated) for the next 5 min, at baseline (pretreatment), and 3, 6, and 12 months following treatment. Evaluation of patients' perception of dry mouth was done using EORTC-QLQ-C30 and HN35 questionnaires at the same time points. Results: Baseline unstimulated and stimulated salivary flow rates were 0.659 ml/min and 1.69 ml/min, respectively. At 3 months, a significant reduction in unstimulated (0.346 ml/min) and stimulated (0.80 ml/min) flow rate was observed. Unstimulated flow rate continued to decrease further till 6 months (0.295 ml/min), but slight improvement was seen in stimulated flow rate (0.91 ml/min). At 12 months, minimal recovery was observed in both unstimulated (0.362 ml/min) and stimulated flow rates (1.09 ml/min). EORTC-QOL questionnaire mean scores for dryness and stickiness of saliva were 10 and 15 at baseline and increased to 36 and 25, respectively, at 3 months. At 6 months, symptom score for dryness further increased to 45 and then decreased to 33 at 12 months. Stickiness score remained static from 3 to 12 months. Salivary flow rate correlated well with dry mouth (P < 0.05) but not with the perception of sticky saliva (P = 0.82) at 6 months and beyond. Conclusions: Both salivary flow rate and xerostomia-related questions worsened at 3 months even with IMRT and showed a similar pattern of recovery.

Purpose: Glioblastoma (GBM) is characterized by early relapse and mortality. Treatment resistance could be a characteristic exhibited by pro-genitor neoplastic cells that reside in the subventricular zone (SVZ). This retrospective study was conducted to assess the correlation of SVZ doses and survival in patients with GBM. Materials and Methods: Forty-seven patients with GBM treated with radiotherapy, concurrent and adjuvant temozolomide therapy, and whose dosimetry data were available were included. The ipsilateral and contralateral SVZs were delineated on co-registered magnetic resonance imaging-computed tomography images as a 5-mm margin along the lateral wall of the lateral ventricles. Median radiotherapy dose prescribed was 59.4 Gy. The mean ipsilateral, contralateral, and bilateral SVZ doses were 56.3 Gy (range 33–63 Gy), 50.4 Gy (range 23–79 Gy), and 52 Gy (28–69 Gy). The progression-free survival (PFS) and overall survival (OS) were calculated from the date of surgery to the date of radiologic and/or clinical progression and death/last follow–up, respectively. Survival probability was estimated using the Kaplan–Meier method. Log-rank test was used to test the significance between groups. Cox proportional hazards analyses were used to identify prognostic factors. Results: At a median follow-up of 19 months, all patients had relapsed. Most recurrences were infield (n = 39). The median PFS and OS were 17 and 19 months, respectively. The PFS and OS at 2 years were 36.2% and 21.3%, respectively. Patients who received ipsilateral SVZ dose of ≥56 Gy appeared to have better but nonsignificant median PFS and OS. Patients receiving contralateral SVZ doses ≥50 Gy showed a similar trend. Only the number of adjuvant temozolomide (≥6 cycles) showed prognostic impact. Conclusion: This retrospective study indicated a trend toward improved–albeit nonsignificant–survival with higher dose to the ipsilateral and contralateral SVZs. A well-designed prospective randomized study is required to identify patients who would benefit from intentional SVZ targeting.

Purpose: Carcinoma cervix is the most common malignancy affecting women in developing countries. Radical radiotherapy is the mainstay of treatment in more than 90% of patients. The present study is a dosimetric and logistic comparison of various techniques of radiotherapy, namely two-dimensional conventional radiotherapy (2DCRT), three-dimensional conformal radiotherapy (3DCRT), and intensity-modulated radiotherapy (IMRT). Methods: All the patients underwent contrast-enhanced computed tomography (CT) scans for simulation. 2DCRT, 3DCRT, and IMRT plans were generated in 24 patients and dosimetrically compared. Radiotherapy treatment time involved in each technique was analyzed in 27 treated patients. Results: The planning target volume (PTV) coverage was best in 3DCRT technique with a median coverage of 99.9% as compared to IMRT (99.3%) and 2DCRT (82.2%). There was progressive sparing of all the organs at risk in IMRT as compared to 3DCRT. The total planning time was longest in IMRT (332.1 min) and shortest in 2DCRT (11.7 min). The mean treatment time for the delivery of each fraction of 2DCRT, 3DCRT, and IMRT were 14.3, 13.6, and 24.7 min, respectively. Conclusion: 3DCRT technique is the most optimal technique for radical radiotherapy of cervical cancers with optimum PTV coverage, acceptable planning time, and minimal treatment time as compared to IMRT. 2DCRT technique should be limited to the setting where CT simulation is unavailable.

Aim: The aim of this study was to measure entrance skin dose (ESD) on the breast of patients who had undergone radiotherapy following surgery, in the presence and absence of bolus. Materials and Methods: In this study, the ESD on the breast of 22 female patients was measured using thermoluminescent dosimeter-100 chips. For each patient, the ESD was measured 3 times (once without bolus and twice using bolus). The bolus types used in this study include super flab and wax. Results: The average ESDs on the breast of patients (from both medial and lateral tangential fields) in the presence of the super flab bolus and absence of bolus were 225.8 and 148.17 cGy, respectively, that when using the bolus, around 52% increasing in ESD was observed. The results showed a significant relationship between the ESD on the breast of patients and bolus types (P = 0.002); in addition, correlation coefficient between the two boluses (super flab and wax) was 0.615 (r = 0.615). Conclusion: When using the bolus in postmastectomy irradiation, it is noted that in dose delivery to the chest wall, surgical scar or skin of the treated region should be considered. The use of the bolus as a substance that increases of the skin dose can sometimes cause an excessive increase in skin dose that may cause severe skin reactions and underdosing of underlying tissues. Furthermore, using wax bolus in regions that do not require a lot of shaping of bolus is affordable.

Aims and Objectives: This study aims to study the effect of geometric- and patient-related variables in achieving the desired dose-volume constraints to parotid for patients undergoing definitive/adjuvant intensity-modulated radiotherapy (IMRT) for head and neck squamous cell carcinomas (HNSCC). Subjects and Methods: This retrospective study considered HNSCC patients who underwent IMRT at our center between 2009 and 2014. Patients' details and dose-volume parameters were collected, and correlated with dose to parotids using Pearson's correlation test. Results: Sixty-seven patients were found to be eligible. Oral primary predominated (37.3%) and 53 (79%) had locally advanced disease. The parotid volume (PV) had no impact on mean dose. There was a negative linear correlation between the ratio (Parotid-planning target volume [PTV] overlap)/PV and mean dose to the whole parotid (y = 1.14-0.011×; R2 = 0.509; P = 0.001), suggesting that a ratio of 0.7 resulted in mean dose ≥ 40 Gy and potentially irreversible xerostomia. No association was found between site of primary and parotid dose, but node-positive (N+) patients received significantly higher dose compared to N0 patients (34.5 Gy vs. 29.5 Gy; P = 0.001). N + patients persisted to receive higher dose even when T stage was accounted for (32.5 Gy vs. 28.9 Gy for </= T2, 35.4 Gy vs. 30.1 Gy for > T2; P = 0.003). On the last follow-up, 35 patients (52%) had >/=Grade II xerostomia. Average mean dose to combined PV was higher in patients with > grade I xerostomia compared to patients with </=Grade I (35 Gy vs. 29 Gy; P = 0.01). Conclusion: The degree of PTV overlap with parotid (≥30%) and N + disease are the strongest predictors of poor parotid sparing by IMRT.

Aim: Cytological detection of peritoneal-free gastric cancer cells is considered as the gold standard with variable sensitivity. Seeding of cancer cells after radical surgery for gastric cancer is a controversial issue. In this study, it was aimed to detect the rate of positive peritoneal washing cytology and the incidence of spreading of tumor cells after radical surgery. Materials and Methods: Patients with pathologically proven and surgically treated gastric adenocarcinoma were enrolled. Three peritoneal washing samples were examined cytologically: at the beginning, after completion of resection, and before closure of the abdomen. Identification of peritoneal-free gastric cancer cells was regarded as the main outcome. Results: Thirty-four patients with a mean age of 60.7 ± 12 years were enrolled. T3 and N0 were the most common stages seen in 16 (47%) and 12 patients (35.3%), respectively. There were two positive results (5.9%) as the first peritoneal sample. Considering T3- or N-positive patients, the incidence increased to 9.1%. There was no conversion of negative to positive cytology. Cytological positivity remained only in one case (2.9%) after the second and the third peritoneal samples. Conclusion: Rate of positive peritoneal washing cytology in patients with gastric cancer is influenced by clinicopathological findings and the technique used. Use of cytology alone is thought to be failed to detect free cancers cells within the peritoneal cavity.

Aim of Study: Computer-based data applications increase the efficiency, ease to access of data, and tidiness, especially in the modern radiotherapy centers. A computer application program is presented here which replaces archaic paper-based daily log (Log Book), quality assurance, and quality control (QA/QC) documentation. Materials and Methods: QALOG-Pro program is installed on an http://server and accessed using wire free (WiFi) network and run on a tablet device. The web browser is used to run this program on the tablet device, and the data is stored on the server. The linear accelerator (LINAC) history of events and QA/QC test results are entered under activity menu. Results: The program can produce reports of the data of activities in the available reports menu; this allows the user to view the various activities on machine. The “calculate” menu gives the total time between the failures and total time to repair also called uptime and downtime, respectively for an equipment and is viewable in a Pie chart display. View menu lists all the available equipments and scheduled activities. The “administrator” and “manage data” menu is accessible for a system administrator to manage various administrator activities and data management. Conclusion: QALOG-Pro helpful to the Radiation Oncology Department in managing LINACs by recording the events of the machine under a daily log and to calculate uptime and downtime of the machine. This application will help the radiotherapy centers or clinics to eliminate printed versions and walk toward paperless for day-to-day log and QA/QC information recording and administration.

Background: Postoperative delirium is described as one of the most common complications for elderly patients with unknown pathophysiological pathways. In this present study, we analyzed the clinical and biochemical parameters in elderly patients with or without a delirium after open abdominal surgery to investigate the possible predicative factors for a delirium. Materials and Methods: Patients aged ≥60 years scheduled to undergo elective gastrointestinal tumor resection via laparotomy from July 2012 to June 2015 were enrolled in this study. Demographic and clinical data, characteristics of the surgical and anesthetic procedure, biochemical parameters were compared between patients with or without a delirium. Multivariate logistic regression testing was used for the evaluation of independent risk factors for postoperative delirium. Results: Overall, 112 participants were enrolled in this study, 49 of which were diagnosed with postoperative delirium. Patients with a delirium had an older age (P = 0.013) and a lower Mini-Mental State Examination (MMSE) score (P < 0.01) compared with those patients who had no delirium. The duration of surgery and anesthesia, the levels of neopterin, C-reactive protein, interleukin-6, insulin-like growth factor-1 in patients with a delirium were significantly higher than those without a delirium (P < 0.05). Independent risk factors in the logistic regression for postoperative delirium were the levels of neopterin and MMSE scores. Conclusions: Our present study suggested the potential roles of neopterin and MMSE scores in the pathophysiology and prediction of delirium in elderly patients after open abdominal surgery.

Background: Golgi protein 73 (GP73) is a potential serum marker for the diagnosis of hepatocellular carcinoma (HCC). However, the diagnostic value of GP73 for HCC remains controversy, and little is known about the relationship between serum GP73 concentration and clinical characteristics of HCC. This study was designed to analyze the clinical values of GP73 in diagnosing HCC and the relationship between GP73 level and clinical characteristics in HCC patients. Materials and Methods: In this study, a total of 443 serum samples including 180 patients with HCC, 61 patients with liver cirrhosis (LC), 99 chronic hepatitis patients, and 103 healthy individuals were enrolled from November 2011 to April 2013. Enzyme-linked immunosorbent assay and chemiluminescent immunoassay were used to detect the serum level of GP73 and other biomarkers. Results: GP73 level in HCC group was significantly higher than LC group, chronic hepatitis B group, and healthy control group. In HCC group, GP73 level significantly increased in patients with lymphatic metastasis; moreover, GP73 level in Child–Pugh Class B and C groups was statistically significantly higher than that in Child–Pugh Class A group (P < 0.05). The area under the receiver operating characteristic (AUROC) curve of GP73 and alpha-fetoprotein (AFP) was 0.840 and 0.718, respectively, when diagnosing HCC. Moreover, the AUROC curve by use of the combination of GP73 and AFP was 0.903. The differences among these three aspects were statistically significant (P < 0.05). Conclusion: GP73 was better than AFP for the diagnosis of HCC, and the expression of serum GP73 is related with the clinical characteristics of HCC patients.

Introduction: Immobilization of patients in radiation therapy can be performed with a vacuum bag (VB). The aim of this study is to measure the effect of the VB in the surface and depth dose of patients in radiation therapy. Materials and Methods: The effect of the VB on the surface dose and depth dose is measured in clinical conditions. Various dosimeters were used in following measurements: parallel plate chamber for depth dose, farmer ionization chamber for various gantry angles, and Mapcheck2 dosimeter for various thicknesses of VB. The effect of VB cap, which may be placed in the beam path, is also measured using EDR2 film. The measurements were performed for 6 MV and 18 MV photons with an Oncor linac. Results: The increase of 30% and 25% in the surface dose with VB was observed for 6 MV and 18 MV, respectively. Though due to the use of VB, the reduction of the absorbed dose at a 5 cm depth is under 1% and can be ignored in MU calculation. For various thicknesses of VB, 8–14 cm, the attenuation of the primary beam were up to 2.5% for 6 MV and 1.2% for 18 MV photon. The presence of VB cap in the path of radiation reduced the depth dose up to 15% and 11% for 6 MV and 18 MV, respectively. Conclusion: The use of VB can increase the surface dose of the patient up to 30% and this fact should be considered in treatment planning. For some lateral fields the cap of the VB may interfere with radiation field. If the cap of VB is placed in the beam path, it can cause a cold spot in tumor. Discussion: The use of VB can increase the surface dose of the patient up to 30%. For some lateral fields, the cap of the VB might interfere with the radiation field. If the cap of VB is placed in the beam path, it can cause a cold spot in the tumor volume.

Introduction: Keloids are characterized by collection of atypical fibroblasts with excessive deposition of extracellular matrix components. Keloids are prone to high recurrence (50%–80%) with unimodality treatment. Radiation is a promising approach among the adjuvant modalities in vogue though consensus is lacking on dose-fractionation schedule. Aim: The present study aimed to analyze the efficacy of single-fraction high-dose adjuvant radiotherapy to prevent keloid recurrence. Materials and Methods: Details of patients treated for keloids using external beam radiation therapy from January 2011 to December 2016 were retrieved from electronic medical records and radiation therapy charts and analyzed. Results: Thirty-seven keloid lesions in thirty patients were analyzed. Keloids received radiation within 24–72 h postsurgery using 6 MeV electron beam. 45.9% of keloids were in the chest wall. Dose ranged between 5 Gy and 12 Gy in 1–3 fractions. Eight Gy was used in 78.4%. The single fraction was preferred in 91.9%. Good cosmesis was achieved in all except three who had wound dehiscence. Median follow-up was 32.67 months. 16.2% had recurrence. Median time to recur was 13.6 months, and median recurrence-free interval 21.23 months. Among those who received 8 Gy single fraction, 73.4% remained recurrence-free at 5 years. Conclusion: Albeit a retrospective analysis, ours is the only study in literature offering 8 Gy single dose, using electrons, as a postoperative adjuvant treatment to prevent recurrence in keloids. Our recurrence rates were similar to that quoted in published series. This hence can be validated in further studies as it is cosmetically acceptable, safe, painless, and cost-effective with good patient compliance.

Aim of Study: Prostate cancer (PCa) is one of the most common cancers among men and has become a significant health problem in developing and developed countries. Prostate-specific antigen (PSA) is a useful marker for screening and monitoring the patients. In this study, the author aimed to detect the prevalence of PCa among Turkish patients who underwent prostate biopsy with PSA level of <:100 ng/ml. Materials and Methods: The patients who underwent prostate biopsy between January 2008 and January 2015 were reviewed retrospectively. The clinical data that include age, PSA level, and biopsy results were recorded. The patients were divided into five groups according to the PSA levels; ≤4, 4.01–10, 10.01–20, 20.01–50, and 50.01–100 ng/ml. Results: There were 1609 patients in this study. Of these patients; 181, 914, 345, 129, and 40 patients had a PSA level of ≤4, 4.01–10, 10.01–20, 20.01–50, and 50.01–100 ng/ml, respectively. The patients' ages and PSA levels were between 40 and 89 years with a median of 62 ± 8.32 years and between 0.3 and 100 ng/ml with a median of 7.40 ± 12.97 ng/ml. PCa prevalence increased from 13.25% to 82.5% in the patients with a PSA level of ≤4 and 50.01–100 ng/ml. Conclusion: Western populations have more common PCa than Asian men. The studies showed the PCa prevalence for Turkish men was higher than Asian and less than Western origins. Prevalence of PCa was increased with PSA level rising, and this prevalence is between Western and Asian origin similar in the literature.

Objective: The objective of this study was to perform a systematic review and meta-analysis to evaluate the two most commonly used chemotherapy regimens gemcitabine plus cisplatin (GC) and methotrexate, vinblastine, doxorubicin/adriamycin, and cisplatin (MVAC) regimens for muscle-invasive bladder cancer (MIBC) patients. Methods: We searched for all studies investigating GC and MVAC for MIBC patients in PubMed, Web of Knowledge, and the Cochrane Central Search Library. A systematic review and meta-analysis were performed. Results: Our searches identified 13 studies among 2174 patients. In the meta-analysis, the pathological complete response to GC regimens was superior to MVAC regimens. No significant difference in pathological partial response was found between the two groups. GC regimens were associated with a significant decrease risk in Grade 3–4 neutropenia, mucositis, and febrile neutropenia, but a significant increase risk in Grade 3–4 thrombocytopenia. There was no significant difference in overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) when compared GC regimens to MVAC regimens. Conclusions: GC regimens significantly improved pathological complete response compared to MVAC regimens. GC regimens were associated with a significant decrease risk in Grade 3–4 neutropenia, mucositis, and febrile neutropenia, but a significant increase risk in Grade 3–4 thrombocytopenia. There was no significant difference in OS, DSS, and DFS when compared the two regimens.

Objective: This study aims to investigate the distribution of HLA-A genes and identify alleles related to cervical cancer. Materials and Methods: A total of 252 cervical cancer patients (56 Han ethnic and 196 Uyghur ethnic) and 213 controls (103 Han ethnic and 110 Uyghur ethnic) were recruited in this study. HLA-A alleles were examined by polymerase chain reaction with sequence-specific primers. The frequencies of different HLA-A alleles were compared between the two ethnic groups as well as patients and controls. The correlation of HLA-A frequencies with various clinical characteristics and short-term treatment efficacy was analyzed. Results: (1) Significantly higher frequencies of HLA-A*03:01 and HLA-A*03:02 and lower frequencies of HLA-A*11:01, HLA-A*24:02, and HLA-A*30:01 were observed in the Uyghur control groups than in Han control groups (P ≤ 0.05). (2) The frequency of HLA-A*01:01 in patients was significantly higher than controls. In contrast, the frequencies of HLA-A*30:01 and HLA-A*33:03 were lower in patients (P ≤ 0.05). (3) The frequency of HLA-A*30:01 in Han patients was lower than Han control group (P ≤ 0.05). However, there was no statistically significant in the frequency of HLA-A between Uyghur patients and controls (P > 0.05). (4) There was no significant association between HLA-A alleles and HPV16 or squamous cell carcinoma antigen levels (P > 0.05). (5) The frequency of HLA-A*30:01 allele in complete response + partial response group was higher than stable disease + progressive disease group (P ≤ 0.05). Conclusions: People from two ethnic groups displayed different HLA-A gene distribution. HLA-A*30:01 and HLA-A*33:03 alleles are the protective factors to cervical cancer patients from Xinjiang while HLA-A*01:01 serves as the susceptible gene.

Purpose: Glioblastoma multiform (GBM) is one of the most common brain tumors. Surgery, radiation therapy, hyperthermia, and chemotherapy are the most common treatments for brain tumors such as GBM. This study investigated the cytogenetic damage caused by hyperthermia, radiation (6 MV-X-rays), and topotecan in glioma spheroids, simultaneously and separately. Materials and Methods: Human glioblastoma cell line was cultured to form spheroids 350 μm in diameter that were arranged in eight groups and coded as follows: control, T: topotecan, H: hyperthermia, T + H: topotecan + hypertermia, X 1–10: X-ray with 1–10 fraction irradiation, H + X (1–10): hypertermia + X-ray with 1–10 fraction irradiation, T + X (1–10): topotecan + X-ray with 1–10 fraction irradiation, and H + T + X (1–10): hypertermia + topotecan + X-ray with 1–10 fraction irradiation. DNA damage was then evaluated using clonogenic assay. Results: The effect of combined treatment with X + H + T was greater than the sum of the effects in other groups. In H + T + X group, failure to form colonies was observed in the seventh session. Conclusion: Use of X + H + T combination therapy significantly increased cell death and possibly improved the treatment. This suggests that the synergistic effect of different therapeutic methods increased cell death in glioblastoma tumor cells and reduced the necessary dose of radiation in the treatment of tumor in radiation therapy.

Aim: Although several associations were found between Dicer rs3742330 single nucleotide polymorphism (SNP) and development and prognosis of some epithelial cancers, relationship between the SNP rs3742330 and endometrial cancer (EC) has not yet been studied. We aimed to investigate the prognostic role of rs3742330 SNP of Dicer gene in EC patients. Subjects and Methods: A total of 80 EC patients and 80 control subjects included in the study. Real-time polymerase chain reaction and the allele discrimination technique was used for genotyping of rs3742330 SNP. Results: There was no significant difference between EC patients and control subjects with regard to the genotype and allele frequencies for Dicer rs3742330 SNP (P > 0.05). Despite Dicer rs3742330 SNP had no prognostic value in terms of stage, grade, lymphovascular invasion, myometrial invasion, tumor size, and histopathology; malignant peritoneal cytology has been detected higher in the patients bearing AA genotype compare with AG genotype (P = 0.023). Higher recurrence rate and shorter time to recurrence were found in patients bearing AG and GG genotype compare with AA genotype (P = 0.009). Conclusion: Dicer rs3742330 AG and GG genotypes may have the potential to be used as a predictor of poor prognosis in the management of EC case.

Objectives: The aim of this study was to evaluate the chemopreventive potential of vanillic acid against 7,12-dimethylbenz(a)anthracene (DMBA)-induced hamster buccal pouch oral carcinogenesis. Materials and Methods: Determine the tumor incidence, tumor volume and burden, assessment of the status of Phase I and Phase II detoxification enzymes were measured in the liver and buccal mucosa of hamsters using specific colorimetric methods. Results: One hundred percent tumor formation was observed in DMBA alone treated hamsters. Phase I and Phase II detoxification enzymes status were significantly altered DMBA-induced oral carcinogenesis. Vanillic acid (200 mg/kg bw p.o) significantly restored the biochemical variables of liver and buccal mucosa in DMBA + vanillic acid treated hamsters to near normal range compared with DMBA alone treated hamsters. Conclusion: The present study thus shows chemopreventive potential of vanillic acid in DMBA-induced hamster buccal pouch carcinogenesis. Vanillic acid improves the phase I and phase II detoxification enzymes in DMBA treated hamsters.

Background: To develop methods for cancer teams to work effectively, it is first necessary to understand how multidisciplinary teams work together as part of an organization. Implementation and adoption of new clinical practices such as team working is a challenging task. It is known that implementation of multidisciplinary working depends on a complex, multilevel interaction of team, and organizational factors. However, little is known about the threats to the sustainability of functioning multidisciplinary teams. Materials and Methods: A questionnaire was mailed to 125 multidisciplinary team meetings (MTMs) attendees. Five focus groups were gathered in order to discuss threats and strengths of cancer team-working. Discussions at the meetings were transcribed verbatim and analyzed for emergent themes using standard qualitative research methodology. Results: About 31 physicians and MTMs attendees participated in the focus groups. They perceive that meetings are very useful for making a good decision over patients. Lack of dedicated time and lack of support by the institution were the most recurrent themes which could be considered as threats for sustainability of cancer conferences. Leadership and decision-making process should be refined. Conclusions: Physicians see enormous value in MTMs but the lack of support from the organization could compromise the future effective working. This research highlights the need to explore local strengths and threats for sustainability of periodic cancer team working.

Introduction: Most preclinical studies using radiopharmaceuticals have been carried out on mice. In nuclear medicine and radioimmunotherapy procedures, I¹³¹ and Y⁹⁰ have been widely used. For better estimation of doses from these procedures, S value plays a vital role. In this study, we have evaluated S values for major source and target combinations of Digimouse voxel phantom. Materials and Methods: We have used the Digimouse voxel phantom which was incorporated in Monte Carlo code FLUKA. Simulation studies were performed using Monte Carlo simulation code FLUKA. Latest publication of International Commission on Radiological Protection (ICRP) report 110 was used for assigning the values of organ compositions and densities. Photon and electron spectra for I¹³¹ and Y⁹⁰ have been taken from the ICRP publication 107. For Digimouse voxel phantom, we have simulated 9 source regions with an assumed uniform distribution of I¹³¹ and Y⁹⁰. Results and Discussion: S values have been evaluated for I¹³¹ and Y⁹⁰ for different source and target combinations of Digimouse voxel phantom and presented in tabular form. The S values can be applied prospectively or retrospectively to the calculation of radiation doses internally exposed to I¹³¹ and Y⁹⁰, including nuclear medicine and radioimmunotherapy procedures. These S values have been very important for the calculation of absorbed doses for various organs similar in size to present study for mice. Conclusion: In this study S value for I¹³¹ and Y⁹⁰ were evaluated for major organs of digimouse voxel phantom. These S values are very important for absorbed dose calculation for various organs of a mouse.

Background: We assessed the efficacy and safety of sunitinib as the first-line treatment in metastatic renal cell carcinoma (mRCC) patients. The predictors of survival and efficacy in mRCC as identified from previous studies, including the Memorial Sloan Kettering Cancer Center (MSKCC) and the International Metastatic RCC Database Consortium (IMDC) factors, were also evaluated. Patients and Methods: Data from 56 patients with mRCC, treated with sunitinib at our institute (2006–2014), were analyzed retrospectively. Prognostic factors for overall survival (OS) and progression-free survival (PFS) were evaluated using univariate and multivariate analyses performed by log-rank test and Cox regression. Results: Fifty-one (91.1%) patients received starting dose of sunitinib of 50 mg/day in 4/2 schedule. The median PFS was 12.7 months (95% confidence interval [CI], 4.5–20.9 months) and the median OS was 16.9 months (95% CI, 3.8–29.9 months). The objective response rate was 27.5%. Dose interruption and reduction due to toxicities were required in 37.5% and 60.7% of patients, respectively. The most common Grades 3–4 toxicities were hand-foot syndrome (HFS) (23.2%), thrombocytopenia (16.1%), and hypertension (14.3%). The Eastern Cooperative Oncology Group performance status ≥2, hemoglobin < lower limit of normal, neutrophil > upper limit of normal (ULN), platelet > ULN, no prior nephrectomy, metastatic sites >:1, liver metastases, lymph node metastases, and development of HFS were independent prognostic factors. Conclusions: Sunitinib treatment has acceptable efficacy and safety profile in Malaysian mRCC patients. The MSKCC and IMDC factors are relevant for predicting survival in our patient cohort while HFS is a promising prognostic predictor which warrants further investigation.

Context: Cancer is one of the leading causes of disability worldwide. The psychological factors that significantly affect the functioning of the cancer patients are anxiety, depressive disorders, and somatization. Aims: To find out the spectrum of psychological disorders in cancer patients, also to find the association between sociodemographic variables and stage of tumor, treatment modality with the various psychological problems among cancer patients. Settings and Design: This cross-sectional study was carried out among cancer patients undergoing treatment in our institution. Subjects and Methods: Patient Health Questionnaire (PHQ)-somatization, anxiety, depression screeners is a prevalidated standard questionnaire which is a combination of PHQ-9, generalized anxiety disorder 7, and PHQ-15 plus panic measures from original PHQ. This questionnaire was given to patients and assessed later. Statistical Analysis: The association between variables of interest is tested using Chi-square test. P < 0.05 is be considered statistically significant. The data were analyzed using SPSS version 16 (SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). Results: Patients suffered from depression and also from other psychiatric morbidities. There was significant association among residential addresses and various scale (P < 0.05), PHQ-9 was maximum among radiotherapy patients (P = 0.04). PHQ-15 had association with stage of cancer (P = 0.007). Conclusion: Psychological problems are highest among patients from rural areas and among female patients compared to male. Highest anxiety and somatization was found among patients in Stage II cancer and depression in Stage IV cancer. Among treatment modalities, highest anxiety was found among patients under chemotherapy treatment, somatization among patients under both chemotherapy and radiotherapy, and depression among patients under radiotherapy treatment.

Introduction: Cancer is one of the leading causes of mortality in the world and there are many types of cancer. The current treatments against cancer are surgery, chemotherapy, and radiation therapy, but these come with varied side effects as they harm noncancer cells too. Therefore, search for new treatments is one of the important research areas nowadays and nanoparticles are one such potential anticancer agent. Aim of the Study: We hypothesized that silver nanoparticles and tea extract may have anticancer activities along with their synergistic counterparts with adriamycin (ADR) on HT-29 human colon cancer cell line, MCF-7 human breast cancer cell line, and MOLT-4 human leukemia cancer cell line. Materials and Methods: The biosynthesized silver nanoparticles were characterized by ultraviolet-visible spectroscopy, nanoparticle tracking analyzer (NTA), X-ray diffraction, scanning electron microscopy, transmission electron microscopy (TEM), and Fourier transform infrared analysis. The cytotoxic activity was measured using the sulforhodamine B assay protocol on the HT-29, MCF-7, and MOLT-4 cell lines. Results: The synthesized AgNPs gave absorption maxima at 415 nm, with four different diffraction peaks (°2θ values) corresponding to the face centered cubic silver lines. Our results showed that AgNPs exhibited the highest cytotoxic activity at 20 μg/mL concentration against all the three cell lines followed by the combination of AgNPs+ADR. Conclusion: The superior activity of the silver nanoparticles may be due to its spherical shape and smaller particle size 10–30 nm as confirmed from NTA and TEM analysis. The data obtained in the study reveal the potent therapeutic value of biogenic silver nanoparticles.

Introduction: Cholecystectomy performed for benign diseases of the gallbladder is important for the diagnosis of gallbladder cancer. This is done by pathological examination of the removed specimens for patients with no detected or suspected complications before surgery. Although some centers undertake selective approaches for histopathological examination of gallbladder specimens, many centers perform this examination routinely. In our study, we investigated results of pathological examinations carried out on cholecystectomy specimens, in respect to unexpected cases of gallbladder cancer. Methods: We reviewed cholecystectomy cases performed for benign diseases of gallbladder from January 2012 to February 2016 by investigating pathological specimens from the gallbladder. We evaluated demographical properties and their association with the pathological diagnosis and frequency of unexpected gallbladder cancer cases. We reported additional treatment and survival information of the malignancy cases after surgery. Results: We reviewed 1294 cases of cholecystectomy, and the mean patient age was 47.5 ± 14.3 years. The most frequent diagnosis was chronic cholecystitis (92.3%), and it was more prevalent among younger patients and female sex (P < 0.0001). Five patients (0.4%) were determined to have gallbladder cancer, and the mean age of these cases was 65.6 ± 18.2 years. Two cases were Stage 2, two cases were Stage 3_B, and one case was Stage 3_A. There was no T₁ or T_is tumor. Conclusion: Routine histopathological examination of gallbladder is significant with respect to the determination of additional interventions at the postoperative period required for cancer cases coincidentally diagnosed.

Background: The current study aimed to compare the clinicopathological characteristics and survival data of the patients with metastatic colorectal cancer who had symptomatic or asymptomatic venous thromboembolism (VTE) and non-VTE. Patients and Methods: The files of the patients diagnosed with 521 metastatic colorectal cancer in our hospital between April 2001 and January 2015 were analyzed retrospectively. VTE was divided into four groups in relation with their locations as extremity, port, visceral, and nonvisceral VTE. VTE was also categorized as symptomatic or asymptomatic in relation with the presence of thrombus-related symptoms. The median overall survival was considered as the period from the diagnosis of metastasis to death or last control. Results: A total of 424 patients were included in the study. The median age was 62 (range 24–95) years. Seventy-two (16.9%) patients developed VTE. Among all, 8.9% of the patients had asymptomatic VTE, 8% of them had symptomatic VTE, and remaining 83.1% of them were in the non-VTE group. Visceral thrombosis located in pulmonary and the thrombosis located in extremities and port location was usually symptomatic while nonvisceral thrombosis and nonpulmonary visceral thrombosis were frequently asymptomatic and found incidentally on radiological imaging obtained for tumor. Anticoagulant treatment was administered to all patients with symptomatic thrombosis. None of the patients with asymptomatic thrombosis was given anticoagulants. The median survival was 16.3 months (95% confidence interval [CI]: 13.8–18.9) in symptomatic, 22.5 months (95% CI: 18.6–26.4) in asymptomatic, and 21 months (95% CI: 20.5–21.5) in the non-VTE groups (P = 0.03). Conclusions: Symptomatic VTE is a predictor of poor survival in patients with metastatic colorectal cancer. The presence of an asymptomatic thrombus does not have any effect on prognosis, and follow-up without anticoagulant treatment may be appropriate in those patients.

Purpose: Physical activity has been introduced as an inexpensive and effective behavior to reduce postmenopausal breast cancer risk. Decreased concentrations of adipokines such as leptin and resistin may be a possible mechanism. This study aimed to investigate the effects of 6 months of aerobic training on leptin and resistin levels in postmenopausal women. Materials and Methods: The study participants were 50–74 years old, sedentary and postmenopausal women. Forty-one women met the inclusion criteria and were randomly assigned to the training (n = 22) or the control group (n = 19). Participants in intervention group engaged in a moderate supervised aerobic training, 3 days per week for 6 months, while controls were asked not to change their physical activity levels for the duration of the trial. Plasma concentrations of leptin and resistin, aerobic fitness, and anthropometric measures were assessed at baseline and after 6 months. Results: Twenty-seven out of 41 participants completed the study. Plasma leptin decreased by 0.6% in exercisers and increased by 8.2% in controls; however, the exercise effect was not statistically significant. Plasma concentrations of resistin also decreased by 16.1% and 15.1% in exercise and control group, respectively. Aerobic fitness increased, and body mass index (BMI) decreased significantly in the intervention group. Conclusions: The exercise intervention did not have a statistically significant impact on the concentrations of the adipokines in question; however, this long-term aerobic training reduced BMI and body fat percentage and enhanced aerobic fitness. Thus, exercise programs can be considered as an effective behavioral modification in breast cancer prevention.

Aim: The aim of this study was to assess and analyze the exit dose in radiotherapy using optically stimulated luminescence dosimeter (OSLD) with therapeutic photon beams. Materials and Methods: Measurements were carried out with OSLD to estimate the exit dose in phantom for different field sizes, various phantom thicknesses, and with added backscatter material. The data obtained were validated with ionization chamber data where applicable. A correction factor was found to determine the actual dose delivered at the exit surface using measured and theoretical dose. Results: The exit dose factor with Co-60, 6 MV, and 18 MV beams for 10 cm phantom thickness was found to be 0.752 ± 0.38%, 0.808 ± 0.34%, and 0.882 ± 0.42%. The dose enhancement factor with field size was ranging from 3% to 7.7% for Co-60 beam, from 2.6% to 6.6% for 6 MV, and from 2.5% to 4.7% for 18 MV beams at 10 cm depth of the phantom with 20 cm backscatter. The percentage reduction in exit dose with no backscatter material at 25 cm depth with field size of 10 cm × 10 cm was 5.6%, 4.4%, and 4.0%, less than the dose with full backscatter thickness of 20 cm for Co-60 beam, 6 MV, and 18 MV beam. Conclusions: The promising results confirm that accurate in vivo exit dose measurements are possible with this potential dosimeter. This technique could be implemented as a part of quality assurance to achieve quality treatment in radiotherapy.

Purpose: The goal of our study is to test whether a naturally occurring plant, Ephedra aphylla, will show antiproliferative ability against tested cell lines and to test its anti-inflammatory and antioxidative potentials. Materials and Methods: In our study, we used four solvents with different polarities – aqueous, chloroform, methanol, and n-hexane – to extract different compounds from the aerial parts of E. aphylla. Antioxidant activity of E. aphylla was determined by measuring nitric oxide (NO) and hydrogen peroxide (H₂O₂) scavenging activities. The anti-inflammatory activity was studied using the inhibition of albumin denaturation assay. Finally, the antiproliferative activity of breast cancer cell lines (T47D, MCF-7) and Vero cell line (African green monkey kidney) was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Results: Phytochemical screening for various extracts of E. aphylla showed the presence of medicinally important compounds including cardiac glycosides, alkaloids, triterpenes, tannins, and flavonoids. The scavenging activity for H₂O₂ of various solvent extracts was in the order of methanol > aqueous > chloroform > ethyl acetate > n-hexane. In addition, E. aphylla solvent extracts also exhibited a scavenging activity for NO in the order of methanol > ethyl acetate > aqueous > chloroform > n-hexane. All of the solvent extracts showed IC₅₀ inhibition of albumin denaturation at a concentration between 209.5 ± 8.1 and 225 ± 11 μg/ml. Moreover, all extracts displayed strong antiproliferative potential against MFC7, T47D tested cell lines and very weak cytotoxic activity against Vero normal cell line. Conclusions: E. aphylla has a promising potential to be used as a drug source for breast cancer treatment based on its strong antiproliferative activity.

Aims: Appendiceal mucocele (AM) is a rare pathology, and its reported incidence is 0.3% in all appendectomy specimens. Here, we report a case series of AM and make a brief review of literature. Subjects and Methods: We conducted a retrospective review of a prospectively collected data of patients who diagnosed as AM by histopathological evaluation between January 2009 and June 2015 were demographic data including age and gender, intraoperative findings, and histopathological reports were recorded. All cases were followed-up by routine examination and telephone interview. Statistical Analysis Used: Definitive statistical methods (mean, standard deviation, median, frequency, and percentage) were used to evaluate the study data. Results: Twelve patients were examined in the study with diagnose of AM. The mean age was 51.8 ± 18.6 years (26–83). Female-to-male ratio was 1.4 (7/5). Indications for surgery were acute abdomen in 8 (72.7%) patients with presumptive diagnosis of acute appendicitis and were AM in four patients diagnosed by imaging. Histopathological evaluation revealed mucinous cystadenoma in eight patients, simple retention cysts in three, and borderline mucinous tumor (pseudomyxoma peritonei) in one. The neuroendocrine tumor was obtained on the remaining portion of the appendix in one of the simple retention cysts patients. None of the patients died because of the AM with an average follow-up of 43 months (range: 7–74). Conclusions: Surgical resection is the first choice therapy for AM. Precise treatment modality can remain unclear in some patients because of insufficient preoperative diagnosis. It is nonmalign AM mostly however having mucocele matters because of the significant association with synchronous tumors.

Aims: The main objective of the present research is to analyze the caregiver effective dose during I-131 therapy of thyroid in some different situations using MCNP4C Monte Carlo code. Patients and Methods: Two separate whole body Medical Internal Radiation Dosimetry (MIRD) phantoms have been defined simultaneously in a single Monte Carlo N-Particle (MCNP) input file as the patient and the caregiver. Two different groups of irradiation situations have been assumed for the caregiver related to the patient, (1) both the patient and the caregiver are standing and (2) the patient is lying in the bed while the caregiver is standing beside the patient. Results: The results show that the caregiver effective dose is highly dependent on the position of the caregiver related to the patient. When the patient is lying on the bed and the caregiver is standing beside the patient near the head of the patient, the effective dose of caregiver will be the maximum value. Conclusions: Although the maximum effective dose (0.2 mSv) is smaller than the allowed value for caregivers (5 mSv for each treatment), the final results of this research indicate the importance of caregiver position in close contact with the patient.

Context: Increased levels of prostaglandins have been detected in cancers of several anatomic sites, including those of endometrium. Several studies have shown that cyclooxygenase-2 (COX-2) expression is aberrantly increased in various human epithelial cancers, and cellular up-regulation of COX-2 may be a common mechanism in epithelial carcinogenesis. Aims: To examine the expressions of COX-2, p53 and vascular endothelial growth factor (VEGF) in endometrial cancer and their relationships with clinicopathologic characteristics. Setting and Design: A retrospective observational study in a tertiary care center of academic and research potential. Subjects and Methods: Sections from fifty cases of endometrial carcinoma were stained imunohistochemically with COX-2, p53, and VEGF. The expressions of COX-2, p53, and VEGF in endometrial cancer were examined. Results: COX-2 was positive 19 cases (38%) of endometrial carcinoma. The COX-2 immunopositivity was 50%, 28%, and 41% in Grade 1, Grade 2, and Grade 3; and 27%, 46%, 67%, and 100% cases of Stage I, II, III, IV, respectively. p53 was positive in 24 cases (48%); 0%, 33%, and 67% in Grade 1, Grade 2, and Grade 3; and 27%, 77%, 83%, and 100% cases of Stage I, II, III, IV, respectively. VEGF was positive in 21 cases (42%); of which 0%, 33%, and 67% cases were in Grade 1, Grade 2, and Grade 3; and 17%, 77%, 83%, and 100% cases were in Stage I, II, III, IV, respectively. Conclusion: The expression of COX-2 increase with stage of the endometrial tumor and with the expression of p53 and VEGF in the endometrial carcinomas. COX-2 inhibitors may have role in the prevention of endometrial carcinomas in high-risk cases and in preventing recurrences after treatment.

Introduction: Increased levels of endoglin may represent a new reagent of active neovascularization and angiogenesis process in various cancer types. The prognostic value of tumor CD105 (endoglin) expression in cervical squamous cell cancer (CSCC) patients treated with radical radiotherapy (RT) ± chemotherapy was investigated. Materials and Methods: CD105 (endoglin) expression was assessed by immunohistochemical methods in seventy patients, who were treated with radical RT ± chemotherapy for CSCC. The prognostic effects of CD105 on patient and treatment characteristics, local-regional control, and survival were assessed. Results: The median follow-up was 24 (5–99) months for the whole cohort. The median CD105 microvessel density was 55.5 (range; 12–136). Age (≤61 vs. >:61 years; P = 0.015), lymph node metastasis status (absent vs. present; P = 0.028), International Federation of Gynecology and Obstetrics stage (Ib–IIa vs. IIb–IVa; P = 0.036), cycles of concurrent chemotherapy (1–3 vs. 4–6 cycles; P = 0.001), and hemoglobin levels (≤10 g/dL vs. >:10 g/dL; P = 0.006) appeared to associate significantly with overall survival on univariate analysis. Discussion: No correlation was identified between the tumor CD105 (endoglin) expression and survival in CSCC patients treated with radical RT ± chemotherapy.

Background: Colorectal cancer (CRC) is the second most diagnosed cancer often identified during the later stages of carcinogenesis. Orientin, a C-glycoside of luteolin, is well known for its versatile therapeutic action toward oxidative stress-induced cellular response may exert chemoprevention against CRC. Materials and Methods: In our study, we investigated the modulatory effect of orientin on lipid peroxidation, antioxidant defense, and biotransforming bacterial enzymes in 1, 2-dimethylhydrazine (DMH)-induced male albino Wistar rats in a dose-dependent manner. Animals were induced with DMH (20 mg/kg b.wt) for 15 weeks and administered with orientin in three different doses (5 mg/kg, 10 mg/kg, and 20 mg/kg b. wt) daily under distinct phases (initiation, postinitiation, and the entire) for a total treatment period of 30 weeks. Results: Orientin reinstates the alterations induced by DMH on lipid peroxidation and enzymatic antioxidants through its rich-free radical scavenging properties. In addition, orientin curtails the DMH-induced augmentation of biotransforming bacterial enzymes to inhibit the colon cancer progression. Overall, experimental findings suggest that orientin significantly inhibits the DMH induced colon cancer in all the three different doses, however, maximum inhibition was observed on supplementation of 10 mg/kg b.wt for the entire period of the study. Conclusion: Hence, the intraperitoneal administration of 10 mg/kg b.wt orientin for the entire period is recommended for further molecular investigation to elucidate the precise mechanism of inhibition and so orientin can be used as a novel chemotherapeutic agent for CRC.

Aim: Dosimetric comparison of three different techniques in female lymphoma patients who had radiotherapy (RT) to the neck and mediastinum. Setting and Design: Retrospective clinical study. Materials and Methods: Computerized tomography-simulator images of eight patients were obtained retrospectively. Using 6 MV-X photon energy, RT plans were formed with three different techniques (anterior posterior-posterior anterior 2-field three-dimensional conformal RT [AP-PA 2-field 3D-CRT], 4-field 3D-CRT and “forward” plan intensity modulated RT [FPIMRT]). Comparisons were in terms of homogeneity index (HI), conformity index (CI), and inhomogeneity coefficient for planning target volume (PTV); mean lung dose, V_5Gy, V_10Gy, V_20Gy, V_30Gy for lung; D_mean, V_7.5Gy, V_15Gy, V_25Gy for heart; D_mean, V_3.5Gy, V_10Gy, V_20Gy for breast; D_max for spine; D_mean, V_10Gy, V_18Gy, V_25Gy, V_30Gy for thyroid. Statistical Analysis Used: Since nonparametric tests had to be used due to the study population being < 30, Friedman and Wilcoxon signed-rank tests were implemented in trilateral and bilateral comparison of techniques, respectively. For statistical significance, P value was required to be <0.05. Results: When FPIMRT was compared with AP-PA and 4-field techniques with respect to, HI (AP-PA/FPIMRT P: 0.017; 4-field/FPIMRT P: 0.03) and CI (AP-PA/FPIMRT P: 0.018; 4-field/FPIMRT P: 0.042), FPIMRT was more advantageous. In addition, FPIMRT was found more useful in terms of D_max (AP-PA/FPIMRT P: 0.012; 4-Field/FPIMRT P: 0.012) for spinal cord and D_mean (AP-PA/FPIMRT P: 0.012; 4-field/FPIMRT P: 0.012) for thyroid. Conclusion: FPIMRT was superior in terms of PTV homogeneity and conformity. However, it was observed that for normal tissues, FPIMRT was advantageous only for spinal cord and thyroid; but it was not the most advantageous technique for some of the dose-volume parameters of the breast, lung, and heart.

Background: The most common subtype of aggressive non-Hodgkin Lymphomas is diffuse large B-cell lymphoma (DLBCL). Mediastinal DLBCL is a distinct entity with unique clinical, pathologic, and genetic features and accepted as a subtype of DLBCL. The aim of this study is to evaluate the patients treated with consolidative radiotherapy (RT) after rituximab-containing chemotherapy for mediastinal DLBCL regarding treatment outcomes and relapse patterns. Material and Methods: Forty-two patients with the diagnosis of mediastinal DLBCL who were treated at the Ege University Hospital between January 2008 and December 2014 were evaluated. All patients received 2–10 cycles of rituximab-containing chemotherapy schedule (mostly CHOP). RT was delivered to a total dose of 30.6–45 Gy with 1.8 Gy daily fractions in 4–5 weeks. The irradiation fields were designed by using involved lymphatic site technique. Results: The median age at diagnosis was 53 years (range, 18–85 years). Ann Arbor clinical stage at diagnosis was as follows: 8 patients (19%) at Stage I, 20 patients (47.6%) at Stage II, 7 patients (16.7%) at Stage III, and 7 patients (16.7%) at Stage IV. The median follow-up period was 47 months (range, 7–96 months). Complete response was obtained in 27 patients (64.3%), partial response was obtained in 14 patients (33.3%) across all stages. Estimated 5-year overall survival (OS) and progression-free survival (PFS) rates were, respectively, 84% and 77% for all patients, 100% and 92% for the patients without residual disease after chemotherapy. Conclusion: The response to chemotherapy is the most important factor affecting both OS and PFS. The role of consolidative RT is not clear in the rituximab era due to the lack of phase III trial. However, available literature shows that consolidative RT may still have a role in mediastinal DBLCLs.

Context: BRAF mutation has been extensively studied and associated with various tumors. Targeted therapeutic intervention against BRAF mutation is established modality against many such tumors. Various studies have estimated that the prevalence of BRAF mutation in colorectal carcinoma (CRC) is 5%–25%. Considering epidemiology differences from Western population and paucity of studies on BRAF mutation in CRC in Asian patients, the present study was done to study the BRAF mutation in CRC in Indian population. Aims: The aim is to study the distribution of BRAF mutation and its correlation with the American Joint Committee on Cancer (AJCC) stage, grade, and other clinicopathological parameters in CRC. Settings and Design: This was a cross-sectional study. Subjects and Methods: Immunohistochemistry study was done using BRAFV600E monoclonal antibody (Clone VE1) for 65 consecutive cases of CRC in a tertiary care center. The results were statistically analyzed using SPSS version 2.0. Results: This study found that BRAF mutation is not significantly present in CRC as only 4.6% of cases were positive for BRAFV600E mutation. However, there was statistically significant relation between increasing AJCC stage and BRAF mutation. Conclusions: This study concluded that BRAF mutation is not prevalent in Indian population with CRC. However, it is significantly related with advanced AJCC stages.

Introduction: The incidence of childhood malignancy is greatest in the 1^st year of life, with the second peak to be found at 2–3 years of age. The aim for the study was to investigate the incidence and nature of oral problems occurring in a population of child cancer patients; the other aim was to assess the dental management of the treatment undergoing children. Materials and Methods: All child patients between 2 and 15 years old were admitted to the medical hospital for the treatment of newly diagnosed oral cancer over a period of 1 year were included in the study. Hundred children, 50 males and 50 females were examined in the study. Out of the 100 children, 65 children who confirmed; with the diagnosis of oral cancer were included in the study. Results: Twenty children were found to have untreated dental caries at their initial dental screening; five children required dental extractions before chemotherapy. Fifty of the children in the study group did develop oral problems at some stage after their admission to the hospital. Conclusions: The delay before diagnosis varies from few weeks to approximately 10 months. Children seem particularly susceptible to the stomatotoxic effects of chemotherapy, and therefore, warrant special attention in preventing and treating these problems.

Background: About 74% of head and neck cancer (HNC) patients need to undergo either definitive or postoperative radiation therapy because of aggressive nature of disease. The transition from two-dimensional conventional radiotherapy to three-dimensional conformal radiotherapy (3D-CRT) and further technological evolutions led to the successful clinical implementation of intensity modulated radiation therapy (IMRT), which constitutes an evolution of 3D-CRT. The IMRT technique gives the ability to create treatment fields with varying beam intensity using inverse planning and optimization algorithms to treat irregularly shaped target volumes with high precision. IMRT is in existence in clinical practice since 1995. Since then, presuming its clinical benefit a significant amount of patients has been treated by this technique. PARSPORT was the first multi-institutional prospective trial comparing IMRT with conventional RT in the treatment of HNC. It has shown a reduction in severe xerostomia but no difference in other toxicity and locoregional control after 24 months' follow or overall survival. Except for early T1, 2 N0 stages, the prognosis for patients with oral cavity cancer (OCC) is dismal than for carcinoma in other sites of the head and neck (HNC). Aim: The aim of this study was to assess the outcome of OCC following IMRT. Materials and Methods: Between January 2013 and January 2015, 40 patients of carcinoma buccal mucosa and carcinoma alveolus were treated by postoperative (19) or definitive (21) radiation therapy by IMRT technique. Of these, 28 patients (70%) presented with locally advanced T3/4 or recurrent tumor. Total radiation doses delivered was between 60 and 70 Gray at 2 Gray/fraction. Of these 31 patients (78%) has received concurrent cisplatin-based chemotherapy. Another group of 42 similar patients treated by 3D-CRT as definitive or postoperative adjuvant treatment over the same period has been selected. Comparisons were performed between these two groups. Statistical Analysis: Data were entered into Excel spreadsheet and expressed as mean and standard deviation for deriving P value, and unpaired t-test was used to calculate 95% confidence interval. Local control (LC) was analyzed using Kaplan–Meier curve. Of all assessed treatment subgroups, LC rate was highest for patients treated with postoperative IMRT (89% LC at 2 years) followed by postoperative 3D-CRT patients (79% LC at 2 years); and finally, poorest LC rates (43% and 32% at 2 years) were seen in definitively irradiated patients with IMRT and 3D-CRT, respectively. LC rate for T1 stage (83%, n = 6) was significantly higher, than that for T2–4 (LC 55%, n = 76) as expected. Conclusion: Postoperative IMRT of carcinoma buccal mucosa and alveolus resulted in the highest LC rate of all the treatment subgroups assessed hence should be generously recommended in such cases especially ones with unfavorable features such as close resection margin, nodal involvement, locally advanced tumor (>T1N0), or recurrent disease, respectively. Despite definitive IMRT, locoregional control in carcinoma buccal mucosa and alveolus remain unsatisfactory, comparable to that following definitive 3D-CRT.

Malignant tumors of the salivary gland are rare, clinically diverse group of neoplasms, among which mucoepidermoid carcinomas (MECs) are reported to be most frequently occurring epithelial carcinomas. MEC at times misleads the clinician because of its atypical location and innocent appearance. Here, we report a case of low-grade MEC in a 70-year-old female patient in the floor of the mouth mimicking as ranula clinically. Individuals with a history of malignancy are at risk for the development of additional malignant tumors; hence, follow-up of 2 years did not show any recurrence or additional tumors.

Ewing's family of tumors is aggressive tumors and frequently arises from bone and soft tissue. They might also arise from nonosseous structures such as gastrointestinal tract, adrenal glands, or kidney. Primary renal Ewing's sarcoma (ES)/primitive neuroectodermal tumor is an extremely rare entity which has aggressive clinical course. These high-grade malignant tumors predominantly affect adolescents and young adults. Patients mostly present with nonspecific symptoms such as pain, hematuria, mass, and sensitivity. It is confused with renal cell cancer in imaging techniques. The definitive diagnosis is based on the histopathological examination. Surgical or radiotherapy treatment is used for local control and multiagent chemotherapy used for systemic treatment. Despite all treatment options, prognosis is poor. We aimed to describe the diagnosis and follow-up and treatment of renal ES case that was considered as renal cell carcinoma in imaging but diagnosed as ES via histopathology.

Metastatic tumor to orbit or mandible as initial presentation is rare. According to the available literature, majority of these described cases had its origin from lung and breast. Adenocarcinoma is the most commonly described histology. Concurrence of both of these metastases from a squamous cell carcinoma of the lung has not been reported in literature as initial presenting symptom. A young female patient with synchronous orbital and mandibular metastases as initial presentation of squamous cell carcinoma of the lung is being presented. The patient was treated with palliative radiation and chemotherapy but unfortunately died of progressive disease. To the best our knowledge, this is the first report describing such unusual presentation.

Acinic cell carcinoma (AciCC) is a low-grade malignancy which rarely metastasizes to bone or cavernous sinuses. A 62-year-old male patient, previously treated for AciCC of right parotid with surgery and local radiotherapy, presented 10 years later with progressive visual impairment and restriction of ocular movements. Magnetic resonance imaging of the head and orbit showed an expansile lobulated mass with heterogeneous signal intensity in bilateral cavernous sinus with encasement of the internal carotid artery on both sides. Fluorodeoxyglucose positron emission tomography/computed tomography showed multiple lytic lesions with increased uptake in the left clavicle (with soft tissue component), sternum, multiple cervico-dorso-lumbar vertebrae, and ribs. Biopsy from the clavicular lesion showed AciCC. He was treated with palliative radiotherapy to cavernous sinuses and other metastatic site followed by palliative chemotherapy with six cycles of paclitaxel and carboplatin. He had a partial response to palliative treatment and had good symptomatic relief at 12 months of follow-up.

Plasma cell leukemia (PCL) is a rare and an aggressive form of plasma cell dyscrasias. We report a 67-year-old male with PCL which developed while on imatinib mesylate (IM) therapy 38 months after diagnosis of chronic myeloid leukemia (CML). The patient has been treated successfully with bortezomib, melphalan and prednisolone. To our knowledge, only one case of PCL superimposed on Philadelphia positive CML has been reported in the literature and this was before the IM era.

We report the third case of bilateral metastatic renal meningeal hemangiopericytoma (HPC) 16 years after initial intracranial presentation. A 47-year-old male patient presented with abdominal mass drew our attention. Computed tomography (CT) demonstrated bilateral renal masses and another mass caudal to the lower pole of left kidney from which it was separated. He had a previous history of meningeal HPC. Since 1996, he underwent four neurosurgical operations and three CyberKnife radiosurgery. He underwent bilateral nephron sparing surgery. Histopathology study deposed for HPC. After 12 months, a CT scan revealed three hepatic lesions, which resulted comparable with HPC metastasis at a fine needle biopsy. An imaging-guided radiofrequency ablation was programmed. The patient is metastatic disease-free after 46 months. Previous history of meningeal HPC in patient with kidney masses should raise the suspicion of renal metastasis. The treatment of choice is surgery. In these cases, abdominal imaging should be included in the follow-up.

Etiologies of lateral cervical masses are complex, most commonly these masses are branchial cleft cysts; however, metastatic thyroid carcinoma should be included in the differential. We report a case of lateral cystic neck mass in a 22-year-old female patient diagnosed as metastatic papillary thyroid carcinoma. The patient was diagnosed after she underwent surgery for branchial cleft cyst. The patient underwent thyroidectomy which revealed multifocal micropapillary thyroid carcinoma with capsular invasion and lymph node metastases. Radioactive iodine treatment was planned. Congenital malformations of the lateral neck may present themselves in the second and third decades of life. Ectopic thyroid tissue within a branchial cleft cyst may give rise to primary papillary carcinoma, as well as branchial cleft cyst may harbor metastases of primary thyroid papillary carcinoma. We classified our patient as a metastasis to the branchial cleft cyst rather than primary papillary carcinoma of the branchial cleft cyst.

We hereby present two rare cases of primary malignant melanoma of vagina in women aged 65 and 50 years, respectively. At the time of presentation, the disease in both cases was locally advanced and subsequently metastasized to distant organs.