A new modality of targeting therapeutic drugs based on the use of bacteriophage (virus), as an emerging tool for specific targeting and for vaccine development, has been an area of interest for genetic and cancer research. The approach is based on genetic manipulation and modification in the chemical structure of a filamentous bacteriophage that facilitates its application not only for in vivo imaging but also for therapeutic purpose, as a gene delivery vehicle, as drug carriers, and also as an immunomodulatory agent. Filamentous bacteriophage on account of its high surface holding ability with adaptable genetic engineering properties can effectively be used in loading of chemical and genetic drugs specifically on to the targeted lesion location. Moreover, the specific peptides/proteins exhibited on the phage surface can be applied directly as self-navigating drug delivery nanovehicles. The present review article has been framed with an objective to summarize the importance of bacteriophage in phage cancer therapy and to understand the possible future prospective of this approach in developing new tools for biotechnological and genetic research, especially in phage -mediated cancer therapy. Importantly, the peptides or proteins emerging from the surface of a nano carrier will make the expense of such peptides economically more effective as compared to other immunological tools, and this seems to be a potential approach for developing a new nanodrug carrier platform.

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Introduction: Prostate cancer is most frequently diagnosed cancer of men and bone is the most common site of metastasis. There is a lack of consensus for the selection criteria for bone scan in low-risk patients. Western guidelines do not recommend use of bone scan in asymptomatic patients and in low prostate-specific antigen (PSA) values. We try to correlate the PSA value with bone metastases through bone scan in the Indian population. Materials and Methods: A total of 68 histologically newly diagnosed prostate cancer subjected to bone scan were retrospectively analyzed. The patients were stratified into four groups according to their PSA level: The first group of patients had PSA level ranging from 0 to 10 ng/ml (n = 4), the second group had PSA level ranging from 10.1 to 20 ng/ml (n = 13), the third group had PSA levels 20.1–100 ng/ml (n = 23), and the fourth group has PSA >100 (n = 28). Results: The incidence of osseous metastases proven by bone scan was found to be zero (0 out of 4) for PSA level 0–10 ng/ml; 38.46% (5 out of 13) for PSA level 10.1–20, 60.87% (14 out of 23) for PSA level 20.1–100 ng/ml, and 100% for PSA >100 (P < 0.005) (95% confidence interval 1.01–1.1). For cut-off value of PSA ≤10 ng/ml, sensitivity and specificity were 100% and 19.05%, respectively, with positive predictive value of 73.44%. Conclusion: The correlation between PSA value and presence of metastases confirms the usefulness of bone scan scintigraphy in prostate cancer staging. The screening bone scan at initial diagnosis should be included for all patients with PSA >10 ng/ml in Indian setting.

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Purpose: Historically, the role of adjuvant radiotherapy (RT) for patients with adrenocortical carcinoma (ACC) has been controversial. The objective of this research is to review systematically the literature evaluating the role of adjuvant RT in patients with ACC undergone a surgical resection. Materials and Methods: The electronic databases were searched for articles published until July 2017 without language restriction: Lilacs, Medline, Embase, and the Cochrane. Two reviewers independently appraised the eligibility criteria and extracted data. When possible, a fixed-effect meta-analysis was done. The systematic review (SR) followed all the criteria of the MOOSE guideline. Results: Overall, 382 citations were identified. After the screening of titles and abstracts, 12 articles (eight case series [48 patients] and 4 cohort studies [136 patients]) were included in the final analysis. For the local recurrence, the pooled relative risk (RR) was RR = 0.46 (95% confidence interval: 0.28–0.75), in favor of adjuvant RT when compared with surgery alone. Concerning overall mortality and disease recurrence, no significant difference between adjuvant RT and surgery was detected, RR = 0.77 (CI 95% 0.49–1.22, P = 0.27), and RR = 0.95 (IC 95% 0.74–1.24, P = 0.67). In all cohort studies, the acute toxicities were graduated as mild and self-limited with nausea and fatigue being the most common symptoms. Only one case (1/50) of impairment of kidney function was detected as late toxicity in these studies. Conclusions: This SR and meta-analysis indicate that adjuvant RT dramatically reduces the local recurrence of ACC after surgery. Moreover, the treatment has a low acute and late toxicity, resulting in a high therapeutic index. Further, prospective studies are needed to confirm or refute the role of RT on survival and disease recurrence.

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Lipoma is called the “universal tumor” or the “ubiquitous tumor” as it occurs anywhere in the body where fat is found. Intraosseous lipoma is a rare lesion that constitutes not more than 0.1% of bone tumors. There are only a few reported cases of intraosseous lipoma of the maxilla in the literature. The diagnosis of intraosseous lipoma of the maxilla may be a challenge, due to its rarity and clinical similarity with many other radiolucent lesions. Therefore, histopathological examination is mandatory. The radiolucent nature and mature adipose tissue admixed with the bony trabeculae confirms the diagnosis of intraosseous lipoma. Here, we report a case of intraosseous lipoma of the left maxillary tuberosity in a 52-year-old male patient.

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Objective: To estimate association between androgen receptor (AR) gene polymorphisms and testicular germ cell tumor (TGCT) susceptibility. Materials and Methods: Systematic search of studies on the association between AR gene polymorphisms and TGCT susceptibility was conducted. Odds ratios and 95% confidence intervals were used to pool effect size. Results: For CAG repeat, no evidence was found for association between (>25 vs. ≤25), (>25 vs. 21–25), (<21 vs. 21–25), (others vs. 21–25), (>23 vs. ≤23), (<21 vs. ≥21), (<21 vs. ≥21)'s some subgroups and TGCT susceptibility, which showed stability. In (>24 vs. ≤24), (>24 vs. 21–24), (<21 vs. 21–24), and (others vs. 21–24) and almost all of their subgroups, increased TGCT risk was found without sensitivity analysis. For GGN, no statistical change of TGCT risk was found in (<23 vs. ≥23), (<23 vs. 23), which showed stability. For single nucleotide polymorphism (SNP) rs6152 G > A, rs1204038 G > A and rs2361634 A > G, no statistical change was found without sensitivity analysis. Conclusions: GGN repeat number <23 may not be associated with TGCTs susceptibility. However, there was insufficient data to fully confirm association in GGN repeat number >23, CAG repeat number, SNP rs6152, rs1204038, and rs2361634.

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Objective: The objective of the study is to present our experience of treating adrenal metastases using stereotactic body radiation therapy (SBRT). Materials and Methods: We retrospectively reviewed patients with adrenal metastases treated using SBRT from 2001 to 2014. Response Evaluation Criteria in Solid Tumors v1.1 was used. Maximum tumor response was defined as the greatest percentage tumor reduction noted on two or more post-SBRT CT scans. Results: We identified 44 patients (median age 61.3 years, range: 25.8–85), with 54 adrenal metastases; primary diagnoses include non-small cell lung cancer (28 patients and 38 lesions), small cell lung cancer (1 patient), hepatocellular carcinoma (6 patients), and other (9 patients). Treatment was delivered in single (16 lesions, median dose 18 Gy [14–18]) or multiple fractions (38 lesions, median dose 30 Gy [16–40]). Median planning target volume was 49.65cc (3.21–984.54). Median response at first post-SBRT follow-up (median 1.65 months (m) (0.33–5.37), n = 46 lesions) was 10.8% with 91.3% local control. Median maximum tumor response was 31.8% (n = 32 lesions) at median follow-up of 5.4 m (0.9–44.8) with 96.6% local control. The response was comparable regardless of tumor histology or treatment fractionation. No patients experienced Grade 3/4 acute toxicities. One patient with a history of naproxen use required suturing with omental patch placement for perforated pyloric ulcer 14 m post-SBRT (18 Gy in single fraction) to the right adrenal metastasis; this region received <5 Gy. Ten patients treated for pain with available follow-up obtained relief. Conclusions: SBRT is a safe and efficacious treatment for adrenal metastases, demonstrating local tumor control. Further study of the impact on survival and quality of life is warranted.

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Aim of Study: Metabolic syndrome (MetS) is an abnormality that increases the risk of cardiovascular disease and diabetes. In the recent years, studies showed that MetS is associated with increased risk of incidence, aggressiveness, and mortality of prostate cancer (PCa). We examined the influence of MetS at final pathology in Turkish patients with PCa. Materials and Methods: MetS was defined according to the American Heart Association, National Heart, Lung, Blood Institute, and International Diabetes Federation and requires any three of five components. The patients without and with MetS were in Group 1 and 2, respectively. Data were compared with independent sample t-test and Chi-squared test. Results: There were 117 patients in the study. The patients' age was between 51 and 77 years with a median of 64.87 ± 5.65 and 62.29 ± 5.57, and prostate-specific antigen (PSA) level of the patients was 8.19 ± 5.35 and 8.68 ± 2.22 ng/ml in Group 1 and 2. Of these patients; Group 1 and 2 had 86 and 31 patients. High-grade PCa (Gleason >7) and advanced PCa (T3, T4) at final pathology were reported in 44.18–18.60% and 38.70–32.25% in Group 1 and 2. Conclusion: The patients with MetS are diagnosed significantly younger and had higher PSA levels than the other patients. Advanced disease of PCa is seen much more in patients with MetS.

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Purpose: Breast and cervical cancers are the two most common cancers among women worldwide. Morphine is a potent analgesic for cancer pain, and radiation therapy is a conventional treatment for cancer. Unfortunately, the combined adjuvant cellular effects of morphine and ionizing radiation in cancer cells are largely unknown. Materials and Methods: In this study, we examined the effects of morphine and single radiation dose of 2 Gy on viability and survival fraction of human breast cancer cell line MDA-MB 231 and human cervical cancer cell line HeLa, by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and colony formation assays. We were also interested in evaluating these effects in human umbilical vein endothelial cells as well. Results: We found that morphine did not have a dose- and time-dependent manner in endothelial, breast, and cervical cancer cells in vitro. It seems that pretreatment of breast and cervical cancer cells with morphine at some doses before irradiation reduces the cytotoxic effect of radiation. We also observed that endothelial cells were less sensitive than breast and cervical cancer cells to radiation or morphine + radiation. Based on the results of endothelial cells, morphine or radiation might not have a selective effect on the viability and clonogenic survival of different cell lines. Conclusions: Our data may suggest that morphine and radiotherapy could not be administered together to breast and cervical cancer patients if additional and in vivo studies confirm our results.

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Renal pelvis squamous cell carcinoma (RSCC) is a rare tumor. It starts with nonspecific symptoms and it is usually at an advanced stage with a poor prognosis at the time of diagnosis. SCC-associated hypercalcemia is a well-known paraneoplastic syndrome; however RSCC-associated hypercalcemia is a rare condition. Our patient is a 57-year-old-male patient with no bone metastases. Based on the literature screening on PubMed Database for paraneoplastic malignant hypercalcemia-associated RSCC, we found a few cases.

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Background: Associated risk factors for renal cell carcinoma (RCC) include smoking, obesity, hypertension, and diabetes mellitus (DM). Studies on their role in Sri Lankan patients are sparse. The aims were to determine the risk factors for RCC in a cohort of Sri Lankan patients. Methods: A hospital-based case–control study was done in a teaching hospital from January 1, 2009, to December 31, 2015. The prospectively collected data included history of smoking, hypertension, DM, and body mass index (BMI). The controls were patients who were admitted after trauma and who required abdominal ultrasonography as part of routine assessment. The controls were accrued at a ratio of 1:2 and were age- and gender-matched. Chi-squared test was used, and P < 0.05 was considered statistically significant. Results: There were 178 patients with RCC. The mean age of patients with RCC was 56.9 years. Male to female ratio was 3.5:1. Forty-nine (27.5%) patients were < 50-year-old. 36.5% were asymptomatic and diagnosed incidentally by ultrasound scanning. Obesity (BMI > 30) (P < 0.01), DM (P < 0.05), and hypertension (P < 0.01) were significantly more common among the cases than in controls. There was no difference in the prevalence of smoking between the two groups (P > 0.5). Conclusions: Average age at the time of diagnosis of RCC in Sri Lankan patients is lower than the developed world, with a large proportion of patients being under 50 years. Obesity, hypertension, and DM are associated risk factors for RCC in Sri Lankan patients while smoking is not.

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Background and Purpose: As a feasible approach, radiotherapy has a great role in prostate cancer (Pca) management. However, Pca patients have an increased risk of femoral head damages including fractures after radiotherapy. The mechanisms of these complications are unknown and time of manifestations is too long; however, they may be predicted by early imaging. The main purpose of this study was to assess the early changes in femoral heads in Pca patients treated with intensity-modulated radiation therapy (IMRT) using multiparametric magnetic resonance imaging (mpMRI) radiomic feature analysis. Materials and Methods: Thirty Pca patients treated with IMRT were included in the study. All patients underwent two mpMRI pre- and postradiotherapy. Thirty-four robust radiomic features were extracted from T1, T2, and apparent diffusion coefficient (ADC) obtained from diffusion-weighted images. Wilcoxon signed-rank test was performed to assess the significance of the change in the mean T1, T2, and ADC radiomic features postradiotherapy relative to preradiotherapy values. The percentage change values were normalized based on the natural logarithm base ten. Features were also ranked based on their median changes. Results: Sixty femoral heads were analyzed. All radiomic features have undergone changes. Significant postradiotherapy radiomic feature changes were observed in 20 and 5 T1- and T2-weighted radiomic features, respectively (P < 0.05). ADC features did not vary significantly postradiotherapy. The mean radiation dose received by femoral heads was 40 Gy. No fractures were observed within the follow-up time. Different features were found as high ranked among T1, T2, and ADC images. Conclusion: Early structural change analysis using radiomic features may contribute to predict postradiotherapy fracture in Pca patients. These features can be identified as being potentially important imaging biomarkers for predicting radiotherapy-induced femoral changes.

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A 29-year-old hypertensive male with von Hippel–Lindau (VHL) syndrome came to the Endocrinology department for evaluation. Contrast-enhanced computed tomography of the abdomen revealed an adrenal mass, bilateral renal cell carcinoma, and multiple pancreatic cysts. The hormonal investigations for adrenal mass were normal. He underwent left-sided adrenalectomy, and the histopathological report was suggestive of an adrenocortical adenoma. Genetic analysis of VHL gene in this patient revealed a heterogeneous 5' splice site variation of intron 1 of the VHL gene that affects splice site of exon 1 (c. 340 + 1G > A). Adrenocortical adenoma is very rare in VHL syndrome. Only two cases of adrenocortical adenoma in VHL have been reported in the literature, and both were associated with pheochromocytoma. This is probably the first reported case of adrenocortical adenoma in VHL syndrome without accompanying pheochromocytoma.

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Purpose: Nowadays, most of the radiotherapy (RT) treatment planning systems (TPSs) uses dose or dose-volume (DV)-based cost functions for Intensity modulated radiation therapy (IMRT) fluence optimization. Recently, some of the TPSs incorporated biological-based cost function for IMRT optimization. Most of the previous studies compared IMRT plans optimized using biological-based and DV-based cost functions in two different TPSs. Hence, the purpose of the study is to compare equivalent uniform dose (EUD)-based and DV-based IMRT plans generated using the same TPS. Materials and Methods: Twenty patients with prostate cancer were retrospectively selected for this study. For each patient, two IMRT plans were generated using EUD-based cost function (EUD_TP) and DV-based cost (DV_Treatment Plan (TP)), respectively. The generated IMRT plans were evaluated using both physical and biological dose evaluation indices. Results: Biological-based plans ended up with a highly inhomogeneous target dose when compared to DV-based plans. For serial organs, D_near-max or D_2%(Gy) of EUD-based plans showed significant difference with DV-based plans (P = 0.003). For both rectum and bladder, there was a significant difference in mean dose and D_30%(Gy) dose between EUD-based plans and DV-based plans. Conclusion: In this study, we decoupled the influence of optimization parameters from the potential use of EUD-based cost functions on plan quality by generating both plans in the same TPS.

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Purpose: Prostate motion during the radiotherapy course is an important issue. This study investigated the inter-fraction prostate motion in controlled rectal filling condition. Methods: 10 prostate cancer patients underwent image-guided radiotherapy (IGRT) using a cone-beam computed tomography (CBCT) system, after the insertion of fiducial markers (FMs). The planning CT was the reference CT (CTref) used to estimate the reference intermarker distances, and CBCTs were used for off-line comparison with CTref. We evaluated the influence of rectal and bladder volume on prostate shifts. We calculated the required planning target volume (PTV) margins in this patient population. Results: 120 CBCTs were analyzed. Mean prostate displacements (± SD) along the 3 axes (x, y, z) averaged over the 10 patients, were: 0.90 ± 0.84 mm in x, 0.00 ± 2.07 mm in y, -0.80 ± 1.28 mm in z. There is a statistically significant anti-correlation between prostate displacements and: bladder volume variations (P < 0.001) in the y-axis, and rectal volume variations (P < 0.05) in the z-axis. PTV margins obtained for the directions x, y and z are respectively 2.5, 5.6 and 3.9 mm. Conclusion: IGRT in reproducible empty rectum condition allow a high reduction of daily treatment uncertainties.

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Context: Renal function assessment is of paramount importance before using the platinum agents especially cisplatin. Glomerular filtration rate (GFR) estimation by diethyl-triamine-penta-acetic acid (DTPA) scan (measured GFR [mGFR]) is considered gold standard. Aims: The aim of this study is to know if we can replace the mGFR with the GFR estimation with Cockcroft–Gault formula (eGFR) in patients undergoing chemoradiation. Settings and Design: This is a prospective, descriptive study. Subjects and Methods: Patients who are planned for definitive chemoradiation will be eligible for the study. Renal function will be measured DTPA scan and Cockcroft–Gault (CG) formula. Subgroup analysis based on the weight, age, and sex will be done. Statistical Analysis Used: Demographic and renal function parameters were analyzed using summary measures. To test the significance of the difference between mGFR and cGFR, a paired t-test will be used; to look for an association between various estimates of renal function, the Pearson's correlation coefficient will be calculated using a two-tailed test. Results: Median mGFR of patients was 82.7 (range: 65–125 ml/min, standard deviation [SD] =14.0 ml/min) while the median eGFR as per the CG formula was 83.9 ml/min (range: 37–137 ml/min, SD = 24.4 ml/min). The median mGFR was only 1.2 ml/min lesser when measures by the CG formula with no significance difference between them (P = 0.66, 95% confidence interval: −4.5–6.3). Conclusions: We concluded that in resource-limited setting eGFR using CG formula can replace mGFR, especially in patients with age <60 years. Although weight did not showed a significant difference by two methods, a study with large sample is needed to confirm the result.

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Objective: We investigate the protective and therapeutic effects of ozone therapy (OT) in radiotherapy (RT)-induced testicular damage. Methods: Thirty healthy adult male Wistar rats divided into five groups consisting of six animals each as follows: (1) Control (C), (2) RT, (3) OT, (4) OT + RT, and (5) RT + OT group. Histopathological findings, Johnsen scores, thiobarbituric acid-reactive substances (TBARS), glutathione (GSH), superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) levels were evaluated. Results: RT caused a significant decrease in testicular weight and Johnsen score compared to the control group. In addition, TBARS level was significantly higher, whereas GSH, SOD, catalase, and GPx levels were significantly lower in the RT group when compared to the control group. Pre and postRT OT significantly increased GSH, SOD, catalase, and GPx levels and decreased TBARS level. Furthermore, testicular weight and Johnsen score were increased with OT. Conclusions: The present study showed that OT is protective and therapeutic in radiation-induced testicular damage. OT may be beneficial to the patients who underwent RT.

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Malignant mesothelioma (MM) of the tunica vaginalis (TV) is a rare tumor. It is seen in elderly patients, with painless scrotal swelling being the most common presentation. The exact etiology is unknown; a few risk factors have been suggested. Here, we present an uncommon case of MM of TV without any known predisposing factors. We also discuss the possible risk factors, clinical presentation, pathological features and the difficulties in diagnosis, and management of this rare malignancy.

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Background/Objective: To report the initial experience and the early outcomes of a modified U-shaped ileal neobladder, which was developed to facilitate the neobladder-urethral anastomosis by minimizing the anastomotic tension. Patients and Methods: Between June 2015 and December 2016, two male and two female patients (median age: 65.5 years, range: 43–72 years) underwent the modified U-shaped ileal neobladder after robotic-assisted radical cystectomy (RARC). The most mobile and dependent ileal segment was first selected intracorporeally as the site for later neobladder-urethral anastomosis. The neobladder was formed extracorporeally, and the previously selected ileal segment formed the most dependent portion of the neobladder. The neobladder-urethral anastomosis was completed after robotic redocking. Results: The median follow-up was 8 months (3–21 months). The median operative time, console time, and extracorporeal reconstruction time were 620 min (534–674 min), 372 min (314–420 min), and 151 min (128–215 min), respectively. In all patients, the neobladder-urethral anastomosis was completed intracorporeally with minimal tension. The median hospital time after the surgery was 14.5 days (14–19 days). Postoperatively, the median peak flow rate and void volume were 10 ml/s (4–35 ml/s) and 258 ml (88–775 ml). The median postvoid residual was 20 ml (10–53 ml). At daytime, two were completely continent; the other two reported mild (1–2 pads) and moderate (>2 pads) incontinence at the postoperative 3 and 4 months, respectively. Three reported nocturnal enuresis. Conclusions: Our initial experience demonstrated that the modified U-shaped neobladder designed for minimizing the anastomotic tension is safe and feasible with its satisfactory functional outcomes.

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Aim of Study: The aim of this study is to evaluate some dosimetry parameters such as uniformity, surface dose, and max depth dose with thermoluminescent dosimetry (TLD) and EBT3 film in total skin electron beam therapy (TSEBT). Methods: Stationary and rotary methods were set on Varian linear accelerator, Clinac 2100C. To create a radiation field large enough (168 cm × 60 cm) and uniform, the source skin distance was set 400 cm. Electron beam energy was 6 MeV. The skin dose values were obtained in 21 different points on the phantom surface. Results: The results of dose uniformity in stationary technique were obtained as 10% and 2.6% by TLDs and 6% and 2.3% by films in longitudinal axis and transverse axis, respectively. The measurements at rotational technique by TLDs at the referred conditions showed a homogeneous total field with intensity variation of 10% in the longitudinal axis and 4% at horizontal axis. Conclusion: Based on the results of this study, stationary techniques are preferred for TSEBT. The main advantage of rotational techniques is reducing the time of treatment. The results also demonstrate that TLD should be routinely used in TSEBT treatment. Due to the high sensitivity of radiochromic films, this type of film was suitable for a wide therapeutic field. Comprehensive treatment to Rando phantom showed that the uniformity is better at the trunk than in the mobile parts of the body; the soles of the feet, perineum region, and scalp vertex should be treated in boost.

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Aims: Based on recent studies, it was indicated that gold (Au-197) nanoparticles could be safely prescribed and used to enhance the absorbed dose during radiation therapy. Subjects and Methods: We evaluated the samarium-153 (Sm-153) radiopharmaceutical and Au-197 and Sm-153 radiopharmaceutical absorbed dose rate by means of the Monte Carlo technique in prostate cancer. Results: The results show that absorbed dose rate in entire prostate volume due to 20 mCi of Sm-153 radiopharmaceutical is 27.339 μGy/s, 48.837 μGy/s, and 76.176 μGy/s for γ-interaction, β¯ particle interaction, and γ+β¯ interaction, respectively. The results in the exterior of the prostate for β¯ interaction, β¯ particle interaction, and γ+β¯ interaction were 20.971 μGy/s, 1.110 μGy/s, and 22.081 μGy/s, respectively. Conclusions: The calculation results for Au-197 and Sm-153 radiopharmaceutical show that the absorbed dose rate in entire prostate volume 3% was increased and undesirable dose value in exterior of prostate 7% was decreased.

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Aim: The aim of this study is to investigate the effect of scattering and differential attenuation on dose profile of 6 MV photon beam in the presence of cadmium (Cd)-free compensator which has been used in compensator-based intensity-modulated radiotherapy. Materials and Methods: Totally, 10 slabs of Cd-free compensator having thicknesses ranging from 2.4 to 61.4 mm have been prepared. Dose profiles have been taken using computer-controlled radiation field analyzer for five field sizes from 30 mm × 30 mm to 200 mm × 200 mm and at three depths in water phantom. Off-axis dose variation (ODV) has been measured with off-axis percentage depth dose scan and with ion chamber by measuring point dose at two diagonal points with respect to dose at central axis point in a plane and at three depths. Results: A decrease in beam flatness has been observed with increase in compensator thickness and depth in phantom. ODV has been found to increase with compensator thickness. Selective beam hardening has been observed due to differential attenuation from compensator. Point dose measurements show approximately 20% and 23% underdose region at 70 and 106 mm off-axis diagonal point, respectively, as compared to dose at central axis point for a field size of 200 mm × 200 mm at a depth of 15 mm, with 30.2-mm slab thickness. Significant increase in scattered penumbra has been observed with field size and thickness of compensator due to increase in scattered photon. Conclusions: The presence of compensator changes photon beam mean energy along the cross-section resulted in decreased beam flatness and increased scattering. This may lead to overestimation of dose along off-axis within radiation field if change in flatness is not taken into account and more exposure to healthy tissues in penumbral region due to large-angle scattering.

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Objectives: There is no consensus regarding the management of Stage 1 seminomas following inguinal orchiectomy. In this study, we evaluated the treatment results and treatment-related toxicity for patients with Stage 1 seminomas treated with adjuvant radiotherapy (RT) at a single institution. Methods: Sixty-five patients who underwent adjuvant RT following orchiectomy for Stage 1 seminomas between January 1996 and December 2007 were retrospectively reviewed. The age, tumor location, histopathological type, stage, tumor size, RT field, and radiation dose were recorded for all patients. Results: The patients' ages ranged from 17 to 61 years (median, 37 years). Sixty-three patients (97%) were diagnosed with classical seminoma and the remaining two patients (3%) had spermatocytic seminoma. After orchiectomy, 37 patients (57%) received para-aortic RT and 28 patients (43%) received dog-leg field RT. RT was applied with 1.8–2 Gy/day fractionation and the median RT dose was 26 Gy (range, 20–38). Follow-up ranged from 0.3 to 18 years (median, 9.5 years). Local control had been achieved in all patients and all of them were alive with no evidence of disease. Fifty-one patients (77%) had at least 5 years of follow-up and 27 patients (41%) had at least 10 years of follow-up. Overall survival at 10 years was 100%. Conclusion: Although retrospective in nature, this single-institutional study provides useful information about the outcomes and toxicities associated with adjuvant RT in patients with Stage 1 seminomas reporting excellent disease control and survival rates at the expense of acceptable toxicity.

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Background: Water equivalent property of any clinical dosimeter is important. Water has the approximately similar radiation absorption and scattering properties to soft tissue. Film dosimeter plays a significant role in radiotherapy quality assurance and treatment plan verification. Aims: In this study, we are evaluating the water equivalent radiological properties of Gafchromic electronic benefit transfer (EBT) and EBT2 film dosimeters. Materials and Methods: Radiological properties such as number of electrons per gram (n_e), electron density (ϼ_e), and effective atomic number (Z_eff) are calculated using Mayneord formula. Mixture rule is used to calculate the mass absorption coefficient (μ_en/ϼ) and mass attenuation coefficient (μ/ϼ), and data are generated using Win-XCom over 10 KeV to 20 MeV. Electron stopping power data are generated with the help of ESTAR database over 10 KeV to 30 MeV. Those results are compared with water and deviations are found. Results: Our results suggest that Z_eff, n_e, and ϼ_e of EBT is showing deviations <8.83%, 4.39%, and 16.18% and for EBT2 is 4.26%, 2.82%, and 19.41% with respect to water. Deviation in μ_en/ϼ and μ/ϼ of EBT and EBT2 film is ≤5% and ≤6%, respectively, with respect to water >100 KeV. Electron stopping power properties are also close in agreements with water having deviations ≤5%. Conclusion: Presence of high atomic number element chlorine, potassium, and bromine may disturb the water equivalent properties in the lower energy range <100 KeV and similarly enhance the dose sensitivity because of the strong photoelectric absorption process.

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Aim: The treatment of the cancers is one of the most important challenges of nuclear medicine. Using targeted radiotherapy has increased the hope for the cure of the cancers. In the targeted radiotherapy, proliferations of tumor cells during radiotherapy are believed to be main reasons of treatment defeat. The aim of this work is the investigation of the cell proliferation on tumor treatment. Materials and Methods: For this purpose, two scenarios were considered. The first scenario, in case of the tumor cells nonproliferation, surviving curve of irradiated cells is an exponential function of accumulated dose. The second scenario, Tumor cells proliferate exponentially with a growth constant and all tumor cells are assumed to be proliferating throughout irradiation. Results: In the nonproliferation condition, the surviving fraction of tumor cells decreases with time. In the proliferation cases, at the beginning of the irradiation, the surviving fraction of cells decreases. If the remained fraction of cells is reduced sufficiently by this time, the tumor may be treated. Unless, as the dose rate continues to decrease, the proliferation exceeds from the sterilization and the tumor cell population increases. Conclusion: Due to high dose-rate, the shorter decay half-life is more effective in comparison to longer ones.

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Incidentally, detected upper urinary tract urothelial carcinoma is a rare entity. We report the case of a 70-year-old female patient who presented with flank pain, pyuria, fever, and a unilateral nonfunctioning kidney with nephrolithiasis and pyonephrosis on pyelography. Routine imaging failed to identify a mass lesion. In an Indian setting, the clinical differential of tuberculosis was considered likely. A nephrectomy was performed in view of the poor perfusion and functional status of the right kidney. Histopathological examination of the kidney showed a tumor of urothelial origin arising at the renal pelvis displaying extensive squamous metaplasia. Such a near total metaplastic change is rare and has hitherto been undescribed in the renal pelvis. Activation of pleuripotent urothelial stem cells in the setting of chronic irritation and inflammation may be the pathogenetic process behind such an occurrence.

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Aims: The clinical presentation and frequency of urogenital tumors varies in different regions of the world. This study was undertaken to analyze the frequency, clinical presentation, and the histopathological spectrum of the various male urogenital tumors diagnosed over a period of 3 years in a tertiary care institute. Materials and Methods: Three-year data were collected from the histopathology laboratory, which included all the cases of male urogenital tumors which were diagnosed histopathologically between November 2012 and October 2015. Results: A total of 10,297 surgical specimens of male patients were received in 3 years, of which 1749 were tumors of various organs in males. Of 1749 surgical specimens, 455 were genitourinary tumors. Frequency of urogenital tumors in males was 13.05%. Malignant tumors comprised the majority (99.53%). The age of the patients ranged from 19 to 98 years. The maximum number of patients was in the 5^th–7^th decade and the mean age of presentation was 64 years. Urinary bladder was the most common site for urogenital tumors (61.09%), with urothelial carcinoma being the most common histological type. Prostatic adenocarcinoma, renal cell carcinoma, and penile squamous cell carcinoma accounted for a significant number of cases. Testicular tumors were the least common and included predominantly mixed germ cell tumors. Conclusion: This study can be taken as a small step toward making the registry of patients with urogenital tumors providing valuable information regarding the frequency, clinical presentation, and histological spectrum. Large population-based studies for a longer duration of time across both males and females are needed in the ever-changing trends of urogenital tumors.

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Context: There are plenty of evidence that suggest that the potential high doses of radiation result in severe health effects to exposed individuals, although there is no consensus about the health impact of low dose of ionizing radiation (IR). Aims: This study aimed to discuss the effect a range of IR doses on the changes of gene expression and serum protein levels of two immune factors transforming growth factor-β (TGF-β) and interferon gamma (IFN-γ) in rats. Findings from this study can be useful to develop a suitable biomarker for biological dosimetry applications. Subjects and Methods: After 24 h of irradiation of rats with the doses of 1000, 500, 100, 50, and 20 mGy, the gene expression of TGF-β and IFN-γ in lymphocytes was assessed using quantitative polymerase chain reaction. Besides, the protein level of these two factors in blood plasma was determined by enzyme-linked immunosorbent assay (ELISA) kits. Statistical Analysis Used: One-way analysis of variance Tukey–Kramer Multiple Comparisons Test was used. P <0.05 was considered statistically significant. Results: Significant increases in the expression levels of TGF-β and IFN-γ genes were observed by increasing the dose from 100 to 500 mGy and then 1000 mGy compared to the control (P < 0.05). The ELISA tests showed significant differences in the serum level of TGF-β cytokine in the dose of 1000 mGy, while the serum level of IFN-γ cytokine showed significant differences in doses of 20 mGy and 1000 mGy compared to the control (P < 0.05). Conclusions: The results of this study showed the changes in the expression of TGF-β and IFN-γ genes after irradiation more than 100 mGy in lymphocytes compared to the control group; the changes in the serum levels of these cytokines only occurred in the specific doses compared to the control group.

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Introduction: Calculations from a treatment planning system (TPS) in heterogeneous regions may present significant inaccuracies due to loss of electronic equilibrium. The purpose of this study is to evaluate and quantify the differences of dose distributions computed by some of the newest dose calculation algorithms, including collapsed cone convolution (CCC), fast Fourier transform (FFT) convolution, and superposition convolution, in heterogeneity of the lung. Materials and Methods: A 6-MV Siemens Primus linear accelerator was simulated by MCNPX Monte Carlo (MC) code, and the results of percentage depth dose (PDD) and dose profile values were compared with measured data. The ISOgray TPS was used and PDDs of CCC, FFT, and superposition convolution algorithms were compared with the results obtained by MCNPX code. CT2MCNP software was used to convert the computed tomography images of the lung tissue to MC input files, and dose distributions from the three algorithms were compared to MC method. Results: For PDD curves in buildup region, the maximum underdosage of ISOgray TPS was at the surface (19%) and comes in closer agreement when depth increases (average 7.08%). Dose differences (DD) between different algorithms and MC were typically 4.81% (range: 1.95% to 7.30%), −1.55% (range: −5.14% to 5.26%) and 4.96% (range: 2.00% to 7.4%) in the lung for the CCC, FFT, and superposition algorithms, respectively. The difference between monitor units and maximum dose calculated using the three algorithms were 0.5% and 1.61%, respectively. The maximum DD of 7% was observed between MC and TPS results. Conclusion: Significant differences were found when the calculation algorithms were compared with MC method in lung tissue, and this difference is not negligible. It is recommended to use of MC-based TPS for the treatment fields including lung tissue.

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Objective: Undesired neutron contamination imposed to patients during treatment is among the main factors increasing the risk of secondary cancer in radiotherapy. This additional undesirable dose is due to neutron contamination production in high-energy accelerators. In this study, neutron contamination is investigated in the presence of wedge and block in 15 MV photon fields of Siemens Primus linear accelerator. Materials and Methods: Neutron production by 30°, 45°, and 60° wedges and cerrobend block was investigated. Measurements were conducted in a 10 cm × 10 cm field at the source to –surface distance of 100 cm at 0.5, 2, 3, and 4 cm depths of a 30 cm × 30 cm × 30 cm Perspex phantom using the CR-39 passive film detectors. Chemical etching was performed using sodium hydroxide solution with 6.25 M concentration as the etchant at 85°C for 3 h. Results: The neutron dosimetry results reveal that the presence of wedge and block increases the neutron contamination. However, the 45° wedge is most effective in producing neutron contamination. The results also show that the fast neutron contamination is lower in the steeper depths. Conclusion: The presence of a wedge in a therapeutic high-energy photon field is a source of neutron contamination and may be of concern regarding clinical aspects. The results of this study show that superficial tissues such as skin will incur higher fast neutron contamination than the deep tissues.

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Aim: By necessity of dosimeters calibration for evaluating delivered dose accuracy to organs out of the radiation field in patients undergoing gamma knife radiosurgery, we calibrated thermoluminescence dosimeters in gamma knife and ⁶⁰Co instruments, and then, compared both results to investigate when one of these devices was out of reach, can we use one of this instruments instead of the ther. Materials and Methods: To individual calibration by ⁶⁰Co, thermoluminescent dosimeters (TLDs) were placed in a Perspex sheet with conditions of source-skin distance = 80 cm, field size = 10 cm × 10 cm, and dose = 100 cGy. For individual calibration by Gamma knife, TLDs placed in flat Perspex were located in a special sphere and were exposed with conditions of source to axis distance = 40 cm, field size = 18 mm, and dose = 100 cGy, and for group calibration, TLDs were divided into six groups and were exposed with doses of 0–1000 cGy in both devices. Results: According to Fisher's exact test, calculated P = 0.27, so the difference is not significant. Conclusions: The result showed despite differences in calibration conditions, ⁶⁰Co unit can be used to calibrate TLD dosimeter for estimating the accuracy of measurement of delivered dose to organs of patients undergoing Gamma Knife 4C radiosurgery treatment.

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Objective: The complete molecular mechanism that cyclophosphamide (CPA) induces the cell death is still unknown. To further reveal the mechanism of CPA contributing to prostate cancer, we conducted analysis on gene expression profile of E-GEOD-42913 to identify attractor modules by integrating systemic module inference with attract method. Methods: First, case and control protein–protein interaction (PPI) networks were inferred based on Spearman correlation coefficient; then clique merging algorithm was performed to explore modules in the reweighted PPI network, and these modules were compared with each other so as to select similar modules; in the following, attractor modules were identified via attract method; finally, pathway enrichment analysis of genes in attractor modules was carried out. Results: A total of 11,535 genes were gained. A novel PPI network with 4698 nodes (20,541 interactions) was established via mapping the genes of the gene expression profile onto the original PPIs. Then, 1635 and 1487 interactions (P < 0.05) were selected to construct the destination network for CPA group and control group, respectively. Moreover, under the threshold value of overlap -threshold value of each two modules ≥ 0.5, 42 and 56 modules were separately determined for CPA group and control group. Twenty-six pairs of similar modules ([J (S_n, T_m)] ≥0.7) were gained. In the following, an attractor module which contained six nodes (15 interactions) (P < 0.05) was identified. Finally, two pathways with terms of DNA replication (P = 0.000137) and nucleotide excision repair (P = 0.024) were identified, and RFC4, POLE2 enriched in both of the pathways. Conclusions: We predicted that during the process of chemotherapy, CPA mainly affected the pathways of DNA replication and nucleotide excision repair to induce the cancer cell's death.

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