Predictors of death anxiety among Iranian cancer patients: Contribution of sense of Coherence

BACKGROUND

Death anxiety is a negative consequence of cancer that influences the quality of life of many patients. This study determined the predictors of death anxiety and the contribution of the sense of coherence to this disorder among Iranians with cancer.

METHODS

The present research was a descriptive-analytical study that examined cancer patients referring to one of the educational hospitals in Tehran, Iran. Two hundred eligible patients selected by purposeful sampling filled out a clinical and demographic questionnaire. The data were analyzed by the SPSS 20 software.

RESULTS

The correlational results revealed a negative and significant relationship between death anxiety and a sense of coherence (r = -0.610). Likewise, age, gender, marital status, occupational and economic circumstances, and cancer type were among the variables that correlated with death anxiety and predicted 85% of this psychological state.

CONCLUSION

The researchers recommend mental assessment in oncological care to identify psychological challenges to realize the ultimate goal of palliative care, i.e. improving patients' quality of life.

The Relevance of Common K-RAS Gene Mutations and K-RAS mRNA Expression with Clinicopathological Findings and Survival in Breast Cancer

INTRODUCTION

Studies have shown the role of mutation and gene expression of K-RAS in luminal breast cancer. In the current study, the status of common K-RAS mutations and mRNA expression in breast cancer were investigated. The aim of this research was determining the relationship of these molecular finding with clinicopathological features and 5 year overall survival.

MATERIAL AND METHODS

In this case control study, we examined tumor tissue obtained from patients who had breast surgery which their paraffin tissue samples were available in the pathology department. Samples who had codon 12 and 13 mutations in exon 2 of K-RAS gene were considered as case group and tumor tissues without these mutations were considered as control group. The expression of K-RAS mRNA was explored by real-time polymerase chain reaction (RT-PCR) and the results were reviewed with clinicopathological features and survival of patients.

RESULTS

The results of the present study showed that 14% and 10% of patients had K-RAS mutations in codons 12 and 13, respectively. There was a significant relationship between K-RAS mutations with T staging and PR positivity in tumors. Five years overall survival was 8% in case group compare to control group who had 69% 5y OS. Furthermore, K-RAS mRNA expression had a significant relationship with T and N staging and 5 year survival. In conclusion, it seems that two molecular markers of mutation and K-RAS gene expression may be used simultaneously to estimate the prognosis of breast cancer.

CONCLUSION

It seems that two molecular markers of mutation and K-RAS gene expression may be used simultaneously to estimate the prognosis of breast cancer.

Comparing Dermolina-Henna Cream with Mometasone Cream in Improving Radiodermatitis Among Patients with Breast Cancer: A Randomized Active-Control Double-Blind Clinical Trial

Objectives: Radiotherapy is one of the treatments used for different types of cancer. Acute radiodermatitis is one of its most common complications. Despite the high prevalence of radiodermatitis, few studies investigated how to prevent or treat this complication. Hence, a standard treatment has not been introduced so far. We sought to evaluate the efficacy of Dermolina-Henna cream, a new polyherbal formulation, compared to Mometasone cream for alleviating acute radiodermatitis among breast cancer patients. Design: Randomized active-control double-blind clinical trial. Setting/Location: The oncology clinic of Shohaday-e Tajrish Hospital (Tehran, Iran). Subjects: Women older than 18 years with breast cancer undergoing radiotherapy. Interventions: Patients were instructed to apply a thin layer of Dermolina-Henna or Mometasone cream once daily on their lesions at least 3 h after radiotherapy for 4 weeks, and if grade I or II radiodermatitis developed, also afterward. Patients were visited weekly until end of study at after 4 weeks. Radiation Therapy Oncology Group standard questionnaires were evaluated and recorded every week as the primary outcome. Outcome measures: Primary outcome was defined as evaluating the efficacy of Dermolina-Henna cream to change the radiodermatitis grade, while the level of patients' satisfaction and the rate of adverse events recorded by patients were secondary outcomes. Results: The trends on decrease in number of lesions, erythema, radiodermatitis grade, burning sensation, pain, and itchiness were statistically significant for each treatment, separately (p < 0.001), except for radiodermatitis grade in Mometasone group (p = 0.4). Dermolina-Henna was significantly better than Mometasone in alleviating burning sensation (p < 0.001) and itchiness (p = 0.041). Approximately 3.7% of patients showed adverse events and 3.7% declared dissatisfaction in both groups. Conclusions: In summary, we showed that Dermolina-Henna cream and Mometasone cream were significantly effective in decreasing severity of radiodermatitis symptoms among patients with breast cancer. Dermolina-Henna cream was significantly superior to Mometasone cream in alleviating burning and itchiness. Clinical Trial Registration Number: IRCT20200115046144N1.

Estimating short-term and long-term survival in rectal cancer patients using cure model

Background

A large number of rectal cancer patients are cured after treatment. In such cases, cure models are used for survival analysis. This study aims to investigate factors that affect survival in rectal cancer using the Cox mixture cure model.

Methods

Following a retrospective design, medical documents and pathological findings of newly diagnosed rectal cancer cases hospitalized at Imam Hossein Hospital, Tehran, Iran, from 2005 to 2013 were reviewed. The patients were followed up with until May 2018. The Cox mixture cure model was used. Data analysis was carried out using Statistical Analysis System (SAS) version 9.4. The statistical significance level was considered to be 0.05.

Results

Four hundred nine patients were included in this study. The mean of disease-free survival was 87.08 ± 3.2 months. The hazard of the event for the patients who were drug abusers was 2.37 (95% CI: 1.30-4.31) times more than the other cases (P = 0.005). The odds ratio of the event for patients of stage III was 3.04 (95% CI: 1.51-6.12) times more than the cases of stage I (P = 0.002), and for the patients of stage IV, it was 12.42 (95% CI: 4.17-37.01) times more than patients of stage I (P < 0.001).

Conclusions

The results of this cure model indicate that the tumor stage, tumor grade, and history of drug abuse are the risk factors for the survival of patients with rectal cancer. These results can attract the attention of doctors and patients who want to be aware of their physical status and prognosis.

Correlation of miR-31 and miR-373 expression with KRAS mutations and its impact on prognosis in colorectal cancer

Introduction

Colorectal cancers (CRC) are among the most common cancers. There are different modalities for treatment including chemotherapy, surgery, and radiotherapy. There are some mutations in cancers which can assist in the treatment and better prognosis of patients. In this study, two molecular markers (miR-31 and miR-373) were involved in the pathogenesis of CRC and their association with histopathological features was investigated. As well, the prognostic value of these molecular markers was investigated in CRC patients with or without common KRAS mutations.

Methods

Paraffin blocks of tissue samples from 150 patients who underwent colon surgery between 2018 and 2020 were prepared by the Pathology Department of Imam Hossein Hospital (Tehran, Iran). After DNA and RNA isolation, gene expression of miR-31 and miR-373 was determined using probe-based quantitative real-time polymerase chain reaction (qRT-PCR). Mutations of KRAS were surveyed using conventional PCR and agarose gel electrophoresis.

Results

The mean age of the patients was 57.2 ± 13.4 years. KRAS codon 12 and 13 mutations were positive in 31 (20.6%) and 22 (14.6%) cases, respectively. The results showed that KRAS common mutations occurred in 32.6% of Iranian CRC patients. The expression levels of miR-31 and miR-373 increased in CRC patients with KRAS mutations in comparison with patients without these mutations.

Conclusion

Considering the role of miR-31 and miR-373 in CRC tumor progression, it seems that the CRC patients bearing KRAS mutations have a poorer prognosis respective to patients without KRAS mutations.

Fabrication and Characterization of a Three-Dimensional Fibrin Gel Model to Evaluate Anti-Proliferative Effects of Astragalus hamosus Plant Extract on Breast Cancer Cells

Background:

Breast Cancer (BC) is a malignancy with high mortality among women. Recently, scaffold-based three-dimensional (3D) models have been developed for anti-cancer drug research. The present study aimed to investigate the anti-proliferative effects of Astragalus hamosus (A. hamosus) in 3D fibrin gel against MCF-7 cell line. We have also evaluated anti-proliferative effect of A. hamosus differences between 3D and 2D cultures.

Methods:

The fibrin gel formulation was first optimized by testing the structural and mechanical properties. Then the cytotoxic effect of A. hamosus extract was assessed on MCF-7 cells by MTT assay. Cell apoptosis was evaluated using TUNEL method and flow cytometry. Cell cycle and proliferation were analyzed by flow cytometry. Apoptosis-related gene expression such as Bcl-2, caspase-3, -8 and -9 were quantified by real time-PCR.

Results:

TUNEL staining showed a significant damage accompanied with cell apoptosis. Flow cytometry analysis revealed that apoptosis increased after treatment with A. hamosus extract in 3D culture model compared to 2D culture. The A. hamosus extract arrested cell cycle in the S and G2/M phases in 3D model while in the 2D culture G0/G1 phase was affected. Treatment with A. hamosus extract led to upregulation of the caspase-3, -8 and -9 genes and downregulation of the Ki-67 in the 3D-culture compared with the 2D culture.

Conclusion:

These results indicated that A. hamosus extract could be used as a therapeutic candidate for BC due to its anti-proliferative effects. Furthermore, 3D fibrin gel could be better than 2D-cultured cells in simulating important tumor characteristics in vivo, namely, anti-proliferative and anti-apoptotic features.

Long non-coding RNA panel as a molecular biomarker in glioma

BACKGROUND

Glioma is one of the most malignant brain tumors, accounting for about half of the gliomas that occur in central nervous system (CNS), originates from the glial tissue of the brain. The aim of the present study was to determine the expression levels of 5 lncRNAs (MDC1-AS1, HOXA11-AS, MALAT1, CASC2, ADAMTS9-AS2) in patients with high-grade glioma in comparison with low grade glioma.

METHODS

This was a retrospective study which determined molecular biomarker on pathologic glioma samples. We examined 100 patients' pathologic block which consisted of 50 pathology samples of high-grade glioma (case group) and control group consisted of 50 pathology samples of low-grade glioma. This research was performed using real time polymerase chain reaction (PCR) technique.

RESULTS

The results showed that the expression of ADAMTS9-AS2 and HOXA11-AS genes significantly increased with increasing tumor grade. Also the expression of CASC2 gene significantly decreased with increasing tumor grade.

CONCLUSIONS

It was concluded that ADAMTS9-AS2 and HOXA11-AS and CASC2 are promising lncRNA markers in prognosis of glioma.

Primary intracranial leiomyosarcoma presenting with frontal bone mass: a case report

Primary intracranial mesenchymal neoplasms are rare tumors. These tumors are usually metastatic disease from other primary sites. We presented a 31-year-old man with a 6-month history of gradually enlarging frontal mass and positional headache. There was no other symptom demonstrating other organs' involvement. The patient underwent an uncomplicated craniotomy with clear surgical margins. The pathology review and the immunohistochemistry staining confirmed leiomyosarcoma grade II. We prescribed radiation therapy with tumor dose of 60 Gy in 30 fractions with conformal treatment planning to the tumor bed. As this disease has a high potency for metastasis, we advised four courses of single agent doxorubicin chemotherapy 75 mg/m2 every 4 weeks starting one month after the end of radiotherapy. In the last follow-up visit 34 months later, the patient was disease free in physical exam and imaging findings.

Tissue engineering applications in breast cancer

In Iran, breast cancer (BC) is the most prevalent cancer among women. The standard treatment for this cancer is partial or total removal of breast tissue, followed by chemotherapy and radiation. Tissue engineering (TE) has made new treatments for tissue loss in these patients by creating functional substitutes in the laboratory. In addition, cancer biology combined with TE provides a new strategy for evaluation of anti-BC therapy. Several innovations in TE have led to the design of scaffold or matrix based culture systems that more closely mimic the native extracellular matrix (ECM). Currently, engineered three-dimensional (3D) cultures are being developed for modelling of the tumour microenvironment. These 3D cultures fulfil the need for in vitro approaches that allow an accurate study of the molecular mechanisms and a better analysis of the drugs effect. In the present study, we review recent developments in utilising of TE in BC. Moreover, this review describes achievements of Iranian researchers in the field of breast TE.

Clinicopathological features and survival of colorectal cancer patients younger than 50 years: a retrospective comparative study

BACKGROUND

Colorectal cancer (CRC) is a disease of old age, but its incidence has been rising among younger population compared to older ones. Nevertheless, there is a controversy over survival of younger patients compared to the older ones. Therefore, in the current study, we investigated the clinicopathological features and survival of the younger (< 50 years) versus older (≥ 50 years) CRC patients.

RESULTS

The younger and older groups consisted of 39.4% and 60.6% of patients, respectively. Both age groups were comparable regarding the symptom presentation and duration, and pre-operative carcinoembryonic antigen (CEA). The younger patients were diagnosed with a higher proportion of poorly differentiated (14.7% vs. 8.3%; p < 0.001) and more advanced tumors (53.2% vs. 45.9%; p = 0.266). The rectum tumor site was significantly more common among the younger patients (p = 0.021). The overall survival (OS) (p = 0.278), the cancer-specific survival (CSS) (p = 0.233), and the disease-free survival (DFS) (p = 0.497) did not differ significantly between the two groups. Based on Cox regression model, elevated pre-operative CEA level (HR = 1.41; 95%CI of 1.01-1.97), advanced tumor stage (6.06; 95%CI of 3.03-12.15), and poorly differentiated tumor (HR = 1.69; 95%CI of 1.05-2.71) were associated with decreased survival.

CONCLUSIONS

The younger patients did not have poor prognosis compared to the older ones despite having an advanced tumor stage and a poor tumor differentiation.

Comparison of three-dimensional vs. conventional radiotherapy in saving optic tract in paranasal sinus tumors

PURPOSE

To assess the possibility of delivering a homogeneous irradiation with respect to maximal tolerated dose to the optic pathway for paranasal sinus (PNS) tumors.

METHODS

Treatment planning with conformal three-dimensional (3D) and conventional two-dimensional (2D) was done on CT scans of 20 patients who had early or advanced PNS tumors. Four cases had been previously irradiated. Dose-volume histograms (DVH) for the planning target volume (PTV) and the visual pathway including globes, chiasma and optic nerves were compared between the 2 treatment plannings.

RESULTS

The area under curve (AUC) in the DVH of the globes on the same side and contralateral side of tumor involvement was significantly higher in 2D planning (p <0.05), which caused higher integral dose to both globes. Also, the AUC in the DVH of chiasma was higher in 2D treatment planning (p=0.002). The integral dose to the contralateral optic nerve was significantly lower with 3D planning (p=0.007), but there was no significant difference for the optic nerve which was on the same side of tumor involvement (p >0.05). The AUC in the DVH of PTV was not significant (201.1 + or - 16.23 mm(3) in 2D planning vs. 201.15 + or - 15.09 mm(3) in 3D planning). The volume of PTV which received 90% of the prescribed dose was 96.9 + or - 4.41 cm(3) in 2D planning and 97.2 + or - 2.61 cm(3) in 3D planning (p >0.05).

CONCLUSION

3D conformal radiotherapy (RT) for PNS tumors enables the delivery of radiation to the tumor with respect to critical organs with a lower toxicity to the optic pathway.

Benzydamine for prophylaxis of radiation induced oral mucositis in head and neck cancers: Double-blind clinical trial

9042

Background: Oral mucositis is one of the most common adverse effects of radiotherapy in head and neck tumors. We determined the efficacy of oral rinse benzydamine in prevention of radiation induced mucositis. Methods: Patients with head and neck cancers were enrolled in a randomize, placebo-controlled clinical trail to receive either benzydamine or placebo. All the cases received at least 50 Gy radiation to the oral cavity and oropharyngeal areas. The end points were comparison of highest grade of mucositis at the end of radiotherapy, frequency of grade 2 or more, the interval days to establishing grade 2 in the groups. Results: 100 patients with head and neck cancers were randomized in this trail. At the end of the study, 19 patients were excluded of the analysis due to minor side effects of drug, or stopping the radiotherapy. In 39 cases in the treated group, the frequency of mucositis grade 3 or more was 43.6% (17 cases) in contrast to 78.6% (33 cases) in 42 cases in the placebo group, which was significant (p=0.001). Mucositis grade 3 or more was 2.6 times frequent in placebo group (CI=95%, relative risk=1.38–5). At the end of RT, at least 42% of the treated group had mucositis grade 3 or more in contrast to at least 76% in the control group which was statistically significant. Intensity of mucositis was increased up to forth week of treatment in both groups to grade 2. In the treated group the grade of mucositis was approximately constant to the end of therapy; but in the control group it raised to grade 3 (p<0.001). The highest grade of mucositis during the treatment time was significantly different between two groups (p=0.049). The median interval days of establishing grade 2 mucositis was 3.6 days sooner in the placebo group (p=0.12). Conclusions: According to these results it seems that oral rinse benzydamine was effective, safe, and well tolerated for prophylactic treatment of radiation-induced oral mucositis in head and neck tumors.

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