Total Neoadjuvant vs. Standard Perioperative Cisplatin/ Doxorubicin Chemotherapy in Patients with Extremities Osteosarcoma: A Multi-Center Cohort Study

INTRODUCTION

Despite improvements in survival of patients with high-grade osteosarcoma after the implementation of perioperative chemotherapy, osteosarcoma remains among the most lethal cancers. Prescription of all chemotherapy courses before the surgery may provide this opportunity to eliminate micrometastases more efficiently, increase the chances of pathologic complete response and organ preserving surgery. This study aimed to compare the outcomes of total neoadjuvant chemotherapy vs. standard perioperative chemotherapy with cisplatin/doxorubicin regimen in patients with extremities osteosarcoma.

METHODS

In this retrospective cohort, all patients with high-grade osteosarcoma admitted to oncologic centers affiliated to Iran University of Medical Sciences in Tehran, Iran from 2015 to 2021 were included. Organ preserving rates, pathologic responses, and survival of patients who received all six courses of cisplatin/doxorubicin regimen preoperatively were compared to those who received the regimen perioperatively.

RESULTS

Sixty-three patients were enrolled (total neoadjuvant chemotherapy: 32 patients and perioperative chemotherapy: 31 patients). In total neoadjuvant chemotherapy and perioperative chemotherapy groups, favorable pathology responses (necrosis>90%) were reported in 80.6% and 15.6% of patients, respectively (p<0.001). With a median follow-up of 24 months, mean overall survival of total neoadjuvant chemotherapy and perioperative chemotherapy groups were 21.29 months (95% CI; 19.3-23.27) and 23.46 months (95% CI; 22.7-24.1), respectively (p=0.2). The mean disease-free survival of patients in total neoadjuvant chemotherapy and perioperative chemotherapy groups were 19.54 months (95% CI; 17.0-22.0) and 21.37 months (95% CI; 19.4-23.2), respectively (p=0.2).

CONCLUSION

Our results showed that prescription of all courses of doxorubicin/cisplatin chemotherapy prior to surgery can increase favorable pathologic response rates, although this improvement is not translated into overall and disease-free survival benefits.

Neutrophil-to-Lymphocyte Ratio (NLR) as a Poor Predictive Biomarker for Pathological Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Prospective Study

BACKGROUND

The literature is inconsistent for the role of neutrophil-to-lymphocyte ratio (NLR) obtained before neoadjuvant therapy (pre-NLR) in predicting pathological response to neoadjuvant chemoradiation (neoCRT) in patients with locally advanced rectal cancer (LARC). In the present cohort study, we explored the predictive role of pre-NLR in this setting.

METHODS

We prospectively included patients with LARC who were candidates for neoCRT at the Shohada-e-Hafte Tir Hospital (Tehran, Iran) between Mar 2018 and Feb 2020. The pre-NLR was obtained through a peripheral blood smear before CRT. We used the AJCC system for evaluating tumor regression grade (TRG). The TRGs were categorized into: response-group 1 (TRG 0-1 vs. 2-3), response-group 2 (TRG 0 vs. 1-3), and response-group 3 (TRG 0-2 vs. 3). We applied receiver operating characteristic (ROC) analysis to assess the predictive value of pre-NLR.

RESULTS

Of the 86 screened patients with rectal cancer, 30   patients who fulfilled the inclusion criteria were included in the study. In total, 63.3% were responsive, and 23.3% had complete pathologic response. Pre-NLR could not predict the pathologic response in response-group 1 (area under the ROC curve [AUC]: 0.45, 95%CI 0.23-0.66) and response-group 2 (AUC: 0.36, 95%CI 0.13-0.59). Nevertheless, it had a poor predictive value in response-group 3 (AUC: 0.55, CI%95 0.33-0.75) with an optimal NLR cutoff value of 2.94.

CONCLUSIONS

Pre-NLR could not predict the pathological response to neoCRT in our cohort of patients with LARC.

Serum Ferritin, Vitamin D and Pathological Factors in Breast Cancer Patients

Background: Breast cancer is one of the most common cancers. Researchers are trying to diagnose the disease through easier and safer methods. Serum markers such as ferritin and vitamin D level would be very helpful. This research could pave the way for more comprehensive studies on how to use this serum factor in breast cancer screening, as well as early detection of the disease in its early stages.

Methods: This study consisted of two groups, the first group comprising patients diagnosed with breast cancer before undergoing any treatment and the second group as control were healthy people. Serum ferritin and vitamin D levels were measured. Pathological information of the patient's tumor, including ER, HER2, KI67, lymphovascular invasion, and disease stage, were collected as well. Data were analyzed by IBM SPSS advanced statistics version 23.0 (SPSS Inc., Chicago, IL). P-value of ≤0.05 was considered significant.

Results: Eighty-eight subjects were enrolled in this study, 29 (33%) breast cancer patients and 59 (67%) healthy women. In breast cancer patients, serum ferritin levels were 106.55±111.25, which were higher than healthy women’s serum ferritin 52.71±36.95 (p=0.083). Furthermore, 18 (66.7%) of breast cancer patients and 55 (93.2%) of healthy women had low serum ferritin levels (p=0.001). 3 (11.1%) patients in the cancer group had serum vitamin D deficiency, while all subjects in the control group had serum vitamin D higher than 10 ng/dl (p =0.009).

Conclusion: The results of this study showed a correlation between breast cancer and vitamin D deficiency, and elevated ferritin. Perhaps with further studies, there could be a role in predicting the prognosis and screening of breast cancer for these associations.

The effect of underlying distribution of asset returns on efficiency in DEA models

According to modern finance theory and increasing need for efficient investments, we evaluate the portfolio performance based on the data envelopment analysis method. By the fact that stock market’s return distributions usually exhibit skewness, kurtosis and heavy-tails, we consider some appropriate underlying distributions that affect the input and output of the model. In this regard, the multivariate skewed t and the multivariate generalized hyperbolic as the heavy-tailed distributions of Normal mean-variance mixture are applied. The models are inspired by the Range Directional Measure (RDM) model to deal with negative values. The value-at-risk (VaR) and conditional VaR (CVaR) as risk measures are used in these optimization problems. We estimate the parameters of such distributions by Expectation Maximization algorithm. Then we present an empirical investigation to measure the relative efficiency of two sets of seven groups of companies from different industries of Iran stock exchange market. By comparing the results of introduced models with previous RDM approach, we show that how well the distribution of assets affect the performance evaluation.

Effectiveness of rectal displacement devices during prostate external-beam radiation therapy: A review

Dose-escalated prostate radiotherapy (RT) can improve treatment outcomes, but rectal toxicity is the main limiting factor for introducing dose-escalated RT. Pushing rectal wall away from the prostate reduces the volume of the rectum in high-dose region, which can decrease both short- and long-term rectal toxicities after RT. This review focuses on the literature using different rectal displacement devices such as endorectal balloons, tissue spacers, rectal retractor, and ProSpare during prostate External beam radiotherapy, with regard to dosimetric effects, clinical benefits, prostate motion, and postoperative RT setting.

Comparison of the Effect of Combined Treatment with Radiotherapy and Hyperthermia versus Exclusively Radiotherapy to Reduce Pain in Patients with Bone Metastases

Based on the extant studies conducted by scholars, recognizing the best and practical treatment methods in patients with bone metastases is an important and conspicuous focus in improving and amelioration of the treatment and prognosis of patients. Ergo, this study aims to compare the effects of radiotherapy and hyperthermia with radiotherapy only to reduce pain in one of the oncology centers located in Tehran (the capital city of Iran). In this randomized clinical trial study, patients with bone metastases were randomly assigned to one of two group’s radiotherapy and hyperthermia or radiotherapy exclusively and the collected data were processed through Statistical Package of Social Science (SPSS). Thenceforth, findings were evaluated and compared between the two groups. A total of 60 patients inclusive of 34 women and 26 men were investigated. In the baseline, 20 patients in the case group (67%) and 21 patients in the control group (70%) used palliative drugs. At the end of the trial, the consumption of palliative drugs was decreased in the case group (12 patients, 43%) but, no change was observed in the control group. After treatment, complete response to treatment (27% vs. 13%), experienced a decrease in the clinical pain (57% vs. 83%) and did not respond to treatment in a stable mode (17% vs. 4%) of which were different between case and control groups, respectively. Regardless of the difference in the ratio of partial response in two groups, there was no significant difference between the two groups in terms of response to treatment. Although the effect of radiotherapy and hyperthermia in comparison with radiotherapy exclusively was more efficacious in some aspects of the intervention of pain with sleep. However, there was no remarkable and significant difference in other cases.

Application of rectal retractor for postprostatectomy salvage radiotherapy of prostate cancer: A case report and literature review

Using a rectal retractor (RR) during salvage radiotherapy after radical prostatectomy is a promising approach for reducing dose to the rectum. The patient well tolerated the daily RR insertion. This area of research encourages researchers for a comprehensive evaluation of the role of the RR in postprostatectomy radiotherapy.

Use of artificial neural network for pretreatment verification of intensity modulation radiation therapy fields

OBJECTIVE

The accuracy of dose delivery for intensity modulated radiotherapy (IMRT) treatments should be determined by an accurate quality assurance procedure. In this work, we used artificial neural networks (ANNs) as an application for the pre-treatment dose verification of IMRT fields based two-dimensional-fluence maps acquired by an electronic portal imaging device (EPID).

METHODS

The ANN must be trained and validated before use for the pretreatment dose verification. Hence, 60 EPID fluence maps of the anteroposterior prostate and nasopharynx IMRT fields were used as an input for the ANN (feed forward type), and a dose map of those fluence maps that were acquired by two-dimensional Array Seven29TM as an output for the ANN.

RESULTS

After the training and validation of the neural network, the analysis of 20 IMRT anteroposterior fields showed excellent agreement between the ANN output and the dose map predicted by the treatment planning system. The average overall global and local γ field pass rate was greater than 90% for the prostate and nasopharynx fields, with the 2 mm/3% criteria.

CONCLUSION

The results indicated that the ANN can be used as a fast and powerful tool for pretreatment dose verification, based on an EPID fluence map.

ADVANCES IN KNOWLEDGE

In this study, ANN is proposed for EPID based dose validation of IMRT fields. The proposed method has good accuracy and high speed in response to problems. Neural network show to be low price and precise method for IMRT fields verification.

X-ray radiation and the risk of multiple sclerosis: Do the site and dose of exposure matter?

BACKGROUND

The sporadic cases of radiation-activated multiple sclerosis (MS) has been previously described, with a few studies focused on the relationship between radiation and the risk of MS. The aim of our study was to evaluate the association between history of X-ray radiation and MS.

METHODS

This case-control study was conducted on 150 individuals including 65 MS patients and 85 age- and sex-matched healthy controls enrolled using non-probability convenient sampling. Any history of previous Xray radiation consisted of job-related X-ray exposure, radiotherapy, radiographic evaluations including chest Xray, lumbosacral X-ray, skull X-ray, paranasal sinuses (PNS) X-ray, gastrointestinal (GI) series, foot X-ray and brain CT scanning were recorded and compared between two groups. Statistical analysis was performed using independent t test, Chi square and receiver operating characteristics (ROC) curve methods through SPSS software.

RESULTS

History of both diagnostic [OR=3.06 (95% CI: 1.32-7.06)] and therapeutic [OR=7.54 (95% CI: 1.5935.76) X-ray radiations were significantly higher among MS group. Mean number of skull X-rays [0.4 (SD=0.6) vs. 0.1 (SD=0.3), p=0.004] and brain CT scanning [0.9 (SD=0.8) vs. 0.5 (SD=0.7), p=0.005] was higher in MS group as well as mean of the cumulative X-ray radiation dosage [1.84 (SD=1.70) mSv vs. 1.11 (SD=1.54) mSv; p=0.008].

CONCLUSION

Our study was one of the first to show higher history of X-ray radiation in patients with MS compared to healthy controls. A possible association was also found between the dose and the site exposed to X-ray radiation and risk of developing MS.

Prediction of Survival in Thyroid Cancer Using Data Mining Technique

Cancer is the second leading cause of death after cardiovascular diseases in the world. Health professionals are seeking ways for suitable treatment and quality of care in these groups of patients. Survival prediction is important for both physicians and patients in order to choose the best way of management. Artificial Neural Network (ANN) is one of the most efficient data mining methods. This technique is able to evaluate the relationship between different variables spontaneously without any prevalent data. In our study ANN and Logistic Regression were used to predict survival in thyroid cancer and compare these results. SEER (Surveillance, Epidemiology and End Result) data were got from SEER site1. Effective features in thyroid cancer have been selected based on supervision by radiation oncologists and evidence. After data pruning 7706 samples were studied with 16 attributes. Multi Layer Prediction (MLP) was used as the chosen neural network and survival was predicted for 1-, 3- and 5-years. Accuracy, sensitivity and specificity were parameters to evaluate the model. The results of MLP and Logistic Regression models for one year are defined as for 1-year (92.9%, 92.8, 93%), (81.2%, 88.9%, 72.5%), for 3-year as (85.1%, 87.8%, 82.8%), (88.6%, 90.2%, 87.2%) and for 5-year as (86.8%, 96%, 74.3%), (90.7%, 95.9%, 83.7) respectively. According to our results ANN could efficiently represent a suitable method of survival prediction in thyroid cancer patients and the results were comparable with statistical models.

Current SEM techniques for de- and re-construction of centromeres to determine 3D CENH3 distribution in barley mitotic chromosomes

Combined light microscopic (LM) and field emission scanning electron microscopic (FESEM) techniques with FluoroNanogold labelling allowed quantification and high resolution analysis of 3D distribution of the centromere-specific histone H3 variant CENH3 in barley mitotic chromosomes. Chromosomes were investigated with fluorescence LM, conventional FESEM, low-voltage FESEM and combined FIB/FESEM techniques for unprecedented comprehensive analysis to determine chromatin distribution patterns in the centromere. Using data from FIB/FESEM sectioning of centromeric regions of chromosomes, it was possible to render 3D reconstruction of the CENH3 distribution with highest resolution achieved to date. Complementary data derived from each approach show that CENH3 localizes not only to the primary constriction, but also in the pericentric regions and is distributed exclusively in the interior, rather than on the surface, of the centromere. This is relevant for understanding kinetochore assembly and digresses from current models of centromere structure. We emphasize here this broad microscopic approach, focusing on technical aspects of combined FESEM techniques, for which advantages and limitations are discussed, providing a relevant example--in the field of centromeric research--for application to investigations of other subcellular biological structures.

Interspecific hybrids of Hordeum marinum ssp. marinum x H. bulbosum are mitotically stable and reveal no gross alterations in chromatin properties

Interspecific hybrids between the related wild barley species Hordeum marinum and H. bulbosum were generated and tested regarding their chromosomal stability and chromatin properties. Unlike in H. vulgare x H. bulbosum hybrid embryos, there was no effect of temperature on uniparental chromosome elimination or retention during hybrid seed development and 7 chromosomes from each parent were detected according to genomic in situ hybridization analyses. The centromere-specific histone H3 gene (CENH3) of both parental genomes is active in hybrid plants. Indirect immunostaining of flow-sorted 2C nuclei indicated that no major reorganization of histone H3 methylation (K4, K9 and K27), H3K9 acetylation and histone H2A ubiquitination marks or location of active RNA polymerase II sites occurred after interspecific hybridization.