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Papers by mona malekzadeh

International Journal of Cancer Management

Background: Vulvovaginal atrophy (VVA) usually occurs during and after menopause due to low estro... more Background: Vulvovaginal atrophy (VVA) usually occurs during and after menopause due to low estrogen levels and can cause frustrating symptoms. Existing treatments such as estrogen compounds have undesired side effects. Objectives: This study was conducted to assess the effectiveness of a chicken tallow product for vaginal use on subjective symptoms of VVA in women with breast cancer. Methods: Menopause induced by chemical drugs with subjective symptoms of VVA were selected from the Oncology-Radiotherapy Clinic of Shohadaye Tajrish Hospital between March and July 2020. Informed consent was obtained. Patients were instructed to apply 5g cream every other night before bedtime for 2 weeks, and 2 nights a week for the next 2 weeks and stop the medication. Patients were assessed at the time of initiation of medication, and 2, 4, 6, and 8 weeks after initiation of the trial, and VVA subjective symptoms were assessed. VVA subjective symptom score (VVA-SSS) form was used to assess itching, ...

Journal of Contemporary Brachytherapy

Purpose: The present study aimed to assess the correlation between dose to pelvic lymph nodes and... more Purpose: The present study aimed to assess the correlation between dose to pelvic lymph nodes and to point B with tandem-ring (TR) applicators for intra-cavitary brachytherapy treatment of locally advanced cervical cancer. Material and methods: Cervical cancer patients treated at brachytherapy department of Lucien Neuwirth Cancer Center, from 2015 to 2018, were included. Target delineation was performed in compliance with GEC-ESTRO guidelines. Revised American Brachytherapy Society (ABS) point A was determined (A RN (right) and A LN (left)) as well as Manchester point B. Prescription dose was 25-35 Gy in 5 fractions. Pelvic lymph nodes were delineated, then dose to points A and B, and dose-volume histogram (DVH) parameters of delineated lymph nodes were extracted. Significant relationships or correlations between lymph nodes reference points, dosage to points B, and their DVH parameters were investigated. Results: The mean dose and mean percentage of the prescription dose to the left and right points B were 4.6 ±0.18 Gy and 82.08 ±0.72%, respectively. Pearson correlation coefficient R = 0.81 (p-value = 0.00) between dose to A RN and A LN points and prescription dose was obtained. Negative correlation between CTV HR volume and difference between French and ABS prescription points was found. Conclusions: Dose to point B can be a moderate surrogate for maximum, minimum, and median dose to the internal iliac and presacral lymph node, but cannot be for maximum dose to the obturator lymph node. Points B cannot be a reliable substitute for common and external iliac chains.

Asian Pacific Journal of Cancer Care, 2017

Background: Radiation dermatitis is one of the most common side effects of radiotherapy for breas... more Background: Radiation dermatitis is one of the most common side effects of radiotherapy for breast cancer, affecting approximately 85 percent of patients. The aim of this study is to assess the effect of Licorice root (Glycyrrhizin glabra) and Yarrow (Achillea millefolium) on preventing radiotherapy-induced dermatitis in breast cancer patients.Methods: Seventy-five patients with breast cancer who had undergone mastectomy and were planned to receive radiotherapy (RT) were enrolled in this randomized, double-blind, placebo-controlled study. The extract of Achillea millefolium and Glycyrrhizin glabra root were incorporated into a vanishing cream base. Patients were randomly divided into three groups and received Glycyrrhizin glabra cream, placebo or Achillea millefolium cream for five weeks during RT. The rate and grade of radiation dermatitis were recorded at baseline, at the end of third week and at the end of treatment using a modified Radiation Therapy Oncology Group (RTOG) grading...

Acute Side Effects of Radiation Therapy, 2017

Archives of Iranian medicine, 2017

Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly fou... more Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly found in the gastrointestinal system. In this study, we examined the epidemiology of NETs in an Iranian population. The incident NET cases diagnosed between January 1, 2009 and December 31, 2014 were collected from databases of three hospitals in Tehran (Shoada-e-Tajrish Hospital, Imam Hossein Hospital and Pars Hospital). A total of 291 cases with NET diagnosis were identified. The most common NET location was gastrointestinal (71.4%), followed by Bronchopulmonary (7.2%) and Genitourinary (7.2%). The total number of identified NETs in our study increased from 25 cases in 2009 to 66 cases in 2014. In conclusion, our data suggests that the incidence of NETs is increasing slowly. Thus, etiologic studies for NETs are needed to help plan future preventive strategies. The authors declare no conflicts of interests.

Acute Side Effects of Radiation Therapy

Acute Side Effects of Radiation Therapy

Radiation-Induced Liver Disease Radiation-induced liver disease (RILD), historically called radia... more Radiation-Induced Liver Disease Radiation-induced liver disease (RILD), historically called radiation hepatitis, has been reported in 6-66% of patients whose livers are irradiated based on radiation dose, exposed liver volume, and baseline liver function [1, 2]. Abnormalities in laboratory liver function tests may be found on routine evaluation of patients when RILD is mild, but in severe cases, liver dysfunction may affect the treatment course and eventually threaten patient's lives.

Acute Side Effects of Radiation Therapy

Acute Side Effects of Radiation Therapy

The acute ear complications of radiation therapy include external, middle, and inner ear injuries... more The acute ear complications of radiation therapy include external, middle, and inner ear injuries. The acute external ear complications include otitis externa or skin reactions involving the preauricular region, the auricle, and the external auditory canal that occur in about 28% of head and neck cancer patients treated with radiation therapy [1]. The acute middle ear complications that include mastoiditis, Eustachian tube dysfunction, consequential otitis media, and transient conductive hearing loss occur in 40-45% of head and neck cancer patients during or after radiation therapy [2, 3]. The acute inner ear complications include sensorineural hearing loss (SNHL) and tinnitus [4]. SNHL may occur early after treatment in up to 50% of patients with head and neck tumors treated with radiation therapy [5-7].

Radiation-induced nausea and vomiting (RINV) is generally less frequent and less severe than the ... more Radiation-induced nausea and vomiting (RINV) is generally less frequent and less severe than the nausea and vomiting encountered in patients receiving chemotherapy. This problem is often underestimated and undertreated by radiation oncologists in clinical practice; however, it can be very distressing and may cause delay or even interruption of radiotherapy [1–3]. The incidence of RINV was studied in two prospective observational studies. The Italian Group for Antiemetic Research in Radiotherapy (IGARR) analyzed the incidence of RINV in 1020 patients receiving various kinds of radiation therapy without concurrent chemotherapy. Vomiting and nausea occurred in 11% and 27.1% of patients, respectively, and 27.9% of patients had both vomiting and nausea [1]. Nausea was twice as frequent as vomiting (27.1% vs. 11%) and lasted longer (median duration 10 vs. 3 days). The RINV incidence rates based on anatomical sites were 28% for breast, 39% for pelvis, 40.4% for head and neck, 48.8% for tho...

Acute Side Effects of Radiation Therapy

Cranial irradiation has an important role in the treatment of brain tumors either with curative i... more Cranial irradiation has an important role in the treatment of brain tumors either with curative intent or for palliation. Cranial irradiation has a unique application in prevention of distant metastasis to brain parenchyma, and prophylactic cranial irradiation may be carried out in selected patients at high risk of neoplastic cranial involvement. Brain is also an organ at risk during radiotherapy of tumors which are located in base of skull and in some head and neck cancers. Cranial irradiation in any condition can cause brain injuries that are classified into three groups based on the timing of their occurrence after radiation exposure: acute (during radiation or up to 6 weeks after radiation), early delayed or subacute (up to 6 months after radiation), and late delayed (6 months or more after the completion of radiation). However in more trials, brain injury simply is defined as acute (within 90 days of the commencement of therapy) and late reactions (after 90 days of the commencement of therapy) [1]. Reports indicate that patients that undergo standard fractionated cranial irradiation and stereotactic radiosurgery may have acute brain reactions in the range of 2–40% [1–12]. However, up to 50% of patients with high doses per fraction (more than 3 Gy) to a large part of the brain may develop acute encephalopathy [3, 13].

Acute Side Effects of Radiation Therapy

Renal cell carcinoma (RCC) has been recognized in a variety of situations with different presenta... more Renal cell carcinoma (RCC) has been recognized in a variety of situations with different presentations including uncommon metastasis and paraneoplastic syndromes.

Profound hematologic toxicity, prominently leukopenia, frequently develops following radiation th... more Profound hematologic toxicity, prominently leukopenia, frequently develops following radiation therapy that includes a large volume of bone marrow in the radiation field [1–8]. The percentage of patients with radiation-induced leukopenia has been reported in up to 50% and 90% of patients treated with pelvic field irradiation alone and with concurrent chemotherapy, respectively [1, 6]. These values are lower for thrombocytopenia (1% and 30% of patients treated with pelvic field irradiation alone and with concurrent chemotherapy, respectively) and anemia (30% and 50% of patients treated with pelvic field irradiation alone and with concurrent chemotherapy, respectively) [1, 10].

A reduction in taste sensitivity (hypogeusia), an absence of taste sensation (ageusia), or a dist... more A reduction in taste sensitivity (hypogeusia), an absence of taste sensation (ageusia), or a distortion of normal taste (dysgeusia) are well-known side effects in cancer patients that receive radiation therapy to the head and neck areas, and it has been reported in up to 100% of these patients [1–4]. The generic term of dysgeusia more commonly refers to any alteration in taste perception [5].

Archives of Iranian medicine, 2017

Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly fou... more Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly found in the gastrointestinal system. In this study, we examined the epidemiology of NETs in an Iranian population. The incident NET cases diagnosed between January 1, 2009 and December 31, 2014 were collected from databases of three hospitals in Tehran (Shoada-e-Tajrish Hospital, Imam Hossein Hospital and Pars Hospital). A total of 291 cases with NET diagnosis were identified. The most common NET location was gastrointestinal (71.4%), followed by Bronchopulmonary (7.2%) and Genitourinary (7.2%). The total number of identified NETs in our study increased from 25 cases in 2009 to 66 cases in 2014. In conclusion, our data suggests that the incidence of NETs is increasing slowly. Thus, etiologic studies for NETs are needed to help plan future preventive strategies. The authors declare no conflicts of interests.

The orbit contains the globe and connective tissues including extraocular muscles, orbital fat, e... more The orbit contains the globe and connective tissues including extraocular muscles, orbital fat, eyelids, eyelashes, lacrimal gland, and lacrimal draining system. Different parts of the globe (e.g., the lens, iris, conjunctiva, sclera, retina, ciliary body, cornea, and optic nerve) have different sensitivities to irradiation. Some structures like the optic nerve respond to radiation in a chronic manner (late-responding tissue), and some like the conjunctiva and eyelids are acute-responding tissues. Some parts of the mentioned structures are very sensitive, and some of them like the lens and sclera are very resistant to radiation. The orbital area may be irradiated as the treatment target or as an organ at risk in the vicinity of the target. Radiation-induced acute side effects in this area require prompt attention to prevent long-term issues like ophthalmitis, permanent dry eyes, and impaired visual acuity. In this chapter, we will focus on more sensitive acute-responding tissues.

Background: Axillary lymph node metastasis is the most important predictive factor for recurrence... more Background: Axillary lymph node metastasis is the most important predictive factor for recurrence risk and survival in patients with invasive breast carcinoma. The aim of this study was to determine the factors associated with the metastatic involvement of axillary lymph nodes in Iranian women with early breast cancer. Methods: This article reports a retrospective study of 774 patients with T1-T2 breast cancer who underwent resection of the primary tumor and axillary staging by SLNB and/or ALND between 2005 and 2015 at our institution. Results: Of the 774 patients included in this study, 35.5% (275 cases) had axillary lymph node involvement at the time of diagnosis. Factors associated with nodal involvement in univariate analyses were tumor size, lymphovascular invasion, tumor grade, ER/PR status and HER2 expression. All factors identified with univariate analyses were entered into a multivariate logistic regression model and tumor size (OR= 3.01, CI 2.01–4.49, P <0.001), ER/ PR ...

Introduction: The aim of this study is evaluation of two Quality Assurance methods in sliding win... more Introduction: The aim of this study is evaluation of two Quality Assurance methods in sliding window IMRT technique and Determination of gamma index in both methods Materials and Methods: In this study two tools named" Delta4" phantom and " Epiqa" software has been used to perform QA on the treatment plan before the actual treatment by Varian linear accelerator Clinac 600C. For this purpose, 20 patient’s treatment plan were assessed with the 3% and 3mm criteria. Results: Each treatment field demonstrated that the gamma index in the delta4 phantom was more than the Epiqa software for all patients. The most uncertainty for a treatment plan in delta4 phantom was 0.88% and for Epiqa software was 1.53%. (p- value <0.05) Conclusion: In spite of these variations in results and also studying similar researches, these tools can be used as a reliable QA method in radiotherapy centers. Delta4 phantom is preferred to Epiqa software because it is a dosimeter. However, ...

Cranial irradiation has an important role in the treatment of brain tumors either with curative i... more Cranial irradiation has an important role in the treatment of brain tumors either with curative intent or for palliation. Cranial irradiation has a unique application in prevention of distant metastasis to brain parenchyma, and prophylactic cranial irradiation may be carried out in selected patients at high risk of neoplastic cranial involvement. Brain is also an organ at risk during radiotherapy of tumors which are located in base of skull and in some head and neck cancers. Cranial irradiation in any condition can cause brain injuries that are classified into three groups based on the timing of their occurrence after radiation exposure: acute (during radiation or up to 6 weeks after radiation), early delayed or subacute (up to 6 months after radiation), and late delayed (6 months or more after the completion of radiation). However in more trials, brain injury simply is defined as acute (within 90 days of the commencement of therapy) and late reactions (after 90 days of the commence...

International Journal of Cancer Management

Background: Vulvovaginal atrophy (VVA) usually occurs during and after menopause due to low estro... more Background: Vulvovaginal atrophy (VVA) usually occurs during and after menopause due to low estrogen levels and can cause frustrating symptoms. Existing treatments such as estrogen compounds have undesired side effects. Objectives: This study was conducted to assess the effectiveness of a chicken tallow product for vaginal use on subjective symptoms of VVA in women with breast cancer. Methods: Menopause induced by chemical drugs with subjective symptoms of VVA were selected from the Oncology-Radiotherapy Clinic of Shohadaye Tajrish Hospital between March and July 2020. Informed consent was obtained. Patients were instructed to apply 5g cream every other night before bedtime for 2 weeks, and 2 nights a week for the next 2 weeks and stop the medication. Patients were assessed at the time of initiation of medication, and 2, 4, 6, and 8 weeks after initiation of the trial, and VVA subjective symptoms were assessed. VVA subjective symptom score (VVA-SSS) form was used to assess itching, ...

Journal of Contemporary Brachytherapy

Purpose: The present study aimed to assess the correlation between dose to pelvic lymph nodes and... more Purpose: The present study aimed to assess the correlation between dose to pelvic lymph nodes and to point B with tandem-ring (TR) applicators for intra-cavitary brachytherapy treatment of locally advanced cervical cancer. Material and methods: Cervical cancer patients treated at brachytherapy department of Lucien Neuwirth Cancer Center, from 2015 to 2018, were included. Target delineation was performed in compliance with GEC-ESTRO guidelines. Revised American Brachytherapy Society (ABS) point A was determined (A RN (right) and A LN (left)) as well as Manchester point B. Prescription dose was 25-35 Gy in 5 fractions. Pelvic lymph nodes were delineated, then dose to points A and B, and dose-volume histogram (DVH) parameters of delineated lymph nodes were extracted. Significant relationships or correlations between lymph nodes reference points, dosage to points B, and their DVH parameters were investigated. Results: The mean dose and mean percentage of the prescription dose to the left and right points B were 4.6 ±0.18 Gy and 82.08 ±0.72%, respectively. Pearson correlation coefficient R = 0.81 (p-value = 0.00) between dose to A RN and A LN points and prescription dose was obtained. Negative correlation between CTV HR volume and difference between French and ABS prescription points was found. Conclusions: Dose to point B can be a moderate surrogate for maximum, minimum, and median dose to the internal iliac and presacral lymph node, but cannot be for maximum dose to the obturator lymph node. Points B cannot be a reliable substitute for common and external iliac chains.

Asian Pacific Journal of Cancer Care, 2017

Background: Radiation dermatitis is one of the most common side effects of radiotherapy for breas... more Background: Radiation dermatitis is one of the most common side effects of radiotherapy for breast cancer, affecting approximately 85 percent of patients. The aim of this study is to assess the effect of Licorice root (Glycyrrhizin glabra) and Yarrow (Achillea millefolium) on preventing radiotherapy-induced dermatitis in breast cancer patients.Methods: Seventy-five patients with breast cancer who had undergone mastectomy and were planned to receive radiotherapy (RT) were enrolled in this randomized, double-blind, placebo-controlled study. The extract of Achillea millefolium and Glycyrrhizin glabra root were incorporated into a vanishing cream base. Patients were randomly divided into three groups and received Glycyrrhizin glabra cream, placebo or Achillea millefolium cream for five weeks during RT. The rate and grade of radiation dermatitis were recorded at baseline, at the end of third week and at the end of treatment using a modified Radiation Therapy Oncology Group (RTOG) grading...

Acute Side Effects of Radiation Therapy, 2017

Archives of Iranian medicine, 2017

Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly fou... more Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly found in the gastrointestinal system. In this study, we examined the epidemiology of NETs in an Iranian population. The incident NET cases diagnosed between January 1, 2009 and December 31, 2014 were collected from databases of three hospitals in Tehran (Shoada-e-Tajrish Hospital, Imam Hossein Hospital and Pars Hospital). A total of 291 cases with NET diagnosis were identified. The most common NET location was gastrointestinal (71.4%), followed by Bronchopulmonary (7.2%) and Genitourinary (7.2%). The total number of identified NETs in our study increased from 25 cases in 2009 to 66 cases in 2014. In conclusion, our data suggests that the incidence of NETs is increasing slowly. Thus, etiologic studies for NETs are needed to help plan future preventive strategies. The authors declare no conflicts of interests.

Acute Side Effects of Radiation Therapy

Acute Side Effects of Radiation Therapy

Radiation-Induced Liver Disease Radiation-induced liver disease (RILD), historically called radia... more Radiation-Induced Liver Disease Radiation-induced liver disease (RILD), historically called radiation hepatitis, has been reported in 6-66% of patients whose livers are irradiated based on radiation dose, exposed liver volume, and baseline liver function [1, 2]. Abnormalities in laboratory liver function tests may be found on routine evaluation of patients when RILD is mild, but in severe cases, liver dysfunction may affect the treatment course and eventually threaten patient's lives.

Acute Side Effects of Radiation Therapy

Acute Side Effects of Radiation Therapy

The acute ear complications of radiation therapy include external, middle, and inner ear injuries... more The acute ear complications of radiation therapy include external, middle, and inner ear injuries. The acute external ear complications include otitis externa or skin reactions involving the preauricular region, the auricle, and the external auditory canal that occur in about 28% of head and neck cancer patients treated with radiation therapy [1]. The acute middle ear complications that include mastoiditis, Eustachian tube dysfunction, consequential otitis media, and transient conductive hearing loss occur in 40-45% of head and neck cancer patients during or after radiation therapy [2, 3]. The acute inner ear complications include sensorineural hearing loss (SNHL) and tinnitus [4]. SNHL may occur early after treatment in up to 50% of patients with head and neck tumors treated with radiation therapy [5-7].

Radiation-induced nausea and vomiting (RINV) is generally less frequent and less severe than the ... more Radiation-induced nausea and vomiting (RINV) is generally less frequent and less severe than the nausea and vomiting encountered in patients receiving chemotherapy. This problem is often underestimated and undertreated by radiation oncologists in clinical practice; however, it can be very distressing and may cause delay or even interruption of radiotherapy [1–3]. The incidence of RINV was studied in two prospective observational studies. The Italian Group for Antiemetic Research in Radiotherapy (IGARR) analyzed the incidence of RINV in 1020 patients receiving various kinds of radiation therapy without concurrent chemotherapy. Vomiting and nausea occurred in 11% and 27.1% of patients, respectively, and 27.9% of patients had both vomiting and nausea [1]. Nausea was twice as frequent as vomiting (27.1% vs. 11%) and lasted longer (median duration 10 vs. 3 days). The RINV incidence rates based on anatomical sites were 28% for breast, 39% for pelvis, 40.4% for head and neck, 48.8% for tho...

Acute Side Effects of Radiation Therapy

Cranial irradiation has an important role in the treatment of brain tumors either with curative i... more Cranial irradiation has an important role in the treatment of brain tumors either with curative intent or for palliation. Cranial irradiation has a unique application in prevention of distant metastasis to brain parenchyma, and prophylactic cranial irradiation may be carried out in selected patients at high risk of neoplastic cranial involvement. Brain is also an organ at risk during radiotherapy of tumors which are located in base of skull and in some head and neck cancers. Cranial irradiation in any condition can cause brain injuries that are classified into three groups based on the timing of their occurrence after radiation exposure: acute (during radiation or up to 6 weeks after radiation), early delayed or subacute (up to 6 months after radiation), and late delayed (6 months or more after the completion of radiation). However in more trials, brain injury simply is defined as acute (within 90 days of the commencement of therapy) and late reactions (after 90 days of the commencement of therapy) [1]. Reports indicate that patients that undergo standard fractionated cranial irradiation and stereotactic radiosurgery may have acute brain reactions in the range of 2–40% [1–12]. However, up to 50% of patients with high doses per fraction (more than 3 Gy) to a large part of the brain may develop acute encephalopathy [3, 13].

Acute Side Effects of Radiation Therapy

Renal cell carcinoma (RCC) has been recognized in a variety of situations with different presenta... more Renal cell carcinoma (RCC) has been recognized in a variety of situations with different presentations including uncommon metastasis and paraneoplastic syndromes.

Profound hematologic toxicity, prominently leukopenia, frequently develops following radiation th... more Profound hematologic toxicity, prominently leukopenia, frequently develops following radiation therapy that includes a large volume of bone marrow in the radiation field [1–8]. The percentage of patients with radiation-induced leukopenia has been reported in up to 50% and 90% of patients treated with pelvic field irradiation alone and with concurrent chemotherapy, respectively [1, 6]. These values are lower for thrombocytopenia (1% and 30% of patients treated with pelvic field irradiation alone and with concurrent chemotherapy, respectively) and anemia (30% and 50% of patients treated with pelvic field irradiation alone and with concurrent chemotherapy, respectively) [1, 10].

A reduction in taste sensitivity (hypogeusia), an absence of taste sensation (ageusia), or a dist... more A reduction in taste sensitivity (hypogeusia), an absence of taste sensation (ageusia), or a distortion of normal taste (dysgeusia) are well-known side effects in cancer patients that receive radiation therapy to the head and neck areas, and it has been reported in up to 100% of these patients [1–4]. The generic term of dysgeusia more commonly refers to any alteration in taste perception [5].

Archives of Iranian medicine, 2017

Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly fou... more Neuroendocrine tumors (NETs) are a rare and heterogeneous group of malignancies most commonly found in the gastrointestinal system. In this study, we examined the epidemiology of NETs in an Iranian population. The incident NET cases diagnosed between January 1, 2009 and December 31, 2014 were collected from databases of three hospitals in Tehran (Shoada-e-Tajrish Hospital, Imam Hossein Hospital and Pars Hospital). A total of 291 cases with NET diagnosis were identified. The most common NET location was gastrointestinal (71.4%), followed by Bronchopulmonary (7.2%) and Genitourinary (7.2%). The total number of identified NETs in our study increased from 25 cases in 2009 to 66 cases in 2014. In conclusion, our data suggests that the incidence of NETs is increasing slowly. Thus, etiologic studies for NETs are needed to help plan future preventive strategies. The authors declare no conflicts of interests.

The orbit contains the globe and connective tissues including extraocular muscles, orbital fat, e... more The orbit contains the globe and connective tissues including extraocular muscles, orbital fat, eyelids, eyelashes, lacrimal gland, and lacrimal draining system. Different parts of the globe (e.g., the lens, iris, conjunctiva, sclera, retina, ciliary body, cornea, and optic nerve) have different sensitivities to irradiation. Some structures like the optic nerve respond to radiation in a chronic manner (late-responding tissue), and some like the conjunctiva and eyelids are acute-responding tissues. Some parts of the mentioned structures are very sensitive, and some of them like the lens and sclera are very resistant to radiation. The orbital area may be irradiated as the treatment target or as an organ at risk in the vicinity of the target. Radiation-induced acute side effects in this area require prompt attention to prevent long-term issues like ophthalmitis, permanent dry eyes, and impaired visual acuity. In this chapter, we will focus on more sensitive acute-responding tissues.

Background: Axillary lymph node metastasis is the most important predictive factor for recurrence... more Background: Axillary lymph node metastasis is the most important predictive factor for recurrence risk and survival in patients with invasive breast carcinoma. The aim of this study was to determine the factors associated with the metastatic involvement of axillary lymph nodes in Iranian women with early breast cancer. Methods: This article reports a retrospective study of 774 patients with T1-T2 breast cancer who underwent resection of the primary tumor and axillary staging by SLNB and/or ALND between 2005 and 2015 at our institution. Results: Of the 774 patients included in this study, 35.5% (275 cases) had axillary lymph node involvement at the time of diagnosis. Factors associated with nodal involvement in univariate analyses were tumor size, lymphovascular invasion, tumor grade, ER/PR status and HER2 expression. All factors identified with univariate analyses were entered into a multivariate logistic regression model and tumor size (OR= 3.01, CI 2.01–4.49, P <0.001), ER/ PR ...

Introduction: The aim of this study is evaluation of two Quality Assurance methods in sliding win... more Introduction: The aim of this study is evaluation of two Quality Assurance methods in sliding window IMRT technique and Determination of gamma index in both methods Materials and Methods: In this study two tools named" Delta4" phantom and " Epiqa" software has been used to perform QA on the treatment plan before the actual treatment by Varian linear accelerator Clinac 600C. For this purpose, 20 patient’s treatment plan were assessed with the 3% and 3mm criteria. Results: Each treatment field demonstrated that the gamma index in the delta4 phantom was more than the Epiqa software for all patients. The most uncertainty for a treatment plan in delta4 phantom was 0.88% and for Epiqa software was 1.53%. (p- value <0.05) Conclusion: In spite of these variations in results and also studying similar researches, these tools can be used as a reliable QA method in radiotherapy centers. Delta4 phantom is preferred to Epiqa software because it is a dosimeter. However, ...

Cranial irradiation has an important role in the treatment of brain tumors either with curative i... more Cranial irradiation has an important role in the treatment of brain tumors either with curative intent or for palliation. Cranial irradiation has a unique application in prevention of distant metastasis to brain parenchyma, and prophylactic cranial irradiation may be carried out in selected patients at high risk of neoplastic cranial involvement. Brain is also an organ at risk during radiotherapy of tumors which are located in base of skull and in some head and neck cancers. Cranial irradiation in any condition can cause brain injuries that are classified into three groups based on the timing of their occurrence after radiation exposure: acute (during radiation or up to 6 weeks after radiation), early delayed or subacute (up to 6 months after radiation), and late delayed (6 months or more after the completion of radiation). However in more trials, brain injury simply is defined as acute (within 90 days of the commencement of therapy) and late reactions (after 90 days of the commence...