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Outcome evaluation of patients with acute lymphocytic leukemia treated by Hyper-CVAD chemotherapy regimen in Omid Hospital, Isfahan, Iran.
Vahid Varmazyari , Amirreza Rashti, Ali Darakhshandeh, Ayda Moghaddas, Azadeh Moghaddas,
Volume 80, Issue 10 (1-2023)
Abstract
Background: Since numerous chemotherapy regimens for the treatment of patients suffering from acute lymphoid leukemia (ALL) have been recently developed, having basic information about the previous results of using the Hyper-CVAD regimen in order to compare with other common chemotherapy regimens is essential. The aim of this study was to evaluate demographic, clinical and outcome of ALL patients receiving Hyper-CVAD regimen.
Methods: In this retrospective study, nighty eligible ALL patients treated with the Hyper-CVAD chemotherapy regimen in Omid Hospital, Isfahan, Iran during April 2016 till April 2019 were considered. We evaluated the demographic variables, pathological data and other clinical factors by an information sheet designed by main investigator. The main purpose of this study was to evaluate overall survival, progression-free survival, and overall response rate of patients along with patients’ clinical characteristics and other relevant factors using Kaplan-Meier or Cox-regression and other statistical analyses. 
Results: The mean overall survival and the median survival of patients were 44.8±2.93 and 36.7±7.47 months; respectively. Also the mean progression free survival of patients was 44.44±3.30 months. More than 84.4% of patients encountered complete remission (CR) after receiving Hyper-CVAD regimen. Reaching to CR had positive significant effects on patients’ overall survival and median survival. However, the bone marrow transplantation variable alone did not affect the patients’ overall survival. The variables such as being B/T Cell ALL, Philadelphia, myeloid marker, and central nervous system involvement did not affect the overall survival of patients but the relapse index indicated the significant effects. The median survival time is higher in patients with no relapse episode. None of the initial lab data had any significant effects on patients’ overall survival.
Conclusion: For the first time in Iran, we have obtained the mean survival outcome of ALL patients after applying the Hyper-CVAD regimen. According to the results, the mean overall survival, progression free survival and other survival items in Iranian patients suffering from ALL and receiving Hyper-CVAD regimen were in consistent with previous studies in the world.

Prognosis of neonates in maternal diseases
Hassan Boskabadi , Nafiseh Pourbadakhshan, Maryam Zakerihamidi,
Volume 80, Issue 10 (1-2023)
Abstract
Background: Maternal diseases such as diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy in pregnancy are associated with fetal and neonatal complications. The aim of this study was to compare the prognosis of neonates in maternal diseases.
Methods: This study was a cross-sectional study. The present study was performed on 600 preterm infants with mothers with diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy. This study was done in Ghaem Hospital of Mashhad from March 2015 to April 2021 with available sampling. The data collection tool was a researcher-made checklist including infant (gestational age, Apgar score of the first minute, Apgar score of the fifth minute) and maternal (mode of delivery, prenatal care, premature rupture of the membranes) characteristics. Neonatal prognosis was compared at birth. All clinical and diagnostic examinations of newborns were performed by a neonatologist. Neonatal and maternal data in the group of newborns with normal mothers and newborns with maternal diseases were analyzed by Kolmogorov-Smirnov and Chi-square tests. The significance level was considered p≤0.05 in all cases.
Results: The results show that 161 newborns (28.90%) had normal mothers, 89 newborns (15.98%) had diabetic mothers, 117 newborns (21.01%) had hypertensive mothers, and 50 newborns (8.98%) had hypothyroid mothers. One hundred tweny newborns (21.72%) had mothers with preeclampsia, 19 newborns (3.41%) had mothers with epilepsy. Newborns with mothers with epilepsy had the lowest Apgar score of the first minute and the lowest gestational age and newborns with mothers with diabetes had the lowest Apgar score of the fifth minute. Mothers with hypothyroidism had the highest rate of premature rupture of the membranes and mothers with hypertension and preeclampsia had the highest incidence of cesarean section.
Conclusion: Maternal diseases including diabetes, hypertension, preeclampsia, hypothyroidism and epilepsy affect the prognosis of neonates in terms of the severity of prematurity, premature rupture of the membranes, type of delivery, Apgar scores of the first and fifth minutes. Therefore, proper control and treatment of these diseases may improve neonatal prognosis.

Secondary cancers evaluation inside organs at risk during the prostate cancer radiotherapy: a brief report
Reza Shamsabadi, Seyed Hamid Zoljalali Moghadam, Hamidreza Baghani , Seyed Ali Zoljalali Moghadam ,
Volume 81, Issue 3 (6-2023)
Abstract
Background: In prostate cancer radiotherapy, due to the proximity of the prostate to the rectum, it can be affected by high radiation doses. It has been reported that about 70% of secondary cancers after prostate cancer radiotherapy occur in the bladder and rectum, which are exposed to direct radiation. Since prostate cancer radiotherapy may be accompanied by side effects, the aim of this study is to investigate the risk of secondary cancers after the radiotherapy of prostate cancer inside the outfield organs.
Methods: The dose volume histogram data relevant to 39 patients with prostate cancer (who were treated with 3-dimensional conformal radiotherapy technique in 2022 in Tehran) were extracted, and the uniform absorbed dose inside the sensitive tissues was calculated according to the gEUD concept. Then, the risks of secondary malignancies following prostate cancer radiotherapy were calculated using the model introduced by the BEIR report. Accordingly, the lifetime attributable risk values (LAR) were estimated based on the desired organs and patient age at exposure time through the calculation of Excess relative risk (ERR) and Excess absolute risk (EAR) values.
Results: From the obtained results, the gEUD values for the rectum ranged from 51.04 Gy to 74.69 Gy and for the bladder from 27.22 Gy to 75.51 Gy. The maximum calculated risk values for the rectum and bladder were calculated to be 49.85% and 74.91%, respectively. Besides, a significant level of secondary cancer risk within the rectum and bladder was obtained for most of the studied patients. Furthermore, small values of secondary cancer risks were estimated for patients who were irradiated at older ages, and higher ones were obtained for patients who were irradiated at younger ages.
Conclusion: The results showed that there is a higher probability of developing secondary malignancies in the bladder than the rectum. The information obtained in this research can improve the performance of the treatment process, so that information about secondary cancers following radiation therapy for prostate cancer will ultimately help doctors design more effective and optimal treatment designs.

Retinoblastoma treatment over time: a review article
Hassan Asadigandomani, Seyed Mohsen Rafizadeh, Elias Khalili Pour , Babak Masoomian,
Volume 81, Issue 4 (7-2023)
Abstract
Retinoblastoma is the most common primary malignant ocular malignancy in children. The management and treatment of retinoblastoma is a very complex process and requires attention to different aspects, such as the stage of the disease based on the International classification of retinoblastoma (ICRB) or International intraocular retinoblastoma classification (IIRC), the genetic status of the tumor and mutations, psycho-social factors of the family and society, cultural beliefs, and available economic resources. From the identification of this malignancy until the beginning of the 20th century (before the introduction of radiation therapy as one of the treatment options), enucleation was the only treatment option for this disease. In addition to not controlling metastatic and extensive features of the disease and increasing the chance of death in these cases, enucleation causes many adverse psychological and aesthetic complications in patients, and especially children, who are the main population affected by this disease. Tremendous progress has been made since the 20th century to identify and invent new methods to preserve the eyes and less invasive treatments (globe salvage treatments), and the set of efforts led to the inventing of new treatment methods such as radiation therapy, systemic chemotherapy, local treatments such as cryotherapy and thermotherapy, intra-arterial chemotherapy and intraocular chemotherapy. In summary, the set of treatments from the beginning until now has gone towards increasing survival, reducing the rate of enucleation and providing more targeted and less invasive treatments. Despite these advances, early diagnosis is the most important prerequisite for better outcomes. However, early detection is influenced by socioeconomic factors and is a major challenge, especially in low- and middle-income countries. In fact, the provision of advanced medical care in high-income areas has provided excellent survival, globe, and vision-saving rates. Unfortunately, these results do not hold true for medical systems in low- and middle-income areas, leading to poor patient outcomes. In this article, we briefly introduce various retinoblastoma treatment methods from the beginning of detection until now, and we assess the evolution of the treatment of this disease from the beginning until now, which has reduced the need for enucleation as a treatment for this disease.

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