Tehran University Medical Journal

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Gastric cancer is the second most common cancer and known as the second cause of death due to cancers worldwide. Adenocarcinoma is the most fatal cancer in Iran and a patient with this kind of cancer, has a lower lifetime than others. In this research, the survival of patients with gastric carcinoma who were registered at Taleghani Hospital, were studied.
Methods:  291 patients with Gastric carcinoma who had received care, chemotherapy or chemoradiotherapy, at Taleghani Hospital in Tehran from 2002 to 2007 were studied as a historical cohort. Their survival rates and its relationship with 12 risk factors were assessed.
Results:  Of the 291 patients with Gastric carcinoma, 70.1 percent were men and others (29.9%) were women. The mean age of men was 62.26 years and of women was 59.32 years at the time of diagnosis. Most of patients (93.91%) were advanced stage and metastasis. The Cox proportional hazards model showed that age at diagnosis, tumor stage and histology type with survival time had significant relationships (p=0.039, p=0.042 and p=0.032 respectively).
Conclusion: The five-year survival rate and median lifetime of gastric cancer patients who underwent chemotherapy or chemoradiotherapy are very low and seems that one of the important reasons for this situation is delayed diagnosis. The scheme of public education about the early warning signs of the disease and diagnosis and administration of periodic examinations is unavoidable.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 !mso]> ject classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui> Background: Infantile colic has been defined as episodes of excessive and persistent crying without known medical cause. Kangaroo mother care is a new method for baby care with several advantages. A universally available and biologically sound method of care for all newborns, with three components: skin-to-skin contact, exclusive breastfeeding, support to the mother-infant dyad. This study designed for evaluating Kangaroo mother care on infantile colic. 

Methods: This study was a randomized controlled trial. From 1th may 2008 to 1 may 2009 a total of 70 children, aged 3-12 weeks with persistent colic symptoms were studied. The children were referred to Sheikh clinic, Mashhad, Iran, because of excessive crying. Normal mother-infant pairs were recruited at 3 to 12 weeks of age after obtaining baseline for two days. Subjects divided randomly to kangaroo care or conventional care group and mothers in both groups filled diary for seven days.

Results: In the beginning of the study, the infants in kangaroo care group had 3.5 hr/d crying and after the intervention, it decreased to 1.7 hr/d, the difference were significant (p<0.05). But there were no difference in feeding duration between two groups (p=0.2). Awake and content (normal behavior) behaviors were significantly increased in the kangaroo care group (p=0.001). Sleep duration was significantly increased in the kangaroo care group (p=0.02).

Conclusions: Kangaroo care may be used as a simple and safe method for treatment of infantile colic.

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Background: Gastric cancer is an important health problem across the world. Chemotherapy in combination with local treatment is the standard treatment for locally advanced gastroesophageal junction (EGJ) cancers. The purpose of this study was to evaluate response and tolerability to neoadjuvant regimen combining epirobicin, oxaliplatin and capecitabin (EOX) in locoregionally advanced gastric cancer.
Methods: We recruited 28 patients with histologically confirmed advanced gastric or EGJ adenocarcinoma in this study performed in the Cancer Institute of Imam Khomeini Hospital in Tehran, Iran in 2010-2011. Staging workup included chest and abdominal computed tomography (CT) scans, upper gastrointestinal endoscopy, endoscopic ultrasonography (EUS), measurement of carcinoembryonic antigen (CEA), complete blood cell count (CBC), and liver and renal function tests. After three treatment cycles with EOX regimen, we evaluated response to the neoadjuvant chemotherapy by performing endoscopic ultrasonography (EUS) and chest and abdominal CT scans.
Results: The mean age of the patients was 56.64±11.08 years (ranging from 37 to 78 years). Most patients were classified as having stage III (98.8%) cancer before chemotherapy while most were classified as stage II (57.14%) after the treatment. Only 28.5% of tumors were resectable before chemotherapy, but 82.1% of them were resectable upon the treatment. 75% of tumors were downstaged after chemotherapy.
Conclusion: Regarding the acceptable response and downstaging of tumors and low toxicity of EOX regimen in locoregionally advanced gastric cancer, evaluation of this regimen as a neoadjuvant chemotherapy in larger phase III clinical trials in Iranian patients would be both necessary and logical.

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Background : Chemotherapy-induced nausea (CIN) in the anticipatory and acute phase is the most common side effect in cancer therapy. The purpose of this study was to investigate the effect of ginger capsules on the alleviation of this problem.

Methods : This randomized, double-blind, placebo-controlled clinical trial was performed on 80 women with breast cancer between August till December 2009 in Imam Khomeini Hospital, Tehran, Iran. These patients underwent one-day chemotherapy regime and suffering from chemotherapy-induced nausea. After obtaining written consent, samples were randomly assigned into intervention and control groups. Two groups were matched based on the age and emetic effects of chemotherapy drugs used. The intervention group received ginger capsules (250 mg, orally) four times a day (1 gr/d) and the same samples from the placebo group received starch capsules (250 mg, orally) for three days before to three days after chemotherapy. To measure the effect of capsules a three-part questionnaire was used, so the samples filled every night out these tools. After collecting the information, the gathered data were analyzed by statistical tests like Fisher’s exact, Kruskal-Wallis and Chi-square using version 8 of STATA software.

Results : The mean ± SD of age in the intervention and placebo groups were 41.8 ± 8.4 and 45.1 ± 10 years, respectively. Results indicated that the severity and number of nausea in the anticipatory phase were significantly lower in the ginger group compared with placebo group (P=0.0008, P=0.0007, respectively). Also, the intensity (P=0.0001) and number (P=0.0001) of nausea in the acute phase were significantly lower in the ginger group. On the other hand, taking ginger capsules compared with placebo did not result in any major complications.

Conclusion: Consuming ginger root powder capsules (1 gr/d) from three days before chemotherapy till three days after it in combination with the standard anti-emetic regimen can help to reduce the anticipatory and acute nausea.

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Background: The aim of this study was to assess the role of consolidative intraperito-neal chemotherapy with carboplatin in decreasing relapse and increasing survival in advanced epithelial ovarian cancers, as well as evaluation of its toxicity. Methods: In this clinical trial 30 patients with epithelial ovarian cancer in stages II-IV who had complete surgery (optimal debulking surgery) received six standard cycles of intravenous carboplatin and paclitaxel. They were enrolled through non-random se-quential selection. The control patients were similar to case group in stage (II-IV) and pathology (epithelial ovarian cancer). The control group was evaluated retrospectively through hospital files. This clinical trial performed in Gynecology Oncology department in Tehran Valiasr University Hospital, during 2005-2010. They including 18 cases as the intervention group receiving intraperitoneal chemotherapy and 12 patients as the control group with only retrospective follow-up. The cases received 3 cycles of 400 mg/m2 intraperitoneal carboplatin every 21 days following intravenous chemotherapy. Relapse of disease was diagnosed as increasing or even doubling CA125 serum titer during one month, or any CA125 above 100 IU, or an abdominal or pelvic mass in ul-trasound or physical exam. Mean survival of two and five years, progression-free inter-val (PFI), overall survival (OS), relapse, demographic parameters, drug toxicities, path-ologic types of cancers in two groups were coded and compared using SPSS 14. Any P<0.05 was considered as a significant difference. Results: The mean ages of cases and controls were 52.4±8.6 and 55.1±11.5 years. The mean duration of relapse-free survival was 13±8.6 months for the cases and 9.5±4.3 months for the control patients (not statistically different, P>0.05). The mean overall survival for cases and controls were 39±16.5 and 30.8±16.2 months, respectively (no significant difference, P>0.05). The frequency of drug toxicities in the cases was 5.6%, and consisted of mild-to-moderate abdominal pain, nausea and vomiting. Conclusion: It seems that consolidation therapy with intraperitoneal carboplatin may not increase overall survival, reduce relapse rate or decrease mortality, though it does not induce considerable side effects. Since the mean survival in the intervention group was nine months more than controls, this difference may be clinically significant.

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Background: Cardiotoxicity of anthracyclines (ANTs) in medium and high doses (more than 350 mg/m2) has been already known but it is still unclear whether or not minimal doses (lower than 350 mg/m2) can also affect cardiac function. The goal of this study was to assess the cardiotoxicity of ANTs in children under minimal doses and evaluation the association of this toxicity with probable risk factors such as age at beginning of regimen, gender or type of malignancy. Methods: In a prospective study 50 children suffering from different malignancies ad-mitted in pediatric oncology department of Besat Hospital of Sanandaj City in 2010 to 2012, under ANTs regimen (Daunorubicin, Doxorubicin) in doses lower than 350 mg/m2 were followed by serial echocardiography for 1-3 years. The deviation from normal values of echocardiographic parameters was measured for all patients in this period and even one parameter's deviation was considered as cardiac dysfunction and ANTs cardi-otoxicity. The association of this toxicity and probable risk factors was analyzed by proper statistical methods in SPSS 18th version. Results: In 22% of patients, mostly children older than 11, at least one of echocardio-graphic parameters including: ejection fraction (EF), left ventricular end systolic diame-ter (LVESD), left ventricular end diastolic diameter (LVEDD), left ventricular mass (LVM) and left ventricular posterior wall diameter (LVPWD) changed during our follow up. The most important risk factor for cardiotoxicity in this study was age at beginning of ANTs regimen. Acute myeloid leukemia (AML) had the most abnormal values among all types of malignancies. In this study there was no statistically significant as-sociation between cardiotoxicity and gender or duration of follow up. Conclusion: Anthracyclines even in doses lower than 350 mg/m2 can induce cardiac dysfunction and alter echocardiographic parameters, although these changes are not always accompanied by clinical signs or symptoms as they were in this study. So long term echocardiographic follow up and cardioprotective techniques are recommended in prescription any doses of these cardiotoxic drugs.

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Background: Nausea and vomiting is one of the most important complications in chemotherapy. Serotonin and dopamine are important neurotransmitters in nausea and vomiting. It seems that oxygen therapy and increase oxygen saturation can cause decrease these neurotransmitters. The aim of this study was to investigate the relationship between arterial oxygen saturation (SaO2) of patients and chemotherapy-induced nausea and vomiting. Methods: A descriptive-analytical study was performed in Koosar Hospital in Semnan, Iran, from 19 September 2013 to 25 April. At first, SaO2 of 30 patients in three periods (pre, during and post chemotherapy) were measured. Severity of nausea and vomiting in three days after chemotherapy was measured with an index of nausea, vomiting and retching (Rhodes Index). Also during chemotherapy, anxiety and depression of patients was measured with Hospital Anxiety and Depression Scale (HADS). Results: In this study thirty patients were evaluated. Most of them were women (66%) with mean age of 55.07±11.9 years old. The most common cancer in patients was breast cancer (46.7%). Mean of SaO2 was 92.1%±3.4 that was not significant difference during the chemotherapy. Mean of nausea and vomiting severity in first day of chemotherapy was (3.27±5.5), in second day was (4.5±6.2) and in third day was (7.2±8.7). The Pearson correlation coefficient did not show the relationship between oxygen saturation with severity of nausea and vomiting (P>0.05). Although severity of anxiety of patients was significant relationship with nausea and vomiting in third day (P=0.03). Conclusion: In this study there was no significant relationship between oxygen saturation and severity of nausea and vomiting, but anxiety of patients was related to nausea and vomiting in third day. Chemotherapy-induced nausea and vomiting was more common in third day and it seems that further research is needed for relationship between oxygen saturation and nausea and vomiting in third day of treatment.

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Background: Standard treatment of Gestational Trophoblastic Disease (GTD) is chemotherapy. Single-agent chemotherapy regime including Methotrexate (MTX) or Actinomycin. Single-agent is widely used in treatment of persistent trophoblastic disease. We reported an uncommon toxicity of low-dose single-agent methotrexate in a patient. Case Presentation: A 20-year-old woman, primary gravid after two months missed period and spotting with diagnosis of incomplete abortion with uterine size equivalent of ten weeks pregnancy (8-10 cm) underwent evacuation curettage. In serial follow-up, based on rise of beta-hCG titer and absence of metastatic disease, it was categorized as low-risk persistent trophoblastic disease. She was referred to gynecology oncology center of Ghaem Hospital, Mashhad University of Medical Sciences in May 2014. Because of rise of beta-hCG titer, after complete metastatic work-up and lack of disease in other sites, persistent disease was diagnosed and candidate for chemotherapy (single agent low-dose). The patient received first course of therapy with MTX (50 mg/m², intra muscular). Unfortunately, after two days of treatment she developed uncommon severe toxicity, fever, severe nausea and vomiting, tachycardia, and generalized weakness. Also, we found hematologic abnormality (WBC: -14000-15000 µI, platelet- 540 µI and sever neutropenia), and abnormal rising in liver function test (SGOT, SGPT) (three to four times) and renal function test (BUN and Creatinine) (two times). In addition, she had disseminated erosive lesion in all of body especially in face. Due to the fatal side effects of chemotherapy, she was admitted to intensive care unit (ICU). Fortunately, after two to three weeks, she was improved by conservative management. After few weeks beta-hCG titer was in normal limit. However she had normal serial beta-hCG in one year of follow-up. Conclusion: It is important to emphasis unpredictable side effects of chemotherapy with low-dose methotrexate.

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Background: The most common symptom of patients with gestational trophoblastic neoplasia is abnormal vaginal bleeding. Despite repeated visits of patients with postpartum choriocarcinoma and abnormal postpartum hemorrhage, delayed diagnosis leads to advanced disease with widespread metastasis. Therefore, occurrence of choriocarcinoma with variable patterns in different diagnosis of late onset postpartum hemorrhage should be considered. Early diagnosis of choriocarcinoma after term pregnancy is important that resulted in decrease of maternal morbidity. Therefor late onset postpartum hemorrhage should have an awareness. The aim of this study was to report a case of choriocarcinoma after caesarian section. Case Presentation: A 33-years-old woman one month after antecedent caesarian section in her second pregnancy admitted with abnormal vaginal bleeding. Based on raised titer concentration of β-hCG was 187000 u, with clinical suspicious of choriocarcinoma she was referred to oncology department of Ghaem Hospital, Mashhad University of Medical Sciences, Iran, in 2016. Vaginal exam revealed an enlarged uterus about 10 weeks of pregnancy. Transvaginal sonography showed an intracavitary heterogeneous mass with irregular surface in fundus without myometrium invasion. Extra pelvic metastasis excluded via vaginal exam, pulmonary X-ray and, ultrasonography and computed tomography scan. Due to early stage of gestational trophoblastic neoplasia and diagnosis of this condition, single agent chemotherapy (methotrexate) was recommended, but because of unresponsive disease, subsequently, she was treated with combination chemotherapy (etoposide, methotrexate, and actinomycin, followed by cyclophosphamide and vincristine) that led to remarkable response. After three courses of therapy, normal level of β-hCG was observed and now the patient is free of disease and under-serial follow-up visit for choriocarcinoma. Conclusion: Diagnosis of choriocarcinoma should be considered in any postpartum woman with abnormal vaginal bleeding.

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Background: The Micronuclei has been discussed as an indicator of chromosomal damage in radiotherapy. This study aimed to investigate the changes of micronuclei in peripheral blood lymphocytes of patients with of the gastrointestinal cancers pre- and post-chemo-radiation.

Methods: This cross-sectional study was conducted in patients with gastrointestinal cancers who referred to oncology ward of Rasool Akram Hospital in Tehran from January to March, 2016. After obtaining informed consent from all patients, 3 cc of peripheral blood samples was obtained for cytogenetic assessment in two stages, before treatment and 4 weeks after treatment. The frequency of micronuclei was examined per 1,000 lymphocytes with two nuclei.

Results: Sixty-one patients were evaluated and 11 patients were excluded at the end of study. Fifty patients (34 males, 16 females) with a 59.74±13.34 years old were evaluated. 24 (48%) and 26 patients (52%) were in the less than 60 years’ age group and more than one, respectively. 37 cases (74%) with gastric cancer and 13 cases (26%) with esophageal cancer enrolled in the study. The significant differences were meaningful pre- and post-treatment (44.88 vs. 364.4 /1000 cells) (P=0.005). Also, there were no significant differences of the mean number of micronuclei between pre- and post-treatment according the type of cancer, sex and age groups. Further analysis according by age, sex and cancer of the esophagus or stomach showed no statistically significant differences between the groups in micronuclei number. In other words, chemotherapy and radiation in patients, regardless of age, sex and type of gastrointestinal cancer is very significant impact on the micronuclei production in peripheral blood of patients.

Conclusion: The number of micronuclei in peripheral blood increased significantly in patients with gastrointestinal tract cancer (esophagus and stomach) under the chemo-radiation therapy. It seems that this increase was not correlated with age, sex and type of cancer (stomach or esophagus).

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Results: 74 patients were monitored, 83.78% of them had uncomplicated pregnancy and labor, 4.05% had the abortion, 4.05% had second molar pregnancy, 2.7% had pre-eclampsia, 5.40% had preterm labor. Moreover, stillbirth and malformation did not occur in this study even after chemotherapy treatment. There was not any significant correlation between age, BMI, parity, and chemotherapy duration with pregnancy outcomes. Conclusion: The outcomes of pregnancy after chemotherapy with actinomycin-D is similar to the general population who did not have chemotherapy. The abortion rate and repeated molar pregnancy were similar between population and sample too. Thus, the study shows that the cured patients with low-risk GTN have as much chance of having a normal pregnancy as normal women. In other words, treatment with actinomycin-D does not have any adverse effect in future pregnancies.

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Background: Cancer is the third leading cause of death in Iran. Cancer treatment is very costly and chemotherapy drugs are one of the main causes of the high cost of cancer treatment. The purpose of this study was to evaluate the cost of chemotherapy drugs of five most common cancers and identifying the factors might affect the costs of chemotherapy drugs in a one of the large provinces of Iran, located in the center of the country.
Methods: In a cross-sectional study, the data of all patients with five common cancer diagnosed from March 2015 to March 2016 in Isfahan Province in Iran were collected from the Cancer Registry Center of Isfahan, as well as the pharmacies which distribute chemotherapy drugs. The required information (including, patient characteristics, type of cancer, and the costs of chemotherapy) of patients was obtained by linking the information of patients registered in the distributor pharmacies with the patients registered at the Isfahan Cancer Registry Center through the national code of the patients.

Results: Breast, skin, colorectal, stomach and thyroid cancers were the most common cancers within the evaluated period of time in Isfahan Province. Colorectal cancer with an annual average total cost of 110,510,720 IRR (Rials) per patient was the most expensive cancer during the evaluated time period while thyroid cancer with an annual average total cost of 40,791,123 IRR per patient was the least costly cancer within the evaluated time period in Isfahan among the five most common cancers, considering the chemotherapy medicines cost. The highest cost in the colorectal cancer was due to the drug cetuximab distributed under the trade name Erbitux®. Regardless of the cancer type, the mean annual total cost of chemotherapy drugs per patient within the considered period of time calculated to be 96,307,145 IRR. Conclusion: The chemotherapy cost of the common cancers was high with an annual average of more than 96 million IRR (Rials) per patient, within the considered time period. This was particularly true for colorectal cancer with an annual average cost of more than 110 million Rials.

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Cancer is the second leading cause of death in the United States and has become a health problem worldwide. The reported incidence of new cancer cases is estimated at 19.3 million, with a mortality rate of 10 million in the world in 2020. There are several therapeutic approaches for cancer, including chemotherapy. Chemotherapy is consuming anti-neoplastic drugs, alone or in combination. However, it causes damages to the normal cells and has many side effects. Cardiac complications are common side effects of some chemotherapy agents. Cardiac myocytes are potentially more susceptible to the long-term adverse effects of chemotherapy agents due to the less regeneration ability in cardiac cells. Moreover, heart muscle dysfunction (cardiomyopathy) and cardiovascular complications may occur in cancer survivors even a year after chemotherapy or radiation therapy and influence their quality of life. Anthracyclines are commonly used in chemotherapy; especially doxorubicin is the most widely used drug of this family. Doxorubicin is an effective anti-malignant agent prescribed for the treatment of some solid tumors (e.g. ovary, breast, and gastrointestinal cancers). Doxorubicin can cause several side effects, ranging from cancer treatment’s common side effects such as fever, nausea, and vomiting to lethal cardiac side effects. Assumed that doxorubicin has many therapeutic and cytotoxic mechanisms, cardiotoxicity induced by doxorubicin is very common and there is no reliable treatment for this problem. The cardiac side effects of doxorubicin during a chemotherapy regimen can be acute, chronic, or even gradually progressive and persistent after the termination of doxorubicin therapy. In patients undergoing doxorubicin therapy, reported symptoms are cardiac rhythm and blood pressure changes, pericarditis, myocarditis, cardiomyopathy, and congestive heart failure. The pathophysiology of doxorubicin-induced cardiotoxicity is very wide. Disruption of normal mitochondrial function, decreased amount of antioxidant factors, production of reactive oxygen species (ROS), an imbalance in calcium hemostasis, activation of inflammatory cytokines, targeting topoisomerase-IIβ (Top2b), and induced DNA damage are associated with doxorubicin-induced cardiotoxicity. Increased doxorubicin in mitochondria activates the redox cycle that ultimately leads to the production of reactive oxygen species in both normal and tumor cells. The present review aims to investigate the cardiotoxic mechanisms of doxorubicin and explain different types of doxorubicin-induced cardiotoxicity.

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Background: With 6,020 new cases and 1,150 deaths annually in the United States, vulvar cancer is uncommon, resulting in age-adjusted incidence rates of 2.8 and 1.7 per 100,000 in white and black women, respectively. Vulvar cancer represents about 4% to 6% of malignancies of the female genital tract and 0.6% of all cancers in women. Vulvar cancer predominantly affects postmenopausal women, and it is the most common anogenital cancer in women with more than 70 years of age. HPV infection is associated with a significant number of vulvar cancers. Bartholin Gland carcinoma is a rare form of vulvar malignancy that accounts for less than 5% of all vulvar cancers and 0.001% of all genital cancers. The aim of this study was to report a rare case of Bartholin's cancer in a young patient. Case Report: The patient was a 37-year-old woman p2l2 (history of two pregnancy and two delivery) who had complains of severe pain in perineal area and was referred to the gynecology emergency clinic, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, in June 2020. In past medical history she had no previous history of medical illnesses or surgical interventions. She had swelling and pain in perineal area since one year ago. Bartholin Gland abscess was diagnosed and she received some oral antibiotics, but did not improve. On the last examination under anesthesia, a firm mass of about 3 cm was palpated in the third distal part of posterior vagina which was at the site of Bartholin Gland and was necrotic. The pathologic report of the mass biopsy confirmed the diagnosis of squamous cell carcinoma. The patient was underwent chemo radiation therapy. At a follow up visit about 5 month later she was cured completely and there was not any symptom of recurrence or metastasis. Conclusion: In dealing with any patient with diagnosis of Bartholin Gland abscess, in the case of resistance to medical treatment, further evaluation and biopsy of the mass should be considered to rule out Bartholin's gland cancer.

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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.

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