PurposeSkin cancers are the most common human malignancy with increasing incidence. Currently, surgery is standard of care treatment for non-melanoma skin cancers. However, brachytherapy is a growing modality in the management of skin cancers. Therefore, we aimed to assess the outcome of patients with non-melanoma skin cancers treated by high-dose-rate (HDR) brachytherapy with surface mold technique.Material and methodsIn this prospective study, we recruited patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin who were candidates for definitive or adjuvant brachytherapy during 2013-2014. Alginate was used for making the individualized surface molds for each patient. Patients were treated with afterloading radionuclide HDR brachytherapy machine, with a total dose of 30-52 Gy in 10-13 fractions. Participants were followed for 2 years for radiation toxicity, cosmetic results, and local failures.ResultsA total of 60 patients (66.7% male; median age, 71 years) were included, of which 42 (70.0%) underwent definitive radiotherapy. Seventy-five percent of lesions were BCC. The mean total dose was 39.6 ± 5.4 Gy. Of patients in definitive group, 40/42 (95.2%) experienced complete clinical response after 3 months. The recurrence rate was 2/18 (11.11%) and 1/42 (2.38%) in adjuvant and definitive groups, respectively. The percentage of grade 3-4 acute (3-month post-treatment) and late toxicities (2 years post-treatment) was 6.7% and 0%, respectively. The cosmetic results were good/excellent in 96.2% of patients after 2 years of follow-up.ConclusionsWith appropriate patient selection and choosing as lowest dose per fraction as possible, HDR brachytherapy with customized surface molds yields good oncological and cosmetic results for the treatment of localized skin BCC and SCC.
Mathematical and computational models are of great help to study and predict phenomena associated with cancer growth and development. These models may lead to introduce new therapies or improve current treatments by discovering facts that may not be easily discovered in clinical experiments. Here, a new two-dimensional (2D) stochastic agent-based model is presented for the spatiotemporal study of avascular tumor growth based on the effect of the immune system. The simple decision-making rules of updating the states of each agent depend not only on its intrinsic properties but also on its environment. Tumor cells can interact with both normal and immune cells in their Moore neighborhood. The effect of hypoxia has been checked off by considering non-mutant proliferative tumor cells beside mutant ones. The recruitment of immune cells after facing a mass of tumor is also considered. Results of the simulations are presented before and after the appearance of immune cells in the studied tissue. The growth fraction and necrotic fraction are used as output parameters along with a 2D graphical growth presentation. Finally, the effect of input parameters on the output parameters generated by the model is discussed. The model is then validated by an in vivo study published in medical articles. The results show a multi-spherical tumor growth before the immune system strongly involved in competition with tumor cells. Besides, considering the immune system in the model shows more compatibility with biological facts. The effect of the microenvironment on the proliferation of cancer and immune cells is also studied.
Neuropathy is a dose limiting side effect of taxanes which may impact the quality of life and treatment outcomes. This randomized placebo‐controlled double‐blinded clinical trial was carried out to assess the efficacy of gabapentin in preventing chemotherapy induced neuropathy. Women with breast cancer were randomized into two groups of paclitaxel chemotherapy with gabapentin 300 mg/three times a day orally or placebo for 2 weeks started at day 1 of each paclitaxel cycle. Two groups were compared based on the relative frequency of neuropathy and change in nerve conducting velocity (NCV). Twenty women were assigned to each study arm. The majority of the neuropathy in gabapentin group was grade 1 in all of the four cycles with no event of ≥grade 3 neuropathy in this group. Compared to the placebo, the rate of 2nd and 3rd grade neuropathy was significantly lower in the gabapentin group (P = 0.000). The change in NCV after four cycles of paclitaxel was significantly lower in the gabapentin group compared to the placebo group (17.7% vs 61.0% decline in NCV for sural and 21.9% vs 62.5% declines in NCV for peroneal nerve). Gabapentin given with paclitaxel is effective in the prevention of intermediate and high grade neuropathies both objectively and subjectively.
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