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Beduk Esen CS, Can GN, Akkus Yildirim B. Comments on "Radiotherapy alone versus concurrent chemoradiotherapy in patients with stage II and T3N0 nasopharyngeal carcinoma with adverse features: A propensity score-matched cohort study". Radiother Oncol 2024:110292. [PMID: 38648993 DOI: 10.1016/j.radonc.2024.110292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Affiliation(s)
| | - Gizem Nur Can
- Department of Radiation Oncology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
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Beduk Esen CS, Yildirim BA. The SOUND Randomized Clinical Trial Results. JAMA Oncol 2024:2816793. [PMID: 38512291 DOI: 10.1001/jamaoncol.2024.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
| | - Berna Akkus Yildirim
- Prof Dr Cemil Tascioglu City Hospital, Department of Radiation Oncology, Istanbul, Turkey
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Gurdal N, Yildirim BA, Gursel OK, Ozkurt S, Ibis K, Gultekin M, Tepetam H, Gul SK, Guzeloz Z, Oksuz DC, Cetin IA, Yalcin B, Duzova M, Kanyilmaz G, Yavas G, Ozsaran Z. Oncological outcomes for encapsulated papillary carcinoma of the breast: Multicentric study of Turkish Society for Radiation Oncology breast cancer study group (TROD 06-014 study). Asia Pac J Clin Oncol 2023; 19:e273-e282. [PMID: 36464924 DOI: 10.1111/ajco.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Encapsulated papillary carcinoma (EPC) is a rare malignant papillary breast cancer accounting for approximately .5%-2% of all breast tumors. The aim of this multicenter study was to evaluate clinicopathologic features of EPC in addition to oncological outcomes and radiotherapy (RT) details. METHODS From 10 different academic hospitals in Turkey, we obtained pathology reports of 80 patients with histologically confirmed EPC between 2005 and 2022. Demographic, diagnostic, and treatment data were collected from medical records, retrospectively. Local failure, distant progression, toxicity-adverse effects, overall survival (OS), and disease-free survival were evaluated, and survival analyzes were performed using the Kaplan-Meier method. RESULTS Eighty patients with the diagnosis of misspelled sorry (ECP) were retrospectively evaluated. The median age of the patients was 63 (range, 35-85). After a median follow-up of 48 (range; 6-206) months, local recurrence was observed in three patients (4%). Local recurrence was less common in the patients who received whole breast RT with a tumour bed boost (p = .025). There were not any distant metastasis or disease-related death. RT was applied to 61% of the cases, and no treatment-related grade 3 or higher toxicity was reported in any of the patients. Five year OS, cancer-specific survival (CSS), and were observed as 85%, 100%, and 96%, respectively. CONCLUSIONS ECP is a rare, slow-progressing breast carcinoma associated with good prognosis, it is a disease of elderly patient, and usually occurs in postmenopausal women. It responds extremely well to optimal local treatments and appropriate adjuvant treatments on a patient basis, and has excellent OS and CSS ratios.
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Affiliation(s)
- Necla Gurdal
- Department of Radiation Oncology, Prof Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Prof Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ozge Kandemir Gursel
- Department of Radiation Oncology, Prof Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Selnur Ozkurt
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kamuran Ibis
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Huseyin Tepetam
- Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Sule Karabulut Gul
- Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Zeliha Guzeloz
- Department of Radiation Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Didem Colpan Oksuz
- Department of Radiation Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ilknur Alsan Cetin
- Department of Radiation Oncology, Marmara University, Pendik Education and Research Hospital, Istanbul, Turkey
| | - Berrin Yalcin
- Department of Radiation Oncology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Mursel Duzova
- Department of Radiation Oncology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Gul Kanyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Guler Yavas
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ozsaran
- Department of Radiation Oncology, Faculty of Medicine, Ege University, Izmir, Turkey
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Sedef AK, Yildirim BA, Sumbul AT, Ozyilkan O. Thoracic Radiotherapy Effect on the Outcome in Extensive Stage Small Cell Lung Cancer. J Coll Physicians Surg Pak 2023; 33:188-192. [PMID: 36797629 DOI: 10.29271/jcpsp.2023.02.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To evaluate the efficacy of thoracic radiotherapy to primary site in patients with extensive stage small cell lung cancer (SCLC) who had responded completely to systemic chemotherapy. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Departments of Radiation and Medical Oncology, Baskent University and Dr. Ersin Arslan Research and Training Hospital in Turkey, between the years of 2011 and 2020. METHODOLOGY The study included 125 patients with extensive stage SCLC. Demographic data and outcomes of chemotherapy and radiotherapy were collected. The efficacy of thoracic radiotherapy to primary site was evaluated in patients who had responded completely to systemic chemotherapy, in terms of progression-free survival and overall survival (OS). RESULTS The median follow-up time was 12 months and 98 (78.4%) patients died during follow-up. Seventy-three (58.4%) patients had complete response. Progression-free survival (PFS) for complete responder patients was 8 months, and OS for the whole group was found 13 months. Twenty (16%) patients received thoracic radiotherapy to primary site after complete response to platinum etoposide combination treatment. Patients receiving thoracic radiotherapy had better OS than those who did not (19 versus 12 months respectively and p=0.002). Patients receiving thoracic radiotherapy had better PFS than those who did not (11 versus 8 months, respectively, and p=0.01). CONCLUSION Thoracic radiotherapy to primary site may improve the survival outcomes in extensive stage SCLC patients who had complete response to initial systemic chemotherapy. KEY WORDS Small cell lung cancer, Thoracic radiotherapy, Complete response, Outcomes, Lung cancer.
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Affiliation(s)
- Ayse Kotek Sedef
- Department of Radiation Oncology, Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Ahmet Taner Sumbul
- Department of Medical Oncology, Baskent University Medical School, Adana, Turkey
| | - Ozgur Ozyilkan
- Department of Medical Oncology, Baskent University Medical School, Adana, Turkey
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Elmali A, Akkus Yildirim B, Cengiz M, Yuce Sari S, Onal HC, Berber T, Arslantas Erken A, Zoto Mustafayev T, Atalar B, Unal I, Kaydihan N, Oner Dincbas F. Stereotactic Radiotherapy for Adrenal Metastases: A Multi-Institutional Review of Patient Characteristics and Outcomes - Turkish Society for Radiation Oncology SBRT Group Study (Trod SBRT 10-004). Oncol Res Treat 2022; 45:717-727. [PMID: 36116432 DOI: 10.1159/000527052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study aimed to report the outcomes of stereotactic body radiotherapy (SBRT) for adrenal metastasis in a retrospective multi-institutional cohort. METHODS The outcomes of 124 patients with 146 adrenal metastases who underwent SBRT within 11 years (2008-2019) were retrospectively evaluated. Survival outcomes were analyzed by the Kaplan-Meier method. Patient, tumor, and treatment characteristics and their effects on survival, local control (LC), and toxicity outcomes were analyzed by log-rank and multivariate Cox regression methods. RESULTS The median age was 60 years. The most frequent primary tumor site was the lung, followed by the gastrointestinal system and breast. The adrenal gland was the only metastatic site in 49 (40%) patients. Median biologically effective dose (BED)10 was 61 Gy. The overall LC rate was 83%, and it was positively correlated with the BED10 and fraction dose. The 1- and 2-year local recurrence-free survival, overall survival (OS), and progression-free survival (PFS) rate was 79% and 69%, 83% and 60%, and 31% and 12%, respectively. OS significantly improved with non-lung cancer and <4-cm lesion and PFS with a fraction dose ≥8 Gy, BED10 >65 Gy, and an isolated adrenal metastasis. Fourteen patients reported an acute toxicity, and late toxicity was observed in 3 patients, including one grade 5. CONCLUSION A satisfactory LC rate was achieved for adrenal metastasis via SBRT. A higher BED10 and fraction dose were positive prognostic factors for tumor control. However, the main problem is DM in these patients, and systemic treatment options are needed to be improved.
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Affiliation(s)
- Aysenur Elmali
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Mustafa Cengiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Huseyin C Onal
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Tanju Berber
- Department of Radiation Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aysun Arslantas Erken
- Department of Radiation Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | | - Banu Atalar
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ilhami Unal
- Department of Radiation Oncology, Guven Hospital, Ankara, Turkey
| | - Nuri Kaydihan
- Department of Radiation Oncology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Fazilet Oner Dincbas
- Department of Radiation Oncology, Memorial Bahcelievler Hospital, Istanbul, Turkey.,Department of Radiation Oncology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Kotek Sedef A, Akkus Yildirim B, Topkan E, Taner Sumbul A. Upfront thoracic radiotherapy to primary lesion improves outcomes in patients with stage IV non-small cell lung cancer harboring EGFR mutations. J BUON 2021; 26:1446-1452. [PMID: 34565003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The role of thoracic radiotherapy in the treatment of metastatic EGFR mutant non-small cell lung cancer (NSCLC) patients in literature data are insufficient.The purpose of this study was to examine the effectiveness of upfront thoracic radiotherapy in metastatic EGFR mutant NSCLC patients treated with chemotherapy or tyrosine kinase inhibitors (TKI). METHODS This study was designed as a hospital-based retrospective observational case-series study. A total of 141 patients with metastatic EGFR mutant NSCLC who were followed in two different oncology centers in Turkey between 2014 and 2019 have been included into this study. RESULTS The median patient age was 63 years (range 35-91). EGFR mutation results of exon 19 deletion, exon 21 mutation and exon 18 mutation were found in 82 (58.2%), 56 (39.7%) and 3 (2.1%) patients, respectively.The median follow-up time was 22 months and 94 (33.3%) patients died during follow-up. Median overall survival (OS) was 26 months and progression free survival (PFS) (for first line treatment) was 10 months for the whole cohort, respectively. Radiotherapy was given to the primary tumor site in 32 (22.6%) patients. Patients receiving radiotherapy to primary tumor site had better OS than those who had not (31 versus 23 months respectively, p=0.02). Survival advantage was also seen for patients group taking TKI at upfront setting (33 versus 23 months respectively, p=0.05). CONCLUSION In this study, we have shown that upfront thoracic radiotherapy to primary lesion as combination with EGFR-TKI treatment may improve the outcome in advanced stage IV NSCLC patients harboring EGFR mutations.
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Affiliation(s)
- Ayse Kotek Sedef
- Dr. Ersin Arslan Research and Training Hospital, Department of Radiation Oncology, Gaziantep,Turkey
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Gultekin M, Guler OC, Yuce Sari S, Akkus Yildirim B, Onal C, Celik H, Yuce K, Ayhan A, Arik Z, Kose F, Altundag O, Zoto Mustafayev T, Atalar B, Bolukbasi Y, Yildiz F. Multi-institutional validation of the ESMO-ESGO-ESTRO consensus conference risk grouping in Turkish endometrial cancer patients treated with comprehensive surgical staging. J OBSTET GYNAECOL 2021; 41:414-420. [PMID: 32347768 DOI: 10.1080/01443615.2020.1737661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statementWhat is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging.
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Affiliation(s)
- Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Husnu Celik
- Department of Gynecologic Oncology, Baskent University Medical School, Adana, Turkey
| | - Kunter Yuce
- Department of Gynecologic Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ali Ayhan
- Department of Gynecologic Oncology, Baskent University Medical School, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Fatih Kose
- Department of Medical Oncology, Baskent University Medical School, Adana, Turkey
| | - Ozden Altundag
- Department of Medical Oncology, Baskent University Medical School, Ankara, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem University Medical School, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem University Medical School, Istanbul, Turkey
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, Koc University Medical School, Istanbul, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
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Gultekin M, Beduk Esen CS, Balci B, Alanyali S, Akkus Yildirim B, Guler OC, Yuce Sari S, Ergen SA, Sahinler I, Alsan Cetin I, Onal C, Yildiz F, Ozsaran Z. Role of vaginal brachytherapy boost following adjuvant external beam radiotherapy in cervical cancer: Turkish Society for Radiation Oncology Gynecologic Group Study (TROD 04-002). Int J Gynecol Cancer 2020; 31:185-193. [PMID: 32998860 DOI: 10.1136/ijgc-2020-001733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE There are a limited number of studies supporting vaginal brachytherapy boost to external beam radiotherapy in the adjuvant treatment of cervical cancer. The aim of this study was to assess the impact of the addition of vaginal brachytherapy boost to adjuvant external beam radiotherapy on oncological outcomes and toxicity in patients with cervical cancer. METHODS Patients treated with post-operative external beam radiotherapy ± chemotherapy ± vaginal brachytherapy between January 2001 and January 2019 were retrospectively evaluated. The treatment outcomes and prognostic factors were analyzed in patients treated with external beam radiotherapy with or without vaginal brachytherapy. RESULTS A total of 480 patients were included in the analysis. The median age was 51 years (range 42-60). At least two intermediate risk factors were observed in 51% of patients, while 49% had at least one high-risk factor. The patients in the external beam radiotherapy + vaginal brachytherapy group had worse prognostic factors than the external beam radiotherapy alone group. With a median follow-up time of 56 months (range 33-90), the 5-year overall survival rate was 82%. There was no difference in 5-year overall survival (87% vs 79%, p=0.11), recurrence-free survival (74% vs 71%, p=0.49), local recurrence-free survival (78% vs 76%, p=0.16), and distant metastasis-free survival (85% vs 76%, p=0.09) rates between treatment groups. There was no benefit of addition of vaginal brachytherapy to external beam radiotherapy in patients with positive surgical margins. In multivariate analysis, stage (overall survival and local recurrence-free survival), tumor histology (recurrence-free survival, local recurrence-free survival and distant metastasis-free survival), parametrial invasion (recurrence-free survival and distant metastasis-free survival), lymphovascular space invasion (recurrence-free survival), and lymph node metastasis (distant metastasis-free survival) were found as negative prognostic factors. CONCLUSION Adding vaginal brachytherapy boost to external beam radiotherapy did not provide any benefit in local control or survival in patients with cervical cancer.
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Affiliation(s)
- Melis Gultekin
- Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Beril Balci
- Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Senem Alanyali
- Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Berna Akkus Yildirim
- Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Ozan Cem Guler
- Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Sezin Yuce Sari
- Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sefika Arzu Ergen
- Radiation Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ismet Sahinler
- Radiation Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ilknur Alsan Cetin
- Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cem Onal
- Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Ferah Yildiz
- Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ozsaran
- Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
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Onal C, Gultekin M, Oymak E, Guler OC, Yilmaz MT, Yuce Sari S, Akkus Yildirim B, Yildiz F. Stereotactic radiotherapy in patients with oligometastatic or oligoprogressive gynecological malignancies: a multi-institutional analysis. Int J Gynecol Cancer 2020; 30:865-872. [PMID: 32273293 DOI: 10.1136/ijgc-2019-001115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/24/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Data supporting stereotactic body radiotherapy for oligometastatic patients are increasing; however, the outcomes for gynecological cancer patients have yet to be fully explored. Our aim is to analyze the clinical outcomes of stereotactic body radiotherapy in the treatment of patients with recurrent or oligometastatic ovarian cancer or cervical cancer. METHODS The clinical data of 29 patients (35 lesions) with oligometastatic cervical cancer (21 patients, 72%) and ovarian carcinoma (8 patients, 28%) who were treated with stereotactic body radiotherapy for metastatic sites were retrospectively evaluated. All patients had <5 metastases at diagnosis or during progression, and were treated with stereotactic body radiotherapy for oligometastatic disease. Patients with ≥5 metastases or with brain metastases and those who underwent re-irradiation for primary site were excluded. Age, progression time, mean biologically effective dose, and treatment response were compared for overall survival and progression-free survival. RESULTS A total of 29 patients were included in the study. De novo oligometastatic disease was observed in 7 patients (24%), and 22 patients (76%) had oligoprogression. The median follow-up was 15.3 months (range 1.9-95.2). The 1 and 2 year overall survival rates were 85% and 62%, respectively, and the 1 and 2 year progression-free survival rates were 27% and 18%, respectively. The 1 and 2 year local control rates for all patients were 84% and 84%, respectively. All disease progressions were observed at a median time of 7.7 months (range 1.0-16.0) after the completion of stereotactic body radiotherapy. Patients with a complete response after stereotactic body radiotherapy for oligometastasis had a significantly higher 2 year overall survival and progression-free survival compared with their counterparts. In multivariate analysis, early progression (≤12 months) and complete response after stereotactic body radiotherapy for oligometastasis were the significant prognostic factors for improved overall survival. However, no significant factor was found for progression-free survival in the multivariable analysis. No patients experienced grade 3 or higher acute or late toxicities. CONCLUSIONS Patients with early detection of oligometastasis (≤12 months) and with complete response observed at the stereotactic body radiotherapy site had a better survival compared with their counterparts. Stereotactic body radiotherapy at the oligometastatic site resulted in excellent local control rates with minimal toxicity, and can potentially contribute to long-term survival.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent Universitesi Tip Fakultesi, Adana, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ezgi Oymak
- 3Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent Universitesi Tip Fakultesi, Adana, Turkey
| | - Melek Tugce Yilmaz
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent Universitesi Tip Fakultesi, Adana, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Onal C, Sari SY, Yildirim BA, Yavas G, Gultekin M, Guler OC, Akyurek S, Yildiz F. A multi-institutional analysis of sequential versus 'sandwich' adjuvant chemotherapy and radiotherapy for stage IIIC endometrial carcinoma. J Gynecol Oncol 2019; 30:e28. [PMID: 30887753 PMCID: PMC6424855 DOI: 10.3802/jgo.2019.30.e28] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/20/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023] Open
Abstract
Objective To analyze the outcomes of sequential or sandwich chemotherapy (ChT) and radiotherapy (RT) in patients with node-positive endometrial cancer (EC). Methods Data from 4 centers were collected retrospectively for 179 patients with stage IIIC EC treated with postoperative RT and ChT (paclitaxel and carboplatin). Patients were either treated with 6 cycles of ChT followed by RT (sequential arm; 96 patients) or with 3 cycles of ChT, RT, and an additional 3 cycles of ChT (sandwich arm; 83 patients). Prognostic factors affecting overall survival (OS) and progression-free survival (PFS) were analyzed. Results The 5-year OS and PFS rates were 64% and 59%, respectively, with a median follow-up of 41 months (range, 5–167 months). The 5-year OS rates were significantly higher in the sandwich than sequential arms (74% vs. 56%; p=0.03) and the difference for 5-year PFS rates was nearly significant (65% vs. 54%; p=0.05). In univariate analysis, treatment strategy, age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology, rate of myometrial invasion, and grade were prognostic factors for OS and PFS. In multivariate analysis, non-endometrioid histology, advanced FIGO stage, and adjuvant sequential ChT and RT were negative predictors for OS, whereas only non-endometrioid histology was a prognostic factor for PFS. Conclusion Postoperative adjuvant ChT and RT for stage IIIC EC patients, either given sequentially or sandwiched, offers excellent clinical efficacy and acceptably low toxicity. Our data support the superiority of the sandwich regimen compared to the sequential strategy in stage IIIC EC patients for OS.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey.
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Guler Yavas
- Department of Radiation Oncology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Serap Akyurek
- Department of Radiation Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Onal C, Yuce Sari S, Akkus Yildirim B, Gultekin M, Guler OC, Yildiz F. Is there any benefit of paraaortic field irradiation in pelvic lymph node positive endometrial cancer patients? A propensity match analysis. J OBSTET GYNAECOL 2019; 40:1012-1019. [PMID: 31793400 DOI: 10.1080/01443615.2019.1679742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We evaluated the survival outcomes and recurrence patterns of endometrial cancer (EC) patients with pelvic lymph node metastases who received postoperative radiotherapy (RT) to the pelvis (P-RT) or to the pelvis plus paraaortic lymph nodes (PA-RT) with or without systemic chemotherapy (ChT). The data from 167 patients with stage IIIC1 EC treated with postoperative RT or RT and ChT were collected retrospectively. Those patients with pelvic lymph node metastases were treated with either P-RT (106 patients, 63%) or PA-RT (61 patients, 37%). The median follow-up time for the entire cohort was 49 (range = 5-199) months. The patients receiving adjuvant ChT and RT had significantly higher 5-year OS rates (77% vs. 33%, p < .001) and 5-year PFS rates (71% vs. 30%, p < .001) when compared to those receiving adjuvant RT alone. The patients receiving P-RT and ChT had significantly higher 5-year OS rates and 5-year PFS rates when compared to those treated with adjuvant PA-RT in the entire cohort and matched cohort. Adjuvant ChT together with RT is the strongest predictor of the OS and PFS. Prophylactic PA-RT is unnecessary, even if ChT is used together with P-RT in EC patients with pelvic lymph node metastasis.Impact statementWhat is already known on this subject? Local and distant recurrence risks are relatively higher in patients with stage IIIC disease, postoperative adjuvant treatment is required to reduce the recurrence risk. Adjuvant RT is a common approach for patients with locally advanced EC. Optimal target volume for RT in patients with stage IIIC EC remains controversial. We demonstrated that extended field RT is unnecessary, even if ChT is used together with pelvic RT in stage IIIC EC patients.What do the results of this study add? We demonstrated that adjuvant ChT together with RT is the strongest predictor of the OS and PFS for EC patients with pelvic lymph node metastases. Extended field RT is unnecessary, even if ChT is used together with pelvic RT in EC patients with pelvic lymph node metastases.What are the implications of these findings for clinical practice and/or further research? Although adjuvant treatment modalities are associated with improvements in survival, distant metastasis still remains the most common site of recurrence in advanced EC patients. Thus, further research is warranted to identify improved combined modality strategies to optimise the outcomes for EC patients with pelvic lymph node metastasis.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Yuce Sari S, Guler OC, Gultekin M, Akkus Yildirim B, Onal C, Ozyigit G, Yildiz F. Radiotherapy After Skin-Sparing Mastectomy and Implant-Based Breast Reconstruction. Clin Breast Cancer 2019; 19:e611-e616. [PMID: 31255547 DOI: 10.1016/j.clbc.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/17/2019] [Accepted: 04/02/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We evaluated the cosmetic results of radiotherapy (RT) after implant-based reconstruction (IBR). PATIENTS AND METHODS We retrospectively evaluated 170 patients with 171 breast cancers treated between December 2004 and January 2016 in 2 university hospitals. RT fields were reconstructed breast (RB) only in 24 (14%), and RB and regional lymphatics in 147 (86%) breasts, respectively. All but 1 patient received a total 50 Gy with conventional fractionation. All patients received systemic chemotherapy. One hundred thirty-eight (81%) patients received hormonal therapy; 118 tamoxifen and 20 aromatase inhibitor. RESULTS Median follow-up time was 46.8 months (range, 1-163 months). The 5-year disease-free and overall survival rate was 83% and 93%, respectively. Cosmetic results were considered excellent in 111 (65%), fair in 46 (27%), and bad in 14 (8%) RB by patients. Thirty-four (20%) RB had restorative surgery; because of surgeons' preference because of implant natural life time span in 5, and contracture, fibrosis, deformation, or dislocation of the implant, or cellulitis in the remaining. Statistically significant adverse factors in univariate analysis for impaired cosmetic outcome were bolus use on the RB, lymphatic irradiation, and volume that received at least 110% of the prescribed dose being > 1%. The use of bolus material was the only prognostic factor for deterioration of the cosmetic result in multivariate analysis. CONCLUSION RT after IBR yields acceptable cosmetic results. Although only 111 (65%) of RBs were considered to have excellent cosmetic results, only a small percentage of patients needed reoperation because of bad cosmetic outcome.
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Affiliation(s)
- Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey.
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Onal C, Sedef AM, Kose F, Oymak E, Guler OC, Sumbul AT, Aksoy S, Akkus Yildirim B, Besen AA, Muallaoglu S, Mertsoylu H, Ozyigit G. The hematologic parameters in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate. Future Oncol 2019; 15:1469-1479. [DOI: 10.2217/fon-2018-0635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Currently, there are no predictive markers of response to abiraterone. We calculated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) at baseline and at 4 and 12 weeks after initiation of abiraterone, and we evaluated prostate-specific antigen (PSA) response every 4 weeks in 102 metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone either pre- or postchemotherapy. With a median follow-up was 24.0 months (range: 0.3–54.9), median overall survival (OS) was 20.8 months. High-NLR patients who remained high or who returned to low NLR after 4 and 12 weeks showed significantly worse OS than patients with low baseline NLR. NLR and prostate-specific antigen response to abiraterone was a significant predictor of OS and progression-free survival (PFS) in metastatic castration-resistant prostate cancer patients treated with abiraterone delivered either pre- or postchemotherapy.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Ali Murat Sedef
- Division of Medical Oncology, Adana City Hospital, Adana, Turkey
| | - Fatih Kose
- Division of Medical Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Ahmet Taner Sumbul
- Division of Medical Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Sercan Aksoy
- Division of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Ali Ayberk Besen
- Division of Medical Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Sadık Muallaoglu
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
| | - Huseyin Mertsoylu
- Division of Medical Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Topkan E, Ekici NY, Ozdemir Y, Besen AA, Yildirim BA, Mertsoylu H, Sezen D, Selek U. Baseline hemoglobin <11.0 g/dL has stronger prognostic value than anemia status in nasopharynx cancers treated with chemoradiotherapy. Int J Biol Markers 2019; 34:139-147. [PMID: 30864463 DOI: 10.1177/1724600818821688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND To retrospectively investigate the influence of pretreatment anemia and hemoglobin levels on the survival of nasopharyngeal carcinoma patients treated with concurrent chemoradiotherapy (C-CRT). METHODS A total of 149 nasopharyngeal carcinoma patients who received C-CRT were included. All patients had received 70 Gy to the primary tumor plus the involved lymph nodes, and 59.4 Gy and 54 Gy to the intermediate- and low-risk neck regions concurrent with 1-3 cycles of cisplatin. Patients were dichotomized into non-anemic and anemic (hemoglobin <12 g/dL (women) or <13 g/dL (men)) groups according to their pre-treatment hemoglobin measures. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of a pre-treatment hemoglobin cut-off that impacts outcomes. Potential interactions between baseline anemia status and hemoglobin measures and overall survival, locoregional progression-free survival (LRPFS), and progression-free survival were assessed. RESULTS Anemia was evident in 36 patients (24.1%), which was related to significantly shorter overall survival (P=0.007), LRPFS (P<0.021), and progression-free survival (P=0.003) times; all three endpoints retained significance in multivariate analyses (P<0.05, for each). A baseline hemoglobin value of 11.0 g/dL exhibited significant association with outcomes in ROC curve analysis: hemoglobin <11.0 g/dL (N=26) was linked with shorter median overall survival (P<0.001), LRPFS (P=0.004), and progression-free survival (P<0.001) times, which also retained significance for all three endpoints in multivariate analyses and suggested a stronger prognostic worth for the hemoglobin <11.0 g/dL cut-off value than the anemia status. CONCLUSION Pre-C-CRT hemoglobin <11.0 g/dL has a stronger prognostic worth than the anemia status with regard to LRPFS, progression-free survival, and overall survival for nasopharyngeal carcinoma patients.
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Affiliation(s)
- Erkan Topkan
- 1 Baskent University Medical Faculty, Department of Radiation Oncology, Adana, Turkey.,2 Nicosia Dr. Burhan Nalbantoglu Goverment Hospital, Radiation Oncology Clinics, Nicosia, Turkish Republic of Northern Cyprus
| | - Nur Yücel Ekici
- 3 Adana City Hospital, Clinics of Otolaryngology, Adana, Turkey
| | - Yurday Ozdemir
- 1 Baskent University Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Ali Ayberk Besen
- 4 Baskent University Medical Faculty, Department of Medical Oncology, Adana, Turkey
| | - Berna Akkus Yildirim
- 1 Baskent University Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Hüseyin Mertsoylu
- 4 Baskent University Medical Faculty, Department of Medical Oncology, Adana, Turkey
| | - Duygu Sezen
- 5 Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey
| | - Ugur Selek
- 5 Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey.,6 The University of Texas, MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX, USA
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Yildirim BA, Onal C, Kose F, Oymak E, Sedef AM, Besen AA, Aksoy S, Guler OC, Sumbul AT, Muallaoglu S, Mertsoylu H, Ozyigit G. Outcome of loco-regional radiotherapy in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate. Strahlenther Onkol 2019; 195:872-881. [DOI: 10.1007/s00066-019-01429-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/11/2019] [Indexed: 12/01/2022]
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16
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Onal C, Yildirim BA, Sari SY, Yavas G, Gultekin M, Guler OC, Yildiz F, Akyurek S. Treatment outcomes of endometrial cancer patients with paraaortic lymph node metastasis: a multi-institutional analysis. Int J Gynecol Cancer 2019; 29:94-101. [DOI: 10.1136/ijgc-2018-000029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/26/2018] [Accepted: 09/06/2018] [Indexed: 01/22/2023] Open
Abstract
ObjectiveTo analyze the prognostic factors and treatment outcomes in endometrial cancer patients with paraaortic lymph node metastasis.MethodsData from four centers were collected retrospectively for 92 patients with endometrial cancer treated with combined radiotherapy and chemotherapy or adjuvant radiotherapy alone postoperatively, delivered by either the sandwich or sequential method. Prognostic factors affecting overall survival and progression-free survival were analyzed.ResultsThe 5-year overall survival and progression-free survival rates were 35 % and 33 %, respectively, after a median follow-up time of 33 months. The 5-year overall survival and progression-free survival rates were significantly higher in patients receiving radiotherapy and chemotherapy postoperatively compared with patients treated with adjuvant radiotherapy alone (P < 0.001 and P < 0.001, respectively). In a subgroup analysis of patients treated with adjuvant combined chemotherapy and radiotherapy, the 5-year overall survival and progression-free survival rates were significantly higher in patients receiving chemotherapy and radiotherapy via the sandwich method compared with patients treated with sequential chemotherapy and radiotherapy (P = 0.02 and P = 0.03, respectively). In the univariate analysis, in addition to treatment strategy, pathology, depth of myometrial invasion, and tumor grade were significant prognostic factors for both overall survival and progression-free survival. In the multivariate analysis, grade III disease, myometrial invasion greater than or equal to 50%, and adjuvant radiotherapy alone were negative predictors for both overall survival and progression-free survival.ConclusionWe demonstrated that adjuvant combined treatment including radiotherapyand chemotherapy significantly increases overall survival and progression-free survival rates compared with postoperative pelvic and paraaortic radiotherapy.
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Yildirim BA, Dolek Y, Guler OC, Arslan G, Onal C. Dosimetric comparison of vaginal vault brachytherapy vs applicator-guided stereotactic body radiotherapy with volumetric modulated arc therapy and helical tomotherapy for endometrium cancer patients. Med Dosim 2018; 44:332-338. [PMID: 30551844 DOI: 10.1016/j.meddos.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/10/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
We performed this dosimetric study to compare a nonstandard volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) techniques with high-dose rate (HDR) brachytherapy (BRT) plan of vaginal vault in patients with postoperative endometrial cancer (EC). Twelve postoperative patients with early stage EC were included in this study. Three plans were performed for each patient; dosimetric and radiobiological comparisons were made using dose-volume histograms and equivalent dose for determining the planning target volume (PTV) coverages in brachytherapy and external beam radiotherapy, and organs-at-risk (OARs) doses between three different delivery techniques. All the plans achieved adequate dose coverage for PTV; however, the VMAT plan yielded better dose conformity, and the HT plan showed better homogeneity for target volume. With respect to the OARs, the bladder D2cc was significantly lower in the BRT plan than in the VMAT and HT plans, with the highest bladder D2cc value being observed in the HT plan. However, no difference was observed in the rectum D2cc of the three plans. Other major advantages of the BRT plan over the VMAT and HT plans were the relatively lower body integral doses and femoral head doses as well as the fact that the integral doses were significantly lower in the BRT plan than in the VMAT and HT plans. This is the first dosimetric comparison of vaginal vault treatment for EC with BRT, VMAT, and HT plans. Our analyses showed the feasibility of stereotactic body radiotherapy technique as an alternative to HDR-BRT for postoperative management of EC patients.
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Affiliation(s)
- Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Yemliha Dolek
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Gungor Arslan
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120 Adana, Turkey.
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Onal C, Guler OC, Yildirim BA. Treatment outcomes of breast cancer liver metastasis treated with stereotactic body radiotherapy. Breast 2018; 42:150-156. [DOI: 10.1016/j.breast.2018.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/30/2018] [Accepted: 09/22/2018] [Indexed: 01/22/2023] Open
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Ozkaya Akagunduz O, Ergen A, Erpolat P, Gultekin M, Akkus Yildirim B, Parvizi M, Ikiz D, Colpan Oksuz D, Onal C, Yildiz F, Ozsaran Z. Local recurrence outcomes after breast conserving surgery and adjuvant radiotherapy in ductal carcinoma in situ of the breast and a comparison with ECOG E5194 study. Breast 2018; 42:10-14. [DOI: 10.1016/j.breast.2018.08.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 11/24/2022] Open
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Topkan E, Yildirim BA. Epoetin receptor status may alter the outcomes in head and neck cancers treated with radiotherapy and darbepoetin-α. Radiother Oncol 2018; 130:190. [PMID: 30414758 DOI: 10.1016/j.radonc.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/10/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Erkan Topkan
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Berna Akkus Yildirim
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey.
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Akkus Yildirim B, Onal C, Erbay G, Cem Guler O, Karadeli E, Reyhan M, Koc Z. Prognostic values of ADC mean and SUV max of the primary tumour in cervical cancer patients treated with definitive chemoradiotherapy. J OBSTET GYNAECOL 2018; 39:224-230. [PMID: 30354907 DOI: 10.1080/01443615.2018.1492528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We analysed the correlation of 18F-fluorodeoxyglucose uptake into primary tumours using the maximum standardised uptake value (SUVmax) and the mean apparent diffusion coefficient (ADCmean) values in magnetic resonance imaging (MRI) with the clinical and pathological factors in patients with cervical cancer who were treated with concurrent chemoradiotherapy. The patients were stratified according to the primary tumour pre-treatment ADCmean and SUVmax cut-off values. There were significant correlations between the SUVmax of the primary tumour and tumour size, and the treatment response. The correlation between the ADCmean and FIGO stage, tumour size, and the lymph node metastasis was significant. The SUVmax was significantly and inversely correlated with the ADCmean for cervical cancer (r = -0.44, p <.001). In the multivariate analysis, the primary tumour ADCmean, treatment response and the lymph node metastasis emerged as significant independent predictors of both OS and DFS, and of the primary tumour SUVmax for DFS. Tumour size has a borderline significance for OS. High SUVmax and low ADCmean of the primary tumour are important predictive factors for identifying high-risk patients with cervical cancer who are treated with definitive chemoradiotherapy. These results point to a future role for the diffusion-weighted MRI and for 18F-fluorodeoxyglucose positron emission tomography, not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy for individual patients. Impact statement What is already known on this subject? A negative correlation between primary tumour SUVmax derived from positron emission tomography (PET/CT) and ADCmin derived from diffusion weighted magnetic resonance imaging (DW-MRI) in various cancer types and cervical cancer has been demonstrated. However, the prognostic value of primary tumour SUVmax and ADCmean in cervical cancer patients treated with definitive chemoradiotherapy is not well studied yet. What the results of this study add? The patients with high-risk features (larger tumours, extensive stage, lymph node metastasis) had higher primary tumour SUVmax and lower ADCmean values. Primary tumour ADCmean and lymph node metastasis emerged as significant independent predictors of both overall and disease-free survival. This study demonstrated that the functional biomarkers delivered from PET-CT and DW-MRI are important in predicting the treatment outcomes in the squamous cell carcinoma of cervix treated with definitive chemoradiotherapy, where clinical and radiological findings are very important, since these patients are not staged surgically. What are the implications of these findings for clinical practice and/or further research? Based on these findings, there may be a future role of DW-MRI and FDG/PET-CT not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy (ChRT) for individual patients.
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Affiliation(s)
- Berna Akkus Yildirim
- a Department of Radiation Oncology , Baskent University Faculty of Medicine , Adana , Turkey
| | - Cem Onal
- a Department of Radiation Oncology , Baskent University Faculty of Medicine , Adana , Turkey
| | - Gurcan Erbay
- b Department of Radiology , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Ozan Cem Guler
- c Department of Radiation Oncology , Karadeniz Technical University Faculty of Medicine , Trabzon , Turkey
| | - Elif Karadeli
- b Department of Radiology , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Mehmet Reyhan
- d Department of Nuclear Medicine , Baskent University Faculty of Medicine , Ankara , Turkey
| | - Zafer Koc
- b Department of Radiology , Baskent University Faculty of Medicine , Ankara , Turkey
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Yildirim BA, Topkan E. In Regard to Ward et al. Int J Radiat Oncol Biol Phys 2018; 101:1273. [PMID: 30012532 DOI: 10.1016/j.ijrobp.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey
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Oymak E, Yildirim BA, Guler OC, Onal C. Responding to Veiga et al. 'Long term radiological features of radiation-induced lung damage'. Radiother Oncol 2018; 129:611-612. [PMID: 30021696 DOI: 10.1016/j.radonc.2018.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/22/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Ezgi Oymak
- Iskenderun Gelisim Hospital, Division of Radiation Oncology, Hatay, Turkey
| | - Berna Akkus Yildirim
- Başkent University, Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey
| | - Ozan Cem Guler
- Başkent University, Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey
| | - Cem Onal
- Başkent University, Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey.
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Guler OC, Torun N, Yildirim BA, Onal C. Pretreatment metabolic tumour volume and total lesion glycolysis are not independent prognosticators for locally advanced cervical cancer patients treated with chemoradiotherapy. Br J Radiol 2018; 91:20170552. [PMID: 29293366 DOI: 10.1259/bjr.20170552] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the prognostic significance of metabolic parameters derived from fludeoxyglucose (FDG) positron emission tomography (PET)/CT, in cervical cancer patients treated with concurrent chemoradiotherapy. METHODS We retrospectively reviewed medical records from 129 biopsy-proven non-metastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at our department. Correlation between metabolic parameters and tumour characteristics was evaluated. Prognostic factors for survival, local control and distant metastasis were analysed. RESULTS The median follow up for all patients and surviving patients was 30.0 months (range, 3.7-94.7 months) and 50.5 months (range, 14.5-94.7 months), respectively. The 2- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 68 42, 54 and 38%, respectively. The maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis were significantly higher in patients with larger tumours (>4 cm) and partial regression or progressive disease after definitive treatment compared to patients with smaller tumour (≤4 cm) and post-treatment complete response. On univariate analysis, stage, lymph node metastasis, tumour size >4 cm, SUVmax, MTV, SUVmean and total lesion glycolysis were prognostic factors for OS and DFS. On multivariate analysis, only larger tumour and presence of lymph node metastasis were significant prognostic factors for both OS and DFS. Additionally, extensive stage was a significant prognosticator for DFS. CONCLUSION Although, metabolic parameters derived from FDG-PET/CT had a prognostic significance in univariate analysis, the significance was lost in multivariate analysis where tumour stage, size and lymph node status were the only independent parameters. Advances in knowledge: The clinical benefit of using FDG-PET/CT metabolic parameters to evaluate the high-risk patients among cervical cancer patients and to eventually change patient management still needs further clarification.
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Affiliation(s)
- Ozan Cem Guler
- 1 Department of Radiation Oncology, Karadeniz Technical University Faculty of Medicine , Trabzon , Turkey
| | - Nese Torun
- 2 Department of Nuclear Medicine, Baskent University Faculty of Medicine , Adana , Turkey
| | - Berna Akkus Yildirim
- 3 Department of Radiation Oncology, Baskent University Faculty of Medicine , Adana , Turkey
| | - Cem Onal
- 3 Department of Radiation Oncology, Baskent University Faculty of Medicine , Adana , Turkey
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Onal C, Akkus Yildirim B, Guler OC. Outcomes of aggressive treatment in esophageal cancer patients with synchronous solitary brain metastasis. Mol Clin Oncol 2017; 7:107-112. [PMID: 28685086 DOI: 10.3892/mco.2017.1263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/03/2017] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to investigate the outcomes of esophageal cancer (EC) patients with isolated synchronous brain oligometastasis (oligo-BM) treated with chemoradiotherapy (CRT) of the primary site and localized treatment of the BM with surgery, radiotherapy (RT) or radiosurgery. Of 125 EC patients investigated, seven patients (6%) had solitary BM. Six patients were diagnosed prior to, and one patient was diagnosed during, treatment. All patients were treated with neoadjuvant chemotherapy and whole-brain RT (WBRT) for BM. All but one patient received definitive CRT with a median RT dose of 50.4 Gy using conventional fractionation RT. The median age at diagnosis was 59 years (range, 48-77 years). Six patients succumbed to mortality, and one continued to receive systemic chemotherapy at the last visit. The median survival time of the patients was 18.9 months (range, 10.0-27.2 months). Median time to progression after completion of the treatments was 8 months (range, 3-9 months). Two patients had progression of the primary tumor, and one patient had progression of the BM. The neurological status of three patients with BM who were identified during the staging work-up did not deteriorate as a consequence of WBRT. In conclusion, the present study has demonstrated that aggressive treatment of the primary tumor and oligo-BM in patients with EC may prolong the survival time.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Centre, 01120 Adana, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Centre, 01120 Adana, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Centre, 01120 Adana, Turkey
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Affiliation(s)
- N Mert
- University of Yuzuncu Yil, Turkey
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Ozdemir Y, Yildirim BA, Topkan E. Whole brain radiotherapy in management of non-small-cell lung carcinoma associated leptomeningeal carcinomatosis: evaluation of prognostic factors. J Neurooncol 2016; 129:329-35. [PMID: 27306442 DOI: 10.1007/s11060-016-2179-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/05/2016] [Indexed: 11/29/2022]
Abstract
To assess the efficacy of whole-brain radiotherapy (WBRT) and prognostic factors in leptomeningeal carcinomatosis (LMC) of non-small-cell lung cancer (NSCLC) patients. WBRT records of 51 LMC patients confined to brain were reviewed. Eligible patients had squamous-cell carcinoma (SCC) or adenocarcinoma, and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-3. The WBRT was either 20 or 30 Gray. The primary and secondary objectives were to determine overall survival (OS) and prognostic factors for improved treatment response, respectively. Median age was 53 years (range 39-68), 58.8 % had SCC, 74.5 % had ECOG PS 1-2, and 70.6 % had LMC accompanied by parenchymal brain metastases (BM). The median follow-up was 4.1 months (range 0.7-14.4); all patients died due to disease progression. Median OS was 3.9 months (95 % CI 3.3-4.5) with 6 and 12 month estimates of 19.6 and 5.9 %, respectively. Evaluation of prognostic factors revealed that patients with ECOG 1, longer time to LMC (TT-LMC) from NSCLC diagnosis (>11.3 months), and absence of parenchymal BM had significantly superior OS than those patients with ECOG 2 (p = 0.01) or 3 (p < 0.001), TT-LMC < 11.3 months (p = 0.001), and parenchymal BM (p = 0.012). Median OS of 3.9 months after WBRT appeared to confirm the poor prognosis of LMC. WBRT might be most effective for patients with favorable PS, longer TT-LMC, and no accompanying BM. Therefore, we identified ECOG PS 1, TT-LMC > 11.3 months, and no BM as independent prognosticators for better response to WBRT in NSCLC patients with LMC.
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Affiliation(s)
- Yurday Ozdemir
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey.
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Baskent University Adana Medical Faculty, Adana, Turkey
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Yildirim BA, Özdemir Y, Colakoglu T, Topkan E. Impact of presence and degree of pretreatment weight loss in locally-advanced pancreatic cancer patients treated with definitive concurrent chemoradiotherapy. Pancreatology 2016; 16:599-604. [PMID: 27029854 DOI: 10.1016/j.pan.2016.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/03/2016] [Accepted: 03/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND To assess the impact of the presence and degree of pretreatment weight loss (WL) on the survival of locally-advanced pancreas cancer (LAPC) patients treated with concurrent chemoradiotherapy (C-CRT). METHODS Seventy-three patients who received 50.4 Gy C-CRT were analyzed. All patients underwent laparoscopy (n = 18) or laparotomy (n = 55), and biopsies were obtained for histologic examination of the primary tumor and enlarged/metabolically active regional lymph nodes. Pretreatment WL and percentage WL (PWL) were calculated by utilizing data obtained 6 months prior to and during hospital admission. The primary objective was to assess the influence WL status on overall survival (OS), and the secondary objective was the identification of a PWL cut-off value, if available. RESULTS Forty-five (61.6%) patients had WL. Median OS was 14.4 months for the entire study population which was significantly longer in the non-WL than the WL cohort (21.4 vs. 11.3 months; p < 0.003). On further analysis a cut-off value of 3.1% was identified for WL. Accordingly, patients with WL < 3.1% had significantly longer OS than those with WL ≥ 3.1% (25.8 vs. 10.1 months; p < 0.001). In multivariate analysis, both the WL status (p < 0.001) and PWL (p = 0.002) retained their independent significance. CONCLUSION Both the presence and degree of WL prior to C-CRT had strong adverse effects on the survival of LAPC patients, even if they presented with a BMI > 20 kg/m(2). Additionally, a WL of ≥3.1% in the last 6 months appeared to be a strong cut-off for the stratification of such patients into distinctive survival groups.
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Affiliation(s)
- Berna Akkus Yildirim
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey.
| | - Yurday Özdemir
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Tamer Colakoglu
- Baskent University Adana Medical Faculty, Department of General Surgery, Adana, Turkey
| | - Erkan Topkan
- Baskent University Adana Medical Faculty, Department of Radiation Oncology, Adana, Turkey
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Topkan E, Yildirim BA, Guler OC, Parlak C, Pehlivan B, Selek U. Safety and palliative efficacy of single-dose 8-Gy reirradiation for painful local failure in patients with stage IV non-small cell lung cancer previously treated with radical chemoradiation therapy. Int J Radiat Oncol Biol Phys 2015; 91:774-80. [PMID: 25752391 DOI: 10.1016/j.ijrobp.2014.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the safety and efficacy of single-dose 8-Gy palliative chest reirradiation (CRI) in metastatic non-small cell lung cancer (M-NSCLC) patients with painful thoracic failures (TF) within the previous radiation portal. PATIENTS AND METHODS We retrospectively analyzed the clinical data of 78 M-NSCLC patients who received single-dose 8-Gy CRI for painful TF after concurrent chemoradiation therapy to a total radiation dose of 52 to 66 Gy between 2007 and 2012. Primary endpoints included significant pain relief (SPR) defined as a ≥2 point decrement in the Visual Analogue Scale for Pain inventory (VAS-P), time to pain relief, and duration of pain control. Secondary objectives were survival and prognostic factors. RESULTS Treatment was well tolerated, with only 5.1% grade 3 pneumonitis and 1.3% grade 2 esophagitis. Pre-CRI median and post-CRI minimum VAS-P were 7 and 3 (P<.001), respectively. SPR was noted in 67 (85.9%) patients, and only 3 (3.9%) scored progressive pain. Median time to lowest VAS-P and duration of pain control were 27 days and 6.1 months, respectively. Median overall survival (OS) was 7.7 months, and the 1-year OS rate was 26.5%. On multivariate analyses, lower Eastern Cooperative Oncology group score (1-2; P<.001), absence of anemia (P=.001), and fewer metastatic sites (1-2; P<.001) were found to be associated with longer OS. CONCLUSIONS Single-dose 8-Gy CRI provides safe, effective, and durable pain palliation for TF in radically irradiated M-NSCLC patients. Because of its convenience, lower cost, and higher comfort, the present protocol can be considered an appropriate option for patients with limited life spans.
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Affiliation(s)
- Erkan Topkan
- Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey.
| | - Berna Akkus Yildirim
- Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey
| | - Ozan Cem Guler
- Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey
| | - Cem Parlak
- Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey
| | - Berrin Pehlivan
- Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, and American Hospital, University of Texas MD Anderson Radiation Treatment Center, Istanbul, Turkey
| | - Ugur Selek
- Medstar Hospital, Department of Radiation Oncology, Antalya, Turkey
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Arguder E, Akkus Yildirim B, Hasanoglu HC. Pulmonary Toxicities and Treatment of Radiation Therapy. Eurasian J Pulmonol 2015. [DOI: 10.5152/ejp.2014.39206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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31
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Karalezli A, Arguder E, Akkus Yildirim B, Soyturk AN, Hasanoglu HC. Cavitation of Tumoral Mass after Radiotherapy in a Patient with Pancoast Tumor. Eurasian J Pulmonol 2015. [DOI: 10.5152/ejp.2014.27928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Topkan E, Yildirim BA, Selek U, Yavuz MN. Cranial prophylactic irradiation in locally advanced non-small cell lung carcinoma: current status and future perspectives. Oncology 2009; 76:220-8. [PMID: 19218826 DOI: 10.1159/000201933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 11/24/2008] [Indexed: 11/19/2022]
Abstract
As a result of improved local and regional control with aggressive multimodality protocols, the brain has become one of the major sites of relapse in patients with locally advanced non-small cell lung carcinoma (LA-NSCLC). The demonstrated efficacy of prophylactic cranial irradiation (PCI) in small-cell lung carcinoma led to studies of its effectiveness in LA-NSCLC, which indicated that PCI also has a high potential to reduce the incidence or delay the occurrence of brain metastases in this patient group. This report provides an extensive review of the current evidence from nonrandomized and randomized trials regarding the use of PCI in LA-NSCLC and discusses related key issues including risk factors, patient selection criteria, timing of PCI, preferred PCI dosing scheme, toxicity profile and potential novel PCI techniques.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University School of Medicine, Adana, Turkey.
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Dilbaz B, Yildirim BA, Yildirim D, Turgal M, Cengiz H, Dilbaz S. Do contraceptive choices of Turkish married adolescents differ from those of older women? EUR J CONTRACEP REPR 2007; 13:71-6. [PMID: 17886155 DOI: 10.1080/13625180701617589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare contraceptive choices of Turkish married adolescents to those of women of reproductive age and perimenopausal women. METHODS Demographic variables, fertility goals and contraceptive choices of adolescents (Group A, n = 95) were compared with those of women of reproductive age (Group B, n = 5224) and perimenopausal women (Group C, n = 2208). RESULTS All women in the study group were married and had delivered at least once. A past history of voluntary terminations of pregnancy (TOPs) was reported often, although significantly less so by adolescents (43.1%) than by women belonging to the other two groups (66.5 and 77.4%, respectively). The percentage of women who applied no contraception was significantly higher in Group A (p < 0.05). The rate of use of withdrawal, oral contraceptives and intrauterine devices did not differ significantly between the three groups. The percentage of women who were indecisive about future pregnancy or wanted to have more children was greatest in Group A (87.4, 46.9 and 25.7%, respectively; p < 0.05). CONCLUSION The distribution of contraceptive methods used was similar among the three age groups, but the absence of contraception was most frequent in the adolescent group. The adolescents we assessed, being married and having delivered at least once, are a highly selected group and not representative of adolescents in general. Nevertheless, their contraceptive choices did not differ from those of older women. The incidence of TOPs among them was quite high. Minimization of the frequent neglect of application of contraceptive measures by adolescents requires improvement of family planning services for this age group.
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Affiliation(s)
- B Dilbaz
- Ministry of Health Ankara Etlik Maternity and Women's Health Research and Teaching Hospital, Ankara, Turkey.
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