_________________________________________________________________________________________________... more _____________________________________________________________________________________________________ ÖZET Amaç: Genç erkek hastaları etkileyen ve iyi prognoza sahip olan testis kanserli hastaların sayısı giderek artmaktadır. Bu çalışmada testis kanseri tanısı konmuş, remisyonda izlenen Evre I seminom olgularında anksiyete ve depresyon düzeylerini, yaşam kalitesini, cinsel işlevleri değerlendirmek ve sağlıklı kontrol grubu ile karşılaştırmak amaçlanmıştır. Yöntem: Örneklem Karadeniz Teknik Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi'nde izlenmekte olan tümü tek taraflı orşiektomili Evre I remisyonda 15 seminom hastasından oluşmaktadır. Tüm hastalar tek taraflı orşiektomili Evre I seminomdur. Çalışma grubu yaş, eğitim düzeyi, medeni durum ve çalışma durumları bakımından eşleştirilmiş eşit sayıda kontrol grubu ile sosyodemografik veriler ve BAÖ, BDÖ, GRCDÖ, EORTC QLQ-C30 versiyon 3.0 ölçeklerini içeren klinik ölçeklerle karşılaştırılmıştır. Çalışma olgu kontrol çalışması olarak düzenlenmiştir. Sonuçlar: Evre I testis kanseri nedeni ile aynı protokole göre radyoterapi ve cerrahi tedaviler uygulanmış, ortalama remisyon süreleri 25.6±19.5 ay olan bir grup hasta (s=15) kontrol grubu ile karşılaştırılmıştır. Klinik değerlendirmede cinsel işlev, yaşam kalitesi, depresyon ve anksiyete düzeylerinde örneklem grubu ile kontrol grubu açısından istatistiksel fark bulunmamıştır. Tartışma: Standart tedavi sonrası remisyona giren Evre I seminom hastalarının yaşam kalitesi, cinsel işlevler açısından sağlıklı kontrollerle arasında fark bulunmaması, örneklemin erken evre remisyonda seminom hastalarında oluşmasına ve örneklemin küçüklüğüne bağlanabilir. Bu sonuçlar ileriki çalışmalar için öngörücü olabilir. (Anadolu Psikiyatri Dergisi 2009; 10:233-238) Anahtar sözcükler: Testis kanseri, cinsellik, yaşam kalitesi Sexual satisfaction and quality of life in cured testicular cancer ABSRACT Objective: The testicular cancer affecting young male has good prognosis, so led to increasing number of cancer survivors. Thus, the aim of this study is to assess level of depression and anxiety symptoms, quality of life, sexual function in cured stage I seminoma patients and to compare them with healthy controls. Methods: The sample consists of 15 cured testicular cancer patients of whom followed in Radiation Oncology Department in Karadeniz Technical University, Medical School Hospital. All patients are stage I seminoma with unilateral orchiectomy. The patient group was compared in means of sociodemographic data and clinical assessment measures including BAS, BDS, GRISS, EORTC QLQ-C30 version 3.0 with the control group matched in age, level of educational, marital status and occupation. The study was designed as case control study. Results: The patients (n=15) with average remission length of 25±19.5 months who completed radiotherapy and surgical therapy with respect to same protocol for stage I testicular cancer were compared with control group matched in age, level of education-_____________________________________________________________________________________________________ * 42. Ulusal Psikiyatri Kongresi'nde poster bildiri olarak sunulmuştur.
Background: Leptin is a peptide hormone that has a role in the regulation of body weight and has ... more Background: Leptin is a peptide hormone that has a role in the regulation of body weight and has effects on metabolic, neuroendocrine, reproductive and hematopoietic systems. Breast cancer has also been associated with obesity and reproductive hormones, especially estradiol. Only a few studies have investigated the relation between plasma leptin and risk of breast cancer and only one study evaluated the effect of tamoxifen on leptin levels in patients with breast cancer. Methods: We investigated serum leptin levels in gender-, body mass index (BMI)-and agematched breast cancer patients and healthy individuals (58 of each). Results: Serum leptin levels were measured by radioimmunoassay (Human Leptin RIA Kit). Serum leptin levels in the breast cancer patients were significantly higher than those in the control group (27.00 versus 17.65 ng/ml, p = 0.019). There were no differences with respect to BMI and age between control and breast cancer patients. There were no significant differences in BMI and leptin levels between pre-and postmenopausal patients (27.00 ± 1.39 and 27.19 ± 0.81 kg/m 2 , 26.81 ± 6.25 and 27.06 ± 2.98 ng/ml) (p > 0.05). We found no difference in serum leptin level between early and late stages of patients (22.38 versus 31.30 ng/ml, p = 0.086). However, the serum leptin level in patients using tamoxifen was significantly higher than that of patients not using tamoxifen (32.71 and 19.39 ng/ml, respectively p = 0.009). There was no correlation between CA 15-3 and leptin level (r = 0.069, p = 0.610). Conclusion: High serum leptin levels seen in breast cancer patients are not related to stage of the disease or to cancer itself but may be associated with the use of tamoxifen.
Male breast cancer, consisting only 1% of all breast cancers, is occasionally associated with oth... more Male breast cancer, consisting only 1% of all breast cancers, is occasionally associated with other primary malignancies, especially in patients with familial breast cancer history. Sporadic male breast cancers with another primary tumor are extremely rare. We report a 67-year-old male with asynchronous bilateral breast cancer and prostate cancer without familial breast cancer history.
Journal of Experimental & Clinical Cancer Research, 2008
To compare computed tomography (CT) with co-registered positron emission tomography-computed tomo... more To compare computed tomography (CT) with co-registered positron emission tomography-computed tomography (PET-CT) as the basis for delineating gross tumor volume (GTV) in unresectable, locally advanced pancreatic carcinoma (LAPC).
To evaluate the impact of four different rectum contouring techniques and rectal toxicities in pa... more To evaluate the impact of four different rectum contouring techniques and rectal toxicities in patients with treated with 3D conformal radiotherapy (3DCRT).
Background: The purpose of this study was to evaluate the efficacy of oral glutamine in the preve... more Background: The purpose of this study was to evaluate the efficacy of oral glutamine in the prevention of acute radiation-induced esophagitis (ARIE) and weight loss in lung carcinoma patients, and to determine the clinical/dosimetric predictors of ARIE. Patients and methods: Data from 41 patients with stage III lung carcinoma treated with thoracic irradiation were retrospectively analyzed. Twenty-two patients (53.6%) received prophylactic powdered glutamine in doses of 10 g/8 h. Prescribed radiation dose to planning target volume was 60 Gy, in 30 fractions, 5 days/week. The primary endpoint included the ARIE incidence and its correlation with clinical/dosimetric factors relative to treatment with glutamine. Results: Glutamine was well tolerated. Grade 2 or 3 ARIE occurred in 20 (48.8%) of 41 patients: seven in the glutamine-supplemented group, and 13 in the glutamine-free group (p = 0.002). All seven patients with grade 3 esophagitis were in the glutamine-free group (36.8% vs. 0%). Glutamine supplementation appeared to significantly delay ARIE onset for six days (22 days vs. 16 days; p = 0.002). Glutamine-supplemented patients demonstrated a lower incidence of grade 2 or 3 ARIE (27.2%), and gained weight during radiotherapy (p = 0.04). V55 was the only dosimetric parameter that correlated with the severity of ARIE in glutamine-free patients: a V55 of <35% had a 31% risk of ARIE grade 2 or 3, and the risk increased to 76% with a V55 of ≥35% (p = 0.01). Conclusion: This schedule and dosage of glutamine may be beneficial in the prevention of ARIE and weight loss in lung cancer patients undergoing thoracic irradiation.
International Journal of Radiation Oncology Biology Physics, 2003
Purpose: A growing body of evidence supports the efficacy of accelerated superfractionated radiot... more Purpose: A growing body of evidence supports the efficacy of accelerated superfractionated radiotherapy with concomitant boost for advanced head-and-neck carcinomas. This study represents a single-institution experience, performed to identify the factors influencing tumor control, survival, and toxicity. Methods and Materials: Between 1988 and 1999, 133 patients with primary squamous cell head-and-neck carcinoma underwent accelerated superfractionated radiotherapy using a concomitant boost. The concomitant boost in this regimen was delivered using reduced fields delivered 3 times weekly in a twice-daily schedule during the final phase. The total radiation dose ranged from 64.8 Gy to 76.5 Gy (mean 71.1). Patients were evaluated in follow-up for local control and late toxicity. Multivariate analysis of treatment and patient parameters was performed to evaluate their influence on toxicity, local control, and overall survival. Results: With a mean follow-up of 37 months, the actuarial overall survival rate for the entire group at 5 years was 24% and the local control rate was 57%. The tumor volume was the most significant predictor of local control, such that each 1-cm 3 increase in volume was associated with a 1% decrease in local control. For patients with tumor volumes <30 cm 3 vs. >30 cm 3 , the 5-year disease-specific survival rate was 52% and 27% (p ؍ 0.004) and locoregional control rate was 76% and 26% (p <0.001), respectively. Seventy-six patients with a minimum of 12 months and median of 39 months toxicity follow-up were studied for late effects. None of these patients experienced Grade 4 or 5 toxicity. The actuarial rate of significant toxicity (Grade III or greater) was 32% at 5 years. Of the toxicities observed, xerostomia (19%) was the most common. Multivariate analysis revealed N stage and dose as independent predictors of Grade 3 effects. Conclusion: The locoregional control and survival for patients in this institutional experience compare favorably to other published reports. Tumors of the larynx had the best prognosis. Larger volume tumors were associated with significantly lower local control and survival. Significant late effects were related to dose and nodal status.
Journal of Experimental & Clinical Cancer Research, 2009
To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer, based on eith... more To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer, based on either orthogonal radiographs (conventional plan) or CT sections (CT plan); the comparison focused on target volume coverage and dose volume analysis of organs at risk (OARs), by representing point doses defined by the International Commission on Radiation Units and Measurement (ICRU) and dose volume histograms (DVHs) from 3D planning.
We compared the effects of amifostine and melatonin in preventing radiation-induced epiphyseal gr... more We compared the effects of amifostine and melatonin in preventing radiation-induced epiphyseal growth plate injury in rats. Four-week-old (65-85 g), growing male Sprague-Dawley rats were randomly assigned to receive radiation alone, at 25 Gy in three fractions (group R), or this dose of fractionated radiation proceeded by prophylactic amifostine 200 mg/kg i.p. (group A), melatonin 15 mg/kg i.p. (group M), or amifostine + melatonin (group AM). The right rear extremity of each animal was irradiated while the contralateral leg was shielded from radiation, as a control. Bone growth based on the length of the tibia, femur, and overall limb was calculated 6 weeks after the treatment. In groups R, A, M, and AM, the mean growth loss (GL) for the overall limb was 56.9 +/- 8.1%, 46.8 +/- 7.7%, 36.6 +/- 4.3%, and 38.5 +/- 5.1%, respectively. The limb length discrepancies (LLD) in groups R, A, M, and AM were 13.8 +/- 1.4%, 10.5 +/- 0.3%, 7.4 +/- 0.7%, and 8.8 +/- 1.1%, respectively. Differences in LLD were significant between each treatment group and group R (range: p = 0.0001-0.001). Differences in either of mean GL and LLD were not significant between groups M and AM; however both of these groups had significantly less GL and LLD than group A. We observed a superior radioprotective function of melatonin over amifostine in preventing radiation-induced epiphyseal growth plate injury, without any increase in radioprotective effect by adding amifostine to melatonin.
Background When combined with adequate tumoricidal doses, accurate target volume delineation rema... more Background When combined with adequate tumoricidal doses, accurate target volume delineation remains to be the one of the most important predictive factors for radiotherapy (RT) success in locally advanced or medically inoperable malignant pleural mesothelioma (MPM) patients. Recently, 18-fluorodeoxyglucose positron emission tomography (PET) has demonstrated significant improvements in diagnosis and accurate staging of MPM. However, role of additional PET data has not been studied in RT planning (RTP) of patients with inoperable MPM or in those who refuse surgery. Therefore, we planned to compare CT with co-registered PET-CT as the basis for delineating target volumes in these patients group. Methods Retrospectively, the CT and co-registered PET-CT data of 13 patients with histologically proven MPM were utilized to delineate target volumes separately. For each patient, target volumes (gross tumor volume [GTV], clinical target volume [CTV], and planning target volume [PTV]) were defined using the CT and PET-CT fusion data sets. The PTV was measured in two ways: PTV1 was CTV plus a 1-cm margin, and PTV2 was GTV plus a 1-cm margin. We analyzed differences in target volumes. Results In 12 of 13 patients, compared to CT-based delineation, PET-CT-based delineation resulted in a statistically significant decrease in the mean GTV, CTV, PTV1, and PTV2. In these 12 patients, mean GTV decreased by 47.1% ± 28.4%, mean CTV decreased by 38.7% ± 24.7%, mean PTV1 decreased by 31.1% ± 23.1%, and mean PTV2 decreased by 40.0% ± 24.0%. In 4 of 13 patients, hilar lymph nodes were identified by PET-CT that was not identified by CT alone, changing the nodal status of tumor staging in those patients. Conclusion This study demonstrated the usefulness of PET-CT-based target volume delineation in patients with MPM. Co-registration of PET and CT information reduces the likelihood of geographic misses, and additionally, significant reductions observed in target volumes may potentially allow escalation of RT dose beyond conventional limits potential clinical benefits in tumor control rates, which needs to be tested in future studies.
Primary intracranial malignant fibrous histiocytoma is a very rare condition. It usually presents... more Primary intracranial malignant fibrous histiocytoma is a very rare condition. It usually presents as a meningeal mass but may occurs intraaxially, as well. We present computed tomography and magnetic resonance imaging findings of an intracerebral malignant fibrous histiocytoma in a 75-year-old woman with histopathological and clinical information.
Purpose To compare the protective effects of the potent antioxidants, melatonin and octreotide, a... more Purpose To compare the protective effects of the potent antioxidants, melatonin and octreotide, against radiation-induced intestinal injury. Methods A total of 42 male 3-month-old Swiss albino mice (40 ± 10 g) were matched according to body weight and randomly assigned to one of six groups: control; radiation treatment (RT) only; melatonin only (15 mg/kg, i.p.); melatonin + RT; octreotide only (50 μg/kg i.p.); and octreotide + RT. Intestinal damage was induced by exposure to a single whole-body radiation dose of 8 Gy. All mice tolerated the experimental interventions, and no deaths were observed. Results Irradiation induced architectural disorganization, including inflammatory mononuclear cell infiltration, villitis, and desquamation with eosinophilic necrosis, and diminished mucosal thickness, crypt height, and villous height. In the melatonin + RT and octreotide + RT groups, the villous pattern was well preserved; desquamation at villous tips and edema was prominent, but necrosis was absent. The radiation-induced decrease in mucosal thickness was significantly reduced by pretreatment with melatonin (p < 0.001) or octreotide (p = 0.01), although the protective effect was significantly greater for melatonin (p = 0.04). Pretreatment with melatonin also preserved villous height (p = 0.009) and crypt height (p = 0.03); although a similar trend was observed for pre-irradiation octreotide, the differences were not significant. Conclusions Melatonin and octreotide potently protected against radiation-induced intestinal injury in mice, but melatonin was significantly more effective in preserving the histological structure of the intestines, a finding that warrants confirmation in clinical studies.
Journal of Experimental & Clinical Cancer Research, 2008
Background Prophylactic cranial irradiation (PCI) has been demonstrated to reduce or delay the in... more Background Prophylactic cranial irradiation (PCI) has been demonstrated to reduce or delay the incidence of brain metastases (BM) in locally advanced non-small cell lung carcinoma (LA-NSCLC) patients with various prognostic groups. With this current cohort we planned to evaluate the potential usefulness of prophylactic cranial irradiation (PCI) specifically in recursive partitioning analysis (RPA) Group 1, which is the most favorable group of LA-NSCLC patients. Methods Between March 2007 and February 2008, 62 patients in RPA group 1 were treated with sequential chemoradiotherapy and PCI for stage IIIB NSCLC. The induction chemotherapy consisted of 3 courses of cisplatin (80 mg/m2) and docetaxel (80 mg/m2); each course was given every 21 days. Thoracic radiotherapy (TRT) was given at a dose of 60 Gy using 3-D conformal planning. All patients received a total dose of 30 Gy PCI (2 Gy/fr, 5 days a week), beginning on the first day of the TRT. Then, all patients received 3 further courses of the same chemotherapy protocol. Results Six (9.7%) patients developed brain metastases during their clinical course. Only one (2%) patient developed brain metastasis as the site of first treatment failure. Median brain metastasis-free survival, overall survival, and progression free survival were 16.6, 16.7, and 13.0 months, respectively. By univariate analysis, rates of BM were significantly higher in patients younger than 60 years of age (p = 0.03). Multivariate analysis showed no significant difference in BM-free survival according to gender, age, histology, and initial T- and N-stage. Conclusion The current finding of almost equal bone metastasis free survival and overall survival in patients with LA-NSCLC in RPA group 1 suggests a longer survival for patients who receive PCI, and thereby have a reduced risk of BM.
Ras oncogenes are found in 25% of human tumors and they significantly affect prognosis. One of th... more Ras oncogenes are found in 25% of human tumors and they significantly affect prognosis. One of the major fields studied to improve anticancer drugs is blockade of the oncogenic ras protein function. One of the mechanisms to block the function of these proteins is to block farnesylation using a farnesyl transferase inhibitor (FTI) and thus to prevent the ras from anchoring to the cell membrane. In this study, we investigated the effects of FTI L-744,832 either alone or in combination with 5-fluorouracil (5-FU; 1 microM/l) and radiotherapy (2, 6, and 10 Gy) on the colon cancer cell line DLD-1 with mutations in K-, N- and H-ras, c-myb, c-myc, p53, fos, sis and DNA repair genes. Drugs were added 3 h after cultivation. Radiotherapy was performed on the 3rd day of the study. On the 3rd day, medium and drugs were changed. Evaluations were performed on the 6th day. Administration of L-744,832, neither alone nor its combination with 5-FU and radiation, affected the number of DLD-1 cells and apoptosis rates. Regarding its effects on the cell cycle, L-744,832 was shown to lead to G(0)/G(1) and G(2)/M accumulation in a dose-dependent manner when administered alone. However, in combination with 5-FU, only a G(0)/G(1) accumulation was observed. Our study showed that FTI L-744,832 does not effect the cell number and apoptosis rate of DLD-1 cells and it cannot overcome 5-FU and radiation resistance, although it is able to modify some phases of the cell cycle.
_________________________________________________________________________________________________... more _____________________________________________________________________________________________________ ÖZET Amaç: Genç erkek hastaları etkileyen ve iyi prognoza sahip olan testis kanserli hastaların sayısı giderek artmaktadır. Bu çalışmada testis kanseri tanısı konmuş, remisyonda izlenen Evre I seminom olgularında anksiyete ve depresyon düzeylerini, yaşam kalitesini, cinsel işlevleri değerlendirmek ve sağlıklı kontrol grubu ile karşılaştırmak amaçlanmıştır. Yöntem: Örneklem Karadeniz Teknik Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi'nde izlenmekte olan tümü tek taraflı orşiektomili Evre I remisyonda 15 seminom hastasından oluşmaktadır. Tüm hastalar tek taraflı orşiektomili Evre I seminomdur. Çalışma grubu yaş, eğitim düzeyi, medeni durum ve çalışma durumları bakımından eşleştirilmiş eşit sayıda kontrol grubu ile sosyodemografik veriler ve BAÖ, BDÖ, GRCDÖ, EORTC QLQ-C30 versiyon 3.0 ölçeklerini içeren klinik ölçeklerle karşılaştırılmıştır. Çalışma olgu kontrol çalışması olarak düzenlenmiştir. Sonuçlar: Evre I testis kanseri nedeni ile aynı protokole göre radyoterapi ve cerrahi tedaviler uygulanmış, ortalama remisyon süreleri 25.6±19.5 ay olan bir grup hasta (s=15) kontrol grubu ile karşılaştırılmıştır. Klinik değerlendirmede cinsel işlev, yaşam kalitesi, depresyon ve anksiyete düzeylerinde örneklem grubu ile kontrol grubu açısından istatistiksel fark bulunmamıştır. Tartışma: Standart tedavi sonrası remisyona giren Evre I seminom hastalarının yaşam kalitesi, cinsel işlevler açısından sağlıklı kontrollerle arasında fark bulunmaması, örneklemin erken evre remisyonda seminom hastalarında oluşmasına ve örneklemin küçüklüğüne bağlanabilir. Bu sonuçlar ileriki çalışmalar için öngörücü olabilir. (Anadolu Psikiyatri Dergisi 2009; 10:233-238) Anahtar sözcükler: Testis kanseri, cinsellik, yaşam kalitesi Sexual satisfaction and quality of life in cured testicular cancer ABSRACT Objective: The testicular cancer affecting young male has good prognosis, so led to increasing number of cancer survivors. Thus, the aim of this study is to assess level of depression and anxiety symptoms, quality of life, sexual function in cured stage I seminoma patients and to compare them with healthy controls. Methods: The sample consists of 15 cured testicular cancer patients of whom followed in Radiation Oncology Department in Karadeniz Technical University, Medical School Hospital. All patients are stage I seminoma with unilateral orchiectomy. The patient group was compared in means of sociodemographic data and clinical assessment measures including BAS, BDS, GRISS, EORTC QLQ-C30 version 3.0 with the control group matched in age, level of educational, marital status and occupation. The study was designed as case control study. Results: The patients (n=15) with average remission length of 25±19.5 months who completed radiotherapy and surgical therapy with respect to same protocol for stage I testicular cancer were compared with control group matched in age, level of education-_____________________________________________________________________________________________________ * 42. Ulusal Psikiyatri Kongresi'nde poster bildiri olarak sunulmuştur.
Background: Leptin is a peptide hormone that has a role in the regulation of body weight and has ... more Background: Leptin is a peptide hormone that has a role in the regulation of body weight and has effects on metabolic, neuroendocrine, reproductive and hematopoietic systems. Breast cancer has also been associated with obesity and reproductive hormones, especially estradiol. Only a few studies have investigated the relation between plasma leptin and risk of breast cancer and only one study evaluated the effect of tamoxifen on leptin levels in patients with breast cancer. Methods: We investigated serum leptin levels in gender-, body mass index (BMI)-and agematched breast cancer patients and healthy individuals (58 of each). Results: Serum leptin levels were measured by radioimmunoassay (Human Leptin RIA Kit). Serum leptin levels in the breast cancer patients were significantly higher than those in the control group (27.00 versus 17.65 ng/ml, p = 0.019). There were no differences with respect to BMI and age between control and breast cancer patients. There were no significant differences in BMI and leptin levels between pre-and postmenopausal patients (27.00 ± 1.39 and 27.19 ± 0.81 kg/m 2 , 26.81 ± 6.25 and 27.06 ± 2.98 ng/ml) (p > 0.05). We found no difference in serum leptin level between early and late stages of patients (22.38 versus 31.30 ng/ml, p = 0.086). However, the serum leptin level in patients using tamoxifen was significantly higher than that of patients not using tamoxifen (32.71 and 19.39 ng/ml, respectively p = 0.009). There was no correlation between CA 15-3 and leptin level (r = 0.069, p = 0.610). Conclusion: High serum leptin levels seen in breast cancer patients are not related to stage of the disease or to cancer itself but may be associated with the use of tamoxifen.
Male breast cancer, consisting only 1% of all breast cancers, is occasionally associated with oth... more Male breast cancer, consisting only 1% of all breast cancers, is occasionally associated with other primary malignancies, especially in patients with familial breast cancer history. Sporadic male breast cancers with another primary tumor are extremely rare. We report a 67-year-old male with asynchronous bilateral breast cancer and prostate cancer without familial breast cancer history.
Journal of Experimental & Clinical Cancer Research, 2008
To compare computed tomography (CT) with co-registered positron emission tomography-computed tomo... more To compare computed tomography (CT) with co-registered positron emission tomography-computed tomography (PET-CT) as the basis for delineating gross tumor volume (GTV) in unresectable, locally advanced pancreatic carcinoma (LAPC).
To evaluate the impact of four different rectum contouring techniques and rectal toxicities in pa... more To evaluate the impact of four different rectum contouring techniques and rectal toxicities in patients with treated with 3D conformal radiotherapy (3DCRT).
Background: The purpose of this study was to evaluate the efficacy of oral glutamine in the preve... more Background: The purpose of this study was to evaluate the efficacy of oral glutamine in the prevention of acute radiation-induced esophagitis (ARIE) and weight loss in lung carcinoma patients, and to determine the clinical/dosimetric predictors of ARIE. Patients and methods: Data from 41 patients with stage III lung carcinoma treated with thoracic irradiation were retrospectively analyzed. Twenty-two patients (53.6%) received prophylactic powdered glutamine in doses of 10 g/8 h. Prescribed radiation dose to planning target volume was 60 Gy, in 30 fractions, 5 days/week. The primary endpoint included the ARIE incidence and its correlation with clinical/dosimetric factors relative to treatment with glutamine. Results: Glutamine was well tolerated. Grade 2 or 3 ARIE occurred in 20 (48.8%) of 41 patients: seven in the glutamine-supplemented group, and 13 in the glutamine-free group (p = 0.002). All seven patients with grade 3 esophagitis were in the glutamine-free group (36.8% vs. 0%). Glutamine supplementation appeared to significantly delay ARIE onset for six days (22 days vs. 16 days; p = 0.002). Glutamine-supplemented patients demonstrated a lower incidence of grade 2 or 3 ARIE (27.2%), and gained weight during radiotherapy (p = 0.04). V55 was the only dosimetric parameter that correlated with the severity of ARIE in glutamine-free patients: a V55 of <35% had a 31% risk of ARIE grade 2 or 3, and the risk increased to 76% with a V55 of ≥35% (p = 0.01). Conclusion: This schedule and dosage of glutamine may be beneficial in the prevention of ARIE and weight loss in lung cancer patients undergoing thoracic irradiation.
International Journal of Radiation Oncology Biology Physics, 2003
Purpose: A growing body of evidence supports the efficacy of accelerated superfractionated radiot... more Purpose: A growing body of evidence supports the efficacy of accelerated superfractionated radiotherapy with concomitant boost for advanced head-and-neck carcinomas. This study represents a single-institution experience, performed to identify the factors influencing tumor control, survival, and toxicity. Methods and Materials: Between 1988 and 1999, 133 patients with primary squamous cell head-and-neck carcinoma underwent accelerated superfractionated radiotherapy using a concomitant boost. The concomitant boost in this regimen was delivered using reduced fields delivered 3 times weekly in a twice-daily schedule during the final phase. The total radiation dose ranged from 64.8 Gy to 76.5 Gy (mean 71.1). Patients were evaluated in follow-up for local control and late toxicity. Multivariate analysis of treatment and patient parameters was performed to evaluate their influence on toxicity, local control, and overall survival. Results: With a mean follow-up of 37 months, the actuarial overall survival rate for the entire group at 5 years was 24% and the local control rate was 57%. The tumor volume was the most significant predictor of local control, such that each 1-cm 3 increase in volume was associated with a 1% decrease in local control. For patients with tumor volumes <30 cm 3 vs. >30 cm 3 , the 5-year disease-specific survival rate was 52% and 27% (p ؍ 0.004) and locoregional control rate was 76% and 26% (p <0.001), respectively. Seventy-six patients with a minimum of 12 months and median of 39 months toxicity follow-up were studied for late effects. None of these patients experienced Grade 4 or 5 toxicity. The actuarial rate of significant toxicity (Grade III or greater) was 32% at 5 years. Of the toxicities observed, xerostomia (19%) was the most common. Multivariate analysis revealed N stage and dose as independent predictors of Grade 3 effects. Conclusion: The locoregional control and survival for patients in this institutional experience compare favorably to other published reports. Tumors of the larynx had the best prognosis. Larger volume tumors were associated with significantly lower local control and survival. Significant late effects were related to dose and nodal status.
Journal of Experimental & Clinical Cancer Research, 2009
To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer, based on eith... more To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer, based on either orthogonal radiographs (conventional plan) or CT sections (CT plan); the comparison focused on target volume coverage and dose volume analysis of organs at risk (OARs), by representing point doses defined by the International Commission on Radiation Units and Measurement (ICRU) and dose volume histograms (DVHs) from 3D planning.
We compared the effects of amifostine and melatonin in preventing radiation-induced epiphyseal gr... more We compared the effects of amifostine and melatonin in preventing radiation-induced epiphyseal growth plate injury in rats. Four-week-old (65-85 g), growing male Sprague-Dawley rats were randomly assigned to receive radiation alone, at 25 Gy in three fractions (group R), or this dose of fractionated radiation proceeded by prophylactic amifostine 200 mg/kg i.p. (group A), melatonin 15 mg/kg i.p. (group M), or amifostine + melatonin (group AM). The right rear extremity of each animal was irradiated while the contralateral leg was shielded from radiation, as a control. Bone growth based on the length of the tibia, femur, and overall limb was calculated 6 weeks after the treatment. In groups R, A, M, and AM, the mean growth loss (GL) for the overall limb was 56.9 +/- 8.1%, 46.8 +/- 7.7%, 36.6 +/- 4.3%, and 38.5 +/- 5.1%, respectively. The limb length discrepancies (LLD) in groups R, A, M, and AM were 13.8 +/- 1.4%, 10.5 +/- 0.3%, 7.4 +/- 0.7%, and 8.8 +/- 1.1%, respectively. Differences in LLD were significant between each treatment group and group R (range: p = 0.0001-0.001). Differences in either of mean GL and LLD were not significant between groups M and AM; however both of these groups had significantly less GL and LLD than group A. We observed a superior radioprotective function of melatonin over amifostine in preventing radiation-induced epiphyseal growth plate injury, without any increase in radioprotective effect by adding amifostine to melatonin.
Background When combined with adequate tumoricidal doses, accurate target volume delineation rema... more Background When combined with adequate tumoricidal doses, accurate target volume delineation remains to be the one of the most important predictive factors for radiotherapy (RT) success in locally advanced or medically inoperable malignant pleural mesothelioma (MPM) patients. Recently, 18-fluorodeoxyglucose positron emission tomography (PET) has demonstrated significant improvements in diagnosis and accurate staging of MPM. However, role of additional PET data has not been studied in RT planning (RTP) of patients with inoperable MPM or in those who refuse surgery. Therefore, we planned to compare CT with co-registered PET-CT as the basis for delineating target volumes in these patients group. Methods Retrospectively, the CT and co-registered PET-CT data of 13 patients with histologically proven MPM were utilized to delineate target volumes separately. For each patient, target volumes (gross tumor volume [GTV], clinical target volume [CTV], and planning target volume [PTV]) were defined using the CT and PET-CT fusion data sets. The PTV was measured in two ways: PTV1 was CTV plus a 1-cm margin, and PTV2 was GTV plus a 1-cm margin. We analyzed differences in target volumes. Results In 12 of 13 patients, compared to CT-based delineation, PET-CT-based delineation resulted in a statistically significant decrease in the mean GTV, CTV, PTV1, and PTV2. In these 12 patients, mean GTV decreased by 47.1% ± 28.4%, mean CTV decreased by 38.7% ± 24.7%, mean PTV1 decreased by 31.1% ± 23.1%, and mean PTV2 decreased by 40.0% ± 24.0%. In 4 of 13 patients, hilar lymph nodes were identified by PET-CT that was not identified by CT alone, changing the nodal status of tumor staging in those patients. Conclusion This study demonstrated the usefulness of PET-CT-based target volume delineation in patients with MPM. Co-registration of PET and CT information reduces the likelihood of geographic misses, and additionally, significant reductions observed in target volumes may potentially allow escalation of RT dose beyond conventional limits potential clinical benefits in tumor control rates, which needs to be tested in future studies.
Primary intracranial malignant fibrous histiocytoma is a very rare condition. It usually presents... more Primary intracranial malignant fibrous histiocytoma is a very rare condition. It usually presents as a meningeal mass but may occurs intraaxially, as well. We present computed tomography and magnetic resonance imaging findings of an intracerebral malignant fibrous histiocytoma in a 75-year-old woman with histopathological and clinical information.
Purpose To compare the protective effects of the potent antioxidants, melatonin and octreotide, a... more Purpose To compare the protective effects of the potent antioxidants, melatonin and octreotide, against radiation-induced intestinal injury. Methods A total of 42 male 3-month-old Swiss albino mice (40 ± 10 g) were matched according to body weight and randomly assigned to one of six groups: control; radiation treatment (RT) only; melatonin only (15 mg/kg, i.p.); melatonin + RT; octreotide only (50 μg/kg i.p.); and octreotide + RT. Intestinal damage was induced by exposure to a single whole-body radiation dose of 8 Gy. All mice tolerated the experimental interventions, and no deaths were observed. Results Irradiation induced architectural disorganization, including inflammatory mononuclear cell infiltration, villitis, and desquamation with eosinophilic necrosis, and diminished mucosal thickness, crypt height, and villous height. In the melatonin + RT and octreotide + RT groups, the villous pattern was well preserved; desquamation at villous tips and edema was prominent, but necrosis was absent. The radiation-induced decrease in mucosal thickness was significantly reduced by pretreatment with melatonin (p < 0.001) or octreotide (p = 0.01), although the protective effect was significantly greater for melatonin (p = 0.04). Pretreatment with melatonin also preserved villous height (p = 0.009) and crypt height (p = 0.03); although a similar trend was observed for pre-irradiation octreotide, the differences were not significant. Conclusions Melatonin and octreotide potently protected against radiation-induced intestinal injury in mice, but melatonin was significantly more effective in preserving the histological structure of the intestines, a finding that warrants confirmation in clinical studies.
Journal of Experimental & Clinical Cancer Research, 2008
Background Prophylactic cranial irradiation (PCI) has been demonstrated to reduce or delay the in... more Background Prophylactic cranial irradiation (PCI) has been demonstrated to reduce or delay the incidence of brain metastases (BM) in locally advanced non-small cell lung carcinoma (LA-NSCLC) patients with various prognostic groups. With this current cohort we planned to evaluate the potential usefulness of prophylactic cranial irradiation (PCI) specifically in recursive partitioning analysis (RPA) Group 1, which is the most favorable group of LA-NSCLC patients. Methods Between March 2007 and February 2008, 62 patients in RPA group 1 were treated with sequential chemoradiotherapy and PCI for stage IIIB NSCLC. The induction chemotherapy consisted of 3 courses of cisplatin (80 mg/m2) and docetaxel (80 mg/m2); each course was given every 21 days. Thoracic radiotherapy (TRT) was given at a dose of 60 Gy using 3-D conformal planning. All patients received a total dose of 30 Gy PCI (2 Gy/fr, 5 days a week), beginning on the first day of the TRT. Then, all patients received 3 further courses of the same chemotherapy protocol. Results Six (9.7%) patients developed brain metastases during their clinical course. Only one (2%) patient developed brain metastasis as the site of first treatment failure. Median brain metastasis-free survival, overall survival, and progression free survival were 16.6, 16.7, and 13.0 months, respectively. By univariate analysis, rates of BM were significantly higher in patients younger than 60 years of age (p = 0.03). Multivariate analysis showed no significant difference in BM-free survival according to gender, age, histology, and initial T- and N-stage. Conclusion The current finding of almost equal bone metastasis free survival and overall survival in patients with LA-NSCLC in RPA group 1 suggests a longer survival for patients who receive PCI, and thereby have a reduced risk of BM.
Ras oncogenes are found in 25% of human tumors and they significantly affect prognosis. One of th... more Ras oncogenes are found in 25% of human tumors and they significantly affect prognosis. One of the major fields studied to improve anticancer drugs is blockade of the oncogenic ras protein function. One of the mechanisms to block the function of these proteins is to block farnesylation using a farnesyl transferase inhibitor (FTI) and thus to prevent the ras from anchoring to the cell membrane. In this study, we investigated the effects of FTI L-744,832 either alone or in combination with 5-fluorouracil (5-FU; 1 microM/l) and radiotherapy (2, 6, and 10 Gy) on the colon cancer cell line DLD-1 with mutations in K-, N- and H-ras, c-myb, c-myc, p53, fos, sis and DNA repair genes. Drugs were added 3 h after cultivation. Radiotherapy was performed on the 3rd day of the study. On the 3rd day, medium and drugs were changed. Evaluations were performed on the 6th day. Administration of L-744,832, neither alone nor its combination with 5-FU and radiation, affected the number of DLD-1 cells and apoptosis rates. Regarding its effects on the cell cycle, L-744,832 was shown to lead to G(0)/G(1) and G(2)/M accumulation in a dose-dependent manner when administered alone. However, in combination with 5-FU, only a G(0)/G(1) accumulation was observed. Our study showed that FTI L-744,832 does not effect the cell number and apoptosis rate of DLD-1 cells and it cannot overcome 5-FU and radiation resistance, although it is able to modify some phases of the cell cycle.
Uploads
Papers by ali yavuz