Türk Ortopedi ve Travmatoloji Birliği Derneği arasında zirve yapar. Genellikle ekstremitelerin uz... more Türk Ortopedi ve Travmatoloji Birliği Derneği arasında zirve yapar. Genellikle ekstremitelerin uzun kemiklerinin metafizyel bölgesinde görülür ve gittikçe azalan sıra ile, distal femur, proksimal tibia, proksimalorta femur ve proksimal humerustan gelişir. Daha nadir olarak da, vücudun diğer kemiklerinden, örneğin pelvisten gelişebilir. [2]
INTRODUCTION: The current study was done by means of clinical and radiological evaluations of ves... more INTRODUCTION: The current study was done by means of clinical and radiological evaluations of vestibular schwannoma patients who treated with stereotactic radiosurgery or stereotactic radiotherapy using Cyberknife® (Accuray, Sunnywhale, USA). MATERIAL and METHODS: Between June 2009 and September 2014,30 vestibular schwannoma patients were treated in Dr. AY. Ankara Oncology Training and Research Hospital, Department of Radiation Oncology. The patients were assessed before and after radiotherapy retrospectively, for hearing capacity (via GardnerRobertsonScale), motor function of cranial nerve 7. (via House-Brackmannscale),the sensorial function of cranial nerve 5. RESULTS: Local control was defined as radiologically stable or regressive disease and achieved for all of the patients at the last control (%100). Preradiotherapy mean values of GRS and HB scores were both statistically different from post radiotherapy mean values (p=0,042 and p=0,046, respectively). Trigeminal toxicity was ...
The role of induction chemotherapy (ICT) for head and neck squamous cell carcinoma (HNSCC) is con... more The role of induction chemotherapy (ICT) for head and neck squamous cell carcinoma (HNSCC) is controversial. The aim of the study was to assess the benefit of ICT with docetaxel, cisplatin and 5-fluorouracil (5-FU) (TPF) when combined with concurrent cisplatin chemoradiotherapy (CRT) for HNSCC. Patients with HNSCC treated between January 2005 and December 2010 with radical intent with either TPF or cisplatin and 5-FU (PF) ICT and documented intention to proceed with concurrent cisplatin CRT were identified retrospectively. The use and choice of ICT regimen was at the clinician's discretion. In total, 68 patients treated with TPF were identified and were matched for T and N stage and tumour site to 68 patients treated with PF. A survival analysis was carried out using Kaplan-Meier and the Cox proportional hazards model. The median follow-up was 29.9 versus 36.3 months for the TPF and PF groups, respectively. Three year locoregional relapse-free survival (RFS), distant RFS, RFS, cancer-specific survival and overall survival rates for the TPF and PF groups were 84.2, 91.6, 82.6, 81.3 and 74.9% versus 73.7, 84.9, 71.9, 72.1 and 62.9%, respectively. On multivariate analysis, treatment with TPF predicted for improved locoregional RFS (P = 0.03) and overall survival (P = 0.05). The addition of docetaxel to a cisplatin doublet ICT regimen before concurrent CRT may improve disease control for locally advanced HNSCC.
Objectives: The optimal management of the N3 neck in head and neck squamous cell carcinoma (HNSCC... more Objectives: The optimal management of the N3 neck in head and neck squamous cell carcinoma (HNSCC) remains controversial. We report the outcomes of patients with N3 disease treated with a strategy of concurrent chemo-radiotherapy (CRT) ± induction chemotherapy (ICT) without a planned neck dissection. Materials and methods: Forty patients with HNSCC N3 disease treated between January 2004 and December 2010 were retrospectively identified. Inclusion criteria for the study were: non-nasopharyngeal HNSCC, N3 nodal disease, intention to treat with CRT ± ICT. Results: Median age was 60 (range 39-74). Median follow up was 32 months (range 8-88). 34 (85%) of patients received ICT. 35 patients received cisplatin-CRT, 4 carboplatin-CRT and 1 patient was treated with radiotherapy alone due to ICT toxicity. 27 (67.5%) patients had a complete response (CR) to CRT. 5 (12.5%) patients had an incomplete response in both the primary and nodal sites. 8 (20%) patients had a CR in the primary site but incomplete in the nodal regions. The crude rate of regional failure following a CR was 3/27 (11.2%). Isolated regional failure occurred in 1/27 (3.7%) patients who had achieved a CR post-CRT. 3 year overall survival, disease free survival, locoregional control, local control and regional control in the whole cohort were 51.4%, 49.6%, 65.7%, 77.3%, 69.3%, and in patients with a CR were 73.3%, 70.0%, 86.6%, 90.5% and 91.7% respectively. Conclusion: Isolated regional nodal failure is rare following a complete response to CRT for N3 HNSCC managed without a planned neck dissection.
PURPOSE: Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided b... more PURPOSE: Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided breast irradiation. The purpose of this study is to evaluate the reproducibility and variability of breath-hold level (BHL) using breath-hold curves and lateral kV setup images together. MATERIAL/METHOD: A retrospective analysis of 30 left breast cancer patients treated using the v-DIBH technique in our department is performed. The BHL difference is measured from breath hold curves and lateral (LAT) kilo-Voltage (kV) setup images. The planning CT image and the selected treatment fraction data are collected. If the changes in BHL relate to the displacement of various bones in the kV setup, images are assessed. Furthermore, the maximum heart distance inside the treatment field is compared from LAT MV portal images. RESULTS: The median and mean values of the BHL are nearly identical in different fractions (good reproducibility). However, the mean BHL values between planning and all measured ...
Fanconi anemia (FA) is a disease that could be accompanied by multiple abnormalities, such as gro... more Fanconi anemia (FA) is a disease that could be accompanied by multiple abnormalities, such as growth retardation, bone marrow abnormalities, and cancer susceptibility. Among the FA patients, head and neck squamous cell cancer (HNSCC) is the most observed solid cancer. The life expectancy of patients with FA has increased with recent medical advances. Furthermore, HNSCC is diagnosed in 3% of FA patients, and half of these patients die because of their HNSCC. The median age of HNSCC patients with FA is 31, and according to the literature HNSCC incidence of FA, patients is more than 700-fold of the normal population. Here, we reported the treatment details and challenges we faced during hypopharyngeal cancer treatment in a FA patient.
Aim: To evaluate retrospectively clinical outcomes of treated with stereotactic ablative radiothe... more Aim: To evaluate retrospectively clinical outcomes of treated with stereotactic ablative radiotherapy (SABR) using the CyberKnife® (Accuray, Sunnyvale, CA, USA), for early primary and oligometastatic lung tumors. Methods: This descriptive study included thirty tumors from 29 patients with primary lung cancer (n=21) or oligometastatic lung tumors (n=9), who underwent SABR with robotic linear accelerator between March 2011 and July2015. Out of the 30 tumors, 21 were NSCLC, 9 were metastatic lung disease. Treatment was given using different tracking methods including fiducial tracking with Synchrony (21 patients), Xsight lung with Synchrony (4 patients) and Xsight spine (5 patients). Treatment was delivered two to three fractions per week and with different fractionations depending on location and other tumor related factors. Factors, potentially effective on local control and overall survival were investigated. Results: Median follow-up time for local control was 11 months (2.4-39 months). Of 25 patients with known follow-up data, local control (LC) rates for 1, 2 and 3 years were 82.8%, 82.8% and 55.2 %, respectively. Overall survival (OS) rates for primary lung tumor patients 1, 2 and 3 years were 72.2%, 64.2%, 51.4% and metastatic lung tumor patients for 1 year was 71%, respectively. Except for gender, none of the factors were statistically significantly associated with local control in univariate analysis; female gender was associated with worse local control (p=0.001). Also in univariate analysis of overall survival, there was a trend for worse survival in females, too (p=0.07). Conclusion: This small study may give some idea about utilizing different tracking ways for CyberKnife® with less toxicity.
Methods: From 2005 to 2008, nine patients (7 women and 2 men), mean age 52.3±12.6 years, with RPS... more Methods: From 2005 to 2008, nine patients (7 women and 2 men), mean age 52.3±12.6 years, with RPS were treated with pre-operative IMRT. Toxicities, loco-regional control, and survival free disease were analyzed. Toxicity was assessed according to the RTOG acute toxicity scale. Results: Four patients (44%) had de novo RPS, and five patients (56%) had recurrent RPS after prior surgical resection. The median follow up was 26 (range: 3−39) months after radiotherapy. Median radiation dose was 50 at 2 Gy/fraction. Surgical resection after radiotherapy was performed in eight patients. In one patient, tumor progressed during treatment and was unresectable. Only minor toxicities were reported with grade 1 nausea in seven patients (77%) and vomiting in two patients (22%), during radiotherapy. No other toxicities or treatment related deaths were reported. Early and delayed postoperative complications included 1 abscess and 1 duodenal stenosis in two patients. At median follow up of 26 months, four patients (44%) were disease free. Five patients (56%) had disease progression, including tumor progression during radiotherapy (2 pts, 22%), local recurrence after surgery (2 pts, 22%), and/or distant metastasis resulting in death (2 pts, 22%). Four (80%) of the five patients with recurrent RPS after prior surgical resection, had disease progression. Conclusion: Local control of de novo RPS is achievable with pre-operative IMRT with minimal toxicities. Henceforward, low toxicities with IMRT could allow dose escalation to improve outcomes in RPS patients. 9424 POSTER Radiotherapy results of 131 patients with soft tissue sarcoma
Turkiye Klinikleri Journal of Medical Sciences, 2013
B rain metastases are the most common intracranial neoplasms and affect 20-40% of all cancer pati... more B rain metastases are the most common intracranial neoplasms and affect 20-40% of all cancer patients. 1,2 However, brainstem metastases are uncommon, comprising approximately 5-7% of intracra-Cyberknife ® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The objective of this small retrospective study is to report imaging and clinical outcomes of the patients with metastatic brain tumors in or adjacent (≤5 mm) to brainstem. The patients underwent both whole-brain radiotherapy (WBRT) and CyberKnife ® fractionated stereotactic radiotherapy (FSRT)/or stereotactic radiosurgery (SRS). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Twenty-one patients with single or multiple brain metastases located in or adjacent to brainstem underwent FSRT/SRS between
International Journal of Radiation Oncology*Biology*Physics, 2013
The aim of this study was to compare the dosimetry and treatment time between tomotherapy (Tomo) ... more The aim of this study was to compare the dosimetry and treatment time between tomotherapy (Tomo) and volumetric-modulated arc therapy (VMAT) for radiosurgery (RS) of multiple intracranial lesions. Materials/Methods: Eleven patients with multiple intracranial lesions (ranged from 2 to 5 lesions) previously treated with Tomo RS were replanned with VMAT technique. Similar plan acceptance criteria of Tomo RS plans were applied to VMAT plans. The dosimetric index used to assess target conformity was conformity number (CN). CN was defined as, CN Z (V T,pi /V T) x (V T,pi /V pi), where V T,pi is the volume of planning target volume (PTV) enclosed by prescribed isodose surface, V T is the volume of PTV, V pi is the volume enclosed by prescribed isodose surface. Homogeneity index (HI, D 5-D 95) was used to evaluate dose homogeneity. HI was the difference between the dose received by the 5% and 95% volume of the PTV. As for organ at risk assessment, the percentage volume of non-target brain tissue receiving 12 Gy (V 12) was recorded. Treatment time was based on actual beam-on time. The data was further analyzed statistically. Results: Dose conformity was generally improved using VMAT. The mean CN for VMAT and Tomo were 0.72 AE 0.13 and 0.56 AE 0.19, (p Z 0.001) respectively. As for dose homogeneity, Tomo plans were better. HI for VMAT and Tomo were 6.14 AE 1.51 and 4.94 AE 1.63 (p Z 0.0029), respectively. V 12 non-target brain tissue for VMAT and Tomo were 1.95 AE1.63 and 4.30 AE 3.64 (p Z 0.001), respectively. Mean treatment time was significantly reduced for VMAT (9.5 minutes). Conclusions: The results suggest that VMAT not only achieved better dose conformity for RS but also significantly reduced the treatment time, whereas Tomo achieved better dose homogeneity. VMAT plans yielded lower V 12 to the normal brain tissues. It might imply that the possibility of late complications of the brain would be lowers in VMAT plans. However, further studies are needed. With these advantages, VMAT could be an efficient modality in the delivery of RS to multiple intracranial lesions.
International Journal of Radiation Oncology*Biology*Physics, 2009
Purpose: Locally recurrent non-small cell lung cancer (LR-NSCLC) remains challenging to treat, pa... more Purpose: Locally recurrent non-small cell lung cancer (LR-NSCLC) remains challenging to treat, particularly in patients having received prior radiotherapy. Heterogeneous populations and varied treatment intent in existing literature result in significant limitations in evaluating efficacy of lung re-irradiation. In order to better establish the impact of re-irradiation in patients with LR-NSCLC following high-dose radiotherapy, we report outcomes for patients treated with prior sublobar resection and brachytherapy that subsequently underwent stereotactic body radiotherapy (SBRT). Methods: A retrospective review of patients initially treated with sublobar resection and I 125 vicryl mesh brachytherapy, who later developed LR-NSCLC along the suture line, was performed. Patients received salvage SBRT with curative intent. Dose and fractionation were based on tumor location and size, with a median prescription dose of 48 Gy in 4 fractions (range 20-60 Gy in 1-4 fractions). Results: Thirteen consecutive patients were identified with median follow-up of 2.1 years (range 0.7-5.6 years). Two in-field local failures occurred at 7.5 and 11.1 months, resulting in 2-year local control of 83.9% (95% CI, 63.5-100.0%). Two-year disease-free survival and overall survival estimates were 38.5% (95% CI, 0.0-65.0%) and 65.8% (95% CI, 38.2-93.4%). Four patients (31%) remained disease-free at last follow-up. All but one patient who experienced disease recurrence developed isolated or synchronous distant metastases. Only one patient (7.7%) developed grade ≥3 toxicity, consisting of grade 3 esophageal stricture following a centrally located recurrence previously treated with radiofrequency ablation. Conclusion: Despite high-local radiation doses delivered to lung parenchyma previously with I 125 brachytherapy, re-irradiation with SBRT for LR-NSCLC results in excellent local control with limited morbidity, allowing for potential disease cure in a subset of patients.
Nazofarenks kanserli hastalarda geç yan etki olarak ortaya çkan ... Factors related with develop... more Nazofarenks kanserli hastalarda geç yan etki olarak ortaya çkan ... Factors related with development of treatment induced trismus in nasopharyngeal cancer patients ... Enis ÖZYAR, Ebru KARAKAYA, Ferah YILDIZ, . Lale ATAHAN ... letiflim (Correspondence): Dr. Enis Özyar. ...
OBJECTIVES: Our objective is to analyse the rate of trismus induced after treatment for nonmetast... more OBJECTIVES: Our objective is to analyse the rate of trismus induced after treatment for nonmetastatic nasopharyngeal cancer patients and to assess the factors on development of it. METHODS: The files of 292 patients with more than two years follow-up between ...
Background: The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) c... more Background: The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) combined with streotactic radiosurgery versus stereotactic radiosurgery (SRS) alone for patients with brain metastases. Materials and Methods: This was a retrospective study that evaluated the results of 46 patients treated for brain metastases at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiation Oncology Department, between January 2012 and January 2015. Twenty-four patients were treated with WBRT+SRS while 22 patients were treated with only SRS. Results: Time to local recurrence was 9.7 months in the WBRT+SRS arm and 8.3 months in SRS arm, the difference not being statistically significant (p= 0.7). Local recurrence rate was higher in the SRS alone arm but again without significance (p=0,06). Conclusions: In selected patient group with limited number (one to four) of brain metastases SRS alone can be considered as a treatment option and WBRT may be omitted in the initial treatment.
Bu çalışmada amaç CyberKnife stereotaktik radyocerrahi-radyoterapi uygulanan vestibuler schwannom... more Bu çalışmada amaç CyberKnife stereotaktik radyocerrahi-radyoterapi uygulanan vestibuler schwannom hastalarının klinik, radyolojik ve toksisite verilerinin sunulmasıdır.
Türk Ortopedi ve Travmatoloji Birliği Derneği arasında zirve yapar. Genellikle ekstremitelerin uz... more Türk Ortopedi ve Travmatoloji Birliği Derneği arasında zirve yapar. Genellikle ekstremitelerin uzun kemiklerinin metafizyel bölgesinde görülür ve gittikçe azalan sıra ile, distal femur, proksimal tibia, proksimalorta femur ve proksimal humerustan gelişir. Daha nadir olarak da, vücudun diğer kemiklerinden, örneğin pelvisten gelişebilir. [2]
INTRODUCTION: The current study was done by means of clinical and radiological evaluations of ves... more INTRODUCTION: The current study was done by means of clinical and radiological evaluations of vestibular schwannoma patients who treated with stereotactic radiosurgery or stereotactic radiotherapy using Cyberknife® (Accuray, Sunnywhale, USA). MATERIAL and METHODS: Between June 2009 and September 2014,30 vestibular schwannoma patients were treated in Dr. AY. Ankara Oncology Training and Research Hospital, Department of Radiation Oncology. The patients were assessed before and after radiotherapy retrospectively, for hearing capacity (via GardnerRobertsonScale), motor function of cranial nerve 7. (via House-Brackmannscale),the sensorial function of cranial nerve 5. RESULTS: Local control was defined as radiologically stable or regressive disease and achieved for all of the patients at the last control (%100). Preradiotherapy mean values of GRS and HB scores were both statistically different from post radiotherapy mean values (p=0,042 and p=0,046, respectively). Trigeminal toxicity was ...
The role of induction chemotherapy (ICT) for head and neck squamous cell carcinoma (HNSCC) is con... more The role of induction chemotherapy (ICT) for head and neck squamous cell carcinoma (HNSCC) is controversial. The aim of the study was to assess the benefit of ICT with docetaxel, cisplatin and 5-fluorouracil (5-FU) (TPF) when combined with concurrent cisplatin chemoradiotherapy (CRT) for HNSCC. Patients with HNSCC treated between January 2005 and December 2010 with radical intent with either TPF or cisplatin and 5-FU (PF) ICT and documented intention to proceed with concurrent cisplatin CRT were identified retrospectively. The use and choice of ICT regimen was at the clinician's discretion. In total, 68 patients treated with TPF were identified and were matched for T and N stage and tumour site to 68 patients treated with PF. A survival analysis was carried out using Kaplan-Meier and the Cox proportional hazards model. The median follow-up was 29.9 versus 36.3 months for the TPF and PF groups, respectively. Three year locoregional relapse-free survival (RFS), distant RFS, RFS, cancer-specific survival and overall survival rates for the TPF and PF groups were 84.2, 91.6, 82.6, 81.3 and 74.9% versus 73.7, 84.9, 71.9, 72.1 and 62.9%, respectively. On multivariate analysis, treatment with TPF predicted for improved locoregional RFS (P = 0.03) and overall survival (P = 0.05). The addition of docetaxel to a cisplatin doublet ICT regimen before concurrent CRT may improve disease control for locally advanced HNSCC.
Objectives: The optimal management of the N3 neck in head and neck squamous cell carcinoma (HNSCC... more Objectives: The optimal management of the N3 neck in head and neck squamous cell carcinoma (HNSCC) remains controversial. We report the outcomes of patients with N3 disease treated with a strategy of concurrent chemo-radiotherapy (CRT) ± induction chemotherapy (ICT) without a planned neck dissection. Materials and methods: Forty patients with HNSCC N3 disease treated between January 2004 and December 2010 were retrospectively identified. Inclusion criteria for the study were: non-nasopharyngeal HNSCC, N3 nodal disease, intention to treat with CRT ± ICT. Results: Median age was 60 (range 39-74). Median follow up was 32 months (range 8-88). 34 (85%) of patients received ICT. 35 patients received cisplatin-CRT, 4 carboplatin-CRT and 1 patient was treated with radiotherapy alone due to ICT toxicity. 27 (67.5%) patients had a complete response (CR) to CRT. 5 (12.5%) patients had an incomplete response in both the primary and nodal sites. 8 (20%) patients had a CR in the primary site but incomplete in the nodal regions. The crude rate of regional failure following a CR was 3/27 (11.2%). Isolated regional failure occurred in 1/27 (3.7%) patients who had achieved a CR post-CRT. 3 year overall survival, disease free survival, locoregional control, local control and regional control in the whole cohort were 51.4%, 49.6%, 65.7%, 77.3%, 69.3%, and in patients with a CR were 73.3%, 70.0%, 86.6%, 90.5% and 91.7% respectively. Conclusion: Isolated regional nodal failure is rare following a complete response to CRT for N3 HNSCC managed without a planned neck dissection.
PURPOSE: Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided b... more PURPOSE: Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided breast irradiation. The purpose of this study is to evaluate the reproducibility and variability of breath-hold level (BHL) using breath-hold curves and lateral kV setup images together. MATERIAL/METHOD: A retrospective analysis of 30 left breast cancer patients treated using the v-DIBH technique in our department is performed. The BHL difference is measured from breath hold curves and lateral (LAT) kilo-Voltage (kV) setup images. The planning CT image and the selected treatment fraction data are collected. If the changes in BHL relate to the displacement of various bones in the kV setup, images are assessed. Furthermore, the maximum heart distance inside the treatment field is compared from LAT MV portal images. RESULTS: The median and mean values of the BHL are nearly identical in different fractions (good reproducibility). However, the mean BHL values between planning and all measured ...
Fanconi anemia (FA) is a disease that could be accompanied by multiple abnormalities, such as gro... more Fanconi anemia (FA) is a disease that could be accompanied by multiple abnormalities, such as growth retardation, bone marrow abnormalities, and cancer susceptibility. Among the FA patients, head and neck squamous cell cancer (HNSCC) is the most observed solid cancer. The life expectancy of patients with FA has increased with recent medical advances. Furthermore, HNSCC is diagnosed in 3% of FA patients, and half of these patients die because of their HNSCC. The median age of HNSCC patients with FA is 31, and according to the literature HNSCC incidence of FA, patients is more than 700-fold of the normal population. Here, we reported the treatment details and challenges we faced during hypopharyngeal cancer treatment in a FA patient.
Aim: To evaluate retrospectively clinical outcomes of treated with stereotactic ablative radiothe... more Aim: To evaluate retrospectively clinical outcomes of treated with stereotactic ablative radiotherapy (SABR) using the CyberKnife® (Accuray, Sunnyvale, CA, USA), for early primary and oligometastatic lung tumors. Methods: This descriptive study included thirty tumors from 29 patients with primary lung cancer (n=21) or oligometastatic lung tumors (n=9), who underwent SABR with robotic linear accelerator between March 2011 and July2015. Out of the 30 tumors, 21 were NSCLC, 9 were metastatic lung disease. Treatment was given using different tracking methods including fiducial tracking with Synchrony (21 patients), Xsight lung with Synchrony (4 patients) and Xsight spine (5 patients). Treatment was delivered two to three fractions per week and with different fractionations depending on location and other tumor related factors. Factors, potentially effective on local control and overall survival were investigated. Results: Median follow-up time for local control was 11 months (2.4-39 months). Of 25 patients with known follow-up data, local control (LC) rates for 1, 2 and 3 years were 82.8%, 82.8% and 55.2 %, respectively. Overall survival (OS) rates for primary lung tumor patients 1, 2 and 3 years were 72.2%, 64.2%, 51.4% and metastatic lung tumor patients for 1 year was 71%, respectively. Except for gender, none of the factors were statistically significantly associated with local control in univariate analysis; female gender was associated with worse local control (p=0.001). Also in univariate analysis of overall survival, there was a trend for worse survival in females, too (p=0.07). Conclusion: This small study may give some idea about utilizing different tracking ways for CyberKnife® with less toxicity.
Methods: From 2005 to 2008, nine patients (7 women and 2 men), mean age 52.3±12.6 years, with RPS... more Methods: From 2005 to 2008, nine patients (7 women and 2 men), mean age 52.3±12.6 years, with RPS were treated with pre-operative IMRT. Toxicities, loco-regional control, and survival free disease were analyzed. Toxicity was assessed according to the RTOG acute toxicity scale. Results: Four patients (44%) had de novo RPS, and five patients (56%) had recurrent RPS after prior surgical resection. The median follow up was 26 (range: 3−39) months after radiotherapy. Median radiation dose was 50 at 2 Gy/fraction. Surgical resection after radiotherapy was performed in eight patients. In one patient, tumor progressed during treatment and was unresectable. Only minor toxicities were reported with grade 1 nausea in seven patients (77%) and vomiting in two patients (22%), during radiotherapy. No other toxicities or treatment related deaths were reported. Early and delayed postoperative complications included 1 abscess and 1 duodenal stenosis in two patients. At median follow up of 26 months, four patients (44%) were disease free. Five patients (56%) had disease progression, including tumor progression during radiotherapy (2 pts, 22%), local recurrence after surgery (2 pts, 22%), and/or distant metastasis resulting in death (2 pts, 22%). Four (80%) of the five patients with recurrent RPS after prior surgical resection, had disease progression. Conclusion: Local control of de novo RPS is achievable with pre-operative IMRT with minimal toxicities. Henceforward, low toxicities with IMRT could allow dose escalation to improve outcomes in RPS patients. 9424 POSTER Radiotherapy results of 131 patients with soft tissue sarcoma
Turkiye Klinikleri Journal of Medical Sciences, 2013
B rain metastases are the most common intracranial neoplasms and affect 20-40% of all cancer pati... more B rain metastases are the most common intracranial neoplasms and affect 20-40% of all cancer patients. 1,2 However, brainstem metastases are uncommon, comprising approximately 5-7% of intracra-Cyberknife ® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The objective of this small retrospective study is to report imaging and clinical outcomes of the patients with metastatic brain tumors in or adjacent (≤5 mm) to brainstem. The patients underwent both whole-brain radiotherapy (WBRT) and CyberKnife ® fractionated stereotactic radiotherapy (FSRT)/or stereotactic radiosurgery (SRS). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Twenty-one patients with single or multiple brain metastases located in or adjacent to brainstem underwent FSRT/SRS between
International Journal of Radiation Oncology*Biology*Physics, 2013
The aim of this study was to compare the dosimetry and treatment time between tomotherapy (Tomo) ... more The aim of this study was to compare the dosimetry and treatment time between tomotherapy (Tomo) and volumetric-modulated arc therapy (VMAT) for radiosurgery (RS) of multiple intracranial lesions. Materials/Methods: Eleven patients with multiple intracranial lesions (ranged from 2 to 5 lesions) previously treated with Tomo RS were replanned with VMAT technique. Similar plan acceptance criteria of Tomo RS plans were applied to VMAT plans. The dosimetric index used to assess target conformity was conformity number (CN). CN was defined as, CN Z (V T,pi /V T) x (V T,pi /V pi), where V T,pi is the volume of planning target volume (PTV) enclosed by prescribed isodose surface, V T is the volume of PTV, V pi is the volume enclosed by prescribed isodose surface. Homogeneity index (HI, D 5-D 95) was used to evaluate dose homogeneity. HI was the difference between the dose received by the 5% and 95% volume of the PTV. As for organ at risk assessment, the percentage volume of non-target brain tissue receiving 12 Gy (V 12) was recorded. Treatment time was based on actual beam-on time. The data was further analyzed statistically. Results: Dose conformity was generally improved using VMAT. The mean CN for VMAT and Tomo were 0.72 AE 0.13 and 0.56 AE 0.19, (p Z 0.001) respectively. As for dose homogeneity, Tomo plans were better. HI for VMAT and Tomo were 6.14 AE 1.51 and 4.94 AE 1.63 (p Z 0.0029), respectively. V 12 non-target brain tissue for VMAT and Tomo were 1.95 AE1.63 and 4.30 AE 3.64 (p Z 0.001), respectively. Mean treatment time was significantly reduced for VMAT (9.5 minutes). Conclusions: The results suggest that VMAT not only achieved better dose conformity for RS but also significantly reduced the treatment time, whereas Tomo achieved better dose homogeneity. VMAT plans yielded lower V 12 to the normal brain tissues. It might imply that the possibility of late complications of the brain would be lowers in VMAT plans. However, further studies are needed. With these advantages, VMAT could be an efficient modality in the delivery of RS to multiple intracranial lesions.
International Journal of Radiation Oncology*Biology*Physics, 2009
Purpose: Locally recurrent non-small cell lung cancer (LR-NSCLC) remains challenging to treat, pa... more Purpose: Locally recurrent non-small cell lung cancer (LR-NSCLC) remains challenging to treat, particularly in patients having received prior radiotherapy. Heterogeneous populations and varied treatment intent in existing literature result in significant limitations in evaluating efficacy of lung re-irradiation. In order to better establish the impact of re-irradiation in patients with LR-NSCLC following high-dose radiotherapy, we report outcomes for patients treated with prior sublobar resection and brachytherapy that subsequently underwent stereotactic body radiotherapy (SBRT). Methods: A retrospective review of patients initially treated with sublobar resection and I 125 vicryl mesh brachytherapy, who later developed LR-NSCLC along the suture line, was performed. Patients received salvage SBRT with curative intent. Dose and fractionation were based on tumor location and size, with a median prescription dose of 48 Gy in 4 fractions (range 20-60 Gy in 1-4 fractions). Results: Thirteen consecutive patients were identified with median follow-up of 2.1 years (range 0.7-5.6 years). Two in-field local failures occurred at 7.5 and 11.1 months, resulting in 2-year local control of 83.9% (95% CI, 63.5-100.0%). Two-year disease-free survival and overall survival estimates were 38.5% (95% CI, 0.0-65.0%) and 65.8% (95% CI, 38.2-93.4%). Four patients (31%) remained disease-free at last follow-up. All but one patient who experienced disease recurrence developed isolated or synchronous distant metastases. Only one patient (7.7%) developed grade ≥3 toxicity, consisting of grade 3 esophageal stricture following a centrally located recurrence previously treated with radiofrequency ablation. Conclusion: Despite high-local radiation doses delivered to lung parenchyma previously with I 125 brachytherapy, re-irradiation with SBRT for LR-NSCLC results in excellent local control with limited morbidity, allowing for potential disease cure in a subset of patients.
Nazofarenks kanserli hastalarda geç yan etki olarak ortaya çkan ... Factors related with develop... more Nazofarenks kanserli hastalarda geç yan etki olarak ortaya çkan ... Factors related with development of treatment induced trismus in nasopharyngeal cancer patients ... Enis ÖZYAR, Ebru KARAKAYA, Ferah YILDIZ, . Lale ATAHAN ... letiflim (Correspondence): Dr. Enis Özyar. ...
OBJECTIVES: Our objective is to analyse the rate of trismus induced after treatment for nonmetast... more OBJECTIVES: Our objective is to analyse the rate of trismus induced after treatment for nonmetastatic nasopharyngeal cancer patients and to assess the factors on development of it. METHODS: The files of 292 patients with more than two years follow-up between ...
Background: The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) c... more Background: The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) combined with streotactic radiosurgery versus stereotactic radiosurgery (SRS) alone for patients with brain metastases. Materials and Methods: This was a retrospective study that evaluated the results of 46 patients treated for brain metastases at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiation Oncology Department, between January 2012 and January 2015. Twenty-four patients were treated with WBRT+SRS while 22 patients were treated with only SRS. Results: Time to local recurrence was 9.7 months in the WBRT+SRS arm and 8.3 months in SRS arm, the difference not being statistically significant (p= 0.7). Local recurrence rate was higher in the SRS alone arm but again without significance (p=0,06). Conclusions: In selected patient group with limited number (one to four) of brain metastases SRS alone can be considered as a treatment option and WBRT may be omitted in the initial treatment.
Bu çalışmada amaç CyberKnife stereotaktik radyocerrahi-radyoterapi uygulanan vestibuler schwannom... more Bu çalışmada amaç CyberKnife stereotaktik radyocerrahi-radyoterapi uygulanan vestibuler schwannom hastalarının klinik, radyolojik ve toksisite verilerinin sunulmasıdır.
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