Japanese Journal of Clinical Oncology, May 1, 2003
We report a breast cancer patient with leptomeningeal carcinomatosis (LM) who showed an excellent... more We report a breast cancer patient with leptomeningeal carcinomatosis (LM) who showed an excellent objective and subjective response to letrozole, with a progression-free survival of 16 months. We think that despite the poor prognosis and short survival of patients with LM, early diagnosis and treatment with appropriate hormonal manipulation may improve the outcome and achieve prolonged palliation in selected hormone-positive breast cancer patients with LM. Possible clues predicting the response were also evaluated in the context of literature data.
The first case of coronavirus disease-2019 (COVID-19) was reported in Wuhan, China, in late Decem... more The first case of coronavirus disease-2019 (COVID-19) was reported in Wuhan, China, in late December 2019, which then spread more rapidly and extensively to the European region and US. 1 COVID-19 is a contagious disease caused by a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which can be transmitted by respiratory droplets as well as close contact and can progress from an asymptomatic form to a severe stage, sometimes even leading to death. 2 The number of cases as well as mortality rates in various countries afflicted by COVID-19 varies as they are regulated by several parameters like population , economic status, demographic structure, the efficiency of the health care system, diagnostic criteria, proficiency of local test center capacity along with calibration of testing strategies. 3 In our country, the first confirmed case of COVID-19 was detected on March 11, 2020, whereas the first death due to COVID-19 occurred on March 17, 2020. 4,5 The COVID-19 pandemic has put enormous pressure on the National Health Service providing basic cancer treatment modalities, from the initial screening, diagnosis process to the resultant surgery followed by other treatment options. The delay in on
To investigate whether there is a predictive effect of NF-kappaB, survivin, and Ki-67 expressions... more To investigate whether there is a predictive effect of NF-kappaB, survivin, and Ki-67 expressions on pathological response and disease relapse in breast cancer (BC) patients. Ki-67, survivin and NF-kappaB expressions were analyzed in the pathology specimens of breast biopsy before and after neoadjuvant chemotherapy (NeoCT) in BC patients (n=52). Event-free survival (EFS) (defined as recurrence or metastasis free) analyze was performed. The median overall survival was 43.5 months and the median EFS was 51 months (95% CI: 33.3-68.9) in all patients. The expression percentages of NF-kappaB, survivin, and Ki-67 significantly decreased after NeoCT (p<0.001). Survivin expression level before NeoCT was significantly higher in patients who did not respond to NeoCT than both partial-responders and complete-responders (p=0.038, p=0.010, respectively). Type of NeoCT was the only independent factor on pathological response status (p=0.007). Addition of taxanes to NeoCT improved pathological complete response rates about six times. However, no predictor was found to be a prognostic factor for EFS in multivariate analyze. Higher survivin expression level before NeoCT may be associated with poor patholog ical response to NeoCT. These findings must be tested with prospective clinical trials.
C-reactive protein (CRP), a marker of systemic low-grade inflammation, is frequently elevated in ... more C-reactive protein (CRP), a marker of systemic low-grade inflammation, is frequently elevated in essential hypertension and predicts cardiovascular prognosis independently of conventional risk factors. The risk profile of white-coat hypertension is not yet completely clear. The aim of this study was to determine the levels of high-sensitivity CRP (hs-CRP) in white-coat hypertensive subjects. Thirty-six age-, sex-, and body mass index-matched white-coat hypertensive subjects, 36 essential hypertensive patients, and 36 normotensive subjects were included in the study. Hs-CRP levels were significantly higher in the essential hypertensive and white-coat hypertensive groups than in the normotensive group (0.66+/-0.29, 0.47+/-0.32, and 0.27+/-0.22 mg/dl, respectively, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). It was also higher in the essential hypertensive group than in the white-coat hypertensive group (p=0.014). Our data show that patients with white-coat hypertension have higher hs-CRP levels than normotensive patients and this may be an indication of increased risk.
The study was planned to determine the hope levels of people with cancer and the variables affect... more The study was planned to determine the hope levels of people with cancer and the variables affecting hope. Hope is essential for patient well-being and positively correlated with improved coping skill. A descriptive and exploratory design. The study sample included 240 consecutive patients treated with chemotherapy and attending the Day Chemotherapy Unit of a University Hospital in Turkey. The study was conducted between December 2009-January 2010. Personal Information Form and Herth Hope Scale were used for data collection. The determinants and subscales of hope were evaluated with univariate and multivariate regression analyses. These mean scores showed high levels of hope among the patients included in the study. It was found that net family income, knowledge level about the disease, feeling of improvement, perception of satisfactory family support by the patient, mouth ulcers, feeling anxious or worried and presence of fear were independently related with the total hope score. The study results showed high levels of hope among the participating patients. It is concluded that physical, financial and psychological well-being and information and support needs are directly and independently related with hope in people with cancer. These findings support the need for clinicians to continue to practise and implement hope fostering/hindering interventions among their patients.
Objectives: We aimed to analyze the predictors of outcome in metastatic germ cell cancer (MGCC) p... more Objectives: We aimed to analyze the predictors of outcome in metastatic germ cell cancer (MGCC) patients treated with High-dose Chemotherapy (HDC) and stem cell rescue. Background: Various prognostic factors have been suggested in the treatment of metastatic germ cell cancer. However, there is no comprehensive evaluation of independent prognostic factors for the efficacy of HDC in published patient cohorts. Methods: Thirty-two published patient cohorts with MGCC (encompassing 2176 patients; 510 patients treated upfront and 1666 at relapse) were identified from PUBMED and Cochrane Registry of Clinical Trials. Weighted Regression Analyses of these trials were conducted to define prognosticators. Results: Independent correlates of overall survival (OAS) when all trials were considered were line of chemotherapy index, an indicator of line of HDC utilization (1st line: 71% vs 2nd or higher line: 40%, p < 0.001), and number of HDC cycles administered (1 cycle: 43%, 1 to 2 cycles: 43%, 2 or more cycles: 64%, p = 0.021). In cohorts having HDC for relapsed disease, lower line of chemotherapy index again (p = 0.004), and higher median age (p = 0.023) were independently associated with better OAS. In trials utilizing upfront HDC, higher number of chemotherapeutics in the HDC regimen was marginally linked with improved OAS (p = 0.047). Conclusion: The efficacy of various forms of HDC in MGCC patients with diverse prognostic factors may vary both as an initial or salvage therapy. Clinicians need to be aware of these factors for optimal patient selection for HDC in MGCC (Tab. 3, Fig. 2, Ref. 54).
To the Editor: We read with great interest the two articles and the editorial in the December 15,... more To the Editor: We read with great interest the two articles and the editorial in the December 15, 2002 issue of the Journal of Clinical Oncology, concerning adjuvant hormonal treatment of breast cancer. 1-3 In both studies, the authors compared a "standard" cyclophosphamide, methotrexate fluorouracil-(CMF-) only treatment arm with goserelin 1 or goserelin plus tamoxifen. 2 According to Jonat et al, 1 "goserelin offers an effective, well-tolerated alternative to CMF chemotherapy in the management of premenopausal patients with ER-[estrogen receptor-] positive and node-positive early breast cancer." According to Jakesz et al, 2 "complete endocrine blockade with goserelin and tamoxifen is superior to standard chemotherapy in premenopausal women with hormone-responsive stage I and II breast cancer." In the editorial commenting on these two studies, Kathleen Pritchard asked, "Is it time for another paradigm shift?" 3 If this question is asked in the context of the previously mentioned studies, the answer might be, "Not yet." Let us repeat what we all know. First, anthracyclinecontaining regimens yield superior results, both for recurrence-free survival (absolute difference at 5 years, 3.2%) and overall survival (absolute difference at 5 years, 2.7%). 4 In both the Jonat et al and Jakesz et al studies, the control arm was patients receiving CMF. We know that 4 months of doxorubicin and cyclophosphamide is clearly equivalent to 6 months of CMF 5 ; however, we also know that there are regimens that are clearly superior to CMF 6,7 that have been defined in previously reported studies. 8 Second, tamoxifen was associated with a highly significant improvement in recurrence-free survival (absolute difference at 10 years, 14.9%-15.2%) and in overall survival (absolute difference at 10 years, 5.5%-10.9%) in ER-positive women. 9 In the article by Jonat et al 1 and in the accompanying editorial, 3 it was acknowledged that there were only 177 women with ER-positive disease who were randomly selected to chemotherapy, or to chemotherapy plus tamoxifen in the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) overview. According to the Jonat et al and the accompanying editorial, although widely used in practice, not enough data were available to support the addition of tamoxifen after standard chemotherapy in premenopausal patients, and this argument was used as a justification for lack of tamoxifen use in the control groups. However, both in the recently published studies, as well as in all other studies cited in the editorial that compared ovarian ablation with chemotherapy (mostly with CMF), the chemotherapy plus tamoxifen regimen is apparently lacking. So "177" is better than "zero," and as a general rule, absence of proof does not mean proof of absence. On the other side, Jakesz et al, 2 in addressing the choice of treatment in the control arm, stated that when Austrian Breast and Colorectal Cancer Study Group Trial 5 was launched in 1990, the data of the EBCTGG overview were largely unknown; therefore, CMFonly, the chemotherapeutic regimen of choice at that time, was chosen. However, knowing the data at present, we do not accept CMF without tamoxifen as a "standard" in this group, and so we can not come to the same conclusion of Jakesz et al, who reported that "complete endocrine blockade with goserelin and tamoxifen is superior to standard chemotherapy in premenopausal woman with hormone responsive stage I and II breast cancer". We still do not know what is the "best standard" chemotherapy for lymph node-positive, ER-positive premenopausal breast cancer; however, we absolutely know what is not. CMF without tamoxifen is clearly not a sufficient treatment in this group of patients. Studies with a control arm of anthracycline-based chemotherapy plus tamoxifen are definitely and urgently needed in order that the conclusions of Jakesz et al be better received. After reading the results of these two trials, we draw a conclusion that is different from those reported. Ovarian ablation with goserelin is equivalent to CMF without tamoxifen, and goserelin plus tamoxifen is more effective than CMF without tamoxifen. If one has a premenopausal patient with ER-positive, lymph node-positive breast cancer, goserelin plus tamoxifen is a good alternative to treating her with intravenous CMF without tamoxifen while achieving the same results. Is there anyone who would treat such a patient with CMF only?
Learning to develop the doctor-patient relationship is very important in the treatment of patient... more Learning to develop the doctor-patient relationship is very important in the treatment of patients with cancer. We aim to train our students in the early years of study about this subject with a course on the patient-doctor communication, prepared for third year students. One hundred fifty-four third year students participated in our study during the 2006-2007 academic years. The same questionnaire was given to the students in the 2009-2010 academic year; their sixth year of study. The rate of return for the questionnaire is 88.7%. Based on this study, we have the opinion that the training given in the third year is beneficial; however, the efficacy of the training diminishes with the advancing years, and therefore, the length of this training should be increased in the upper classes and additional hours should be added.
Medicine Science | International Medical Journal, 2020
Results from studies in several cancers on single nucleotide polymorphisms (SNPs) suggest that DN... more Results from studies in several cancers on single nucleotide polymorphisms (SNPs) suggest that DNA repair capacity may have prognostic implication for disease recurrence, survival, and responses to treatment. This study aimed to evaluate the potential prognostic value of SNPs as biomarkers in patients with metastatic non-small cell lung cancer (mNSCLC) treated with platinum. Analysis of SNPs from peripheral blood cells was performed by polymerase chain reaction. Excision repair cross-complementing group 1 (ERCC1)-Asn118Asn, excision repair cross-complementing group 2 (ERCC2)-Lys751Gln, X-ray repair cross-complementing group 1 (XRCC1)-Arg-399Gln, and tumor protein 53 (TP53)-Arg72Pro polymorphisms were evaluated in conjunction with clinical and pathological parameters, and survival. The median progression-free survival (PFS) and overall survival (OS) of 145 patients were 5.1 months and 30.9 months, respectively. In the univariate analysis ERCC1 genotype, XRCC1 genotype, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) were significant parameters for OS. In the multivariate analysis ERCC1 genotype, XRCC1 genotype, and ECOG-PS retained their significance. The median OS was 45.2 months for the ERCC1 normal (CC) and heterozygote (CT) genotypes, and 25.5 months for the ERCC1 mutant (TT) genotype. The median OS was 31.4 months for the XRCC1 normal (AA) and heterozygote (AG) genotypes, and 23.1 months for the XRCC1 mutant (GG) genotype. The median OS was 30,7 months for ECOG-PS≤ 1 and 10.2 months for ECOG-PS≥ 2. ERCC1 and XRCC1 genotypes, and ECOG-PS independently predicted OS in mNSCLC patients. Additional studies are needed for the further evaluation of potential prognostic SNPs in mNSCLC.
Data is limited on treatment delay and its prognostic impact on breast cancer patients. In this s... more Data is limited on treatment delay and its prognostic impact on breast cancer patients. In this study, we retrospectively measured the time between biopsy and surgery and between surgery to adjuvant therapy in our patients, and analyzed the prognostic impact of this delay. Ninety-six regularly followed patients with breast cancer, treated with mastectomy and adjuvant chemotherapy±radiotherapy were analyzed for the effect of time intervals between biopsy to surgery and surgery to adjuvant chemotherapy on relapse free survival (RFS). Standard prognostic factors (age, tumor size, grade, axilla and hormone receptor status) were also evaluated. In the univariate analysis, age, tumor diameter, number of axillary nodes involved, estrogen receptor status and time to surgery (quick surgery worse) showed a statistical significance. In the multivariate analysis, older age, smaller tumor and smaller number of axillary nodes involved were associated with a better relapse free survival (RFS) (P<0.05). Time to chemotherapy and time treatment (total) were not linked with RFS in univariate analysis (P=0.445 and P=0.413). Delay in surgery up to several weeks has no detrimental effect on outcome (in fact there was a trend for a reverse relation reflecting surgeon's sense). Up to several months of delay in chemotherapy does not have a major impact on disease free survival and delay should not be a reason for omitting adjuvant therapy.
We aimed to identify whether abdominal fat distribution could affect the outcome in metastatic br... more We aimed to identify whether abdominal fat distribution could affect the outcome in metastatic breast cancer (MBC) patients treated with aromatase inhibitors (AIs) or not. A total of 42 MBC patients treated with first line hormonal therapy were enrolled in this study. Factors associated with overall survival in the univariate analysis were age, c-erb-B2 expression intensity (þþþ versus others by immunohistochemistry), and WHR, whereas only WHR retained significance in the multivariate analysis. Median overall survival figures were 472 days versus unreached for patients with a WHR of <0.92 and 0.92 (Log rank statistic ¼ 9.76, P ¼ 0.002). Similarly, the corresponding progression free survival figures for patients with a WHR of <0.92 and 0.92 were 423 versus 1004 days (Log rank statistic ¼ 6.37, P ¼ 0.012). This study suggests that WHR may serve as a potential predictive marker in MBC patients treated with AIs.
Experimental and Therapeutic Medicine, Mar 11, 2016
Opioids are commonly used in cancer pain management. The present study aimed to investigate the o... more Opioids are commonly used in cancer pain management. The present study aimed to investigate the occurrence of endocrine dysfunction in patients with cancer pain treated with opioids. The study included 20 patients with cancer-associated pain. All data were obtained from malignant tumors diagnosed and followed up at the Oncology Clinic of Akdeniz University Hospital (Akdeniz, Turkey) between May 2009 and December 2013. Serum samples were collected to determine the levels of hypophyseal, gonadal and thyroid hormones. The inclusion criteria for the study were as follows: Chronic cancer pain, daily treatment with a morphine equivalent daily dose (MEDD) of ≥25 mg/dl for ≥1 month, and a visual analog score of <2. All independent predictors were evaluated using logistic regression analysis. The results did not demonstrate any significant association between MEDD and gender, or the levels of adrenocorticotropic hormone, cortisol, prolactin, thyroid-stimulating hormone, free thyroxine, follicle-stimulating hormone and luteinizing hormone. However, the levels of testosterone (P=0.040) and of free testosterone (P=0.041) were significantly affected by the MEDD. Conversely, prolactin levels were demonstrated to significantly increase with MEDD (P= 0.083). The results also indicated that the required opioid analgesic dose and MEDD were significantly affected by age (P≤0.001). Opioid therapy in patients with cancer may inhibit gonadal function and cause hyperprolactinemia.
e16038 Background: The metabolic activity in visceral and subcutaneous adipose tissue have differ... more e16038 Background: The metabolic activity in visceral and subcutaneous adipose tissue have different metabolic risk profiles for colorectal cancer. The aim of this study was to investigate the prognostic significance of adipose tıssue distribution and metabolic activity in PET-CT and predict the overall survival in patients with metastatic colorectal cancer (mCRC). Methods: A total of 83 patients diagnosed with mCRC between 2010-2018 were evaluated retrospectively. Pretreatment PET-CT images were reevaluated to determine adipose tissue distribution and metabolic activity. Volume and metabolic activity of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) on FDG PET-CT images were measured. SAT volume, SAT density (HU), SAT ratio (SAT volume/ SAT density) were calculated. The maximum standardized uptake (SUV) of tumor tissue was measured. The relationship between adipose tissue and overall survival was examined. Results: 53 patients died during follow-up and the median overall survival was 33.76 months (95% CI: 28.185-39.349). According to univariate analysis results, tumor location (HR:2.5; 95% CI 1.27-4.98, p = 0.008) and SAT ratio (HR:0.5; 95% CI 0.34-1.00, p = 0.053) were the significant parameters for the OAS. VAT volume (p = 0.774), VAT density (p = 0.899), VAT suv mean (p = 0.831) and SAT volume (p = 0.423), SAT density (p = 0.353), SAT suv mean (p = 0.575), tumor suv max (p = 0.589) values were not correlated with OAS. In the multivariate analysis, SAT ratio (p = 0.011) and tumor location (p = 0.001) were correlated significantly with OAS. The median OAS for the patients with SAT ratio value &amp;amp;amp;amp;amp;amp;amp;amp;lt; -1.1 and -1.1 were 38.5 (95% CI 31.54-45.58) and 24.5 (95% CI 14.13-34.93) months, respectively (p = 0.05). Conclusions: This study showed that SAT ratio was an independent prognostic factor for OAS in patients with mCRC. We need prospective studies for to observe the relationship between adipose tissue distribution and response to treatment in mCRC.
Patients with cancer are at increased risk of thrombosis. Additionally, an increased mean platele... more Patients with cancer are at increased risk of thrombosis. Additionally, an increased mean platelet volume (MPV) has been demonstrated to be associated with thromboembolism. Tyrosine kinase inhibitors (TKIs) may modulate the activation of systemic coagulation in cancer patients, rendering them more susceptible to thromboembolism. The aim of the current study was to investigate the association between antiangiogenic TKIs and MPV. A total of 45 patients with metastatic renal cell carcinoma (RCC), who were treated with TKIs and were patients at the
Japanese Journal of Clinical Oncology, May 1, 2003
We report a breast cancer patient with leptomeningeal carcinomatosis (LM) who showed an excellent... more We report a breast cancer patient with leptomeningeal carcinomatosis (LM) who showed an excellent objective and subjective response to letrozole, with a progression-free survival of 16 months. We think that despite the poor prognosis and short survival of patients with LM, early diagnosis and treatment with appropriate hormonal manipulation may improve the outcome and achieve prolonged palliation in selected hormone-positive breast cancer patients with LM. Possible clues predicting the response were also evaluated in the context of literature data.
The first case of coronavirus disease-2019 (COVID-19) was reported in Wuhan, China, in late Decem... more The first case of coronavirus disease-2019 (COVID-19) was reported in Wuhan, China, in late December 2019, which then spread more rapidly and extensively to the European region and US. 1 COVID-19 is a contagious disease caused by a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which can be transmitted by respiratory droplets as well as close contact and can progress from an asymptomatic form to a severe stage, sometimes even leading to death. 2 The number of cases as well as mortality rates in various countries afflicted by COVID-19 varies as they are regulated by several parameters like population , economic status, demographic structure, the efficiency of the health care system, diagnostic criteria, proficiency of local test center capacity along with calibration of testing strategies. 3 In our country, the first confirmed case of COVID-19 was detected on March 11, 2020, whereas the first death due to COVID-19 occurred on March 17, 2020. 4,5 The COVID-19 pandemic has put enormous pressure on the National Health Service providing basic cancer treatment modalities, from the initial screening, diagnosis process to the resultant surgery followed by other treatment options. The delay in on
To investigate whether there is a predictive effect of NF-kappaB, survivin, and Ki-67 expressions... more To investigate whether there is a predictive effect of NF-kappaB, survivin, and Ki-67 expressions on pathological response and disease relapse in breast cancer (BC) patients. Ki-67, survivin and NF-kappaB expressions were analyzed in the pathology specimens of breast biopsy before and after neoadjuvant chemotherapy (NeoCT) in BC patients (n=52). Event-free survival (EFS) (defined as recurrence or metastasis free) analyze was performed. The median overall survival was 43.5 months and the median EFS was 51 months (95% CI: 33.3-68.9) in all patients. The expression percentages of NF-kappaB, survivin, and Ki-67 significantly decreased after NeoCT (p<0.001). Survivin expression level before NeoCT was significantly higher in patients who did not respond to NeoCT than both partial-responders and complete-responders (p=0.038, p=0.010, respectively). Type of NeoCT was the only independent factor on pathological response status (p=0.007). Addition of taxanes to NeoCT improved pathological complete response rates about six times. However, no predictor was found to be a prognostic factor for EFS in multivariate analyze. Higher survivin expression level before NeoCT may be associated with poor patholog ical response to NeoCT. These findings must be tested with prospective clinical trials.
C-reactive protein (CRP), a marker of systemic low-grade inflammation, is frequently elevated in ... more C-reactive protein (CRP), a marker of systemic low-grade inflammation, is frequently elevated in essential hypertension and predicts cardiovascular prognosis independently of conventional risk factors. The risk profile of white-coat hypertension is not yet completely clear. The aim of this study was to determine the levels of high-sensitivity CRP (hs-CRP) in white-coat hypertensive subjects. Thirty-six age-, sex-, and body mass index-matched white-coat hypertensive subjects, 36 essential hypertensive patients, and 36 normotensive subjects were included in the study. Hs-CRP levels were significantly higher in the essential hypertensive and white-coat hypertensive groups than in the normotensive group (0.66+/-0.29, 0.47+/-0.32, and 0.27+/-0.22 mg/dl, respectively, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). It was also higher in the essential hypertensive group than in the white-coat hypertensive group (p=0.014). Our data show that patients with white-coat hypertension have higher hs-CRP levels than normotensive patients and this may be an indication of increased risk.
The study was planned to determine the hope levels of people with cancer and the variables affect... more The study was planned to determine the hope levels of people with cancer and the variables affecting hope. Hope is essential for patient well-being and positively correlated with improved coping skill. A descriptive and exploratory design. The study sample included 240 consecutive patients treated with chemotherapy and attending the Day Chemotherapy Unit of a University Hospital in Turkey. The study was conducted between December 2009-January 2010. Personal Information Form and Herth Hope Scale were used for data collection. The determinants and subscales of hope were evaluated with univariate and multivariate regression analyses. These mean scores showed high levels of hope among the patients included in the study. It was found that net family income, knowledge level about the disease, feeling of improvement, perception of satisfactory family support by the patient, mouth ulcers, feeling anxious or worried and presence of fear were independently related with the total hope score. The study results showed high levels of hope among the participating patients. It is concluded that physical, financial and psychological well-being and information and support needs are directly and independently related with hope in people with cancer. These findings support the need for clinicians to continue to practise and implement hope fostering/hindering interventions among their patients.
Objectives: We aimed to analyze the predictors of outcome in metastatic germ cell cancer (MGCC) p... more Objectives: We aimed to analyze the predictors of outcome in metastatic germ cell cancer (MGCC) patients treated with High-dose Chemotherapy (HDC) and stem cell rescue. Background: Various prognostic factors have been suggested in the treatment of metastatic germ cell cancer. However, there is no comprehensive evaluation of independent prognostic factors for the efficacy of HDC in published patient cohorts. Methods: Thirty-two published patient cohorts with MGCC (encompassing 2176 patients; 510 patients treated upfront and 1666 at relapse) were identified from PUBMED and Cochrane Registry of Clinical Trials. Weighted Regression Analyses of these trials were conducted to define prognosticators. Results: Independent correlates of overall survival (OAS) when all trials were considered were line of chemotherapy index, an indicator of line of HDC utilization (1st line: 71% vs 2nd or higher line: 40%, p < 0.001), and number of HDC cycles administered (1 cycle: 43%, 1 to 2 cycles: 43%, 2 or more cycles: 64%, p = 0.021). In cohorts having HDC for relapsed disease, lower line of chemotherapy index again (p = 0.004), and higher median age (p = 0.023) were independently associated with better OAS. In trials utilizing upfront HDC, higher number of chemotherapeutics in the HDC regimen was marginally linked with improved OAS (p = 0.047). Conclusion: The efficacy of various forms of HDC in MGCC patients with diverse prognostic factors may vary both as an initial or salvage therapy. Clinicians need to be aware of these factors for optimal patient selection for HDC in MGCC (Tab. 3, Fig. 2, Ref. 54).
To the Editor: We read with great interest the two articles and the editorial in the December 15,... more To the Editor: We read with great interest the two articles and the editorial in the December 15, 2002 issue of the Journal of Clinical Oncology, concerning adjuvant hormonal treatment of breast cancer. 1-3 In both studies, the authors compared a "standard" cyclophosphamide, methotrexate fluorouracil-(CMF-) only treatment arm with goserelin 1 or goserelin plus tamoxifen. 2 According to Jonat et al, 1 "goserelin offers an effective, well-tolerated alternative to CMF chemotherapy in the management of premenopausal patients with ER-[estrogen receptor-] positive and node-positive early breast cancer." According to Jakesz et al, 2 "complete endocrine blockade with goserelin and tamoxifen is superior to standard chemotherapy in premenopausal women with hormone-responsive stage I and II breast cancer." In the editorial commenting on these two studies, Kathleen Pritchard asked, "Is it time for another paradigm shift?" 3 If this question is asked in the context of the previously mentioned studies, the answer might be, "Not yet." Let us repeat what we all know. First, anthracyclinecontaining regimens yield superior results, both for recurrence-free survival (absolute difference at 5 years, 3.2%) and overall survival (absolute difference at 5 years, 2.7%). 4 In both the Jonat et al and Jakesz et al studies, the control arm was patients receiving CMF. We know that 4 months of doxorubicin and cyclophosphamide is clearly equivalent to 6 months of CMF 5 ; however, we also know that there are regimens that are clearly superior to CMF 6,7 that have been defined in previously reported studies. 8 Second, tamoxifen was associated with a highly significant improvement in recurrence-free survival (absolute difference at 10 years, 14.9%-15.2%) and in overall survival (absolute difference at 10 years, 5.5%-10.9%) in ER-positive women. 9 In the article by Jonat et al 1 and in the accompanying editorial, 3 it was acknowledged that there were only 177 women with ER-positive disease who were randomly selected to chemotherapy, or to chemotherapy plus tamoxifen in the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) overview. According to the Jonat et al and the accompanying editorial, although widely used in practice, not enough data were available to support the addition of tamoxifen after standard chemotherapy in premenopausal patients, and this argument was used as a justification for lack of tamoxifen use in the control groups. However, both in the recently published studies, as well as in all other studies cited in the editorial that compared ovarian ablation with chemotherapy (mostly with CMF), the chemotherapy plus tamoxifen regimen is apparently lacking. So "177" is better than "zero," and as a general rule, absence of proof does not mean proof of absence. On the other side, Jakesz et al, 2 in addressing the choice of treatment in the control arm, stated that when Austrian Breast and Colorectal Cancer Study Group Trial 5 was launched in 1990, the data of the EBCTGG overview were largely unknown; therefore, CMFonly, the chemotherapeutic regimen of choice at that time, was chosen. However, knowing the data at present, we do not accept CMF without tamoxifen as a "standard" in this group, and so we can not come to the same conclusion of Jakesz et al, who reported that "complete endocrine blockade with goserelin and tamoxifen is superior to standard chemotherapy in premenopausal woman with hormone responsive stage I and II breast cancer". We still do not know what is the "best standard" chemotherapy for lymph node-positive, ER-positive premenopausal breast cancer; however, we absolutely know what is not. CMF without tamoxifen is clearly not a sufficient treatment in this group of patients. Studies with a control arm of anthracycline-based chemotherapy plus tamoxifen are definitely and urgently needed in order that the conclusions of Jakesz et al be better received. After reading the results of these two trials, we draw a conclusion that is different from those reported. Ovarian ablation with goserelin is equivalent to CMF without tamoxifen, and goserelin plus tamoxifen is more effective than CMF without tamoxifen. If one has a premenopausal patient with ER-positive, lymph node-positive breast cancer, goserelin plus tamoxifen is a good alternative to treating her with intravenous CMF without tamoxifen while achieving the same results. Is there anyone who would treat such a patient with CMF only?
Learning to develop the doctor-patient relationship is very important in the treatment of patient... more Learning to develop the doctor-patient relationship is very important in the treatment of patients with cancer. We aim to train our students in the early years of study about this subject with a course on the patient-doctor communication, prepared for third year students. One hundred fifty-four third year students participated in our study during the 2006-2007 academic years. The same questionnaire was given to the students in the 2009-2010 academic year; their sixth year of study. The rate of return for the questionnaire is 88.7%. Based on this study, we have the opinion that the training given in the third year is beneficial; however, the efficacy of the training diminishes with the advancing years, and therefore, the length of this training should be increased in the upper classes and additional hours should be added.
Medicine Science | International Medical Journal, 2020
Results from studies in several cancers on single nucleotide polymorphisms (SNPs) suggest that DN... more Results from studies in several cancers on single nucleotide polymorphisms (SNPs) suggest that DNA repair capacity may have prognostic implication for disease recurrence, survival, and responses to treatment. This study aimed to evaluate the potential prognostic value of SNPs as biomarkers in patients with metastatic non-small cell lung cancer (mNSCLC) treated with platinum. Analysis of SNPs from peripheral blood cells was performed by polymerase chain reaction. Excision repair cross-complementing group 1 (ERCC1)-Asn118Asn, excision repair cross-complementing group 2 (ERCC2)-Lys751Gln, X-ray repair cross-complementing group 1 (XRCC1)-Arg-399Gln, and tumor protein 53 (TP53)-Arg72Pro polymorphisms were evaluated in conjunction with clinical and pathological parameters, and survival. The median progression-free survival (PFS) and overall survival (OS) of 145 patients were 5.1 months and 30.9 months, respectively. In the univariate analysis ERCC1 genotype, XRCC1 genotype, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) were significant parameters for OS. In the multivariate analysis ERCC1 genotype, XRCC1 genotype, and ECOG-PS retained their significance. The median OS was 45.2 months for the ERCC1 normal (CC) and heterozygote (CT) genotypes, and 25.5 months for the ERCC1 mutant (TT) genotype. The median OS was 31.4 months for the XRCC1 normal (AA) and heterozygote (AG) genotypes, and 23.1 months for the XRCC1 mutant (GG) genotype. The median OS was 30,7 months for ECOG-PS≤ 1 and 10.2 months for ECOG-PS≥ 2. ERCC1 and XRCC1 genotypes, and ECOG-PS independently predicted OS in mNSCLC patients. Additional studies are needed for the further evaluation of potential prognostic SNPs in mNSCLC.
Data is limited on treatment delay and its prognostic impact on breast cancer patients. In this s... more Data is limited on treatment delay and its prognostic impact on breast cancer patients. In this study, we retrospectively measured the time between biopsy and surgery and between surgery to adjuvant therapy in our patients, and analyzed the prognostic impact of this delay. Ninety-six regularly followed patients with breast cancer, treated with mastectomy and adjuvant chemotherapy±radiotherapy were analyzed for the effect of time intervals between biopsy to surgery and surgery to adjuvant chemotherapy on relapse free survival (RFS). Standard prognostic factors (age, tumor size, grade, axilla and hormone receptor status) were also evaluated. In the univariate analysis, age, tumor diameter, number of axillary nodes involved, estrogen receptor status and time to surgery (quick surgery worse) showed a statistical significance. In the multivariate analysis, older age, smaller tumor and smaller number of axillary nodes involved were associated with a better relapse free survival (RFS) (P<0.05). Time to chemotherapy and time treatment (total) were not linked with RFS in univariate analysis (P=0.445 and P=0.413). Delay in surgery up to several weeks has no detrimental effect on outcome (in fact there was a trend for a reverse relation reflecting surgeon's sense). Up to several months of delay in chemotherapy does not have a major impact on disease free survival and delay should not be a reason for omitting adjuvant therapy.
We aimed to identify whether abdominal fat distribution could affect the outcome in metastatic br... more We aimed to identify whether abdominal fat distribution could affect the outcome in metastatic breast cancer (MBC) patients treated with aromatase inhibitors (AIs) or not. A total of 42 MBC patients treated with first line hormonal therapy were enrolled in this study. Factors associated with overall survival in the univariate analysis were age, c-erb-B2 expression intensity (þþþ versus others by immunohistochemistry), and WHR, whereas only WHR retained significance in the multivariate analysis. Median overall survival figures were 472 days versus unreached for patients with a WHR of <0.92 and 0.92 (Log rank statistic ¼ 9.76, P ¼ 0.002). Similarly, the corresponding progression free survival figures for patients with a WHR of <0.92 and 0.92 were 423 versus 1004 days (Log rank statistic ¼ 6.37, P ¼ 0.012). This study suggests that WHR may serve as a potential predictive marker in MBC patients treated with AIs.
Experimental and Therapeutic Medicine, Mar 11, 2016
Opioids are commonly used in cancer pain management. The present study aimed to investigate the o... more Opioids are commonly used in cancer pain management. The present study aimed to investigate the occurrence of endocrine dysfunction in patients with cancer pain treated with opioids. The study included 20 patients with cancer-associated pain. All data were obtained from malignant tumors diagnosed and followed up at the Oncology Clinic of Akdeniz University Hospital (Akdeniz, Turkey) between May 2009 and December 2013. Serum samples were collected to determine the levels of hypophyseal, gonadal and thyroid hormones. The inclusion criteria for the study were as follows: Chronic cancer pain, daily treatment with a morphine equivalent daily dose (MEDD) of ≥25 mg/dl for ≥1 month, and a visual analog score of <2. All independent predictors were evaluated using logistic regression analysis. The results did not demonstrate any significant association between MEDD and gender, or the levels of adrenocorticotropic hormone, cortisol, prolactin, thyroid-stimulating hormone, free thyroxine, follicle-stimulating hormone and luteinizing hormone. However, the levels of testosterone (P=0.040) and of free testosterone (P=0.041) were significantly affected by the MEDD. Conversely, prolactin levels were demonstrated to significantly increase with MEDD (P= 0.083). The results also indicated that the required opioid analgesic dose and MEDD were significantly affected by age (P≤0.001). Opioid therapy in patients with cancer may inhibit gonadal function and cause hyperprolactinemia.
e16038 Background: The metabolic activity in visceral and subcutaneous adipose tissue have differ... more e16038 Background: The metabolic activity in visceral and subcutaneous adipose tissue have different metabolic risk profiles for colorectal cancer. The aim of this study was to investigate the prognostic significance of adipose tıssue distribution and metabolic activity in PET-CT and predict the overall survival in patients with metastatic colorectal cancer (mCRC). Methods: A total of 83 patients diagnosed with mCRC between 2010-2018 were evaluated retrospectively. Pretreatment PET-CT images were reevaluated to determine adipose tissue distribution and metabolic activity. Volume and metabolic activity of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) on FDG PET-CT images were measured. SAT volume, SAT density (HU), SAT ratio (SAT volume/ SAT density) were calculated. The maximum standardized uptake (SUV) of tumor tissue was measured. The relationship between adipose tissue and overall survival was examined. Results: 53 patients died during follow-up and the median overall survival was 33.76 months (95% CI: 28.185-39.349). According to univariate analysis results, tumor location (HR:2.5; 95% CI 1.27-4.98, p = 0.008) and SAT ratio (HR:0.5; 95% CI 0.34-1.00, p = 0.053) were the significant parameters for the OAS. VAT volume (p = 0.774), VAT density (p = 0.899), VAT suv mean (p = 0.831) and SAT volume (p = 0.423), SAT density (p = 0.353), SAT suv mean (p = 0.575), tumor suv max (p = 0.589) values were not correlated with OAS. In the multivariate analysis, SAT ratio (p = 0.011) and tumor location (p = 0.001) were correlated significantly with OAS. The median OAS for the patients with SAT ratio value &amp;amp;amp;amp;amp;amp;amp;amp;lt; -1.1 and -1.1 were 38.5 (95% CI 31.54-45.58) and 24.5 (95% CI 14.13-34.93) months, respectively (p = 0.05). Conclusions: This study showed that SAT ratio was an independent prognostic factor for OAS in patients with mCRC. We need prospective studies for to observe the relationship between adipose tissue distribution and response to treatment in mCRC.
Patients with cancer are at increased risk of thrombosis. Additionally, an increased mean platele... more Patients with cancer are at increased risk of thrombosis. Additionally, an increased mean platelet volume (MPV) has been demonstrated to be associated with thromboembolism. Tyrosine kinase inhibitors (TKIs) may modulate the activation of systemic coagulation in cancer patients, rendering them more susceptible to thromboembolism. The aim of the current study was to investigate the association between antiangiogenic TKIs and MPV. A total of 45 patients with metastatic renal cell carcinoma (RCC), who were treated with TKIs and were patients at the
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Papers by Hakan Bozcuk