Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey

BackgroundThe Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions.Patients and methodsEstrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS.ResultsA total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18.ConclusionThis first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS

Radiation induced broncıolitis obliterans organizing pneumonia (BOOP) syndrome after radiotherapy for breast cancer

Radyasyona bağlı bronşiolitis obliterans organize pnömoni (BOOP) sendromu patolojik olarak bronşiol ve alveoler kanallarda granülasyon dokusu polipleri ve organize pnömoni yamalı alanları ile karakterize bir akciğer hastalığıdır. İdiopatik gelişebileceği gibi infeksiyon, ilaç reaksiyonları, kollajen vasküler hastalıklar, hipersensitivite pnömonisi, toksik gaz inhalasyonu, akut solunumsal yetmezlik sendromu, tiroidit ve radyoterapi de etyolojik nedenler arasında sayılabilir. Işınlanan akciğer dokusunda görülen radyasyon pnömonisinden farklı olarak alan dışında ve her iki akciğerde de görülebilen bu hastalıkta radyoterapi sahası içinde kalan akciğer ve plevral dokudaki lenfosit stimülasyonu ve salgılanan sitokinlere bağlı aşırı duyarlılık mekanizması sorumlu tutulmaktadır. Erken evre meme kanseri nedeniyle meme koruyucu cerrahi ile postoperatif radyoterapi uygulanmış ve iki akciğerinde toksisite gelişmiş bir olgumuz sunulacaktır.Radiation-induced bronchiolitis obliterans organising pneumonia (BOOP) is a lung disease which is pathologically characterized by the presence of granulation tissue polyps within respiratory bronchioles and alveoler ducts and patchy areas of organizing pneumonia. Etiologic factors include infection, drug administration, collagen vascular disease, hypersensitivity pneumonia, toxic fume inhalation, acute respiratory deficiency syndrome, thyroiditis and radiotherapy and it may also develop idiopathic. Occurence of radiation injury in the lung outside the tangential fields and appearance of patchy infiltrates in both lungs are characteristic. It is assumed that radiation exposure to lung and pleura initiates a lymphocytic stimulation which then triggers a cytokin mediated immunologic reaction and causes the injury in both lungs. We report an early breast cancer patient treated with breast conservation surgery and postoperative breast radiotherapy who later developed BOOP syndrome in both lungs

Dosimetry and acute toxicity in prostate cancer patients treated with image-guided intensity modulated radiotherapy: preliminary results in the first 100 men

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Lokalize prostat kanseri olgularında uygulanan görüntü rehberliğinde yoğunluk ayarlı radyoterapinin (YART) dozimetrik ölçütlerini ve erken dönem akut yan etkilerini araştırmak amacıyla ilk 100 olgunun dosyaları retrospektif olarak incelendi. Gereç Ve Yöntem: Görüntü rehberliği amacıyla her olguda prostat içersine transüretral ultrason eşliğinde üç adet altın marker yerleştirildi, her tedavi öncesi bu markerların lokalizasyonu verifiye edildikten sonra radyoterapi uygulandı. Olguların risk gruplarına göre prostat +/- seminal veziküller +/- pelvik lenf nodları klinik hedef volüme dahil edildi. Hedef volüme ortanca 76 Gy (aralık, 74-78 Gy) radyoterapi uygulandı. Tedavi sonrası en az üç ay takip edilen olgular tedavi sırasında her hafta, tedavi sonrasında da 1. ayda akut toksisite açısından değerlendirildi ve akut yan etkiler RTOG skorlamasına göre derecelendirildi.Objectives: We aimed to analyze the dosimetric criteria and preliminary acute toxicity in the first 100 men treated with image-guided intensity modulated radiotherapy (IG-IMRT) for localized prostate cancer. Methods: For image guidance, three fiducial gold markers were implanted in each patient under transurethral ultrasound guidance. According to the risk group classification, prostate and/or seminal vesicles and/or pelvic lymph nodes were defined as the clinical target volume. A median of 76 Gy (range, 74-78 Gy) was delivered to the planning target volume. The patients were evaluated once a week during the treatment and one month after the completion of the treatment. Acute toxicity was scored according to the RTOG scoring system

Yoğunluk ayarlı radyoterapi uygulanan baş-boyun kanserli olgularda brakial pleksopati

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Yoğunluk ayarlı radyoterapi (YART) ile tedavi edilen baş boyun kaserli olgularda brakial bleksopati gelişmesinde rol oynayan prediktif faktörlerin belirlenmesi. Gereç ve Yöntem: Kliniğimizde 2005-2010 yılları arasında 159 baş boyun kanserli olguya YAET uygulanmıştır. Bu olgulardan en az 1 yıl takibi olan ve lokorejyonel kontrol sağlanmış 45’i bu çalışmaya dahil edilmiştir. En sık primer tümör bölgesi nazofarenks (%64) ve orofarenks (%16) idi. Onsekiz olguda hyoid altı lenf nodlarında tutulum vardı. Otuzsekiz olgu küratif, 7 olgu postoperatif amaçla ışınlanmıştı

True local recurrences after breast conserving surgery have poor prognosis in patients with early breast cancer.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.İstanbul Bilim Üniversitesi, Sağlık Yüksekokulu.Background: This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy. Methods: 1,400 patients who were treated between 1998 and 2007 and had breast-conserving surgery (BCS) for early breast cancer (cT1-2/N0-1/M0) were evaluated. Demographic and pathologic parameters, radiologic data, treatment, and follow-up related features of the patients were recorded

Replacement of tumor bed after oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Oncoplastic breast-conserving surgery satisfies oncologic principles of negative margins and improves cosmetic outcomes, even if excision of a considerably large breast volume is required. During this surgical procedure quadrantectomy cavity is filled by the latissimus dorsi mini-flap which might shift tumor bed. The purpose of this study is to evaluate geographic variability after this procedure and its relevance to radiation therapy planning.http://www.redjournal.org/article/S0360-3016(14)01490-4/fulltex

Stereotactic Vacuum-Assisted Core Biopsy Results for Non-Palpable Breast Lesions

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Background: The increase in breast cancer awareness and widespread use of mammographic screening has led to an increased detection of (non-palpable) breast cancers that cannot be discovered through physical examination. One of the methods used in the diagnosis of these cancers is vacuum-assisted core biopsy, which prevents a considerable number of patients from undergoing surgical procedures. The aim of this study was to present the results of stereotactic vacuum-assisted core biopsy for suspicious breast lesions. Materials and Methods: Files were retrospectively scanned and data on demographic, radiological and pathological findings were recorded for patients who underwent stereotactic vacuum-assisted core biopsy due to suspicious mammographic findings at the Interventional Radiology Centre of the Florence Nightingale Hospital between January 2010, and April 2013. Statistical analysis was carried out using Pearson's Chi-square, continuity correction, and Fisher's exact tests. Results: The mean age of the patients was 47 years (range: 36-70). Biopsies were performed due to BIRADS 3 lesions in 8 patients, BIRADS 4 lesions in 77 patients, and BIRADS 5 lesions in 3 patients. Mammography elucidated clusters of microcalcifications in 73 patients (83%) and focal lesions (asymmetrical density, distortion) in 15 patients (17%). In terms of complications, 1 patient had a hematoma, and 2 patients had ecchymoses (3/88; 3.3%). The histopathologic results revealed benign lesions in 63 patients (71.6%) and malignant lesions in 25 patients (28.4%). The mean duration of the procedure was 37 minutes (range: 18-55). Although all of the BIRADS 3 lesions were benign, 22 (28.6%) of the BIRADS 4 lesions and all of the BIRADS 5 lesions were malignant. Among the malignant cases, 80% were in situ, and 20% were invasive carcinomas. These patients underwent surgery. Conclusions: In cases where non-palpable breast lesions are considered to be suspicious in mammography scans, the vacuum-assisted core biopsy method provides an accurate histopathologic diagnosis thus preventing a significant number of patients undergoing unnecessary surgical procedures