Changes in lung perfusion scintigraphy and pulmonary function tests in irradiated breast cancer patients

Objectives: To investigate the utility of quantitative lung perfusion scintigraphy and pulmonary function tests (PFTs) in the assessment of radiation-induced lung injury. Methods: Forty-three breast cancer patients underwent lung perfusion scintigraphy with Tc-99m macroaggregated albumin before and after radiotherapy (RT). Along with above mentioned tests pulmonary function tests and carbon monoxide diffusing capacity (DLCO) tests were carried out on all patients. The relationship between treatment related changes and its association with doses of RT were also analyzed. Results: DLCO values before RT showed a significant decrease at 6 and 12 months after RT (p=0.002 and p=0.004, respectively), while none of the parameters of the PFTs showed a significant difference before and after RT. Also, the median percentage of perfusion studies in the irradiated lung significantly decreased from 51.61% to 48.81% (p 20%. Conclusion: DLCO and Quantitative lung perfusion scintigraphy may be a useful tool for the early diagnosis and monitoring of radiation-induced lung injury. Continuous...

The results of postoperative chemoradiotheapy in gastric carcinoma patients: Bulent ecevit university experience

Amaç: Mide kanseri tanısıyla postoperatif kemoradyoterapi uyguladığımız olgularımızın tedavi sonuçları değerlendirildi. Gereç ve Yöntem: 2007-2011 yılları arasında postoperatif kemoradyoterapi uygulanan toplam 77 mide kanseri tanı- lı olgu geriye dönük olarak incelendi. Kemoradyoterapi, Intergroup-0116 çalışma protokolüne göre uygulandı. Üç boyutlu konformal planlama sonrası mide loju ve bölgesel lenfatiklere 45 Gy, cerrahi sınır pozitif olanlara 50.4 Gy radyoterapi verildi. Bulgular: Olguların 46’si erkek (% 59.7), 31’i kadın (% 40.3) olup, ortanca yaş 59 (dağılım 31-78) idi. Ortanca genel sağkalım ve hastalıksız sağkalım süreleri sırasıyla 28.3 ve 21 aydı. Üç yıllık genel ve hastalıksız sağkalım oranları sı- rasıyla % 43.8 ve % 41.7 bulundu. Takipleri sırasında 10 olguda (% 13) lokal-bölgesel yineleme, 22 olguda (% 28.6) uzak organ metastazı, 3 olguda (% 3.9) ise hem lokal- bölgesel yineleme hem de uzak organ metastazı saptandı. Kemoradyoterapi süresi boyunca grad 1-2 hematolojik yan etki 23 (% 30) olguda, 3-4 hematolojik yan etki 46 (% 59.7) olguda, grad 1-2 gastrointestinal yan etki 30 (% 39) olgu- da, grad 3-4 gastrointestinal yan etki 11 (% 14.3) olguda görüldü. Tek değişkenli analizde lenf nodu evresi ve lenf nodu tutulum oranı hem genel hem de hastalıksız sağkalım üzerine etkili prognostik faktörler olarak bulunurken, çok değişkenli analizde lenf nodu diseksiyon tipi ve lenf nodu tutulum oranı genel ve hastalıksız sağkalım ile ilişkili prog- nostik faktörler olarak bulundu. Sonuç: Kemoradyoterapinin lokal kontrol üzerinde etkili olduğu, uzak metastaz gelişimini engellemede ise yetersiz kaldığı saptanmıştır. Erken dönem özellikle hematolojik yan etkiler sık gözlenmiştir.Objective: The treatment results of postopeative chemoradi- otherapy in patients with gastric carcinoma were evaluated. Material and Methods: A total of 77 patients with gast- ric carcinoma, treated with postoperative chemoradiothe- rapy between 2007-2011, were evaluated retrospectively. Chemoradiotherapy was applied in accordance with the Integroup-0116 study protocol. Total 45 Gy radiotherapy was delivered to the gastric bed and regional lymphatic no- des and 50.4 Gy was given to patients with positive surgical margins after 3-dimensional conformal planning. Results: Forty-six of the patients were male (59.7 %), and 31 of the patients were female (40.3 %) with a median age of 59 (31-78). Median overall survival and disease-fee sur- vival were 28.3, and 21 months, respectively. The 3-year overall and disease-free survival rates were 43.8 % and 41.7 %, respectively. Locoregional recurrence was detected in 10 (13 %), distant metastasis was detected in 22 (28.6 %) and both locoregional and distant metastasis were detected in 3 (3.9 %) of patients. During chemoradiotherapy grade 1-2 hematological toxicity was seen in 23 (30 %) patients, grade 3-4 hematological toxicity in 46 (59.7 %) patients, grade 1-2 gastrointestinal toxicity in 30 (39 %) patients, and grade 3-4 gastrointestinal toxicity in 11 (14.3 %) pa- tients. While in the univariate analysis lymph node stage and percentage of positive lymph nodes were found to be prognostic factors for overall and disease-free survival, in the multivariate analysis type of lymph node dissection and percentage of positive lymph nodes were found to be prog- nostic factors that are correlated with overall and disease- free survival. Conclusion: Chemoradiotherapy improved loco-regional control rather than reduction of distant metastases. Acute es- pecially hematologic side effects were commonly observed

Effects of Ozonated Olive Oil on Acute Radiation Proctitis in Rats

Background: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Aims: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Study Design: Animal experimentation. Methods: Rats were divided into three groups: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. Results: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10th day. Macroscopic finding scores on the 10th day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiationinduced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10th day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. Conclusion: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats.Background: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Aims: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. Study Design: Animal experimentation. Methods: Rats were divided into three groups: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. Results: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10th day. Macroscopic finding scores on the 10th day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiationinduced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10th day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. Conclusion: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats

Protective Effect of L-carnitine on Morphological Alterations and Occurrence in Developing Follicles Exposed Ionising Radiation in Rat Ovary

Amaç: Radyasyon hücrelerin çekirdek ve sitoplazmasında bir takım değişikliklere sebebiyet verebilir, memeli germ hücreleri de iyonize radyasyona (İR) karşı oldukça duyarlıdır. İyonize radyasyon ovaryum folliküllerindeki dejenerasyonu arttırır. Bu çalışmanın amacı tüm vücudu iyonize radyasyona maruz kalan sıçanların ovaryum folliküllerinde L-karnitinin (LK) antiapoptotik ve radyoprotektif etkilerini araştırmaktır. Materyal-Method: Çalışmamızda 30 adet Wistar albino dişi sıçan 5 ayrı gruba ayrıldı. Radyasyon hasarı için kontrol hariç tüm sıçanlara 8,3 Gy X ışını uygulandı. LK gruplarına ışınlamadan önce günlük 200mg/kg LK uygulandı. Işınlama sonrası 6.saatte (Rad-1) ve 4. günde (Rad-2) ovaryum dokuları toplandı. Ovaryum dokusundan her 5. kesit alınarak hematoksilen-eozin boyaması yapılarak oosit çekirdeğinin görüldüğü her oosit sayıldı. Folliküller primordiyal, primer, preantral ve antral olacak şekilde sınıflandırıldı. Serumdaki IL-1? (interlökin-1 alfa), IL-4 (interlökin-4) ve GM-CSF (granülosit monosit koloni sitümülan faktör) değerleri flow sitometri ile analiz edildi. Bulgular: İyonize radyasyon uygulamasının sonrasında 6.saat ve 4. gün ovaryum dokuları alınan gruplarda atretik folliküllerin oranında artış gözlendi. Granüloza hücreleri yuvarlak şekilli ve apoptotik hücre görünümünde izlendi. İyonize radyasyona maruz kalan sıçanların ovaryum dokuları incelendiğinde 4.gün İR grubunda atretik folliküllerin sayısı 6. saat İR grubuna göre belirgin bir şekilde artmıştı. LK uygulanan gruplarda İR'nun yarattığı hasarda belirgin bir düzelme gözlendi. İR gruplarında serumdaki IL-1?, IL-4 ve GM-CSF düzeyleri kontrol grubu ve tedavi grubuna göre artmış olarak izlendi.Sonuç: İyonize radyasyonun akut olarak primordiyal ve primer folliküllerdeki dejenerasyonu arttırdığı sonucuna varılmıştır. Ayrıca, L-karnitinin iyonize radyasyona bağlı gelişen folliküler atrezide koruyucu bir rolü olduğunu düşünmekteyiz.Objective: This study deals with the morphological degenerations of normal and atretic follicles based on artificially induced radiation apoptosis. Ovarian follicular degeneration is accelerated by ionising radiation. The aim of the present study was to assess the radioprotective effects of L-carnitine on ovarian follicles. Material-Method: Thirty Wistar albino female rats were divided into five groups. Rats with or without pretreatment with 200 mg/kg L-carnitine, were irradiated with 8.3 Gy of X ray. The ovaries were collected at 6 h and 4 d after irradiation. Every fifth section throughout the entire ovary was stained with Hematoxylin and Eosin and follicles with a nucleus present in the oocyte were counted. The follicles were classified as primordial, primary, preantral and antral. The levels of IL-1?, IL-4 and GM-CSF in serum were determined by flow cytometric analysis. Results: The ratio (%) of normal to atretic follicles decreased with time after the irradiation in primordial follicles and in primary follicles as well. At 6 h after irradiation, the number of degenerated primordial follicles increased. Granulosa cells became round in shape and apoptotic cells started to appear. When the ovarian tissues of the rats exposed to ionizing radiation were examined, the number of atretic follicles in the 4th day ID group was significantly prominent at 6th hour according to the IR group. A significant improvement in IR damage was observed in LK treated groups. Serum levels of IL-1?, IL-4 and GM-CSF were increased in the IR groups compared to the control group and the treatment group. Conclusions: It is concluded that the ionizing radiation acutely induces the degeneration of primordial and primary follicles These results can provide morphological clues for the identification of the degenerating primordial and primary follicles in normal and irradiated rat ovaries

Radiation therapy for biliary tract tumors: the joint experience of three centers

Conclusion: Since local recurrence is still the leading cause of failure following postoperative RT and the outcome following palliative RT is far from satisfactory, the indications, the target volume, and the doses for RT should be reconsidered

Diagnostic delay in rare diseases

OBJECTIVE Post-operative radiotherapy (PORT) in non-small cell lung cancer (NSCLC), especially after complete resection, has long been an unresolved dilemma and debated among therapeutic disciplines. We aimed to evaluate the effects of different radiotherapy volumes and techniques on local-regional recurrence patterns and PORT results in patients with NSCLC. METHODS The results of 389 patients who underwent surgery and received PORT at 11 centers were analyzed retrospectively. The surgical margin was positive or closes in 100 (26%) patients. The PORT dose was a median of 50 Gy (36-60 Gy). Intensity-modulated RT methods were used in 68 (17.5%) patients. RESULTS The first recurrence of the patients who developed relapse, local recurrence was found in 77 (19.8%) patients, distant recurrence was found in 95 (24%) patients, and both recurrences was found in 30 (8%) patients. The median time to locoregional relapse was 14 months (1.84-59.7 months). Local-regional recurrence was not significantly higher in patients with positive surgical margins than in negative pa-tients (39% vs. 29%, p=0.1), but the dose administered to these patients was also higher. Mediastinal recurrence occurred in 28 (19%) patients who did not receive radiotherapy to the mediastinum; 25 of these recurrences (89%) were just near or outside the field. Cardiac events became 7% in all groups and did not change according to chosen mediastinal radiotherapy volume. CONCLUSION A clear description of the PORT volumes according to the localization of the primary tumor and the involved lymph nodes would be beneficial in terms of establishing the recurrence/toxicity balance better