Intramedullary spinal cord metastasis and radiotherapy

Aim: Intramedullary spinal cord metastasis (ISCM) is a rare but a severe condition. We aimed to evaluate the clinical features, the effect of radiotherapy on the functional results, and the quality of life and survival in patients with ISCM.Material andMethods: We retrospectively assessed the results of 15 patients. Patients underwent 3D conformal radiotherapy (3D-CRT). Patients were reviewed in terms of neurological deficits, the localization of primary tumors, the duration of symptoms, onset symptoms, the localization of ISCM,and the interval between diagnosis and spinal metastasis. Post-radiotherapy outcomes and factors influencing the survival and the quality of life were analyzed.Results: The mean duration of symptoms before diagnosis was 14.93 days (range; 1-52 days).The most common presenting symptoms of patients were lower back and back pain. Neurological deficit was present in 9 patients. Of these patients, partial improvement was observed following the radiotherapy in four patients. After the radiotherapy, the need of painkillers and pain were decreased in 10 of the patients with pain at the outset (66.7%). An association was detected between the initiation of radiotherapy within 10 days from the onset of symptoms and the quality of life (p0.026).The mean survival rate was 5.9 months after being diagnosed with ISCM.Conclusions: Motor deficit and pain-related quality of life were corrupted in most of the patients with ISCM. Early diagnosis and suitable treatment might promote to the functional condition of the patient. It is important to initiate radiotherapy within a period of less than 10 days from the onset of symptoms

The Significance of Extent of Extracapsular Extension in Patients with T1-2 and N1 Breast Cancer

WOS:000446223100006PubMed ID: 30288496Objective: The prognostic importance of extracapsular extension (ECE) in breast cancer is not yet clear, especially in patients with pathologicalT1-2 and N1 (pT1-2N1) disease. We aimed to investigate whether the extent of ECE was an independent prognostic factor for survival outcomesin patients with pT1-2N1 breast cancer.Materials and Methods: A total number of 131 patients with pT1-2N1 breast cancer treated between 2009 and 2015 were retrospectively evaluated. A single pathologist re-analyzed the histologic examples of all cases. The extent of ECE was graded from 0 to 4.Results: There was a significant correlation between the number of lymph nodes involved and ECE grade (p0.004). According to the univariateanalysis, lymphovascular invasion (LVI) and ECE grade were the significant prognostic factors for overall survival (OS); age, number of metastaticlymph nodes, menopausal status, and ECE grade were the prognostic factors for disease-free survival (DFS). With a median follow-up of 46 months,grade 3-4 ECE seems to be notably associated with a shorter OS and DFS in multivariate analysis. The mean OS was 85 months for the patients withgrade 0-2 ECE vs 75 months for the patients with grade 3-4 ECE (p0.003). The mean DFS was 83 months for the patients with grade 0-3 ECE vs68 months for the patients with grade 4 ECE (p0.0001).Conclusion: This research has shown that the extent of ECE is an important prognostic factor for survival in pT1-2N1 breast cancer patients andgrade 3-4 ECE seems to be notably associated with a shorter OS and DFS

Five-Year Survival Outcomes of Breast Cancer and Prognostic Factors. A Single Institution Experience

Kliniğimizde tedavi edilen olgu serisini retrospektif olarak inceleyerek 5 yıllık sağkalım sonuçlarını ve sağkalımı etkileyen prognostik parametreleri saptamaktır. Meme kanseri tanısıyla başvuran ve kliniğimizin rutin meme prosedürüne göre küratif olarak tedavi olmuş olgu verileri incelenmiştir. Tüm olgular üç boyutlu konformal RT tekniği ile göğüs duvarı veya meme dokusuna karşılıklı paralel tanjansiyel alanlar kullanılarak günlük 2 Gy fraksiyon dozuyla haftada 5 gün olacak şekilde tedavi edilmiştir. Rejyonel lenf nodu bölgesinin tedavi edilmesi gereken durumlarda ise supraklavikuler fossa ışınlaması da tedaviye eklenmiştir. Olgulara sıklıkla antrasiklin bazlı kemoterapi rejimleri uygulanmış olup, östrojen reseptörü pozitif olan olgular hormon tedavisi, Her-2 reseptör pozitif olgular da trastuzumab tedavisi almıştır. Çalışmanın birincil sonlanım noktaları genel sağkalım (GS) ve hastalıksız sağkalım (HS) idi. İkincil sonlanım noktası ise sağkalım süreleri üzerine etkili olan prognostik faktörleri saptamak idi. Tüm istatistiksel analizler SPSS (Statistical Package for Social Sciences) 13 versiyonu kullanılarak yapılmıştır. 11.02.2010- 01.05.2016 tarihleri arasında kliniğimize başvuran toplam 559 meme kanseri olgusu değerlendirilmiştir. 2 ve 5 yıllık GS oranları sırasıyla %97 ve %84; 2 ve 5 yıllık HS oranları sırasıyla %97 ve %71 olarak bulunmuştur. Çok değişkenli analizlerde, 70 yaş, triple (-) olmak, T3-4 evre hastalığa sahip olmak, N2-3 nodal evre hastalığa sahip olmak ve metastaz yada lokal- bölgesel nüks olması GS’ yi olumsuz etkileyen bağımsız prognostik faktörler olarak bulunurken; N2-3 nodal hastalığa sahip olmak ve triple (-) olmak HS’ yi olumsuz etkileyen faktörler olarak saptanmıştır. Meme kanseri dünya genelinde kadınlar arasında görülen en sık kanser türü olup insidansı artmasına rağmen hastalığa bağlı mortalite oranları zamanla düşmeye başlamıştır. Güncel tedavi modaliteleri ışığında prognostik faktörlerin bilinmesi hem en doğru tedavi modalitesinin seçilmesi hem de uygulanan tedavi modalitesine alınacak yanıtın öngörülebilmesi açısından önemlidir.To evaluate the five year survival outcomes of breast cancer patients treated at our department and to assess the prognostic factors that affect survival parameters. All patients underwent our department’s routine procedure for breast cancer. All patients received RT to the breast or chest wall using 3D conformal technique with 2 Gy fraction doses, five days a week with two opposite tangential fields. If necessary, ipsilateral supraclavicular fossa field was added to the treatment field . Anthracycline -based chemotherapy was primarily used, patients with estrogen receptor- positive disease received hormonal therapy and patients with Her- 2 receptor -positive disease received trastuzumab. The primary end points of this study were to evaluate the overall survival (OS) and the disease-free survival (DFS) of the patients. The secondary end points of this study were to assess the prognostic factors that affect the survival outcomes. Statistical analysis were carried out using SPSS Statistic program version 13. Between 11.02.2010 and 01.05.2016, 559 patients with breast cancer who had been irradiated postoperatively were included in this retrospective study. 2 and 5 year OS rates were 97% and 84%; 2 and 5 year DFS rates were 97% and 71%, respectively. According to multivariate analysis, 70 year, to have triple (-) hormonal status, to have T3-4 disease, to have N2-3 nodal stage and to have locoregional recurrence or distant metastasis were the independent prognostic factors that affect OS. Also, to have N2-3 nodal stage and to have triple (-) hormonal status were independent prognostic factors that affect DFS. Breast cancer is the most common cancer among women. Its incidence has been increasing but mortality has been decreasing in the last 10-15 years . In the light of current treatment modalities, to know the prognostic factors that affect survival outcomes is very important for both choosing the most appropriate treatment modality and the prediciton of treatment response

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

General analysis of breast cancer patients tested for BRCA mutations and evaluation of acute radiotherapy toxicity

OBJECTIVE: The objective of our study is to evaluate breast cancer patients with BRCA1 or BRCA2 gene mutations and compare them with patients without these mutations. Specifically, we aim to assess the acute side effects of radiotherapy in both groups. METHODS: Data were collected from four participating centers, comprising information from 73 patients who underwent known mutation analysis and had complete data. Patients were monitored on a weekly basis throughout their treatment for acute toxicity, which was evaluated using the Radiation Therapy Oncology Group (RTOG) acute toxicity criteria. RESULTS: The median age of the 73 patients included in our study was 43. Among them, 17 had BRCA1-positive mutations and 19 had BRCA2-positive mutations. Invasive ductal carcinoma was present in 67 patients, all of whom underwent surgery. Of the patients, 57 received conventional radiotherapy doses, while 16 received hypofractionated radiotherapy doses. During follow-up, metastasis occurred in three patients. In BRCA-positive patients, those under 40 years of age (p<0.001), with high nodal positivity (p=0.008), grade 2–3 (p=0.022), and lymphovascular invasion (p=0.002) were significantly more fre-quent compared to BRCA-negative patients (p<0.001). The median survival was 35.8 months. Grade 1 dysphagia developed in seven BRCA-negative patients and four BRCA-positive patients, with no significant difference observed between the two groups (p=0.351). There was also no statistical difference observed in the occurrence of grade 2–3 skin reactions, with 11 BRCA-negative patients and eight BRCA-positive patients experiencing these side effects. CONCLUSION: Our study supports existing literature by identifying an association between the presence of BRCA mutations and young age, nodal status, grade, and lymphovascular invasion. Additionally, we found no significant difference in the occurrence of radiotherapy toxicity between BRCA-positive and BRCA-negative patients. These findings suggest that radiotherapy can be safely administered to BRCA-positive patients after breast-conserving surgery or mastectomy. Keywords for our study include breast cancer, BRCA mutation, radiotherapy, and side effects

Radiotherapy for benign diseases in Turkey: a patterns of care survey of the Turkish Society for Radiation Oncology (TROD 05-002)

Article; Early AccessPurposeWe aimed to investigate the patterns of radiotherapy (RT) care in cases of benign diseases in Turkey.MethodsA questionnaire survey was sent to all radiation oncology (RO) departments in Turkey. The number of patients treated for benign disease between 2015 and 2020 was requested. A list of benign conditions was given, and information on the number of patients per disease, single and total doses prescribed, weekly fractions, radiation type, energy, and device was requested.ResultsOf the 138 RO departments, 29 (21%) responded. The data received concerned 15 (52%) university, 10 (34%) public, and four (14%) private hospitals. A total of 130,846 patients were treated with RT in these departments. Of these patients, 6346 (4.85%) were treated for benign conditions. The most common benign diseases treated with RT were meningioma (35%), plantar fasciitis (19%), schwannoma (16%), arteriovenous malformation (11%), and pituitary adenoma (7%). Most centers performed RT for paraganglioma, heterotopic ossification, vertebral hemangioma, and Graves' ophthalmopathy, but none treated arthrosis. Wide variations were observed across the departments. Radiosurgery for intracranial pathologies was performed intensively in four centers. By contrast, RT for plantar fasciitis was predominantly treated in five centers, one of which had more than 1000 patients.ConclusionThe ratio of patients who underwent RT for benign diseases in Turkey among all patients who underwent RT was 4.85%. The common pattern of RT in 72% of patients was radiosurgery for intracranial benign diseases, followed by low-dose RT for plantar fasciitis in 19%

Radiotherapy for benign diseases in Turkey: a patterns of care survey of the Turkish Society for Radiation Oncology (TROD 05-002).

Purpose: We aimed to investigate the patterns of radiotherapy (RT) care in cases of benign diseases in Turkey. Methods: A questionnaire survey was sent to all radiation oncology (RO) departments in Turkey. The number of patients treated for benign disease between 2015 and 2020 was requested. A list of benign conditions was given, and information on the number of patients per disease, single and total doses prescribed, weekly fractions, radiation type, energy, and device was requested. Results: Of the 138 RO departments, 29 (21%) responded. The data received concerned 15 (52%) university, 10 (34%) public, and four (14%) private hospitals. A total of 130,846 patients were treated with RT in these departments. Of these patients, 6346 (4.85%) were treated for benign conditions. The most common benign diseases treated with RT were meningioma (35%), plantar fasciitis (19%), schwannoma (16%), arteriovenous malformation (11%), and pituitary adenoma (7%). Most centers performed RT for paraganglioma, heterotopic ossification, vertebral hemangioma, and Graves’ ophthalmopathy, but none treated arthrosis. Wide variations were observed across the departments. Radiosurgery for intracranial pathologies was performed intensively in four centers. By contrast, RT for plantar fasciitis was predominantly treated in five centers, one of which had more than 1000 patients. Conclusion: The ratio of patients who underwent RT for benign diseases in Turkey among all patients who underwent RT was 4.85%. The common pattern of RT in 72% of patients was radiosurgery for intracranial benign diseases, followed by low-dose RT for plantar fasciitis in 19%

Radiotherapy for benign diseases in Turkey: a patterns of care survey of the Turkish Society for Radiation Oncology (TROD 05-002)

PurposeWe aimed to investigate the patterns of radiotherapy (RT) care in cases of benign diseases in Turkey.MethodsA questionnaire survey was sent to all radiation oncology (RO) departments in Turkey. The number of patients treated for benign disease between 2015 and 2020 was requested. A list of benign conditions was given, and information on the number of patients per disease, single and total doses prescribed, weekly fractions, radiation type, energy, and device was requested.ResultsOf the 138 RO departments, 29 (21%) responded. The data received concerned 15 (52%) university, 10 (34%) public, and four (14%) private hospitals. A total of 130,846 patients were treated with RT in these departments. Of these patients, 6346 (4.85%) were treated for benign conditions. The most common benign diseases treated with RT were meningioma (35%), plantar fasciitis (19%), schwannoma (16%), arteriovenous malformation (11%), and pituitary adenoma (7%). Most centers performed RT for paraganglioma, heterotopic ossification, vertebral hemangioma, and Graves' ophthalmopathy, but none treated arthrosis. Wide variations were observed across the departments. Radiosurgery for intracranial pathologies was performed intensively in four centers. By contrast, RT for plantar fasciitis was predominantly treated in five centers, one of which had more than 1000 patients.ConclusionThe ratio of patients who underwent RT for benign diseases in Turkey among all patients who underwent RT was 4.85%. The common pattern of RT in 72% of patients was radiosurgery for intracranial benign diseases, followed by low-dose RT for plantar fasciitis in 19%

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