MEDİASTEN IŞINLAMASI YAPILAN AKCİĞER KANSERLİ OLGULARDA ORAL GLUTAMİN DESTEĞİNİN ÖZOFAGUSA OLAN ETKİLERİ (GÖZLEM ÇALIŞMASI)

Akciger kanserinde torasik RT’ nin asıl amacı tümöre yeterli etkinlikteki dozu uygularken komsu normal dokuları kabul edilebilir oranlarda korumak ve böylece teröpatik oranı en üst düzeyde tutmaktır. Tedaviye baglı gelisen akut radyasyon özofajiti gbi komplikasyonlar ciddi morbiditeye sebep olurlarken aynı zamanda beklenmedik sekilde tedaviye ara verilmesine de neden olmaktadırlar. Bu durum hastaların yasam kalitesinin bozulmasına yol açtıgı gibi tümör kontrolünün azalmasına ve yasam süresi oranlarının kısalmasına sebep olmaktadır. Daha etkin tedavi biçimi olan RT ve kemoterapinin birlikte kullanımı ile bu yan ekinin insidansı ve siddeti de artmaktadır. Bu etkiyi en aza indirgemek amacıyla üç boyutlu konformal RT teknikleri ya da yogunluk ayarlı RT teknikleri kullanılsa dahi özafagusun tedavi hedefinin çok yakınında olması nedeniyle bu yan etki etkin bir sekilde önlenememektedir. Bu nedenle esas stratejiler akut radyasyon özofajitinin kontrolünde etkili olabilecek radyoprotektör ajanların kullanımına yönelik olmaya baslamıstır. Kanser hastalarında kaslardan sürekli olarak glutamin deplesyonu olmaktadır, bu durum kansere baglı kasekside anahtar role sahiptir. Akut radyasyon özofajiti ve buna baglı bulantı, kusma, agrı, disfaji ve odynojaji normal doku toleransını daha da bozmaktadır. Bu nedenle Glutamin destegi ile torasik RT’ ye baglı gelisen yan etkilerin azalacagı ve akut radyasyon özofajitinin azalacagı düsünülmüstür. Biz, Gazi Üniversitesi Tıp Fakültesinde küratif amaçlı tedavi ettigimiz 32 akciger kanseri tanılı hastayı es zamanlı ya da tek basına RT ile tedavi ederken hastaların tedaviye baglı yan etkilerini takip ettik. Bu çalısmadaki esas amacımız torasik RT uygulanan hastalarda oral glutaminin akut radyasyon özofajiti gelisimi ve kilo kaybını önlemedeki etkinligini degerlendirmektir. kincil amacımız ise özofajit gelisiminde klinik (serum immünolojik parametreleri ve özafagus sintigrafisi gibi) ve dozimetrik (DVH gibi) parametrelerin rolünü degerlendirmektir. Glutamin alan grupta özofajit siddeti ve görülme süresi, kilo kaybı, serum sitokin seviyeleri ve özafagus transit zamanları istatistiksel anlamlı olacak sekilde almayan gruptan daha düsük bulunmustur. Glutamin inflamasyonu baskılaması nedeniyle hem hastalıga hem de tedaviye baglı gelisen toksisiteyi anlamlı sekilde azaltmıstır. Sonuç olarak, bu çalısmanın sonuçları akciger kanseri tanısıyla definitif RT uygulanan hastalarda oral glutamin kullanımı ile akut radyasyon özofajit siddet ve insidansı ile kilo kaybının azaldıgını göstermektedir. Bu sonuçlar hastaların hayat kalitelerine olumlu yönde katkıda bulunacaktır. Bu nedenle akciger kanseri tanısı ile definitif RT uygulanacak hastalara glutamin destegi önerilmektedir

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

Oncological outcomes for encapsulated papillary carcinoma of the breast: Multicentric study of Turkish Society for Radiation Oncology breast cancer study group (TROD 06-014 study)

BackgroundEncapsulated papillary carcinoma (EPC) is a rare malignant papillary breast cancer accounting for approximately .5%-2% of all breast tumors. The aim of this multicenter study was to evaluate clinicopathologic features of EPC in addition to oncological outcomes and radiotherapy (RT) details. MethodsFrom 10 different academic hospitals in Turkey, we obtained pathology reports of 80 patients with histologically confirmed EPC between 2005 and 2022. Demographic, diagnostic, and treatment data were collected from medical records, retrospectively. Local failure, distant progression, toxicity-adverse effects, overall survival (OS), and disease-free survival were evaluated, and survival analyzes were performed using the Kaplan-Meier method. ResultsEighty patients with the diagnosis of misspelled sorry (ECP) were retrospectively evaluated. The median age of the patients was 63 (range, 35-85). After a median follow-up of 48 (range; 6-206) months, local recurrence was observed in three patients (4%). Local recurrence was less common in the patients who received whole breast RT with a tumour bed boost (p = .025). There were not any distant metastasis or disease-related death. RT was applied to 61% of the cases, and no treatment-related grade 3 or higher toxicity was reported in any of the patients. Five year OS, cancer-specific survival (CSS), and were observed as 85%, 100%, and 96%, respectively. ConclusionsECP is a rare, slow-progressing breast carcinoma associated with good prognosis, it is a disease of elderly patient, and usually occurs in postmenopausal women. It responds extremely well to optimal local treatments and appropriate adjuvant treatments on a patient basis, and has excellent OS and CSS ratios

Evaluation of Nutritional Status and Anxiety Levels in Patients Applying to the Radiation Oncology Outpatient Clinic during the COVID-19 Pandemic: Turkish Society for Radiation Oncology Group Study (TROD 12:02)

Cancer patients often face malnutrition, which negatively affects their response to cancer treatment. This study aims to analyze the effects of the COVID-19 pandemic on nutritional status and anxiety in cancer patients with different types and stages of cancer. This is a cross-sectional cohort study that includes 1,252 patients with varying cancer types from 17 radiation oncology centers. The nutritional risk scores (NRS-2002) and coronavirus anxiety scale (CAS) scores of all patients were measured. NRS-2002 >= 3 and CAS >= 5 were accepted as values at risk. Of all patients, 15.3% had NRS-2002 >= 3. Breast cancer was the most prevalent cancer type (24.5%) with the lowest risk of nutrition (4.9%, p = 5) were significantly related to voluntary avoidance and clinical postponement of hospital visits due to the pandemic (p < 0.001), while clinical postponement was particularly frequent among patients with NRS-2002 < 3 (p = 0.0021). Fear and anxiety in cancer patients with COVID-19 cause hesitations in visiting hospitals, leading to disrupted primary and nutritional treatments. Thus, nutritional monitoring and treatment monitoring of cancer patients are crucial during and after radiotherapy

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