Brain Metastases, Large Cell Neuroendocrine Carcinomas and Prognosis

Objective: Pulmonary large cell neuroendocrine carcinomas (LNECs) are not common but brain metastases are common in LNEC patients. Because of their rarity, there are no randomized controlled trials on optimal treatment. Generally available data are based on case reports and retrospective studies. For this reason, we retrospectively analyzed patients with LNEC that we followed up for brain metastases to contribute to the literature. Methods: Between 2009 and 2020, 38 patients with brain metastases diagnosed with LNEC in our center were reviewed retrospectively. Results: 38 patients were evaluated. The mean survival time was 5.17 months (95% confidence interval (CI) : 3.17-7.13). In multivariate analysis showed us that; shorter overal survival is associated with age (p=0.001), uncontrol of primary cancer (p=0.014), presence of metachronous metastases (p=0.003), poor Eastern Cooperative Oncology Group (ECOG) performance score (p=0.025), and high uric acid level (p=0.001) and high lactate dehydrogenase (LDH) levels (p=0.009). Conclusion: LNECs are rare but aggressive cancers. LNECs often metastasize to the brain. According to our study, high LDH, high uric acid, poor ECOG performance score, ≥65 years, metachronous metastasis, uncontrolled primary tumor are associated poor prognosis. LDH, uric acid, age, presence of metachron metastasis, controbility of primary tumor can be used as easy and inexpensive biomarkers to determine the prognosis and in the follow-up and treatment of patients with LNECs with brain metastases as metastases seen of other cancers

Guattari'nin Makineleri ve Özgün Perspektifler

Although Felix Guattari extensively incorporated the terminology from the Freud-Lacan line of psychoanalysis, he employs those terms in a revolutionary way in his philosophical outlook. Besides central concepts such as desire, libido and Oedipus, he employed the machine as a core concept to form an original perspective. A term reflecting the multiplicity and political novelty, its psychoanalytic background is an indispensable aspect for Guattari’s machines’ origins, their function and temporal progression. Through Freud’s and Lacan’s theories, psychoanalytic political line and related criticisms are investigated in this thesis to provide a background for Guattari’s machines. Then, the particularities of the machine concept are followed in Guattari’s texts to see what kind of problems and original solutions it addresses. Those insights indicate that the machinic approach itself functions in a machinic fashion to develop the multiplicity in the relatively rigid field of psychoanalysis. Additionally, the thesis strives to answer the question “How does Guattari and his machine concept manage to construct an original perspective?” To answer these questions, the final part of the thesis will investigate the theoretical approaches to physics corresponding to Freud’s, Lacan’s and Guattari’s peculiarities along with their views on time and temporality. The ultimate aim of the study is to discuss the background of philosophically original perspectives brought about by Guattari’s machine concept and its machinic function through the field of psychoanalysis.Terminolojisini Freud-Lacan psikanaliz geleneğinden almış olmasına karşın, Felix Guattari bu terimleri devrimci bir şekilde kullanır. Arzu, libido, Oidipus gibi terimlere ek olarak makine kavramını da kendi özgün bakış açısını oluşturmak için temel bir terim olarak kullanmıştır. Çeşitlilik ve politik çoğulculukla ilişkili bir kavram olarak makinelerin, kaynağı, işlevi ve zamansal değişimini ortaya koymak için psikanalitik arka plan önem arz eder. Bu tez için; Freud ve Lacan’ın teorilerinden ortaya çıkan psikanalitik politik tutum ve bu tutuma yönelik eleştiriler, Guattari’nin makineleri için arka planı oluşturmak üzere incelenecektir. Sonrasında, makine konseptinin kendine has özellikleri Guattari’nin metinleri boyunca şekilde takip edilecektir. Bu bölümlerden edinilen çıktılar makinesel yaklaşımın da psikanalizin nispeten katı alanı boyunca bir analiz ve çoğulculuğu geliştirme yöntemi olarak makinesel işlev gösterdiğini ortaya koymaktadır; diğer yaklaşımlar ile yapılan karşılaştırma da bu iddiayı örnekler. Ek olarak, tez şu soruya da cevap vermeye çalışır: “Guattari ve kendisinin makine kavramı orijinal bir perspektif oluşturmayı nasıl başarmıştır?” Bu soruya cevap verebilmek için, tezin son bölümünde Freud, Lacan ve Guattari’nin özgün görüşlerine karşılık gelen fizik alanındaki teorik yaklaşımlar, düşünürlerin zaman ve zamansallık üzerine görüşleriyle birlikte tartışılmaktadır. Tezin nihai amacı, Guattari’nin makine kavramı ve psikanaliz alanındaki makinesel işlevinin ortaya koyduğu özgün felsefi perspektifi arka planıyla ortaya koymaktır.M.A. - Master of Art

Fiber bragg ızgara tabanlı optik sensörler ile kaynak proses kontrol sistemi

Başvuru konusu buluş, kaynak torcuna bağlanan fiber bragg ızgara tabanlı optik sensör sistemi kullanılarak alınan zamana bağlı konum (pozisyon) bilgisinin kaynak kalitesinin tahmini ve/veya kontrolü ile ilgilidir. Kaynak proses parametreleri ve torcun zamana bağlı konumu torcun mekanik yapısını değiştirmeden sistemin çalışmasını engellemeyecek şekilde yapılmaktadır. Önerilen sistemle kaynak operasyon parametreleri ile birlikte torcun işleme parçasına göre uzaydaki konumu da dikkate alınarak kaynak kalitesi kestirimi için daha isabetli bir korelasyon kurulmaktadır

Mediating role of social support in resilience and quality of life in patients with breast cancer: structural equation model analysis

Objective: This study aimed to investigate the mediating role of social support in the relationship between resilience and quality of life (QoL) among Turkish patients with early-stage breast cancer. Methods: The study used a descriptive and cross-sectional design and was carried out in the oncology ward of a hospital in the Central Anatolia region of Turkey. A demographic-disease survey, the Turkish version of the Connor–Davidson Resilience Scale 25, the Multidimensional Perceived Social Support Scale, the European Organization for Research and Treatment of Cancer QoL Questionnaire Core, and the QoL Questionnaire Breast Cancer 23 were used to interview 113 patients with breast cancer. Results: Social support played a partial mediator role in the relationship between resilience and functional QoL. There was a negative correlation between functional QoL Questionnaire Breast Cancer 23 and psychological resilience and social support (P < 0.005). The mediation effect ratio was 10.2% (R2 = 0.102). Social support was found to not have a mediating role in the relationship between psychological resilience and general QoL (P < 0.05). Conclusions: Patients do not want social support to end, and their weakness in the eyes of others may have a negative impact on their QoL and resilience

Epidermal growth factor receptor expression and adjuvant chemoradiotherapy in rectal cancer Epidermal growth factor recepto in operated rectal cancer

Aim: Epidermal Growth Factor Receptor (EGFR) is a trans-membrane protein with tyrosine kinase activity and is expressed in 25-80% of colon cancer cases. EFGR expression is prognostic in patients with metastatic colorectal cancer, and anti-EGR- based therapies are routinely used in the treatment of patients with metastatic colorectal cancer. To the best of our knowledge, the relationship between EGFR expression and prognosis in directly operated patients who did not receive neoadjuvant treatment and subsequently received chemo-radiotherapy is unknown. Therefore, we retrospectively evaluated patients with stage 3 rectal cancer who underwent surgery without any preoperative treatment in our center and aimed to investigate the relationship between EGFR expression and prognosis in patients who received adjuvant chemoradiotherapy. Material and Methods: The data of patients who underwent surgery for rectal cancer and received chemoradiotherapy between 2010 and 2016 at Manisa State Hospital were retrospectively analyzed. Results: According to EGFR expression, it was 127.01 (95% CI, 85.43-168.59) months in the group with 10% less staining and 47.44 (95% CI, 26.77-68.12) months in the group with 10% or more staining. Lymphovascular invasion (p=0.032), perineural invasion (p=0.023), histologic grade (p=0.004) and EGFR expression percentage (p=0.005) were significantly associated with survival in multivariate analyses Discussion: The presence of 10% or more EGFR expression, LVI, PNI, and histological grade are significantly associated with survival in stage 3 rectal cancer patients who have undergone surgery and received postoperative chemotherapy. These markers can be used as prognostic biomarkers in the follow-up and treatment of these patients

Efficacy and safety of folfiri plus aflibercept in second-line treatment of metastatic colorectal cancer: Real-life data from Turkish oncology group

Aims: The addition of aflibercept to the fluorouracil and irinotecan (FOLFIRI) regimen significantly improved clinical outcomes in patients with metastatic colorectal cancer (CRC) previously treated with oxaliplatin. We aimed to investigate the efficacy and safety of second-line FOLFIRI and aflibercept combination in patients with metastatic CRC in real-life experience. Materials and Methods: Four hundred and thirty-three patients who treated with FOLFIRI and aflibercept in the second-line were included in the study. The clinical and pathological features of the patients were recorded retrospectively. Survival (overall and progression-free survival [PFS]), response rates, and safety data were analyzed. Results: The median age was 61. Majority of patients (87.5%) received first-line bevacizumab and 10.1% of patients received anti-epidermal growth factor receptor agents. About 80% of patients had KRAS, 18.6% of patients had NRAS, and 6.4% of patients had BRAF mutations. The median OS was 11.6 months (95% confidence interval [CI], 10.6-12.6) and the median PFS was 6 months (95% CI, 5.5-6.5). About 4.6% of patients had complete response and 30.6% of patients had partial response as best tumor response. Grade 1-2 toxicities were seen in 33.4% of patients, while grade 3-4 toxicities were recorded in 27% of patients. Eight patients (2%) died due to treatment toxicity. Conclusions: Overall and PFS were similar in routine clinical practice compared to phase III pivotal VELOUR trial. However, response rates were found to be higher. It was observed that there were fewer adverse events compared to the VELOUR trial

Does primary tumor localization has prognostic importance in seminoma patients?: Turkish Oncology Group Study

Purpose: The purpose of this study was to determine whether primary tumor localization may be a risk factor for relapse and survival in seminomatous germ cell tumors (GCT) patients.Methods: In our study, 612 seminomatous GCT patients diagnosed in 22 centers between 01.01.1989 and 03.02.2019 were retrospectively evaluated. Patient interview information, patient files and electronic system data were used for the study.Results: The primary tumor was localized in the right testis in 305 (49.9%) patients and in 307 (50.1%) in the left testis. Mean age of the patients was 36 years (range 16-85 +/- 10.4).The median follow-up period was 47 months (1-298). Recurrence was observed in 78 (127%) patients and 29 (4.7%) died during the follow-up period. Four-year overall survival (OS) was 95.4% and 4-year progression-free survival (PFS) was 84.5%. The relationship between localization and relapse was significant in 197 patients with stage 2 and stage 3 (p=0.003). In this patient group, 41 (20.8%) relapses were observed. Thirty (73.2%) of the relapses were in the right testis and 11 (26.8%) in the left testis.Four-year OS was 92.1% in patients with right tumor; and 98.7% in patients with left tumor (p=0.007). When 612 patients were evaluated with a mean follow-up of 4 years, there was a 6.6% survival advantage in patients with left testicular tumor and this difference was significant (p=0.007).Conclusion: Survival rates of patients with primary right testicular localization were worse compared with left testicular localization, and relapse rates were higher in stage 2 and 3 patients with right testicular localization

Real-life comparison of afatinib and erlotinib in non-small cell lung cancer with rare EGFR exon 18 and exon 20 mutations: a Turkish Oncology Group (TOG) study

Objectives To compare the survival of first- and second-generation tyrosine kinase inhibitors (TKIs) in patients with rare EGFR exon 18 and exon 20 mutation-positive non-small cell lung cancer (NSCLC). Materials and methods We retrospectively evaluated survival characteristics of 125 patients with EGFR exon 18 and exon 20 mutated NSCLC who received erlotinib or afatinib as first line treatment between 2012 and 2021 from 34 oncology centres. Since exon 20 insertion is associated with TKI resistance, these 18 patients were excluded from the study. Results EGFR exon 18 mutations were seen in 60%, exon 20 mutations in 16%, and complex mutations in 24% of the patients with NSCLC who were evaluated for the study. There were 75 patients in erlotinib treated arm and 50 patients in afatinib arm. Patients treated with erlotinib had progression-free survival time (PFS) of 8.0 months and PFS was 7.0 months in the afatinib arm (p = 0.869), while overall survival time (OS) was 20.0 vs 24.8 months, respectively (p = 0.190). PFS of exon 18 mutated arm was 7.0 months, exon 20 mutated arm was 4.3 months, and complex mutation positive group was 17.3 months, and this was statistically significant (p = 0.036). The longest OS was 32.5 months, seen in the complex mutations group, which was not statistically different than exon 18 and in exon 20 mutated groups (21.0 and 21.2 months, respectively) (p = 0.323). Conclusion In this patient group, especially patients with complex mutations are as sensitive to EGFR TKI treatment similar to classical mutations, and in patients with rare exon 18 and exon 20 EGFR mutation both first- and second-generation EGFR-TKIs should be considered, especially as first- and second-line options