Dosimetric comparison of 3-dimensional conformal technique, intensity-modulated, volumetric arc modulation, and helical tomotherapy with radixact in patients with breast cancer

OBJECTIVE Adjuvant radiotherapy (RT) has been used often at breast cancer treatment. RT techniques differ from each other in terms of accessibility and applicability. We aimed to compare the dosimetric evaluations of four modern RT techniques through ten breast cancer patients that had been treated previously with intensity-modulated RT (IMRT) technique. METHODS A single-center dosimetric study was performed based on treatment plannings of left-sided breast cancer patients. The patient’s images, simulated at computed tomography with deep inspiration breath hold technique between March and June 2023, were used. Four different techniques, field-in-field (FinF), dynamic IMRT (dIMRT), volumetric modulated arc treatment (VMAT), and helical therapy (HT) were created on each patient image. Conformal index (CI) and homogeneity index (HI) were calculated. Mean doses of heart, contralateral breast, volume of doses 5 Grey (Gy) (V5) and 10 Gy (V10) of left lung and total lungs were also calculated for each plan and the descripted and comparisons analysis was performed. RESULTS The better results of CI and HI were reported with dIMRT, VMAT, and HT techniques. However, these approaches were expected with increased percentage of lower doses at organs at risk (OAR). The lowest of V5 of left and total lungs, mean heart, and contralateral breast doses were achieved with FinF tech-niques, HT values were observed similar to FinF by these factors at OAR. Particularly, the lowest V20 value was demonstrated at HT techniques. CONCLUSION Adjuvant RT techniques at breast cancer still carry controversial subtitles. New technologic improvements might be indispensable and treatment plannings should be based on the individual properties of patients

ÖZEL BİR SAĞLIK KURULUŞUNDA ÇALIŞAN HEMŞİRE VE HASTA BAKICILARDA BEL AĞRISI SIKLIĞI VE İLGİLİ OLABİLECEK BAZI RİSK FAKTÖRLERİNİN İNCELENMESİ

Bu çalısma Ankara&#8217; da özel bir saglık kurulusunda çalısan ve yardımcı saglık personeli olarak nitelendirilen hemsire ve hastabakıcılarda bel agrısı sıklıgı ve bel agrısı olusumunu etkileyen bazı risk faktörleri ile iliskisinin incelenmesi amacıyla yapılmıstır. Arastırmada bayındır hastanesi Kavaklıdere ve Sögütözü subelerinde çalısan 195 hemsire, 14 saglık memuru ve 46 hastabakıcı incelenmistir. Bayındır Hastanesi Sögütözü binasında 84 doktor, 205 hemsire, 37 hastabakıcı ve 408 idari personel (tıp teknisyeni, hasta danısmanı, biyolog, eczacı vb) olmak üzere toplam 697 personel görev yapmaktadır. Kavaklıdere binasında ise 35 doktor, 36 hemsire, 15 hastabakıcı ve 89 idari personel olmak üzere toplam 175 personel görev yapmaktadır. Bayındır Hastanesi Kavaklıdere binasında sadece poliklinik hizmeti, Sögütözü binasında ise hem poliklinik hizmeti, hem de yatan hasta hizmeti verilmekte olup iki bina arasında nadiren yer degisikligi yapılabilmektedir. Çalısmada veri kaynagı olarak çalısanların sosyo-demografik özellikleri, hastanede bulundukları sırada meslekleri geregi yaptıkları islerin nitelikleri ve mevcut kas-iskelet sistemi hastalıkları ve bel agrısı yakınmasını varlıgını belirlemeye yönelik olarak bir anket formu kullanılmıstır. Verilerin istatiksel çözümlemesinde tanımlayıcı istatistikler yanında ki-kare testi uygulanmıstır. Verilerin analizi spss- 11.0 programında yapılmıstır. Arastırma sonucunda bel agrısı görülme sıklıgı; hemsirelerde %70.4, hastabakıcılarda %73.9 olmak üzere tüm grupta % 71.4 olarak bulunmustur. Bel agrısı olanların % 74.6&#8217; sının 1-3 yıl arasında bir süredir bel agrısı çektigi belirlenmistir. ncelenenlerde bel agrısı hakkında egitim alanlarda bel agrısı görülme sıklıgı %63.0, bel agrısı hakkında egitim almayanlarda ise %79.5 olarak saptanmıstır. Egitim alanlarda bel agrısı görülme sıklıgı almayanlardan düsük ve fark istatistiksel olarak anlamlı bulunmustur (p<0.05). Yüksek topuklu ayakkabı giydigini belirtenlerde bel agrısı görülme sıklıgı %81.6 olarak belirlenirken, yüksek topuklu ayakkabı giymeyenlerde %68.2 olarak tespit edilmistir. Yüksek topuklu ayakkabı giyenlerde bel agrısı görülme sıklıgı ortalamanın üzerinde tespit edilmis ve yüksek topuklu ayakkabı giyme ile bel agrısı arasında anlamlı bir iliski tespit edilmistir. Çalısmamızda incelenenlerde halen sigara içenlerde bel agrısı görülme sıklıgı %79.4, daha önce içip bırakanlarda %71.8, hiç içmeyenlerde ise %63.3 olarak saptanmıstır. Sigara içenlerde bel agrısı görülme sıklıgı, içmeyenlerden anlamlı olarak yüksek bulunmustur (p<0.05). Bel agrısı nedeniyle doktora basvurma sıklıgı % 29.7 olarak tespit edilmistir. Bel agrısı nedeni ile ilgili konulan tanıların basında % 65.4 ile kas ve bagların zorlanması tanısı gelmektedir. Saglık personelinde bel agrısı görülme sıklıgını azaltmaya yönelik olarak egitim programları düzenlenmesi, gün içinde sıkça yaptıkları ve bel agrısına neden olabilecek hareketleri kolayca yapmalarını saglayacak alet kullanımının yaygınlastırılmasının, bel agrısı görülme sıklıgını azaltmada önemli müdahaleler olacagı düsünülmektedir.This study was carried out to determine low back pain complaints and risk factors that may be related to low back pain among nurses and porters called assistant health care workers in a private hospital. A total of 195 nurses, 14 health technicians and 46 porters who work in Kavaklıdere and Sögütözü departments of Bayindir Hospital were involved in the study. A questionnaire form to determine the sociodemographical characteristics, the kind of duties they perform while working in the hospital, presence of musculoskeletal disorders and low back pain of the participants was used as the data source. Descriptive statistics and chisquare tests were performed by SPSS Version 11.0 statistical package program. As a result, it has been found out that 71.4% of the participants suffer from low back pain, and 74.6% of them stated that pain have been continuing for 1-3 years. It has been found out that %70.4 of nurses and %73.9 of porters suffer low back pain. It has been found out that the frequency of suffering low back among participants educated about low back pain is %63.0 and not educated about low back pain is %79.5. The frequency of suffering low back among participants eduçated about low back pain is less then participants not educated about low back pain and difference is found out significant (p<0.05). It has been found out that %81.6 of the participants wearing high heel shoes suffer low back pain. The frequency of suffering low back among participants wearing high heel shoes is higher than the participants not wering high hell shoes. It has been found out that %79.4 of the participants still smoke suffers low back pain. This frequency is found out %71.8 among participants giving up smoking and %63.3 among never smokers. The frequency of suffering low back pain is found out significantly higher among smoker participants. Most important risk factors are lfiting patients (92.9%) and standing for long hours (91.8%). The prevalence of admission to doctor due to low back pain was found as 29.7%. The participants seen by a physician for low back problems have been diagnosed mostly as injury of muscles and ligaments (65.4%)

Outcomes of patients with anal cancer treated with volumetric-modulated arc therapy or intensity-modulated radiotherapy and concurrent chemotherapy

Aims: To evaluate the results of chemoradiation with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) for the treatment of anal canal cancer patients at three institutions that had advanced devices. Materials and Methods: A retrospective analysis was performed for patients treated with 5-fluorouracil and mitomycin-based chemotherapy and IMRT or VMAT for anal cancer from 2011 to 2013. Complete response (CR) rates, colostomy-free survival (CFS), disease-free survival (DFS), overall survival (OS), and toxicities were investigated. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events, Version 3.0. Results: Fifteen patients were included in the analysis. The majority of patients had T2 (53.3%) and N0 (40%) disease according to the staging system that was developed by the American Joint Committee on Cancer. CR was observed in 14 patients (93%), and the median follow-up was 26 months (13-42 months). The 3-year CFS, DFS, and OS were 86%, 86%, and 88%, respectively. Acute Grade 3 toxicities were observed as 6% of hematological, 26% of gastrointestinal, and 26% of dermatological. Conclusion: Early results confirm that IMRT or VMAT for anal cancer treatment reduces acute toxicities while maintaining high control rates

The Effect of Individual Nutritional Support and Nurse Follow-up on Weight Loss During Radiotherapy in Cancer Patients

Purpose: The aim of this study was to evaluate the nutritional status of patients receiving definitive or adjuvant radiotherapy with head and neck, pelvic, thoracic and intraabdominal tumors and to determine their weight loss. Methods: 40 patients admitted to the radiation oncology outpatient clinic since 01.11.2015 and planned; head, thoracic, abdominal and pelvic radiotherapy, were included in the study. The patients were evaluated before the treatment and in addition to the daily nutrition of the patients, special nutritional support was provided as 35 kcal/kg energy, 2gr/kg protein and 15 mg glutamine daily. The weight loss of the patients evaluated by radiation oncologists and nurses was recorded. Results: The mean age was 61 years (range, 39-86 years). 9 patients with lung cancer were over 70 years old and had definitive radiotherapy. All patients underwent radiotherapy treatment without interrupting treatment, except for an 86-year-old patient scheduled for adjuvant therapy with gastric cancer and two patients with lung cancer receiving chemoradiotherapy. 72% of the patients continued their nutritional support during the entire treatment. When weight loss was evaluated, only 8% of patients had more than 10% weight loss. According to nutritional support, weight loss rates were found to be significantly lower in patients who fully applied for nutritional support (p: 0.003). Conclusion: Early and intense nutritional support of cancer patients with risk of malnutrition may lead to less weight loss during radiotherapy

Neoadjuvant chronomodulated capecitabine with radiotherapy in rectal cancer: a phase II brunch regimen study

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Purpose The aim of this study was to evaluate efficacy and safety of chronomodulated capecitabine administered according to a specific time schedule (Brunch Regimen: Breakfast and Lunch) as a part of neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer. Methods Eighty-five patients with stage II and III rectal cancer were included. Patients received capecitabine (1,650 mg/m2 per day; 60 % dose at 8:00 AM and 40 % dose at 12:00 noon) administered during pelvic radiation (total 50.4 Gy in 28 fractions, 1.8 Gy daily dose between 2:00 p.m. and 4:00 p.m.). After chemoradiotherapy, patients underwent surgery. The primary endpoints were pathological complete response (pCR) rate and toxicity. Results In 17 patients (20 %), total tumor regression was achieved according to Dworak pathological grading system. Grade III diarrhea occurred in nine patients (10.5 %), while only one patient had grade 3 thrombocytopenia. Grade II or III proctitis were seen in nine (10.5 %) subjects, and grade I or II cystitis in six (6.9 %). Only three patients (3.3 %) developed hand and foot syndrome (both grade I–II). There were no grade IV toxicities. Conclusions Brunch Regimen for locally advanced rectal cancer consisting of neoadjuvant chronomodulated capecitabine and concurrent radiation therapy is effective and well tolerated with good safety profile, particularly with regard to the occurrence of hand and foot syndrome, in patients with locally advanced rectal cancer

Impact of Superoxide Dismutase-Gliadin on Radiation-induced Fibrosis: An Experimental Study

Aim: Radiation-induced fibrosis (RIF) has since long been considered as irreversible. Further understanding of its mechanisms has led to trials investigating RIF treatment and prevention. The effect of superoxide dismutase (SOD)-gliadin, an oral form of SOD that resists gastrointestinal inactivation, on RIF treatment was evaluated in this experimental study. Materials and Methods: A total of 36 Wistar albino mice were randomly distributed into four groups. According to group, 25 Gy radiation or sham-radiation were performed on day 0. Acute and late reactions were recorded. After 6 months, mice were treated with SOD-gliadin, 10,000 units per kg per day, or placebo. SOD-gliadin and placebo treatments were administered daily for 8 days by oral gavage. Later the mice were sacrificed, dissected and histopathologically analyzed. Accumulated hyaline and collagen at the dermis is an indicator of fibrosis. Therefore measurements of the dermal thickness were used to quantify the degree of RIF. Additionally, the morphological changes were analyzed, and the differences reported. Results: The mean and standard deviation for dermal thickness were 0.45 +/- 0.09 mm in the sham-irradiated placebo-treated group, 0.51 mm +/- 0.16 mm in the sham-irradiated SOD-gliadin-treated group, 0.92 mm +/- 0.23 mm in the irradiated placebo-treated group and 0.71 mm +/- 0.17 mm in the irradiated SOD-gliadin-treated group. The difference in mean dermal thickness between irradiated placebo-treated and irradiated SOD-gliadin-treated mice was statistically significant (p=0.002). Conclusion: Quality of life while prolonging survival has an increasing importance in patients with cancer. RIF can be a crucial problem after all radiotherapy modalities. SOD-gliadin has advantageous effects on conditions that call for an increased expression of antioxidant enzymes. The results of our study suggest that oral SOD-gliadin may prevent or ameliorate RIF and patients can benefit from the positive effects of SOD

Evaluation of the relationship between serum ghrelin levels and cancer cachexia in patients with locally advanced nonsmall-cell lung cancer treated with chemoradiotherapy

Background: Ghrelin plays a role in mechanisms related to cancer progression - including cell proliferation, invasion and migration, and resistance to apoptosis in the cell lines from several cancers. We investigated the role of ghrelin levels in cancer cachexia-anorexia in patients with locally advanced nonsmall-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT). Materials and Methods: This study involved 84 NSCLC patients who had received concomitant CRT. Blood ghrelin levels were compared before and 3 months after CRT. Meanwhile, changes in body weight of the patients were also investigated with changes in ghrelin levels before and after CRT. Results: Ghrelin levels were significantly decreased in line with changes in patients' weights in patients receiving CRT (P 0.40 g/dL, 0.38 +/- 0.20) when compared with its baseline levels (3.40 +/- 0.55 g/dL,P 0.71,P 6.53 mg/L) when compared with its baseline levels (9.54 +/- 3.80 mg/L,P = 0.038). After RT, ghrelin levels in patients were positively correlated with body mass index (r = 0.830,P < 0.001) and albumin (r = 0.758,P < 0.001). Conclusion: Ghrelin may play a role in the pathogenesis of weight loss in NSCLC patients. Ghrelin seems to be implicated in cancer-related weight loss. Ghrelin, cancer, and RT all together have a role in tumor-related anorexia-cachexia in patients with NSCLC. Results of this study need further evaluation as regards to its potential role as an adjuvant diagnostic or prognostic marker

Neoadjuvant hyperfractionated accelerated radiotherapy plus concomitant 5-fluorouracil infusion in locally advanced rectal cancer: A phase. study

AI

Primary breast lymphoma; disease recurrence

Primary breast lymphoma (PBL) accounts 0.4-0.5% of all breast cancers. The aim is to present the patient diagnosed with recurrency of primary breast lymphoma treated six year ago without radiotherapy. A 63-years-old woman patient admitted to our hospital with a palpabl mass in her left breast. Six years ago she was treated with chemoterapy after local excision for primary left breast lymphoma. Imaging modalities showed multiple lesion in breast and confirmed with biopsy. Pathologic results were similar with first one and the case was accepted as PBL recurrence. Multipl metastases has been determined with staging modalities. Patient started to chemotherapy treatment. PBL is a rare cancer of breast and there is no consensus at the treatment of disease. In the literature addition of radiotherapy to the treatment prevents local recurrence. There were occured recurrence without radiotherapy, mimicked that radiotherapy is an essential modality in PBL treatment

LGALS3 and AXIN1 gene variants playing role in the Wnt/beta-catenin signaling pathway are associated with mucinous component and tumor size in colorectal cancer

The Wnt pathway alterations have been identified in colorectal and many other cancer types. It has been reported that galectin-3 (which is encoded by the LGALS3 gene) alters the signaling mechanism in the Wnt/beta-catenin pathway by binding to beta-catenin in colon and other cancers. AXIN1 is mainly responsible for the assembly of the beta-catenin destruction complex in the Wnt pathway. This study investigated the relationship of rs4644 and rs4652 variants of the LGALS3 gene and rs214250 variants of the AXIN1 gene to histopathological and clinical properties. Our study included a total of 236 patients, of whom 119 had colorectal cancer (42 women, 77 men) and 117 were healthy controls. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) and allele-specific oligonucleotide (ASO) PCR methods were used. In addition, the serum galectin-3 level was studied with the enzyme-linked immunosorbent assay (ELISA) method. For the rs4644 variant of the LGALS(3) gene, the CC genotype a mucinous component was significantly more common than those without a mucinous component (p=0.026). C allele frequency of the rs214250 variant of the AXIN1 gene was significantly correlated to tumor size in the advanced tumor stage (p=0.022). The CCAACT haplotype was more common in colorectal cancer patients (p=0.022). Serum galectin-3 level was higher in the patient group compared to the control group (5.9 +/- 0.69 ng/ml vs. 0.79 +/- 0.01 ng/ml; p<0.001). In conclusion, variants of LGALS3 and AXIN1 genes affect tumor sizes and the mucinous component via Wnt/beta-catenin pathway in the pathogenesis of colorectal cancer