Publications by authors named "Çağlayan Selenge Bedük-Esen"

7 Publications

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Gemcitabine based trimodality treatment in patients with muscle invasive bladder cancer: May neutrophil lymphocyte and platelet lymphocyte ratios predict outcomes?

Urol Oncol 2020 Nov 11. Epub 2020 Nov 11.

Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Purpose: Cisplatin based chemoradiation has been commonly used as a definitive treatment for muscle-invasive bladder cancer (MIBC). The aim of the current study is to evaluate oncologic results and toxicity profile of bladder-sparing treatment with external beam radiotherapy (EBRT) and gemcitabine chemotherapy (ChT) in patients with MIBC.

Materials And Methods: Between April 2005 and November 2018 44 patients with nonmetastatic and N0 MIBC were treated with transurethral resection of bladder (TURB), EBRT and concurrent gemcitabine. All patients were staged using thorax-abdomen-pelvic CT and pelvic MRI. EBRT was delivered using 3D conformal technique or intensity modulated radiotherapy. Patients received 50 Gy in 25 to 28 fractions to full bladder followed by a boost dose of 10 Gy in 5 fractions to empty bladder with weekly concurrent gemcitabine of 50 mg/m. All patients were evaluated for age, gender, smoking status, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) at diagnosis, presence of hydroureteronephrosis (HUN), preoperative tumor size, tumor multifocality, presence of CIS, clinical tumor stage. Acute/late genitourinary (GUS) and gastrointestinal (GIS) toxicity, recurrence status, cancer specific survival (CSS) and overall survival (OS) were evaluated. Statistical analysis was performed using SPSS v21.0. Kaplan-Meier survival estimates were calculated to describe CSS and OS. The effect of different parameters on survival was investigated using the log rank test.

Results: Median age of the patients was 72 years (interquartile [IQR]; 66-80). The median tumor size was 30 mm (IQR, 15-59 mm). Thirty-two (77%) patients had T2, 6 (14%) patients had T3, and 4 (9%) patients had T4a disease. Median NLR was 2.6 (IQR, 1.7-3.8) and median PLR was 126.47 (IQR, 77.4-184.8). Median follow-up time was 21 months (range, 6-153 months). At the first TURB performed 6 weeks after CRT, complete response, partial response, stable disease, and progression was detected in 37 (84%), 3 (7%), 1 (2%), and 3 (7%) patients, respectively. One- and 2-year OS, CSS, LRFS, and DMFS rates were 86% and 64%; 88% and 66%; 65% and 44%; 68% and 48%, respectively. In univariate analysis; prognostic factors were age and presence of HUN for OS and DMFS; age, HUN, presence of CIS, NLR, and PLR for DSS; HUN, NLR, and PLR for LRFS, respectively. In multivariate analysis, the independent predictor was the presence of HUN for OS, LRFS, and DMFS; NLR for DSS; PLR for LRFS and age for DMSF. For a subgroup of 17 patients with complete TURB and no CIS and HUN symptoms, 2-year OS, DSS, LRFS, and DMFS rates were 88%, 88%, 72%, and 79%, respectively. The treatment was well-tolerated and all patients completed the planned EBRT and ChT. No acute or late ≥ grade 3 toxicity was observed. Grade II acute GIS toxicity was detected in 3 (7%) patients and grade II acute GUS toxicity was detected in 9 (21%) patients, respectively. Grade II late GUS toxicity was observed in 2 (5%) patients.

Conclusion: Gemcitabine based trimodality treatment is well-tolerated with similar oncologic outcomes reported in the literature. Older age, presence of CIS and high NLR and PLR values seem to deteriorate DSS.
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http://dx.doi.org/10.1016/j.urolonc.2020.11.006DOI Listing
November 2020

Factors affecting post-treatment radiation-induced lung disease in patients receiving stereotactic body radiotherapy to lung.

Radiat Environ Biophys 2021 03 24;60(1):87-92. Epub 2020 Oct 24.

Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.

The aim of the study is to investigate factors that may cause radiation-induced lung disease (RILD) in patients undergoing stereotactic body radiotherapy (SBRT) for lung tumors. Medical records of patients treated between May 2018 and June 2019 with SBRT were retrospectively evaluated. All patients should have a diagnosis of either primary non-small cell lung cancer (NSCLC) or less than three metastases to lung from another primary. The median treatment dose was 50 Gy in 4-5 fractions. Tumor response and RILD were evaluated in thoracic computer tomography (CT) using RECIST criteria. 82 patients with 97 lung lesions were treated. The median age was 68 years (IQR = 62-76). With a median follow-up of 7.2 months (3-18 months), three patients had grade 3 radiation pneumonitis (RP). RILD was observed in 52% of cases. Patients who had RILD had a higher risk of symptomatic RP (p = 0.007). In multivariate analyses older age, previous lung radiotherapy history, and median planning treatment volume (PTV) D95 value of ≥ 48 Gy were associated with RILD. Local recurrence (LR) was observed in 5.1% of cases. There was no difference in overall survival and LR with the presence of RILD. Older age, previous lung radiotherapy history, and median PTV D95 value of ≥ 48 Gy seems to be associated with post-SBRT RILD.
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http://dx.doi.org/10.1007/s00411-020-00878-3DOI Listing
March 2021

Role of vaginal brachytherapy boost following adjuvant external beam radiotherapy in cervical cancer: Turkish Society for Radiation Oncology Gynecologic Group Study (TROD 04-002).

Int J Gynecol Cancer 2021 Feb 30;31(2):185-193. Epub 2020 Sep 30.

Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey.

Objective: There are a limited number of studies supporting vaginal brachytherapy boost to external beam radiotherapy in the adjuvant treatment of cervical cancer. The aim of this study was to assess the impact of the addition of vaginal brachytherapy boost to adjuvant external beam radiotherapy on oncological outcomes and toxicity in patients with cervical cancer.

Methods: Patients treated with post-operative external beam radiotherapy ± chemotherapy ± vaginal brachytherapy between January 2001 and January 2019 were retrospectively evaluated. The treatment outcomes and prognostic factors were analyzed in patients treated with external beam radiotherapy with or without vaginal brachytherapy.

Results: A total of 480 patients were included in the analysis. The median age was 51 years (range 42-60). At least two intermediate risk factors were observed in 51% of patients, while 49% had at least one high-risk factor. The patients in the external beam radiotherapy + vaginal brachytherapy group had worse prognostic factors than the external beam radiotherapy alone group. With a median follow-up time of 56 months (range 33-90), the 5-year overall survival rate was 82%. There was no difference in 5-year overall survival (87% vs 79%, p=0.11), recurrence-free survival (74% vs 71%, p=0.49), local recurrence-free survival (78% vs 76%, p=0.16), and distant metastasis-free survival (85% vs 76%, p=0.09) rates between treatment groups. There was no benefit of addition of vaginal brachytherapy to external beam radiotherapy in patients with positive surgical margins. In multivariate analysis, stage (overall survival and local recurrence-free survival), tumor histology (recurrence-free survival, local recurrence-free survival and distant metastasis-free survival), parametrial invasion (recurrence-free survival and distant metastasis-free survival), lymphovascular space invasion (recurrence-free survival), and lymph node metastasis (distant metastasis-free survival) were found as negative prognostic factors.

Conclusion: Adding vaginal brachytherapy boost to external beam radiotherapy did not provide any benefit in local control or survival in patients with cervical cancer.
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http://dx.doi.org/10.1136/ijgc-2020-001733DOI Listing
February 2021

Role of Hypofractionated Stereotactic Radiosurgery in Recurrent Pineal Parenchymal Tumors of Intermediate Differentiation: A Case Report and Review of the Literature.

Cureus 2020 Aug 13;12(8):e9709. Epub 2020 Aug 13.

Radiation Oncology, Hacettepe University Medical School, Ankara, TUR.

A pineal parenchymal tumor of intermediate differentiation (PPID) is a rare entity, and optimal treatment is still unclear. Combined multimodality treatment should be considered in PPID due to high recurrence rates. Gross total resection is the first choice of treatment, however, it may not be feasible in every case due to location. Stereotactic radiosurgery (SRS) can be considered for the treatment of primary and recurrent disease, as it enables us to deliver a high radiation dose to the target while minimizing radiation exposure to normal tissue. In this report, we present a case treated with hypofractionated SRS for recurrent/metastatic PPID after the primary tumor was controlled with the combination of surgery and conventionally fractionated radiotherapy.
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http://dx.doi.org/10.7759/cureus.9709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489324PMC
August 2020

Using a pessary during radiotherapy in reducible pelvic organ prolapse and vaginal cancer: a case report and review of the literature.

J Contemp Brachytherapy 2020 Apr 11;12(2):175-180. Epub 2020 Feb 11.

Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey.

Purpose: Primary vaginal cancer and pelvic organ prolapse (POP) combination is extremely rare. Although definitive chemoradiotherapy (CRT) and brachytherapy (BT) is the standard treatment for advanced stage primary vaginal cancer, there is a limited data about the treatment of primary vaginal cancer combined with POP due to its rarity. In addition, radiotherapy (RT) process may be difficult in these cases and often result in more toxicity.

Case Presentation: In this case report, we present a 77-year-old woman with a diagnosis of primary vaginal cancer associated with POP, who was treated with definitive CRT using a pessary to restore vaginal anatomy for optimal radiation. Following CRT, complete response was observed and vaginal cuff BT was performed. The patient tolerated the treatment very well and is still alive without disease at 10-months follow-up.

Conclusions: Combined primary vaginal cancer and POP is an extremely rare clinical entity, with only a few cases reported in the literature. When applying CRT in these cases, critical organ doses may be higher than expected due to the downward descent of the pelvic organs. Especially in elderly patients, a pessary can be used as a non-surgical procedure to restore the anatomy for symptom relief during definitive CRT. Additionally, it allows tumors to be targeted more precisely.
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http://dx.doi.org/10.5114/jcb.2020.92997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207234PMC
April 2020

Ewing sarcoma in an infant and review of the literature.

Turk J Pediatr 2019 ;61(5):760-764

Departments of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Bedük Esen ÇS, Gültekin M, Aydın GB, Akyüz C, Karlı Oğuz K, Orhan D, Cengiz M, Gürkaynak M, Yıldız F. Ewing sarcoma in an infant and review of the literature. Turk J Pediatr 2019; 61: 760-764. Ewing sarcoma (ES) is a rare tumor in infants and prognosis is controversial. There are no standard recommendations for treatment in such very young patients. Generally, radiotherapy (RT) is not a part of treatment in infants due to the risk of severe late side effects. In this case report, we report a 7-month-old boy with diagnosis of left mastoid bone ES with lung metastases at diagnosis, showing a rapidly fatal outcome despite aggressive systemic chemotherapy and RT without surgery.
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http://dx.doi.org/10.24953/turkjped.2019.05.016DOI Listing
August 2020

In Regard to Bondiau et al.

Int J Radiat Oncol Biol Phys 2019 07;104(3):694

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.ijrobp.2019.03.019DOI Listing
July 2019