Publications by authors named "Fazilet Oner Dincbas"

20 Publications

  • Page 1 of 1

Interobserver agreement between interpretations of acute changes after lung stereotactic body radiotherapy.

Strahlenther Onkol 2021 May 24;197(5):423-428. Epub 2020 Nov 24.

Department of Radiation Oncology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Cerrahpaşa Ave. Kocamustafapaşa St. No:34/E Fatih, Istanbul, Turkey.

Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment modality for inoperable early-stage lung cancer or metastatic lung lesions. Post-SBRT, acute radiological lung changes sometimes mimic tumor progression, so over-investigation may be applied. We aimed to reveal the interobserver agreement among physicians regarding acute radiographic changes on CT of the thorax obtained shortly after SBRT MATERIALS AND METHODS: Radiologic images of 20 lesions treated with SBRT were evaluated for acute lung changes. Two physicians, one senior and one junior, from diagnostic radiology, radiation oncology, nuclear medicine, and chest disease departments reviewed these images. The final interpretations were categorized as stable, regression/consolidation, progressive disease, and SBRT-related changes. The evaluations of the physicians were compared with the experienced reference radiation oncologist. The gold standard was accepted as the reference physician's final score. Unweighted Cohen's kappa (κ) coefficient was used for assessing interobserver agreement between physicians.

Results: The evaluations of the physicians were compared with the reference radiation oncologist. The strongest coherence coefficient was found with the senior radiation oncologist (κ: 0.72). The kappa coefficients between the junior radiation oncologist, junior nuclear medicine physician, and the reference physician were 0.61 and 0.55, respectively. The disciplines with the lowest kappa coefficients were junior chest disease and senior radiologist, and the kappa values were 0.37 and 0.44, respectively.

Conclusion: Disciplines dealing with lung cancer treatment may not be aware of the various radiologic changes after SBRT or inexperienced in interpreting them from recurrence. Therefore, physicians must have detailed radiotherapy information such as planning target volume (PTV), dose/fractionation, etc. In addition, final evaluations should be performed in the multidisciplinary team dealing with the treatment of the patient.
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May 2021

Comparison of kV Orthogonal Radiographs and kV-Cone-Beam Computed Tomography Image-Guided Radiotherapy Methods With and Without Implanted Fiducials in Prostate Cancer.

Cureus 2020 Aug 21;12(8):e9916. Epub 2020 Aug 21.

Radiation Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, TUR.

Introduction The aim of this study is to investigate the performance of kilovoltage (kV) cone-beam computed tomography (CBCT)-based adjustments with respect to kV-orthogonal fiducial marker-based matching in a group of patients with prostate cancer.  Methods Twenty prostate cancer patients were evaluated retrospectively: 10 with implanted fiducial markers and 10 without. Daily orthogonal kV imaging was recorded prior to radiation delivery. Images were evaluated in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions by matching either the implanted fiducials or going off bony anatomy, depending on the presence or absence of markers, respectively. Cone-beam computed tomography (CBCT) imaging was also subsequently acquired and images were aligned with the planning CT. The couch shifts were calculated and the patient's position was adjusted accordingly. Standard deviations and random errors were also computed. Pearson correlation and Bland-Altman analysis were performed to evaluate relationships between the datasets. Results A total of 240 images were evaluated. The Pearson correlation coefficient for shifts applied to patients with markers using kV and CBCT was 88.3%, 87.8%, and 94.5% for the LR, AP, and SI directions, respectively. For those without markers, the respective values for the LR, AP, and SI directions were: 39.3%, 22.4%, and 3.7%. A Bland-Altman analysis comparing kV and CBCT in patients with markers, revealed R values of 0.152, 0.282, and 0.097 in the LR, AP, and SI directions, respectively. The R values for patients without markers were 0.008, 0.01, and 0.057, in the LR, AP, and SI directions, respectively. Conclusions Our data suggest that CBCT can be a viable option for image-guidance in clinical settings where fiducial markers are unavailable such as situations of inaccessibility or medical contraindications.
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August 2020

Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study.

Clin Respir J 2020 Nov 17;14(11):1050-1059. Epub 2020 Aug 17.

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

Objective: We identified factors influencing outcomes in patients with medically inoperable early stage lung cancer (MIESLC) treated with stereotactic ablative radiation therapy (SABR) at 14 centers in Turkey.

Materials And Methods: We retrospectively analyzed 431 patients with stage I-II MIESLC treated with SABR from 2009 through 2017. Age; sex; performance score; imaging technique; tumor histology and size; disease stage radiation dose, fraction and biologically effective dose with an α/β ratio of 10 (BED ); tumor location and treatment center were evaluated for associations with overall survival (OS), local control (LC) and toxicity.

Results: Median follow-up time was 27 months (range 1-115); median SABR dose was 54 Gy (range 30-70) given in a median three fractions (range 1-10); median BED was 151 Gy (range 48-180). Tumors were peripheral in 285 patients (66.1%), central in 69 (16%) and <1 cm from mediastinal structures in 77 (17.9%). Response was evaluated with PET/CT in most cases at a median 3 months after SABR. Response rates were: 48% complete, 36.7% partial, 7.9% stable and 7.4% progression. LC rates were 97.1% at 1 year, 92.6% at 2 years and 91.2% at 3 years; corresponding OS rates were 92.6%, 80.6% and 72.7%. On multivariate analysis, BED > 100 Gy (P = .011), adenocarcinoma (P = .025) and complete response on first evaluation (P = .007) predicted favorable LC. BED > 120 Gy (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1-3.2, P = .019) and tumor size (<2 cm HR 1.9, 95% CI 1.3-3, P = .003) predicted favorable OS. No grade 4-5 acute side effects were observed; late effects were grade ≤3 pneumonitis (18 [4.2%]), chest wall pain (11 [2.5%]) and rib fracture (1 [0.2%]).

Conclusion: SABR produced encouraging results, with satisfactory LC and OS and minimal toxicity. BED > 120 Gy was needed for better LC and OS for large, non-adenocarcinoma tumors.
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November 2020

The effect of preoperative radiotherapy on local control and prognosis in high-grade non-metastatic intramedullary osteosarcoma of the extremities.

Arch Orthop Trauma Surg 2020 Jun 6. Epub 2020 Jun 6.

Cerrahpasa Medical Faculty, Department of Radiation Oncology, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Introduction: This study aimed to analyse the effect of preoperative radiotherapy on survival, recurrence and necrosis rates in osteosarcoma patients treated with neoadjuvant chemotherapy and limb-salvage surgery.

Materials And Methods: Osteosarcoma patients who referred to our clinic from 1998 to 2015 were investigated retrospectively. 141 patients with non-metastatic osteosarcoma of the limb who received neoadjuvant chemotherapy and underwent limb-sparing surgery with or without preoperative radiotherapy were included in the study. 73 patients had neoadjuvant chemotherapy only (CT group), while 68 patients had additional preoperative radiotherapy (CT + RT group). 5-year survival, disease-free survival, limb survival, local recurrence, metastasis, complication and necrosis rates were compared between the two groups.

Results: Overall 5-year survival, 5-year disease-free survival, 5-year limb survival rates were 68.5, 64.3, 65.7 for CT group and 72.1, 67.6, 64.7 for CT + RT group, respectively. Preoperative radiotherapy gave similar survival and disease-free survival rates. Limb survival, recurrence and metastasis rates were similar between the groups. The necrosis rate of the lesions was significantly higher in the CT + RT group compared to the CT group.

Conclusion: Preoperative radiotherapy can provide a higher necrosis rate and may allow the resection of unresectable lesions in the treatment of osteosarcoma. CT + RT provided similar 5-year survival despite the larger tumour size compared to CT group. Due to the higher wound complication rate (8.2% in CT, 23.5% in CT + RT group, p = 0.01), CT + RT should be restricted to the lesions with large size or close proximity to neurovascular structures.

Level Of Evidence: Level III; Therapeutic, Retrospective comparative study.
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June 2020

Erectile dysfunction in prostate cancer patients treated with intensity-modulated radiation therapy.

Indian J Cancer 2020 Jan-Mar;57(1):70-75

Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.

Background: Sexual dysfunction is an important side-effect after radiotherapy (RT) for prostate cancer (PCa). The aim of this study was to compare sexual functions of PCa patients before and after intensity-modulated RT and to analyze their correlation with penile bulb (PB) doses and patient characteristics.

Materials And Methods: Forty-two patients who underwent RT ± hormone therapy for PCa between 2010 and 2013 were analyzed. Sexual functions assessed by patient-reported questionnaire and physician reported scale before and 3 years after treatment. The effect of patients' age, prostate volume, testosterone levels, comorbidity, smoking status, tumor stage, RT technique, hormone therapy, and PB doses to sexual functions were investigated.

Results: After 3 years of RT, 64.3% of all patients had a lower erectile score; and 75% of patients who were previously potent (n = 24) had become impotent after treatment. However sexual desire still remained in 75.8% of patients who had desire before treatment (n = 33). Statistical analysis showed that two parameters were correlated with postradiotherapy impotency outcome; PB mean radiation dose (P = 0.033) and testosterone levels (P = 0.032).

Conclusions: RT, despite modern techniques, affects the sexual function of PCa patients in varying degrees. Reducing radiation doses to penile structures may play a role in preventing erectile dysfunction.
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October 2020


Acta Ortop Bras 2019 Jul-Aug;27(4):207-211

Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Radiation Oncology Department, Istanbul, Turkey.

Objective: To assess the prognostic factors and results of limb sparing surgery and postoperative radiotherapy (PORT) in patients with non-metastatic soft tissue sarcomas (STS) of the extremities.

Methods: Between 1980-2007, 114 extremity-located STS treated with PORT were analyzed retrospectively. Tumors were mostly localized in the lower extremities (71,9%). The median radiotherapy (RT) dose was 60.9 Gy. Chemotherapy was administered to 37.7% of the patients. Tumor sizes were between 3-26 cm (median 7 cm). The three most frequent histological types included undifferentiated pleomorphic sarcoma (26.3%), liposarcoma (25.4%), and synovial sarcoma (13.2%). The median follow-up for all patients was 60 months, and 81 months for survivors.

Results: The 5- and 10-year local control (LC) rates were 77% and 70.4%, respectively; actuarial survival rates for 5 and 10 years were 71.8% and 69.1%, respectively. Increasing the dose above 60 Gy for all patients and the patients with positive margins demonstrated a clear benefit on 5-year LC (p=0.03 and p=0.04, respectively). Based on multivariate analysis, the addition of chemotherapy and RT dose were independent prognostic factors for LC. A recurrent presentation significantly affects the disease-free survival.

Conclusions: PORT for STS of the extremities provides good long-term disease control with acceptable toxicity in a multidisciplinary approach. .
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August 2019

The Role of Radiotherapy in the Treatment of Primary or Recurrent Desmoid Tumors and Long-Term Results.

Balkan Med J 2016 May 1;33(3):316-21. Epub 2016 May 1.

Department of Radiation Oncology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.

Background: Desmoid tumors are uncommon and benign mesenchymal neoplasms. The optimal treatment of patients with desmoid tumors is still controversial. Surgery is the primary treatment for locally invasive or recurrent desmoid tumors. Also, radiotherapy is a treatment option for patients at high risk for local failure such as those with positive margins or recurrent and unresectable tumors.

Aims: To report our institutional experience and long-term results of patients with desmoid tumors who received radiotherapy.

Study Design: Retrospective cross-sectional study.

Methods: Between 1980 and 2009, 20 patients who received radiotherapy (RT) in our institution were analyzed. The majority of patients (80%) were referred with a recurrent tumor after previous surgery. Thirteen patients underwent marginal resection, 4 had wide local excision and 3 patients had only biopsy. Resection margin was positive in 15 (75%) patients. All patients received radiation therapy. The median prescribed dose was 60 Gy. Five patients received less than 54 Gy.

Results: The median follow-up time was 77.5 months (28-283 months). Nine patients developed local recurrence after RT. Seven local failures (78%) were in field. Time to local recurrence ranged from 3-165 months (median 33 months). The 2-5 year local control (LC) rates were 80% and 69%, respectively. On univariate analysis, the 5 year local control rate was significantly better in the patients treated with ≥54 Gy than in patients who received <54 Gy (p=0.023). The most common acute side effect was grade 1-2 skin toxicity. As a late side effect of radiotherapy, soft tissue fibrosis was detected in 10 patients and lymphangitis was seen in 1 patient. One patient developed radiation-induced sarcoma.

Conclusion: According to our results, radiotherapy is especially effective in recurrent disease and provides a high local control rate in the patients received more than 54 Gy.
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May 2016

Long-term treatment results in soft tissue sarcomas of the thoracic wall treated with pre-or-postoperative radiotherapy--a single institution experience.

Asian Pac J Cancer Prev 2014 ;15(22):9949-53

Department of Radiation Oncology, Cerrahpasa Medical Faculty, Istanbul University, Turkey E-mail :

Objective: To evaluate the long term results among patients with soft tissue sarcoma of the thoracic wall.

Materials And Methods: Twenty-six patients who were treated with pre-or postoperative radiotherapy between December 1980-December 2007, with a diagnosis of soft tissue sarcoma of the thoracic wall were retrospectively evaluated.

Results: The median age was 44 years (14-85 years) and 15 of them were male. A total of 50% of patients were grade 3. The most common histologic type of tumor was undifferentiated pleomorphic sarcoma (26.9%). Tumor size varied between 2-25 cm (median 6.5 cm). Seventeen of the cases had marginal and 9 had wide local resection. Four cases received preoperative radiotherapy and 22 postoperative radiotherapy. Six of the patients with large and high grade tumors received chemotherapy. Median follow-up time was 82 months (9-309 months). Local recurrence and metastasis was detected in 34.6% and 42.3% of patients, respectively. Five- year local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) were 62%, 38%, 69%, and 76% respectively. On univariate analysis, the patients with positive surgical margins had a markedly lower 5-year LC rate than patients with negative surgical margin, but the difference was not significant (43% vs 78%, p=0.1). Five-year DFS (66% vs 17%) and DSS (92% vs 60%) rates were significantly worse for the patients who had high grade tumors (p=0.01, p=0.008 respectively).

Conclusions: Tumor grade and surgical margin are essential parameters for determining the prognosis of thoracic wall soft tissue sarcoma both in our series and the literature.
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August 2015

Does rectum and bladder dose vary during the course of image-guided radiotherapy in the postprostatectomy setting?

Tumori 2014 Sep-Oct;100(5):529-35

Aims And Background: To assess the variations in actual doses delivered to the rectum and bladder in the course of postprostatectomy radiotherapy using kilovoltage-cone-beam computed tomography datasets acquired during image-guided radiotherapy.

Methods And Study Design: Twenty consecutive patients treated with intensity-modulated or intensity-modulated arc therapy to the prostate bed were retrospectively evaluated. Both the planning tomography and kilovoltage-cone-beam computed tomography were acquired with an empty rectum and a half-full bladder. Target localization was performed on the basis of soft tissue matching using cone-beam computed tomography scans before each treatment fraction. A total of 16 cone-beam computed tomography scans per patient (acquired at the first 5 fractions and twice weekly thereafter) were used for the assessments. The bladder and rectum were re-contoured offline on each cone-beam computed tomography scan by a single physician, and the delivered doses were recalculated. The variations in certain dose-volume parameters for the rectum and bladder (BD2cc, RD 2cc, V40%, V50%, V60%, V65%) were analyzed using the paired t test.

Results: Most of the dose volume variations for rectum and bladder were significantly higher than predicted (P <0.05) for the 320 kilovoltage-cone-beam computed tomography sets, except for the doses received by 2 cc of the bladder and V50 and V60 of the rectum. The dose-volume parameters of the bladder did not meet our criteria of V65 ≤25% and V40 ≤50% in 10% and 20% of the patients, respectively. None of the dose-volume histograms showed rectal V65 ≥17%; however, the rectal V40 ≤35% dose constraint was not met in 11 patients. For all patients, the ANOVA test revealed no significant difference between the variations.

Conclusion: Actual doses delivered during treatment were found to be higher than predicted, but the majority of calculated bladder and rectal doses remained in the limits of our plan acceptance criteria. Interfraction variability of the rectum and bladder is a major concern in the postprostatectomy radiotherapy setting, even when patients are instructed about rectal and bladder preparation before the radiotherapy course. Image guidance with cone-beam computed tomography at each treatment fraction may offer a viable tool to account for interfraction variations of the rectum and bladder throughout the treatment course.
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December 2014

Non-metastatic Ewing's sarcoma family of tumors of bone in adolescents and adults: prognostic factors and clinical outcome-single institution results.

Tumori 2014 Jul-Aug;100(4):452-8

Aims And Background: There is limited data regarding outcomes of Ewing's sarcoma family of tumors in adolescents and adults compared with the same tumors in childhood. The aim of the study was to analyze prognostic factors and treatment results in a cohort of adolescents and adults with non-metastatic skeletal Ewing's sarcoma family of tumors.

Methods And Study Design: From 1992-2008, 90 adolescents and adults with Ewing's sarcoma family of tumors of the bone were referred to our institution. Sixty-five (72%) non-metastatic patients with analyzable data and treated in our institution were retrospectively evaluated. All patients were treated with alternated chemotherapy regimens administered every 3 weeks. The local treatment modality was selected according to tumor and patient characteristics.

Results: The median age was 21 years (range, 13-50). Most patients (74%) were >17 years of age. Forty-six percent of the tumors were located in the extremities. Local therapy was surgery in 45 patients and radiotherapy alone in 19 patients. Twenty-one patients received preoperative and 13 patients postoperative radiotherapy. Median follow-up was 43 months (range, 7-167). The 5-year event-free and overall survival rates for all patients were 44% and 49%, respectively. On univariate survival analysis, event-free and overall survival were worse for patients >17 years of age, tumor size >8 cm in diameter, an axial location, positive surgical margins, and poor histopathological response (<90% necrosis). Age, tumor site and tumor size on event-free and overall survival remained significant on multivariate analysis.

Conclusions: We identified age, tumor size, and tumor site as independent prognostic factors, in accord with the Western literature. These patients require novel treatment modalities.
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December 2014

Neoadjuvant treatment with preoperative radiotherapy for extremity soft tissue sarcomas: long-term results from a single institution in Turkey.

Asian Pac J Cancer Prev 2014 ;15(4):1775-81

Department of Radiation Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey E-mail :

Background: To assess the long term clinical outcome of preoperative radiotherapy with or without chemotherapy followed by limb sparing surgery in patients with non-metastatic soft tissue sarcomas (STS) of the extremities.

Materials And Methods: Sixty patients with locally advanced STS were retrospectively analyzed. The median tumor diameter was 12 cm. All patients were treated with preoperative radiotherapy delivered with two different fractionation schedules (35Gy/10fr or 46-50Gy/23-25fr). Neoadjuvant chemotherapy was added to 44 patients with large and/or high grade tumors. Surgery was performed 2-6 weeks after radiotherapy. Chemotherapy was completed up to 6 courses after surgery in patients who had good responses.

Results: Median follow-up time was 67 months (8-268 months). All of the patients had limb sparing surgery. The 5-year local control (LC), disease free (DFS) and overall survival (OSS) rates for all of the patients were 81%, 48.1% and 68.3% respectively. 5-year LC, DFS and cause specific survival (CSS) were 81.7%, 47%, 69.8%, and 80%, 60%, 60% in the chemoradiotherapy and radiotherapy groups, respectively. On univariate analysis, patients who were treated with hypofractionation experienced significantly superior LC, DFS and CSS rates with similar rates of late toxicity when compared with patients who were treated with conventional fractionation and statistical significance was retained on multivariate analysis.

Conclusions: Treatment results are consistent with the literature. As neoadjuvant chemoradiotherapy provides effective LC and CSS with acceptable morbidity, it should be preferred for patients with large and borderline resectable STS.
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November 2014

Extraskeletal Ewing's sarcoma family of tumors in adults: prognostic factors and clinical outcome.

Jpn J Clin Oncol 2012 May 12;42(5):420-6. Epub 2012 Mar 12.

Department of Medical Oncology, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.

Objective: The aim of this study was to evaluate prognostic factors, survival rate and the efficacy of the treatment modalities used in patients with extraskeletal Ewing's sarcoma.

Methods: Data of patients with extraskeletal Ewing's sarcoma followed up at our center between 1997 and 2010 were retrospectively analyzed.

Results: The median age of 27 patients was 24 years (range, 16-54 years). The median follow-up was 31.8 months (range, 6-144 months). Tumor size was between 1.5 and 14 cm (median: 8 cm). Eighty-five percent of patients had localized disease at presentation and 15% had metastatic disease. Local therapy was surgery alone in 16% of patients, surgery combined with radiotherapy in 42% and radiotherapy alone in 27%. All patients were treated with vincristine, doxorubicin, cyclophosphamide and actinomycin-D, alternating with ifosfamide and etoposide every 3 weeks. In patients with localized disease at presentation, the 5-year event-free survival and overall survival were 59.7 and 64.5%, respectively. At univariate analysis, patients with tumor size ≥ 8 cm, high serum lactate dehydrogenase, metastasis at presentation, poor histological response to chemotherapy and positive surgical margin had significantly worse event-free survival. The significant predictors of worse overall survival at univariate analysis were tumor size 8 ≥ cm, high lactate dehydrogenase, metastasis at presentation, poor histological response to chemotherapy, radiotherapy only as local treatment and positive surgical margin.

Conclusions: Prognostic factors were similar to primary osseous Ewing's sarcomas. Adequate surgical resection, aggressive chemotherapy (vincristine, doxorubicin, cyclophosphamide and actinomycin-D alternating with ifosfamide and etoposide) and radiotherapy if indicated are the recommended therapy for patients with extraskeletal Ewing's sarcoma.
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May 2012

Adult langerhans cell histiocytosis of bones : a rare cancer network study.

Acta Orthop Belg 2010 Oct;76(5):663-8

Rare Cancer Network (RCN).

Langerhans Cell Histiocytosis (LCH) is an uncommon benign bone tumour typically seen in children. LCH of bones in adults has been reported as solitary cases. The aim of the current study is to analyze different treatment approaches and the role of radiotherapy (RT) in adult LCH. Thirty patients from five Rare Network Cancer centers were included in this retrospective study. Median age was 30 years. The localization of tumours was skull bones in 12 (40%), lower extremity in 6 (20%), thoracic bones in 4 (133%), spine in 3 (10%), pelvis in 2 (6.7%) and multiple sites in 3 (10%) patients. Primary treatment was surgery in 1 (33%), surgery+ radiotherapy (RT) in 15 (50%), RT in 12 (40%), RT + CHT in 1 (33%) and corticosteroids in 1 (33%) patient. Median follow-up was 58 months. Complete remission was obtained in 21 (70%), partial remission in 4 (133%); 2 lesions were stable (6.7%) and progression was noted in 2 (6.7%) of the patients. Nine patients (30%) had recurrent disease. Recurrence rates were significantly lower in patients who were treated with surgery and RT (p < 0.003). Surgery plays a major role in the treatment of adult LCH of bones ; radiotherapy should be considered in the adjuvant setting and palliation.
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October 2010

The role of amifostine on late normal tissue damage induced by pelvic radiotherapy with concomitant gemcitabine: an in vivo study.

Med Oncol 2009 Dec 30;26(4):402-8. Epub 2008 Nov 30.

Department of Radiation Oncology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, 34303 Istanbul, Turkey.

In this in vivo study, we aimed to assess the radioprotective effect of amifostine on late normal tissue damage induced by gemcitabine concomitant with pelvic radiotherapy by histopathological and quantitative methods. Fifty-six male Wistar albino rats were randomly divided into seven experimental groups as follows: (I) gemcitabine, (II) radiation + gemcitabine, (III) radiation + gemcitabine + amifostine, (IV) radiation + amifostine, (V) sham radiation, (VI) amifostine, (VII) radiation. Irradiation was given to pelvic region with a dose of 25 Gy in 5 fractions. Amifostine was given for 30 min; gemcitabine was administered 24 h before the first fraction of radiotherapy. All animals were killed at the end of 4th month. Pathological examination was performed and the tissue collagen content was measured in bladder and rectal tissues. Fifty-one animals that were alive at the end of the follow-up period were analyzed. Thirty-five animals (68.6%) revealed grades I-III late effect in histopathological examination. We observed grade III colitis in 1 animal (radiation + gemcitabine) and bladder fibrosis in 4 animals (radiation and radiation + gemcitabine groups). There was no significant difference between any groups for bladder cystitis and fibrosis by Kruskal-Wallis method. Colitis was seen significantly lower in the radiation + gemcitabine + amifostine group (P = 0.0005). The collagen contents in the bladder and rectum of radiation and radiation + gemcitabine groups were markedly increased as compared to the sham group. This effect was reversed in the groups which received amifostine in addition to radiation and radiation + gemcitabine groups, but this difference was not significant. This study demonstrated that amifostine may have a beneficial effect in limiting rectal colitis from the radiosensitizing effect of gemcitabine.
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December 2009

Small cell carcinoma of the bladder: a case report and review of the literature.

Int Urol Nephrol 2006 ;38(1):15-9

Department of Urology, Cerrahpasa School of Medicine, University of Istanbul, Istanbul, Turkey.

Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an aggressive tumor with an average five-year survival rate of less than 10% as cited by multiple case reports. We report a 48 year-old male patient with primary small cell neuroendocrine carcinoma of the bladder who was treated with TUR-T, adjuvant carboplatin-based chemotherapy and radiotherapy. The patient is free of disease at the end of 30 months with a normally functioning bladder.
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August 2006

Outcomes and patterns of failure in solitary plasmacytoma: a multicenter Rare Cancer Network study of 258 patients.

Int J Radiat Oncol Biol Phys 2006 Jan 17;64(1):210-7. Epub 2005 Oct 17.

Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Purpose: To assess the outcomes and patterns of failure in solitary plasmacytoma (SP).

Methods And Materials: The data from 258 patients with bone (n = 206) or extramedullary (n = 52) SP without evidence of multiple myeloma (MM) were collected. A histopathologic diagnosis was obtained for all patients. Most (n = 214) of the patients received radiotherapy (RT) alone; 34 received chemotherapy and RT, and 8 surgery alone. The median radiation dose was 40 Gy. The median follow-up was 56 months (range 7-245).

Results: The median time to MM development was 21 months (range 2-135), with a 5-year probability of 45%. The 5-year overall survival, disease-free survival, and local control rate was 74%, 50%, and 86%, respectively. On multivariate analyses, the favorable factors were younger age and tumor size <4 cm for survival; younger age, extramedullary localization, and RT for disease-free survival; and small tumor and RT for local control. Bone localization was the only predictor of MM development. No dose-response relationship was found for doses >30 Gy, even for larger tumors.

Conclusion: Progression to MM remains the main problem. Patients with extramedullary SP had the best outcomes, especially when treated with moderate-dose RT. Chemotherapy and/or novel therapies should be investigated for bone or bulky extramedullary SP.
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January 2006

Unusual cause of dysphagia: inflammatory pseudotumor of the lung.

South Med J 2005 Jun;98(6):665-8

Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Inflammatory pseudotumor (IPT) is a rare disease that usually occurs in the lung. Patients with IPT are usually asymptomatic, with a solitary pulmonary nodule or mass detected on routine chest roentgenogram. IPT can behave as a malignant tumor both clinically and radiologically. Cough, fever, dyspnea, and hemoptysis are the usual presenting symptoms. This report describes the case of a 37-year-old man with a 4-month course of dysphagia secondary to lower esophageal invasion by the posterior mediastinal extension of a lung IPT.
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June 2005

The role of preoperative radiotherapy in nonmetastatic high-grade osteosarcoma of the extremities for limb-sparing surgery.

Int J Radiat Oncol Biol Phys 2005 Jul;62(3):820-8

Department of Radiation Oncology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.

Purpose: To assess the role of preoperative radiotherapy in patients with nonmetastatic high-grade osteosarcoma of the extremities for limb-sparing surgery and to compare the response of neoadjuvant therapies, local control, and survival with the literature results.

Methods And Materials: Forty-six patients with osteosarcoma of the limbs who were treated within a limb salvage protocol including preoperative radiotherapy and chemotherapy between 1987 and 2002, were retrospectively analyzed. Median age was 17 years (range, 14-66 years). Treatment was started with neoadjuvant chemotherapy. Cisplatin, epidoxorubicin, ifosfamide, and methotrexate were used in different combinations. Preoperative radiotherapy was applied, usually between the second and third cycle of chemotherapy. Radiotherapy was given (35 Gy in 10 fractions) to 44 patients. Two patients were treated with 46 Gy at 2 Gy/day. Definitive surgery was administered after the third course of chemotherapy. Chemotherapy was complete 6 courses postsurgery.

Results: Median follow-up time was 44 months (range, 2-154 months). Forty-four patients had limb-sparing surgery, whereas 2 had amputation. Tumor necrosis rate was >/=90% in 87% of the patients (Huvos Grade 3-4). Two patients had local failures, and 26 patients (56.5%) had distant metastases. The 5-year local control and overall survival rates were 97.5% and 48.4%, respectively. On univariate analysis, age
Conclusion: Preoperative radiotherapy helps to increase the chance of extremity-sparing surgery with good local control and necrosis rate when combined with chemotherapy.
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July 2005

Results and complications of high dose rate and low dose rate brachytherapy in carcinoma of the cervix: Cerrahpaşa experience.

Radiother Oncol 2003 Apr;67(1):97-105

Department of Radiation Oncology, Cerrahpaşa Medical School, Istanbul University, 34303, Istanbul, Turkey.

Purpose: To evaluate the results and complications of treatment with high dose rate (HDR) compared to low dose rate (LDR) brachytherapy in cervical carcinoma.

Methods: Three hundred and seventy patients who were treated with external irradiation and intracavitary brachytherapy and followed for more than 2 years between 1978 and 1998 have been recently updated. The low dose rate group consisted of 77 cases treated between 1978 and 1982 and HDR group consisted of 293 cases treated between 1982 and 1998. All patients first received external irradiation with 60Co or 9-18 MV photons and a median dose of 54 Gy was given in 6 weeks. In the LDR group, intracavitary treatment was given with Manchester applicators loaded with radium (30 mg) in an intrauterine tube and 20 mg in vaginal ovoids. The dose delivered to point A was on average 32 Gy in one application. In the HDR group, a total dose of 24 Gy was given to point A in three insertions 1 week apart. The dose rate was 0.62 Gy at point A.

Results: The 5-year pelvic control rate was found to be 73% in the HDR group, compared with 86% in the radium group for stage I cases. In stage IIB and IIIB cases, the rates were 68% and 45% for HDR and 65% and 53% for LDR, respectively. In all stages, there was no statistical difference in pelvic control and survival rates between the two groups. Overall incidence of late complications was found as 31.1% and 31.9% in HDR and LDR groups, respectively. The grade 2-4 late complication rate was 14% in the HDR group compared to 19% in the LDR group (P>0.05).

Conclusion: HDR brachytherapy in the management of the cervix appears to be a safe and efficacious approach. Pelvic control, survival and complications rates are quite similar when compared with LDR.
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April 2003