Publications by authors named "Guler Yavas"

33 Publications

Comment on Hunt et al, "Feasibility of magnetic resonance guided radiotherapy for the treatment of bladder cancer".

Clin Transl Radiat Oncol 2021 May 6;28:88-89. Epub 2021 Apr 6.

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

•Bladder cancer patients who are unsuitable for standard radical treatments present a large unfulfilled clinical need.•Hypofractionated RT can be an appropriate solution for these patients; however organ movement and changes in bladder filling is important obstacle for such treatment strategies.•The only way to overcome this obstacle is that using online adaptive image-guided RT.•There is need of new studies evaluating the role of MRgRT for bladder cancer patients.
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http://dx.doi.org/10.1016/j.ctro.2021.03.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065181PMC
May 2021

Effects of Adipose-Derived Stem Cells and Platelet-Rich Plasma for Prevention of Alopecia and Other Skin Complications of Radiotherapy.

Ann Plast Surg 2021 May;86(5):588-597

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

Background: Radiotherapy (RT) involves the use of ionizing radiation in treating malignancies and benign disorders. However, RT damages target and healthy surrounding tissues in a dose-dependent manner. This effectively reduces patient compliance and quality of life, thereby warranting the prevention of RT-induced adverse effects on skin. Adipose-derived stem cells (ASCs) are used to treat RT-induced damage and platelet-rich plasma (PRP) provides a scaffold that potentiates the effects of ASCs. Thus, the aim of this study was to determine the mechanism employed by ASCs and PRP in protecting against RT-induced adverse effects.

Methods: We have established an immunodeficient mouse transplantation model using which human hair follicular units were implanted. When the follicular units were macroscopically and microscopically mature and anagenic, we administered localized RT. Subsequently, the mice were randomly divided into 4 groups based on the subcutaneous injection of the following to the irradiated transplantation site: saline, PRP, ASCs, and a combination of ASCs and PRP. Next, we used macroscopic and microscopic analyses to determine the protective effects of the injected solutions on skin and hair follicles.

Results: Adipose-derived stem cells reduced RT-induced adverse effects, such as impaired wound healing, alopecia, skin atrophy, and fibrosis by suppressing inflammation, dystrophy, degeneration, connective tissue synthesis, and apoptosis and increasing cellular proliferation, differentiation, and signaling. Moreover, these effects were augmented by PRP.

Conclusions: Thus, co-administering ASCs with PRP in mice prevented RT-induced adverse effects and can be tested for use in clinical practice.
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http://dx.doi.org/10.1097/SAP.0000000000002573DOI Listing
May 2021

Delayed Radiation Myelopathy in a Child With Hodgkin Lymphoma and ARTEMIS Mutation.

J Pediatr Hematol Oncol 2021 04;43(3):e404-e407

Departments of Pediatric Hematology and Oncology.

The authors present a case of delayed radiation myelopathy in a 12-year-old girl with Hodgkin lymphoma and Artemis mutation. This is the first of such a case presented in the literature.
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http://dx.doi.org/10.1097/MPH.0000000000001815DOI Listing
April 2021

Comment on De Felice et al, "Intensified Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer in Elderly Patients: Toxicity, Disease Control, and Survival Outcomes".

Clin Colorectal Cancer 2019 12 11;18(4):e368-e369. Epub 2019 Jul 11.

Department of Radiation Oncology, Selcuk University, Konya, Turkey.

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http://dx.doi.org/10.1016/j.clcc.2019.07.002DOI Listing
December 2019

A multi-institutional analysis of sequential versus 'sandwich' adjuvant chemotherapy and radiotherapy for stage IIIC endometrial carcinoma.

J Gynecol Oncol 2019 May;30(3):e28

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

Objective: To analyze the outcomes of sequential or sandwich chemotherapy (ChT) and radiotherapy (RT) in patients with node-positive endometrial cancer (EC).

Methods: Data from 4 centers were collected retrospectively for 179 patients with stage IIIC EC treated with postoperative RT and ChT (paclitaxel and carboplatin). Patients were either treated with 6 cycles of ChT followed by RT (sequential arm; 96 patients) or with 3 cycles of ChT, RT, and an additional 3 cycles of ChT (sandwich arm; 83 patients). Prognostic factors affecting overall survival (OS) and progression-free survival (PFS) were analyzed.

Results: The 5-year OS and PFS rates were 64% and 59%, respectively, with a median follow-up of 41 months (range, 5-167 months). The 5-year OS rates were significantly higher in the sandwich than sequential arms (74% vs. 56%; p=0.03) and the difference for 5-year PFS rates was nearly significant (65% vs. 54%; p=0.05). In univariate analysis, treatment strategy, age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology, rate of myometrial invasion, and grade were prognostic factors for OS and PFS. In multivariate analysis, non-endometrioid histology, advanced FIGO stage, and adjuvant sequential ChT and RT were negative predictors for OS, whereas only non-endometrioid histology was a prognostic factor for PFS.

Conclusion: Postoperative adjuvant ChT and RT for stage IIIC EC patients, either given sequentially or sandwiched, offers excellent clinical efficacy and acceptably low toxicity. Our data support the superiority of the sandwich regimen compared to the sequential strategy in stage IIIC EC patients for OS.
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http://dx.doi.org/10.3802/jgo.2019.30.e28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424855PMC
May 2019

Treatment outcomes of endometrial cancer patients with paraaortic lymph node metastasis: a multi-institutional analysis.

Int J Gynecol Cancer 2019 01;29(1):94-101

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

Objective: To analyze the prognostic factors and treatment outcomes in endometrial cancer patients with paraaortic lymph node metastasis.

Methods: Data from four centers were collected retrospectively for 92 patients with endometrial cancer treated with combined radiotherapy and chemotherapy or adjuvant radiotherapy alone postoperatively, delivered by either the sandwich or sequential method. Prognostic factors affecting overall survival and progression-free survival were analyzed.

Results: The 5-year overall survival and progression-free survival rates were 35 % and 33 %, respectively, after a median follow-up time of 33 months. The 5-year overall survival and progression-free survival rates were significantly higher in patients receiving radiotherapy and chemotherapy postoperatively compared with patients treated with adjuvant radiotherapy alone (P < 0.001 and P < 0.001, respectively). In a subgroup analysis of patients treated with adjuvant combined chemotherapy and radiotherapy, the 5-year overall survival and progression-free survival rates were significantly higher in patients receiving chemotherapy and radiotherapy via the sandwich method compared with patients treated with sequential chemotherapy and radiotherapy (P = 0.02 and P = 0.03, respectively). In the univariate analysis, in addition to treatment strategy, pathology, depth of myometrial invasion, and tumor grade were significant prognostic factors for both overall survival and progression-free survival. In the multivariate analysis, grade III disease, myometrial invasion greater than or equal to 50%, and adjuvant radiotherapy alone were negative predictors for both overall survival and progression-free survival.

Conclusion: We demonstrated that adjuvant combined treatment including radiotherapyand chemotherapy significantly increases overall survival and progression-free survival rates compared with postoperative pelvic and paraaortic radiotherapy.
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http://dx.doi.org/10.1136/ijgc-2018-000029DOI Listing
January 2019

Adjuvant carboplatin and paclitaxel after concurrent cisplatin and radiotherapy in patients with locally advanced cervical cancer.

Int J Gynecol Cancer 2019 01;29(1):42-47

Department of Medical Oncology, Selcuk University, Konya, Turkey.

Introduction: Standard treatment for locally advanced cervical cancer (LACC) includes concomitant chemoradiotherapy (CRT) that typically controls localized disease. However, most patients develop distant metastasis, ultimately leading to death.

Objective: To determine the role of adjuvant carboplatin and paclitaxel for clinical outcomes in patients with LACC.

Methods: Between 2010 and 2017, 109 patients with LACC were retrospectively evaluated. All patients received cisplatin (40 mg/m) with concurrent external-beam radiotherapy (up to 50.4 Gy), followed by intra-cavitary brachytherapy. Forty-six of 109 patients received a median of six cycles (range 3-6 cycles) of adjuvant chemotherapy consisting of paclitaxel (175 mg/m) and carboplatin (CRT + chemotherapy group; area under the curve 5). The remaining 63 patients did not receive adjuvant chemotherapy (CRT group).

Results: Disease-free survival and overall survival after a median follow-up of 24.5 months (range 2.6-94.75 months) were 93.5% and 95.7% and 69.8% and 82.5 % for the CRT + chemotherapy and CRT groups, respectively (p = 0.001, p = 0.012, respectively). No acute grade 3/4 gastrointestinal or genitourinary toxicities were seen during CRT. During adjuvant chemotherapy, the most troublesome side effects were hematologic and neurologic toxicities; however, most were manageable. No chronic grade 3/4 genitourinary toxicities were seen.

Discussion: Adjuvant chemotherapy in patients with LACC significantly improved both disease-free survival and overall survival without increasing unmanageable toxicity. Future larger prospective trials are warranted to verify these findings.
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http://dx.doi.org/10.1136/ijgc-2018-000022DOI Listing
January 2019

Beta-Hydroxy-Beta-Methyl-Butyrate, L-glutamine, and L-arginine Supplementation Improves Radiation-Induce Acute Intestinal Toxicity.

J Diet Suppl 2019 3;16(5):576-591. Epub 2018 Jul 3.

Selcuk University, Department of Medical Oncology , Konya , Turkey.

We aimed to evaluate effects of β-hydroxy-β-methylbutyrate, L-glutamine, and L-arginine (HMB/GLN/ARG) on radiation-induced acute intestinal toxicity. Forty rats were divided into four groups: group (G) 1 was defined as control group, and G2 was radiation therapy (RT) control group. G3 and G4 were HMB/GLN/ARG control and RT plus HMB/GLN/ARG groups, respectively. HMB/GLN/ARG started from day of RT and continued until the animals were sacrificed 10 days after RT. The extent of surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis, crypt distortion, regenerative atypia, vascular dilatation and congestion, and fibrosis were quantified on histological sections of intestinal mucosa. Statistical analyses were performed using the analysis of variance (ANOVA) test. There were significant differences between study groups regarding extent of surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis and crypt distortion, regenerative atypia, vascular dilatation and congestion, and fibrosis ( values were 0.019 for fibrosis, <.001 for the others). Pair-wise comparisons revealed significant differences regarding surface epithelium smoothing, villous atrophy, lamina propria inflammation, cryptitis, vascular dilatation, and congestion between G2 and G4 ( values were <.001, .033, <.001, .007, and <.001, respectively). Fibrosis score was significantly different only between G1 and G2 ( = .015). Immunohistochemical TGF-β score of G2 was significantly higher than G1 and G3 ( values were .006 and .017, respectively). There was no difference between TGF-β staining scores of G2 and G4. Concomitant use of HMB/GLN/ARG appears to ameliorate radiation-induced acute intestinal toxicity; however, this finding should be clarified with further studies.
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http://dx.doi.org/10.1080/19390211.2018.1472709DOI Listing
February 2020

Sleep quality of endometrial cancer survivors and the effect of treatments.

Turk J Obstet Gynecol 2017 Dec 30;14(4):243-248. Epub 2017 Dec 30.

Selçuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey.

Objective: Sleep disorders affect 54.9% of gynaecologic cancer survivors. The effect of treatment methods on sleep quality is not clear. This study evaluated the sleep quality of survivors of endometrial cancer and compared the effects of different treatments on sleep quality.

Materials And Methods: Patients were categorised as surgery (group 1), surgery + brachytherapy (BRT) (group 2), surgery + external beam radiation therapy (EBRT) (group 3), and surgery + EBRT + BRT + chemotherapy (group 4). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The PSQI was completed by the participants before surgery, 1, 3, and 6 months after each treatment was completed. The PSQI scores were compared between the different measurement times and different study groups.

Results: This study enrolled 114 patients with a mean age of 58.1±11 years. The number of participants in each group was 53 (46.5%), 14 (12.3%), 12 (10.5%), and 35 (30.7%), respectively. At baseline, 28 (24.6%) patients reported poor sleep quality. The mean PSQI score reached the maximum level at the second measurement and decreased slightly during follow-up and the change in the PSQI score was significant (p=0.001). Group 3 and group 4 had significantly higher scores from baseline (p<0.008). At time point 3, the differences between the groups were significant. At time point 4, the most prominent effect of treatment on sleep quality was observed in patients with combined chemo-radiotherapy when compared with the other study groups.

Conclusion: Most survivors of endometrial cancer are affected by poor sleep quality during their treatment. To improve these patients' quality of life, this disorder must be considered at each visit and tailored care plans should be developed to meet the women's needs. Further studies are needed to evaluate the long-term results of sleep quality on patients with endometrial cancer.
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http://dx.doi.org/10.4274/tjod.59265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5780569PMC
December 2017

Locally advanced squamous cell cervical cancer in a patient with septate uterus.

J Contemp Brachytherapy 2017 Oct 20;9(5):487-489. Epub 2017 Oct 20.

Department of Radiation Oncology, Selcuk University, Konya, Turkey.

A 33-year-old premenopausal multiparous woman with the history of septate uterus was referred to the hospital with menorrhagia and inter-menstrual bleeding occurring for the last 6 months. Work-up revealed a stage IIB cervical cancer. The patient underwent curative chemo/radiotherapy. The patient's septate uterus presented several difficulties during application. Brachytherapy was applied using standard computed tomography-compatible tandem and ovoids. The high-risk clinical target volume (HR-CTV), intermediate risk CTV, and organs at risk were contoured according to the Groupe Européen de Curiethérapie - European Society for Radiology and Oncology (GEC-ESTRO) guidelines. Treatment was performed via 3-dimensional high-dose-rate technique with Ir, with brachytherapy dose of 28 Gy in 4 fractions/7 Gy each, prescribed to the HR-CTV. Treatment was well tolerated with manageable acute toxicities. To the best of our knowledge, the current case is the second case of septate uterus with locally advanced cervical carcinoma. Due to the lack of guidelines about brachytherapy applications in patients with uterine anomaly and owing to the anatomical anomaly, brachytherapy application is challenging in this patients population.
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http://dx.doi.org/10.5114/jcb.2017.70996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705835PMC
October 2017

Pelvic radiotherapy does not deteriorate the quality of life of women with gynecologic cancers in long-term follow-up: A 2 years prospective single-center study.

J Cancer Res Ther 2017 Jul-Sep;13(3):524-532

Department of Obstetrics and Gynecology, Selcuk University, Konya, Turkey.

Purpose: To evaluate the emotional, sexual and health-related quality of life (HRQoL) concerns of the women with gynecologic malignancy treated with curative radiotherapy (RT).

Patients And Methods: A 100 women with diagnosis of gynecologic malignancy were prospectively enrolled. HRQoL at baseline, at the end of RT and during follow-up was assessed using European Organization for Research and Treatment of Cancer QoL Questionnaire-C30 (EORTC QLQ-C30), EORTC QLQ-cervical cancer module 24, and Hospital Anxiety and Depression Scale.

Results: The appetite loss, diarrhea, fatigue, dyspnea, insomnia, nausea and vomiting, pain scores, and sexual activity and sexual enjoyment scores were deteriorated after RT (P = 0.02 for pain scores and P < 0.001 for all other). Body image scores were higher in patients with endometrial cancer (P < 0.01). The emotional function, nausea and vomiting, body image and symptom experience scores were higher in patients who underwent chemotherapy (P = 0.04 and P = 0.01). All the complaints of patients improved during follow-up period. The global health status scores and the level of depression deteriorated in patients with locoregional recurrent disease and distant metastasis. The anxiety (P = 0.001) and depression (P = 0.007) levels were higher in basal and after-RT visits but then decreased through the subsequent follow-up visits.

Conclusion: Although pelvic RT deteriorated HRQoL in patients with gynecologic malignancy, HRQoL improved during the follow-up period. The progressive disease had a negative impact on HRQoL.
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http://dx.doi.org/10.4103/0973-1482.187243DOI Listing
May 2018

Spironolactone ameliorates the cardiovascular toxicity induced by concomitant trastuzumab and thoracic radiotherapy.

Rep Pract Oncol Radiother 2017 Jul-Aug;22(4):295-302. Epub 2017 May 5.

Selcuk University, Department of Nephrology, Konya, Turkey.

Aim: We aimed to evaluate impact of spironolactone (S) on cardiovascular toxicity of concomitant use of radiotherapy (RT) and trastuzumab (T).

Background: S, an aldosterone receptor antagonist, is known to ameliorate the cardiac damage. S ameliorates anthracycline -induced cardiotoxicity, there is no data regarding to effect of S on both T and radiation-induced cardiotoxicity.

Materials/methods: Eighty rats were divided into eight groups: group (G) 1 was defined as control group. G2, G3 and G4 were RT, S and T groups respectively. G5, G6, G7 and G8 were RT + T, T + S, RT + S and RT + T + S groups respectively. Rats were sacrificed at 6th hour; 21st and 100th days after RT. Heart and thoracic aorta samples were taken for microscopical examination.

Results: Cardiac inflammation and fibrosis scores and; TGF-β expression were not significantly different within study groups at 6th hour and 21st days of RT. By 100th days of RT fibrosis scores and TGF-β expression in cardiac samples were significantly different between study groups (p values were 0.004 and 0.002 respectively). Pair-wise comparisons revealed that both cardiac fibrosis scores and TGF-β expression levels were higher in G5 when compared to G8 ( values were 0.046 and 0.028 respectively). Moreover the TGF-β expression was higher in G5 when compared to G2 ( = 0.046). We could not demonstrate any significant differences with respect to inflammation, fibrosis and TGF-β expression in thoracic aorta samples between study groups.

Conclusions: Although S had a protective effect on cardiac tissue it had no protective effect on thoracic aorta when administered with RT + T.
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http://dx.doi.org/10.1016/j.rpor.2017.01.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422008PMC
May 2017

An aggressive parameningeal rhabdomyosarcoma with multiple spinal cord metastases: a case report and review of the literature.

Childs Nerv Syst 2017 May 12;33(5):843-847. Epub 2016 Dec 12.

Department of Pediatric Hematology and Oncology, Selcuk University, Konya, Turkey.

Purpose: Spinal cord metastasis from rhabdomyosarcoma (RMS) is extremely rare, with three cases reported to date. Herein, we report an aggressive case of RMS of the infratemporal fossa who which developed spinal cord metastases during treatment.

Case Presentation: A 6-year-old girl presented with an enlarging painless mass around her right ear for 3 months. An enhanced magnetic resonance imaging (MRI) revealed a 5 × x4 × x4.5 5 cm mass on her right infratemporal fossa. A tru-cut biopsy was performed, and histopathologic examination revealed the diagnosis of rhabdomyosarcoma. At the time of the diagnosis, cerebrospinal fluid cytology was negative for malignant cells. The patient underwent induction chemotherapy. There was minimal response to chemotherapy, and the patient underwent curative radiotherapy. However, by 12th fraction of RT, the patient developed a progressive weakness on her lower extremity. Spinal MRI revealed multiple gross masses in different parts of the spinal cord. The local radiotherapy was changed toas craniospinal radiotherapy. However, two 2 weeks after the completion of the RT, the patient developed sepsis and expired because of septic shock.

Conclusion: Parameningeal RMS is a peculiar subgroup of RMS, which needs an aggressive approach. Despite aggressive approach, meningeal spread is the most important cause of the treatment failure. We should keept in mind that during the treatment, there can be meningeal spread towards to either the brain or spinal cord; therefore, we should follow -up the patients closely from this aspect.
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http://dx.doi.org/10.1007/s00381-016-3318-5DOI Listing
May 2017

Hyoid osteoradionecrosis accompanied by candida infection.

Kulak Burun Bogaz Ihtis Derg 2015 ;25(5):310-4

Department of Radiation Oncology, Medical Faculty of Selçuk University, 42080 Meram, Konya, Turkey.

Osteoradionecrosis of the hyoid bone is a rare complication of therapeutic irradiation performed for head and neck cancer. In this article, we present a 52-year-old male patient who admitted with severe odynophagia following chemo-radiotherapy administration for tonsil carcinoma. Fluorine-18-fluorodeoxy-glucose positron emission tomography-computed tomography revealed a metabolic activity in hyoid bone. The pathological findings were consistent with fungal infection and hyoid bone necrosis. Hyoid osteoradionecrosis should be kept in mind in patients with intractable dysphagia following irradiation for head and neck tumors.
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http://dx.doi.org/10.5606/kbbihtisas.2015.59219DOI Listing
June 2016

Effect of the percentage of body fat on surgical, clinical and pathological outcomes in women with endometrial cancer.

J Obstet Gynaecol Res 2015 Mar 20;41(3):449-55. Epub 2014 Oct 20.

Department of Obstetrics and Gynecology, Selçuk University Medicine Faculty, Konya, Turkey.

Aim: This study used the measure of percentage of body fat (%BF) to define obesity and evaluated the effect of percentage of %BF on clinical, surgical and pathological features in women with endometrial cancer.

Methods: Between 2011 and 2013, bioelectrical impedance analysis and body size measurements of 94 patients whose endometrial biopsy revealed endometrial cancer were obtained. Patients were divided into two groups according to body mass index (BMI) (normal, < 30 kg/m(2); elevated, ≥ 30 kg/m(2)), and also classified by %BF (normal, < 32%; elevated, ≥ 32%).

Results: The patients' mean age was 55.0 ± 10.9 years. Mean %BF and BMI were 40.8% ± 9.8% and 32.9 ± 7.5, respectively. Eighty-three (88%) patients were obese according to %BF; 54 (57%) were obese according to BMI. Patients with elevated %BF were more likely to have less than 50% myometrial invasion (P = 0.004). Significantly more para-aortic lymph nodes were retrieved in patients with normal %BF or BMI (P < 0.001, P < 0.001). Patients with elevated %BF had longer operating times (P = 0.043) and were more likely to have stage I disease than patients with normal %BF (P < 0.001).

Conclusion: Endometrial cancer patients with an elevated %BF are more likely to have stage I disease and less than 50% myometrial invasion than patients with normal %BF. Defining obesity by BF may provide better estimation of obesity prevalence in patients with endometrial cancer and further understanding the relationship between BF with endometrial cancer may give more information about the effects of obesity on endometrial cancer.
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http://dx.doi.org/10.1111/jog.12554DOI Listing
March 2015

The impact of body mass index on radiotherapy technique in patients with early-stage endometrial cancer: a single-center dosimetric study.

Int J Gynecol Cancer 2014 Nov;24(9):1607-15

*Department of Radiation Oncology, Selcuk University; †Department of Radiation Oncology, Konya Training and Research Hospital; and ‡Department of Obstetrics and Gynecology, Selcuk University.

Objective: We aimed to evaluate the impact of body mass index on radiotherapy (RT) technique in patients with early-stage endometrial cancer.

Materials And Methods: Twenty-seven consecutive patients were included in the study and divided into 3 groups with respect to their body mass index (normal weight, 18.5-24.9 kg/m; overweight, 25-29.9 kg/m; obese, 30-39.9 kg/m). Treatment plans using field-in-field (FIF) and 3-dimensional conformal RT (3D-CRT) were compared for the doses in the planning target volume (PTV), organs-at-risk (OAR) volumes, dose homogeneity index, and monitor unit counts required for the treatment.

Results: The FIF technique was superior to 3D-CRT with respect to the maximum and mean doses received by OAR and dose homogeneity index values. The subgroup analyses revealed that the maximum dose received by the right femur and the mean doses received by the rectum and bladder were significantly reduced only in obese patients (Ps = 0.021, 0.008, and 0.008, respectively). The FIF technique significantly reduced the PTV volumes irradiated with greater than 105% of the prescribed dose (P < 0.001). The volumes of bowel and bone marrow receiving more than the prescribed dose of 30 Gy were significantly reduced only in obese patients (Ps = 0.025 and 0.043, respectively). The volumes of bladder, bowel, and bone marrow receiving more than the prescribed dose of 45 Gy were significantly reduced in only obese patients (Ps = 0.011, 0.011, and 0.008, respectively).

Conclusions: Considering the lower maximum doses in OAR and PTV, we demonstrate the FIF technique to be more advantageous than 3D-CRT during adjuvant RT for early-stage endometrial cancer patients. This advantage is more prominent in obese patients. Therefore, FIF technique represents an effective pelvic RT treatment option for obese patients in clinics that do not have access to or prefer an alternative to intensity-modulated RT.
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http://dx.doi.org/10.1097/IGC.0000000000000298DOI Listing
November 2014

Evaluation of the effect of changes in dose rate on rat lung cells.

Technol Cancer Res Treat 2015 Jun 14;14(3):343-9. Epub 2014 Sep 14.

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

The aim of this study is to evaluate the effect of dose rate (DR) on lung tissue. The rats included in the study were randomly grouped into 3 groups: Group (G) 1 was defined as control group, and in this group rats were sham irradiated. G2 was the group receiving a single dose of 12 Gy in DR of 300 monitor unit (MU)/min. G3 was the group receiving a single dose of 12 Gy in DR of 600 MU/min. Radiotherapy (RT) was applied under general anesthesia with 6-MV photon beams to both lungs. At the 6th and 16th week of the RT, animals from each group were killed for light and electron microscopy evaluation. We evaluated the scores of each group in the 6th and the 16th week and found that in G2, there were significant increases in the perivascular fibrosis (P = .018), interstitial fibrosis (P = .002), total inflammation (P = .040), and total fibrosis (P = .003) scores. In G3, we found statistically significant increases in perivascular fibrosis (P = .001), interstitial fibrosis (P = .002), and total fibrosis scores (P = .029). There was no significant difference in the total inflammation score in G3 (P = .225). When we compare G2 and G3 in the 6th week, we found significant increase in the interstitial thickening (P = .039) and total inflammation (P = .035) scores in G3. Dose rate per fraction may have an impact on normal tissue toxicity. The prominent effect of increased DR in lung tissue is fibrosis which should be kept in mind, especially in cases where higher doses per fraction are used.
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http://dx.doi.org/10.1177/1533034614547450DOI Listing
June 2015

Fluorodeoxyglucose positron emission tomography/computed tomography imaging of a patient with squamous cell carcinoma of prostate.

Case Rep Med 2014 24;2014:860570. Epub 2014 Mar 24.

Department of Nuclear Medicine, Faculty of Medicine, Selcuk University, Selcuklu, Konya, Turkey.

Primary squamous cell carcinoma is an uncommon tumor of the prostate gland. We report a 77-year-old male patient with urinary frequency and constipation. Fine needle biopsy from prostate was suspicious of squamous cell carcinoma of the prostate. Whole body positron emission tomography/computed tomography scan revealed high fluorodeoxyglucose uptake in prostate gland. Transurethral resection confirmed the diagnosis. In contrast to prostatic adenocarcinoma, high fluorodeoxyglucose accumulation was observed in the primary tumor of the prostate gland.
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http://dx.doi.org/10.1155/2014/860570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982275PMC
April 2014

Aggressive rhabdoid meningioma with osseous, papillary and chordoma-like appearance.

Neuropathology 2014 Oct 7;34(5):475-83. Epub 2014 Apr 7.

Department of Pathology, Faculty of Medicine, Selcuk University, Konya, Turkey.

Meningiomas are the most common primary intracranial tumors. They are usually benign and slowly growing; however, they may show histologically malignant features categorizing them into grade II or III of World Health Organization (WHO) classification. Rhabdoid meningioma (RM) is an uncommon meningioma variant categorized as WHO grade III. The clinical course of RM is determined by local recurrences, invasion of adjacent brain and/or dura, widespread leptomeningeal dissemination, remote metastases and fatal clinical outcome. Herein we report a case with recurrent aggressive left occipital parasagittal region RM in which the patient initially declined radiation treatment. The tumor was resected four times in 5 years. Histopathological examination revealed a rhabdoid meningioma with metaplastic, papillary and chordoid differentiation. Six months after her fourth operation the patient died of progressive disease. RM is a rare subtype of malignant meningioma and the role of different adjuvant therapeutic options are still unknown. Clinical presentation, radiological features and pathologic findings of this uncommon tumor are discussed.
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http://dx.doi.org/10.1111/neup.12122DOI Listing
October 2014

Comment on Sridharan V et al., 'effects of radiation on the epidermal growth factor receptor pathway in the heart'.

Int J Radiat Biol 2014 Apr 18;90(4):334-5. Epub 2014 Mar 18.

Selcuk University, Department of Radiation Oncology , Konya.

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http://dx.doi.org/10.3109/09553002.2014.886799DOI Listing
April 2014

Basal renal function reserve and mean kidney dose predict future radiation-induced kidney injury in stomach cancer patients.

Support Care Cancer 2014 Feb 3;22(2):445-51. Epub 2013 Oct 3.

Department of Radiation Oncology, Selcuk University, Konya, Turkey,

Background: Adjuvant chemoradiotherapy (CRT) improves the survival in patients with locally advanced stomach cancer. The kidneys are the major dose-limiting organs for radiotherapy (RT) in upper abdominal cancers. We aimed to evaluate the impact of adjuvant CRT on renal function of patients with stomach cancer.

Material And Methods: Fifty-nine stomach cancer patients who underwent postoperative CRT were included. Demographic parameters (age, gender), and basal and 12th-month biochemical parameters were recorded. Mean kidney dose (MKD) administered was determined. Estimated glomerular filtration rate (eGFR) was calculated by modification of diet in renal disease formula.

Results: Fifty-nine patients were recruited (age 60.8 ± 11.9 years; female/male 25/34; follow-up duration 15.6 ± 9.8 months). Twenty-one patients (35.6 %) had basal eGFR <90 ml/min/1.73 m(2). When the basal and 12th-month eGFR was compared, eGFR decreased in 27 patients (45.8 %), whereas eGFR remained stable in 32 (54.2 %) patients. Cox regression analyses revealed that a MKD ≥1,500 cGy and basal eGFR <90 ml/min/1.73 m(2) significantly increased the risk of a decreased eGFR at 12th month (HR = 2.288, 95 % CI 1.009-5.188, p = 0.048 and HR = 2.854, 95 % CI 1.121-7.262, p = 0.028, respectively).

Conclusion: MKD ≥1,500 cGy and a basal eGFR <90 ml/min/1.73 m(2) significantly increased the risk of a decreased eGFR at 12th month. We suggest that patients with stomach cancer be evaluated for their basal renal reserve prior to RT, and it may be more convenient to further minimize the dose to the kidneys with more sophisticated RT techniques in patients with stomach cancer, more specifically in patients with decreased renal reserve.
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http://dx.doi.org/10.1007/s00520-013-1996-zDOI Listing
February 2014

Intracranial metastasis of neuroblastoma: in two different areas at the same time.

Childs Nerv Syst 2013 Oct 21;29(10):1799-802. Epub 2013 Jun 21.

Faculty of Medicine, Department of Pediatric Hematology and Oncology, Selcuk University, Konya, Turkey,

Introduction: Neuroblastoma (NB) is the most common extracranial solid malignancy in children. The major cause of death from this cancer is metastasis of tumors, and metastasis can be seen in different areas of the body. Metastasis of NB occurs by hematogenous and lymphatic routes. Generally, brain metastases have been reported in only one area of the brain parenchyma.

Case Report: A 4-year-old male patient was treated in our clinic due to the NB that settled in the intra-abdominal region, but the patient presented with headache and nausea approximately 5 months after completion of the treatment. Whereupon, cranial imaging was performed and two masses were detected in the bilateral frontal lobe, and then the patient underwent surgery. Metastatic NB diagnosis was confirmed histopathologically. The patient's chemotherapy treatment is still ongoing.

Conclusion: We report the case of a male patient with two separate metastatic masses in the brain parenchyma, which occurred in two different areas at the same time.
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http://dx.doi.org/10.1007/s00381-013-2203-8DOI Listing
October 2013

Does spironolactone ameliorate trastuzumab-induced cardiac toxicity?

Med Hypotheses 2013 Aug 18;81(2):231-4. Epub 2013 May 18.

Department of Radiation Oncology, Selcuk University, Konya, Turkey.

The ErbB2 receptor is a proto-oncogene associated with a poor prognosis in breast cancer. Trastuzumab, a humanized anti-ErbB2 antibody currently in clinical use, has proven to be an essential tool in the immunotherapy of breast carcinoma. Additionally, ErbB2 is involved in the growth and survival pathway of adult cardiomyocytes which accounts for the trastuzumab-induced cardiotoxicity. Moreover, in metastatic breast cancer patients treated with trastuzumab, endomyocardial biopsy documented focal vacuolar changes, pleomorphic mitochondria, myocardial cell hypertrophy, and mild interstitial fibrosis on electron microscopy without accompanying light microscopic abnormalities, a finding consistent with a reversible pattern of cardiac injury. On the other hand, aldosterone and mineralocorticoid receptor (MR) researches have experienced a revival after the discovery that aldosterone and MR are not only involved in the electrolyte and volume balance but also in the pathophysiological processes of the reno-cardiovascular system. Aldosterone has both genomic and nongenotropic effects on epidermal growth factor receptor (EGFR) expression. Genomic effect induces genomic up-regulation of the EGFR protein expression via EGFR promoter, whereas nongenotropic effect leads to the EGFR transactivation resulting in persistent pathophysiological effects including formation of extracellular matrix and myocardial hypertrophy. Spironolactone, an aldosterone receptor antagonist, is known to ameliorate the cardiac damage. The underlying mechanism for the genomic interactions seem to be the stimulation of the EGFR promoter by aldosterone-bound MR, which then dose-dependently enhances the EGFR protein levels, which may be successively inhibited by spironolactone. By the light of these findings, we hypothesize that spironolactone may ameliorate trastuzumab-induced cardiotoxicity via inhibition of transactivation of the EGFR by aldosterone and reversing myocardial hypertrophy. This issue warrants further studies.
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http://dx.doi.org/10.1016/j.mehy.2013.04.042DOI Listing
August 2013

Comparison of "sandwich chemo-radiotherapy" and six cycles of chemotherapy followed by adjuvant radiotherapy in patients with stage IIIC endometrial cancer: a single center experience.

Arch Gynecol Obstet 2013 Oct 4;288(4):845-50. Epub 2013 Apr 4.

Department of Gynecologic Oncology, Faculty of Medicine, Selcuk University, Tip fakultesi Alaeddin Keykubat Kampusu, Kadin hastalikları ve dogum AD, Selcuklu, 42075, Konya, Turkey,

Objective: To compare "sandwich chemo-radiotherapy" with six cycles of chemotherapy followed by adjuvant radiotherapy with respect to tolerability and acute toxicity.

Materials And Methods: Twenty-five women with surgically staged IIIC endometrial cancer were included. Treatment consisted of either three cycles of paclitaxel (175 mg/m²) and carboplatin (AUC 6) on a q21-day schedule followed by irradiation (45-50.4 Gy) or six cycles of the same chemotherapy followed by radiotherapy. Acute toxicity related to either chemotherapy or radiotherapy was evaluated.

Results: Median age was 61.5 years (range 36-83 years). Eleven patients had sandwich chemo-radiotherapy, and the other 14 patients had 6 cycles of chemotherapy followed by radiotherapy. Three out of the five patients who could not complete all the cycles in the sandwich chemo-radiotherapy group had pelvic and para-aortic radiotherapy. Acute radiotherapy related grade 1-2 gastrointestinal system (GIS) and genitourinary system (GUS) toxicities were observed in 72.8 and 63.6 % of patients, respectively, for sandwich group. Undesired treatment breaks in the course of radiotherapy were observed in six patients for sandwich chemo-radiotherapy and in one patient receiving six cycles of chemotherapy followed by radiotherapy. All the patients who had undesired treatment breaks in the sandwich chemo-radiotherapy group had pelvic and para-aortic radiotherapy.

Conclusion: Sandwich chemo-radiotherapy seems to be more toxic particularly for patients who had pelvic and para-aortic irradiation. Therefore, it might be more convenient to delay radiotherapy after six cycles of chemotherapy for patients with the indication of pelvic para-aortic radiotherapy.
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http://dx.doi.org/10.1007/s00404-013-2817-9DOI Listing
October 2013

The effect of Halofuginone in the amelioration of radiation induced-lung fibrosis.

Med Hypotheses 2013 Apr 23;80(4):357-9. Epub 2013 Jan 23.

Selcuk University, Faculty of Medicine, Department of Radiation Oncology, Konya, Turkey.

The lung is one of the most sensitive organs to ionizing radiation, and damage to normal lung tissue remains a major dose limiting factor for patients receiving radiation to the thorax. Radiation induced lung injury (RILI) which is also named as "radiation pneumonpathy" is a continuous process and regarded as the result of an abnormal healing response. It has been shown that transforming growth factor β-1 (TGF-β1) plays an integral role in the radiation induced lung fibrosis formation by promoting the chemoattraction of fibroblasts and their conversion to myofibroblasts. Halofuginone is a, low molecular weight plant derived alkaloid, isolated from the Dichroa febrifuga plant that exhibits antifibrotic activity and inhibition of type I collagen synthesis. Halofuginone has been shown to protect against radiation induced soft tissue fibrosis by virtue of inhibiting various members of TFG-β signaling pathway. By the light of these findings, we hypothesize that Halofuginone may be able to ameliorate the radiation induced lung fibrosis.
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http://dx.doi.org/10.1016/j.mehy.2013.01.001DOI Listing
April 2013

Dosimetric comparison of 3-dimensional conformal and field-in-field radiotherapy techniques for the adjuvant treatment of early stage endometrial cancer.

Phys Med 2013 Nov 5;29(6):577-82. Epub 2012 Dec 5.

Selcuk University, Faculty of Medicine, Department of Radiation Oncology, 42075 Konya, Turkey. Electronic address:

Background: The purpose of this study is to compare field-in-field radiotherapy (FIF) with conformal radiotherapy (CRT) in terms of dosimetric benefits for early stage endometrial cancer patients.

Materials And Methods: Ten consecutive early stage endometrial cancer patients who underwent adjuvant external beam radiotherapy were included in the study. For each patient, two different treatment plans were created. FIF and CRT plans were compared for doses in the planning target volume (PTV), the organ at risk (OAR) volumes including rectum, bladder, bowel, bilateral femurs and bone marrow, the dose homogeneity index, and the monitor unit counts required for the treatment.

Results: The FIF technique significantly reduced the maximum dose of the PTV, rectum, bladder, bowel, left femur, right femur and bone marrow (p values were: <0.001, 0.031, 0.003, <0.001, 0.001, 0.001 and <0.001 respectively). When the OAR volumes irradiated with >30 and >45 Gy were compared, the results were in favor of the FIF technique. The volumes of rectum, bladder, bowel, left femur, right femur and bone marrow receiving more than the prescription dose of 45 Gy were significantly reduced with FIF technique (p values were 0.016, 0.039, 0.01, 0.04, 0.037 and 0.01 respectively). The dose homogeneity index (DHI) was significantly improved with FIF technique (p < 0.001).

Conclusions: FIF allowed more homogeneous dose distribution in the PTV and reduced the doses received by OAR. Considering the lower maximum doses in the OAR and PTV, FIF technique seems to be more advantageous than CRT during adjuvant radiotherapy for early stage endometrial cancer patients.
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http://dx.doi.org/10.1016/j.ejmp.2012.11.002DOI Listing
November 2013

Amelioration of radiation-induced acute inflammation and mucosal atrophy by beta-hydroxy-beta-methylbutyrate, L-glutamıne, and L-argınıne: results of an experimental study.

Support Care Cancer 2013 Mar 21;21(3):883-8. Epub 2012 Sep 21.

Department of Radiation Oncology, Konya Training and Research Hospital, Konya, Turkey.

Purpose: We aimed to evaluate the effects of β-hydroxy-β-methylbutyrate, L-glutamine, and L-arginine (HMB/Glu/Arg) on radiation-induced acute inflammation and mucosal atrophy in the oral mucosa.

Methods: Twenty-eight rats were divided into four groups. group (G) 1 was defined as control group, and G2 was the radiation therapy (RT) group. G3 and G4 were HMB/Glu/Arg control and 17 Gy RT plus HMB/Glu/Arg groups, respectively. A single dose of 17 Gy RT was given to the head and neck area, and the active supplement consisting of 5.2 g of HMB, 29.6 g arginine, and 29.6 g of glutamine which was equivalent to 60 kg adult dose was calculated for each rat and administrated orally. HMB/Glu/Arg started from the day of RT and continued until the animals were sacrificed 7 days after the RT. The extent of acute inflammation and mucosal atrophy for each rat was quantified with image analysis of histological sections of the oral mucosa.

Results: There were significant differences in terms of epithelial thickness, subepithelial edema, inflammation, and congestion between all groups (p values were <0.001, 0.003, <0.001, and 0.001 for each parameter, respectively). Using HMB/Glu/Arg alone led to hypertrophic changes in the epithelial layer. Moreover, when used with RT, HMB/Glu/Arg reversed radiation-induced epithelial atrophy (p, 0.006) and decreased radiation-induced inflammation at a significant level (p, 0.007).

Conclusion: Concomitant use of HMB/Glu/Arg appears to ameliorate the radiation-induced acute inflammation and mucosal atrophy which represent the early phase of acute oral mucositis; however, this finding should be clarified with further clinical studies.
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http://dx.doi.org/10.1007/s00520-012-1601-xDOI Listing
March 2013

Comparison of the effects of aromatase inhibitors and tamoxifen on radiation-induced lung toxicity: results of an experimental study.

Support Care Cancer 2013 Mar 1;21(3):811-7. Epub 2012 Sep 1.

Selcuklu Faculty of Medicine, Department of Radiation Oncology, Selcuk University, Konya, Turkey.

Purpose: The purpose of this study is to compare the effects of anastrozole, letrozole and tamoxifen on radiation-induced pulmonary fibrosis.

Methods: Eighty female Wistar albino rats were divided into eight groups. Group (G) 1 was defined as control group. G2 was radiation therapy (RT) only group. Groups 3, 4 and 5 were tamoxifen, anastrozole and letrozole control groups respectively. Groups 6, 7 and 8 were RT plus tamoxifen, anastrozole and letrozole groups, respectively. A single dose of 12 Gy RT was given to both lungs. Tamoxifen, anastrozole and letrozole were started 1 week before the RT and continued until the animals were sacrificed 16 weeks after the RT. As an end point, the extent of pulmonary fibrosis for each rat was quantified with image analysis of histological sections of the lung. Kruskal-Wallis and Mann-Whitney U tests were used for statistical analyses.

Results: The congestion, inflammation and pulmonary fibrosis scores were significantly different between all the study groups (p values were <0.001 for each). When compared with RT only group, concomitant RT and tamoxifen group increased the radiation-induced pulmonary fibrosis (p = 0.005). However, using either anastrozole or letrozole with RT did not increase the radiation-induced pulmonary fibrosis (p values were 0.768 and 0.752, respectively).

Conclusion: Concomitant use of tamoxifen with RT seems to increase radiation-induced pulmonary toxicity. However, the use of both anastrozole and letrozole appears to be safe with concomitant RT, without increasing the risk of pulmonary fibrosis. This finding should be clarified with further clinical studies.
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http://dx.doi.org/10.1007/s00520-012-1584-7DOI Listing
March 2013

HER-2 positive primary solid neuroendocrine carcinoma of the breast: a case report and review of the literature.

Breast Cancer 2015 Jul 19;22(4):432-6. Epub 2012 Jun 19.

Department of Radiation Oncology, Selcuklu Faculty of Medicine, Selcuk University, 42075, Konya, Turkey,

Primary pure neuroendocrine carcinoma of the breast is an extremely rare tumor. We report a case of primary solid neuroendocrine carcinoma in a 77-year-old postmenopausal woman who was admitted to the hospital with masses on her right breast and axillary region. Radical mastectomy with axillary lymph node resection was performed. Immunohistochemical stainings of the tumor cells with synaptophysin, GCDFP-15, estrogen, progesterone, and c-erbB-2 were positive. Five of 16 lymph nodes were metastatic. She did not receive adjuvant chemotherapy. After 15 months of follow-up she is free of the disease. Literature review revealed that this is the second case of HER-2 positive primary neuroendocrine tumor of the breast.
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http://dx.doi.org/10.1007/s12282-012-0382-xDOI Listing
July 2015

Prospective assessment of quality of life and psychological distress in patients with gynecologic malignancy: a 1-year prospective study.

Int J Gynecol Cancer 2012 Jul;22(6):1096-101

Department of Radiation Oncology, Selcuklu Faculty of Medicine, Selcuk University, Konya, Turkey.

Objective: Our aim was to evaluate the health-related quality of life (HRQoL) and psychological distress in patients treated with radiotherapy (RT) for gynecologic malignancy.

Methods: Fifty-seven women with either cervical or endometrial cancer were prospectively enrolled. We assessed HRQoL at baseline (after surgery before RT), at the end of RT, and during follow-up (every 3 months thereafter) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 24 (EORTC QLQ-CX24), and Hospital Anxiety and Depression Scale.

Results: We demonstrated changes in appetite loss (P = 0.03), nausea and vomiting (P = 0.02), and role function score (P = 0.003) domains of EORTC QLQ-C30. Only the mean body image score of EORTC QLQ-CX24 was significantly different during follow-up (P = 0.02). Type of surgery, histopathological diagnosis, and the menopausal and marital status of the patients affected baseline body image scores (P = 0.032, 0.004, and 0.019 and 0.005, respectively). Patients who underwent chemotherapy had higher baseline body image scores when compared with patients without any chemotherapy before RT (P = 0.028). All the complaints of patients except body image scores improved during the follow-up period. The baseline and follow-up anxiety and depression scores did not differ significantly.

Conclusions: Although pelvic RT deteriorated HRQoL in gynecologic cancer, patients' improvement in HRQoL during follow-up was observed. Patients receiving RT could be reassured about the improvement of acute adverse effects in the course of treatment.
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http://dx.doi.org/10.1097/IGC.0b013e3182559c03DOI Listing
July 2012