Publications by authors named "Meltem Nalça Andrieu"

15 Publications

  • Page 1 of 1

A Case Report of Primary Breast Angiosarcoma: Clinical Presentation and Outcome After Adjuvant Radiotherapy.

Eur J Breast Health 2020 Oct 30;16(4):290-294. Epub 2020 Mar 30.

Department of Radiation Oncology, Near East University School of Medicine, Nicosia, Turkish Republic of Northern Cyprus.

Angiosarcomas of the breast are infrequent subtypes of sarcoma that are often diagnosed after radiation therapy for primary breast cancer. Primary angiosarcomas (PAS) are rare tumors that constitute 0.04% of all malignant breast tumors. We report a case of a 40-year-old woman with a lump in the right breast and diagnosed as angiosarcoma by pathological evaluation. She underwent simple mastectomy followed by adjuvant radiation. She is alive and disease-free for 66 months although tumor size was large and one surgical margin was tumor positive. Breast angiosarcoma is often in advanced stage at diagnosis and tends to recur locally. Although surgical methods constitute the primary treatment, we believe that a multidisciplinary treatment strategy should be used in high-risk patients with large primary tumors and tumor positive margins.
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http://dx.doi.org/10.5152/ejbh.2020.4984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535994PMC
October 2020

A Case Report of Primary Breast Angiosarcoma: Clinical Presentation and Outcome After Adjuvant Radiotherapy.

Eur J Breast Health 2020 Oct 30;16(4):290-294. Epub 2020 Mar 30.

Department of Radiation Oncology, Near East University School of Medicine, Nicosia, Turkish Republic of Northern Cyprus.

Angiosarcomas of the breast are infrequent subtypes of sarcoma that are often diagnosed after radiation therapy for primary breast cancer. Primary angiosarcomas (PAS) are rare tumors that constitute 0.04% of all malignant breast tumors. We report a case of a 40-year-old woman with a lump in the right breast and diagnosed as angiosarcoma by pathological evaluation. She underwent simple mastectomy followed by adjuvant radiation. She is alive and disease-free for 66 months although tumor size was large and one surgical margin was tumor positive. Breast angiosarcoma is often in advanced stage at diagnosis and tends to recur locally. Although surgical methods constitute the primary treatment, we believe that a multidisciplinary treatment strategy should be used in high-risk patients with large primary tumors and tumor positive margins.
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http://dx.doi.org/10.5152/ejbh.2020.4984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7535994PMC
October 2020

Challenges and differences in external radiation therapy for retinoblastoma: from standard techniques to new developments.

Tumori 2017 Sep 28;103(5):438-442. Epub 2015 Aug 28.

Department of Radiation Oncology, Ankara University School of Medicine, Cebeci Hospital, Ankara - Turkey.

Aims: The purpose of this study is to calculate the treatment plans and to compare the dose distributions and dose-volume histograms (DVH) for 6 external radiotherapy techniques for the treatment of retinoblastoma as well as intensity-modulated radiotherapy (IMRT) and fractionated stereotactic radiotherapy (Cyberknife).

Methods: Treatment plans were developed using 6 techniques, including an en face electron technique (ET), an anterior and lateral wedge photon technique (LFT), a 3D conformal (6 fields) technique (CRT), an inverse plan IMRT, tomotherapy, and conventional focal stereotactic external beam radiotherapy with Cyberknife (SBRT). Dose volume analyses were carried out for each technique.

Results: All techniques except electron provided similar target coverage. When comparing conformal plan with IMRT and SBRT, there was no significant difference in planning target volume dose distribution. The mean volume of ipsilateral bony orbit received more than 20 Gy, a suggested threshold for bone growth inhibition. The V20 Gy was 73% for the ET, 57% for the LFT, 87% for the CRT, 65% for the IMRT, 66% for the tomotherapy, and 2.7% for the SBRT.

Conclusions: This work supports the potential use of IMRT and SBRT to spare normal tissues in these patients.
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http://dx.doi.org/10.5301/tj.5000406DOI Listing
September 2017

Comparison of 2-dimensional and 3-dimensional conformal treatment plans in gastric cancer radiotherapy.

Asian Pac J Cancer Prev 2014 ;15(17):7401-5

Department of Radiation Oncology, Manisa State Hospital, Manisa, Turkey E-mail :

Background: Postoperative chemoradiotherapy is accepted as standard treatment for stage IB-IV, M0 gastric cancer. Radiotherapy (RT) planning of gastric cancer is important because of the low radiation tolerance of surrounding critical organs. The purpose of this study was to compare the dosimetric aspects of 2-dimensional (2D) and 3-dimensional (3D) treatment plans, with the twin aims of evaluating the adequacy of 2D planning fields on coverage of planning target volume (PTV) and 3D conformal plans for both covering PTV and reducing the normal tissue doses.

Materials And Methods: Thirty-six patients with stage II-IV gastric adenocarcinoma were treated with adjuvant chemoradiotherapy using 3DRT. For each patient, a second 2D treatment plan was generated. The two techniques were compared for target volume coverage and dose to normal tissues using dose volume histogram (DVH) analysis.

Results: 3DRT provides more adequate coverage of the target volume. Comparative DVHs for the left kidney and spinal cord demonstrate lower radiation doses with the 3D technique.

Conclusions: 3DRT produced better dose distributions and reduced radiation doses to left kidney and spinal cord compared to the 2D technique. For this reason it can be predicted that 3DRT will result in better tumor control and less normal tissue complications.
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http://dx.doi.org/10.7314/apjcp.2014.15.17.7401DOI Listing
June 2015

Evaluation of the radiation pneumonia development risk in lung cancer cases.

Asian Pac J Cancer Prev 2014 ;15(17):7371-5

Department of Radiation Oncology, Diyarbakir State Hospital, Diyarbakir, Turkey E-mail :

Background: Concurrent chemo-radiotherapy is the recommended standard treatment modality for patients with locally advanced lung cancer. The purpose of three-dimensional conformal radiotherapy (3DCRT) is to minimize normal tissue damage while a high dose can be delivered to the tumor. The most common dose limiting side effect of thoracic RT is radiation pneumonia (RP). In this study we evaluated the relationship between dose-volume histogram parameters and radiation pneumonitis. This study targeted prediction of the possible development of RP and evaluation of the relationship between dose-volume histogram (DVH) parameters and RP in patients undergoing 3DCRT.

Materials And Methods: DVHs of 41 lung cancer patients treated with 3DCRT were evaluated with respect to the development of grade ≥ 2 RP by excluding gross tumor volume (GTV) and planned target volume (PTV) from total (TL) and ipsilateral (IPSI) lung volume.

Results: Were admitted statistically significant for p<0.05.

Conclusions: The cut-off values for V5, V13, V20, V30, V45 and the mean dose of TL-GTV; and V13, V20,V30 and the mean dose of TL-PTV were statistically significant for the development of Grade ≥ 2 RP. No statistically significant results related to the development of Grade ≥ 2 RP were observed for the ipsilateral lung and the evaluation of PTV volume. A controlled and careful evaluation of the dose-volume histograms is important to assess Grade ≥ 2 RP development of the lung cancer patients treated with concurrent chemo-radiotherapy. In the light of the obtained data it can be said that RP development may be avoided by the proper analysis of the dose volume histograms and the application of optimal treatment plans.
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http://dx.doi.org/10.7314/apjcp.2014.15.17.7371DOI Listing
June 2015

Gliosarcoma: a study of four cases.

Rare Tumors 2010 Jun 30;2(2):e37. Epub 2010 Jun 30.

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

Gliosarcomas (GS) are highly malignant and rare tumors of the central nervous system with a poor prognosis. We report here on four patients with GS, the median survival for whom was 9.25 months. Prognosis of GS remains poor, and a multidisciplinary approach (surgery, radiation therapy, and chemotherapy) seems to be associated with slightly more prolonged survival times.
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http://dx.doi.org/10.4081/rt.2010.e37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994509PMC
June 2010

Role of Radionuclide Therapy as Adjuvant to Palliative External Beam Radiotherapy for Painful Multiple Skeletal Metastasis.

World J Oncol 2010 Aug 29;1(4):158-166. Epub 2010 Aug 29.

Ankara University School of Medicine Department of Nuclear Medicine, Turkey.

Background: The aim of this study was to evaluate the palliative efficacy of localized external radiotherapy (RT) combined with systemic radionuclide (RN) therapy in patients who had multiple painful osseous metastases of different primary origins.

Methods: Thirty-three patients initially local external radiotherapy was delivered to the most symptomatic region in all patients. Then they received either Re 186 HEDP or Sm 153 EDTMP. The performance status was assessed according to ECOG scale. Before treatment, at the end of the radiotherapy and after the four weeks of systemic radionuclide therapy, analgesic intake and pain status were recorded by the RTOG scoring system, and EORTC QLQ C30 (Version 3.0 Turkish) questionnaire was performed to evaluate the quality of life.

Results: Improved performances of 33.3% for post radiation therapy and 50% for post radionuclide therapy in the ECOG scale were observed. Statistically significant correlations were found between the primary origins and decreased pain and analgesic intake (p < 0.05), but no differences were observed on the self assessment quality of life questionnaire.

Conclusions: Both Re 186 HEDP, Sm 153 EDTMP are effective and safe in bone pain palliation as an adjuvant to local field radiation therapy of breast and prostate cancer patients, who also continued to receive chemotherapy and/or hormontherapy.
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http://dx.doi.org/10.4021/wjon235wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649856PMC
August 2010

Patterns of care for lung cancer in radiation oncology departments of Turkey.

Int J Radiat Oncol Biol Phys 2008 Dec 15;72(5):1530-7. Epub 2008 Aug 15.

Dokuz Eylul University Medical School, Department of Radiation Oncology, Izmir, Turkey.

Purpose: To determine the patterns of care for lung cancer in Turkish radiation oncology centers.

Methods And Materials: Questionnaire forms from 21 of 24 (87.5%) centers that responded were evaluated.

Results: The most frequent histology was non-small cell lung cancer (NSCLC) (81%). The most common postoperative radiotherapy (RT) indications were close/(+) surgical margins (95%) and presence of pN2 disease (91%). The most common indications for postoperative chemotherapy (CHT) were ">/= IB" disease (19%) and the presence of pN2 disease (19%). In Stage IIIA potentially resectable NSCLC, the most frequent treatment approach was neoadjuvant concomitant chemoradiotherapy (CHRT) (57%). In Stage IIIA unresectable and Stage IIIB disease, the most frequent approach was definitive concomitant CHRT (91%). In limited SCLC, the most common treatment approach was concomitant CHRT with cisplatin+etoposide for cycles 1-3, completion of CHT to cycles 4-6, and finally prophylactic cranial irradiation in patients with complete response (71%). Six cycles of cisplatin + etoposide CHT and palliative thoracic RT, when required, was the most commonly used treatment (81%) in extensive SCLC. Sixty-two percent of centers did not have endobronchial brachytherapy (EBB) facilities.

Conclusion: There is great variation in diagnostic testing, treatment strategies, indications for postoperative RT and CHT, RT features, and EBB availability for LC cases. To establish standards, national guidelines should be prepared using a multidisciplinary approach.
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http://dx.doi.org/10.1016/j.ijrobp.2008.03.035DOI Listing
December 2008

Mid-course thoracic radiotherapy with cisplatin-etoposide chemotherapy in limited-stage small-cell lung cancer.

Med Oncol 2006 ;23(4):499-505

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

Combination chemoradiotherapy is a standard treatment for limited-stage small-cell lung cancer (LSSCLC). However, there is still controversery about the optimal timing of thoracic radiotherapy (TRT). In this study, the outcome of 70 patients who had received TRT at a dose of median 50 Gy (range, 46-60 Gy) with a second or third cycle of chemotherapy (CHT) either concurrently (n=41) or sequentially (n=29) were analyzed retrospectively. All patients were administered a median of five cycles (range, four to six cycles) cisplatin plus etoposide (EP) CHT. Prophylactic cranial radiotherapy was delivered to 30 (43%) patients. The median follow-up for all patients was 15 mo (range, 6-60 mo). The median overall survival was 19 mo in the concurrent arm vs 15 mo in the sequential arm. The 2-yr local control, disease-free survival, and overall survival rates were 60%, 19%, and 36%, respectively. The most common toxicity was esophagitis. However, there were no grade 3-4 esophagitis in either arm. Grade 3-4 hematologic toxicity, on the other hand, appeared significantly more in the concurrent arm (p < 0.001). Mid-course of once-daily TRT at a moderate total dose with CHT failed to show any improvement in survival. Additionally, there were no differences between concurrent and sequential CHT with TRT. However, acceptable toxicity rates support the use of once-daily fractionation to higher total dose of TRT.
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http://dx.doi.org/10.1385/MO:23:4:499DOI Listing
March 2007

Cases of glioblastoma multiforme metastasizing to spinal cord.

Neurol India 2006 Dec;54(4):428-30

Department of Radiation Oncology, Ankara University Faculty of Medicine, Cebeci Hospital, Dikimevi Ankara, Turkey.

Cases of glioblastoma multiforme (GBM) metastasizing to the leptomeninx or the intramedullary spine are quite rare and prognoses are relatively poor. We present three cases of GBM with spinal metastasis, one of which also had leptomeningeal dissemination. Three patients with GBM were admitted to our clinic for postoperative radiotherapy after surgery. Leptomeningeal metastasis and dissemination were diagnosed with magnetic resonance imaging. Radiotherapy provided only temporary relief from pain with small improvement in neurological deficit but no survival advantage.
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http://dx.doi.org/10.4103/0028-3886.28122DOI Listing
December 2006

Ghrelin may reduce radiation-induced mucositis and anorexia in head-neck cancer.

Med Hypotheses 2007 9;68(3):538-40. Epub 2006 Oct 9.

Department of Radiation Oncology, Ankara University School of Medicine, Cebeci Hospital, Dikimevi, Ankara 06590, Turkey.

Body weight loss is common in cancer patients, and is often associated with poor prognosis, it greatly impairs quality of life (QOL). Radiation therapy (RT) is used in head and neck cancers (HNC) either as a primary treatment or as an adjuvant therapy to surgery. Patients with HNC are most susceptible to malnutrition especially due to anorexia, which is aggravated by RT. Multiple pro-inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-1beta (IL-1beta), interferon (IFN)-gamma and tumor necrosis factor-alpha(TNF-alpha), have been all associated with the development of both anorexia and oral mucositis. Radiation-induced mucositis occurs in almost all patients, who are treated for HNC, it could also cause weight loss. Ghrelin is a novel 28-amino acid peptide, which up-regulates body weight through appetite control, increase food intake, down-regulate energy expenditure and induces adiposity. Furthermore, ghrelin inhibits pro-inflammatory cytokines such as IL-1alpha, IL-1beta, TNF-alpha which may cause oral mucositis and aneroxia, which are the results of weight loss. Thus weight loss during RT is an early indicator of nutritional decline, we propose that recombinant ghrelin used prophylactically could be useful as an appetite stimulant; and preventive of mucositis because of its anti-inflammatory effect, it might help patients maintain weight over the course of curative RT of the HNC and can improve specific aspects of QOL. This issue warrants further studies.
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http://dx.doi.org/10.1016/j.mehy.2006.08.022DOI Listing
April 2007

Effects of probiotics on radiation-induced intestinal injury in rats.

Nutrition 2006 Feb;22(2):179-86

Ankara University School of Medicine, Ankara, Turkey.

Objective: Radiotherapy is an important aspect of multimodal cancer therapy, but radiation-induced acute intestinal injury is a common and serious problem. Disruption of morphologic mucosal integrity and normal bacterial microflora after abdominal radiation leads to malabsorption and bacterial translocation.

Methods: Lactobacillus bulgaricus strain isolated from yogurt was given as a probiotic to rats subjected to radiotherapy. On postradiation day 8 rats were killed. Mesenteric lymph nodes, liver, and spleen were excised for microbiologic examinations. Segments of jejunum, ileum, and colon were evaluated for the presence of inflammation, vascularity, and mucus cells.

Results: The results of this study suggest that probiotics may have a protective effect on intestinal mucosa.

Conclusion: Probiotics added as substrates can be given by an oral or enteral route to patients who undergo radiotherapy to prevent radiation-induced enteritis and related malnutrition.
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http://dx.doi.org/10.1016/j.nut.2005.08.003DOI Listing
February 2006

Carnosine may reduce lung injury caused by radiation therapy.

Med Hypotheses 2006 10;66(5):957-9. Epub 2006 Jan 10.

Ankara University School of Medicine, Department of Radiation Oncology, Cebeci Hospital, Dikimevi, Turkey.

Ionising radiation is known one of the most effective tools in the therapy of cancer but in many thoracic cancers, the total prescribed dose of radiation that can be safely administered to the target volume is limited by the risk of complications arising in the normal lung tissue. One of the major reasons for cellular injury after radiation is the formation of reactive oxygen species (ROS). Radiation pneumonitis is an acute phase side-effect which generally subsides after a few weeks and is followed by a chronic phase characterized by inflammation and fibrosis, that can develop months or years after irradiation. Carnosine is a dipeptide composed by the amino acids beta-histidine and l-alanine. The exact biological role of carnosine is not totally understood, but several studies have demonstrated that it possesses strong and specific antioxidant properties, protects against radiation damage,and promotes wound healing. The antioxidant mechanism of carnosine is attributed to its chelating effect against metal ions, superoxide dismutase (SOD)-like activity, ROS and free radicals scavenging ability . Either its antioxidant or anti-inflammatuar properties, we propose that carnosine ameliorates irradiation-induced lung injury. Thus, supplementing cancer patients to whom applied radiation therapy with carnosine, may provide an alleviation of the symptoms due to radiation-induced lung injury. This issue warrants further studies.
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http://dx.doi.org/10.1016/j.mehy.2005.11.023DOI Listing
May 2006

In vivo study to evaluate the protective effects of amifostine on radiation-induced damage of testis tissue.

Oncology 2005 12;69(1):44-51. Epub 2005 Aug 12.

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

Objective: To investigate the early protective effects of amifostine against radiation-induced damage on rat testis tissue.

Methods: Eighty adult male Wistar rats were randomized to 4 groups: Saline solution was given to group A for control, 200 mg/kg amifostine (WR-2721) to group B, a single fraction of 6 Gy local irradiation to testes in group C and 200 mg/kg amifostine 15-30 min before 6 Gy testicular irradiation to group D. Animals were sacrificed 3 weeks after treatment and their testes were removed for macroscopic, microscopic and ultrastructural histopathological examination.

Results: The weights, widths and lengths of testes in the last 3 groups had decreased significantly when compared with the control group, but the decrease in widths after irradiation was found to be significantly less only in the amifostine plus radiation group. There was a significant reduction of testis weights in relation to the individual body weights in the irradiated testes compared with the other groups (p < 0.005), while there was no significant change of testis weight/total body weight ratio in amifostine plus irradiation group. Spermatogonium A and primary spermatocyte counts were also less in the treatment groups, and primary spermatocyte numbers were significantly higher in amifostine plus radiation group when compared with radiation alone group (p < 0.005). Pretreatment with amifostine reduced the decrease of primary spermatocyte counts by a factor of 1.28. Electron microscopic analysis did not show any cytotoxic effect of amifostine alone, and furthermore, ultrastructural findings were normal with the addition of amifostine prior to irradiation, though there was damage in the radiation exposure group.

Conclusion: Amifostine when given alone by itself appears to cause adverse alterations in testis tissue; however, it has a radioprotective effect on spermiogenetic cells when used prior to radiation.
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http://dx.doi.org/10.1159/000087475DOI Listing
September 2005