Publications by authors named "Murat Beyzadeoğlu"

58 Publications

Concise review of stereotactic irradiation for pediatric glial neoplasms: Current concepts and future directions.

World J Methodol 2021 May 20;11(3):61-74. Epub 2021 May 20.

Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey.

Brain tumors, which are among the most common solid tumors in childhood, remain a leading cause of cancer-related mortality in pediatric population. Gliomas, which may be broadly categorized as low grade glioma and high grade glioma, account for the majority of brain tumors in children. Expectant management, surgery, radiation therapy (RT), chemotherapy, targeted therapy or combinations of these modalities may be used for management of pediatric gliomas. Several patient, tumor and treatment-related characteristics including age, lesion size, grade, location, phenotypic and genotypic features, symptomatology, predicted outcomes and toxicity profile of available therapeutic options should be considered in decision making for optimal treatment. Management of pediatric gliomas poses a formidable challenge to the physicians due to concerns about treatment induced toxicity. Adverse effects of therapy may include neurological deficits, hemiparesis, dysphagia, ataxia, spasticity, endocrine sequelae, neurocognitive and communication impairment, deterioration in quality of life, adverse socioeconomic consequences, and secondary cancers. Nevertheless, improved understanding of molecular pathology and technological advancements may pave the way for progress in management of pediatric glial neoplasms. Multidisciplinary management with close collaboration of disciplines including pediatric oncology, surgery, and radiation oncology is warranted to achieve optimal therapeutic outcomes. In the context of RT, stereotactic irradiation is a viable treatment modality for several central nervous system disorders and brain tumors. Considering the importance of minimizing adverse effects of irradiation, radiosurgery has attracted great attention for clinical applications in both adults and children. Radiosurgical applications offer great potential for improving the toxicity profile of radiation delivery by focused and precise targeting of well-defined tumors under stereotactic immobilization and image guidance. Herein, we provide a concise review of stereotactic irradiation for pediatric glial neoplasms in light of the literature.
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http://dx.doi.org/10.5662/wjm.v11.i3.61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127424PMC
May 2021

Dosimetric evaluation of the effect of dental restorative materials in head and neck radiotherapy.

Indian J Cancer 2021 Jan 27. Epub 2021 Jan 27.

Department of Radiation Oncology, University of Health Sciences, Ankara, Turkey.

Background: The aim of our study is to assess the dose enhancement from scattered radiation due to dental restorative materials used for occlusal and mesio-occlusal-distal (MOD) cavity filling during simulated head and neck radiotherapy.

Methods: We have studied the dose enhancement ratio (DER) of conventional amalgam, high-copper amalgam, and resin composite dental restorative materials at cadaver mandible teeth using 2 therapeutic photon energies of 1.25 MeV (Co-60 gamma ray) and 6 MV (Linac X-ray) for irradiation.

Results: DER values at buccal position for Co-60 and 6 MV X-ray were 1.250 ± 0.013 and 1.151 ± 0.012, respectively. For dental cavity fillings, DER values for 6 MV X-ray were 1.065 ± 0.021, 1.100 ± 0.014, and 1.162 ± 0.016 for resin composite filling, low-copper amalgam filling, and high-copper amalgam filling, respectively. Our results revealed that DER regarding irradiation energy was minimum for 6 MV X-rays. With respect to dental restorative filling material, DER was minimum for resin composite filling. Regarding the cavity type, our results with standard deviation (SD) calculations revealed that DER was slightly but not significantly different for both Co-60 gamma ray (1.25 MeV) and 6 MV X-ray energies for both occlusal and MOD cavities.

Conclusion: Our dosimetric results for a single beam geometry suggest that, among the three types of filling, resin composite filling is an ideal restorative filling material with minimal morbidity-inducing radiation dose enhancement that may result in increased osteoradionecrosis and secondary caries risk. There is a need for further dosimetric studies with actual clinical beam arrangements.
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http://dx.doi.org/10.4103/ijc.IJC_897_19DOI Listing
January 2021

Evaluation of breathing-adapted radiation therapy for right-sided early stage breast cancer patients.

Indian J Cancer 2021 Apr-Jun;58(2):195-200

Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Gn.TevfikSaglam Cad., Etlik, 06018, Kecioren, Ankara, Turkey.

Background: Adverse effects of breast irradiation have been an important concern given the increased survival of early stage breast cancer (ESBC) patients with more effective treatments. However, there is paucity of data on the utility of Active Breathing Control (ABC) technique for right-sided ESBC patients. In this study, we assessed the incorporation of ABC into adjuvant Radiation Therapy (RT) of right-sided ESBC patients and report our dosimetric results.

Methods: Thirty-six patients receiving whole breast irradiation followed by a sequential tumor bed boost were included in the study. All patients received field-in-field intensity modulated radiation therapy with incorporation of active breathing control-moderate deep inspiration breath-hold (ABC-mDIBH) after breast conserving surgery. Dose-volume parameters in both plans with and without ABC-mDIBH were compared using Mann-Whitney U test.

Results: Mean lung dose decreased from 7 Gy to 5.2 Gy (26% reduction) for the total lung (p < 0.001) and from 12.6 to 9.4 Gy (25% reduction) for the ipsilateral lung (p < 0.001). Mean dose decreased from 4.6 Gy to 1.7 Gy (58% reduction) for liver (p < 0.001) and 1.7 Gy to 1.4 Gy (16% reduction) for the heart (p < 0.001).

Conclusion: Our study revealed that incorporation of ABC-mDIBH into adjuvant RT of right-sided ESBC patients results in significantly improved critical organ sparing.
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http://dx.doi.org/10.4103/ijc.IJC_140_19DOI Listing
January 2021

Comparative Evaluation of Topical Corticosteroid and Moisturizer in the Prevention of Radiodermatitis in Breast Cancer Radiotherapy.

Indian J Dermatol 2020 Jul-Aug;65(4):279-283

Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey.

Background: Radiodermatitis is a frequent side effect of breast cancer radiotherapy (RT). Treating radiation oncologist should know the prevention and treatment of every grade of radiodermatitis.

Aims: The aim of this study was to compare the topical corticosteroid and moisturizer usage in breast cancer RT.

Materials And Methods: Fifty patients with early-stage breast cancer undergoing breast-conserving surgery referred to our department for adjuvant RT between October 2009 and October 2016 were compared with regard to topical steroid or moisturizer usage. Patients were followed up weekly after the start of treatment.

Results: Mean age was 46 years. Twenty-four patients had stage 1 breast cancer and 26 patients had stage 2 disease. KPS (Karnofsky performance score) was 100 for all patients. Five patients (20.8%) had grade 2 and seven (29.1%) patients had grade 1 acute radiodermatitis in the first group. Eleven (42.3%) patients had grade 2 and 12 (46.1%) patients had grade 1 acute radiodermatitis in the second group. Thirteen (54.1%) patients in the first group had no acute radiodermatitis and three (11.5%) patients in the second group had no acute radiodermatitis. No patient in either group experienced grade 3 radiodermatitis.

Conclusions: Daily use of topical betamethasone for breast cancer RT improves dermal sparing, reduces acute radiodermatitis, and may be recommended for patients receiving RT to the breast.
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http://dx.doi.org/10.4103/ijd.IJD_607_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423239PMC
August 2020

Adaptive radiation therapy of breast cancer by repeated imaging during irradiation.

World J Radiol 2020 May;12(5):68-75

Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Etlik, Ankara 06018, Turkey.

Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide. A multimodality treatment approach may be utilized for optimal management of patients with combinations of surgery, radiation therapy (RT) and systemic treatment. RT composes an integral part of breast conserving treatment, and is typically used after breast conserving surgery to improve local control. Recent years have witnessed significant improvements in the discipline of radiation oncology which allow for more focused and precise treatment delivery. Adaptive radiation therapy (ART) is among the most important RT techniques which may be utilized for redesigning of treatment plans to account for dynamic changes in tumor size and anatomy during the course of irradiation. In the context of breast cancer, ART may serve as an excellent tool for patients receiving breast irradiation followed by a sequential boost to the tumor bed. Primary benefits of ART include more precise boost localization and potential for improved normal tissue sparing with adapted boost target volumes particularly in the setting of seroma reduction during the course of irradiation. Herein, we provide a concise review of ART for breast cancer in light of the literature.
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http://dx.doi.org/10.4329/wjr.v12.i5.68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288774PMC
May 2020

Breathing adapted radiation therapy for leukemia relapse in the breast: A case report.

World J Clin Oncol 2019 Nov;10(11):369-374

Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey.

Background: Infiltration of the breast by leukemic cells is uncommon but may manifest as an oncological emergency requiring prompt management. Extramedullary relapse of T-cell acute lymphoblastic leukemia (T-ALL) within the breast is exceedingly rare and there is paucity of data in the literature regarding this entity. No consensus exists on management of isolated extramedullary breast relapses of T-ALL. Herein, we report a case of isolated extramedullary breast relapse of T-ALL treated with breathing adapted radiation therapy (BART) using the active breathing control (ABC) system.

Case Summary: The patient was a 33-year-old female with diagnosis of T-ALL. She received intensive systemic chemotherapy that resulted in complete remission of her disease, and then underwent allogeneic hematopoietic stem cell transplantation. After a 15 mo period without symptoms and signs of progression, the patient presented with palpable masses in both breasts. She complained from severe pain and swelling of the breasts. Imaging workup showed bilateral breast lesions, and diagnosis of breast infiltration by leukemic cells was confirmed after immunohistopathological evaluation. The patient suffering from severe pain, discomfort, and swelling of both breasts due to leukemic infiltration was referred to the Radiation Oncology Department for symptomatic palliation. Whole breast irradiation was delivered to both breasts of the patient with BART using the ABC system. The patient had complete resolution of her symptoms after treatment with BART.

Conclusion: BART with the ABC system resulted in complete resolution of the patient's symptoms due to leukemic infiltration of both breasts with T-ALL. This contemporary treatment technique should be preferred for radiotherapeutic management of patients with leukemic infiltration of the breasts to achieve effective symptomatic palliation.
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http://dx.doi.org/10.5306/wjco.v10.i11.369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895000PMC
November 2019

Evaluatıon of hypofractıonated stereotactıc radıotherapy (HFSRT) to the resectıon cavıty after surgıcal resectıon of braın metastases: A sıngle center experıence.

Indian J Cancer 2019 Jul-Sep;56(3):202-206

Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey.

Introducton: Adjuvant radiotherapy after surgical resection is used for the treatment of patients with brain metastasis. In this study, we assessed the use of adjuvant hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavity for the management of patients with brain metastasis.

Materials And Methods: A total of 28 patients undergoing surgical resection for their brain metastasis were treated using HFSRT to the resection cavity. A total HFSRT dose of 25-30 Gray (Gy) was delivered in 5 consecutive daily fractions. Patients were retrospectively assessed for toxicity, local control, and survival outcomes. Kaplan-Meier method and log-rank test were used for statistical analysis.

Results: Median planning target volume (PTV) was 27.2 cc (range: 6-76.1 cc). At a median follow-up time of 11 months (range: 2-21 months.), 1-year local control rate was 85.7%, and 1-year distant failure rate was 57.1% (16 patients). Median overall survival was 15 months from HFSRT. Higher recursive partitioning analysis class (P = 0.01) and the presence of extracranial metastases (P = 0.02) were associated with decreased overall survival on statistical analysis. There was no radiation necrosis observed during follow-up.

Conclusion: HFSRT to the resection cavity offers a safe and effective adjuvant treatment for patients undergoing surgical resection of brain metastasis. With comparable local control rates, HFSRT may serve as a viable alternative to whole brain irradiation.
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http://dx.doi.org/10.4103/ijc.IJC_345_18DOI Listing
January 2020

A Concise Review of Pelvic Radiation Therapy (RT) for Rectal Cancer with Synchronous Liver Metastases.

Int J Surg Oncol 2019 21;2019:5239042. Epub 2019 Apr 21.

Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey.

Background And Objective: Colorectal cancer is a major health concern as a very common cancer and a leading cause of cancer-related mortality worldwide. The liver is a very common site of metastatic spread for colorectal cancers, and, while nearly half of the patients develop metastases during the course of their disease, synchronous liver metastases are detected in 15% to 25% of cases. There is no standardized treatment in this setting and no consensus exists on optimal sequencing of multimodality management for rectal cancer with synchronous liver metastases.

Methods: Herein, we review the use of pelvic radiation therapy (RT) as part of potentially curative or palliative management of rectal cancer with synchronous liver metastases.

Results: There is accumulating evidence on the utility of pelvic RT for facilitating subsequent surgery, improving local tumor control, and achieving palliation of symptoms in patients with stage IV rectal cancer. Introduction of superior imaging capabilities and contemporary RT approaches such as Intensity Modulated Radiation Therapy (IMRT) and Image Guided Radiation Therapy (IGRT) offer improved precision and toxicity profile of radiation delivery in the modern era.

Conclusion: Even in the setting of stage IV rectal cancer with synchronous liver metastases, there may be potential for extended survival and cure by aggressive management of primary tumor and metastases in selected patients. Despite lack of consensus on sequencing of treatment modalities, pelvic RT may serve as a critical component of multidisciplinary management. Resectability of primary rectal tumor and liver metastases, patient preferences, comorbidities, symptomatology, and logistical issues should be thoroughly considered in decision making for optimal management of patients.
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http://dx.doi.org/10.1155/2019/5239042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500597PMC
August 2019

Fractionated stereotactic radiosurgery for locally recurrent brain metastases after failed stereotactic radiosurgery.

Indian J Cancer 2019 Apr-Jun;56(2):151-156

Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey.

Aims And Background: There is scant data on the utility of repeated radiosurgery for management of locally recurrent brain metastases after upfront stereotactic radiosurgery (SRS). Most studies have used single-fraction SRS for repeated radiosurgery, and the use of fractionated stereotactic radiosurgery (f-SRS) in this setting has been poorly addressed. In this study, we assessed the utility of f-SRS for the management of locally recurrent brain metastases after failed upfront single-fraction SRS and report our single-center experience.

Methods And Study Design: A total of 30 patients receiving f-SRS for locally recurrent brain metastases after upfront single-fraction SRS at our department between September 2011 and September 2017 were retrospectively evaluated for local control (LC), toxicity, and overall survival outcomes.

Results: Median age and Karnofsky performance status were 57 (range: 38-78 years) and 80 (range: 70-100) at repeated radiosurgery (SRS2). The median time interval between the two radiosurgery applications was 13.5 months (range: 3.7-49 months). LC after SRS2 was 83.3%. Radionecrosis developed in 4 of the 30 lesions after SRS2, and total rate of radionecrosis was 13.3%. Statistical analysis revealed that the volume of planning target volume (PTV) at SRS2 was significantly associated with radionecrosis (P = 0.014). The volume of PTV was >13 cm at SRS2 in all patients with radionecrosis.

Conclusion: A repeated course of radiosurgery in the form of f-SRS may be a viable therapeutic option for the management of locally recurrent brain metastases after failed upfront SRS with high LC rates and an acceptable toxicity profile despite the need for further supporting evidence.
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http://dx.doi.org/10.4103/ijc.IJC_786_18DOI Listing
September 2019

Utility of Molecular Imaging with 2-Deoxy-2-[Fluorine-18] Fluoro-DGlucose Positron Emission Tomography (18F-FDG PET) for Small Cell Lung Cancer (SCLC): A Radiation Oncology Perspective.

Curr Radiopharm 2019 ;12(1):4-10

Department of Radiation Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey.

Background And Objective: Although accounting for a relatively small proportion of all lung cancers, small cell lung cancer (SCLC) remains to be a global health concern with grim prognosis. Radiotherapy (RT) plays a central role in SCLC management either as a curative or palliative therapeutic strategy. There has been considerable progress in RT of SCLC, thanks to improved imaging techniques leading to accurate target localization for precise delivery of RT. Positron emission tomography (PET) is increasingly used in oncology practice as a non-invasive molecular imaging modality.

Methods: Herein, we review the utility of molecular imaging with 2-deoxy-2-[fluorine-18] fluoro-Dglucose PET (18F-FDG PET) for SCLC from a radiation oncology perspective.

Results: There has been extensive research on the utility of PET for SCLC in terms of improved staging, restaging, treatment designation, patient selection for curative/palliative intent, target localization, response assessment, detection of residual/recurrent disease, and prediction of treatment outcomes.

Conclusion: PET provides useful functional information as a non-invasive molecular imaging modality and may be exploited to improve the management of patients with SCLC. Incorporation of PET/CT in staging of patients with SCLC may aid in optimal treatment allocation for an improved therapeutic ratio. From a radiation oncology perspective, combination of functional and anatomical data provided by integrated PET/CT improves discrimination between atelectasis and tumor, and assists in the designation of RT portals with its high accuracy to detect intrathoracic tumor and nodal disease. Utility of molecular imaging for SCLC should be further investigated in prospective randomized trials to acquire a higher level of evidence for future potential applications of PET.
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http://dx.doi.org/10.2174/1874471012666181120162434DOI Listing
May 2019

Evaluation of adaptive radiotherapy (ART) by use of replanning the tumor bed boost with repeated computed tomography (CT) simulation after whole breast irradiation (WBI) for breast cancer patients having clinically evident seroma.

Jpn J Radiol 2018 Jun 5;36(6):401-406. Epub 2018 Apr 5.

Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Gn.TevfikSaglam Cad., Etlik, 06018, Kecioren, Ankara, Turkey.

Purpose: The aim of this study is to evaluate adaptive radiotherapy (ART) by use of replanning the tumor bed boost with repeated computed tomography (CT) simulation after whole breast irradiation (WBI) for breast cancer patients having clinically evident seroma.

Materials And Methods: Forty-eight patients with clinically evident seroma at the time of planning CT simulation for WBI were included. Two RT treatment plannings were generated for each patient based on the initial CT simulation and tumor bed boost CT simulation to assess seroma and boost target volume (BTV) changes during WBI. Also, dosimetric impact of ART was analyzed by comparative evaluation of critical organ doses in both RT treatment plannings.

Results: Median time interval between the two CT simulations was 35 days. Statistically significant reduction was detected in seroma volume and BTV during the conventionally fractionated WBI course along with statistically significant reduction in critical organ doses with ART (p < 0.0001).

Conclusion: Our data suggest significant benefit of ART by use of replanning the tumor bed boost with repeated CT simulation after WBI for patients with clinically evident seroma.
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http://dx.doi.org/10.1007/s11604-018-0735-2DOI Listing
June 2018

Cross-Cultural Adaptation and Psychometric Evaluation of the Turkish Version of the Cancer Behavior Inventory-Brief Version.

J Pain Symptom Manage 2017 12 12;54(6):929-935. Epub 2017 Aug 12.

Department of Radiation Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey.

Context: Cancer Behavior Inventory-Brief Version (CBI-B) is a simple and non-burdensome tool used to evaluate the self-efficacy of the cancer patients.

Objectives: The aim of this study was to examine the psychometric properties of the Turkish version of the CBI-B.

Methods: This methodologic study was conducted on 143 cancer patients who received radiotherapy at the Department of Radiation Oncology at a Training and Research Hospital in Turkey. Data were collected using Medical and Demographic Information Form, CBI-B, Satisfaction With Life Scale, and European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Descriptive statistics, exploratory factor analysis, and correlation coefficients were used for the analysis of data.

Results: Exploratory factor analysis confirmed four-factor structure explaining 74.7% of the total variance: 1) Maintaining Independence and Positive Attitude, 2) Participating in Medical Care, 3) Coping and Stress Management, and 4) Managing Affect. The CBI-B had acceptable internal consistency (Cronbach α = 0.87) and test-retest reliability (intraclass correlation coefficient = 0.961) and concurrent validity with Satisfaction With Life Scale and EORTC QLQ-C30 scores. The measures of life satisfaction and quality of life were positively correlated with CBI-B, whereas the symptom levels and the functions (with the exception of the role function) were negatively correlated.

Conclusion: The CBI-B was found to be a valid and reliable inventory for assessing the self-efficacy of Turkish cancer patients. The CBI-B, is a simple and brief measure of self-efficacy for coping with cancer, could be easily used in clinical and research settings.
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http://dx.doi.org/10.1016/j.jpainsymman.2017.08.006DOI Listing
December 2017

Hypofractionated stereotactic radiotherapy (HFSRT) for who grade I anterior clinoid meningiomas (ACM).

Jpn J Radiol 2016 Nov 22;34(11):730-737. Epub 2016 Sep 22.

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

Purpose: While microsurgical resection plays a central role in the management of ACMs, extensive surgery may be associated with substantial morbidity particularly for tumors in intimate association with critical structures. In this study, we evaluated the use of HFSRT in the management of ACM.

Materials And Methods: A total of 22 patients with ACM were treated using HFSRT. Frameless image guided volumetric modulated arc therapy (VMAT) was performed with a 6 MV linear accelerator (LINAC). The total dose was 25 Gy delivered in five fractions over five consecutive treatment days. Local control (LC) and progression free survival (PFS) rates were calculated using the Kaplan-Meier method. Common Terminology Criteria for Adverse Events, version 4.0 was used in toxicity grading.

Results: Out of the total 22 patients, outcomes of 19 patients with at least 36 months of periodic follow-up were assessed. Median patient age was 40 years old (range 24-77 years old). Median follow-up time was 53 months (range 36-63 months). LC and PFS rates were 100 and 89.4 % at 1 and 3 years, respectively. Only two patients (10.5 %) experienced clinical deterioration during the follow-up period.

Conclusion: LINAC-based HFSRT offers high rates of LC and PFS for patients with ACMs.
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http://dx.doi.org/10.1007/s11604-016-0581-zDOI Listing
November 2016

Evaluation of mycosis fungoides management by total skin electron beam therapy with "translational technique".

J BUON 2015 Jul-Aug;20(4):1124-31

Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey.

Purpose: The aim of this study was to evaluate the outcomes of total skin electron beam therapy (TSEBT) with "translational technique" in the management of mycosis fungoides (MF).

Methods: Between January 1995 and October 2014, 51 patients with MF were treated using TSEBT with translational technique. The total dose was 2800-3600 cGy, de-livered in 7 to 20 fractions. Out of the total 51 patients, 22 (43.1%) had T2 (generalized patch/plaque) disease, 20 (39.3%) had T3 disease (tumor stage), and 9 (17.6%) had T4 (erythrodermic) disease. Radiation-related late skin injury parameters including atrophy, pigmentation changes, hair loss, telangiectasia and ulceration were assessed according to RTOG/EORTC Late Radiation Morbidity Scoring Schema after at least 3 months from TSEBT.

Results: Treatment response was categorized as complete remission (CR), partial remission (PR), or non-responding (NR) lesions. After TSEBT with translational technique, CR rate was 68.6% and PR rate 23.5%, while the NR rate was 7.9%. Overall, the rates of grade 1, grade 2, grade 3, and grade 4 toxicity were 17.6% )9 patients), 39.3% (20 patient), 35.3% (18 patients), and 7.8% (4 patients), respectively. At a median follow-up of 79 months (range 14-142), overall survival (OS) and disease-free survival (DFS) rates were 83% and 46%, respectively.

Conclusion: For patients with MF refractory to topical chemotherapy and phototherapy, TSEBT with translational technique offers excellent local control (LC: CR+PR) and favorable OS rates along with substantial relief of symptoms.
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November 2015

Evaluation of transforming growth factor-β2 for radiation-induced diarrhea after pelvic radiotherapy.

Tumori 2015 Sep-Oct;101(5):474-7. Epub 2015 May 12.

Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara - Turkey.

Aims And Background: Radiotherapy (RT) plays a central role in the management of cancers located in the abdomen and pelvis. However, radiation-induced toxicity remains a major concern for patients receiving RT to the abdominopelvic region. In this context, our study aims to evaluate the use of transforming growth factor (TGF)-β2-enriched formula for amelioration of radiation-induced diarrhea for patients undergoing pelvic RT.

Methods And Study Design: Between September 2013 and September 2014, 86 malnourished patients undergoing RT for pelvic cancers who received oral nutritional supplementation with or without TGF-β2-enriched formula were assessed retrospectively in 3 groups. Oral diphenoxylate-atropine tablets were used at onset of diarrhea in all groups. Kruskal-Wallis and chi-square tests were used in the comparison of continuous and categorical variables, respectively.

Results: Patients receiving nutritional supplemention with TGF-β2-enriched formula (groups I and II) experienced a significantly lower median number of diarrhea episodes compared to patients receiving nutritional supplementation with other products (group III), which was statistically significant (p<0.05). Also, number of patients experiencing grade 2 and grade 3 diarrhea was significantly lower in groups I and II compared to group III (p<0.05).

Conclusions: Nutritional supplemention with TGF-β2-enriched formula offers amelioration of radiation-induced diarrhea for patients receiving pelvic RT. Since this is the first study assessing the use of nutritional supplementation with TGF-β2-enriched formula for patients undergoing pelvic RT, future prospective studies are needed to confirm the results.
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http://dx.doi.org/10.5301/tj.5000328DOI Listing
January 2016

Castleman's disease and radiotherapy: a single center experience.

J Cancer Res Ther 2015 Jan-Mar;11(1):170-3

Department of Radiation Oncology, Gulhane Military Medical Academy, Istanbul, Ankara, Turkey.

Context: The role of radiotherapy (RT) in the management of Castleman's disease (CD) is analyzed.

Aims: The main goal of this study is to examine the efficiency of RT in the treatment of unresectable and recurrent CD.

Settings And Design: Retrospective study.

Subjects And Methods: Between 1980 and 2012, 11 CD patients referred and treated at our clinic were studied. Three of the patients were female, and eight of them were male. Four patients had multicentric (MC) and seven patients had unicentric CD. Five patients were managed with incisional biopsy and RT; three unicentric patients underwent total excision followed by RT, and three unicentric patients had total excision and chemotherapy. Patients were retrospectively evaluated. Median follow-up time was 36 (24-60) months with median age 41 (24-52) years and RT dose 30 (30-45) Gy.

Statistical Analysis Used: Kaplan-Meier method.

Results: About 72.7% of patients were male, and 27.3% were female. 63.6% of the patients were unicentric, and 36.4% were MC CD. 54.5% of the patients were managed with total excision, and 45.5% underwent incisional biopsy. About 63.6% of CD patients received RT and 27.3% were given only chemotherapy, whereas one patient (9.09%) received both RT and chemotherapy. Three-year survival was 83%, and 3-year disease free survival was 91%. No late toxicity was noted with. Acute toxicity was noted in two patients who received 45 Gy and no late radiation-induced toxicity was observed.

Conclusions: RT is an effective treatment option for CD recurrences and sole treatment for unresectable CD.
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http://dx.doi.org/10.4103/0973-1482.140766DOI Listing
January 2016

Management of patients with recurrent glioblastoma using hypofractionated stereotactic radiotherapy.

Tumori 2015 Mar-Apr;101(2):179-84. Epub 2015 Mar 19.

Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara - Turkey.

Background: Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. The chance of cure is very limited due to treatment-refractory disease course with frequent recurrences despite aggressive multimodality management. In this retrospective study, we evaluated treatment outcomes of hypofractionated stereotactic radiotherapy (HFSRT) in the management of recurrent GBM and report our single-center experience.

Methods: Twenty-eight patients receiving HFSRT for recurrent GBM between September 2008 and February 2014 were retrospectively assessed. Total radiotherapy dose was 25 Gy delivered in 5 fractions over 5 consecutive days for all patients. High-precision, image-guided volumetric modulated arc therapy was delivered with a linear accelerator using 6-MV photons using the frameless technique. Analyzed prognostic factors were age, gender, Karnofsky performance status (KPS), tumor location, planning target volume (PTV) size, overall survival (OS), progression-free survival (PFS), time interval between completion of treatment with Stupp protocol at primary diagnosis and recurrence.

Results: Median follow-up time was 42 months (range 2-68). Median time interval between primary chemoradiotherapy and HFSRT was 11.2 months (range 4-57.9). Median OS and PFS calculated from reirradiation was 10.3 months and 5.8 months, respectively. Longer interval between initial treatment and recurrence (p = 0.01), smaller PTV size (p = 0.001), KPS ≥70 (p = 0.005) and younger age (p = 0.004) were associated with longer OS on statistical analysis.

Conclusion: HFSRT offers a feasible and effective salvage treatment option for recurrent GBM management. Prognostic factors associated with longer OS in our study were longer interval between initial treatment and recurrence, smaller PTV size, KPS ≥70 and younger age.
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http://dx.doi.org/10.5301/tj.5000236DOI Listing
July 2015

Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives.

CNS Oncol 2015 ;4(2):105-14

Department of Radiation Oncology, Gulhane Military Medical Academy, Gn. Tevfik Saglam Cad. 06018, Etlik, Kecioren, Ankara, Turkey.

Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature.
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http://dx.doi.org/10.2217/cns.14.56DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093031PMC
November 2015

Outcomes of trimodality approach in the management of T2N0M0 bladder cancer.

Tumori 2015 Mar-Apr;101(2):232-7. Epub 2015 Mar 9.

Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara - Turkey.

Aims And Background: The main objective of this study is to evaluate outcomes of bladder preservation treatment for patients with muscle-invasive bladder cancer.

Methods And Study Design: 38 patients with histologically proven muscle-invasive bladder cancer treated at our department between January 2008 and December 2013 were analyzed retrospectively. Age, gender, pathology, stage, 3-year overall survival, 3-year disease-free survival, radiotherapy (RT) dose, genitourinary and gastrointestinal toxicity scores and response evaluation of the patients were recorded. 3-year overall survival and 3-year disease-free survivals were calculated by Kaplan-Meier method along with the analysis of gender, pathology, stage and therapy response of the study group.

Results: 33 patients (86.8%) were managed with concomitant chemoradiotherapy whereas 5 patients (13.2%) received only radiation therapy due to renal insufficency and comorbid diseases. 6 (15.8%) out of 38 patients had partial response (PR) and remaining 32 (84.2%) patients experienced complete response (CR). The PR group underwent salvage cystectomy and CR group had been followed-up after radical radiotherapy. Mean age of the group was 70.9 (range 45-90) years. 26 of all patients were male (68.4%) and 12 were female (31.6%). Mean follow-up time after completion of radiotherapy was 24.7 months (range 12-40). Mean RT dose was 64 Gy (range 60-66). 3-year overall survival was 64% and 3-year disease free survival was 73%.

Conclusions: Bladder preserving approach is an alternative definitive therapy solution to radical cystectomy in the treatment of muscle-invasive bladder cancer with less morbidity, preserved natural bladder, and high quality of life.
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http://dx.doi.org/10.5301/tj.5000294DOI Listing
July 2015

Adaptive splenic radiotherapy for symptomatic splenomegaly management in myeloproliferative disorders.

Tumori 2015 Jan-Feb;101(1):84-90. Epub 2015 Feb 3.

Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara - Turkey.

Aims And Background: Symptomatic, massive splenomegaly is a debilitating complication of myeloproliferative disorders. In the study, we evaluated the use of a contemporary, individualized radiotherapeutic approach for splenic irradiation, including 3-dimensional computed tomography-based treatment planning, individualized treatment margins based on splenic motion assessment, online setup verification with volumetric image guidance at each fraction, and adaptive radiation treatment planning to account for changes in splenic size during the fractionated radiotherapy course.

Methods And Study Design: Between December 2008 and January 2014, 18 patients (13 males, 5 females) with myeloproliferative disorders referred to Gulhane Military Medical Academy Radiation Oncology Department underwent 22 courses of splenic irradiation using 3-dimensional computed tomography-based treatment planning and volumetric image guidance for palliation of symptomatic splenomegaly.

Results: Median age was 64 years (range 28-79). Significant pain relief was achieved in 20 of the 22 splenic irradiation courses (90.9%). Improvement in hematological parameters was achieved in 8 of the 11 splenic irradiation courses applied for cytopenia (72.7%). At least a 50% reduction in splenic size was achieved in 18 of the 22 splenic irradiation courses (81.8%). Toxicity was manageable with supportive treatment including antiemetics and platelet or red blood cell transfusions.

Conclusions: Splenic irradiation with a contemporary radiotherapeutic approach offers safe and effective palliation of symptomatic splenomegaly in myeloproliferative disorders.
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http://dx.doi.org/10.5301/tj.5000221DOI Listing
June 2015

Evaluation of stereotactic body radiation therapy in the management of adrenal metastases from non-small cell lung cancer.

Tumori 2015 Jan-Feb;101(1):98-103. Epub 2015 Feb 5.

Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara - Turkey.

Aims And Background: In this retrospective analysis, we evaluated the use of stereotactic body radiation therapy in the management of adrenal metastases from non-small cell lung cancer and report our single center experience.

Methods And Study Design: Fifteen non-small cell lung cancer patients (9 male, 6 female) with 17 adrenal metastases referred to Gulhane Military Medical Academy Radiation Oncology Department were treated using active breathing control-guided stereotactic body radiation therapy between December 2009 and October 2013. Dose per fraction was 10 Gy to deliver a total dose of 30 Gy over 3 consecutive days for all metastatic adrenal lesions. The mean gross tumor volume was 28.4 cc (range 6.6-101.5) and mean planning target volume was 57.4 cc (range 16.5-143.8).

Results: At a median follow-up of 16 months, local control was 86.7% and overall survival was 33.3%. Median disease-free survival was 10 months. Treatment response according to RECIST was categorized as complete response in 3 patients (20%), partial response in 5 patients (33.3%), stable disease in 5 patients (33.3%), and progressive disease in 2 patients (13.3%). Most common acute toxicity was grade 1 nausea (n = 7) and grade 1 fatigue (n = 12). There was no case of grade ≥3 acute or late toxicity.

Conclusions: Stereotactic body radiation therapy offers a safe and efficacious management strategy for adrenal metastases from non-small cell lung cancer by providing excellent local control with negligible treatment related toxicity.
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http://dx.doi.org/10.5301/tj.5000222DOI Listing
June 2015

Automatic segmentation of anatomical structures from CT scans of thorax for RTP.

Comput Math Methods Med 2014 18;2014:472890. Epub 2014 Dec 18.

Radiation Oncology Department, Gülhane Military Medical Academy, Etlik, 06018 Ankara, Turkey.

Modern radiotherapy techniques are vulnerable to delineation inaccuracies owing to the steep dose gradient around the target. In this aspect, accurate contouring comprises an indispensable part of optimal radiation treatment planning (RTP). We suggest a fully automated method to segment the lungs, trachea/main bronchi, and spinal canal accurately from computed tomography (CT) scans of patients with lung cancer to use for RTP. For this purpose, we developed a new algorithm for inclusion of excluded pathological areas into the segmented lungs and a modified version of the fuzzy segmentation by morphological reconstruction for spinal canal segmentation and implemented some image processing algorithms along with them. To assess the accuracy, we performed two comparisons between the automatically obtained results and the results obtained manually by an expert. The average volume overlap ratio values range between 94.30 ± 3.93% and 99.11 ± 0.26% on the two different datasets. We obtained the average symmetric surface distance values between the ranges of 0.28 ± 0.21 mm and 0.89 ± 0.32 mm by using the same datasets. Our method provides favorable results in the segmentation of CT scans of patients with lung cancer and can avoid heavy computational load and might offer expedited segmentation that can be used in RTP.
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http://dx.doi.org/10.1155/2014/472890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281476PMC
October 2015

Management of patients with ≥4 brain metastases using stereotactic radiosurgery boost after whole brain irradiation.

Tumori 2014 May-Jun;100(3):302-6

Aims And Background: Brain metastases are a prevalent consequence of systemic cancer, and patients suffering from brain metastases usually present with multiple metastatic lesions. An overwhelming majority of the available literature assessing the role of stereotactic radiosurgery in brain metastasis management includes patients with up to 4 metastases. Given the significant benefit of stereotactic radiosurgery for the treatment of 1 to 3 brain metastases, we evaluated the use of stereotactic radiosurgery boost after whole brain irradiation in the management of patients with ≥4 brain metastases.

Methods: In this retrospective analysis, outcomes of 50 patients who underwent linear accelerator-based stereotactic radiosurgery boost within 4 to 6 weeks of whole brain irradiation for ≥4 brain metastases were assessed in terms of local control, overall survival, primary involved organ, recursive partitioning analysis class and Karnofsky performance status at the time of stereotactic radiosurgery, number of lesions, age, status of the primary cancer (controlled vs uncontrolled), presence of extracranial disease and toxicity.

Results: Fifty patients with ≥4 brain metastases were treated using linear accelerator-based stereotactic radiosurgery boost after whole brain irradiation between April 1998 and April 2013. Mean and median number of intracranial lesions was 6.02 and 6, respectively. Median lesion volume was 10.9 cc (range, 0.05-32.6). Median survival time after radiosurgery was 10.1 months (range, 1-25). Status of the primary cancer (controlled vs uncontrolled), recursive partitioning analysis class, Karnofsky performance status, and extracranial metastasis showed statistically significant correlations with overall survival (P <0.001). Treatment-related side effects after stereotactic radiosurgery included temporary edema (n = 14, 28%), hemiparesis (n = 1, 2%), seizure (n = 1, 2%), leukoencephalopathy (n = 2, 4%), and radiation necrosis (n = 6, 12%).

Conclusions: Linear accelerator-based stereotactic radiosurgery boost within 4 to 6 weeks after whole brain irradiation proved to be an efficacious and well-tolerated treatment strategy for the management of patients with ≥4 brain metastases in our study.
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http://dx.doi.org/10.1700/1578.17210DOI Listing
November 2014

Evaluation of linear accelerator-based stereotactic radiosurgery in the management of glomus jugulare tumors.

Tumori 2014 Mar-Apr;100(2):184-8

Aims And Background: Although mostly benign and slow-growing, glomus jugulare tumors have a high propensity for local invasion of adjacent vascular structures, lower cranial nerves and the inner ear, which may result in substantial morbidity and even mortality. Treatment strategies for glomus jugulare tumors include surgery, preoperative embolization followed by surgical resection, conventionally fractionated external beam radiotherapy, radiosurgery in the form of stereotactic radiosurgery or fractionated stereotactic radiation therapy, and combinations of these modalities. In the present study, we evaluate the use of linear accelerator (LINAC)-based stereotactic radiosurgery in the management of glomus jugulare tumors and report our 15-year single center experience.

Methods And Study Design: Between May 1998 and May 2013, 21 patients (15 females, 6 males) with glomus jugulare tumors were treated using LINAC-based stereotactic radiosurgery at the Department of Radiation Oncology, Gulhane Military Medical Academy. The indication for stereotactic radiosurgery was the presence of residual or recurrent tumor after surgery for 5 patients, whereas 16 patients having growing tumors with symptoms received stereotactic radiosurgery as the primary treatment.

Results: Median follow-up was 49 months (range, 3-98). Median age was 55 years (range, 24-77). Of the 21 lesions treated, 13 (61.9%) were left-sided and 8 (38.1%) were right-sided. Median dose was 15 Gy (range, 10-20) prescribed to the 85%-100% isodose line encompassing the target volume. Local control defined as either tumor shrinkage or the absence of tumor growth on periodical follow-up neuroimaging was 100%.

Conclusions: LINAC-based stereotactic radiosurgery offers a safe and efficacious management strategy for glomus jugulare tumors by providing excellent tumor growth control with few complications.
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http://dx.doi.org/10.1700/1491.16409DOI Listing
July 2014

Management of pulmonary oligometastases by stereotactic body radiotherapy.

Tumori 2014 Mar-Apr;100(2):179-83

Aims And Background: The aim of the study was to evaluate the feasibility, toxicity and effectiveness of active breathing control-guided stereotactic body radiotherapy in the management of pulmonary oligometastases.

Methods And Study Design: Between June 2010 and June 2012, 20 patients (13 males, 7 females) with 31 pulmonary metastases referred to the Department of Radiation Oncology, Gulhane Military Medical Academy were treated using active breathing control-guided stereotactic body radiotherapy. Response Evaluation Criteria in Solid Tumors and Common Terminology Criteria for Adverse Events were used in the assessment of treatment response and toxicity, respectively.

Results: Assessment of treatment response revealed complete response, partial response, stable disease, and progressive disease in 30%, 25%, 30%, and 15% of the patients, respectively. At a median follow-up of 14 months, local control was 85% and overall survival was 70%, with negligible treatment-related toxicity.

Conclusions: Stereotactic body radiotherapy is safe and effective in the management of pulmonary oligometastases. It offers favorable treatment outcomes as a viable non-invasive therapeutic modality.
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http://dx.doi.org/10.1700/1491.16407DOI Listing
July 2014

Role of radiotherapy in the management of heel spur.

Eur J Orthop Surg Traumatol 2015 Feb 17;25(2):387-9. Epub 2014 May 17.

Department of Radiation Oncology, Gulhane Military Medical Academy, Gn. Tevfik Saglam Cad., 06018, Etlik, Kecioren, Ankara, Turkiye,

Aims And Background: The purpose of this study is to investigate the use of low-dose radiotherapy (RT) in benign painful heel spur management.

Methods: Between the years of 2009 and 2012, in Gulhane Military Medical Academy Radiation Oncology Department, patients with heel spur undergoing radiotherapy for pain relief were analyzed retrospectively. In the evaluation of treatment response, Verbal Numeric Scale (VNS) scoring method was used to compare the pain status before and after radiotherapy. Age, gender, laterality, VNS score before RT, VNS score after RT, RT doses of the patients and patients undergoing second course of radiotherapy were recorded. All patients received 8 Gy RT in two fractions with Co-60 teletherapy machine. Statistical Package for Social Sciences, version 16.0 was used for data analysis with the level of significance set at p < 0.05.

Results: The total number of patients receiving RT for heel spur pain was 450. Median age was 52 years (range 40-85 years). Two hundred and ninety-two (65%) of the patients were women and 158 (35%) were men. Radiologically calcaneal spurs were bilateral in 432 (96%) patients, whereas unilateral left in 8 (1.8%) patients and unilateral right heel location in 10 (2.2%) patients. Ten (2.2%) of the patient group received second course of RT due to refractory pain. Comparative evaluation of VNS scores before and after RT revealed statistically significant pain relief by radiotherapy (p < 0.05).

Conclusion: Low-dose radiotherapy is an effective and reliable painkilling treatment method that can be used in the treatment of epin calcanei refractory to medical and surgical treatment.
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http://dx.doi.org/10.1007/s00590-014-1482-4DOI Listing
February 2015

Evaluation of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for cerebral cavernous malformations: a 15-year single-center experience.

Ann Saudi Med 2014 Jan-Feb;34(1):54-8

Dr. Omer Sager, Department of Radiation Oncology,, Gulhane Military Medical Academy and Medical Faculty,, Ankara 06018, Turkey, T: +903123044683, F: +903123044680,

Background And Objectives: Surgery is the principal treatment for safely accessible hemorrhagic and symptomatic cavernous malformations. Nevertheless, the role of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in the management of high-risk, symptomatic cavernoma lesions warrants further refinement. In this study, we evaluate the use of LINAC-based SRS for cerebral cavernous malformations (CMs) and report our 15-year single-center experience.

Design And Settings: A retrospective study from the Department of Radiation Oncology and the Department of Neurosurgery at Gulhane Military Medical Academy and Medical Faculty, Ankara from April 1998 to June 2013.

Patients And Methods: Fifty-two patients (22 females and 30 males) with cerebral CM referred to our department underwent high-precision single-dose SRS using a LINAC with 6-MV photons. All patients had at least 1 bleeding episode prior to radiosurgery along with related symptoms. Median dose prescribed to the 85% to 95% isodose line encompassing the target volume was 15 Gy (range, 10-20).

Results: Out of the total 52 patients, follow-up data were available for 47 patients (90.4%). Median age was 35 years (range, 19-63). Median follow-up time was 5.17 years (range, 0.08-9.5) after SRS. Three hemorrhages were identified in the post-SRS period. Statistically significant decrease was observed in the annual hemorrhage rate after radiosurgical treatment (pre-SRS 39% vs post-SRS 1.21, P < .0001). Overall, there were no radiosurgery-related complications resulting in mortality.

Conclusion: LINAC-based SRS may be considered as a treatment option for high-risk, symptomatic cerebral CM of selected patients with prior bleeding from lesions located at surgically inaccessible or eloquent brain areas.
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http://dx.doi.org/10.5144/0256-4947.2014.54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074929PMC
August 2015

Immunosuppressive effects of multipotent mesenchymal stromal cells on graft-versus-host disease in rats following allogeneic bone marrow transplantation.

Turk J Haematol 2013 Sep 5;30(3):256-62. Epub 2013 Sep 5.

Gülhane Medical Academy, Department of Immunology, Ankara, Turkey.

Objective: Graft-versus-host disease (GVHD) is a major obstacle to successful allogeneic bone marrow transplantation (allo-BMT). While multipotent mesenchymal stromal cells (MSCs) demonstrate alloresponse in vitro and in vivo, they also have clinical applications toward prevention or treatment of GVHD. The aim of this study was to investigate the ability of MSCs to prevent or treat GVHD in a rat BMT model.

Materials And Methods: The GVHD model was established by transplantation of Sprague Dawley rats' bone marrow and spleen cells into lethally irradiated (950 cGy) SDxWistar rat recipients. A total of 49 rats were randomly assigned to 4 study and 3 control groups administered different GVHD prophylactic regimens including MSCs. After transplantation, clinical GVHD scores and survival status were monitored.

Results: All irradiated and untreated control mice with GVHD died. MSCs inhibited lethal GVHD as efficiently as the standard GVHD prophylactic regimen. The gross and histopathological findings of GVHD and the ratio of CD4/CD8 expression decreased. The subgroup given MSCs displayed higher in vivo proportions of CD25+ T cells and plasma interleukin-2 levels as compared to conventional GVHD treatment after allo-BMT.

Conclusion: Our results suggest that clinical use of MSCs in both prophylaxis against and treatment of established GVHD is effective. This study supports the use of MSCs in the prophylaxis and treatment of GVHD after allo-BMT; however, large scale studies are needed.

Conflict Of Interest: None declared.
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http://dx.doi.org/10.4274/Tjh.2013.0032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878544PMC
September 2013

Management of vestibular schwannomas with linear accelerator-based stereotactic radiosurgery: a single center experience.

Tumori 2013 Sep-Oct;99(5):617-22

Aims And Background: The primary goal of treatment for vestibular schwannoma is to achieve local control without comprimising regional cranial nerve function. Stereotactic radiosurgery has emerged as a viable therapeutic option for vestibular schwannoma. The aim of the study is to report our 15-year single center experience using linear accelerator-based stereotactic radiosurgery in the management of patients with vestibular schwannoma.

Methods And Study Design: Between July 1998 and January 2013, 68 patients with unilateral vestibular schwannoma were treated using stereotactic radiosurgery at the Department of Radiation Oncology, Gulhane Military Medical Academy. All patients underwent high-precision stereotactic radiosurgery using a linear accelerator with 6-MV photons.

Results: Median follow-up time was 51 months (range, 9-107). Median age was 45 years (range, 20-77). Median dose was 12 Gy (range, 10-13) prescribed to the 85%-95% isodose line encompassing the target volume. Local tumor control in patients with periodic follow-up imaging was 96.1%. Overall hearing preservation rate was 76.5%.

Conclusions: Linear accelerator-based stereotactic radiosurgery offers a safe and effective treatment for patients with vestibular schwannoma by providing high local control rates along with improved quality of life through well-preserved hearing function.
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http://dx.doi.org/10.1700/1377.15312DOI Listing
February 2014

Dosimetric evaluation of critical organs at risk in mastectomized left-sided breast cancer radiotherapy using breath-hold technique.

Tumori 2013 Jan-Feb;99(1):76-82

Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey.

Aims And Background: The aim of the study was to evaluate the dosimetric impact of the active breathing control-moderate deep inspiration breath-hold (ABC-mDIBH) technique on normal tissue sparing in locally advanced left-sided breast cancer radiotherapy.

Methods And Study Design: Twenty-seven consecutive patients with left-sided locally advanced breast cancer referred to our department for adjuvant radiotherapy were enrolled in the study. Each patient was scanned at free breathing and ABC-mDIBH for radiation treatment planning. Two separate radiotherapy treatment plans were generated with and without ABC-mDIBH to investigate the dosimetric impact of ABC-mDIBH in breast cancer radiotherapy.

Results: Between June 2011 and February 2012, 27 consecutive patients with left-sided locally advanced breast cancer referred to our department for adjuvant radiotherapy were enrolled in the study. Dose-volume parameters of left anterior descending coronary artery, lungs, heart, contralateral breast, esophagus and spinal cord were significantly reduced with the use of ABC-mDIBH (P <0.001).

Conclusions: Our study revealed that the use of ABC-mDIBH in the practice of locally advanced mastectomized left-sided breast cancer radiotherapy improves normal tissue sparing with the expected potential of decreasing treatment-related morbidity and mortality. Moreover, the resultant reduction achieved with ABC in doses to the left anterior descending coronary artery, which plays a central role in cardiac perfusion, may have implications for decreasing the potential of radiation-induced cardiac morbidity and mortality.
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http://dx.doi.org/10.1700/1248.13792DOI Listing
May 2013