Publications by authors named "Murat Caloğlu"

32 Publications

Prostate-specific antigen cutoff value for ordering sodium fluoride positron emission tomography/computed tomography bone scan in patients with prostate cancer.

World J Nucl Med 2018 Oct-Dec;17(4):281-285

Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait.

The use of F-18 sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) bone scan is increasing because of its higher sensitivity and specificity over standard bone scintigraphy (BS). Studies previously reported a prostate-specific antigen (PSA) cutoff value for ordering standard BS. However, this has not been determined for NaF PET yet. In this study, our goal was to determine a PSA cutoff level for ordering NaF PET/CT bone scan. Newly diagnosed and previously treated prostate cancer patients who had NaF PET/CT scan and PSA measurements within 2 mos of PET study were selected for analysis. When available, other parameters, such as Gleason score (GS), clinical stage, alkaline phosphatase levels, skeletal symptoms, and correlative image findings, were recorded. Receiver operating characteristic (ROC) analysis was performed to determine PSA cutoff values. Sixty-two patients (32 newly diagnosed and 30 previously treated) met the inclusion criteria. Near half of previously treated patients were on hormone therapy. NaF PET/CT was positive in 9 newly diagnosed (PSA mean: 91.6 ng/ml, range: 6.2-226 ng/ml) and in 6 previously treated patients (PSA mean: 146.4 ng/ml, range: 6.6-675 ng/ml). ROC analysis indicated that PSA cutoff value for NaF PET/CT positivity was >20 ng/ml in newly diagnosed and >6 ng/ml in previously treated patients. PSA cutoff value for ordering NaF PET/CT in newly diagnosed patients does not seem significantly different than the previous results for BS (>20 ng/ml). However, we found a lower PSA cutoff value of >6 ng/ml in previously treated patients.
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http://dx.doi.org/10.4103/wjnm.WJNM_87_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6216736PMC
December 2018

Survivin expression, HPV positivity and microvessel density in oropharyngeal carcinomas and relationship with survival time.

Arch Med Sci 2017 Oct 27;13(6):1467-1473. Epub 2016 Apr 27.

Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Introduction: Among head and neck cancers, those of the oral cavity and oropharynx are the second most prevalent following the larynx. This study aimed to research immunohistochemical expression of survivin, HPV positivity and microvessel density in tumors and their relationships with prognosis.

Material And Methods: Pathological materials and demographic properties of 46 patients were retrospectively evaluated. Survivin, HPV and CD34 (for microvessel density evaluation) antibodies were applied tumoral tissues. Survival times, clinical stage and differentiation were evaluated.

Results: In univariate analysis, we observed that survivin, microvessel density and stage were significantly associated with survival time ( < 0.05). In multivariate analysis, only survivin and microvessel density were associated with survival time ( < 0.05). But we did not find significant correlation between neither tumor differentiation nor HPV positivity and survival ( > 0.05).

Conclusions: Survivin levels and microvessel density were found to be effective prognostic factors and were related to survival in oral cavity and oropharyngeal cancers. Treatments targeting survivin expression and angiogenesis might be employed against these tumor groups.
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http://dx.doi.org/10.5114/aoms.2015.56616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701673PMC
October 2017

Prognostic Value of Angiogenesis and Survivin Expression in Patients with Glioblastoma.

Turk Neurosurg 2016 ;26(4):484-90

Trakya University, School of Medicine, Department of Pathology, Edirne, Turkey.

Aim: Glioblastoma (GBM) is the most common and the most aggressive primary brain tumor with poor prognosis. We aimed to evaluate the association between immunohistochemical expression of survivin and angiogenic parameters (microvessel density and vascular pattern) in patients who underwent surgery for GBM.

Material And Methods: The pathology reports and also clinical and follow-up data of patients with GBM were retrospectively evaluated. Control tissues were obtained from the archive for each antibody (Survivin, CD 34). Then, control staining of these antibodies was performed. Vessels were evaluated according to the standardized assessment of vascular pattern.

Results: Mean survival for classical vascular pattern was longer than bizarre vascular pattern (p < 0.001). The survival time of patients decreased with increasing score of survivin staining. There was a significant correlation between survivin and survival time (p < 0.001). There was no significant correlation between microvessel density and survival time (p > 0.05).

Conclusion: With these findings, it is considered that high expression of survivin, bizarre vascular pattern and development of secondary GBM correlates with the low survival rates, however microvessel density has no correlation with the survival rates. Since only malignant cells express survivin, it might be a target protein for the development of novel therapies.
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http://dx.doi.org/10.5137/1019-5149.JTN.16552-15.1DOI Listing
April 2017

Comparison of the protective roles of L-carnitine and amifostine against radiation-induced acute ovarian damage by histopathological and biochemical methods.

J Cancer Res Ther 2015 Apr-Jun;11(2):447-53

Department of Radiation Oncology, Trakya University, Faculty of Medicine, Edirne, Turkey.

Purpose: The aim of this study was to compare the radioprotective efficacies of L-carnitine (LC) and amifostine against radiation-induced acute ovarian damage.

Materials And Methods: Forty-five, 3-month-old Wistar albino rats were randomly assigned to six groups. Control (CONT, n = 7); irradiation alone RT: radiation therapy (RT, n = 8); amifostine plus irradiation (AMI + RT, n = 8); LC plus irradiation (LC + RT, n = 8); LC and sham irradiation (LC, n = 7); and amifostine and sham irradiation (AMI, n = 7). The rats in the AMI + RT, LC + RT and RT groups were irradiated with a single dose of 20 Gy to the whole abdomen. LC (300 mg/kg) and amifostine (200 mg/kg) was given intraperitoneally 30 min before irradiation. Five days after irradiation, both antral follicles and corpus luteum in the right ovaries were counted, and tissue levels of malondialdehyde (MDA) and advanced oxidation protein product (AOPP) were measured.

Results: Irradiation significantly decreased antral follicles and corpus luteum (P: 0.005 and P < 0.0001). LC increased the median number of antral follicles and corpus luteum (P: 0.009 and P < 0.0001, respectively). Amifostine improved median corpus luteum numbers but not antral follicle (P < 0.000, P > 0.05). The level of MDA and AOPP significantly increased after irradiation (P = 0.001 and P < 0.0001, respectively). MDA and AOPP levels were significantly reduced by LC (P: 0.003, P < 0.0001) and amifostine (P < 0.0001, P: 0.018). When comparing CONT group with AMI + RT and LC + RT groups, MDA and AOPP levels were similar (P > 0.005). The levels of both MDA and AOPP were also similar when LC + RT is compared with AMI + RT group (P > 0.005).

Conclusions: L-carnitine and amifostine have a noteworthy and similar radioprotective effect against radiation-induced acute ovarian toxicity.
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http://dx.doi.org/10.4103/0973-1482.146091DOI Listing
March 2016

Acute histopathological responses of testicular tissues after different fractionated abdominal irradiation in rats.

Postgrad Med 2015 Jan 16;127(1):73-7. Epub 2014 Dec 16.

Department of Urology, Trakya University , Edirne , Turkey.

Purpose: To compare the effects of different fractionated doses of abdominal radiation therapy on acute histopathological responses of testicular tissues in rats.

Methods: Thirty-three 3-week-old Wistar albino rats were randomized into 6 groups: group 1 (n = 5), control; group 2 (n = 4), hypofractionated total abdominal irradiation (TAI) of 6 Gy/1 fraction/day for 2 days; group 3 (n = 6), hypofractionated TAI of 4 Gy/1 fraction/day for 3 days; group 4 (n = 6), hypofractionated TAI of 3 Gy/1 fraction/day for 4 days; group 5 (n = 6), conventionally fractionated TAI of 2 Gy/1 fraction/day for 6 days; group 6 (n = 6), conventionally fractionated TAI of 1.7 Gy/1 fraction/day for 7 days. Mean epithelial length and diameter of seminiferous tubules of testicular tissues were determined after euthanasia.

Results: Initially, a highly significant decrease in both the mean tubular diameter and epithelial height of the seminiferous tubules was demonstrated in all irradiated rats compared with the control group. No significant differences regarding both damage parameters were found between different hypofractionated radiation therapies. Both conventional radiation therapies reduced the epithelial height and mean diameter of the seminiferous tubules to a lesser extent when compared with 6 Gy/1 fraction/day hypofractionated therapy. It was further shown that parameter values were comparable between rats that received 3 Gy/day hypofractionated therapy and rats that received either of the two conventional therapies. Furthermore, although 4 Gy/day hypofractionation decreased tubular diameter and epithelial length to a greater degree compared with the conventional therapy of 1.7 Gy/1 fraction/day, no statistically significant difference was found when compared with conventional therapy of 2 Gy/1 fraction/day. Additionally, no statistically significant difference was demonstrated between the two types of conventional radiotherapy application.

Conclusion: The present study demonstrated that hypofractionated abdominal irradiation leads to more prominent tissue damage in the testes than conventional irradiation.
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http://dx.doi.org/10.1080/00325481.2015.993270DOI Listing
January 2015

The histopathological comparison of L-carnitine with amifostine for protective efficacy on radiation-induced acute small intestinal toxicity.

J Cancer Res Ther 2012 Apr-Jun;8(2):260-5

Department of Radiation Oncology, Trakya University, Edirne, Turkey.

Background: The aim of the study was to compare the protective efficacy of l-carnitine (LC) to amifostine on radiation-induced acute small intestine damage.

Materials And Methods: Thirty, 4-week-old Wistar albino rats were randomly assigned to four groups - Group 1: control (CONT, n = 6), Group 2: irradiation alone (RT, n = 8), Group 3: amifostine plus irradiation (AMI+RT, n = 8), and Group 4: l-Carnitine plus irradiation (LC+RT, n = 8). The rats in all groups were irradiated individually with a single dose of 20 Gy to the total abdomen, except those in CONT. LC (300 mg/kg) or amifostine (200 mg/kg) was used 30 min before irradiation. Histopathological analysis of small intestine was carried out after euthanasia.

Results: Pretreatment with amifostine reduced the radiation-induced acute degenerative damage (P = 0.009) compared to the RT group. Pretreatment with LC did not obtain any significant difference compared to the RT group. The vascular damage significantly reduced in both of the AMI+RT (P = 0.003) and LC+RT group (P = 0.029) compared to the RT group. The overall damage score was significantly lower in the AMI+RT group than the RT group (P = 0.009). There was not any significant difference between the LC+RT and RT group.

Conclusions: Amifostine has a marked radioprotective effect against all histopathological changes on small intestinal tissue while LC has limited effects which are mainly on vascular structure.
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http://dx.doi.org/10.4103/0973-1482.98982DOI Listing
December 2012

Trimodality treatment in patients with superior sulcus tumors: hopes and realities.

Tumori 2011 Jul-Aug;97(4):459-65

Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey.

Aims And Background: In late 2001 at our institution, we started offering induction radiochemotherapy as a treatment option for superior sulcus tumors. Our aim was to evaluate treatment choices and outcome in this patient group treated over the past 7 years at our institution.

Methods: The records of 34 patients were retrospectively reviewed and 33 were assessable for the analysis.

Results: Twenty of 28 patients with M0 disease had operable disease. The induction radiochemotherapy for superior sulcus tumors was possible in about two-thirds (14/20) of the cases with operable disease, with only one-third (5/14) of these having undergone surgery. The most common reason for not proceeding to surgery following induction radiochemotherapy was patient refusal (n = 5). The median follow-up of all 33 patients was 17 months. In curatively treated patients with (n = 11) or without surgery (n = 15), the median overall survival time was 26 months (range, 10-26) and 26 months (range, 7-71), respectively ( P = 0.534). Local-regional and/or distant failure developed in 20 of 26 patients treated curatively. In patients treated with the trimodality regimen (n = 5), no local-regional failure was observed, and distant failure occurred in one case.

Conclusions: The trimodality treatment was possible in 25% of cases with operable disease due to the high rate of patient refusal to proceed to surgery following induction radiochemotherapy. No difference in survival was observed between patients treated with surgery and those treated with radiochemotherapy only because of a limited follow-up. So, the benefit of additional surgery is not clear, and a longer follow-up is needed before final conclusions can be drawn.
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http://dx.doi.org/10.1700/950.10398DOI Listing
March 2012

Radiation-induced chronic oxidative renal damage can be reduced by amifostine.

Med Oncol 2012 Jun 24;29(2):768-75. Epub 2011 Feb 24.

Department of Radiation Oncology, Trakya University Faculty of Medicine, 22030 Edirne, Turkey.

In the current study, amifostine is evaluated for its radioprotective role in serum and kidney tissue by oxidative (malondialdehyde-MDA, advanced oxidation protein product-AOPP) and antioxidative markers (catalase, glutathione-GSH, free-thiols-F-SH). Thirty Wistar albino 3-4 months old, female rats, were randomly divided into Group I (n = 10): Control, Group II (n = 10): Irradiation-alone, Group III (n = 10): Amifostine before irradiation. In Group II and III, right kidneys of the rats were irradiated with a single dose of 6 Gy using a 60Co treatment unit. Rats in Group III received 200 mg/kg amifostine intraperitoneally, 30 min prior to irradiation. Following sacrification at 24th week, blood and kidney tissue samples were collected. Statistical analysis was done by One-way ANOVA, Post hoc Bonferroni, Dunnett T3, and Mann-Whitney U tests. Administration of amifostine significantly decreased the serum AOPP and MDA levels when compared to the irradiation-only group (P = 0.004, P = 0.006; respectively). Also amifostine significantly increased serum catalase activities and GSH levels, when given 30 min prior to irradiation (P = 00.02, P = 0.000; respectively). In the kidney tissue, administration of amifostine significantly decreased AOPP and MDA levels (P = 0.002, P = 0.016; respectively). Tissue GSH activity was increased following amifostine administration (P = 0.001). There was no statistically significant result on histopathological evaluation. Amifostine may reduce radiation-induced nephropathy by inhibiting chronic oxidative stress. Biomarkers of oxidative stress in serum and kidney tissue may be used for evaluation of the radiation-induced nephropathy.
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http://dx.doi.org/10.1007/s12032-011-9870-7DOI Listing
June 2012

Comparison of protective effects of L-carnitine and amifostine on radiation-induced toxicity to growing bone: histopathology and scintigraphy findings.

Asian Pac J Cancer Prev 2010 ;11(3):661-7

Department of Radiation Oncology, Trakya University, Edirne, Turkey.

Purpose: The aim of the present study was to evaluate the radioprotective efficacy of L-carnitine (LC) in growing bones in comparison to amifostine.

Materials And Methods: Sixty two-week-old Wistar albino rats were randomly assigned to six equal groups: Group 1, control (CONT); Group 2, irradiation alone (RT); Group 3, amifostine plus irradiation (AMI+ RT); Group 4, L-carnitine plus irradiation (LC+ RT); Group 5, amifostine alone (AMI); Group 6, L-carnitine alone (LC). The rats in the AMI+ RT, LC+ RT and RT groups were irradiated individually with a single dose of 20 Gy to the left femur. LC (300 mg/kg) and amifostine (200 mg/kg) were applied 30 min before irradiation. The animals were scanned for bone area, mineral content and bone mineral density (BMD) by DEXA and the 99mTc methylene diphosphonate uptake ratio (MUR) was calculated by bone scintigraphy. Histopathological analysis of bone and cartilage was also carried out after euthanasia.

Results: Pretreatment with LC or amifostine reduced the radiation-induced damage in growing bone (p= 0.007 and p= 0.04 respectively) and in the epiphysial cartilage (p= 0.002 and p= 0.015 respectively). The protective effect of LC was similar to that of amifostine on both growing bone and on the epiphysial cartilage. The mean left-femur BMD values were significantly higher in the LC+RT (p= 0.02) and AMI+RT (p= 0.01) groups than in the RT group. but did not differ with the two protective agents. Pretreatment with AMI (p= 0.002) and LC (p= 0.01) improved the MUR.

Conclusions: L-carnitine is equally as effective as amifostine at protecting growing bone against single dose irradiation damage.
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March 2011

PSA bounce and biochemical failure after brachytherapy for prostate cancer: a study of 820 patients with a minimum of 3 years of follow-up.

Int J Radiat Oncol Biol Phys 2011 Jul 18;80(3):735-41. Epub 2010 Jun 18.

Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Purpose: To determine clinical or dosimetric factors associated with a prostate-specific antigen (PSA) bounce, as well as an association between a PSA bounce and biochemical relapse-free survival (bRFS), in patients treated with iodine-125 brachytherapy.

Methods And Materials: A variety of clinical and treatment factors were examined in 820 patients who had a minimum of 3 years of PSA follow-up with T1-T2cN0M0 prostate cancer. Four different PSA threshold values were used for defining a PSA bounce: a PSA rise of ≥ 0.2, ≥ 0.4, ≥ 0.6, and ≥ 0.8 ng/mL.

Results: A PSA bounce of ≥ 0.2, ≥ 0.4, ≥ 0.6, and ≥ 0.8 ng/mL was noted in 247 patients (30.1%), 161 (19.6%), 105 (12.8%), and 78 (9.5%), respectively. The median time to the first PSA rise was 17.4, 16.25, 16.23, and 15.71 months, respectively, vs. 34.35 months for a biochemical failure (p < 0.0001). A PSA rise of ≥ 0.2 ng/mL was the only definition for which there was a significant difference in bRFS between bounce and non-bounce patients. The 5-year bRFS rate of patients having a PSA bounce of ≥0.2 was 97.7% vs. 91% for those who did not have a PSA bounce (p = 0.0011). On univariate analysis for biochemical failure, age, risk group, and PSAs per year had a statistically significant correlation with PSA bounce of ≥ 0.2 ng/mL. On multivariate analysis, age and PSAs per year remained statistically significant (p < 0.0001 and p = 0.0456, respectively).

Conclusions: A bounce definition of a rise ≥ 0.2 ng/mL is a reliable definition among several other definitions. The time to first PSA rise is the most valuable factor for distinguishing between a bounce and biochemical failure.
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http://dx.doi.org/10.1016/j.ijrobp.2010.02.021DOI Listing
July 2011

Histopathological and scintigraphic comparisons of the protective effects of L-carnitine and amifostine against radiation-induced late renal toxicity in rats.

Clin Exp Pharmacol Physiol 2009 May 28;36(5-6):523-30. Epub 2008 Oct 28.

Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

1. The aim of the present study was to compare the protective effects of L-carnitine and amifostine against radiation-induced late nephrotoxicity using technetium-99m diethylenetriaminepentaacetic acid scintigraphy and histopathological examination. 2. Seventy-one Albino rats were randomly divided into six groups as follows: (i) AMI + RAD (n = 15), 200 mg/kg, i.p., amifostine 30 min prior to irradiation (a single dose of 9 Gy); (ii) LC + RAD (n = 15), 300 mg/kg, i.p., L-carnitine 30 min prior to irradiation; (iii) LC (n = 10), 300 mg/kg, i.p., L-carnitine 30 min prior to sham irradiation; (iv) AMI (n = 10), 200 mg/kg, i.p., amifostine 30 min prior to sham irradiation; RAD (n = 11), 1 mL/kg, i.p., normal saline 30 min prior to irradiation; and (vi) control (n = 10), 1 mL/kg, i.p., normal saline 30 min prior to sham irradiation. Scintigraphy was performed before treatment and again 6 months after treatment. Kidneys were examined by light microscopy and a histopathological scoring system was used to assess the degree of renal damage. 3. The main histopathological findings were proximal tubular damage and interstitial fibrosis. Glomerular injury was similar in all groups. Tubular degeneration and atrophy were less common in the AMI + RAD group than in the RAD group (P = 0.011 and P = 0.015, respectively), as well as in the LC + RAD group compared with the RAD group (P = 0.028 and P = 0.036, respectively). Interstitial fibrosis in the AMI + RAD and LC + RAD groups was significantly less than that in the RAD group (P = 0.015 and P = 0.015, respectively). The highest total renal injury score (9) was seen in the RAD group. On scintigraphy, there were significant differences in post-treatment time to peak count (T(max)) and time from peak count to half count (T((1/2))) values (P = 0.01 and 0.02, respectively) between groups in the right kidney. In the control and RAD groups, the T((1/2)) of the right kidney was 8 +/- 2 and 21 +/- 2 min, respectively. The T(max) values for the AMI + RAD and LC + RAD groups (2.8 +/- 0.2 and 3.2 +/- 0.2 min, respectively) were similar to those in the control group (2.5 +/- 0.3 min). 4. Based on the results of the present study, L-carnitine and amifostine have comparable and significant protective effects against radiation-induced late nephrotoxicity.
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http://dx.doi.org/10.1111/j.1440-1681.2008.05103.xDOI Listing
May 2009

Prostate-specific antigen bounce after prostate brachytherapy: review of a confusing phenomenon.

Urology 2009 Dec 9;74(6):1183-90. Epub 2009 May 9.

Department of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, Turkey.

Prostate brachytherapy is a commonly used modality for the treatment of prostate cancer. After prostate brachytherapy, the prostate-specific antigen (PSA) level may fluctuate and increase temporarily without a clear reason in 30-40% of successfully treated men. This phenomenon is called "PSA bounce" and engenders anxiety on the part of the patient and physician. Having reviewed the literature we found 19 articles and summarized in the current review to delineate the facts of this relatively common and ambiguous phenomenon. Although several patient and treatment related factors were assessed by studies, only age remained as the most consistent predictor.
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http://dx.doi.org/10.1016/j.urology.2009.01.043DOI Listing
December 2009

Recurrent solitary fibrous tumor of the pleura: significant response to radiotherapy.

Med Oncol 2010 Mar 23;27(1):45-8. Epub 2009 Jan 23.

Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey.

Solitary fibrous tumor (SFT) of the pleura is an uncommon neoplasm with non-specific symptoms and non-pathognomonical radiological findings. Surgery allows establishment of a definitive diagnosis as well as a cure of the disease. The role of radiotherapy or chemotherapy in the management of the disease is unclear because of the rarity of the disease and the successful results of the surgical treatment. Long-term clinical follow-up may be useful for the patients with SFT because of the potential adverse biological behavior of this tumor, which may lead to repeated recurrences and/or malignant transformation. We reported a 66-year-old woman with recurrence of SFT in the right lung, which had significant response to external thoracic radiotherapy.
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http://dx.doi.org/10.1007/s12032-009-9168-1DOI Listing
March 2010

The better performance status, the better outcome: laryngeal carcinoma treated with definitive radiotherapy.

J Otolaryngol Head Neck Surg 2008 Dec;37(6):799-806

Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey.

Purpose: To evaluate the prognostic factors affecting locoregional control (LRC) and overall survival (OS) of patients with laryngeal carcinoma who were not candidates for surgical treatment due to tumour or host factors but were treated with definitive radiotherapy (RT).

Patients And Methods: Sixty-three consecutive patients, treated with definitive RT between 1999 and 2005, were retrospectively analyzed. All patients had histologically proven squamous cell carcinomas of the larynx. The median age was 62 years (range 43-83 years). Follow-up ranged from 22 days to 68 months (median 32 months).

Results: The LRC rates at 2 and 5 years were 70% and 48%. The 2- and 5-year OS rates were 65% and 40%. No statistically significant relationship was found between World Health Organization performance status score (WHO PS) and age (p=.21), tumour site (p=.42), overall stage (p=.11), T stage (p=.19), and N stage (p=.69). Multivariate analyses showed that a WHO PS score>or=2 (p<.0001) and RT treatment time>or=50 days (p=.0172) significantly decreased LRC. Moreover, a WHO PS score>or=2 (p<.0001), RT treatment time>or=50 days (p=.0138), and RT dose<66 Gy (p=.04) were significantly negative prognostic factors on OS.

Conclusion: Definitive RT, in patients with early- and more advanced-stage squamous cell carcinoma of the larynx, is an important treatment option. It is clear that patients with good pretreatment PS would get better results from definitive RT.
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December 2008

The comparison of weekly and three-weekly cisplatin chemotherapy concurrent with radiotherapy in patients with previously untreated inoperable non-metastatic squamous cell carcinoma of the head and neck.

Cancer Chemother Pharmacol 2009 Aug 3;64(3):601-5. Epub 2009 Jan 3.

Department of Medical Oncology, Medical Faculty, Kocaeli University, Kocaeli, Turkey.

Purpose: Several studies have shown that the concurrent administration of chemotherapy (CHT) and radiotherapy (RT) is superior to RT alone in patients with inoperable non-metastatic squamous cell carcinoma of the head and neck (InSCCHN). We compared the efficacy and safety profile of RT and concurrent cisplatin CHT given in two different schedules to patients with previously untreated InSCCHN.

Methods: Fifty patients with previously untreated InSCCHN admitted to our oncology department were included in the study. Thirty of 50 (60%) patients with a younger age or good performance status (PS) (ECOG 0-1) received cisplatin 100 mg/m(2) on a 21-day schedule (group A). Other 20 (40%) patients with older age or poor PS (ECOG 2) received cisplatin 40 mg/m(2) on a 7-day schedule (group B). Each of the 50 patients received concurrent conventional dose RT according to primer tumor location.

Results: The median follow-up is 12 months for group A and 12.5 months for group B. Twenty-eight (93.3%) patients in group A and 18 (90%) in group B were evaluable for response. The complete response rate was 50% in group A and 40% in group B (P > 0.05). The objective response rate was 92% in group A and 90% in group B (P > 0.05). All grade 3-4 toxic events were seen in 16 (53.3%) of group A patients and 8 (40%) of group B patients (P > 0.05).

Conclusions: Comparison between two treatment modalities appears to result in statistically similar response rates and adverse event profile. A randomized phase III trial is required to confirm the safety and efficacy of weekly cisplatin therapy in patients with poor PS and/or older age at diagnosis.
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http://dx.doi.org/10.1007/s00280-008-0911-7DOI Listing
August 2009

Pre-treatment hemoglobin levels are important for bladder carcinoma patients with extravesical extension undergoing definitive radiotherapy.

Asian Pac J Cancer Prev 2009 ;10(6):1151-7

Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Purpose: To evaluate prognostic factors affecting local control (LC), distant metastases-free survival (DMFS) and overall survival (OS) in bladder carcinoma patients undergoing extravesical extension.

Patients And Methods: We retrospectively reviewed the charts of 61 consecutive patients with T3 or T4 bladder carcinoma, treated with definitive radiotherapy from 1999 through 2007.

Results: Median age was 69 years and follow-up was 29 months. The LC rate was 33% at 4 years and was increased in patients with a Hb< 12 g/dl (p= 0.003) or a LDH< 180 U/L (p= 0.021) and in those who received concurrent chemotherapy (p= 0.022) on univariate analysis. DMFS was affected by anemia (Hb< 12 g/dl) (p= 0.039), the absence of chemotherapy (p= 0.034) and the presence of newly-diagnosed disease (p= 0.01). The OS rate was 19% at 4 years. Non-pure transitional cell carcinoma histological type (p= 0.024), anemia (p= 0.004), elevated LDH (p= 0.003), and newly diagnosed disease (p= 0.011) were poor prognostic factors on univariate analyses for OS. Anemia was the only negative prognostic factor for LC (p= 0.03), DMFS (p= 0.002) and OS (p< 0.0001) on multivariate analysis.

Conclusion: Pre-treatment Hb level is the most important prognostic factor in patients treated with definitive radiotherapy, so that anemia may act as a surrogate biological marker for aggressive disease.
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September 2010

Amifostine use in radiation-induced kidney damage. Preclinical evaluation with scintigraphic and histopathologic parameters.

Strahlenther Onkol 2008 Jul 1;184(7):370-5. Epub 2008 Oct 1.

The Ministry of Health, Numune Hospital, Erzurum, Turkey.

Purpose: To assess the degree of protective effects of amifostine on kidney functions via semiquantitative static renal scintigraphy and histopathologic analysis.

Material And Methods: 30 female albino rats were divided into three equal groups as control (CL), radiotherapy alone (RT), and radiotherapy + amifostine (RT+AMI). The animals in the CL and RT groups were given phosphate-buffered saline, whereas the animals in the RT+AMI group received amifostine (200 mg/kg) by intraperitoneal injection 30 min before irradiation. RT and RT+AMI groups were irradiated with a single dose of 6 Gy using a (60)Co unit at a source-skin distance of 80 cm to the whole right kidney. They were followed up for 6 months. CL, RT, and RT+AMI groups underwent static kidney scintigraphy at the beginning of the experiment and, again, on the day before sacrificing. Histopathologically, tubular atrophy and fibrosis of the kidney damage were evaluated.

Results: After irradiation, the median value of right kidney function was 48% (44-49%) and 50.5% (49%-52%) in RT and RT+AMI groups, respectively (p = 0.0002). Grade 1 kidney fibrosis was observed to be 60% in the RT group, while it was only 30% in the RT+AMI group. Grade 2 kidney fibrosis was 30% and 0% in the RT and RT+AMI group, respectively. Grade 1 tubular atrophy was 70% and 50% in the RT and RT+AMI group, respectively. Grade 2 tubular atrophy effect was the same in both groups (10%).

Conclusion: Static kidney scintigraphy represents an objective and reproducible method to noninvasively investigate kidney function following irradiation. Amifostine produced a significant reduction in radiation-induced loss of renal function.
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http://dx.doi.org/10.1007/s00066-008-1777-7DOI Listing
July 2008

Inguinal lymph node as the only evidence of progressive lung cancer.

Rev Port Pneumol 2008 Sep-Oct;14(5):709-13

Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey.

Tumours that metastasise to groin nodes most frequently originate in genital and reproductive organs, skin, rectum or anus, or urinary bladder. However, rare cases of inguinal metastases from tumours above the diaphragm have been reported and only three of them had an inguinal metastasis which was recognised antemortem and reported in detail in the English medical literature. The primary tumours of these cases were malignant mesothelioma, salivary duct and breast carcinoma. In this paper, we report a case of carcinoma of the lung metastatic to an inguinal lymph node as the only evidence of progressive lung cancer.
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January 2009

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

An unusual metastatic site of tongue carcinoma: shoulder muscles.

Auris Nasus Larynx 2008 Sep 25;35(3):443-6. Epub 2007 Oct 25.

Trakya University Hospital, Department of Radiation Oncology, Edirne, Turkey.

The incidence of skeletal muscle metastases is reported to be less than 1% of metastases of haematogenous origin. Distant skeletal muscle metastases from head and neck squamous cell carcinomas are exceedingly rare. Only a case with tongue carcinoma metastasized to paravertebral muscles, has been reported so far. The reasons for the rarity of metastatic involvement of skeletal muscle are still unclear. The presence of skeletal muscle metastases in the setting of disseminated disease offers no hope for curative treatment. We report an unusual case of a 63-year-old patient with tongue carcinoma metastasizing to the left shoulder muscles. To our knowledge, this is the first such case to be reported in the English medical literature.
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http://dx.doi.org/10.1016/j.anl.2007.08.005DOI Listing
September 2008

Lung, bone, skeletal muscles and cutaneous metastases from adenoid cystic carcinoma of the parotid gland: a case report and review of the literature.

Med Oncol 2007 ;24(4):458-62

Faculty of Medicine, Department of Radiation Oncology, Trakya University, Edirne, Turkey.

Adenoid cystic carcinoma is the second most common malignancy of the major and minor salivary glands after mucoepidemoid carcinoma. The risk of distant metastases is approximately 20-50%. Although bone, the central nervous system and the other organs may become involved, the lungs are favored sites for metastases. Skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the parotid gland are extremely rare. In this case, a 40-year-old man with lung and bone metastases followed by skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the right parotid gland is presented.
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http://dx.doi.org/10.1007/s12032-007-0016-xDOI Listing
February 2008

The efficacy of tamoxifen in patients with advanced epithelial ovarian cancer.

Med Oncol 2007 ;24(1):39-43

Department of Medical Oncology, Faculty of Medicine, Trakya University, Turkey.

Background: Activity of tamoxifen as a salvage therapy in patients with advanced epithelial ovarian cancer was evaluated by a number of studies. In this study, we evaluated efficacy of tamoxifen in our patients with platinum-resistant epithelial ovarian carcinoma.

Patients And Methods: A retrospective analysis was conducted of patients who received tamoxifen at a dose 20 mg twice daily for the treatment of advanced epithelial ovarian cancer.

Results: Twenty-nine eligible patients were included to the study. There were 1 (3%) complete response, 2 (7%) partial response, 6 (21%) stable disease, and 20 (69%) progressive disease. All patients were progressed after initiation of tamoxifen. Median progression-free survival was 4 mo (95% CI: 2.98-5.02). Disease progression of 19 (65%) patients were shown within the first 6 mo after initiation of tamoxifen. Progression-free survival was between 6 and 12 mo for 7 (24%) patients and > or =12 mo for 3 (10%) patients. The median survival after initiation of tamoxifen was 15 mo (95% CI: 7.2-22.8). No toxicity attributable to tamoxifen was seen in any of the patients. The only independent prognostic factor that had a significant predictive value for progression- free survival was the response to tamoxifen treatment (p = 0.043, hazard ratio: 0.12, 95% CI: 0.01-0.94).

Conclusion: Considering minimal side effects and ability to cause objective responses, there is a place for tamoxifen in treatment of patients with platinum-resistant ovarian cancer. A phase III trial is required to con- firm the value of the drug in patients presenting these clinical settings.
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http://dx.doi.org/10.1007/BF02685901DOI Listing
September 2007

Extrapulmonary small-cell carcinoma compared with small-cell lung carcinoma: a retrospective single-center study.

Cancer 2007 Sep;110(5):1068-76

Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Background: The study was conducted with the aim of reviewing the clinical features, therapy, and natural course of patients with extrapulmonary small-cell carcinoma (EPSCC) and small-cell lung carcinoma (SCLC) to better define current concepts regarding EPSCCs.

Methods: The medical records of patients with proven diagnosis of small-cell carcinoma (SmCC) between January 1999 and May 2006 were retrospectively reviewed. A total of 65 SmCC cases were included in the study (11 [17%] cases of EPSCC and 54 [83%] cases of SCLC).

Results: Progression-free survival of all patients with EPSCC and patients with extensive EPSCC disease was 7 months (95% confidence interval [CI], 0.58-13.42) and 7 months (95% CI, 4.71-13.29), respectively. Overall survival of all patients with EPSCC and patients with extensive EPSSC disease was 32 months (95% CI, 18.74-45.26) and 28 months (95% CI, 12.24-43.76), respectively. Progression-free survival and overall survival for all patients with SCLC were 5 months (95% CI, 2.26-7.74) and 10 months (95% CI, 5.95-14.05), respectively. Progression-free survival and overall survival for patients with extensive disease were 3 months (95% CI, 4.71-13.29) and 5 months (95% CI, 3.33-6.67), respectively. Overall survival was significantly better in all patients with EPSCC and in patients with extensive EPSCC disease compared with all patients with SCLC and patients with extensive SCLC disease (P = .014, P = .004, respectively). Early death and brain metastasis were observed in a higher number of patients with SCLC compared with EPSCC; however, these results were not statistically significant (P = .33 and P = .076, respectively). Smoking history was significantly less in the EPSCC group (P < .0001).

Conclusions: EPSCC is usually treated similarly to SCLC. However, this study suggests some differences such as etiology, clinic course, survival, frequency of brain metastases, and early death between these entities. These possible differences may influence the choice of therapeutic approach.
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http://dx.doi.org/10.1002/cncr.22887DOI Listing
September 2007

An ambiguous phenomenon of radiation and drugs: recall reactions.

Onkologie 2007 Apr 23;30(4):209-14. Epub 2007 Mar 23.

Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

The term 'radiation recall' describes an acute inflammatory reaction in previously irradiated areas after the administration of certain inciting systemic agents. It was first described in 1959 by D'Angio that dermatitis is related to the application of actinomycin D on the skin. Though this reaction occurs frequently on the skin, it may also be seen in the oral mucosa, the larynx, esophagus, small intestine, lungs, muscle tissue, and brain. Most drugs associated with recall reactions are cytotoxics, however, several other drugs may also elicit the phenomenon. Although this phenomenon is well known, its etiology is not understood. Radiation recall reactions are generally associated with megavoltage radiotherapy. The time interval between the completion of radiotherapy and the recall reaction ranges from days to years. The recall reaction occurs on average 8 days (3 days to 2 months) after the application of the promoting agent. Although no standard treatment exists, some authors suggest discontinuation of the inciting drug and the use of corticosteroids or nonsteroidal anti-inflammatory agents.
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http://dx.doi.org/10.1159/000099632DOI Listing
April 2007

Paraneoplastic syndrome of non-small cell lung carcinoma: a case with pancytopenia, leukocytoclastic vasculitis, and hypertrophic osteoarthropathy.

Lung Cancer 2007 Jun 12;56(3):455-8. Epub 2007 Feb 12.

Department of Radiation Oncology, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey.

Various remote effects of cancer or paraneoplastic syndromes (PNS) are common in lung cancer, and may be the manifestation of the disease or its recurrence. The symptoms may be endocrine, neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, gastrointestinal, renal, or miscellaneous in nature. Since the symptoms of paraneoplastic syndromes may occur before the local symptoms of the primary tumor, it might be helpful in the early diagnosis of malignancy. We present a 65-year-old man with multiple paraneoplastic syndrome forms consisting of pancytopenia leukocytoclastic vasculitis and hypertrophic pulmonary osteoarthropathy, associated with non-small cell lung carcinoma.
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http://dx.doi.org/10.1016/j.lungcan.2007.01.008DOI Listing
June 2007

Oncocytic carcinoma of the parotid gland.

Onkologie 2006 Sep 5;29(8-9):388-90. Epub 2006 Sep 5.

Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Background: Oncocytic carcinoma is a rare tumor of major salivary glands. Despite being described 5 decades ago, not much is known about these rare tumors. Histochemical or electron microscopic confirmation of the oncocytic nature of the tumor cell is needed for differential diagnosis. The main treatment modality is surgery with or without adjuvant radiotherapy. Malignant oncocytomas have the potential risk of developing distant metastases and demand long term follow-up after therapy.

Case Report: A 58-year old man presented with a recurrent mass in the left parotid gland with a prior diagnosis of monomorphic adenoma in the same localization which had been treated by tumor excision in July 2002. Left superficial parotidectomy followed by radiotherapy into tumor bed and upper neck were carried out in September 2004. To date, he has had no evidence of recurrence for 14 months.

Conclusion: For an accurate approach in the management of patients, oncocytic adenocarcinoma should be considered in the differential diagnosis of lesions of the parotid gland, most of which are benign.
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http://dx.doi.org/10.1159/000095029DOI Listing
September 2006

Treatment results of 165 pediatric patients with non-metastatic nasopharyngeal carcinoma: a Rare Cancer Network study.

Radiother Oncol 2006 Oct 11;81(1):39-46. Epub 2006 Sep 11.

Hacettepe University, Oncology Institute, Ankara, Turkey.

Purpose: This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors.

Patients And Methods: The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months.

Results: The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06-84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33-76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC (p=0.04); male gender for DMFS (p=0.03); T3/T4 disease for LRFS (p=0.01); and N3 disease for DFS (p=0.002) and OS (p=0.002); EBRT dose of less than 66 Gy for LRFS (p=0.02) and LRRFS (p=0.0028); and patients treated with RT alone for LRFS (p=0.0001), LRRFS (p=0.007) and DFS (p=0.02).

Conclusion: Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity.
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http://dx.doi.org/10.1016/j.radonc.2006.08.019DOI Listing
October 2006

Metastatic giant basal cell carcinoma and radiotherapy.

J Plast Reconstr Aesthet Surg 2006 21;59(7):783-4. Epub 2006 Feb 21.

Department of Radiation Oncology, Trakya University Hospital, Edirne, Turkey.

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http://dx.doi.org/10.1016/j.bjps.2005.12.015DOI Listing
September 2006

Nasopharyngeal carcinoma with extensive nodular skin metastases: a case report.

Tumori 2006 Mar-Apr;92(2):181-4

Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.

Skin metastasis from nasopharyngeal carcinoma is a rare clinical finding. The most common form of appearance is a few solitary skin nodules. However, massive and extensive nodular dissemination or diffuse dermal lymphatic infiltration is extremely rare. We here present a case of a 40-year-old man with widespread nodular skin metastases from undifferentiated nasopharyngeal carcinoma.
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June 2006