Publications by authors named "Murat Gürkaynak"

33 Publications

Ewing sarcoma in an infant and review of the literature.

Turk J Pediatr 2019 ;61(5):760-764

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

Bedük Esen ÇS, Gültekin M, Aydın GB, Akyüz C, Karlı Oğuz K, Orhan D, Cengiz M, Gürkaynak M, Yıldız F. Ewing sarcoma in an infant and review of the literature. Turk J Pediatr 2019; 61: 760-764. Ewing sarcoma (ES) is a rare tumor in infants and prognosis is controversial. There are no standard recommendations for treatment in such very young patients. Generally, radiotherapy (RT) is not a part of treatment in infants due to the risk of severe late side effects. In this case report, we report a 7-month-old boy with diagnosis of left mastoid bone ES with lung metastases at diagnosis, showing a rapidly fatal outcome despite aggressive systemic chemotherapy and RT without surgery.
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http://dx.doi.org/10.24953/turkjped.2019.05.016DOI Listing
August 2020

Dosimetric comparison of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for left-sided chest wall and lymphatic irradiation.

J Appl Clin Med Phys 2019 Dec 3;20(12):36-44. Epub 2019 Nov 3.

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

Introduction: The aim of this study was to compare five different techniques for chest wall (CW) and lymphatic irradiation in patients with left-sided breast carcinoma.

Methods: Three-dimensional conformal radiotherapy (3DCRT), forward-planned intensity-modulated radiotherapy (FP-IMRT), inverse-planned IMRT (IP-IMRT; 7- or 9-field), and hybrid IP-/FP-IMRT were compared in 10 patients. Clinical target volume (CTV) included CW and internal mammary (IM), supraclavicular (SC), and axillary nodes. Planning target volumes (PTVs), CTVs, and organs at risks (OARs) doses were analyzed with dose-volume histograms (DVHs).

Results: No differences could be observed among the techniques for doses received by 95% of the volume (D95%) of lymphatics. However, the FP-IMRT resulted in a significantly lower D95% dose to the CW-PTV compared to other techniques (P = 0.002). The 9-field IP-IMRT achieved the lowest volumes receiving higher doses (hotspots). Both IP-IMRT techniques provided similar mean doses (Dmean) for the left lung which were smaller than the other techniques. There was no difference between the techniques for maximum dose (Dmax) of right breast. However, FP-IMRT resulted in lower Dmean and volume of right breast receiving at least 5 Gy doses compared to other techniques.

Conclusion: The dose homogeneity in CW-CTV was better using IMRT techniques compared to 3DCRT. Especially 9-field IP-IMRT provided a more homogeneous dose distribution in IM and axillary CTVs. Moreover, the OARs volumes receiving low radiation doses were larger with IP-IMRT technique, while volumes receiving high radiation doses were larger with FP-IMRT technique. Hybrid IMRT plans were found to have the advantages of both FP- and IP-IMRT techniques.
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http://dx.doi.org/10.1002/acm2.12757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909119PMC
December 2019

Reirradiation of Pediatric Tumors Using Hypofractionated Stereotactic Radiotherapy.

Technol Cancer Res Treat 2017 04 8;16(2):195-202. Epub 2016 Jul 8.

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

Background: This study aimed to evaluate the efficacy and safety of hypofractionated stereotactic radiotherapy for reirradiation of recurrent pediatric tumors.

Methods And Materials: The study included 23 pediatric patients who were reirradiated using hypofractionated stereotactic radiotherapy in the radiation oncology department between January 2008 and November 2013. In total, 33 tumors were treated-27 (82%) cranial and 6 (18%) extracranial. Hypofractionated stereotactic radiotherapy was administered due to recurrent disease in 31 (94%) tumors and residual disease in 2 (6%) tumors. The median total dose was 25 Gy (range: 15-40 Gy), and the median follow-up was 20 months (range: 2-68 months).

Results: The 1-year and 2-year local control rates in the entire study population were 42% and 31%, respectively. The median local control time was 11 months (range: 0-54 months) following hypofractionated stereotactic radiotherapy. The patients with tumor response after hypofractionated stereotactic radiotherapy had significantly longer local control than the patients with post-hypofractionated stereotactic radiotherapy tumor progression (21 vs 3 months, P < .001). Tumor volume <1.58 cm was correlated (not significantly) with better local control (23 vs 7 months, P = .064).

Conclusion: Reirradiation of pediatric tumors using hypofractionated stereotactic radiotherapy is a safe and effective therapeutic approach. This treatment modality should be considered as a treatment option in selected pediatric patients.
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http://dx.doi.org/10.1177/1533034616655952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5616030PMC
April 2017

High-grade glioma in children and adolescents: a single-center experience.

Childs Nerv Syst 2016 Feb 17;32(2):291-7. Epub 2015 Dec 17.

Department of Radiation Oncology, School of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.

Purpose: The aim of this study was to report the outcome in children with high-grade astrocytoma outside the brain stem and spinal cord that were treated at a single center.

Materials And Methods: The study included 26 patients with anaplastic astrocytoma and 37 patients with glioblastoma; all patients were aged ≤18 years. At initial diagnosis, 18 of the patients with glioblastoma received only temozolomide (TMZ), 14 received other chemotherapies, and 5 did not receive any chemotherapy. Among the patients with anaplastic astrocytoma, 9 received TMZ, 9 received other chemotherapy regimens, and 8 patients did not receive any chemotherapy. The median radiotherapy dose in all patients was 60 Gy.

Results: Median age of the patients was 12.5 years. Median overall survival was 20 months and mean progression-free survival was 4.7-11.3 months (median: 8 months) in all patients. Patients with a Karnofsky performance score (KPS) ≥70 had median overall survival of 32 months, versus 7 months in those with a KPS < 70. Patients aged <15 years had median survival of 38 months, versus 16 months in those aged 15-18 years. Patients with anaplastic astrocytoma that received TMZ, other chemotherapy regimens, and no chemotherapy had median survival of 21 months, 132 months, and 11 months, respectively. Patients with glioblastoma that received TMZ, other chemotherapy regimens, and no chemotherapy had median survival of 32 months, 12 months, and 8 months, respectively.

Conclusion: In the present study, patients with anaplastic astrocytoma treated with chemotherapy protocols other than TMZ had the longest OS; however, in the glioblastoma group, OS was 32 months in those treated with standard TMZ and 12 months in those treated with other protocols (P = 0.493). Although TMZ is less toxic than PCV, it was not shown to be superior.
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http://dx.doi.org/10.1007/s00381-015-2980-3DOI Listing
February 2016

Impact of locoregional treatment on survival in patients presented with metastatic breast carcinoma.

Breast 2014 Dec 5;23(6):775-83. Epub 2014 Sep 5.

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey.

Objectives: In this study, we tried to evaluate the efficacy of locoregional treatment (LRT) in patients with metastatic breast carcinoma (MBC).

Materials And Methods: The medical records of 227 patients with MBC at initial presentation between April 1999 and January 2013 were retrospectively evaluated. The median age at diagnosis was 50 years (range, 27-83 years). Thirty-nine patients (17%) had no LRT. Among patients who had LRT, 2 (1%) had locoregional radiotherapy (RT) alone, 54 (29%) had surgery alone [mastectomy, n = 50; breast conserving surgery (BCS), n = 4] and 132 (70%) had surgery (mastectomy, n = 119; BCS, n = 13) followed by locoregional RT.

Results: The median follow-up time was 35 months (range, 4-149 months). Five-year OS and PFS rates were 44% and 20%, respectively. In both univariate and multivariate analysis LRT per se did not affect OS and PFS rates. However, the 5-year OS and PFS rates were significantly higher in patients treated with locoregional RT than the ones who were not. The corresponding rates were 56% vs. 24% for OS and 27% vs. 7% for PFS (p < 0.001). Median survival was 67 months and 37 months, respectively.

Conclusion: Our study showed that patients with MBC who received postoperative locoregional RT may have a survival advantage compared with patients who were only treated by surgery. A phase III trial testing the role of adjuvant locoregional RT may help to distinguish patients who will benefit from adjuvant RT.
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http://dx.doi.org/10.1016/j.breast.2014.08.008DOI Listing
December 2014

Hypofractionated stereotactic reirradiation for recurrent glioblastoma.

J Neurooncol 2014 Oct 11;120(1):117-23. Epub 2014 Jul 11.

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

Treatment choices for recurrent glioblastoma patients are sparse and the results are not satisfactory. In this retrospective analysis, we evaluated the results of re-irradiation of locally recurrent glioblastoma patients with an image-guided, fractionated, frameless stereotactic radiotherapy (SRT) technique. We treated 37 patients with the diagnosis of recurrent glioblastoma from September 2009 to December 2011. SRT was performed in a median five fractions (range, 1-5 fractions) with CyberKnife(®) (Accuray Incorporated, Sunnyvale, CA, USA). The dose given ranged from 14 to 32 Gy (median, 30 Gy). The median volume of the GTV was 24 cc (range, 2-81 cc). Median follow-up was 9.3 months. Five patients had regression in their lesions, 14 had stable disease, progression was observed in eight patients, and seven patients had pseudoprogression. The median survival following SRT was 10.6 months (range, 1.1-20 months) and overall survival following initial treatment was 35.5 months. The time to progression following SRT was 7.9 months in median. Patients with pseudoprogression had significantly longer survival after the first magnetic resonance imaging (MRI) compared to those with regression, stable or progressive disease (p = 0.012). The median survival after SRT for patients with pseudoprogression was 20 months. Patients who had GTV <24 cc had significantly longer survival following SRT compared to those with lesions ≥24 cc (p = 0.015). Patients who had chemotherapy after SRT had a median survival of 16.8 months. This was 9.7 months for patients who were not prescribed any chemotherapy (p = 0.062).
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http://dx.doi.org/10.1007/s11060-014-1524-0DOI Listing
October 2014

Metaplastic breast carcinoma: a heterogeneous disease.

Asian Pac J Cancer Prev 2014 ;15(6):2851-6

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey E-mail :

The aim of this study is to evaluate clinicopathologic characteristics and the multi-disciplinary treatment results of metaplastic breast cancer (MBC) patients treated in a single institute. Seventeen female patients with MBC treated in our department between June 2000 and January 2012 were identified and retrospectively evaluated. The median age at diagnosis was 46 years (range, 26-66 years). The median tumor size at diagnosis was 3.5 cm (range 1.5-12 cm). Six (35%) patients underwent breast conservation surgery and 11 (65%) mastectomy. Axillary lymph node metastasis was found in 6 (35%) patients. Twelve (71%) had triple negative tumors. Postoperative RT and systemic adjuvant treatment was given to all patients accordingly to stage and biological characteristics. Median follow-up time was 27 months (range, 12-151 months). At the time of this analysis, 14 (82%) patients were alive with no evidence of disease, and 1 (6%) was alive with disease. The 3-year OS was 91% and 5-year 80%, and DFS rates were 76% and 76%, respectively. Despite the young age of our patients with mostly high grade tumors, larger tumor size and higher rates of lymph node metastasis, the survival outcomes in our study are favorable in comparison with previously reported series.
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http://dx.doi.org/10.7314/apjcp.2014.15.6.2851DOI Listing
January 2015

Comparison of Chest Wall and Lymphatic Radiotherapy Techniques in Patients with Left Breast Carcinoma.

J Breast Health 2014 Apr 1;10(2):106-110. Epub 2014 Apr 1.

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

Objective: The aim of this study was to find the most appropriate technique for postmastectomy chest wall (CW) and lymphatic irradiation.

Materials And Methods: Partially wide tangent, 30/70 photon/electron mix, 20/80 photon/electron mix and CW and internal mammary en face electron field, were studied on computerized tomography (CT) scans of 10 left breast carcinoma patients and dosimetric calculations have been studied. Dose volume histograms (DVH) obtained from treatment planning system (TPS) were used for minimal, maximal and mean doses received by the clinical target volumes and critical structures.

Results: Partially wide tangent field resulted in the most homogeneous dose distribution for the CW and a significantly lower lung and heart doses compared with all other techniques. However, right breast dose was significantly higher for partially wide tangent technique than that each of the other techniques. Approximately 0.6-7.9% differences were found between thermoluminescent dosimeter (TLD) and treatment planning system (TPS). The daily surface doses calculating using Gafchromic® external beam therapy (EBT) dosimetry films were 161.8±2.7 cGy for the naked, 241.0±1.5 cGy when 0.5 cm bolus was used and 255.3±2.7 cGy when 1 cm bolus was used.

Conclusion: As a result of this study, partially wide tangent field was found to be the most appropriate technique in terms of the dose distribution, treatment planning and set-up procedure. The main disadvantage of this technique was the higher dose to the contralateral breast comparing the other techniques.
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http://dx.doi.org/10.5152/tjbh.2014.2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351467PMC
April 2014

A simple strategy to decrease fatal carotid blowout syndrome after stereotactic body reirradiaton for recurrent head and neck cancers.

Radiat Oncol 2013 Oct 18;8:242. Epub 2013 Oct 18.

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

Background: This study aimed to compare the therapeutic outcomes and fatal carotid blow out syndrome (CBOS) incidence rates between two different stereotactic body radiotherapy (SBRT) protocols.

Methods: The study included 75 patients with inoperable locally recurrent head and neck cancer treated with SBRT in our department between June 2007 and March 2011. The first 43 patients were treated sequentially (group I). Then our SBRT protocol was changed due to the high rate of CBOS, and the following 32 patients were treated every other day in a prospective institutional protocol (group II).

Results: Median overall survival in group I and group II was 11 months and 23 months, respectively (P = 0.006). We observed 11 cases of CBOS. Only 1 of 7 patients (14%) with CBOS survived in group I, whereas 2 of 4 patients (50%) in group II remain alive. CBOS free median overall survivals were 9 months, and 23 months in group I and group II respectively (P = 0.002). The median radiation dose received by the carotid artery in patients with CBOS was 36.5 Gy (range: 34-42.8 Gy), versus 34.7 Gy (range: 0-44 Gy) in the patients that didn't have CBOS (P = 0.15). CBOS did not occur in any of the patients with a maximum carotid artery radiation dose <34 Gy.

Conclusions: Every other day SBRT protocol for re-irradiation of recurrent head and neck cancer is promising in terms of decreasing the incidence of fatal CBOS.
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http://dx.doi.org/10.1186/1748-717X-8-242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016484PMC
October 2013

Robotic stereotactic radiosurgery in patients with nasal cavity and paranasal sinus tumors.

Technol Cancer Res Treat 2014 Oct 31;13(5):409-13. Epub 2013 Aug 31.

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey.

The aim of this retrospective study is to evaluate our therapeutic results in patients with paranasal sinus (PNS) or nasal cavity (NC) malignancies treated with robotic stereotactic radiosurgery (SRS). Between August 2007 and October 2008, 27 patients with PNS or NC tumors were treated in our department using SRS. Median age was 53 years (range, 27-84 years). Eleven patients were female and sixteen were male. Most common histopathology was SCC (44%). The disease involved the maxillary sinus in 15 patients (55%). SRS was applied to 6 patients (22%) for reirradiation, while the others received it as a primary treatment. Seven patients had SRS as a boost dose to external beam radiotherapy. SRS was delivered with cyberknife (Accuray Incorporated, Sunnyvale, CA, USA). The median dose to the tumor was 31 Gy (range, 15-37.5 Gy) in median 5 fractions (range, 3-5 fractions). After a median follow-up of 21.4 months (range, 3-59 months), 76% of the patients were free of local relapse. Three patients showed local progression and 3 developed distant metastases. One- and two-year survival rates for the entire group were 95.2% (SEM = 0.046) and 77.1% (SEM = 0.102), respectively. We observed brain necrosis in 2 patients, visual disorder in 2 patients, bone necrosis in 2 patients and trismus in 1 patient as a SRS related late toxicity. Robotic SRS seems to be a feasible treatment strategy for patients with PNS tumors. Further prospective studies with longer follow up times should be performed.
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http://dx.doi.org/10.7785/tcrtexpress.2013.600264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527521PMC
October 2014

Determination of gonad doses during robotic stereotactic radiosurgery for various tumor sites.

Med Phys 2013 Apr;40(4):041703

Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara 06100, Turkey.

Purpose: The authors evaluated the absorbed dose received by the gonads during robotic stereotactic radiosurgery (SRS) for the treatment of different tumor localizations.

Methods: The authors measured the gonad doses during the treatment of head and neck, thoracic, abdominal, or pelvic tumors in both RANDO phantom and actual patients. The computerized tomography images were transferred to the treatment planning system. The contours of tumor and critical organs were delineated on each slice, and treatment plans were generated. Measurements for gonad doses were taken from the geometric projection of the ovary onto the skin for female patients, and from the scrotal skin for male patients by attaching films and Thermoluminescent dosimeters (TLDs). SRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA).

Results: The median gonadal doses with TLD and film dosimeter in actual patients were 0.19 Gy (range, 0.035-2.71 Gy) and 0.34 Gy (range, 0.066-3.18 Gy), respectively. In the RANDO phantom, the median ovarian doses with TLD and film dosimeter were 0.08 Gy (range, 0.03-0.159 Gy) and 0.05 Gy (range, 0.015-0.13 Gy), respectively. In the RANDO phantom, the median testicular doses with TLD and film dosimeter were 0.134 Gy (range 0.056-1.97 Gy) and 0.306 Gy (range, 0.065-2.25 Gy).

Conclusions: Gonad doses are below sterility threshold in robotic SRS for different tumor localizations. However, particular attention should be given to gonads during robotic SRS for pelvic tumors.
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http://dx.doi.org/10.1118/1.4794180DOI Listing
April 2013

Health-related quality of life in high-grade glioma patients: a prospective single-center study.

Support Care Cancer 2012 Oct 13;20(10):2315-25. Epub 2011 Dec 13.

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

Purpose: In this single center study, we aimed to assess quality of life and cognitive and emotional distress in patients treated for high-grade glioma.

Methods And Materials: A hundred and eighteen patients with high-grade glioma were prospectively enrolled. We assessed HRQoL at baseline (after surgery before radiotherapy), at the end of radiotherapy and during follow-up (every 3 months for the first 2 years and every 6 months between 2 and 5 years) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC-C30), Brain Cancer Module-20 (BN-20), Minimental State Examination (MMSE) and Hospital Anxiety and Depression Scale (HADS). Baseline scores, and first 18-month follow-up period scores were included to statistical analysis.

Results: Sixty-five (55%) patients had progressive tumor. Global score, physical, role and emotional function, insomnia (p for each <0.001) and appetite loss (p: 0.008) scores of EORTC-C30 significantly related to disease progression. According to BN-20 seizure and leg weakness (p < 0.001), drowsiness and bladder control (p: 0.002), motor dysfunction (p: 0.001), future uncertainty (p: 0.04), visual disorder (p: 0.008) and communication deficit (p: 0.006) symptoms significantly related to disease progression. There were significant decrements in orientation, attention and calculation and language scores (p values were 0.017, 0.005 and 0.003, respectively) of MMSE. The baseline and follow-up anxiety and depression scores did not differ significantly.

Conclusion: We conclude that there were many changes in patients with high-grade glioma during the course of the disease and most of them were related to disease progression.
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http://dx.doi.org/10.1007/s00520-011-1340-4DOI Listing
October 2012

Robotic stereotactic body radiotherapy in the treatment of sinonasal mucosal melanoma: report of four cases.

Head Neck 2013 Mar 11;35(3):E69-73. Epub 2011 Nov 11.

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

Background: Sinonasal mucosal melanoma (SNMM) is a rare entity originating from melanocytes of the sinonasal mucosa. Postoperative radiotherapy is recommended in all cases to increase local control. However, external radiotherapy is rarely used as a definitive treatment modality. In this report, we present 4 cases of SNMM treated with CyberKnife (Accuray, Sunnyvale, CA).

Methods: All patients were immobilized with a thermoplastic mask. A planning CT scan with 1-mm thickness was obtained, and these images were fused with MRI for the contouring procedure. Multiplan (Accuray) inverse planning software was used for treatment planning. Robotic stereotactic body radiotherapy (SBRT) was delivered with CyberKnife.

Results: Median follow-up was 26 months. Three patients had complete response to CyberKnife, and 1 patient had partial response.

Conclusion: Robotic SBRT seems to be an appealing treatment option for local control. Effective systemic treatment is required to prevent distant metastases.
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http://dx.doi.org/10.1002/hed.21895DOI Listing
March 2013

Prospective assessment of health-related quality of life in patients with low-grade glioma: a single-center experience.

Support Care Cancer 2012 Aug 8;20(8):1859-68. Epub 2011 Oct 8.

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

Purpose: The assessment of Health-Related Quality of Life (HRQoL) in cancer patients has become increasingly important during the past decades. The aim of this study was to evaluate the HRQoL in patients treated for low-grade glioma (LGG).

Methods And Materials: Forty-three adult patients with LGG were evaluated prospectively between September 2006 and December 2010. We assessed HRQoL at baseline (after surgery before radiotherapy), at the end of radiotherapy and during follow-up (every 3 months for the first 2 years and every 6 months between 2 and 5 years), using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC-C30), Brain Cancer Module-20 (BN-20), Mini Mental State Examination (MMSE) and Hospital Anxiety and Depression Scale (HADS).

Results: We demonstrated changes in global score (p = 0.004), and future uncertainty (p < 0.001), communication deficit (p = 0.007), headache (p < 0.001), drowsiness (p = 0.002) and hair loss (p < 0.001), and recall score (p = 0.0029) during follow-up. All complaints of LGG patients showed improvement, except for the hair loss. Although the baseline cognitive function scores was not significantly different, the third-year cognitive function scores of patients who used antiepileptic drugs had lower when compared to patients who did not use (p < 0.001). The baseline and follow-up anxiety and depression scores did not differ significantly.

Conclusion: Our results suggested that there were improvement in HRQoL in LGG patients during follow-up and antiepileptic drugs had negative effect on cognitive functions.
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http://dx.doi.org/10.1007/s00520-011-1288-4DOI Listing
August 2012

A retrospective comparison of robotic stereotactic body radiotherapy and three-dimensional conformal radiotherapy for the reirradiation of locally recurrent nasopharyngeal carcinoma.

Int J Radiat Oncol Biol Phys 2011 Nov 22;81(4):e263-8. Epub 2011 Apr 22.

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

Purpose: We assessed therapeutic outcomes of reirradiation with robotic stereotactic radiotherapy (SBRT) for locally recurrent nasopharyngeal carcinoma (LRNPC) patients and compared those results with three-dimensional conformal radiotherapy (CRT) with or without brachytherapy (BRT).

Methods And Materials: Treatment outcomes were evaluated retrospectively in 51 LRNPC patients receiving either robotic SBRT (24 patients) or CRT with or without BRT (27 patients) in our department. CRT was delivered with a 6-MV linear accelerator, and a median total reirradiation dose of 57 Gy in 2 Gy/day was given. Robotic SBRT was delivered with CyberKnife (Accuray, Sunnyvale, CA). Patients in the SBRT arm received 30 Gy over 5 consecutive days. We calculated actuarial local control and cancer-specific survival rates for the comparison of treatment outcomes in SBRT and CRT arms. The Common Terminology Criteria for Adverse Events v3.0 was used for toxicity evaluation.

Results: The median follow-up was 24 months for all patients. Two-year actuarial local control rates were 82% and 80% for SBRT and CRT arms, respectively (p = 0.6). Two-year cancer-specific survival rates were 64% and 47% for the SBRT and CRT arms, respectively (p = 0.4). Serious late toxicities (Grade 3 and above) were observed in 21% of patients in the SBRT arm, whereas 48% of patients had serious toxicity in the CRT arm (p = 0.04). Fatal complications occurred in three patients (12.5%) of the SBRT arm, and four patients (14.8%) of the CRT arm (p = 0.8). T stage at recurrence was the only independent predictor for local control and survival.

Conclusion: Our robotic SBRT protocol seems to be feasible and less toxic in terms of late effects compared with CRT arm for the reirradiation of LRNPC patients.
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http://dx.doi.org/10.1016/j.ijrobp.2011.02.054DOI Listing
November 2011

Salvage reirradiaton with stereotactic body radiotherapy for locally recurrent head-and-neck tumors.

Int J Radiat Oncol Biol Phys 2011 Sep 2;81(1):104-9. Epub 2010 Aug 2.

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

Purpose: In this study, we present our results of reirradiation of locally recurrent head-and-neck cancer with image-guided, fractionated, frameless stereotactic body radiotherapy technique.

Methods And Materials: From July 2007 to February 2009, 46 patients were treated using the CyberKnife (Accuray, Sunnyvale, CA) at the Department of Radiation Oncology, Hacettepe University, Ankara, Turkey. All patients had recurrent, unresectable, and previously irradiated head-and-neck cancer. The most prominent site was the nasopharynx (32.6%), and the most common histopathology was epidermoid carcinoma. The planning target volume was defined as the gross tumor volume identified on magnetic resonance imaging and computed tomography. There were 22 female and 24 male patients. Median age was 53 years (range, 19-87 years). The median tumor dose with stereotactic body radiotherapy was 30 Gy (range, 18-35 Gy) in a median of five (range, one to five) fractions.

Results: Of 37 patients whose response to therapy was evaluated, 10 patients (27%) had complete tumor regression, 11 (29.8%) had partial response, and 10 (27%) had stable disease. Ultimate local disease control was achieved in 31 patients (83.8%). The overall survival was 11.93 months in median (ranged, 11.4-17.4 months), and the median progression free survival was 10.5 months. One-year progression-free survival and overall survival were 41% and 46%, respectively. Grade II or greater long-term complications were observed in 6 (13.3%) patients. On follow-up, 8 (17.3%) patients had carotid blow-out syndrome, and 7 (15.2%) patients died of bleeding from carotid arteries. We discovered that this fatal syndrome occurred only in patients with tumor surrounding carotid arteries and carotid arteries receiving all prescribed dose.

Conclusions: Stereotactic body radiotherapy is an appealing treatment option for patients with recurrent head-and-neck cancer previously treated with radiation to high doses. Good local control with considerable 1-year survival is achieved with a relatively high rate of morbidity and related mortality.
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http://dx.doi.org/10.1016/j.ijrobp.2010.04.027DOI Listing
September 2011

Second line palliative endobronchial radiotherapy with HDR Ir 192 in recurrent lung carcinoma.

Yonsei Med J 2008 Aug;49(4):620-4

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

Purpose: To observe the efficiency of reirradiation with high dose rate intraluminal brachytherapy in symptomatic palliation of recurrent endobronchial tumors.

Materials And Methods: Between January 1994 and June 1998, 21 patients diagnosed with recurrent endobronchial tumors following external beam radiotherapy were treated palliatively with high dose rate intraluminal irradiation at Hacettepe University Oncology Institute. A single fraction of 10 Gy was prescribed to the specified area in 9 patients and 15 Gy to 12.

Results: Endobronchial treatment improved the performance and reduced symptomatology in 17 (81%) patients. Ten dyspneic patients (10/14, 71%) recovered clinically with an accompanying radiological downstaging. The median symptomatic palliation was 45 days (range, 0-9 months), and the overall median survival was 5.5 months (range, 4-12 months). The palliative intrabronchial brachytherapy was well tolerated, with the exception of in one patient with a fatal hemorrhage, and another with medically salvaged bronchospasm and intrabronchial edema.

Conclusion: Recurrent patients with a history of previous thoracic external beam irradiation can be effectively palliated with high dose rate endobronchial reirradiation if the symptoms are directly related to the endobronchial tumor.
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http://dx.doi.org/10.3349/ymj.2008.49.4.620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615289PMC
August 2008

Percent positive axillary involvement predicts for the development of brain metastasis in high-risk patients with nonmetastatic breast cancer receiving post-mastectomy radiotherapy.

Breast J 2008 May-Jun;14(3):245-9. Epub 2008 Apr 21.

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

We retrospectively assessed the predictive factors for brain metastasis in high-risk breast cancer patients receiving radiotherapy after mastectomy. Between January 1994 and 2002, the medical charts of nonmetastatic breast cancer patients receiving post-mastectomy radiotherapy were evaluated. The clinical and pathologic features of patients who developed brain metastasis as the first site metastatic disease were compared with nonmetastatic patients treated at the same time period. All eligible patients in this study were treated with postoperative radiotherapy +/- chemotherapy. Age, stage, percent positive lymph node involvement, number of lymph node metastasis, primary tumor size, grade, surgical margin status, estrogen receptor status, and perinodal fat tissue invasion were analyzed as predictive factors for brain metastasis. Statistical analyses were performed by using Log-rank test and Cox's regression analysis. Median follow-up-time was 61 months. In this period, 32 out of 957 patients (3.3%) developed brain metastasis. In univariate analysis percent positive axillary lymph node involvement (p < 0.001), primary tumor size (p < 0.001), number of lymph node metastasis (p = 0.01), and American Joint Committee on Cancer 2002 stage (p < 0.001) were found to be predictive for brain metastasis. Multivariate analysis revealed that only the primary tumor size and percent positive lymph node involvement were significant predictive factors for the development of brain metastasis. The primary tumor size and percent positive lymph node involvement increases the risk of brain metastasis in patients with nonmetastatic breast cancer receiving postoperative radiotherapy and chemotherapy.
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http://dx.doi.org/10.1111/j.1524-4741.2008.00569.xDOI Listing
June 2008

Percent positive axillary lymph node metastasis predicts survival in patients with non-metastatic breast cancer.

Acta Oncol 2008 ;47(2):232-8

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

Purpose: We retrospectively evaluated the impact of percent positive axillary nodal involvement on the therapeutic outcomes in patients with non-metastatic breast cancer receiving postmastectomy radiotherapy and chemotherapy.

Materials And Methods: Between January 1994 and December 2002, the medical records of 939 eligible non metastatic breast carcinoma patients were analyzed. Chest wall radiotherapy was indicated in case of positive surgical margin, tumor size equal or more than 4 cm, skin-fascia invasion. Lymphatic irradiation was applied for more than three metastatic axillary lymph nodes, incomplete axillary dissection (<10 lymph nodes), extracapsular extension or perinodal fat tissue invasion. A total dose of 50 Gy was given to chest wall and lymph node regions with 2 Gy daily fractions. Statistical analyses were performed by Kaplan-Meier method, Log-rank test and Cox's regression analysis.

Results: The median follow-up for all patients alive was 62 months. The 5-year overall survival (OS) and disease-free survival (DFS) for entire cohort were 81%, and 65%, respectively. Univariate analysis for OS revealed significance for tumour size (< or =5 cm vs. >5 cm, p<0.001), metastatic nodal involvement (0 vs. 1-3 vs. >4 LN, p<0.001), percent positive nodal involvement ([metastatic nodes/total nodes removed] x 100; 0 vs. < or =25% vs. 26-50% vs. >50%, p<0.001), surgical margin status (negative vs. positive, p=0.05), and hormonal treatment (present vs. absent, p=0.03). DFS had similarly significance for age (< or =40 years vs. >40 years, p=0.006), tumour size (0.02), metastatic nodal involvement (p<0.001), percent positive nodal involvement (p<0.001), and perinodal invasion (present vs. absent, p=0.01). Multivariate analysis revealed significance for tumour size, percent positive nodal involvement, hormonal treatment, and surgical margin status for OS. Age and percent positive nodal involvement were found to be significant for DFS.

Conclusion: Percent positive nodal involvement was found to be a significant prognostic factor for survival in all end-points.
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http://dx.doi.org/10.1080/02841860701678761DOI Listing
May 2008

Concurrent gemcitabine and radiotherapy for locally advanced pancreatic cancer.

Med Oncol 2007 ;24(2):239-43

Dept. of Radiation Oncology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey. mcengiz@hacettepe

This study is designed to assess the toxicity and therapeutic effectiveness of concurrent gemcitabine and radiotherapy in patients with unresectable pancreatic cancer. Concurrent gemcitabine (400 mg/m2/wk) in six weekly cycles starting on d 1 of radiotherapy (50.4 Gy; 1.8 Gy/fraction/d; 5 d/wk) was prescribed on 22 patients with locally advanced pancreatic cancer. Patients were analyzed with regard to radiological response on computerized tomography, overall survival, and toxicity. Twelve (55%) patients completed the prescription of six gemcitabine cycles and 50.4 Gy radiotherapy; while 10 (45%) received one to five cycles of gemcitabine owing to neutropenia. All patients experienced abdominal discomfort during treatment and three patients required medical intervention. Other toxicities reported were nausea in 13 patients (60%), grade 3 vomiting in 3 (14%). Radiological response evaluations were as follows: complete, 2 (9%); partial, 9 (41%); stable, 7 (32 %); and progressive, 4 (18 %). Median survival was 8.7 mo. Combination of weekly gemcitabine (400 mg/m2) and radiotherapy provided response in 50% of the patients but was associated with severe toxicity resulting in incomplete delivery of the planned chemotherapy.
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http://dx.doi.org/10.1007/BF02698046DOI Listing
December 2007

Craniospinal radiotherapy in adult medulloblastoma.

Strahlenther Onkol 2007 May;183(5):236-40

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

Purpose: To evaluate the outcome and prognostic factors of adult patients with medulloblastoma.

Patients And Methods: 26 adult medulloblastoma patients with a median age of 27 were subjected to craniospinal radiotherapy. A dose of 30.6 Gy with 1.8 Gy/fraction/day was prescribed to M0 patients, while 36 Gy were to be applied in patients with positive cerebrospinal liquor findings. The posterior fossa was boosted to 54 Gy. While 20 patients underwent external-beam radiotheray alone, only six received sequential adjuvant chemotherapy.

Results: Male/female ratio was 1.2. Preradiotherapy Karnofsky performance status was recorded as median 100%. 50% were classified as poor risk (n = 10, subtotal resection; n = 3, M+). The median follow-up time was 46.5 months. The 5-year actuarial survival rates for recurrence-free, distant metastasis-free, disease-free, and overall survival were 82.5%, 90.8%, 73.5%, and 89.7%, respectively. Patient characteristics, treatment factors and tumor characteristics failed to show any significance in univariate analysis. Grade 3 or 4 late morbidities were not observed.

Conclusion: Yet, the current standard of care seems to remain craniospinal irradiation after maximal surgical resection of the primary neoplasm without clear indications for adjuvant chemotherapy.
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http://dx.doi.org/10.1007/s00066-007-1563-yDOI Listing
May 2007

Postoperative radiotherapy in the treatment of male breast carcinoma: a single institute experience.

J Natl Med Assoc 2006 Apr;98(4):559-63

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

Background: To evaluate the outcomes of radiation therapy treatment of male patients with breast cancer in our single institutional cohort and discover possible adverse prognostic factors.

Methods: We retrospectively evaluated 42 male patients (median age 55; range 33-77 years) with breast cancer. Patients were irradiated postoperatively in 2 Gy/fraction/day to chest wall +/- lymphatics.

Results: Median follow-up was 29 months. Eleven patients had neoadjuvant and 36 patients had adjuvant Adriamycin-based chemotherapy. Nine patients (21%) had local or regional, two (5%) had distant, and one (2.5%) had both local and distant disease at the time of analysis. The actuarial five-year Overall Survival (OS) was 77%, whereas the actuarial five-year Disease-Free (DFS), Locoregional Recurrence-free (LRRFS), and Distant Metastases-Free (DMFS) survival rates were 45%, 69% and 66%, respectively. Univariate analysis of variables, including patient characteristics, treatment modalities and factors, and tumor characteristics, failed to show an association with LRRFS and DFS except percent positive nodal involvement > or = 30% and 50%.

Conclusion: Though radiotherapy seems quite effective in reducing local recurrence, we have revealed that male breast cancer patients in our cohort with extensive nodal involvement (PPNI >30% and 50%) appeared not to have had a significant benefit from postmastectomy irradiation and adjuvant CMF-based chemotherapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569252PMC
April 2006

Postoperative radiotherapy in cranial ganglioglioma.

J Neurooncol 2006 May 29;77(3):321-4. Epub 2005 Nov 29.

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

We performed an institutional database search for patients with ganglioglioma in order to evaluate postoperative radiotherapy in the light of our experience. This search identified 5 patients with a mean age of 23.3 (range, 9-54 years) treated between April 1994 and April 2003. The latter date was chosen to allow a minimum follow-up of 1 year at the time of our analysis. Median follow up was 7 years (range, 1.5-11 years). Gross total tumor resection could only be achieved in one case, while other four patients had been referred after subtotal tumor excisions. All patients were treated postoperatively with conventionally fractionated (1.8-2 Gy/day) external beam radiotherapy (EBRT) to a total dose of 54-60 Gy. Patients were treated with megavoltage beams using Co(60 )or 6-MV photons. None of the patients were lost to follow up with a median follow up time of 80 months (range, 5.5-122.5 months) and all patients were alive with no evidence of disease at last follow-up. We believe that long term follow-up is necessary to observe the relapse patterns and the significance of postoperative radiotherapy needs to be further evaluated with large patient numbers to remark a conclusive statement.
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http://dx.doi.org/10.1007/s11060-005-9050-8DOI Listing
May 2006

Trismus as a presenting symptom in nasopharyngeal carcinoma.

Radiother Oncol 2005 Oct 12;77(1):73-6. Epub 2005 Sep 12.

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

Trismus is a more common symptom in NPC patients with young age and an indicator of advanced primary tumour. Overall response rate after treatment was 88%. Trismus recovered in majority of patients at the end of treatment and patients with complete recovery of trismus may have a better survival.
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http://dx.doi.org/10.1016/j.radonc.2005.07.006DOI Listing
October 2005

Postoperative radiotherapy and chemotherapy in the management of oligodendroglioma: single institutional review of 88 patients.

J Neurooncol 2005 Nov;75(2):189-93

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey. gozyigit

We retrospectively evaluate the prognostic factors affecting the local control, survival and the potential role of chemotherapy in the management of patients with oligodendroglioma. The medical records of 88 patients treated by postoperative external beam radiotherapy +/- chemotherapy at our institution between December 1993 and December 2002 were analyzed. Nine patients (10%) were treated with an accelerated fractionation scheme, while 79 patients were treated with conventional doses. The median RT dose was 54.8 +/- 2.58 Gy for low-grade tumors, and 58.7 +/- 2.46 Gy for high-grade tumors. PCV chemotherapy regimen was given to 18 patients; temozolamide was administered in three patients. Chemotherapy was not given concomitantly in any patients. The median follow-up was 56 months (range 7-134 months). The 5-year overall and progression-free survival rates for entire group were 86% and 79%, respectively. Patients with epilepsy at presentation had better 5-year overall survival (93% vs. 74%, P=0.04). High grade tumors had significantly lower overall survival rate. Age, presence of motor deficit at diagnosis and histological grade were found have a significant impact on progression-free survival. The 5-year overall and progression free survival rates of patients with high-grade tumors were 69%, 51% and 74%, 68% for chemotherapy and no-chemotherapy group, respectively (P=0.9 for OS, P=0.3 for PFS). In multivariate analysis no significant factor affecting the overall survival and progression-free survival was found. Chemotherapy given after postoperative radiotherapy in patients with oligodendroglioma did not improve survival in this retrospective study.
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http://dx.doi.org/10.1007/s11060-005-2057-3DOI Listing
November 2005

Radiotherapy in the management of Klippel-Trénaunay-Weber syndrome: report of two cases.

Ann Vasc Surg 2005 Jul;19(4):566-71

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

Klippel-Trénaunay-Weber syndrome (KTWS) is characterized by combined vascular malformations of capillary, venous, and lymphatic types usually observed during infancy or childhood. In this report, we describe two KTWS patients treated with radiotherapy after long-term conservative treatment or multiple surgical interventions. The first patient, a 15-year-old female, presented with vascular masses located on the right upper extremity. She was treated conservatively for 14 years, and amputation was offered at the age of 14 due to cardiac failure. A course of radiotherapy to a total dose of 40 Gy with conventional daily fractionation was administered as an alternative to the mutilating surgery, and prominent improvement both subjectively and objectively was detected 1 year after radiotherapy. The second patient, a 40-year-old male, suffered from huge vascular masses of both the trunk and lower extremities. Despite multiple surgical interventions and conservative treatment, disease progressed and neurological symptoms occurred due to compression of vertebral structures. He was administered a course of 30 Gy radiotherapy with 1.5 Gy daily fractions to the lower thoracic region and whole abdominal cavity. Six months after radiotherapy, subjective relief described by the patient but without any objective response was detected. Though considered as a benign disease, KTWS can cause life-threatening complications. The response of one of our patients is a hopeful finding for considering radiotherapy as an alternative treatment modality for these patients.
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http://dx.doi.org/10.1007/s10016-005-5027-5DOI Listing
July 2005

Postoperative radiotherapy results in primary spinal cord astrocytomas.

Radiother Oncol 2005 Jan;74(1):45-8

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey.

Background And Purpose: We retrospectively evaluated the therapeutic outcomes of patients with primary spinal cord astrocytomas treated with conventional radiotherapy at our institute.

Patients And Methods: Between May 1975 and December 1997, 26 patients with histologically proven spinal cord astrocytomas were treated with conventional radiotherapy, and twenty-four eligible patients were evaluated. Median age was 19 years (2-41 years). Fourteen of astrocytomas were grade I, 6 of them grade II and 4 grade III. Ten patients had subtotal excision, and 14 had only biopsy of the primary lesion. Patients were treated with 1-2 Gy daily fractions, and given to a median total dose of 49.5 Gy (range 35-60 Gy) external radiotherapy to primary tumor.

Results: Median follow-up was 39 months. Seventeen patients died of their disease. Two patients have progression, and 5 patients are followed with stabile disease. Five-year overall survival was 45% and progression free survival was 40%. Among the analyzed factors only gender and age were found to be significant.

Conclusions: Our results are slightly worse than previous retrospective radiotherapy series in the literature. With new imaging and radiation therapy techniques, radiotherapy may have a role as an adjuvant treatment especially in subtotally resected tumors.
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http://dx.doi.org/10.1016/j.radonc.2004.07.019DOI Listing
January 2005

Prospective study of combined modality treatment or radiotherapy alone in the management of early-stage adult Hodgkin's disease.

Int J Radiat Oncol Biol Phys 2004 Nov;60(3):839-46

Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey.

Purpose: To determine the efficacy and toxicity of combined modality treatment (CMT) or radiotherapy (RT) alone in the management of clinical Stage I-IIA adult Hodgkin's disease patients.

Methods And Materials: Forty-seven patients with supradiaphragmatic clinical Stage I-IIA Hodgkin's disease without bulky mediastinal lymphadenopathy were enrolled into this prospective study between September 1997 and February 2002. Patients with very favorable criteria presenting with one or two nonbulky nodal areas involved, an erythrocyte sedimentation rate of <50 mm/h, age <40 years, and either lymphocyte predominant or nodular sclerosing histologic findings were treated by RT alone. Patients missing any of these favorable criteria were classified as the other favorable group and were treated with three courses of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy followed by involved-field RT. The median age was 36 years (range, 19-53 years). Of the 47 patients, 15 were women and 32 were men. Only 3 patients were classified as the most favorable group and treated with mantle RT alone; the remaining 44 were treated with CMT.

Results: The median follow-up was 51 months (range, 20-74 months). Only 2 patients developed recurrence, both out of the irradiated field, one in the contralateral neck and the other in the abdomen. The 5-year relapse-free and overall survival rate was 95.4% and 97.8%, respectively. Although none of the prognostic factors were statistically significant for relapse-free survival, a trend was noted for the response to chemotherapy (p = 0.06). Only 2 patients developed treatment-related complications. One patient treated with mantle RT alone developed severe ischemic heart disease and one in the CMT arm developed subclinical hypothyroidism.

Conclusion: Despite the short follow-up, CMT or RT alone tailored according to the clinical prognostic factors were successful in terms of disease control in clinical Stage I-IIA Hodgkin's disease. Longer follow-up is required to make definitive conclusions.
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http://dx.doi.org/10.1016/j.ijrobp.2004.04.002DOI Listing
November 2004

Possible therapeutic role of vitamin D3 in aggressive fibromatosis.

Jpn J Clin Oncol 2004 Aug;34(8):472-5

Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey.

Desmoids, also known as aggressive fibromatoses, are locally invasive tumors that are intermediate in their biological behavior that lies between benign fibrous proliferations and low-grade fibrosarcomas. In this report, we present a case of a young female patient with a huge tumoral mass located in the right shoulder region that recurred after total resection and was resistant to radio-chemo-hormonal therapy. Eventually, she responded to 1,25-(OH)(2)-vitamin D(3) treatment.
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http://dx.doi.org/10.1093/jjco/hyh075DOI Listing
August 2004

Non-metastatic stage IV nasopharyngeal carcinoma patients: analysis of the pattern of relapse and survival.

Radiother Oncol 2004 Jul;72(1):71-7

Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey.

Background And Purpose: The objective of this study is to analyze the mode of recurrence patterns and survival of our 96 non-metastatic stage IVA and IVB nasopharyngeal carcinoma (NPC) patients.

Patients And Methods: A total of 234 previously untreated, histologically confirmed non-metastatic NPC patients were treated in our department between 1993 and 2001. Among them 96 patients (41%) were staged as IVA or B disease. All patients were uniformly staged using the fifth edition of AJCC/UICC staging system. There were 76 male and 20 female patients. Their ages ranged from 9 to 72 years (median age: 43.5). Histopathological diagnosis was WHO 2 and 3 in 89 (93%) patients. All patients were treated with external radiotherapy and 77 out of 96 patients (80%) with stage IV disease received either concomitant or neoadjuvant cisplatin based combined chemotherapy regimens. Median follow-up time was 30 months (range: 4-101 months).

Results: At the time of this analysis, 60 (62%) patients were alive and 48 of them were free of disease. Local recurrence rate was found to be significantly higher in stage IVA patients (28 vs. 11%, P=0.02) and distant metastasis rate was significantly higher in stage IVB patients (40 vs. %8, P=0.0001). The 3 year overall (OS), disease free (DFS), loco regional relapse free (LRRFS) and distant metastasis free survival (DMFS) rates were 71, 74, 77 and 94% for stage IVA and 60, 46, 77 and 58% for stage IVB patients, respectively. Three year LRFS rates for stage IVA and IVB were 77 and 89%, respectively (P=0.1). Age older than 40 years was found to be statistically significant adverse prognostic factor both for OS (P=0.01) and LRRFS (P=0.005) in univariate analysis. Advanced N status was an unfavorable prognostic factor both for OS (P=0.03), DFS (P=0.0004) and DMFS (P=0.0003). DMFS was adversely affected by the presence of cranial nerve palsy at diagnosis (P=0.01), advanced T status (P=0.03) and advanced N status (P=0.0003). In univariate analysis treatment with chemotherapy was found to be an unfavorable prognostic factor for DMFS (P=0.02). According to the multivariate analysis, older age (>40 year of age) was a significant independent prognostic factor for OS (P=0.02), DFS (P=0.05) and LRRFS (P=0.01). Patients with advanced N status had worse OS (P=0.03), DFS (P<0.0001) and DMFS (P=0.07). Patients treated with chemotherapy as an adjuvant to radiotherapy had tended to have a better DFS (P=0.04).

Conclusions: The local relapse was the major cause of failure in patients with stage IVA disease, and distant metastasis was the predominant treatment failure in stage IVB patients. While stage IVA patients may benefit more intensive local treatment strategies, stage IVB patients definitely need more systemic treatment.
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http://dx.doi.org/10.1016/j.radonc.2004.02.012DOI Listing
July 2004