Publications by authors named "Serdar Ozkok"

17 Publications

  • Page 1 of 1

COVID-19 Lung Findings Detected by 68Ga-PSMA PET/CT for Staging Purposes in Patients With Prostate Cancer.

Clin Nucl Med 2021 May 12. Epub 2021 May 12.

From the Departments of Nuclear Medicine Radiation Oncology Urology, Ege University Medical Faculty, Izmir, Turkey.

Abstract: We report 3 patients with COVID-19 findings in 68Ga-PSMA PET/CT taken for staging. The first patient, A 64-year-old man with prostate cancer, who had COVID-19 in November 2020 and whose treatment was completed, was observed to continue with COVID-19 findings in 68Ga-PSMA PET/CT in December 2020 before surgery. Other patients were asymptomatic for the disease. It was determined that a PSMA uptake in the lungs corresponding to the CT findings of COVID-19 had increased in 68Ga-PSMA PET/CT.
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http://dx.doi.org/10.1097/RLU.0000000000003723DOI Listing
May 2021

Associations of sarcopenic obesity versus sarcopenia alone with functionality.

Clin Nutr 2021 May 12;40(5):2851-2859. Epub 2021 Apr 12.

Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey.

Background & Aims: There have been several attempts to come up with a global operational definition of sarcopenia (S), and consequently, a definition of S has been established, to some extent. That said, the definition of sarcopenic obesity (SO), which is defined as the presence of obesity + sarcopenia, remains obscure, hindering evaluations of the prevalence and relevance of SO. It has yet to be elucidated whether SO is associated with worse functionality when compared to S alone (S without obesity). In the present study, we compare SO and S alone in terms of their associations with functional measures through the application of alternative definitions of SO. As a secondary output, we document the prevalence of SO based on alternative definitions.

Methods: This retrospective cross-sectional study included community-dwelling adults over 60 years of age who presented as outpatients to a university hospital between 2012 and 2020. All were evaluated for body composition (bioimpedance analysis), handgrip strength (Jamar hand dynamometer) and functional health status [activities of daily living (ADL), instrumental activities of daily living (IADL)]. The fat percentile method was used to define the obesity component of SO. Low muscle mass (LMM) was defined using two different adjustment methods of skeletal muscle mass (LMM adjusted by height or LMM adjusted by BMI). S was defined based on the EWGSOP2 definition, as probable S (low muscle strength) or confirmed S (low muscle strength + LMM). Accordingly, three alternative definitions of SO were applied based on three alternative definitions of S, i.e., "obesity + sarcopenia (probable)", "obesity + sarcopenia (confirmed, LMM adjusted by height)" and "obesity + sarcopenia (confirmed, LMM adjusted by BMI)". The associations of SO and S alone with functional measures were examined with univariate analyses and adjusted multivariate analyses.

Results: Included in the study were 1468 older adults (median age 75; 68.8% female). The prevalence of SO was very low (0.2%) based on the SO definition "obesity + sarcopenia (confirmed, LMM adjusted by height), but it was present at a considerable and comparable rate based on SO definition "obesity + sarcopenia (probable)" and SO definition "obesity + sarcopenia (confirmed, LMM adjusted by BMI)" (4.1%, 4.0%; respectively). As SO by "obesity + sarcopenia (confirmed, LMM adjusted by height)" had an ignorable prevalence, this definition of SO was excluded from further analyses. Multivariate analyses revealed that, when compared to the Non-S Non-Obese group, S alone definitions had odds ratio (OR) of 5.4 and 3.4 while SO definitions had an OR of 3.2 and 2.7 for impaired ADL, and an OR of 7.9 and 6.4, while SO definitions had an OR of 3.0 and 2.7 for impaired IADL. SO was thus found to be associated with a lower prevalence of impaired functional measures than that of S alone.

Conclusions: Our results suggest that the SO definition confirmed, LMM adjusted by height has an ignorable prevalence in populations in which underweight or malnutrition is uncommon. Among sarcopenic older individuals, obesity may have a protective effect against the limitations of some functional measures, providing evidence of the possible protective effect of obesity in sarcopenic individuals.
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http://dx.doi.org/10.1016/j.clnu.2021.04.002DOI Listing
May 2021

Prognostic significance of early complete response in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy: Multicentric study of Turkish Society for Radiation Oncology Group (TROD).

Turk J Gastroenterol 2020 05;31(5):368-377

Department of Radiation Oncology, Ege University Institute of Oncology, İzmir, Turkey.

Background/aims: To assess the effect of various parameters on the oncologic outcomes, including the time interval between therapy and surgery (S) in locally advanced rectal cancer (LARC) patients receiving preoperative chemoradiotherapy (CRT).

Materials And Methods: The data of 914 LARC patients who received preoperative CRT between 1994 and 2015 were collected retrospectively. Patients received 45-50.4 Gy RT with 5FU based chemotherapy (CT). They all underwent radical resection followed by maintenance CT. Clinical and pathologic variables were compared between the pCR and no-pCR groups. Survival was estimated by the Kaplan-Meier method and Cox proportional hazard model was used in multivariate analysis.

Results: After median follow-up of 60.5 (range=12-297.6) months, median overall survival (OS) was 58.75 months and disease-free survival (DFS) 53.32 months. pCR was observed in 18.9% of all cases. pCR, lymphovascular invasion and metastatic lymph node ratio (mLNR) were significantly associated with OS and DFS on multivariate analysis. The 5-year OS and DFS rates were better in pCR group (95.3% vs 80.7% for OS, p<0.0001 and 87.4% vs 71% for DFS, p<0.0001). pCR patients with 4-8 weeks interval had lower rates of distant metastasis (9% vs 20%, p=0.01) and any recurrences (13.6% vs 29.6%, p=0.001) than the remaining. Both OS and DFS were better in favor of pCR achieved at 4-8 week interval time (p<0.0001 for each).

Conclusion: pCR after preoperative CRT in LARC correlated with better oncologic outcome. The best OS and DFS durations were achieved in patients who experienced pCR after 4-8-weeks interval before surgery.
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http://dx.doi.org/10.5152/tjg.2020.19225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289170PMC
May 2020

Some comments for better understanding of the study entitled "Which factors are associated with length of stay in older patients with acute decompensated heart failure with preserved ejection function?: AURORA study".

Geriatr Gerontol Int 2020 04;20(4):390

İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, İstanbul, Turkey.

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http://dx.doi.org/10.1111/ggi.13881DOI Listing
April 2020

Some Comments for Better Understanding of the Study Entitled "Reduced Vitamin D Levels are Associated with Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke" [Letter].

Clin Interv Aging 2020 5;15:159-160. Epub 2020 Feb 5.

Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul, Turkey.

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http://dx.doi.org/10.2147/CIA.S245730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008182PMC
July 2020

Lymphopaenia and accidental splenic doses: Do they have any prognostic value for locally advanced gastric cancer patients treated with radiochemotherapy?

Contemp Oncol (Pozn) 2019 30;23(4):226-233. Epub 2019 Dec 30.

Department of Radiation Oncology, Ege University Faculty of Medicine Hospital, İzmir, Turkey.

Aim Of The Study: To determine the effect of chemoradiotherapy (CRT)-induced lymphopaenia, and irradiated splenic volume and splenic doses on oncological outcomes in patients with locally advanced gastric cancer (LAGC).

Material And Methods: A consecutive cohort of 52 patients with LAGC treated between 2005 and December 2016 was included. The absolute neutrophil, lymphocyte, and platelet counts were recorded prior to any treatment (baseline), just after the completion of CRT, and 2 6 weeks after the completion of CRT (control evaluation).

Results: The median follow-up time was 30 months (range, 8 130). The incidence of severe lymphopaenia was only 1% at control evaluation, but it was 93% after CRT (< 0.001). Both in univariate and multivariate analyses, stage 3 disease (< 0.001 and = 0.041, respectively) and metastatic to dissected lymph node (MDLN) ratio > 20% (< 0.001 and = 0.032) had a negative effect on OS. Mean splenic dose ≥ 35 Gy was a significant poor prognostic factor for OS and recurrence-free survival (RFS) ( = 0.042 and = 0.50, respectively). Maximum splenic dose ≥ 58 Gy effected OS unfavourably ( = 0.050). Volumetric modulated arc therapy (VMAT), intravenous CT, and age ≥ 65 years were significant predictors for subsequent severe lymphopaenia.

Conclusions: Severe lymphopaenia could not be accepted as a predictive or prognostic factor for LAGC. Mean and maximum splenic doses should be kept on mind while evaluating the treatment dose-volume histograms (DVHs). Patient age, IV usage of concomitant CT agent, and RT technique can influence the ALC. Disease-related factors such as stage and MDLN ratio were the most important factors.
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http://dx.doi.org/10.5114/wo.2019.91524DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978759PMC
December 2019

Treatment outcomes of prostate cancer patients with Gleason score 8-10 treated with definitive radiotherapy : TROD 09-001 multi-institutional study.

Strahlenther Onkol 2019 Oct 29;195(10):882-893. Epub 2019 May 29.

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

Purpose: To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8-10 disease treated with external beam radiotherapy (EBRT) + androgen deprivation therapy (ADT) in the modern era.

Methods: Institutional databases of biopsy proven 641 patients with GS 8-10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1-T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT.

Results: The median follow-up time was 5.9 years (range 0.4-18.2 years); 5‑year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9-10.

Conclusions: Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9-10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving 'non-optimal treatment' (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.
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http://dx.doi.org/10.1007/s00066-019-01476-zDOI Listing
October 2019

The effects of chemoradiotherapy on recurrence and survival in locally advanced rectal cancers with curative total mesorectal excision: a prospective, nonrandomized study.

World J Surg Oncol 2017 Nov 22;15(1):205. Epub 2017 Nov 22.

Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey.

Background: There are only two prospective, randomized studies comparing preoperative long-term chemoradiotherapy and postoperative chemoradiotherapy in locally advanced rectal cancer (LARC); however, conflicting results in terms of locoregional recurrence (LR) and survival rates have been reported. This prospective study aims to compare the effects of preoperative versus postoperative chemoradiotherapy on recurrence and survival rates in LARC patients.

Methods: From January 2003 to January 2016, a total of 336 eligible patients who were clinically diagnosed with LARC (T-T tm or node-positive disease) were prospectively assigned into preoperative chemoradiotherapy (n = 177) and postoperative chemoradiotherapy (n = 159) groups. The preoperative treatment consisted of 50.4 Gy total dose of radiotherapy (delivered in fractions of 1.8 Gy) and concomitant two cycles chemotherapy of 5-fluorouracil and leucovorin. The patients in the preoperative group underwent curative total mesorectal excision (TME) following long-term chemoradiotherapy. Surgery was performed 8 (range 4-12) median weeks after the completion of the chemoradiotherapy. Similar protocol was administered to the postoperative group 4 weeks after the operation. Four cycles of adjuvant chemotherapy were added to the groups. The primary end points were locoregional recurrences and 5-year cancer-specific, overall, and disease-free survivals.

Results: The mean follow-up period was 60.4 (range 12 to 168) months. Five-year cumulative incidence of locoregional recurrence (LR) was 7.4% in the preoperative group and 13.4% in the postoperative group (p = 0.021). Five-year cancer-specific survival (CSS) was 87.5% in the preoperative group and 80% in the postoperative group (p = 0.022). Overall survival (OS) was 79.8 versus 74.7% (p = 0.064), disease-free survival (DFS) was 75.2 versus 64.8% (p = 0.062), and severe late toxicity was 7.4 versus 13.2% (p = 0.002), respectively. The rate of patient compliance was higher in the preoperative group (p < 0.001).

Conclusions: Preoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy, significantly improved local control, patient compliance, CSS, and late toxicity and suggested a trend toward improved overall and disease-free survival.
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http://dx.doi.org/10.1186/s12957-017-1275-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700528PMC
November 2017

The role of delineation education programs for improving interobserver variability in target volume delineation in gastric cancer.

Br J Radiol 2017 May 24;90(1073):20160826. Epub 2017 Mar 24.

3 Department of Radiation Oncology, Faculty of Medicine, Ege University, Izmir, Turkey.

Objective: To assess whether delineation courses for radiation oncologists improve interobserver variability in target volume delineation for post-operative gastric cancer radiotherapy planning.

Methods: 29 radiation oncologists delineated target volumes in a gastric cancer patient. An experienced radiation oncologist lectured about delineation based on contouring atlas and delineation recommendations. After the course, the radiation oncologists, blinded to the previous delineation, provided delineation for the same patient.

Results: The difference between delineated volumes and reference volumes for pre- and post-course clinical target volume (CTV) were 19.8% (-42.4 to 70.6%) and 12.3% (-12.0 to 27.3%) (p = 0.26), respectively. The planning target volume (PTV) differences pre- and post-course according to the reference volume were 20.5% (-40.7 to 93.7%) and 13.1% (-10.6 to 29.5%) (p = 0.30), respectively. The concordance volumes between the pre- and post-course CTVs and PTVs were 467.1 ± 89.2 vs 597.7 ± 54.6 cm (p < 0.001) and 738.6 ± 135.1 vs 893.2 ± 144.6 cm (p < 0.001), respectively. Minimum and maximum observer variations were seen at the cranial part and splenic hilus and at the caudal part of the CTV. The kappa indices compared with the reference contouring at pre- and post-course delineations were 0.68 and 0.82, respectively.

Conclusion: The delineation course improved interobserver variability for gastric cancer. However, impact of target volume changes on toxicity and local control should be evaluated for further studies. Advances in knowledge: This study demonstrated that a delineation course based on current recommendations helped physicians delineate smaller and more homogeneous target volumes. Better target volume delineation allows proper target volume irradiation and preventing unnecessary normal tissue irradiation.
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http://dx.doi.org/10.1259/bjr.20160826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605107PMC
May 2017

Practice patterns for oropharyngeal cancer in radiation oncology centers of Turkey.

Tumori 2014 May-Jun;100(3):284-8

Aims And Background: The aim of the study was to review the current clinical practices of radiation oncologists involved in the treatment of oropharyngeal cancer.

Methods And Study Design: The daily practices of radiation oncology centers for patients diagnosed with oropharyngeal cancer in 2010 were evaluated by a two-part questionnaire that separately assessed the information of the participating center and the charts of the treated patients.

Results: A total of 22 centers participated in the study, and 105 oropharyngeal cancer patients reported for our review. The use of positron emission tomography was a common practice in staging and radiotherapy planning. Multidisciplinary head and neck cancer clinics were available in 14 (64%) centers and were absent in 8 centers. Thirty-six of the 105 patients were not evaluated by a multidisciplinary clinic before the initiation of therapy, and adjuvant radiotherapy administration was found to be higher in this group. Percutaneous endoscopic gastrostomy tube placement was not a routine practice in any of the centers. Seventy-five patients received chemotherapy - 46 concurrently with radiotherapy and 29 as induction chemotherapy. Two centers administered conventional radiotherapy alone, 20 centers conformal radiotherapy, and 7 centers were able to provide intensity-modulated radiotherapy.

Conclusions: Across all the centers there were small differences in the pretreatment evaluation of patients with oropharyngeal cancer. The greatest difference was in the technical delivery of radiation, with most of the centers using conformal radiotherapy despite the increasing availability of intensity-modulated radiotherapy. The use of chemotherapy has more readily adopted the current international standards in the treatment of oropharyngeal cancer.
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http://dx.doi.org/10.1700/1578.17204DOI Listing
November 2014

Phase II study of loading-dose ibandronate treatment in patients with breast cancer and bone metastases suffering from moderate to severe pain.

Onkologie 2012 24;35(5):254-8. Epub 2012 Apr 24.

Medical Oncology Department, Hacettepe University School of Medicine, Sıhhiye, Ankara, Turkey.

Background: The aim of this study was to determine the efficacy and safety of loading-dose intravenous (i.v.) ibandronate in women with breast cancer and bone metastases.

Patients And Methods: In this prospective, phase II, open-label study, 13 women with breast cancer, bone metastases, and moderate/severe bone pain received ibandronate 6 mg/day (i.v. loading-dose 15 min infusion over 3 consecutive days) with follow-up until day 14. Endpoints included pain response (primary), duration until pain response, analgesic use, Karnofsky index, safety (including hematologic, biochemical, and urine examinations), and adverse events.

Results: Pain intensity decreased on days 7 and 14 versus day 1 (mean visual analogue scale score: 3.2 ± 2.2 and 3.0 ± 2.1 versus 6.1 ± 0.9, respectively; p < 0.01 for both). Mean time to pain response was 8.2 ± 3.3 days. Mean rate of analgesic use decreased (69.2%, 16.7% and 15.4% on days 1, 7 and 14, respectively). Mean Karnofsky index score increased (80.8 ± 13.1 and 80.8 ± 13.2, on days 7 and 14 versus 77.7 ± 11.7 on day 1; p < 0.05 on both days).

Conclusion: Bone pain and analgesic use decreased in women with breast cancer and bone metastases following loading dose i.v. ibandronate which was well-tolerated with no renal safety concerns.
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http://dx.doi.org/10.1159/000338369DOI Listing
January 2013

Postoperative radiotherapy in rectal cancer: long-term results of 290 patients.

Hepatogastroenterology 2010 Sep-Oct;57(102-103):1099-105

Ege University School of Medicine, Department of Radiation Oncology, Izmir, Turkey.

Background/aims: To evaluate treatment results and to identify prognostic factors affecting local-relapse-free (LRFS), disease-free (DFS) and overall survival (OS) in patients treated with postoperative radiotherapy (RT) for rectal cancer.

Methodology: A retrospective review was performed in 290 patients treated between January 1990 and December 2005. Median RT dose was 54 Gy. A total of 220 (75.8%) patients also received 5-fluorouracil based chemotherapy.

Results: During a median follow-up of 56 months (range 9-216 months), 68 patients (23.4%) developed local recurrence and 96 patients (33.1%) developed distant metastases. Five-year LRFS, DFS, and OS rates were 74.6%, 52.6%, and 53.7%, respectively. On multivariate analysis, significant prognostic factors for LRFS were age, pathologic T stage (pT), and distance from anal verge; for DFS were pT stage, and positive surgical margin; for OS were pT and pathologic N (pN) stages. One hundred and fifty-two node-positive patients whose number of retrieved and metastatic nodes are known were evaluated according to the lymph node ratio (LNR). OS and DFS rates significantly decreased with increasing LNR (p = 0.005, and p = 0.023 respectively). RT related Grade 3-4 late morbidity rate was 3.1%. A second primary malignancy developed in 4.8% of patients.

Conclusion: Among several prognostic factors, pT stage significantly predicted for LRFS, DFS and OS on multivariate analysis, while pN stage was significant for all three only on univariate analysis. LNR which affected DFS and OS could be an important tool for prognostic prediction for node-positive patients.
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April 2011

Postoperative gemcitabine alone and concurrent with radiation therapy in locally advanced pancreatic carcinoma.

Tumori 2010 Jul-Aug;96(4):560-7

Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey.

Aims And Background: To evaluate the treatment results of gemcitabine alone and concurrent with radiotherapy after R0/R1 resection of locally advanced pancreatic cancer.

Methods And Study Design: From 1999 to 2005, 55 patients with stage II resected pancreatic cancer treated with gemcitabine-based radiochemotherapy were retrospectively evaluated. Initially, one cycle of induction gemcitabine was administered and followed by weekly gemcitabine concurrent with radiotherapy. After the completion of radiochemotherapy, patients received 3 additional courses of gemcitabine.

Results: Thirteen patients were stage IIA and 42 were stage IIB. Forty-six patients (83.6%) had R0 and 9 patients (16.4%) had R1 resection. All of the patients received induction chemotherapy and radiotherapy, all but 3 received concurrent radiochemotherapy, and 46 (84%) patients received maintenance chemotherapy. During induction, concurrent and maintenance phases of the protocol, 11%, 13.5% and 19.5% of the patients had at least one > or = grade 3 toxicity, respectively. Within a median 47 months (range, 34-105) of follow-up, 4 (7.3%) patients had isolated local recurrence, 5 (9%) patients had local recurrence and distant metastases, and 27 (49%) had only distant metastases. Median disease-free survival and overall survival were 13 (range, 4-105) and 19 months (range, 6-105), respectively. In multivariate analysis, nodal stage, AJCC stage and number of lymph nodes dissected were the significant factors affecting disease-free survival whereas Karnofsky performance status was the only significant factor for overall survival.

Conclusions: The prognosis for pancreatic cancer remains poor despite adjuvant radiochemotherapy. More aggressive treatments should be considered in patients with unfavorable prognostic factors.
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November 2010

Carboplatin and etoposide followed by once-daily thoracic radiotherapy in limited disease small-cell lung cancer: unsatisfactory results.

Tumori 2010 Mar-Apr;96(2):234-40

Department of Pulmonary Medicine, Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey.

Aims And Background: There has been a trend to replace cisplatin with carboplatin in the treatment of small-cell lung carcinoma. The goal of the present study was to determine the efficacy of carboplatin and etoposide followed by thoracic radiotherapy in patients with previously untreated limited disease small-cell lung carcinoma.

Methods: From February 2001 to March 2007, 47 patients with limited disease small-cell lung cancer were enrolled in the study. Etoposide, 100 mg/m2, was administrated intravenously on days 1-3 in combination with carboplatin, AUC 6, on day 1 every 21 days for 6 cycles. In cases considered to have non-progressive disease following induction chemotherapy, thoracic radiotherapy was given with in a once daily fraction of 2.0 Gy, 5/wk, up to 50-60 Gy.

Results: Forty-one patients were evaluated. Median age was 62 (range, 40-78), 88% of patients were male. ECOG PS was 0-1 in 38 patients. Seven of the 41 patients (17.5%) had pleural effusion (one malignant) and 7 patients (17.5%) had involved supraclavicular lymph nodes. Ninety percent of patients had elevated serum lactate dehydrogenase levels. Median follow-up was 13.5 mo. A total of 209 cycles of chemotherapy was administered (median, 6; range, 1-6). Thoracic irradiation was given to 33 patients. The overall response rate to combined modality on an intention-to-treat basis was 73%. Median survival time was 13.7 months (95% CI, 10.3-17.1), and median progression-free survival was 9.5 months (95% CI, 8.6-10.4). Two- and four-year overall survival was 23% and 7%, respectively. Grade 3-4 neutropenia and leukopenia were the most common adverse events and occurred in 46.0% and 24.0% of the patients, respectively. Six (14%) patients experienced febrile neutropenia. Three patients (7%) died of sepsis and neutropenic fever. Non-hematological toxicities were mild.

Conclusions: Carboplatin and etoposide chemotherapy followed by thoracic radiotherapy in LD-SCLC appears to be unsatisfactory.
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July 2010

Postoperative radiotherapy in the management of resected non-small-cell lung carcinoma: 10 years' experience in a single institute.

Int J Radiat Oncol Biol Phys 2010 Feb 20;76(2):433-9. Epub 2009 Apr 20.

Department of Radiation Oncology, Celal Bayar University Medical School, Manisa, Turkey.

Purpose: This study reports the long term outcomes of postoperative radiotherapy in patients with resection for non-small-cell lung cancer (NSCLC).

Methods And Materials: A total of 98 patients with resected NSCLC who received postoperative radiotherapy (PORT) between January 1994 and December 2004 were retrospectively analyzed. The most frequently performed surgical procedure was lobectomy (59 patients), followed by pneumonectomy (25), wedge resection (8), and bilobectomy (6). Postoperative radiotherapy was delivered as an adjuvant treatment in 71 patients, after a wedge resection in 8 patients, and after an R1 resection in 19 patients. The PORT was administered using a Co-60 source in 86 patients and 6-MV photons in 12 patients. A Kaplan-Meier estimate of overall survival, locoregional control, and distant metastasis-free survival were calculated.

Results: Stages included I (n =13), II (n = 50), IIIA (n = 29), and IIIB (n = 6). After a median follow-up of 52 months median survival was 61 months. The 5-year overall survival, locoregional control, and distant metastasis-free survival rates for the whole group were 50%, 78%, and 55% respectively. The RT dose, Karnofsky performance status, age, lateralization of the tumor, and pneumonectomy were independent prognostic factors for OAS; anemia and the number of involved lymph nodes were independent prognostic factors for LC.

Conclusions: Doses of PORT of greater than 54 Gy were associated with higher death rate in patients with left-sided tumor, which may indicate a risk of radiation-induced cardiac mortality.
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http://dx.doi.org/10.1016/j.ijrobp.2009.02.010DOI Listing
February 2010

High dose rate endobronchial brachytherapy in the management of lung cancer: response and toxicity evaluation in 158 patients.

Lung Cancer 2008 Dec 14;62(3):326-33. Epub 2008 May 14.

Ege University, Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey.

The aim of this study was to evaluate the symptomatic and endoscopic responses as well as the toxicities in 158 patients with endobronchial lung cancer treated with high dose rate endobronchial brachytherapy (HDR-EB). Forty-three patients with stage III NSCLC were treated with 60Gy external beam radiotherapy (ERT) and three applications of 5Gy each of HDR-EB (group A). Seventy-four patients who did not receive previous RT were treated with 30Gy ERT and two applications of 7.5Gy HDR-EB with palliative intent (group B). Forty-one patients with recurrent tumor who were irradiated previously were treated with three applications of 7.5Gy HDR-EB, with palliative intent (group C). In group A, bronchoscopic complete (CR) and overall response rates (ORR) were 67% and 86%, respectively. Symptomatic improvement was obtained in 58% of patients with cough, 77% of patients with dyspnea and 100% of patients with hemoptysis. Two and 5-year survival rates were 25.5% and 9.5%, respectively and the median survival time (MST) was 11 months. In group B, the bronchoscopic CR and ORR were 39% and 77%, respectively and 28% and 72% in group C. The symptomatic response rates were 57% and 55% for cough, 90% and 78% for dyspnea and 94% and 77% for hemoptysis, with a MST of 7 and 6 months in Groups B and C, respectively. Eighteen patients (11%) died of fatal hemoptysis (FH) with the median time to this event of 7 months. Treatment intent (p<0.001), total BED (p<0.001) and the number of HDR-EB fractions (p<0.001) were significant prognostic factors for FH. HDR-EB provides effective palliation in relieving the symptoms of patients with endobronchial lung cancer, however, there is a risk of developing FH that is associated with a high BED and multiple HDR-EB applications.
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http://dx.doi.org/10.1016/j.lungcan.2008.03.018DOI Listing
December 2008