Ahmet Dirier

FDG PET-CT in cervical cancer: relationship between primary tumor FDG uptake and metastatic potential.

ObjectiveWe retrospectively evaluated the relationships between primary tumor 18F-fluorodeoxyglucose (FDG) uptake measured as the maximum standardized uptake value (SUVmax) and local extension, and nodal or distant metastasis in patients with cervical cancer on pretreatment FDG positron emission tomography–computed tomography (PET-CT). MethodsForty-three patients (mean age, 55.14 years; range, 34–90 years) with cervical cancer who underwent FDG PET-CT scans for staging before the initiation of treatment were included in the study. Primary tumor SUVmax was calculated; clinical tumor stages, presence of local extension, sites of lymph node and distant organ metastases were recorded. The patients were divided into low and high SUV groups by using the median primary tumor SUVmax. The low SUV group consisted of 21 patients with SUVmax less than 13.5, the high SUV group consisted of 22 patients with SUVmax ≥13.5. Their data were compared statistically. ResultsThe average SUVmax was 9.6±2.6 and 19.9±4.9 in the low and high SUV groups, respectively. In the low SUV group, six patients (29%) had a local extension, eight (38%) had pelvic and/or para-aortic lymph node metastasis, and one had distant organ metastasis (4.7%). In the high SUV group, 10 patients (45%) had a local extension, 16 (73%) had pelvic and/or para-aortic lymph node metastasis, and two (9%) had distant organ metastases. There was a significant difference in the lymph node metastasis rate between the two groups (P<0.05), but differences in local extension and distant organ metastasis were not statistically significant (P>0.05). In addition, there was a moderate correlation between SUVmax and clinical tumor stages (r=0.40, P=0.0075). ConclusionHigher primary tumor FDG uptake predicts higher nodal metastatic potential in cervical cancer patients. Patients with higher SUVmax in cervical tumor may need a close follow-up because of their higher metastatic potential.

Leech Therapy for Symptomatic Relief of Cancer Pain

OBJECTIVE Most patients with advanced stage cancer report moderate to severe pain. The leech (Hirudo medicinalis) is commonly used in traditional medicine for relief of localized pain. DESIGN We report a case of severe pain related to advanced stage cancer successfully treated by self-applied leeches. SETTING AND PATIENTS A 62-year-old male patient with synchronous renal cell carcinoma and leiomyosarcoma was admitted with severe pain in the lumbar region. The pain was refractory to radiotherapy, and systemic and epidural analgesic infusion. RESULTS Two months the patient came to the clinic in good condition free of pain. The patient reported outpatient self-treatment with seven leeches to the lumbar region in the interim that resulted in complete healing of pain. CONCLUSIONS This is the first report indicating possible activity of leeches in cancer pain.

A dosimetric comparison of different treatment plans of palliative spinal bone irradiation: analysis of dose coverage with respect to ICRU 50 report

BackgroundThis study aimed to analyze three-dimensional (3D) dosimetric data of conventional two-dimensional (2D) palliative spinal bone irradiation using different reference points and treatment plans with respect to the International Commission on Radiation Units and Measurements (ICRU) Report 50.MethodsForty-five simulation CT scans of 39 patients previously treated for thoraco-lumbar spinal bone metastases were used. Three different treatment plans were created: (1) single posterior field plans using the ICRU reference points (ICRUrps); (2) single posterior field plans using the International Bone Metastasis Consensus Working Party reference points (IBMCrps); (3) two opposed anterior-posterior (AP-PA) field plans using the ICRUrps. The intended dose range for planning target volume (PTV) was 90% to 110% of the prescribed dose for AP-PA field plans. Cumulative dose-volume histograms were generated for each plan, and minimum, maximum and mean doses to the PTV, medulla spinalis, esophagus and intestines were analyzed.ResultsThe mean percentages of minimum, maximum and mean PTV doses ± standard deviation were, respectively, 91 ± 1.3%, 108.8 ± 1.3% and 99.7 ± 1.3% in AP-PA field plans; 77.3 ± 2.6%, 122.2 ± 4.3% and 99.8 ± 2.6% in ICRUrp single field plans; and 83.7 ± 3.3%, 133.9 ± 7.1% and 108.8 ± 3.3% in IBMCrp single field plans. Minimum doses of both single field plans were significantly lower (p < 0.001) while maximum doses were significantly higher (p < 0.001) than AP-PA field plans. Minimum, maximum and mean doses were higher in IBMCrp single field plans than in ICRUrp single field plans (p < 0.001). The mean medulla spinalis doses were lower in AP-PA field plans than single posterior field plans (p < 0.001). Maximum doses for medulla spinalis were higher than 120% of the prescribed dose in 22 of 45 (49%) IBMCrp single field plans. Mean esophagus and intestinal doses were higher (p < 0.001) in AP-PA field plans than single field plans, however, less than 95% of the prescribed dose.ConclusionIn palliative spinal bone irradiation, 2D conventional single posterior field radiotherapy did not accomplish the ICRU Report 50 recommendations for PTV dose distribution, while the AP-PA field plans did achieve the intended dose ranges with a homogenous distribution and reasonable doses to the medulla spinalis, esophagus and intestines.

The effects of Nigella sativa oil, thymoquinone, propolis, and caffeic acid phenethyl ester on radiation-induced cataract

SummaryBackgroundThe aim of this study was to investigate the antioxidant and radioprotective effects of propolis, caffeic acid phenethyl ester (CAPE), Nigella sativa oil (NSO), and thymoquinone (TQ) against ionizing radiation-induced cataracts in lens after total cranium irradiation of rats with single dose of 5-Gy cobalt-60 gamma rays.MethodsA total of 74 Sprague–Dawley rats were divided into 8 groups to test the radioprotective effectiveness of Nigella sativa oil, thymoquine, propolis, or caffeic acid phenethyl ester administered by either orogastric tube or intraperitoneal injection. Appropriate control groups were also studied.ResultsChylack’s cataract classification was used in the study. At the end of the tenth day, cataracts developed in 80 % of the rats in the radiotherapy group. After irradiation, cataract rate dropped to 20 % in NSO, 30 % in propolis, 40 % in CAPE, and 50 % in TQ groups and was limited to grade 1 and grade 2. Cataract formation was observed the least in NSO group and the most in TQ group. In the irradiated (IR) group, superoxide dismutase activity was lower, while glutathione peroxidase and xanthine oxidase activities and malondialdehyde level were higher compared with the other groups. Total superoxide scavenger activity and nonenzymatic superoxide scavenger activity were not statistically significant in IR group compared with the other groups.ConclusionsThe findings obtained in the study might suggest that propolis, CAPE, NSO, and TQ could prevent cataractogenesis in ionizing radiation-induced cataracts in the lenses of rats, wherein propolis and NSO were found to be more potent.

A rare tumor: tracheal Ewing's sarcoma.

A 70-year-old man, with renal failure, applied with the complaint of shortness of breath. Thoracic computed tomography revealed dense intraluminal fields at distal trachea. The bronchoscopy revealed a solid mass, located on the lateral wall of the trachea (Fig. 1). During bronchoscopy, an endobronchial mass excision with laser was performed. The immunohistochemical examination revealed that the tumor cells reacted positively to vimentin and friend leukemia integration (FLI)-1, and negatively to desmin, CD31, S-100, and pancytokeratin (Figs. 2 and 3). The findings were consistent with ES. Due to the suspicions concerning the surgical margin, radiotherapy (RT) was recommended. Postoperatively, 50.4-Gy RT was applied. Metastatic lesions in the scalp and humerus were revealed 3 months after the RT. Chemotherapy could not be performed because of the renal insufficiency. The patient died 8 months after surgery due to renal failure.

Depression, anxiety and quality of life through the use of complementary and alternative medicine among breast cancer patients in Turkey

BACKGROUND AND AIM Breast cancer is the most common type of cancer amongst women today. The aim of this study was to examine the association between complementary and alternative medicine (CAM) and the quality of life (QoL), anxiety and depression and demographic characteristics of women with breast cancer. MATERIALS AND METHODS QoL was measured by the European Organization for Treatment and Research of Cancer quality of life core questionnaire (QLQ-C30, version 3.0) and anxiety and depression was measured by the hospital anxiety and depression scale. RESULTS In total, 122 patients with breast cancer were enrolled in the study and 50% (n=61) of them reported that they were using CAM. The most commonly used CAM methods were stinging nettle (57%) and prayer and spiritual healing (49%). No relationship was found between the use of CAM and the patients age, time to diagnosis, cancer stage, chemotherapy use, smoking and residence. However, the analyses showed a positive association between CAM and role functioning (P=0.014) and financial difficulties (P=0.011); and a negative association between CAM and emotional functioning (P=0.033). CONCLUSIONS Based on the previous studies, 20-83.3% of breast cancer patients among different countries and cultures used CAM. Our results suggested that the use of CAM among women is quite popular, but they showed no correlation between CAM usage and anxiety and depression. In addition, CAM usage was more common in breast cancer patients with a poor emotional and financial status.

Reduction of irradiated small bowel volume with Trendelenburg position in gynecologic pelvic radiotherapy

The aim of this study was to assess the effect of Trendelenburg position in comparison to prone position on small bowel volume and treatment dose in gynecologic pelvic external beam radiotherapy using three‐dimensional conformal treatment plans. Eight patients with gynecologic cancers, treated with definitive or postoperative pelvic radiotherapy were investigated. Pelvic computerized tomography (CT) scans for treatment planning were performed in prone and 25 degree Trendelenburg positions for each patient. The dose‐volume histograms of small bowel within the treatment fields were obtained and compared for both positions. The clinical target volume (CTV) and the planning target volume (PTV) were also defined and evaluated in the subjects. Treatment dose was 5040 cGy to PTV with 180 cGy daily fraction doses in both techniques for all patients. The average irradiated small bowel volume was 726 cc for prone position and 458 cc for the Trendelenburg position. The average irradiated small bowel volume reduction in the Trendelenburg position was 38.0% (95% CI 19.5 ± 38%) compared with the prone position. The average small bowel percent dose was 25.4% (1280 cGy) for Trendelenburg position and 39.9% (2010 cGy) for prone position. PTV doses were similar in both techniques. The results of this dosimetric study suggest that gynecologic pelvic radiotherapy in the Trendelenburg position decreases the volume of irradiated small bowel compared to prone position and may decrease treatment related small bowel morbidity. Clinical benefit of this position should be evaluated in further clinical studies.

Another cause of pancytopenia in a patient receiving temozolomide.

Objective: To report pancytopenia caused by temozolomide, a second-generation alkylating agent. Clinical Presentation and Intervention: A 22-year-old patient presenting with seizures and confusion was seen in the emergency room. Cranial magnetic resonance imaging revealed a mass. After surgery, the patient was diagnosed with glioblastoma multiforme and was given temozolomide at 150 mg/m2 on days 1 through 5 every 4 weeks. During the last cycle of temozolomide, grade 3 thrombocytopenia persisted. Possible causes of pancytopenia including vitamin B12 deficiency were investigated. Conclusion: This case report shows that vitamin B12 deficiency can be a potential cause of pancytopenia and it should be kept in mind for patients receiving chemotherapy.