Ali Murat Sedef

Procalcitonin as a biomarker for infection-related mortality in cancer patients.

PURPOSE OF REVIEW Infectious diseases are the second leading cause of death following direct cancer-related complications in the field of oncology. Clinical studies using the classic inflammatory biomarkers, C-reactive protein, erythrocyte sedimentation rate, leukocytosis, and thrombocytosis fail to show a significant correlation between these biomarkers and infection-related mortality. It is therefore crucial to define new biomarkers that are not affected by the primary cancer and precisely show the severity of the infection to help in the decision-making process. RECENT FINDINGS A significant increase in the number of cancer patients in the past decades has created an exponential increase in the number of immunocompromised patients. Preemptive and typically unnecessary usage of broad-spectrum antibiotics is common during the treatment of these patients and may result in an increase in multidrug-resistant microbial strains. Recent clinical studies suggest that a significant reduction in antibiotic consumption may be achieved by procalcitonin-guided algorithms without sacrificing the outcome of patients with severe infection. SUMMARY In this article, we focus on procalcitonin and its potential role in differentiating cancer and infection-induced inflammation. Using this strategy may significantly reduce the usage of empirical broad-spectrum antibiotics and result in earlier discharge of patients.

Concurrent Chemoradiotherapy with Vinorelbine plus Split-Dose Cisplatin may be an Option in Inoperable Stage III Non-Small Cell Lung Cancer: A Single-Center Experience

Background Concurrent chemoradiotherapy is the current standard treatment for inoperable stage III non-small cell lung cancer (NSCLC). In this study we aimed to investigate the efficacy and toxicity of CCRT with split dose of cisplatin (30 mg/m2) and vinorelbine (20 mg/m2) in patients with inoperable stage III NSCLC followed in our oncology clinic. Material/Methods Medical records of 97 patients with inoperable stage III NSCLC treated with concurrent chemoradiotherapy with cisplatin-vinorelbine were retrospectively analyzed. Cisplatin (30 mg/m2) and vinorelbine (20 mg/m2) were administered on days 1, 8, 22, and 29 during radiotherapy. Two cycles of consolidation chemotherapy were given. All patient data, including pathological, clinical, radiological, biochemical, and hematological data, were assessed retrospectively using our database system. Results Our study included 97 unresectable stage III NSCLC patients who were treated with CCRT. Median age was 58 years old (range 39–75) and 87 (89.7%) of the patients were men. ECOG performance score was 0–1 in 93 patients (95.9%). Squamous histology, the most common histology, was diagnosed in 46 patients (47.4%). Median follow-up time was 23.8 months. Median progression-free survival (PFS) and median overall survival time (OS) were 10.3 months and 17.8 months, respectively. Objective response rate and clinical benefit rate were 75.3% and 83.5%, respectively. Distant and local relapse rate were 57.1% and 42.9%, respectively. Hematological and non-hematological grade 3–4 toxicities were seen in 13 (13.4%) and 16 (16.5%) patients, respectively. Six (6.1%) patients died due to toxicity. Conclusions The results of this study suggest that split-dose cisplatin may offer fewer grade III–IV toxicities without sacrificing efficacy and could be an option in patients with inoperable stage III NSCLC during CCRT. Similar to past studies, despite high response rate during CCRT, distant relapse is the major parameter that influences patient survival in long-term in NSCLC.

Primary extranodal non-Hodgkin's lymphoma: clinicopathological features, survival and treatment outcome in two cancer centers of southern Turkey.

BACKGROUND The aim of this study was to assess the epidemiological and clinicopathological characteristics of primary extranodal non-Hodgkins lymphoma (pENL) patients, focusing on treatment and survival outcome. MATERIALS AND METHODS Between October 2003 and March 2012, 802 patients with non-Hodgkins lymphoma (NHL) were diagnosed and treated in two different cancer centers of Southern Turkey. RESULTS pENL, constituted 12.4% (100/802) of all NHL studied during this period. Median age of the patients was 56 years (range 17-87 years) and the male: female distribution was 3:2. Eighty-five of 100 patients (85%) were in stage I/II, 9/100 (9%) in stage III, whereas 6/100 (6%) were in stage IV. Head and neck constituted the most common site (51/100, 51%), followed by gastrointestinal tract (GIL) (37/100, 37%), and cerebrum (CL) (5/100, 5%). Diffuse large B cell lymphoma (DLBCL) was the most common histological type, observed in 53% of patients, followed by marginal zone extranodal lymphoma (13%). Most of patients (76%) received a CHOP containing regimen. Complete remission (CR) were achieved in 71% of patients. The median follow-up duration of all patients was reported as 37.6 months (range, 0.8-165 months). This period was reported as 137.5 months (range, 117.5- 1578.6 months) in gastrointestinal lymphoma (GIL) patients, 119.0 months (range, 91.8-146.1 months) in head and neck lymphoma (HNL) patients, and 18.4 months (range, 12.6-24.1 months) in cerebral lymphoma (CL) patients. CONCLUSIONS Head and neck, and the gastrointestinal tract were the two most common extranodal sites observed. Histologically DLBC accounted for the majority of cases. Most patients were on earlier stages, had low-low intermediate IPI scores and had a favorable prognosis.

Acute fatal interstitial lung disease in two cases under treatment of crizotinib

Crizotinib is an orally active, small molecule tyrosine kinase inhibitor of anaplastic lymphoma kinase (ALK), mesenchymalepithelial transition factor (met), hepatocyte growth factor receptor (HGFR) and ROS1 proto-oncogene receptor tyrosine kinase (ROS-1) [1]. Crizotinib actively used in treatment of advanced stage non-small cell lung cancer (NSCLC) with modest increase in survival rates with low rate of serious side effects [2,3]. Phase trials reported interstitial lung disease (ILD) as most feared complication of crizotinib [4]. However, clinical course, predictive risk factors, and management strategies remain uncertain. Here, we describe two cases of advanced stage NSCLC with an acute form of crizotinib-induced ILD.

Adjuvant uzatılmış temozolamid tedavisinin glioblastoma multiforme hastalarının sağkalımına etkisi

Amac: Retrospektif bu calismanin amaci cerrahi/biyopsi ile glioblastoma multiforme tanisi almis, kemoradyoterapi uygulanmis hastalarda uzatilmis temozolamid kullaniminin genel ve progresyonsuz sagkalim etkisini arastirmak olarak belirlendi. Gerec ve Yontem: Klinigimize basvuran cerrahi/biyopsi ile glioblastoma multiforme tanisi almis 225 hastadan, temozolamid ile birlikte radyoterapi tedavisi uygulandiktan sonra, ≤6 ay ve >6 ay sureyle adjuvan temozolamid kemoterapisi uygulanmis 116 hastatedavi toleransi, genel ve progresyonsuz sagkalimlari arasindaki farklar retrospektif olarak incelendi. Bulgular: Hastalarin ortalama takip suresi 18 ay (2-125 ay) olarak belirlenirken, 65(%56) hasta halen hayattadir. Uzatilmis temozolamid (>6 ay) olan grupta genel sagkalim daha uzun tespit edilirken istatistiksel bir fark tek degiskenli analizde tespit edilememistir sirasiyla 49.0 (≤6)vs 68.33 ay(>6). Ancak progresyonsuz sagkalim suresi uzatilmis temozolamid grubunda standart temozolamid alan gruba gore istatistiksel olarak anlamli oranda uzun saptanmistir 14 (>6)vs 9 ay(≤6). Gruplar arasinda anlamli bir yan etki farkliligi gorulmemistir. Sonuc: Calismamizda glioblastoma multiforme tanisi almis hastalarda uzatilmis temozolamid kullanimi hastalarin progresyonsuz sagkalim ve genel sagkalimlarinin belirgin oranda artmasina neden olur.