Bilge Gursel

Protective Effect of Lycopene against Radiation-Induced Hepatic Toxicity in Rats

The radioprotective effect of lycopene against liver damage was investigated in 80 female Sprague Dawley rats (10 per group). Early-group rats included: controls (group 1), lycopene (group 2), radiotherapy alone (group 3), and lycopene + radiotherapy (group 4). Lycopene (5 mg/kg per day) was administered orally for 7 days; single-fraction 8 Gy abdominopelvic radiotherapy was administered on day 8. Early-group rats were sacrificed on day 10. Late-group rats (groups 5 – 8) underwent treatment with the same regimens but, in groups 6 and 8, lycopene was administered until all rats were sacrificed, 60 days postradiotherapy. Liver malondialdehyde levels increased significantly and glutathione (GSH) levels, GSH-peroxidase (GSH-Px) and superoxide dismutase (SOD) activity decreased significantly in radiotherapy versus control groups. In lycopene + radiotherapy groups, malondialdehyde levels decreased significantly and GSH levels, GSH-Px and SOD activity increased significantly compared with radiotherapy groups. No significant between-group histopathological differences were observed in early groups; in late groups, histopathological changes increased significantly in the radiotherapy group versus control group. A significant decrease in histopathological changes occurred in the lycopene + radiotherapy group compared with the radiotherapy group. Lycopene supplementation significantly reduced radiotherapy-induced oxidative liver injury.

Multiple Primary Malignant Neoplasms from the Black Sea Region of Turkey

Long-term cancer survival is increasing and, as a consequence, so is the prevalence of secondary malignancies. This study evaluated the patient and tumour characteristics of 117 patients with multiple primary malignant neoplasms (MPMN). The incidence of MPMN in children and adults was 0.28% and 1.23%, respectively. The male: female ratio was 1.7: 1. The mean ± SE age at tumour diagnosis was 60.56 ± 1.18 years. Overall, the top three tumour sites were the larynx, bladder and breast. Among secondary tumours, lung cancer was the most frequent, followed by breast and colon cancer. Among males, the leading primary and secondary tumour sites were the larynx (30.1%) and lung (50.7%), respectively. Among females, the breasts were both the leading primary (32.6%) and secondary (37.2%) cancer site. The mean ± SE overall survival was 97.2 ± 15.0 months. During follow-up, the brain was the most commonly observed site of metastasis. The occurrence and characteristics of MPMN reported in the literature are also reviewed. The present study contributes towards increasing understanding and treatment of MPMN in a different population group.

Dosimetric comparison of three different external beam whole breast irradiation techniques

IntroductionThe purpose of this study was to compare the dosimetries of three different external beam whole breast radiotherapy techniques: two-dimensional RT (2D-RT), three-dimensional conformal RT (3D-CRT), and field-in-field intensity-modulated RT (FiF-IMRT). In addition, we aimed to evaluate the patients who needed more or less complex treatment modalities.MethodsThirty patients were included in the study. All the patients had earlystage breast cancer and conserving surgery had been performed. Plans that employed the three techniques were generated for each patient. Dosimetric comparisons were conducted, and correlations with patient characteristics and dosimetric outcomes were analyzed.ResultsThe 2D-RT technique was found to be suboptimal for treating the intact breast. Its dose homogeneity index (DHI) was 20.68. The authors were unable to define a patient characteristic in which 2D-RT dosimetry would perform better. FiF-IMRT was found to be the superior technique with a better homogeneity in the breast (DHI=9.35 and P=0.000002 when compared to 3D-CRT). When compared according to patient characteristics, again the FiF-IMRT planning is the best for all subgroups, but the DHI gets worse by increased breast volume and separation. While FiF-IMRT achieves better DHI in the breast, it has little effect on heart and lung doses. But the normal tissues’ volume (cc) that gets the 100% of the prescribed dose (V100) was lowered because of the treatment without wedges and scatter and with less monitor unit.Conclusions2D-RT could not be performed safely on the intact breast in any of the subgroups. FiF-IMRT is a superior technique for breast dosimetry, and normal tissue. For patients with large breast size or separation, further intensive techniques must be investigated.

Intrathoracic malignant peripheral nerve sheath tumor with angiosarcoma in a child with NF1.

Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon in children and adolescents but occur more frequently in NF1 patients. Angiosarcomatous differentiation in MPNSTs is a rare entity with poor prognosis. We report on a 13-year-old boy with intrathoracic angiosarcoma arising in MPNST associated with NF1.

Religious and Spiritual Practices Among Patients with Cancer

The aim of this study was to investigate the frequency with which cancer patients engage in religious and spiritual practices, the methods used, the reasons for such a search, and the levels of depression and hopelessness in patients who seek spiritual assistance. One hundred and ten radiation oncology patients, who gave voluntary informed consent were included in this study. Questionnaires about religious and spiritual practices were administered, along with the Beck Depression and Beck Hopelessness scales. Twenty percent of the patients preferred spiritual practices. Female gender, lower education levels, and higher depression and hopelessness scores were associated with this preference. The frequency of depression was 18.2%, and the frequency of hopelessness was 20.9%. A significant number of cancer patients engaged in religious and spiritual practices. We recommend that practitioners offer their patients brief but sufficient information about religious and spiritual support and determine their patients’ depression and hopelessness levels.

Male Breast Cancer: 20 Years Experience of a Tertiary Hospital from the Middle Black Sea Region of Turkey

BACKGROUND Male breast cancer is a rare neoplasm, and its treatments are based on those of female breast cancer. This study aimed to analyze 20 years of male breast cancer clinical characteristics and treatment results from the Middle Black Sea Region of Turkey. MATERIALS AND METHODS A retrospective analysis of 16 male breast cancer patients treated in our tertiary hospital between 1994 and 2014 was performed. Epidemiologic data, tumor characteristics, and treatments were recorded and compared with 466 female breast cancer ((premenopausal; n=230)+(postmenopausal n=236)) patients. The 5-year disease-free and overall survival rates were calculated. RESULTS Male breast cancer constituted 0.1% of all malignant neoplasms in both sexes, 0.2% of all malignant neoplasms in males, and 0.7% of all breast cancers. The mean patient age in this study was 59.8±9.5 (39-74) years. The mean time between first symptom and diagnosis was 32.4±5.3 (3-60) months. Histology revealed infiltrative ductal carcinoma in 81.3% of patients. The most common detected molecular subtype was luminal A, in 12 (75%) patients. Estrogen receptor rate (93.8%) in male breast cancer patients was significantly higher than that in female breast cancer (70.8% in all females, p=0.003; 68.2% in postmenopausal females, p=0.002) patients. Most of the tumors (56.3%) were grade 2. Tumor stage was T4 in 50% of males. The majority (56.3%) of the patients were stage III at diagnosis. Surgery, chemotherapy, radiotherapy and endocrine-therapy were applied to 62.5%, 62.5%, 81.2% and 73.3%, respectively. Loco-regional failure did not occur in any of the cases. All recurrences were metastastic. The 5-year disease-free and overall survival rates in male breast cancer patients were 58% and 68%, respectively. CONCLUSIONS Tumors found in male breast cancer patients were similar in size to tumors found in females, but they advanced to T4 stage more rapidly because of the lack of breast parenchymal tissues. The rate of estrogen receptor expression tended to be higher in male breast cancer patients than in female breast cancer patients. Metastasis is the most important problem in initially non-metastatic male breast cancer patients.

Effects of preoperative conventional and hyperfractionated radiotherapy on the healing of rat colonic anastomoses.

Background: One problem associated with end to end anastomoses after preoperative radiotherapy is leakage. The strength of the anastomoses is very important. Fractionation schedules are widely under investigation to achieve higher doses with less toxicity and high curative potential. The aim of this study was to compare preoperative conventional and hyperfractionated radiotherapy effects on anastomoses. Materials and Methods: Sixty Wistar albino rats were divided into 3 groups: control, conventional radiotherapy (2 Gy/fraction, total 44 Gy), and hyperfractionated radiotherapy (1.2 Gy/fraction, total 52.8 Gy). 5 weeks after completion of the treatment, the rats underwent end to end anastomoses to the rectum. Following the surgery, the bursting pressure of the anastomoses and the hydroxyproline levels were measured on days 3 and 7. Results: The bursting pressure was lower in both radiotherapy groups on the 3rd day. On day 7, the results of the conventional radiotherapy arm matched those of the control group, but the results of the hyperfractionated group did not (p = 0.001). On day 3, hydroxyproline levels were significantly lower in both radiotherapy groups than in the control group (p = 0.001). On the 7th day, the statistical difference disappeared within the radiotherapy groups. However, the hydroxyproline levels of the 2 radiotherapy arms were still lower than those of the control group (p = 0.001). Conclusion: Hyperfractionation strongly inhibits collagen synthesis and is associated with protracted healing.

Management of the Axilla in T1-2 Breast Cancer Patients with Macrometastatic Sentinel Node Involvement Who Underwent Breast-Conserving Therapy

ABSTRACT Purpose: The aims of our study were to determine the incidence of axillary recurrence and arm morbidity in T1-2 invasive breast cancer patients with macrometastases on the sentinel lymph node (SLN) who underwent breast-conserving therapy (BCT), with or without axillary lymph node dissection (ALND). Methods: One hundred and nine T1-2 invasive breast cancer patients with macrometastases on the SLN who underwent BCT in our institution were included in the study. Patients with 1–2 positive SLN and without extra nodal extension (ENE) on the SLN did not undergo ALND (SLN-only group) and patients with ENE or patients who had >2 metastatic nodes underwent level I, II ALND (ALND group). The SLN-only group received radiotherapy to three axillary levels, the supraclavicular fossa, and ± mammaria interna. ALND group received radiotherapy to axillary level III, the supraclavicular fossa, and ± mammaria interna. The incidence of axillary recurrence and arm morbidity were investigated. Results: Of the 109 patients, 18 patients with >2 metastatic SLNs and 10 with ENE on the SLN underwent ALND and 81 patients underwent SLN only. Median follow-up time was 37 months (3–77). There was no axillary recurrence in SLN-only group. However, in the ALND group 1 patient had developed axillary metastasis. There were 2 objective lymphoedema and 3 arm-shoulder restriction cases in the SLN-only group, and 2 and 3 in the ALND group, respectively. Conclusions: Axillary dissection could safely be omitted in patients with 1–2 macrometastatic SLN and without ENE who undergo BCT and axillary radiotherapy.

Dosimetric Comparison of Three Different Radiotherapy Techniques in Antrum-Located Stomach Cancer

Background: The current optimal radiotherapy (RT) planning technique for stomach cancer is controversial. The design of RT for stomach cancer is difficult and differs according to tumor localization. Dosimetric and clinical studies have been performed in patients with different tumor localizations. This may be the main source of inconsistencies in study results. For this reason, we attempted to find the optimal RT technique for patients with stomach cancer in similar locations. Methods: This study was based on the computed tomography datasets of 20 patients with antrum-located stomach cancer. For each patient, treatments were designed using physical wedge-based conformal RT (WB-CRT), field-in-field intensity-modulated RT (FIF-IMRT), and dynamic intensity-modulated RT (IMRT). The techniques were compared in terms of expected target volume coverage and the dose to organs at risk (OAR) using a dose-volume histogram analysis. Results: FIF-IMRT was the most homogenous technique, with a better homogeneity index than WBCRT (p<0.001) or IMRT (p<0.001). However, IMRT had a better conformity index than WBCRT (p<0.001) or FIF-IMRT (p<0.001). Additionally, all OAR, including the kidneys, liver, and spinal cord, were better protected with IMRT than with WBCRT (p=0.023 to <0.001) or FIF-IMRT (p=0.028 to <0.001). Conclusions: In comparison to FIF-IMRT and WBCRT, IMRT appears to be the most appropriate technique for antrum-located stomach cancer. To establish whether IMRT is superior overall will require clinical studies, taking into account differences in both tumor localization (cardia, body, and antrum) and organ movement in patients with stomach cancer.

Interaction of Chemotherapy, Radiotherapy, and Timing

New methods that have been developed to regulate and modify the biological response of tumors and of normal tissues to radiation to achieve maximum benefit with minimum harm to the adjacent normal tissues should be considered be among the most significant developments in radiotherapy (RT) in recent years. These methods include different fractionation schemes, the application of chemical and biological agents, and effective therapies targeted toward molecular pathway-signal transduction mechanisms. Among these treatment strategies, the most widely used method in clinical practice is the combination of chemotherapy (CT) with RT. Since the development of CT and RT, many studies have been published regarding adjuvant treatment of breast cancer, which remains a controversial issue. However, despite advances and innovations in breast cancer treatment, there is still no consensus on the optimal treatment approach, mainly because breast cancer is a heterogeneous group of diseases with a wide spectrum of biological behaviors. In this section, the molecular biological mechanisms of the interaction between RT and CT in breast cancer, as well as the optimal timing of RT and CT, will be discussed in light of relevant randomized trials.