Münir Kinay

Prognostic factors in lung cancer with brain metastasis

Abstract Background and purpose : Metastasis to the brain develops in 25% of all patients with lung cancer. Although the outcome is usually poor, there seems to be a subset of patients with favorable prognostic factors who may live longer. Prognostic factors were analyzed retrospectively in 103 patients with brain metastases from lung carcinoma to identify patients who would benefit from more intensive treatment strategies. Materials and methods : Between October 1991 and December 1994, 103 patients with brain metastasis from lung cancer were irradiated with palliative intent. Palliation was defined as 50% or more regression of neurological signs and symptoms 2 weeks after the completion of cranial radiotherapy. Local (related to the lung tumor) symptom status at the time of brain metastasis, the presence of metastases other than brain, multiplicity of brain metastases on CT scan and time of occurrence of brain metastasis were the factors which were evaluated with multivariate analysis. Results : Palliation was accomplished in 85% of cases. Palliation duration ranged from 0.5 to 54 months (median 3 months). The overall median survival was 5 months. Only one patient is under follow-up without any symptoms related to the brain metastasis. According to the multivariate analysis survival was significantly decreased in the presence of symptoms related to the primary tumor ( P =0.001). Conclusion : The presence of symptoms related to the primary tumor at the time of brain metastasis is one of the factors that can be used to distinguish patients with a favorable outcome. In patients with favorable prognostic factors and thus longer survival probability, the role of boost dose after whole brain radiotherapy or surgical resection in suitable cases needs to be investigated.

Turkish people's knowledge of cancer and attitudes toward prevention and treatment.

BACKGROUND The basic level of cancer knowledge of the population is as important in controlling cancer as diagnostic tools, screening, and new approaches to prevention, early diagnosis, and treatment. METHODS A questionnaire consisting of 24 questions was given to 630 healthy Turkish people to determine their basic knowledge and attitudes regarding cancer. RESULTS The majority of respondents (78%) were found to have little knowledge of cancer despite the fact that the average level of education of the sample was superior to that of the general population. Educational level was the major predictive factor influencing the basic knowledge and attitudes of the respondents. CONCLUSION The overall education of the public as well as the basic level of knowledge of cancer must be improved in cooperation with oncology societies and media in order to overcome the cancer burden in Turkey.

Experience of the Izmir Pediatric Oncology Group on Neuroblastoma: IPOG-NBL-92 Protocol

This multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkeys social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.

Assessment of treatment-related thyroid dysfunction in patients with head and neck cancer

OBJECTIVE To assess thyroid dysfunction in head and neck cancer patients who have received external beam radiotherapy according to radiotherapy fields and dose, tumor site and other local or systemic treatments retrospectively and prospectively and propose a follow-up schedule. MATERIAL AND METHODS A total of 378 patients was classified into two groups. Group I (n = 345) consisted of surgically treated 153 laryngeal, 80 nasopharyngeal and 112 oral cavity/oropharyngeal carcinoma patients; these patients were evaluated retrospectively for treatment-related thyroid dysfunction using their data files. Group II included 33 patients with head and neck cancer who were evaluated prospectively. Thyroid function tests were performed at the beginning of the radiotherapy and every three months after the radiotherapy course, and thyroid dysfunction regarding surgery, radiotherapy and chemotherapy was evaluated. RESULTS In Group I, the median follow-up for 153 operated laryngeal carcinoma patients was 44 months. Four (2.6%) of them were found to have clinically apparent hypothyroidism. After a median follow-up of 36 months, none of the 80 nasopharyngeal carcinoma patients showed signs of hypothyroidism. Clinically apparent hypothyroidism was detected in only 1 (0.8%) of the oral cavity/oropharyngeal carcinoma patients after a median follow-up of 25 months. In Group II, 1 (3%) patient was found to have thyroid dysfunction postoperatively prior to radiotherapy. At the time of analysis, 29 (87.8%) patients were euthyroidic, 2 (6.1%) patients had subclinical and 2 (6.1%) patients had clinical hypothyroidism. All patients with thyroid dysfunction have had combined surgery and radiotherapy, and none of the patients treated with radical radiotherapy has experienced hypothyroidism. CONCLUSIONS Even after a short follow-up, the incidence of thyroid dysfunction was 12.2% in head and neck cancer patients treated with combined surgery and radiotherapy. We recommend thyroid function tests in these patients prior to and once every 3-6 months after the radiotherapy course.

The variability of applicator position among high dose rate intracavitary brachytherapy applications in cervical cancer patients treated with ring & tandem applicators

Objective To evaluate the interindividual and intraindividual applicator position variability in high dose rate ring and tandem intracavitary brachytherapy applications in locally advanced cervical cancer. Patients and Methods Eight patients with locally advanced cervical cancer formed the study population. They had been treated in Dokuz Eylül University Department of Radiation Oncology between the years 2000 and 2005 with high dose rate intracavitary brachytherapy using ring and tandem applicators. The 3-dimensional geometric variation of the applicator center in craniocaudal, mediolateral and anteroposterior directions was determined on the basis of bony reference points in 24 pairs of orthogonal films obtained in the conventional simulator. Then the following evaluations were performed: 1) the applicator position variability in all applications (interindividual variability), 2) the intraindividual applicator position variability relative to the first application, 3) the intraindividual applicator position variability relative to the average of three applications. Among the potential factors that might influence the reproducibility of ring and tandem applications, age, stage, the period between external radiotherapy and brachytherapy were evaluated by univariate analysis. Results Standard deviation of interindividual applicator variability was 3.83 mm in craniocaudal, 0.39 mm in mediolateral and 2.86 mm in anteroposterior directions. The standard deviation of intraindividual variability relative to the first application was 1.91 mm in craniocaudal, 0.4 mm in mediolateral, and 4.26 mm in anteroposterior directions. The standard deviation of intraindividual variability relative to the average of three applications was 0.95 mm in craniocaudal, 1.86 mm in mediolateral, and 1.24 mm in anteroposterior directions. According to univariate analysis, no factor influenced applicator position variability. Conclusions In order to extract definitive conclusions about factors that affect positional reproducibility of ring and tandem applicators, studies are needed that include larger numbers of patients.

A pilot study for human tumor/DNA banking: returned more questions than answers

A pilot study was performed for setting up the Dokuz Eylül University Breast Tumor DNA Bank (DEUBTB) to facilitate the sharing of tumor DNA/RNA samples and related data from cases collected by collaborators specializing in the breast cancer diseases between 2004 and 2006. The pilot study aimed to provide answers for certain questions on: (1) ethical concerns (informing the volunteer for donating specimen, anonymizing the sample information, procedure on sample request), (2) obtaining and processing samples (technical issues, flowchart), (3) storing samples and their products (storing forms and conditions), (4) clinical database (which clinical data to store), (5) management organization (quality and quantity of personnel, flowchart for management relations), (6) financial issues (establishment and maintenance costs). When the bank had 64 samples, even though it is quite ready to supply samples for a research project, it revealed many questions on details that may be answered in more than one way, pointing that all biobanks need to be controlled by a higher degree of management party which develops and offers quality standards for these establishments.

185 Our treatment protocol in nasopharyngeal carcinoma

Nasopharynx cancers are classified differently from other types of head and neck cancers by their extensive lymphatic spread and frequent distant metastasis. In most cases RT is the only treatment modality because of the localization. Neoadjuvant chemotherapy studies are held to have better results in the local-regional advanced disease. 39 was treated in our clinic between August 91–June 94. Thirty of the 39 cases were treated according to the NF cancer treatment protocol of Dokuz Eylul University Head and Neck Cancer Group. Our treatment protocol for Stage I–III disease is curative RT and for Stage IV disease both neoadjuvant CT (CDDP + Bleomycin + Methotrexate) and RT. This protocol is activated in October 1992. Twenty-six cases were Stage IV, 3 cases Stage III, 1 case Stage II. Fifteen cases were treated by RT and CT and 15 cases were treated with RT alone. The applied RT technique and total doses are standard in all cases. Each case is irradiated with 50 Gy to the supraclavicular and cervical areas without lymphatic involvement and with 70 Gy irradiation to the primary tumor and to involved cervical lymph node areas. Neoadjuvant CT is applied two courses every 21 days and after and after subsequent tumor response evaluation, RT was started. Median follow-up period is 22 month (3–40 months). Three cases with distant metastases died. Local recurrence is detected in two cases and second series of RT was applied. A case with regional recurrence was treated with CT alone. Two cases were lost in follow up (one having a pulmonary metastasis). The rest of the patients are disease free.

184 Radiotherapy results in early stage (T1-T2) vocal cord carcinoma

In early stage larynx carcinoma, the function preserving treatment can be performed only if patients are evaluated properly. In this study we present the preliminary results of 44 patients of early stage larynx carcinoma which are treated according to the prospective larynx carcinoma protocol of Dokuz Eylul Head And Neck Cancer Group. Forty-three patients were male and 1 patient was female. The average age is 61 (27–87). Thirty-seven patients were staged as TIN0 and 7 patients as T2N0. In 40 cases, the tumor localization was in the glottic and in 4 cases in the supraglottic area. The tumor histology was squamous cell carcinoma in 36 patients, in-situ carcinoma 7 and small cell carcinoma in 1 patient. Lung cancer was detected as a second primary in 1 patient. Diagnosis was made by biopsy in 28 cases, by stripping in 12 cases, by cordectomy in 1 case, by polypectomy in 1 case, and by mass excision in 2 cases. All cases were treated by radiotherapy alone. Treatments were completed in all cases. The delivered total dose is 66–70 Gy in 33–35 fractions (in 200 cGy fractions). There was total tumor regression in all cases, 2 months after radiotherapy. No serious side effects were observed. The self evaluation of voice quality was revealed as very satisfactory in 43 patients. Only in the cordectomy case the voice quality was unsatisfactory. The case with lung cancer is lost to follow up. Two cases died because of other reasons and the rest are disease free.

149 Prognostic factors in lung cancer with brain metastasis

BACKGROUND AND PURPOSE Metastasis to the brain develops in 25% of all patients with lung cancer. Although the outcome is usually poor, there seems to be a subset of patients with favorable prognostic factors who may live longer. Prognostic factors were analyzed retrospectively in 103 patients with brain metastases from lung carcinoma to identify patients who would benefit from more intensive treatment strategies. MATERIALS AND METHODS Between October 1991 and December 1994, 103 patients with brain metastasis from lung cancer were irradiated with palliative intent. Palliation was defined as 50% or more regression of neurological signs and symptoms 2 weeks after the completion of cranial radiotherapy. Local (related to the lung tumor) symptom status at the time of brain metastasis, the presence of metastases other than brain, multiplicity of brain metastases on CT scan and time of occurrence of brain metastasis were the factors which were evaluated with multivariate analysis. RESULTS Palliation was accomplished in 85% of cases. Palliation duration ranged from 0.5 to 54 months (median 3 months). The overall median survival was 5 months. Only one patient is under follow-up without any symptoms related to the brain metastasis. According to the multivariate analysis survival was significantly decreased in the presence of symptoms related to the primary tumor (P = 0.001). CONCLUSION The presence of symptoms related to the primary tumor at the time of brain metastasis is one of the factors that can be used to distinguish patients with a favorable outcome. In patients with favorable prognostic factors and thus longer survival probability, the role of boost dose after whole brain radiotherapy or surgical resection in suitable cases needs to be investigated.