Senem Demirci

Multiple spinal metastases of cranial gliosarcoma: a case report and review of the literature.

Gliosarcoma is a rare brain tumor that consists of both glial and mesenchymal components. We report the case of a 68-year-old female with cranial gliosarcoma metastatic to the spinal cord. Initially, the patient was diagnosed with cranial gliosarcoma and treated with surgical resection followed by radiotherapy. Four months after she completed treatment, she presented with a sudden onset of hemiplegia. MRI (Magnetic Resonance Imaging) scan demonstrated two masses at the thoracic spinal cord. Immediate surgery was performed and the lesions were resected. No further therapy was recommended due to the poor condition of the patient. The patient subsequently died 3 months after diagnosis of the spinal cord metastases. There are about 20 reported cases of metastatic gliosarcoma and most focus on systemic metastases of gliosarcoma. Spinal cord metastases are, however, very rare and here we report such a case. Available literature on metastatic gliosarcoma was also reviewed.

The interaction between antioxidant status and cervical cancer: a case control study.

AIMS AND BACKGROUND To compare the antioxidant status of cervical cancer patients with healthy controls and to assess the antioxidant levels before and after radiotherapy or radiochemotherapy. METHODS AND STUDY DESIGN Antioxidant levels (glutathione, glutathione peroxidase, superoxide dismutase, and malondialdehyde) were measured in 35 patients with cervical cancer and 35 age-matched healthy controls. Blood samples were collected twice (before and after treatment) from cervical cancer patients and once from healthy control subjects. RESULTS In the patient group, pre-radiotherapy glutathione and glutathione peroxidase levels were significantly lower (P <0.01 and P <0.0001, respectively) than the control group. Pre-radiotherapy levels of superoxide dismutase were significantly higher in cancer patients (P <0.01). In general, no difference was observed between pre- and post-radiotherapy antioxidant levels in cancer patients. However, when post-radiotherapy glutathione levels were analyzed, patients who did not respond to treatment had significantly higher levels than those who did respond (P <0.01). CONCLUSIONS Levels of antioxidants significantly differed between the patients with cervical cancer and the controls, and no change in antioxidant levels was observed after treatment. Moreover, further studies evaluating the predictive value of glutathione levels on treatment response are warranted.

A Comparison of Clinical and Dosimetric Outcomes in Patients Receiving Partial Breast Irradiation with Photon-Only versus Mixed Photon/Electron Treatment Plans

Several series evaluating external-beam partial breast irradiation (PBI) have linked negative cosmetic outcomes to large normal tissue treatment volumes. We compared patients treated with PBI whose treatment plans included only photons to those whose plans incorporated electrons. Twenty-seven patients were identified: median age 67 years, pT1 82%, pN0 56%, margin negative 100%. All received 38.5 Gy using 3-5 noncoplanar photon beams (6-15X). Electrons (9-20 MeV) were included in 59%. Median follow-up was 22 months. Ninety percent experienced good/excellent cosmetic outcomes. Two patients had fair cosmesis, and both were treated with a mixed photon/electron approach. Median conformity index for photon-only treatment plans was 1.7 (range, 0.9-2.0) and for photon/electron plans, 1.0 (0.3-1.4). Median percent ipsilateral breast volume receiving 100% and 50% of prescription dose was 19 and 50 for photon-only plans vs. 10 and 38 for photon/electron plans (p < 0.05). Median percent target volume receiving 100% and 95% of prescription dose was 93 and 98 for photon-only plans vs. 75 and 94 for photon/electron plans (p < 0.05). A mixed photon/electron, noncoplanar technique decreases the volume of treated normal breast tissue at the cost of slightly decreased tumor bed coverage. Further study is needed to determine whether this results in a more favorable therapeutic ratio than photon-only approaches.

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

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 ≥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.