Senem Demirci Alanyalı

Evaluation of unusual and highly aggressive variant of endometrium cancer: nonendometrioid endometrium carcinoma of the uterus.

Aims To evaluate the survival and treatment outcomes of patients with nonendometrioid endometrium carcinoma after postoperative radiotherapy. Methods The records of 94 patients treated with postoperative radiotherapy (RT) between January 2005 and December 2011 were retrospectively reviewed. Postoperative RT was delivered with a dose of 45-50.4 Gy with 1.8 Gy daily fractions and brachytherapy was added to external RT for 62 patients with a dose of 3 × 6 Gy. Median follow-up time was 35 months (range 6-95 months). Results Median age was 63 years (range 43-83 years) and lymph node metastasis (LNM) was positive in 15 (16.0%) patients. The stage distribution of the patients was as follows: stage I, 58 (61.7%); stage II, 16 (17.0%); stage III, 18 (19.1%); stage IV, 2 (2.2%). Five-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) rates were 92.3%, 68.2%, and 78.6%, respectively. In univariable analysis, it was determined that the factors affecting OS rates were stage (p = 0.003), presence of LNM (p = 0.003), and presence of lymphovascular space invasion (LVSI) (p = 0.007); factors affecting DFS rates were stage (p = 0.019), presence of LVSI (p = 0.002), and having LNM (p = 0.049); and the factor affecting LRC rates was tumor size (>5 cm) (p = 0.011). In subgroup analyses, among all stage I patients, the DFS rates were lower for those with histologic grade 3 tumors and more than ½ myometrial invasion. Conclusions Due to its rarity, the prognostic factors and outcomes of nonendometioid endometrium carcinoma are not fully understood. In our analysis, stage, LNM, and presence of LVSI were found to be the most important prognostic factors. In order to tailor the optimal treatment strategy, prospective studies are needed.

Treatment results and prognostic factors of patients with vulvar cancer treated with postoperative or definitive radiotherapy.

Purpose Vulvar cancer is a relatively uncommon type of gynecologic cancer. The aim of this study is to analyze the treatment results and prognostic factors of vulvar cancer. Methods Forty-four vulvar cancer patients treated between 2000 and 2011 at the Department of Radiation Oncology, Ege University Faculty of Medicine, were retrospectively reviewed. External radiotherapy (RT) was applied with 6-18 MV linear accelerators with 1.8 Gy daily fractions with a median total dose of 50.4 Gy (45-59.4 Gy) for postoperative cases and 64.8 Gy (range 54-66 Gy) for definitive cases. Statistical analyses were performed with SPSS 13.0. Results Among 44 patients with a median age of 68 years (range 28-86), 14 (31.8%) were treated with curative and 30 (68.2%) were treated with postoperative RT or radiochemotherapy (RCT). According to International Federation of Gynecology and Obstetrics staging, 11 (25%) had stage IB, 10 (22.7%) had stage II, 6 (13.6%) had stage IIIA, 5 (11.4%) had stage IIIB, and 12 (27.3%) had stage IVA disease. Within a median of 24 months (range 6-135) of follow-up, 11 (27.3%) patients had local recurrence, 8 had regional recurrence, 2 had both local and regional recurrence, and 6 had distant metastases. Five-year locoregional, disease-free, and overall survival rates were 45%, 40%, and 54%, respectively. Older age, poor tumor differentiation, positive surgical margin, and lymphovascular space invasion were found to be important prognostic factors for disease-related outcomes. Conclusions Prognosis of vulvar cancer remains poor even with a multidisciplinary approach. Molecular prognostic factors need to be defined for individualized treatment options to achieve better treatment results.

Staging of Breast Cancer

Five decades ago, Denoix et al. proposed classification system (tumor node metastasis [TNM]) based on the dissemination of cancer according to the features of the primary tumor (localization, size, and extension to the surrounding structures), regional lymph nodes, and the presence of metastases. Currently, the TNM system which was formulated by Union International Cancer Centre (UICC) and the American Joint Committee on Cancer (AJCC) is being used for every cancer site.

The Organs at Risk and Radiation Tolerance Doses

During the last two decades, early diagnosis and better treatment options have improved the survival rates of breast cancer patients [1]. Radiotherapy (RT) is an essential component of the treatment of patients with early and locally advanced disease and has been shown to reduce local recurrence risk by approximately 20% and breast cancer mortality risk by 5% [2]. However, RT-induced toxicities may manifest from months to decades after treatment and may be related to severe morbidity and mortality. Older RT techniques are particularly associated with an excess risk of non-breast cancer mortality, which was mainly from heart disease [2]. The goal of modern RT techniques is to improve the therapeutic ratio by increasing tumor control and decreasing toxicity.

Adverse effects of endocrine therapy in breast cancer: single institute experience

Aim of the study The main purpose of this study is to assess the known adverse effects of adjuvant endocrine therapy for non-metastatic breast cancer patients and to present our single center experience with light of literature. Material and methods The breast cancer patients treated with adjuvant radiotherapy in Medical School of Ege University between January 2007 and December 2009 were evaluated for this trial after obtaining their acceptance. Vital findings, bone mineral densitometry, endometrium thickness measured with trans-vaginal ultrasonography, biochemical results including liver function tests and blood lipid profile (total cholesterol, HDL, LDL, VLDL, triglyceride) were recorded for each controls. Socio-demographic data, financial statuses, medical history, co-morbid diseases were obtained from first controls. Patients were followed without any local recurrence and distant metastases until June 2011. Results Endometrium thickness was not seen in AI using patients. As compared with tamoxifen group, lack of thickness in AI group was statistically significant (p = 0.000). When compared the values before AI, the number of patients who had osteoporosis was gradually increasing. The decrease was seen in the number of patients with osteopenia. The number of patients with normal lipid profile was gradually increasing up to the second evaluation for tamoxifen group (p = 0.000). On the other hand, the number of patients with hyperlipidemia was increasing for AIs group in follow-up period statistically (p = 0.006). Conclusions With the aid of careful patient follow and effective disease management strategies, the negative effect over the QoL can be minimized and also the greatest benefit from endocrine therapy can be obtained.

Prognostic and Predictive Factors

There is an increasing recognition that breast cancer can be heterogeneous and composed of a variety of subgroups with different prognosis. Identification of favorable and unfavorable groups helps clinicians to individualize and tailor the treatment for each patient. In order to complete risk stratification, patient and tumor characteristics were being used as prognostic and predictive factors. By definition, the prognostic factor is a measurable variable that correlates with the natural history of the disease. In contrast, a predictive factor is one that is associated with response to a given therapy. Some factors, such as estrogen receptor (ER)/progesterone receptor (PR) status and human epidermal growth factor receptor-2 (Her-2)/neu gene amplification and/or overexpression, are both prognostic and predictive [1]. This chapter focuses on the widely used major prognostic and predictive factors related to patient and tumor characteristics for breast cancer-specific outcomes.

Metastatic Breast Cancer

The role of radiotherapy (RT) for metastatic breast cancer is broken down into three settings: the first and most common is palliative radiotherapy, the second is stereotactic RT for oligometastases instead of surgery, and the third is the irradiation of the breast for locoregional control. The goal of treatment is to prolong survival, to lengthen the time to progression, to provide relief for disease-related symptoms, and to improve the quality of life of the metastatic patient. Nevertheless, treatment modalities with minimal toxicity are preferred for each patient on an individual basis. A multidisciplinary team including a medical oncologist, a radiation oncologist, a breast surgeon, and a psychiatrist is necessary for guiding optimal treatment.