Yücel Pak

Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study.

Objectives:The purpose of the present study was to evaluate the nutritional status of cancer patients receiving radiotherapy (RT) and to assess the possible contributions of nutritional support to patients with malnutrition. Methods:Prospectively, 207 patients referred to our outpatient radiotherapy department were included. The patients were classified according to tumor site (head/neck, breast, lung, stomach, or colorectal). Nutritional status at the onset, at the end of RT, and 3 and 6 months after irradiation was evaluated with the subjective global assessment (SGA). All of the patients were supported with additional portions of meal or standard enteral feeding formula during and after the irradiation period as long as they were in the moderately or severely malnourished groups, respectively. Results:At the onset, malnutrition was present in 31% of all patients, and it increased to 43% at the end of RT. This difference predominated in head/neck cancer patients. Malnutrition ratios in head/neck cancer patients at the onset and after RT were 24% and 88%, respectively. By a 6-month follow-up, the ratio of patients with malnutrition decreased to 8%. Nutritional status of all groups was found to improve during the 6-month follow-up period, except for the breast cancer group, which included no patients with severe malnutrition at any time. Conclusion:The results of the present study may be helpful in planning an appropriate nutritional support for cancer patients undergoing radiotherapy according to the irradiation site.

Clinical and prognostic features of plasmacytomas: a multicenter study of Turkish Oncology Group-Sarcoma Working Party.

To identify the outcomes of prognostic factors of solitary plasmacytoma mainly treated with local radiotherapy (RT). The data were collected from 80 patients with solitary plasmacytoma (SP). Forty patients (50.0%) received radiotherapy (RT) alone while 38 of them (47.5%) were treated with surgery (S) and RT. The median radiation dose was 46 Gy (range 30–64). The median follow up was 2.41 years (range 0.33–12.33). Ten‐year overall survival (OS) and local relapse‐free survival (LRFS) were 73% and 94%, respectively. The median progression‐free survival (PFS) and multiple myeloma‐free survival (MMFS) were 3.5 years and 4.8 years, respectively. On multivariate analyses, the favorable factors were radiotherapy dose of ≥50 Gy and RT + S for PFS and younger age for MMFS. For the patients with medullary plasmacytoma, the favorable factor was younger age for MMFS. RT at ≥50 Gy and RT + S may be favorable prognostic factors on PFS. Younger patients, especially with head‐neck lesion and without pre‐RT macroscopic tumor, seem to have the best outcome when treated with RT ± S. Progression to MM remains as the main problem especially for older patients. Am. J. Hematol., 2008.

Effects of two conventional preoperative radiation schedules on anastomotic healing in the rat colon.

Background: Preoperative radiotherapy (RT) is an increasingly popular form of adjunct therapy for rectal cancer; however, little is known about its effects on matrix metalloproteinase (MMP) expression in colonic anastomotic healing. Methods: Wistar rats were irradiated to a total dose of 25 or 40 Gy. Four days after the end of RT, an end-to-end colorectal anastomosis was performed. Animals were sacrificed at 1, 3, and 7 days after the anastomosis. A control group was studied similarly, but was not irradiated. Results: No significant differences were found in peritonitis rate and anastomotic complications. The average bursting pressure and breaking strength were only reduced significantly in the rats irradiated with 40 Gy. However, the concentration and the content of hydroxyproline in anastomotic tissues were unchanged. In irradiated rats, MMP-2 and MMP-9 were significantly increased at 40 Gy, but not at 25 Gy. On the other hand, 25-Gy irradiation induced a smaller increase in the levels of the tissue inhibitors of metalloproteinase-1 compared with the controls. Conclusion: Anastomotic strength is adversely affected by high-dose fractionated preoperative RT. In contrast, preoperative RT at 25 Gy in five fractions over 5 days is safe with regard to the maintenance of wound strength in colorectal anastomosis.

Evaluation of fractionated total body irradiation and dose rate on cataractogenesis in bone marrow transplantation.

PURPOSE To assess dose rate effect on cataractogenesis in allogeneic or autologous bone marrow transplanted patients conditioned with fractionated total-body irradiation (FTBI). MATERIALS AND METHODS Between 1987 and 2001, a total of 105 patients have received TBI conditioning for Bone Marrow Transplantation (BMT) for hematological malignancies at Gulhane Military Medical School. 12 Gy FTBI was applied in 6 fractions over 3 consecutive days with a Co60 teletherapy machine. 46 patients who have survived and were followed up after more than one year were evaluated for cataractogenesis in relation to dose rate. Conditioning therapy included only cyclophosphamide (60 mg/kg/day for two days) + TBI with no steroid and veno-occlusive disease prophylaxis. RESULTS The median follow-up is 32 months. Posterior subcapsular cataract developed in 5 eyes of three patients out of 46 patients. The 5-year and 10-year estimated cataract incidence in the high-dose rate (> 0.04 Gy/min) group was 29% and 43% respectively while no cataracts occurred in the low-dose rate (< or = 0.04 Gy/min) group. Cataract development in the high-dose rate group versus low-dose rate group was statistically significant (p < 0.039). CONCLUSION Cataract is a late side effect of TBI. Low-dose rate fractionated TBI is a reliable conditioning program in BMT with effective lens sparing to avoid cataractogenesis.

Megestrol acetate for cachexia and anorexia in advanced non-small cell lung cancer: A randomized study comparing two different doses

Background The primary aim of the study was to compare two different dose levels of megestrol acetate, administered for cancer-related anorexia and cachexia for 3 months. Methods From August 1996 to December 2000, 119 patients with advanced non-small cell lung cancer were randomized to take 160 mg/day or 320 mg/day of megestrol acetate for 3 months at the Gülhane Military Medicine Academy of Ankara, Turkey. Patients were controlled at biweekly periods. Results There were 59 patients in the single dose arm (group 1) and 60 patients in the twice a day dose arm (group 2). The mean percentages of weight loss were 16.9% and 16.7% in group 1 and 2, respectively. In the first and the second month of weight gain, there were no significant differences in the two groups (P = 0.23 and P = 0.11). In the third month, weight gain was significantly higher in group 2 than in group 1 (P = 0.038). Toxicity was similar for both dose levels. Conclusions Megestrol acetate can be safely and effectively given to patients with advanced non-small cell lung cancer. Although lower doses of megestrol acetate can be effective for anorexia and cachexia, the higher dose level seems to be more efficient.

Retrospective analysis of 74 cases of seminoma treated with radiotherapy

Background:  Standard post‐orchiectomy radiotherapy (RT) is accepted as a standard management option for stage I seminoma.

Unresectable huge sternal and mediastinal metastasis of follicular thyroid carcinoma; radiotherapy as first-line and palliative therapy.

Distant metastases as initial manifestation of follicular thyroid carcinoma is rare. We report a case of an unusual initial presentation of follicular thyroid carcinoma on follow-up. A 52- year-old woman presented with a 12-month history of progressively enlarging mass in the anterior chest wall. The mass was fixed to the chest wall, measuring 12 x 10 cm in diameter. Computed tomography demonstrated a lobulated soft-tissue mass (17 x 11 x 6 cm) destructing sternum and extending into the anterior mediastinum. There was no lung metastasis. Invasion of tumor to the ascending aorta, superior vena cava, and right atrium could not be excluded. Multiple lymph nodes were observed in the supraclavicular regions. Ultrasonography of the thyroid gland showed 46 x 37 mm nodule in the left lobe with milimetric gross calcifications and cystic-necrotic areas. Hyperthyroidism was detected. Biopsy from this nodule and the sternal mass revealed typical histology of follicular carcinoma. She was considered inoperable. Since there was huge tumor burden and iodinated contrast exposure for several times during evaluation, we decided to treat the patient with external beam radiotherapy (EBRT) rather than radioiodine as first-line therapy. After a course of conventional radiation with 50 Gy in 25 fractions over 4 weeks, encompassing the thyroid bed and the gross disease, tumor regressed remarkably in 6 months. In conclusion, when surgical resection is not possible, EBRT may be used for palliative purpose to obtain local control for extensive disease as first-line therapy. The indications of EBRT for differentiated thyroid cancer still remain poorly defined.

Meme Kanserli 640 Hastada Hormon Reseptör Durumu ve C-erbB-2 Düzeyi ile Tedavi Sonuçları Arası İlişki

Amac: Calismada meme kanseri seyrini etkileyebilen hormon reseptor durumu ve c-erbB-2 duzeylerinin tedavi sonuclari uzerine olan etkileri saptanmaya calisilmistir. Yontemler: Kuratif amacla tedavi uygulanan 640 meme kanserli hastada genel ve hastaliksiz sag kalim verileri incelenmistir. Ortalama takip 59,1 ay’dir. Hastalarda SPSS 16.0 versiyonunda Kaplan-Meier yontemiyle genel ve hastaliksiz sag kalim oranlari, LogRank testi ile prognostik faktorlerin etkileri degerlendirilmistir. Bulgular: ER (+) ve (-) olgularda sirasiyla bes yillik genel sag kalim oranlari %85,7, %71,2 (p<0,001), hastaliksiz sag kalim oranlari %79,9, %63,7 (p<0,001); PR (+) ve (-) hastalarda sirasiyla bes yillik genel sag kalim oranlari %85,6, %71,6 (p<0,001), hastaliksiz sag kalim oranlari %79,6, %64,3 (p<0,001) olarak bulunmustur. ER ve PR pozitifliginin genel ve hastaliksiz sag kalimi anlamli derecede arttirdiklari saptanmistir. C-erbB-2 asiri saliniminda, negatiflere gore sirasiyla bes yillik genel sag kalimda %76,4, %85,3 (p=0,002), hastaliksiz sag kalimda %69,7, %79,1’lik (p=0,012) oranlar elde edilmistir. En kotu prognostik grubun ER (-), PR (-), c-erbB-2 (+) hastalar oldugu gosterilmistir. Sonuc: ER, PR ve c-erbB-2 duzeylerinin meme kanserinde buyuk onem arz ettigi gosterilmis ve hasta takiplerinde dikkat edilmesi gereken faktorler oldugu belirtilmistir.

Can radiotherapy be a treatment option for elderly women with invasive vulvar carcinoma without radical surgery

PURPOSE OF THE INVESTIGATION To evaluate the impact of radiotherapy after limited surgery in vulvar carcinoma. METHODS Between March 1980 and January 2000, 22 patients older than 60 years and suffering from invasive vulvar carcinoma were treated with limited surgery and radiotherapy at Gülhane Military Medicine Academy. These are the subjects of this review. RESULTS The median age of the patients was 67 (range 60 to 78 years). Median follow-up was 35 months (range 12 to 60 months). Local recurrence rate was 18%. Median time to local failure was 12 months (range 8 to 14 months). Two patients with local failure also developed lung metastases. Five-year survival rate was 60% and cause-specific survival rate was 69%. No treatment delay or death related to treatment was observed. CONCLUSIONS Radiotherapy and conservative surgery can be an alternative to radical surgery with less morbidity in elderly patients.

Increasing the target number of nucleated cells and administration of r-metHuG-CSF expedite neutrophil engraftment in allogeneic bone marrow transplantation.

SINCE 1960, allogeneic bone marrow transplantation (AlloBMT) has been instituted to treat various malignant or nonmalignant disorders. However, AlloBMT has being increasingly replaced by allogeneic peripheral blood stem cell transplantation (AlloPBSCT) over the past 10 years. As Gratwohl and colleagues reported, AlloPBSCT accounted for 30% of whole allogeneic hematopoietic stem cell transplantations (AlloHSCT) performed in European countries in 1997, whereas all AlloHSCT were bone marrow derived in 1991. Faster neutrophil and platelet engraftment and no risk of general anesthesia for donors seems to be the major reasons for this trend. To obtain faster neutrophil engraftment, and reduce morbidity from infections in the allogeneic bone marrow setting, and because of the relatively prolonged neutropenia compared to AlloPBSCT, G-CSF or GM-CSF have been successfully employed. However, the hematologic recovery provided by AlloBMT has always remained slower than that provided by AlloPBSCT. Lower infectious complications, rapid immunologic recovery, shorter hospitalization stay, and lower cost appear as other advantages of AlloPBSCT. Despite these advantages, AlloPBSCT has certain drawbacks. One of the most serious complication is the concern that AlloPBSCT is associated with an increased incidence and severity of chronic graft-versus-host disease (GVHD) as compared to AlloBMT. Furthermore, whether chronic GVHD decreases relapse rate due to graft-versus-leukemia (GVL) effect in patients undergoing AlloPBSCT remains to be determined. Standards for AlloBMT or AlloPBSCT have not yet been optimized. Therefore, some centers have sought to combine both modalities by giving bone marrow and peripheral blood stem cells. In this report, the results of patients undergoing AlloBMT in which the targeted nucleated cell count was 3 10/kg and in which r-metHuG-CSF was administered after the transplantation are presented. Of interest, our patients had fast neutrophil engraftment, low infectious complications, and an acceptable relapse rate, which are comparable to those in AlloPBSCT as reported in the literature. Chronic GVHD rate seems to be less than that in AlloPBSCT.