Yurday Ozdemir

Chemoradiotherapy-Induced Hemoglobin Nadir Values and Survival in Patients with Stage III Non-Small Cell Lung Cancer

PURPOSE We investigated the influence of change in hemoglobin (Hgb) levels during concurrent chemoradiotherapy (C-CRT) on outcomes of non-anemic patients with stage IIIA/B non-small cell lung cancer (NSCLC). METHODS We identified 722 patients with stage IIIA/B NSCLC without anemia at baseline [hemoglobin (Hgb) <12 g/dL for women or <13 g/dL for men], either nonsmokers or ex-smokers, who received C-CRT between 2007 and 2012. All patients had received 1-3 cycles of platinum-based doublet chemotherapy during radiotherapy to 60-66 Gy and had documented Hgb measurements before treatment and at weekly intervals for 6 weeks during the C-CRT. Potential associations were assessed between baseline, nadir, extent of change in Hgb level, and anemia and overall survival (OS), locoregional progression-free survival (LRPFS), and PFS. RESULTS The median baseline Hgb level was 13.9 g/dL (range 12.0-16.8) and declined to a median 12.4 g/dL (range 7.9-16.1) during treatment. Anemia appeared in 237 patients (32.8%) and was more common among women (44.8% vs. 26.5%, P < 0.001). Neither baseline Hgb level nor change during treatment nor anemia emergence influenced any survival endpoint. Receiver operating curve analysis revealed an Hgb nadir of 11.1 g/dL to be associated with outcomes, in that a nadir Hgb <11.1 g/dL (in 156 patients) was linked with shorter median OS time (P < 0.001), LRPFS time (P < 0.001), and PFS time (P < 0.001); retained significance for all three endpoints in multivariate analyses; and was more strongly associated with OS in squamous cell carcinoma (P < 0.001) than in adenocarcinoma (P = 0.009). CONCLUSION Nadir Hgb <11.1 g/dL levels during C-CRT were associated with significantly poorer survival times in initially non-anemic patients presenting with locally advanced NSCLC.

Adjuvant uzatılmış temozolamid tedavisinin glioblastoma multiforme hastalarının sağkalımına etkisi

Amac: Retrospektif bu calismanin amaci cerrahi/biyopsi ile glioblastoma multiforme tanisi almis, kemoradyoterapi uygulanmis hastalarda uzatilmis temozolamid kullaniminin genel ve progresyonsuz sagkalim etkisini arastirmak olarak belirlendi. Gerec ve Yontem: Klinigimize basvuran cerrahi/biyopsi ile glioblastoma multiforme tanisi almis 225 hastadan, temozolamid ile birlikte radyoterapi tedavisi uygulandiktan sonra, ≤6 ay ve >6 ay sureyle adjuvan temozolamid kemoterapisi uygulanmis 116 hastatedavi toleransi, genel ve progresyonsuz sagkalimlari arasindaki farklar retrospektif olarak incelendi. Bulgular: Hastalarin ortalama takip suresi 18 ay (2-125 ay) olarak belirlenirken, 65(%56) hasta halen hayattadir. Uzatilmis temozolamid (>6 ay) olan grupta genel sagkalim daha uzun tespit edilirken istatistiksel bir fark tek degiskenli analizde tespit edilememistir sirasiyla 49.0 (≤6)vs 68.33 ay(>6). Ancak progresyonsuz sagkalim suresi uzatilmis temozolamid grubunda standart temozolamid alan gruba gore istatistiksel olarak anlamli oranda uzun saptanmistir 14 (>6)vs 9 ay(≤6). Gruplar arasinda anlamli bir yan etki farkliligi gorulmemistir. Sonuc: Calismamizda glioblastoma multiforme tanisi almis hastalarda uzatilmis temozolamid kullanimi hastalarin progresyonsuz sagkalim ve genel sagkalimlarinin belirgin oranda artmasina neden olur.

Effects of vaginal cylinder position on dose distribution in patients with endometrial carcinoma in treatment of vaginal cuff brachytherapy

Purpose To investigate the impact of different cylinder positions on dosimetry of critical structures in patients with endometrial carcinoma undergoing three-dimensional image-based vaginal cuff brachytherapy (VCB). Material and methods We delivered VCB at a dose of 4 Gy to a depth of 5 mm in the vaginal cuff of 15 patients using three different cylinder positions (neutral [N], parallel [P], and angled [A]) according to the longitudinal axis of the patient. We analyzed the dose-volume distribution and volumetric variability of the rectum and bladder. We converted the total doses to equivalent doses in 2 Gy (EQD2) using a linear-quadratic model (a/b = 3 Gy). Results The mean rectum volume for the N, P, and A positions was 68.2 ± 22.7 cc, 79.3 ± 33.7 cc, and 74.2 ± 29.6 cc, respectively. The mean rectum volume for the P position was significantly larger than that for the N position (p = 0.03). Relative to the N position, the A position resulted in a lower total EQD2 in the highest irradiated 2 cc (D2cc; p = 0.001), 1 cc (D1cc; p = 0.004), and 0.1 cc (D0.1cc; p = 0.047) of the rectum. Similarly, the P position resulted in a lower EQD2 in the D2cc (p = 0.018) and D1cc (p = 0.024) of the rectum relative to the N position. In the bladder, the P position resulted in a higher EQD2 in the D2cc relative to the N position (p = 0.02). There was no dosimetric difference between the P and A positions in either the rectum or the bladder. Conclusions Vaginal cuff brachytherapy in the P and A positions is significantly superior to that in the N position in terms of rectum dosimetry. The bladder dose in the N position is considerably lower than that in the other positions.

Stereotactic Cranial Radiosurgery for Metastatic Non-small-cell Lung Carcinoma

Brain metastasis (BM) is either present at the initial presentation or emerges somewhere during the treatment course in up to 64 % patients. Therapeutic strategies of BM include chemotherapy, neurosurgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), or different combinations of them. In general, the priority of the single- or combination-treatment modality is usually decided in view of the information about the patient’s performance status, extracranial disease status, number, size, total volume, and localization of the BM. Based on the comparative phase III trials, with its high-precision capability in delivery of large doses of RT in a single session, SRS appears to be a noninvasive alternative to neurosurgery for single BM. Similarly, available data suggests almost equal effectiveness of SRS in ≤3 versus >3 BM situations. Therefore, in lack of any documented evidence suggesting inefficacy of SRS in patients with >3 BM, it is reasonable to offer SRS for suitable patients with larger BM. Tumor bed SRS (TB-SRS) is a relatively new treatment approach with no randomized data published to date. Available literature on use of TB-SRS is encouraging, but much is still unknown about the required doses and optimal margins, which underlines the need for appropriately designed future studies on this highly specific issue. Clinically, SRS alone results in better neurocognitive functions compared to WBRT and is equivalent to neurosurgery with no overall survival differences compared to these treatment options. Therefore, SRS alone can be safely utilized in particular patients with close follow-ups for distant brain recurrences. Technically, SRS can be performed in various ways by using Gamma Knife or high-capacity novel linear accelerators. Absolutely some technical differences exist among diverse SRS hardware and related treatment planning systems with associated pros and cons, but available comparative outcomes do not suggest any differences in clinical outcomes including the tumor control and survival rates, as long as the fundamental tenets of SRS are pursued.