Browsing by Author "Erbay, Gurcan"

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Abdominal CT Findings in Patients with Primary Lymphoma Causing Small Bowel Obstruction
(2017) Karadeli, Elif; Erbay, Gurcan; Parlakgumus, Alper; Yabanoglu, Hakan; 0000-0002-0352-8818; 0000-0002-1706-8680; 0000-0002-1161-3369; 29132484; AAK-5399-2021; AAK-5370-2021; AAJ-7865-2021
The purpose of this study was to investigate retrospectively CT findings in patients with primary lymphoma causing small bowel obstruction. CT scans of 11 patients with small bowel lymphoma were separately analysed in terms of affected section of the small bowel, focality, wall thickness, pattern and degree of contrast enhancement, lymphadenopathy, organ involvement, perforation, and the presence of intraabdominal fluid. Eight patients had diffuse large B-cell lymphoma, and one patient each had marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT), T-cell lymphoma, and anaplastic T-cell lymphoma. Affected sections of the bowels involved were jejunum (n=5, 45.4%), ileum (n=2, 18.1%), and one case (9%) each of distal ileum, distal jejunum, distal jejunum and ileum, and distal jejunum and colon. Primary gastrointestinal (GI) lymphoma is an uncommon disease, that may lead to small bowel obstruction sometimes.
Bilateral renal leiomyoma with 5 year follow-up: Case report
(2015) Goren, Mehmet Resit; Erbay, Gurcan; Ozer, Cevahir; Goren, Vinil; Bal, Nebil; 26664510
Renal leiomyomas are exceptionally rare benign tumours of the kidney. Although the renal leiomyomas usually do not metastasize, the differential diagnosis between renal leiomyomas and malign lesions (leiomyosarcoma or renal cell carcinoma) cannot be done by radiological examinations, but is possible by histological examination. Surgery is the preferred treatment. After surgery, the prognosis is excellent without recurrence. Although uterine leiomyomas can be multicentric, renal leiomyomas have been single lesions. We report an incidentally detected case of bilateral renal leiomyoma in a 50-year-old woman with a 5-year follow-up. We also review the literature and discuss clinical, radiological and histological features of renal leiomyomas.
Can We Predict the Outcome of Varicocelectomy Based on the Duration of Venous Reflux?
(2016) Goren, Mehmet Resit; Erbay, Gurcan; Ozer, Cevahir; Kayra, Mehmet Vehbi; Hasirci, Eray; https://orcid.org/0000-0002-2001-1386; https://orcid.org/0000-0002-1706-8680; https://orcid.org/0000-0001-6037-7991; https://orcid.org/0000-0002-7349-9952; https://orcid.org/0000-0002-4147-2966; 000373464600021; Y-6143-2019; AAK-5370-2021; AAK-8372-2021; AAI-7997-2021
OBJECTIVE To investigate the outcome of varicocelectomy based on the duration of venous reflux (DVR) of the pampiniform plexus veins. MATERIALS AND METHODS In total, 138 patients with clinically palpable varicoceles were evaluated for DVR with color Doppler ultrasonography from May 2009 to August 2014. The DVR was defined as the DVR of a varicocele in the supine position during the Valsalva maneuver. Patients with bilateral, recurrent, or subclinical varicoceles; hormonal imbalances involving follicle-stimulating hormone, luteinizing hormone, or total testosterone; azoospermia; and intraoperative or postoperative complications were excluded. Of the 138 patients, 76 met the inclusion criteria. All patients were treated with subinguinal microscopic varicocelectomy. Restoration of all three semen parameters (concentration, motility, and morphology) to normal values 6 months postoperatively was considered to indicate treatment success. The patients were divided into those with a DVR of <4.5 seconds (Group 1) and >= 4.5 seconds (Group 2). RESULTS The mean age of the patients was 29.39 (+/- 6.03) years. No statistically significant relationship was found between the success rate and varicocele grade. The cutoff DVR value was calculated as 4.5 seconds using a receiver operating characteristics curve according to patients who underwent successful treatment. The success rates of Groups 1 and 2 were 40.0% and 88.2%, respectively (P = .0001). CONCLUSION The results of this analysis indicate that a DVR of >= 4.5 seconds predicts better outcomes of varicocelectomy. (C) 2016 Elsevier Inc.
Clinical characteristics of relapsed ovarian cancer patients with striking response to the bevacizumab at first relapse
(2020) Kose, Fatih; Alemdaroglu, Songul; Mertsoylu, Huseyin; Besen, Ali Ayberk; Guler, Ozan Cem; Simsek, Seda Yuksel; Erbay, Gurcan; Onal, Cem; Celik, Husnu; 0000-0002-2742-9021; 0000-0003-4335-6659; 0000-0001-6908-3412; 0000-0002-0156-5973; 0000-0002-7862-0192; 0000-0002-1932-9784; D-5195-2014; AAI-8400-2021; AAC-5654-2020; G-4827-2016; AAD-6910-2021; M-9530-2014
Background: Ovarian cancer is fifth leading cause of the cancer related death in women. Platin based doublet regimen plus bevacizumab is standard treatment in relapse. The primary aim of this study is to define clinicopathological characteristics of the relapsed ovarian cancer who derived unexpectedly long benefit from bevacizumab treatment. Methods: Total number of 106 patients with relapsed ovarian cancer and treated with bevacizumab (bevacizumab is not reimbursed as a part of adjuvant treatment in Turkey) on their first relapse were included. For the purpose of the study, the patients were placed into two groups, Group A and B, selected on the basis of the rate of PFS 1 (time between first day of adjuvant chemotherapy and first radiological progression) to PFS 2 (time between first day of second line treatment and second radiological progression). The patients included into Group A if PFS 1 greater than PFS 2 and Group B vice versa. Results: Group A and B were consisted of 67 (63%) and 39 (37%) patients. At a median follow-up of 32.1 months (5.3-110.8), 56 (52.8%) patients were died. Significant number of patients (78.4%) treated with primary surgery without neoadjuvant treatment and 59 (57.8%) out of the 102 patients had debulking surgery when their cancer relapsed. PFS 1 and 2 were estimated as 16.5 mo (14.1-18.9) vs. 13.7 mo (9.9-17.5) and 13.4 mo (8.0-18.6) vs. 29.7 mo (21.5-38.0) in group A and B, respectively (p < 0.001 and p < 0.001). Only parameter that show significant difference between groups was the rate of platin resistant patients; Group A: 13 (19.4%) out of 67 patients vs. Group B: 15 (38.6%) out of 39 patients with ap value of 0.041. Binary logistic regression indicates PFS1 is significant inverse predictor (shorter PFS-1 means greater chance of being in group B) of entering Group B [Chi-Square = 16.5, df = 6 and p = 0.011 (< 0.05)]. PFS1 is significant at the 5% level [ PFS1 wald = 4.33,p = 0.038 (p < 0.05)]. In multivariate analysis, cox-regression proportional hazard, cytoreductive surgery at second relapse (yes or no) (p: 0.028; HR: 0.3, 0.02-0.7, 95% CI) showed significant effect on PFS-2. On the other hand, platin resistance (< 6 mos; yes or no) (p: 0.04; HR: 4.0, 1.1-14.4, 95% CI) and secondary surgery outcome (no visible vs. visible) (p: 0.003; HR: 0.2, 0.07-0.58, 95% CI) showed significant effect on OS. Bevacizumab related adverse effects with greater than grad 3 detected in 13 (15%) and 10 (25%) in group A and B (p: 0.77). Conclusions: Our findings indicate that bevacizumab produced strikingly high PFS (over 24 months) in significant portion of relapsed ovarian cancer patients whom were mostly platin resistant cases with short PFS-1. This gain specifically achieved in patients who had aggressive secondary surgery with no-visible surgical outcome.
The clinical outcomes of ovarian cancer in patients with brain metastasis
(2021) Simsek, Seda Yuksel; Guler, Ozan Cem; Durdag, Gulsen Dogan; Sari, Sezin Yuce; Gultekin, Melis; Yildiz, Ferah; Celik, Husnu; Erbay, Gurcan; Onal, Huseyin Cem; 0000-0003-3191-9776; AAK-7016-2021
Objective: To present the clinical characteristics and treatment outcomes of patients with ovarian cancer with brain metastasis. Methods: This study was designed as a retrospective observational study. Patients' data were obtained from hospital records. Patients who were diagnosed with brain metastatic ovarian cancer in two tertiary referral centers between 2012 and 2020 were included in the study. Results: In total, there were 56 patients diagnosed as having brain metastatic ovarian cancer. The median age was 56 years, 91% of patients were at an advanced stage at initial diagnosis. The median time from the initial diagnosis to brain metastasis was 34.0 months. Sixty-seven percent of patients were determined as having multiple brain metastatic lesions. Whole brain radiotherapy (WBRT) , stereotactic radiosurgery (SRS) and combined approach were utilized as primary treatment. The 1 and 2-year survival rates were 38% and 17%, respectively. Patient age and tumor histology were found to be significant prognostic factors that impact the survival in univariate analyses. The 1-year survival of patients aged younger than 55 years was 49.2%, and 28.2% for patients aged over 55 years (p = 0.04). Patients with nonserous histology had significantly longer one year overall survival compared to serous histology (61.4% vs 29.8%) (p= 0.01). Conclusion: The brain is one of the rarest locations for ovarian cancer metastasis. Radiotherapeutic approaches are the mainstay of treatment but survival rates are low. Age and tumor histology were determined as significant parameters that affected survival rates.
Correlation of Clinical Risk Factors with Diffusion-Weighted Magnetic Resonance Images in Prostate Cancer Patients Treated with Definitive Radiotherapy
(2015) Erbay, Gurcan; Onal, Cem; Guler, Ozan C.; Karadeli, Elif; Koc, Zafer
This study is aimed to correlate apparent diffusion coefficient (ADC) values and clinical T-stage, serum PSA, pathology Gleason scores. We also further analyzed whether ADC values could be used to appropriately define the risk groups. 135 biopsy-proven, radiotherapy-(RT)-treated, prostate cancer patients who underwent pre-RT DW-MRI and standard T2W pelvic MRI were included. ADC and normalized ADC (nADC) values were calculated from DW-MRI delivered a median 8.1 weeks after prostate biopsy. ADC values were correlated with clinical risk factor values by using Pearson correlation test. ADCs in low-, intermediate-, and high-risk patients were 0.873 +/- 0.122X10(-3) mm(2)/s, 0.763 +/- 0.124X10(-3) mm(2)/s, and 0.701 +/- 0.132X10(-3) mm(2)/s (p = 0.001), respectively. Patients with preRT PSA <10 ng/mL had significantly higher ADCs than patients with preRT PSA 10-20 ng/mL (p = 0.02) or >20 ng/mL (p < 0.001). Mean ADC for patients with Gleason score <7 was significantly higher than patients scoring 7 (p = 0.001) or >7 (p < 0.001). Clinical stage
CT findings of Intramural Small Bowel Hematoma Secondary to use of Oral Anticoagulant Therapy
(2016) Karadeli, Elif; Tok, Sermin; Erbay, Gurcan
Cystic lymphangioma of the ascending colon and cecum
(2018) Karadeli, Elif; Erbay, Gurcan
Half-dose bevacizumab experience in relapsed ovarian cancer patients in Turkey due to formal regulations: similar effectiveness with lower rate of hypertension
(2020) Kose, Fatih; Alemdaroglu, Songul; Mertsoylu, Huseyin; Besen, Ali Ayberk; Guler, Ozan Cem; Simsek, Seda Yuksel; Erbay, Gurcan; Onal, Cem; Celik, Husnu; 0000-0003-4335-6659; 0000-0002-2742-9021; 0000-0001-6908-3412; 0000-0002-1706-8680; 0000-0002-0156-5973; 0000-0002-7862-0192; 0000-0002-1932-9784; 33099934; AAI-8400-2021; D-5195-2014; AAC-5654-2020; AAK-5370-2021; G-4827-2016; AAK-7016-2021; AAD-6910-2021; M-9530-2014
Purpose: Ovarian cancer is the fifth leading cause of cancer related death in women. Platin-based doublet regimens plus bevacizumab is standard treatment in relapse. Due to formal regulation of Turkish Ministry of Health, adjuvant bevacizumab has not been reimbursed and clinicians can use bevacizumab at a dose of 7.5 mg/kg/3wk in platin-resistant and sensitive relapse settings. The primary aim of this study was to evaluate 7.5 mg/kg/3wk bevacizumab dosing in platin-resistant and sensitive relapse ovarian cancer and compare these findings with the current literature. Methods: A total of 106 patients with relapsed ovarian cancer and treated with bevacizumab (bevacizumab is not reimbursed as a part of adjuvant treatment in Turkey) on their first relapse were included. Results: At a median follow-up of 32.1 months (5.3-110.8), 56 (52.8%) patients died. Progression-free survival (PFS) and overall survival (OS) were estimated at 18.8 months (14.4-23.3) vs 29.7 months (24.3-35.1) of the whole group overall survival. We observed that 78.4% of patients treated with primary surgery without neoadjuvant treatment and 59 (57.8%) out of the 102 patients with debulking surgery relapsed. A significant number of patients (81%) treated with primary surgery without neoadjuvant treatment and 59 (76.6 %) had secondary debulking surgery at relapse. In relapse, 38 patients were treated with single agent liposomal doxorubicin (LPD) plus bevacizumab. On the other hand, 68 patients were treated with carboplatin and LPD plus bevacizumab. Multivariate analysis failed to show any clinicopathological characteristics with significant effect on PFS. However, cytoreductive surgery at relapse showed significant effect on OS. Bevacizumab-related toxicities were detected in 23 (21.7%) patients; hypertension, pulmonary embolism, perforation, and other toxicities (nephrotic syndrome in 2, osteonecrosis in 2, cerebrovascular and cardiac ischemia in 3 patients) were seen in 12 (11.3%), 3 (2.8%), 1 (0.9%) and 7 (6.6%) patients, respectively. Conclusions: In conclusion, our findings showed that 7.5 mg/ kg/3week dosing of bevacizumab in relapsed ovarian cancer could have similar effectiveness compared to standard 15 mg/ kg/3week dosing. Increase of OS and PFS in patients treated with primary and secondary debulking surgery with no-visible disease was more pronounced. No new safety information was observed but lower rate of grade 3 or above hypertension with similar rate of severe vascular and intestinal complications were detected.
Internal Comparison Standard for Abdominal Diffusion-Weighted Imaging
(2017) Koc, Zafer; Erbay, Gurcan; Karadeli, Elif; 0000-0002-1706-8680; 0000-0002-0352-8818; 0000-0003-0987-1980; 27956463; AAK-5370-2021; AAK-5399-2021; S-8384-2016
Background: Standards for abdominal diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) measurements, and analysis are required for reproducibility. Purpose: To identify optimal internal comparison standards for DWI to normalize the measured ADC for increased accuracy of differentiating malignant and benign abdominal lesions. Material and Methods: We retrospectively studied 97 lesions (89 patients; age, 57 +/- 13 years) with histopathologically confirmed abdominal disease. Seven normal body parts/contents (normal parenchyma, spleen, kidney, gallbladder bile, paraspinal muscle, spinal cord, and cerebrospinal fluid [CSF]) were assessed as internal references for possible use as comparison standards. Three observers performed ADC measurements. Statistical analyses included interclass correlation coefficients (ICCs), Mann-Whitney and Kruskal-Wallis tests, and coefficient of variation (CV). ROC analyses were performed to assess diagnostic accuracy of lesion ADC and normalized ADC for differentiating lesions. Pathology results were the reference standard. Results: Mean and normalized ADCs were significantly lower for malignant lesions than for benign lesions (P< 0.001). ICC was excellent for all internal references. Gallbladder had the lowest CV. Receiver operating characteristic (ROC) analyses showed that normalized ADCs obtained using normal parenchyma were better than lesion ADCs for differentiating malignant and benign abdominal lesions (area under the curve [AUC], 0.808 and 0.756, respectively). The normalized ADCs obtained using CSF shows higher accuracy than lesion ADCs (0.80 and 0.76, respectively) for differentiating between malignant and benign abdominal lesions. Conclusion: The normal parenchyma from a lesion-detected organ can be used as an internal comparison standard for DWI. CSF can be used as a generalizable in plane reference standard.
Late pancreatic metastasis of renal cell carcinoma with absence of FDG-uptake in PET-CT
(2016) Karadeli, Elif; Tok, Sermin; Erbay, Gurcan; Reyhan, Mehmet; 0000-0002-1706-8680; 0000-0002-0352-8818; 0000-0001-8550-3368; AAK-5370-2021; AAK-5399-2021; AAJ-5242-2021
The primary tumors, which raise isolated pancreas metastases are frequently of renal origin, where colorectal cancer, melanoma, breast and lung cancers and sarcoma are the following causes of metastatic pancreas cancer. In this article, we present a case of pancreas-metastatic renal cell carcinoma with its radiological features, which did not exert anF-18 FDG-uptake in the whole-body positron emission tomography (PET).
Leiomyomatosis Peritonealis Disseminata Mimicking Peritoneal Carcinomatosis
(2022) Erbay, Gurcan; Yalcin, Cigdem
MRI Findings of Borderline Retroperitoneal Serous Cystadenocarcinoma
(2019) Erbay, Gurcan; Karadeli, Elif; Parlakgumus, Alper; 30823957
Retroperitoneal serous cystadenocarcinoma is an extremely uncommon lesion. Here, we present MR imaging findings of a 40-year woman who was admitted to the hospital due to abdominal pain. The patient was evaluated with abdominal Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Abdominal CT revealed a 13x18 cm large retroperitoneal and cystic mass with polypoid projections. MRI was superior than CT in showing polypoid projections. Contrast enhanced MRI detected enhancement of thin septations and cyst appearance inner the cyst. Diffusion-weighted MRI showed restricted diffusion in the polypoid component with contrast enhancement. Therefore, we thought malignant lesion. The findings of contrast-enhanced CT and MRI were helpful in the diagnosis of those lesions. In addition, diffusion weighted MRI with multi parametric modalities played unlimited role in the assesment of the differential diagnosis.
On Visualization and Quantification of Lesion Margin in CT Liver Images
(2020) Arica, Sami; Altuntas, Tugce Sena; Erbay, Gurcan; 0000-0002-1706-8680; AAK-5370-2021
Cancer is the one of the leading causes of death worldwide, and cancer incidence increases every year. The analysis of lesion margin is quite important to diagnose malignant and benign masses and to detect the presence and the stage of tumor invasion in case of cancer. Accordingly, the aim of the study is to visualize and quantify margin of lesions on radiological images by means of a digital computer. In this study, computed tomography (CT) images of liver have been employed for analysis because the liver has crucial tasks in our body and liver cancerrelated deaths is ranked as the forth among the cancer-related deaths. The proposed method consisted of four main steps: image cropping and smoothing, specification of target lesion, the boundary detection of target lesion, and visualization and quantification of margin. First, the images were converted to gray scale. The blank regions surrounding the liver in the CT images were removed before specification of target lesion, and further were smoothed with a bilateral filter. Next, the target region was specified roughly by drawing it manually. The boundary of lesion was more precisely determined with the active contour method employing the sketched borderline as the initial curve. Next, the properties of the target region: the centroid, major axis length, and the orientation values were computed. The intensities along a line passing through the center of the tumor were obtained for eighteen different rotation angles. A pulse model was fit to each of the intensity signal corresponding to a rotation. Then, the intensity change, margin sharpness and width were acquired from the pulse approximation associated to each rotation angle. The level difference provided the intensity change, the slope of edges gave the margin sharpness, and distance between the start and end points of the pulse edge represented margin width. Besides, the inner (core) and outer diameter with respect to angle were also displayed.
Optimal b Value in Diffusion-Weighted Imaging for Differentiation of Abdominal Lesions
(2014) Koc, Zafer; Erbay, Gurcan; https://orcid.org/0000-0003-0987-1980; https://orcid.org/0000-0002-1706-8680; 24115207; S-8384-2016; AAK-5370-2021
Purpose: To explore the optimal b value in diffusion-weighted imaging (DWI) for differentiation of benign and malignant abdominal lesions. Materials and Methods: A total of 108 consecutive patients (age 60 +/- 12.5 years) with 127 pathologically confirmed diagnoses of abdominal lesions were included. Single-shot echoplanar imaging (SH-EPI) DWI (1.5T) with seven b values and eight apparent diffusion coefficient (ADC) maps were obtained. The lesions were analyzed visually on DWI and ADC maps for benignity/malignity using a 5-point scale and by measuring the ADC values and ADC lesion/normal parenchyma ADC ratio. ROC analysis was used to evaluate the diagnostic accuracy of ADC for differentiating between benign and malignant lesions. Pathology results were the reference standard. Results: Differentiation between malignant and benign lesions using visual scoring was successful at b values of 600 or higher (sensitivities, specificities, and accuracies were 100/93.8/92.5, 84.7/82.6/80.4, and 94.4/89.7/88.1, respectively, for b600, 800, and 1000). The mean ADC values of malignant lesions were significantly lower than those of benign lesions for all b-value combinations except b0 and 50 s/mm(2) (P = 0.032 for b0 and 50 s/mm(2), P = 0.000 for other b values). The best b-value combination was 0 and 600 s/mm(2) and multiple b2. The lesion/normal parenchymal ADC ratio for b600, b1000, and multiple b2 better distinguished between benign and malignant lesions. Conclusion: In DWI, the optimal b value is 600 s/mm(2); multiple b values of 600 s/mm(2) and higher are recommended to differentiate between benign and malignant abdominal lesions. The lesion ADC/normal parenchyma ADC ratio is more accurate than using lesion ADC only.
Perforation without manifestations of acute abdomen after ERCP
(2016) Karadeli, Elif; Tok, Sermin; Erbay, Gurcan; 0000-0002-0352-8818; 0000-0002-1706-8680; AAK-5399-2021; AAK-5370-2021
Perforations are rare after endoscopic retrograde cholangiography (ERCP) but they are serious complications. Perforations may occur due to patient-related factors or procedural technique. The mortality rate is higher than 37.5%. We are presenting a patient with perforation detected on a computed tomography (CT) scan after ERCP for obstructive jaundice that was treated conservatively. Perforation after ERCP can be operated or treated conservatively according to the patient's condition.
A Plain Segmentation Algorithm Utilizing Region Growing Technique for Automatic Partitioning of Computed Tomography Liver Images
(2018) Arica, Sami; Avsar, Tugce Sena; Erbay, Gurcan; 0000-0002-1706-8680; AAK-5370-2021
Medical image segmentation is quite significant, especially for diagnosis and treatment of diseases. In this study, similar and different tissues in computed tomography (CT) images of liver are decomposed by utilizing region growing method. The images are preprocessed before segmentation. First, gray scale CT images are smoothed with a median filter, and a coarse segmentation is done with four level uniform quantization. A pixel from each connected component of the quantized image is selected as a seed point and is employed by region growing algorithm to specify corresponding segment. The number of segments depends on the number of connected components. Experimental results show that this basic method has successfully segmented the liver.
Predicting Tumor Recurrence in Patients with Cervical Carcinoma Treated with Definitive Chemoradiotherapy: Value Of Quantitative Histogram Analysis On Diffusion-Weighted MR Images
(2017) Erbay, Gurcan; Onal, Cem; Karadeli, Elif; Guler, Ozan C.; Arica, Sami; Koc, Zafer; https://orcid.org/0000-0002-1706-8680; https://orcid.org/0000-0002-0352-8818; https://orcid.org/0000-0001-6908-3412; https://orcid.org/0000-0003-0987-1980; 27445314; AAK-5370-2021; HOC-5611-2023; AAK-5399-2021; AAC-5654-2020; S-8384-2016
Background: Further research is required for evaluating the use of ADC histogram analysis in more advanced stages of cervical cancer treated with definitive chemoradiotherapy (CRT). Purpose: To investigate the utility of apparent diffusion coefficient (ADC) histogram derived from diffusion-weighted magnetic resonance images in cervical cancer patients treated with definitive CRT. Material and Methods: The clinical and radiological data of 50 patients with histologically proven cervical squamous cell carcinoma treated with definitive CRT were retrospectively analyzed. The impact of clinicopathological factors and ADC histogram parameters on prognostic factors and treatment outcomes was assessed. Results: The mean and median ADC values for the cohort were 1.043 +/- 0.135 x 10(-3) mm(2)/s and 1.018 x 10(-3) mm(2)/s (range, 0.787-1.443 x 10(-3) mm(2)/s). The mean ADC was significantly lower for patients with advanced stage (>= IIB) or lymph node metastasis compared with patients with stage < IIB or no lymph node metastasis. The mean ADC, 75th percentile ADC (ADC75), 90th percentile ADC (ADC90), and 95th percentile ADC (ADC95) were significantly lower in patients with tumor recurrence compared with patients without recurrence. In multivariate analysis, tumor size, ADC75 and ADC95 were independent prognostic factors for both overall survival and disease-free survival. Conclusion: ADC histogram parameters could be markers for disease recurrence and for predicting survival outcomes. ADC75, ADC90, and ADC95 of the primary tumor were significant predictors of disease recurrence in cervical cancer patients treated with definitive CRT.
The prognostic value of mean apparent diffusion coefficient measured with diffusion-weighted magnetic resonance image in patients with prostate cancer treated with definitive radiotherapy
(2022) Onal, Cem; Erbay, Gurcan; Guler, Ozan Cem; Oymak, Ezgi; 35753556
Purpose: To assess the correlation between initial tumor apparent diffusion coefficient (ADC) values and clinicopathological parameters in prostate cancer (PCa) patients treated with definitive radiotherapy (RT). Additionally, the prognostic factors for freedom from biochemical failure (FFBF) and progressionfree survival (PFS) in this patient cohort were analyzed. Materials and methods: The clinical data of 503 patients with biopsy-confirmed PCa were evaluated retrospectively. All patients had clearly evident tumors on diffusion-weighted magnetic resonance imaging (DW-MRI) for ADC values. Univariable and multivariable analyses were used to determine prognostic factors for FFBF and PFS. Results: The median follow-up was 72.9 months. The 5-year FFBF and PFS rates were 93.2% and 86.2%, respectively. Significantly lower ADC values were found in patients with a high PSA level; advanced clinical stage; higher ISUP score, and higher risk group than their counterparts. Receiver operating characteristic (ROC) curve analysis revealed an ADC cut-off value of 0.737 x 10-3 mm2/sec for tumor recurrence. Patients who progressed had a lower mean ADC value than those who did not (0.712 +/- 0.158 vs. 1.365 +/- 0. 227 x 10-3 mm2/sec; p < 0.001). There was a significant difference in 5-year FFBF (96.3% vs. 90%; p < 0.001) and PFS rates (83.8% vs. 73.5%; p = 0.002) between patients with higher and lower mean ADC values. The FFBF and PFS were found to be correlated with tumor ADC value and ISUP grades in multivariable analysis. Additionally, older age was found to be a significant predictor of worse PFS. Conclusions: Lower ADC values were found in patients with high-risk characteristics such as a high serum PSA level, stage or grade of tumor, or high-risk disease, implying that ADC values could be used to predict prognosis. Lower ADC values and higher ISUP grades were associated with an increased risk of BF and progression, implying that treatment intensification may be required in these patients. (c) 2022 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 173 (2022) 285-291
Prognostic values of ADC(mean) and SUVmax of the primary tumour in cervical cancer patients treated with definitive chemoradiotherapy
(2019) Yildirim, Berna Akkus; Onal, Cem; Erbay, Gurcan; Guler, Ozan Cem; Karadeli, Elif; Reyhan, Mehmet; Koc, Zafer; 0000-0002-2742-9021; 0000-0003-0987-1980; 30354907; D-5195-2014; S-8384-2016
We analysed the correlation of F-18-fluorodeoxyglucose uptake into primary tumours using the maximum standardised uptake value (SUVmax) and the mean apparent diffusion coefficient (ADC(mean)) values in magnetic resonance imaging (MRI) with the clinical and pathological factors in patients with cervical cancer who were treated with concurrent chemoradiotherapy. The patients were stratified according to the primary tumour pre-treatment ADC(mean) and SUVmax cut-off values. There were significant correlations between the SUVmax of the primary tumour and tumour size, and the treatment response. The correlation between the ADC(mean) and FIGO stage, tumour size, and the lymph node metastasis was significant. The SUVmax was significantly and inversely correlated with the ADC(mean) for cervical cancer (r = -0.44, p <.001). In the multivariate analysis, the primary tumour ADC(mean), treatment response and the lymph node metastasis emerged as significant independent predictors of both OS and DFS, and of the primary tumour SUVmax for DFS. Tumour size has a borderline significance for OS. High SUVmax and low ADC(mean) of the primary tumour are important predictive factors for identifying high-risk patients with cervical cancer who are treated with definitive chemoradiotherapy. These results point to a future role for the diffusion-weighted MRI and for F-18-fluorodeoxyglucose positron emission tomography, not only in the staging of cervical cancer but as an aid in the selection of an adjuvant treatment regimen after chemoradiotherapy for individual patients.