Browsing by Author "Ozyigit, Gokhan"

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Bone Only Oligometastatic Renal Cell Carcinoma Patients Treated with Stereotactic Body Radiotherapy: A Multi Institutional Study
(2022) Onal, Cem; Guler, Ozan Cem; Hurmuz, Pervin; Yavas, Guler; Tilki, Burak; Oymak, Ezgi; Yavas, Cagdas; Ozyigit, Gokhan; 0000-0002-2742-9021; 35695908; D-5195-2014
Purpose This study aimed to analyze the prognostic factors associated with overall survival (OS) and progression-free survival (PFS) in patients with bone-only metastatic renal cell carcinoma (RCC) who have five or fewer lesions treated with stereotactic body radiotherapy (SBRT). Methods The clinical data of 54 patients with 70 bone metastases undergoing SBRT treated between 2013 and 2020 with a dose of at least 5 Gy per fraction and a biologically effective dose (BED) of at least 90 Gy were retrospectively evaluated. Results The majority of lesions were located in the spine (57.4%) and had only one metastasis (64.8%). After a median follow-up of 22.4 months, the 1- and 2-year OS rates were 84.6% and 67.3%, respectively, and median OS was 43.1 months. The 1- and 2-year PFS rates and median PFS were 63.0%, 38.9%, and 15.3 months, respectively. In SBRT-treated lesions, the 1-year local control (LC) rate was 94.9%. Age, metastasis localization, and number of fractions of SBRT were significant prognostic factors for OS in univariate analysis. In multivariate analysis, patients with spinal metastasis had better OS compared to their counterparts, and patients who received single-fraction SBRT had better PFS than those who did not. No patient experienced acute or late toxicities of grade 3 or greater. Conclusion Despite excellent LC at the oligometastatic site treated with SBRT, disease progression was observed in nearly half of patients 13 months after metastasis-directed local therapy, particularly as distant disease progression other than the treated lesion, necessitating an effective systemic treatment to improve treatment outcomes.
Clinical parameters and nomograms for predicting lymph node metastasis detected with Ga-68-PSMA-PET/CT in prostate cancer patients candidate to definitive radiotherapy
(2021) Onal, Cem; Ozyigit, Gokhan; Oymak, Ezgi; Guler, Ozan Cem; Hurmuz, Pervin; Tilki, Burak; Reyhan, Mehmet; Tuncel, Murat; Akyol, Fadil; 0000-0002-2742-9021; 33949694; D-5195-2014
Background Defining the extent of disease spread with imaging modalities is crucial for therapeutic decision-making and definition of treatment. This study aimed to investigate whether clinical parameters and nomograms predict prostate-specific membrane antigen (PSMA)-positive lymph nodes in treatment-naive nonmetastatic prostate cancer (PC) patients. Materials and Methods The clinical data of 443 PC patients (83.3% high-risk and 16.7% intermediate-risk) were retrospectively analyzed. Receiver operating characteristic (ROC) curves with areas under the curve (AUC) were generated to evaluate the accuracy of clinical parameters (prostate-specific antigen [PSA], T stage, Gleason score [GS], International Society of Urological Pathology [ISUP] grade) and nomograms (Roach formula [RF], Yale formula [YF], and a new formula [NF]) in predicting lymph node metastasis. The AUCs of the various parameters and clinical nomograms were compared using ROC and precision-recall (PR) curves. Results A total of 288 lymph node metastases were identified in 121 patients (27.3%) using Ga-68-PSMA-11-positron emission tomography (PET)/computed tomography (CT). Most PSMA-avid lymph node metastases occurred in external or internal iliac lymph nodes (142; 49.3%). Clinical T stage, PSA, GS, and ISUP grade were significantly associated with PSMA-positive lymph nodes according to univariate logistic regression analysis. The PSMA-positive lymph nodes were more frequently detected in patients with PSA >20 ng/ml, GS >= 7 or high risk disease compared to their counterparts. The clinical T stage, serum PSA level, GS, and ISUP grade showed similar accuracy in predicting PSMA-positive metastasis, with AUC values ranging from 0.675 to 0.704. The median risks for PSMA-positive lymph nodes according to the RF, YF, and NF were 31.3% (range: 12.3%-100%), 22.3% (range: 4.7%-100%), and 40.5% (range: 12.3%-100%), respectively. The AUC values generated from ROC and PR curve analyses were similar for all clinical nomograms, although the RF and YF had higher accuracy compared to NF. Conclusion The clinical T stage, PSA, GS, and ISUP grade are independent predictors of PSMA-positive lymph nodes. The RF and YF can be used to identify patients who can benefit from Ga-68-PSMA-11 PET/CT for the detection of lymph node metastasis. Together with nomograms, Ga-68-PSMA-11 PET/CT images help to localize PSMA-positive lymph node metastases and can thus assist in surgery and radiotherapy planning.
The Comparision of Breast Cancer in the Young and Elderly Patients
(2019) Petek Erpolat, Ozge; Yuce Sari, Sezin; Ergen, Sefika Arzu; Aydin, Barbaros; Akkus, Berna; Gultekin, Melis; Copan Oksuz, Didem; Arican, Zumre; Onal, Cem; Gursel, Bilge; Akmansu, Muge; Ozyigit, Gokhan; Bilkay Gorken, Ilknur; Yildiz, Ferah
OBJECTIVE To compare the tumor characteristics, treatment approaches, recurrence patterns and survival results rates of young and elderly patients with breast cancer. METHODS In this study, Between between 2000-2013, a total of 779 patients were treated for breast cancer at nine radiation oncology departments were evaluated retrospectively. Three-hundred eight four of these patients were young (<= 35 years), and 395 of those the patients were elderly (>= 70 years). RESULTS Young patients were more likely to present with aggressive tumor features. They were more often received comprehensive lymphatic irradiation, tumor bed boost and intense chemotherapy. No difference was found for 5 and 10-year loco-regional recurrence- free survival rates were (96% and 93% for young, 97% and 97% for elderly). The 5 and 10-year distant recurrence- free survival rates were lower in the young patients (77% and 67% for young, 85% and 85% for elderly, p<0.0001). No difference was found in 5 and 10-year breast cancer- specific survival (91% and 79% for young, 92% and 87% for elderly). The 5 and 10-year overall survival rates were higher in the young patients (92% and 78% for young, 78% and 63% for elderly, p<0.0001). CONCLUSION The reason for the similarity between the age groups in terms ofregarding loco-regional recurrence- free survival can be more comprehensive lymphatic irradiation and tumor bed boost, the young patients received. The distant recurrence- free survival rates rates were significantly lower in the young patients even though they received more intensive chemotherapy. Future studies aimed at more effective systemic regimens to decrease distant recurrence in young patients are warranted.
Daily Workflow and Workload of Radiation Oncology Specialists in Turkey
(2015) Akman, Fadime; Kamer, Serra; Onal, Cem; Agaoglu, Fulya; Guney, Yildiz; Hicsonmez, Ayse; Koc, Mehmet; Colpan Oksuz, Didem; Ozyigit, Gokhan; Ozkok, Serdar; 0000-0002-2742-9021; D-5195-2014
OBJECTIVES This study aimed to research the effort required by patient evaluation, radiotherapy planning and treatment processes in the daily applications of radiation oncology in terms of time, and to use this effort as the primary source for human power and infrastructure planning required in radiotherapy. METHODS The surveys carried out by Turkish Radiation Oncology Association Proficiency Board, Curriculum Preparation and Evaluation Commission on Education Institutions, Surveys delivered to the officers of the center via electronic mail, were answered and evaluated in accordance with the data of 2012. RESULTS 26 University and 8 Ministry of Health Hospitals participated in the study. The total number of specialists employed in the participant centers, were 227. For per specialist, 383 hours in a year were spent for the patients at follow-up, 334 hours were spent for the patients that were in treatment, and 950 hours were spent for planning and treatment set-ups. It was determined that the time spent for per patient in intensity modulated radiotherapy technique, was 2-3 times more when compared to the location of tumor, which is a conformal technique. It was observed that this duration was much longer in special radiotherapy applications such as brachytherapy, total body irradiation and radiosurgery. CONCLUSION Technological advancements in radiotherapy, require more effort and working time for new job descriptions and in daily practice.
The hematologic parameters in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate
(2019) Onal, Cem; Sedef, Ali Murat; Kose, Fatih; Oymak, Ezgi; Guler, Ozan Cem; Sumbul, Ahmet Taner; Aksoy, Sercan; Yildirim, Berna Akkus; Besen, Ali Ayberk; Muallaoglu, Sadik; Mertsoylu, Huseyin; Ozyigit, Gokhan; 0000-0001-6908-3412; 0000-0002-5573-906X; 0000-0002-0156-5973; 30977383; D-4793-2014; AAC-5654-2020
Currently, there are no predictive markers of response to abiraterone. We calculated neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) at baseline and at 4 and 12 weeks after initiation of abiraterone, and we evaluated prostate-specific antigen (PSA) response every 4 weeks in 102 metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone either pre-or postchemotherapy. With a median follow-up was 24.0 months (range: 0.3-54.9), median overall survival (OS) was 20.8 months. High-NLR patients who remained high or who returned to low NLR after 4 and 12 weeks showed significantly worse OS than patients with low baseline NLR. NLR and prostate-specific antigen response to abiraterone was a significant predictor of OS and progression-free survival (PFS) in metastatic castration-resistant prostate cancer patients treated with abiraterone delivered either pre-or postchemotherapy.
The hematologic parameters in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate.
(2019) Cem, Onal; Sedef, Ali Murat; Kose, Fatih; Oymak, Ezgi; Guler, Ozan Cem; Sumbul, Ahmet Taner; Aksoy, Sercan; Yildirim, Berna Akkus; Besen, Ali Ayberk; Mullaoglu, Sadik; Mertsoylu, Huseyin; Ozyigit, Gokhan; 0000-0001-6908-3412; D-4793-2014; AAC-5654-2020
Integration of 68Ga-PSMA-PET/CT in Radiotherapy Planning for Prostate Cancer Patients
(2019) Onal, Cem; Torun, Nese; Akyol, Fadil; Guler, Ozan Cem; Hurmuz, Pervin; Yildirim, Berna Akkus; Caglar, Meltem; Reyhan, Mehmet; Ozyigit, Gokhan; 0000-0001-6908-3412; 31283600
Purpose To assess the role of (68)Gallium-labeled-prostate-specific membrane antigen PET/CT (Ga-68-PSMA-PET/CT) in risk group definition and radiotherapy planning in the initially planned definitive radiotherapy (RT) for prostate cancer patients. Methods The clinical data of 191 prostate cancer patients treated with definitive intensity-modulated RT were retrospectively analyzed. All patients were initially staged with thoracoabdominal CT and bone scintigraphy, and the second staging was performed using Ga-68-PSMA-PET/CT. Both stages were evaluated for the decision making of RT and any change in RT target volumes. Results After staging with Ga-68-PSMA-PET/CT, 26 patients (13.6%) had risk group changes, 16 patients (8.4%) had an increase in risk group, and 10 patients (5.2%) had a decrease in risk group. Down-staging occurred in 22 patients (11.5%), and upstaging was observed in 30 patients (15.7%). A total of 26 patients (13.6%) had nodal stage changes. After the Ga-68-PSMA-PET/CT scans, the number of metastatic patient increased to 17 (8.9%), with 4 of them moving from oligo- to polymetastatic disease. An additional irradiation of pelvic lymphatics and metastatic site was performed in 13 patients (6.8%) and 6 patients (3.2%), respectively. The RT was aborted in 4 patients (2.1%) because of parenchymal or distant site metastasis observed in the Ga-68-PSMA-PET/CT. Conclusions We found that Ga-68-PSMA-PET/CT causes considerable migration in stage, risk group, and RT field arrangements, especially in high-risk patients regardless of the GS and baseline prostate-specific antigen values alone. Ga-68-PSMA-PET/CT seems to have a great influence on RT decision making in prostate cancer patients.
Oligometastatic Bone Disease in Castration-Sensitive Prostate Cancer Patients Treated With Stereotactic Body Radiotherapy Using Ga-68-PSMA PET/CT TROD 09-004 Study
(2021) Onal, Cem; Ozyigit, Gokhan; Akgun, Zuleyha; Atalar, Banu; Igdem, Sefik; Oymak, Ezgi; Agaoglu, Fulya; Selek, Ugur; Guler, Ozan Cem; Hurmuz, Pervin; 33661210
Purpose To evaluate the outcomes of metastasis-directed treatment (MDT) using stereotactic body radiotherapy (SBRT) for bone-only oligometastasis (OM) detected with gallium prostate-specific membrane antigen (Ga-68-PSMA) PET/CT in castration-sensitive prostate cancer (PC) patients. Methods In this multi-institutional study, clinical data of 74 PC patients with 153 bone lesions who were undergoing MDT were retrospectively evaluated. Twenty-seven patients (36.5%) had synchronous, and 47 (63.5%) had metachronous OM. All patients had PC with 5 metastases or fewer detected by Ga-68-PSMA PET/CT and treated using SBRT with a median dose of 20 Gy. The prognostic factors for PC-specific survival (PCSS) and progression-free survival (PFS) were analyzed. Results The median follow-up was 27.3 months. Patients with synchronous OM were older and received higher rates of androgen deprivation therapy after SBRT compared with patients with metachronous OM. The 2-year PCSS and PFS rates were 92.0% and 72.0%, respectively. A prostate-specific antigen (PSA) decline was observed in 56 patients (75.7%), and 48 (64.9%) had a PSA response defined as at least 25% decrease of PSA after MDT. The 2-year local control rate per lesion was 95.4%. In multivariate analysis, single OM and PSA response after MDT were significant predictors for better PCSS and PFS. In-field recurrence was observed in 4 patients (6.5%) with 10 lesions at a median of 13.1 months after MDT completion. No serious late toxicity was observed. Conclusions We demonstrated that SBRT is an efficient and well-tolerated treatment option for PC patients with 5 bone-only oligometastases or fewer detected with Ga-68-PSMA PET/CT.
Outcome of Elderly Nasopharyngeal Carcinoma Patients: A Single Center Study
(2020) Basaran, Hamit; Cengiz, Mustafa; Yazici, Gozde; Ozdemir, Yurday; Suslu, Nilda; Gullu, Ibrahim H.; Ozyigit, Gokhan; 0000-0002-2218-2074; AAG-5629-2021
Objective: This study aimed to assess the efficiency of radiotherapy and evaluate its outcomes for elderly (> 65 years) patients who have undergone treatment for nasopharyngeal carcinoma (NPC). Methods: Forty- five (male, 35; female, 10) elderly patients with a diagnosis of undifferentiated NPC who were treated at our institution between 1994 and 2012 were retrospectively evaluated. The primary endpoint was the relationship between the patients' characteristics and overall survival (OS); progression-free survival (PFS), locoregional progression-free survival (LR-PFS), and toxicity analysis were the secondary endpoints. Results: The patients had a median age of 74.2 years. At a median follow-up period of 64 months, the median OS, PFS, and LR-PFS were 45 (95% confidence interval [CI]: 5.887-84.113), 34 (95% CI: 0.0-70.504), and 45 (95% CI: 20.092-69908) months, respectively. The 2-, 3-, and 5-year OS rates were 61.5%, 53.1%, and 50.0%, respectively, and the 2-, 3-, and 5-year PFS rates were 57.6%, 46.8%, and 43.7%, respectively. Patients with T stage (T3-T4 vs.T1-T2) or N stage (N0-1 vs. N2) had significantly shorter OS (p<0.05), PFS (p<0.05), and LR-PFS (p<0.05) outcomes, respectively, which were also confirmed using a multivariate analysis (p<0.05). Conclusion: Our results demonstrated that the established prognostic factors, including T and N stages, were important prognostic indicators of NPC in elderly patients
Outcome of loco-regional radiotherapy in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate
(2019) Yildirim, Berna Akkus; Onal, Cem; Kose, Fatih; Oymak, Ezgi; Sedef, Ali Murat; Besen, Ali Ayberk; Aksoy, Sercan; Guler, Ozan Cem; Sumbul, Ahmet Taner; Mualloglu, Sadik; Mertsoylu, Huseyin; Ozyigit, Gokhan; 30701292
Purpose To evaluate the potential benefit of curative radiotherapy (RT) to the primary tumor in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone. Materials and methods The clinical parameters of 106 mCRPC patients treated with abiraterone were retrospectively evaluated. Patients were either oligometastatic (<= 5 metastases) at diagnosis or became oligometastatic after the systemic treatment was analyzed. Local RT to the primary tumor and pelvic lymphatics was delivered in 44 patients (41%), and 62 patients (59%) did not have RT to the primary tumor. After propensity match analysis, a total of 92 patients were analyzed. Resultsn Median follow-up time was 14.2 months (range: 2.3-54.9 months). Median overall survival (OS) was higher in patients treated with local RT to the primary tumor than in those treated without local RT with borderline significance (24.1 vs. 21.4 months; p=0.08). Local RT to the prostate and pelvic lymphatics significantly diminished the local recurrence rate (16 patients, 31% vs. 2 patients, 5%; p=0.003). In multivariate analysis, the prostate specific antigen (PSA) response >= 50% of the baseline obtained 3 weeks after abiraterone therapy was the only significant prognostic factor for better OS and progression-free survival (PFS). Patients treated with primary RT to the prostate had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT. Conclusions Local prostate RT significantly improved OS and local control in mCRPC patients treated with abiraterone. The patients treated with primary RT had significantly less progression under abiraterone and a longer abiraterone period than those treated without local prostate RT.
The outcome of loco-regional radiotherapy in metastatic castration-resistant prostate cancer patients treated with abiraterone acetate.
(2019) Yildirim, Berna; Cem, Onal; Kose, Fatih; Oymak, Ezgi; Sedef, Ali Murat; Besen, Ali Ayberk; Aksoy, Sercan; Guler, Ozan Cem; Sumbul, Ahmet Taner; Mertsoylu, Huseyin; Ozyigit, Gokhan; 0000-0001-6908-3412; D-4793-2014; AAC-5654-2020
Prevention of Radiation-Induced Retinopathy with Amifostine in Wistar Albino Rats
(2015) Yildirim, Berna Akkus; Cetin, Eren; Topkan, Erkan; Ozyigit, Gokhan; Cengiz, Mustafa; Surucu, Selcuk; Usubutun, Alp; Akyol, Fadil; 0000-0001-6661-4185; 25768249; V-5717-2017
The Promise of Metastasis-Directed Therapy for Oligometastatic Prostate Cancer: Going Beneath the Surface with Molecular Imaging
(2022) Sutera, Philip; Phillips, Ryan M.; Deek, Matthew; Ozyigit, Gokhan; Onal, Cem; Tran, Phuoc T.; 35058322
Prostate-specific membrane antigen PET response associates with radiographic progression-free survival following stereotactic ablative radiation therapy in oligometastatic castration-sensitive prostate cancer.
(2022) Sutera, Philip; Deek, Matthew; Guler, Ozan Cem; Hurmuz, Pervin; Reyhan, Mehmet; Rowe, Steven P.; Hrinivich, William; Ren, Lei; Kiess, Ana Ponce; Song, Daniel Y.; Oymak, Ezgi; Pienta, Kenneth J.; Pomper, Martin; Feng, Felix Y.; Ozyigit, Gokhan; Tran, Phuoc T.; Phillips, Ryan; Onal, Huseyin Cem
Radiotherapy After Skin-Sparing Mastectomy and Implant-Based Breast Reconstruction
(2019) Sari, Sezin Yuce; Guler, Ozan Cem; Gultekin, Melis; Yildirim, Berna Akkus; Onal, Cem; Ozyigit, Gokhan; Yildiz, Ferah; 0000-0001-6908-3412; 31255547; AAC-5654-2020
We aimed to evaluate the cosmetic results of radiotherapy in 170 breast cancer patients after implant-based reconstruction. Cosmetic results were excellent or fair in most patients after radiotherapy. However, bolus use, lymphatic irradiation, and the volume receiving at least 110% of the prescribed dose being >1% significantly deteriorated the outcomes. Introduction: We evaluated the cosmetic results of radiotherapy (RT) after implant-based reconstruction (IBR). Patients and Methods: We retrospectively evaluated 170 patients with 171 breast cancers treated between December 2004 and January 2016 in 2 university hospitals. RT fields were reconstructed breast (RB) only in 24 (14%), and RB and regional lymphatics in 147 (86%) breasts, respectively. All but 1 patient received a total 50 Gy with conventional fractionation. All patients received systemic chemotherapy. One hundred thirty-eight (81%) patients received hormonal therapy; 118 tamoxifen and 20 aromatase inhibitor. Results: Median follow-up time was 46.8 months (range, 1-163 months). The 5-year disease-free and overall survival rate was 83% and 93%, respectively. Cosmetic results were considered excellent in 111 (65%), fair in 46 (27%), and bad in 14 (8%) RB by patients. Thirty-four (20%) RB had restorative surgery; because of surgeons' preference because of implant natural life time span in 5, and contracture, fibrosis, deformation, or dislocation of the implant, or cellulitis in the remaining. Statistically significant adverse factors in univariate analysis for impaired cosmetic outcome were bolus use on the RB, lymphatic irradiation, and volume that received at least 110% of the prescribed dose being >1%. The use of bolus material was the only prognostic factor for deterioration of the cosmetic result in multivariate analysis. Conclusion: RT after IBR yields acceptable cosmetic results. Although only 111 (65%) of RBs were considered to have excellent cosmetic results, only a small percentage of patients needed reoperation because of bad cosmetic outcome. (C) 2019 Elsevier Inc. All rights reserved.
Role of 68-Ga-PSMA-PET/CT in pelvic radiotherapy field definitions for lymph node coverage in prostate cancer patients
(2020) Onal, Cem; Ozyigit, Gokhan; Guler, Ozan Cem; Hurmuz, Pervin; Torun, Nese; Tuncel, Murat; Dolek, Yemliha; Yedekci, Yagiz; Oymak, Ezgi; Tilki, Burak; Akyol, Fadil; 0000-0002-2742-9021; 0000-0001-6908-3412; 32861704; AAE-2718-2021; D-5195-2014; AAC-5654-2020
Purpose: To evaluate the distribution of metastatic lymph nodes (LN) detected on Ga-68-PSMA-positron emission tomography/computed tomography (PET/CT) in treatment-naive prostate cancer (PC) patients and to analyze the LN coverage rates of the pelvic fields defined in the GETUG trial and RTOG guidelines and a pelvic field extending superiorly from the L4/L5 interspace. Materials and methods: Ga-68-PSMA-PET/CT images obtained at diagnosis of 138 PC patients were retro-spectively analyzed. The number and locations of Ga-68-PSMA-positive LNs were co-registered with one single-planning CT. The numbers, locations, and sizes of LNs located outside the three pelvic volumes were investigated for the entire cohort and for patients with LN metastasis in the pelvic area only. Results: A total of 441 PSMA-PET-positive LN metastases were identified. The most frequent metastatic LNs were internal iliac LNs (25.2%). Para-aortic and presacral LNs outside the three pelvic fields were present in 20 (14.5%) and 22 patients (15.9%), respectively. The LN coverage rates according to the GETUG trial, the RTOG guidelines, and the pelvic field extending superiorly from L4/L5 were 44.2%, 52.2%, and 71, respectively, in the entire cohort and 51.7%, 61 and 83.1%, respectively, in patients with only pelvic LN metastasis. The number of metastatic LNs was a predictive factor for LNs located outside the three pelvic fields. Conclusions: Extending the cranial margin of the pelvic field from L5/S1 to L4/L5 increases the accuracy of pelvic field irradiation in approximately 20% of patients, highlighting the importance of proximal common iliac irradiation, particularly in patients with multiple LN metastasis. (C) 2020 Elsevier B.V. All rights reserved.
The Role Of Stereotactic Body Radiotherapy In Switching Systemic Therapy For Patients With Extracranial Oligometastatic Renal Cell Carcinoma
(2022) Onal, Cem; Hurmuz, Pervin; Guler, Ozan Cem; Yavas, Guler; Tilki, Burak; Oymak, Ezgi; Yavas, Cagdas; Ozyigit, Gokhan; https://orcid.org/0000-0002-2742-9021; 35119653; D-5195-2014
Background Targeting oligometastatic lesions with metastasis-directed therapy (MDT) using stereotactic-body radiotherapy (SBRT) may improve treatment outcomes and postpone the need for second-line systemic therapy (NEST). We looked at the results of oligometastatic renal cell carcinoma (RCC) patients who had five or fewer lesions and were treated with SBRT. Methods We examined the treatment outcomes of 70 extracranial metastatic RCC (mRCC) patients treated at two oncology centers between 2011 and 2020. The clinical parameters of patients with and without NEST changes were compared. The prognostic factors for overall survival (OS), progression-free survival (PFS), and NEST-free survival were evaluated. Results Median age was 67 years (range 31-83 years). Lung and bone metastasis were found in 78.4% and 12.6% of patients, respectively. With a median follow-up of 21.1 months, median OS was 49.1 months and the median PFS was 18.3 months. Histology was a prognostic factor for OS, BED, and treatment switch for PFS in univariate analysis. In multivariate analysis, the significant predictor of poor OS was clear cell histology, and a lower BED for PFS. Following SBRT for oligometastatic lesions, 19 patients (27.2%) had a median NEST change of 15.2 months after MDT completion. There were no significant differences in median OS or PFS between patients who had NEST changes and those who did not. No patient experienced grade >= 3 acute and late toxicities. Conclusions The SBRT to oligometastatic sites is an effective and safe treatment option for <= 5 metastases in RCC patients by providing favorable survival and delaying NEST change.
Stereotactic Body Radiotherapy and Tyrosine Kinase Inhibitors in Patients with Oligometastatic Renal Cell Carcinoma: A Multi-Institutional Study
(2023) Onal, Cem; Oymak, Ezgi; Guler, Ozan Cem; Tilki, Burak; Yavas, Guler; Hurmuz, Pervin; Yavas, Cagdas; Ozyigit, Gokhan; https://orcid.org/0000-0002-2742-9021; 36450836; HOC-5611-2023
Purpose Few studies have determined the viability of stereotactic body radiotherapy (SBRT) and tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC). We examined the results of RCC patients who had five or fewer lesions and were treated with TKI and SBRT.Methods The clinical data of 42 patients with 96 metastases treated between 2011 and 2020 were retrospectively evaluated. The prognostic factors predicting overall survival (OS) and progression-free survival (PFS) were assessed in uni-and multivariable analyses.Results Median follow-up and time between TKI therapy and SBRT were 62.3 and 3.7 months, respectively. The 2-year OS and PFS rates were 58.0% and 51.3%, respectively, and 2-year local control rate was 94.1% per SBRT-treated lesion. In univariable analysis, the time between TKI therapy and SBRT and treatment response were significant prognostic factors for OS and PFS. In multivariable analysis, a time between TKI therapy and SBRT of less than 3 months and complete response were significant predictors of better OS and PFS. Only 12 patients (28.6%) had a systemic treatment change at a median of 18.2 months after SBRT, mostly in patients with a non-complete treatment response after this therapy. Two patients (4.8%) experienced grade III toxicity, and all side effects observed during metastasis-directed therapy subsided over time.Conclusion We demonstrated that SBRT in combination with TKIs is an effective and safe treatment option for RCC patients with <= 5 metastases. However, distant metastasis was observed in 60% of the patients, indicating that distant disease control still has room for improvement.
Stereotactic body radiotherapy for oligoprogressive lesions in metastatic castration-resistant prostate cancer patients during abiraterone/enzalutamide treatment
(2021) Onal, Cem; Kose, Fatih; Ozyigit, Gokhan; Aksoy, Sercan; Oymak, Ezgi; Muallaoglu, Sadik; Guler, Ozan C.; Tilki, Burak; Hurmuz, Pervin; Akyol, Fadil; 0000-0002-2742-9021; 33905131; D-5195-2014
Background Metastasis-directed therapy (MDT) utilizing stereotactic body radiotherapy (SBRT) for oligoprogressive lesions could provide a delay in next-line systemic treatment (NEST) change while undergoing androgen receptor-targeted agents (ARTA) treatment. We evaluated prognostic factors for prostate cancer-specific survival (PCSS) and progression-free survival (PFS) to characterize patients receiving treatment with ARTA who may benefit from MDT for oligoprogressive lesions. The impact of MDT on delaying NEST and the predictive factors for NEST-free survival (NEST-FS) were also assessed. Materials and Methods The clinical data of 54 metastatic castration-resistant prostate cancer patients with 126 oligoprogressive lesions receiving abiraterone (1 g/day) or enzalutamide (160 mg/day) before or after systemic chemotherapy were analyzed. A median of three lesions (range: 1-5) were treated with MDT. The primary endpoints were PCSS and PFS. The secondary endpoints were time to switch to NEST and NEST-FS. Results The median follow-up time was 19.1 months. Univariate analysis showed that the number of oligoprogressive lesions treated with SBRT and the time between the start of ARTA treatment and oligoprogression were significant prognostic factors for PCSS, and the timing of ARTA treatment (before or after chemotherapy) and the prostate-specific antigen (PSA) response after MDT were significant prognostic factors for PFS. Multivariate analysis showed that early MDT for oligoprogressive lesions delivered less than 6 months after the beginning of ARTA and higher PSA levels after MDT were significant predictors of worse PCSS and PFS. The median total duration of ARTA treatment was 13.8 months. The median time between the start of ARTA treatment and the start of MDT for oligoprogressive lesions was 5.2 months, and MDT extended the ARTA treatment by 8.6 months on average. Thirty-two (59.3%) patients continued ARTA treatment after MDT. ARTA treatment after chemotherapy, early oligoprogression requiring MDT, and lower radiation doses for MDT were independent predictors of NEST-FS in multivariate analysis. Conclusions MDT for oligoprogressive lesions is effective and may provide several benefits compared to switching from ARTA treatment to NEST. Patients with early progression while on ARTAs and inadequate PSA responses after MDT have a greater risk of rapid disease progression and poor survival, which necessitates intensified treatment.
Stereotactic radiotherapy to oligoprogressive lesions detected with Ga-68-PSMA-PET/CT in castration-resistant prostate cancer patients
(2021) Onal, Cem; Ozyigit, Gokhan; Oymak, Ezgi; Guler, Ozan Cem; Tilki, Burak; Hurmuz, Pervin; Akyol, Fadil; 0000-0002-2742-9021; 33693965; D-5195-2014
Purpose We assessed the outcomes of stereotactic body radiotherapy (SBRT) to treat oligoprogressive castration-resistant prostate cancer (CRPC) patients with <= 5 lesions using gallium prostate-specific membrane antigen-positron emission tomography (Ga-68-PSMA-PET/CT). Methods The clinical data of 67 CRPC patients with 133 lesions treated with Ga-68-PSMA-PET/CT-based SBRT were retrospectively analyzed. All of the patients had oligoprogressive disease during androgen-deprivation therapy (ADT). The prognostic factors for overall- (OS) and progression-free survival (PFS) and the predictive factors for switching to next-line systemic treatment (NEST) and NEST-free survival (NEST-FS) were analyzed. Results With a median follow-up of 17.5 months, the 2-year overall survival (OS) and PFS rates were 86.9% and 34.4%, respectively. The PSA response was observed in 49 patients (73.1%). Progression was observed in 37 patients (55.2%) at a median of 11.0 months following SBRT. A total of 45 patients (67.2%) remained on ADT after SBRT, and 22 patients (32.8%) had a NEST change at a median of 16.4 months after metastasis-directed treatment (MDT). Patients with a NEST change had higher post-SBRT PSA values and fewer PSA nadirs after MDT than their counterparts. In multivariate analysis, higher pre-SBRT PSA values were the only significant predictor for worse OS and NEST-FS, and no significant factor was found for PFS. No serious acute or late toxicities were observed. Conclusion This study demonstrated the feasibility of MDT using SBRT to treat oligoprogressive lesions by Ga-68-PSMA-PET/CT in CRPC patients is efficient and well-tolerated, prolonging the effectiveness of ADT by delaying NEST.