Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Innovations in Cervical Cancer Treatment-There is Still Room for Improvement(2023) Onal, Cem; Yavas, Guler; HOC-5611-2023; AAE-2822-2020Item 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-5611-2023Purpose 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.Item Stereotactic Ablative Body Radiotherapy as a Bridge to Liver Transplant for Hepatocellular Carcinoma: Preliminary Results of Baskent University Experience(2022) Yavas, Guler; Soy, Ebru Hatice Ayvazoglu; Coskun, Mehmet; Onal, Cem; Boyvat, Fatih; Haberal, Mehmet; https://orcid.org/0000-0002-3462-7632; 35384806; HOC-5611-2023; AAJ-8097-2021Objectives: Hepatocellular carcinoma is the most common primary liver tumor, with curative treatment options being liver transplant and resection. However, approximately 20% to 30% of patients have substantial disease progression while awaiting transplant. Here, we report our initial experience on stereotactic ablative body radiotherapy as a bridge to liver transplant for patients with hepatocellular carcinoma. Materials and Methods: Seven patients with 9 lesions received stereotactic ablative body radiotherapy as a bridge treatment to transplant. All patients underwent radiofrequency ablation, transcatheter arterial chemoembolization, or hepatic resection before stereotactic ablative body radiotherapy. Magnetic resonance imaging was used to evaluate radiographic responses 1 month later. Results: Median age of patients was 65 years (range, 63-71 years), median stereotactic ablative body radiotherapy dose was 45 Gy (range, 30-54 Gy; delivered in 3-5 fractions), and median tumor diameter was 17 mm (range, 12-30 mm). Before stereotactic ablative body radiotherapy, all patients underwent liver-directed therapies, including transcatheter arterial chemoembolization for 3 lesions, transcatheter arterial chemoembolization and radiofrequency ablation for 4 lesions, surgical resection for 1 lesion, and surgical resection plus transcatheter arterial chemoembolization for the remaining lesion. Patients showed no evidence of gastrointestinal toxicity or radiation-induced liver disease. Acute toxicity was negligible; all patients completed the treatment course. One month after stereotactic ablative body radiotherapy administration, response rates were assessed with magnetic resonance imaging, with complete responses obtained in 5 lesions (55.5%), partial responses for 2 lesions, and stable disease for 2 lesions. No disease progression was shown following stereotactic ablative body radiotherapy application. Conclusions: Stereotactic ablative body radiotherapy is an effective, safe, and tolerable bridging therapy option. Although we observed an early response after treatment, exact response rates will not be known for at least 3 months following stereotactic ablative body radiotherapy. Thus, our findings should be confirmed through additional prospective studies with longer follow-up.Item Treatment Outcomes of Stereotactic Body Radiotherapy in Patients with Synchronous and Metachronous Oligometastatic Renal Cell Carcinoma(2023) Guler, Ozan Cem; Oymak, Ezgi; Hurmuz, Pervin; Yavas, Guler; Tilki, Burak; Yavas, Cagdas; Ozyigit, Gokhan; Onal, Cem; 0000-0002-2742-9021; 36455527; D-5195-2014Introduction: The aim of this study was to investigate the clinical outcomes of metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT) in patients with synchronous or metachronous oligometastatic renal cell carcinoma (RCC). Methods: The clinical data of 87 patients with 138 lesions who received MDT between February 2008 and January 2019 were retrospectively analyzed. All patients had <= 5 metastasis at diagnosis (synchronous) or during progression (metachronous) and were treated with SBRT for their metastasis. The primary endpoints were local control (LC) and progression-free survival (PFS). The secondary endpoint was overall survival (OS). Results: Median follow-up was 20.4 months for entire cohort and 27.2 months for survivors. Synchronous oligometastatic disease was observed in 35 patients (40.2%), and 52 patients (59.8%) had metachronous disease. Seventy-two patients (82.8%) received systemic treatment synchronously or after MDT, while 15 patients (17.2%) did not receive any systemic treatment. The 1- and 2-year OS rates were 79.4% and 58.1%, respectively, and the 1- and 2-year PFS rates were 58.6% and 15.1%, respectively. The 1- and 2-year LC rates per lesion were 96.6% and 91.4%, respectively. There were no significant differences in survival between patients with synchronous oligometastasis and those with metachronous oligometastasis. All disease progressions were observed at a median time of 31.6 months (range: 1.9-196.9 months) after the completion of SBRT. Patients with solitary oligometastasis had significantly better OS compared to patients with >1 metastasis (p = 0.04). No patients experienced grade 3 or higher acute or late toxicities. Conclusion: SBRT is a successful treatment for oligometastatic RCC patients due to its excellent LC and minimal toxicity profile. There were no statistically significant survival differences between patients with synchronous and metachronous oligometastasis. Patients with solitary oligometastasis outlived their counterparts.Item Oncological Outcomes For Encapsulated Papillary Carcinoma Of The Breast: Multicentric Study Of Turkish Society For Radiation Oncology Breast Cancer Study Group (TROD 06-014 Study)(2023) Gurdal, Necla; Yildirim, Berna Akkus; Gursel, Ozge Kandemir; Ozkurt, Selnur; Ibis, Kamuran; Gultekin, Melis; Tepetam, Huseyin; Gul, Sule Karabulut; Guzeloz, Zeliha; Oksuz, Didem Colpan; Cetin, Ilknur Alsan; Yalcin, Berrin; Duzova, Mursel; Kanyilmaz, Gul; Yavas, Guler; Ozsaran, Zeynep; 36464924BackgroundEncapsulated papillary carcinoma (EPC) is a rare malignant papillary breast cancer accounting for approximately .5%-2% of all breast tumors. The aim of this multicenter study was to evaluate clinicopathologic features of EPC in addition to oncological outcomes and radiotherapy (RT) details. MethodsFrom 10 different academic hospitals in Turkey, we obtained pathology reports of 80 patients with histologically confirmed EPC between 2005 and 2022. Demographic, diagnostic, and treatment data were collected from medical records, retrospectively. Local failure, distant progression, toxicity-adverse effects, overall survival (OS), and disease-free survival were evaluated, and survival analyzes were performed using the Kaplan-Meier method. ResultsEighty patients with the diagnosis of misspelled sorry (ECP) were retrospectively evaluated. The median age of the patients was 63 (range, 35-85). After a median follow-up of 48 (range; 6-206) months, local recurrence was observed in three patients (4%). Local recurrence was less common in the patients who received whole breast RT with a tumour bed boost (p = .025). There were not any distant metastasis or disease-related death. RT was applied to 61% of the cases, and no treatment-related grade 3 or higher toxicity was reported in any of the patients. Five year OS, cancer-specific survival (CSS), and were observed as 85%, 100%, and 96%, respectively. ConclusionsECP is a rare, slow-progressing breast carcinoma associated with good prognosis, it is a disease of elderly patient, and usually occurs in postmenopausal women. It responds extremely well to optimal local treatments and appropriate adjuvant treatments on a patient basis, and has excellent OS and CSS ratios.Item 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-5195-2014Purpose 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.Item The Impact Of Serum Albumin-To-Alkaline Phosphatase Ratio In Cervical Cancer Patients Treated With Definitive Chemoradiotherapy(2022) Onal, Cem; Gultekin, Melis; Yavas, Guler; Oymak, Ezgi; Sari, Sezin Yuce; Guler, Ozan Cem; Yigit, Ecem; Yildiz, Ferah; 35653776We retrospectively analysed the prognostic significance of serum albumin, alkaline phosphatase (ALP) and albumin to ALP ratio (AAPR) and other prognostic factors affecting the overall survival (OS) and progression-free survival (PFS) in 200 cervical cancer patients treated with definitive chemoradiotherapy (CRT). The prognostic factors for OS and DFS, in addition to the predictive factors of albumin, ALP and AAPR, were investigated. Older age, lymph node metastasis, non-complete response (CR) to treatment and low serum albumin levels emerged as predictors of poor OS and PFS in multivariate analysis. However, with a cut-off value of 0.51, AAPR was not a significant prognostic factor of survival in multivariable analysis. There were no significant differences in clinicopathological factors between patients with low and high AAPR, except for lymph node metastasis, where lymph node metastasis rate was significantly higher in patients with a low AAPR compared to those with a high AAPR. Patients with CR had a significantly higher serum albumin level and AAPR compared to patients without CR. The pre-treatment serum albumin level was independent predictive for survival; therefore, it could be a suitable biomarker to guide systemic therapy and predict patient outcomes. Impact Statement What is already known on this subject? Two major determinants of tumour progression are nutritional status and inflammation. The albumin-to-alkaline phosphatase ratio (AAPR), which was originally proposed as a marker for nutritional status and immune response, was recently discovered to be a prognostic factor for various cancer types. However, its utility in the treatment of cervical cancer has not been established. What do the results of this study add? Low serum albumin levels were associated with a significantly shorter OS and PFS in cervical cancer patients treated definitively with CRT. AAPR, on the other hand, was not a significant prognostic factor for survival with a cut-off value of 0.51. Regional lymph node metastasis was significantly more common in patients with a low AAPR than in those with a high AAPR. What are the implications of these findings for clinical practice and/or further research? Patients with multiple clinicopathological risk factors and low serum albumin levels had an increased risk of disease recurrence and a poorer prognosis, highlighting the importance of additional adjuvant treatment strategies in these patients. Due to the preliminary nature of our findings, additional research is required to corroborate them.Item Prognostic Significance of Serum Human Epididymis Protein 4 Level in Patients with Locally Advanced Non-Small Cell Lung Cancer who Underwent Definitive Chemo-Radiotherapy(2022) Yavas, Guler; Birgi, Sumerya Duru; Unlu, Ali; Yavas, Cagdas; Duzova, Mursel; Akyurek, SerapWe aimed to investigate the prognostic significance of serum human epididymis protein 4 (HE4) level in patients with locally advanced non-small cell lung cancer (LA-NSCLC) who underwent definitive chemo-radiotherapy (CRT). A hundred seventeen patients with the diagnosis of LA-NSCLC were enrolled. The serum concentrations of HE4 were measured at the beginning of CRT, at the end of CRT, and 3 months after the completion of CRT. The median follow-up period was 21.7 months (range, 5.4-39.8 months). The mean serum HE4 levels prior to CRT, at the end of the CRT, and 3rd month after the completion of CRT were 159.2, 130.2, and 127.5, respectively (p= 0.023). The median progression free survival (PFS) was 15.4 months. One, and two-year PFS rates were 58.1%, and 22.2%, respectively. One, and two-year expected survival rates were 81.2%, and 62%, respectively. In multivariate analysis, stage (p= 0.002), HE4 levels after 3 months of CRT (p= 0.037) were predictive of OS. Stage IIIC patients had 10.2 times likely to death when compared to stage IIIA patients (95%CI: 2.3-45.7; p= 0.037). The increase of 1 HE4 levels after 3 months of CRT increased the mortality rate 1.002 (95%CI: 1.000-1.0004; p= 0.037). In multivariate analysis stage was predictive of PFS. When compared to stage IIIA patients, stage IIIC patients have 2.5 times risk for progression (95% CI: 1.2-5.2; p= 0.014). Our findings suggested that serum HE4 may be an important prognostic biomarker for LA-NSCLC patients. This issue warrants further prospective studies with more patient populations.Item 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-5195-2014Background 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.Item Role of Consolidative Thoracic Radiotherapy for Extensive-stage Small Cell Lung Cancer: Trod Thoracic Oncology Study Group 08-006 Multi-institutional Study(2022) Yavas, Guler; Kirakli, Esra Korkmaz; Dagdelen, Meltem; Topkan, Erkan; Saynak, Mert; Dincbas, Fazilet Oner; OzdemIr, Yurday; Yavas, Cagdas; Birgi, Sumerya Duru; Akyurek, SerapOBJECTIVE We aimed to evaluate the role of consolidative thoracic radiotherapy (TRT) in patients with extensive-stage small cell lung cancer (ES-SCLC). METHODS The clinical data for 151 patients with the diagnosis of ES-SCLC treated with consolidative TRT from six different hospitals from Turkey analyzed. RESULTS The median age of the patients was 61 years (range 36-83 years). The median dose of radiotherapy (RT) was 45 Gy (range: 30-66 Gy) applied in median 25 fractions (range 10-34 fractions). For 151 assessable patients, the median survival time (MST) was 14 months (range: 12.6-15.3). The patients who has complete response and partial response had 16 months, and 14 months of MST. In multivariate analyses prophylactic cranial irradiation (PCI) (p=0.011), female gender (p=0.017), and comorbidity (p=0.006) were found as significant parameters associated with survival. The MSTs were 12 months in patients without comorbidity, and 16 months for the patients with at least one comorbid disease. The patients who received PCI had improved MSTs when compared the ones without PCI (16 months vs. 12 months). There was a trend towards improved overall survival times in patients who received EQD2 >= 47 Gy RT doses (p=0.08). CONCLUSION Female gender, use of PCI, and unavailability of comorbid disease were associated with improved survival in ES-SLCL patients. There was a trend towards overall survival times in patients who received >= 47 Gy EQD2 doses; however, we believe that this statistical insignificance was related to our limited patient numbers.