Tıp Fakültesi / Faculty of Medicine

Permanent URI for this collectionhttps://hdl.handle.net/11727/1403

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Author: search.filters.author.Yildirim, Berna AkkusHas files: Yes

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    Restaging of Cervical Cancer Patients Treated with Adjuvant Radiotherapy According to FIGO 2018 and Suggestions for the Next Staging: Turkish Society for Radiation Oncology Gynecologic Group Study (TROD 04-004)
    (2022) Alanyali, Senem; Balci, Beril; Esen, Caglayan Selenge Beduk; Gultekin, Melis; Yildirim, Berna Akkus; Ozkurt, Selnur; Ergen, Sefika Arzu; Gursel, Sukriye Bilge; Cetin, Ilknur Alsan; Sert, Fatma; Sari, Sezin Yuce; Ibis, Kamuran; Onal, Cem; Sahinler, Ismet; Yildiz, Ferah; Ozsaran, Zeynep
    OBJECTIVE The objective of this study was to compare Federation of Gynecology and Obstetrics (FIGO) 2009 and 2018 staging systems in patients with uterine cervical cancer. METHODS Medical records of 571 patients who were treated with adjuvant radiotherapy or radiochemotherapy between 2001 and 2018 were retrospectively reviewed. Differences in overall survival (OS) and progression-free survival (PFS) rates according to FIGO 2009 and FIGO 2018 staging systems were compared using the log-rank test. Cox regression model was used to identify independent prognostic factors for survival. RESULTS The median follow-up was 59 months. Five-year OS and PFS rates were 81.1% and 77.7%, respectively. Stage migration was recorded in 401 patients (70.2%) and the most remarkable stage migration was detected in stage I patients (60%). A total of 157 (27.5%) patients upstaged to stage IIIC disease. According to FIGO 2009, 5-year OS rates were 87.3%, 80.5% (p=0.076), and PFS rates were 82.8%, 77.5% (p=0.036) for stage IB1 and IB2, respectively. According to FIGO 2018, the 5-year OS rates for stage IB1, IB2, and IB3 were 89.8%, 87.1%, and 81.4% (p=0.310), and PFS rates were 90.2%, 80.5%, and 80.1% (p=0.189), respectively. Patients with >= 2 pelvic lymph node (LN) metastases had worse 5-year OS and PFS rates than patients with one metastasis (p=0.015 and p=0.006). Number of para-aortic LN metastasis and metastatic LN ratio (MLNR) were also correlated with 5-year OS and PFS. CONCLUSION Current FIGO staging system better discriminates patients with cervical cancer. However, integration of metastatic LN number and/or MLNR to the upcoming FIGO staging system may improve the prognostic value of the staging.
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    A multi-institutional analysis of sequential versus 'sandwich' adjuvant chemotherapy and radiotherapy for stage IIIC endometrial carcinoma
    (2019) Onal, Cem; Sari, Sezin Yuce; Yildirim, Berna Akkus; Yavas, Guler; Gultekin, Melis; Guler, Ozan Cem; Akyurek, Serap; Yildiz, Ferah; 0000-0002-2742-9021; 30887753; D-5195-2014
    Objective: To analyze the outcomes of sequential or sandwich chemotherapy (ChT) and radiotherapy (RT) in patients with node-positive endometrial cancer (EC). Methods: Data from 4 centers were collected retrospectively for 179 patients with stage IIIC EC treated with postoperative RT and ChT (paclitaxel and carboplatin). Patients were either treated with 6 cycles of ChT followed by RT (sequential arm; 96 patients) or with 3 cycles of ChT, RT, and an additional 3 cycles of ChT (sandwich arm; 83 patients). Prognostic factors affecting overall survival (OS) and progression-free survival (PFS) were analyzed. Results: The 5-year OS and PFS rates were 64% and 59%, respectively, with a median followup of 41 months (range, 5-167 months). The 5-year OS rates were significantly higher in the sandwich than sequential arms (74% vs. 56%; p=0.03) and the difference for 5-year PFS rates was nearly significant (65% vs. 54%; p=0.05). In univariate analysis, treatment strategy, age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology, rate of myometrial invasion, and grade were prognostic factors for OS and PFS. In multivariate analysis, non-endometrioid histology, advanced FIGO stage, and adjuvant sequential ChT and RT were negative predictors for OS, whereas only non-endometrioid histology was a prognostic factor for PFS. Conclusion: Postoperative adjuvant ChT and RT for stage IIIC EC patients, either given sequentially or sandwiched, offers excellent clinical efficacy and acceptably low toxicity. Our data support the superiority of the sandwich regimen compared to the sequential strategy in stage IIIC EC patients for OS.
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    Local control and vertebral compression fractures following stereotactic body radiotherapy for spine metastases
    (2019) Ozdemir, Yurday; Torun, Nese; Guler, Ozan Cem; Yildirim, Berna Akkus; Besen, Ali A.; Yetisken, Aylin Gunesli; Onal, H. Cem; Topkan, Erkan; 0000-0002-2742-9021; 0000-0001-6908-3412; 0000-0002-2742-9021; 30815342; D-5195-2014; AAC-5654-2020
    Purpose: We aimed to retrospectively assess the incidence of vertebral compression fractures (VCF), examine clinicopathologic factors potentially associated with VCF, and evaluate treatment response in patients who received stereotactic body radiotherapy (SBRT) for spine metastases (spMets). Methods and Materials: We identified 78 patients with 125 spMets at baseline and subsequent assessments. Patients received SBRT doses of 16 or 18 Gy. Patients with pre-existing VCF and co-existing local progression were excluded. Spine instability neoplastic score (SINS) was used for spMets categorization. Response to SBRT and VCF were assessed according to the Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) and Genant scores, respectively. Kaplan-Meier analyses were used to assess local control of disease and vertebral compression fracture-free survival (FFS). Results: We treated 103 cases with single spMets and 11 cases involving double spMets with SBRT. Progressive disease was reported in 3.2% and 8.2% of the cases in the first and last PET/CT reports, respectively. The distribution of treatment response in the remaining patients was: complete response in 30.6% of patients, partial response in 47.1% of patients, and stable disease in 22.3% of patients in the first PET/CT; complete response in 62.3% of patients, partial response in 16.7% of patients, and stable disease in 21% of patients at the last monitoring. Local failures were observed in 15 (12%) of cases. Median SINS was 5 (range: 1 - 13); majority of patients in our cohort (70.4%) were categorized as stable according to SINS, five (4%) patients had Grade 3 VCF at a median time of 16 months after SBRT (range: 2 - 22 months), and 60% of VCF occurred after an interval of at least 12 months after SBRT. No bisphosphonate usage was significantly associated with VCF (r = -0.204; p = 0.022). Median FFS was 21 months. Univariate analyses indicated that female gender (p < 0.001), bisphosphonate use (p = 0.005), >6 months of bisphosphonates use (p = 0.002), and the lowest vertebral body collapse score (p = 0.023) were associated with higher FFS. Female gender (p = 0.007), >6 months of bisphosphonates usage (p = 0.018), and the lowest vertebral body collapse score (p = 0.044) retained independent significance. Conclusions: This study demonstrated that spine SBRT with doses of 16-18 Gy promises good local control of disease with acceptable VCF rates. Lowest vertebral body collapse score, female gender, and >6 months of bisphosphonate use were significantly associated with longer FFS.
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    Baseline hemoglobin <11.0 g/dL has stronger prognostic value than anemia status in nasopharynx cancers treated with chemoradiotherapy
    (2019) Topkan, Erkan; Ekici, Nur Yucel; Ozdemir, Yurday; Besen, Ali Ayberk; Yildirim, Berna Akkus; Mertsoylu, Huseyin; Sezen, Duygu; Selek, Ugur; 30864463
    Background: To retrospectively investigate the influence of pretreatment anemia and hemoglobin levels on the survival of nasopharyngeal carcinoma patients treated with concurrent chemoradiotherapy (C-CRT). Methods: A total of 149 nasopharyngeal carcinoma patients who received C-CRT were included. All patients had received 70 Gy to the primary tumor plus the involved lymph nodes, and 59.4 Gy and 54 Gy to the intermediate- and low-risk neck regions concurrent with 1-3 cycles of cisplatin. Patients were dichotomized into non-anemic and anemic (hemoglobin <12 g/dL (women) or <13 g/dL (men)) groups according to their pre-treatment hemoglobin measures. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of a pre-treatment hemoglobin cut-off that impacts outcomes. Potential interactions between baseline anemia status and hemoglobin measures and overall survival, locoregional progression-free survival (LRPFS), and progression-free survival were assessed. Results: Anemia was evident in 36 patients (24.1%), which was related to significantly shorter overall survival (P=0.007), LRPFS (P<0.021), and progression-free survival (P=0.003) times; all three endpoints retained significance in multivariate analyses (P<0.05, for each). A baseline hemoglobin value of 11.0 g/dL exhibited significant association with outcomes in ROC curve analysis: hemoglobin <11.0 g/dL (N=26) was linked with shorter median overall survival (P<0.001), LRPFS (P=0.004), and progression-free survival (P<0.001) times, which also retained significance for all three endpoints in multivariate analyses and suggested a stronger prognostic worth for the hemoglobin Conclusion: Pre-C-CRT hemoglobin <11.0 g/dL has a stronger prognostic worth than the anemia status with regard to LRPFS, progression-free survival, and overall survival for nasopharyngeal carcinoma patients.
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    Outcomes of aggressive treatment in esophageal cancer patients with synchronous solitary brain metastasis
    (2017) Onal, Cem; Yildirim, Berna Akkus; Guler, Ozan Cem; 0000-0002-2742-9021; 0000-0001-6661-4185; 0000-0001-6908-3412; 28685086; D-5195-2014; V-5717-2017; AAC-5654-2020
    The aim of the present study was to investigate the outcomes of esophageal cancer (EC) patients with isolated synchronous brain oligometastasis (oligo-BM) treated with chemoradiotherapy (CRT) of the primary site and localized treatment of the BM with surgery, radiotherapy (RT) or radiosurgery. Of 125 EC patients investigated, seven patients (6%) had solitary BM. Six patients were diagnosed prior to, and one patient was diagnosed during, treatment. All patients were treated with neoadjuvant chemotherapy and whole-brain RT (WBRT) for BM. All but one patient received definitive CRT with a median RT dose of 50.4 Gy using conventional fractionation RT. The median age at diagnosis was 59 years (range, 48-77 years). Six patients succumbed to mortality, and one continued to receive systemic chemotherapy at the last visit. The median survival time of the patients was 18.9 months (range, 10.0-27.2 months). Median time to progression after completion of the treatments was 8 months (range, 3-9 months). Two patients had progression of the primary tumor, and one patient had progression of the BM. The neurological status of three patients with BM who were identified during the staging work-up did not deteriorate as a consequence of WBRT. In conclusion, the present study has demonstrated that aggressive treatment of the primary tumor and oligo-BM in patients with EC may prolong the survival time.