Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item 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, ZeynepOBJECTIVE 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.Item Should We Accept the HPV Type 66 into a Probable High-Risk Group? The Prevalence, Clinical and Histopathological Evaluation of HPV Type 66 in Gazi University, Ankara(2021) Kazanci, Ferah; Kocak, Aylin Altay; Colak, Meryem; Erdem, Ozlem; Onan, M. Anil; Bozdayi, Gulendam; 0000-0002-0451-0142; AAI-8012-2021Introduction: The prevalence of infection by different genotypes of human papillomavirus (HPV) varies among different geographic areas. The objective of the study is to determine the prevalence and distribution of HPV66 genotype among women with normal or abnormal Pap smear tests. Methods: This retrospective study was conducted in a tertiary care university hospital between January 2017 and February 2018, in central Anatolia of Turkey. This study included 288 women, 66 (%22.9) of whom had HPV DNA positive. HPV DNA screening was done by an automatized system using real time PCR method (Cobas 4800 System, Roche Diagnostics Ltd, Switzerland) and this method distinguishes types 16 and 18, while the other 12 oncogene types are reported as high-risk HPV (HR-HPV: 31,33,35,39,45,51,52,56,58,59,66,68). For the genotyping of other oncogene types, a commercial real time PCR method (NLM Genotypes 14 Real-TM Quant, NLM Diagnostic, Italy) was used. Results: The most common identified HPV types were HPV16 (%6.3), HPV 56 (%3.8), HPV 18(%3.1), HPV 66 (%3.1), HPV 51 (%2.8), HPV 52(%2.1). HPV type 66 which has admitted recently other-subtypes with their unclear oncogenicity is the third most identified type in our study. In our study 9 (%3.1) women had type 66 and 2 (%0.7) of whom had abnormal Pap smear results. One patient with syphilis whose pap smear test results was ASC-H/HSIL was evaluated by colposcopic examination and LEEP (Loop Electrosurgical Excision Procedure) and ECC (Endocervical Curettage) were performed. The result of histopatological report was benign. The other patient whose Pap smear test result was LSIL evaluated by colposcopic examination and found no pathological finding. Conclusion: The frequency of HPV 66 infection was found to be higher in our study compared to previous reports. In 2 patients out of 9 cases (% 2.4) who were detected HPV 66 had normal pap test results.Item The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer(2021) Kim, Sarah H.; 34666213Purpose: Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. Methods: Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. Results: Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. Conclusion: The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally. (c) 2021 Elsevier Ltd. All rights reserved.Item Clinicopathologic importance of atypical glandular cells in cervico-vaginal cytology(2020) Yuksel, Seda; Simsek, Erhan; Yetkinel, Selcuk; Alemdaroglu, Songul; Bolat, Filiz Aka; Celik, Husnu; 0000-0003-4335-6659; 0000-0002-2165-9168; 31450881; AAI-8400-2021; AAL-1530-2021; AAK-7016-2021Objective: To analyze the histopathologic outcomes of patients with atypical glandular cells (AGC) in cervicovaginal cytology examinations. Material and Methods: Patients with AGC in cervicovaginal cytology were included in this study between March 2011 and March 2018 and patient data were collected retrospectively among all cytology results. AGC classification of cervicovaginal cytology were based on the Bethesda 2001 classification system. Results: The total prevalence of cervical epithelial cell abnormality and AGC were found as 9.2% and 0.2%, respectively, in the study cohort. AGC-favor neoplasia (AGC-FN) was the subgroup of AGC, with the highest malignancy rate with 62.5% (p=0.06). The incidence of malignancy in the postmenopausal group (33.3%) was detected higher than in the premenopausal group (8.3%) (p=0.07). Conclusion: The probability of malignancy in AGC-FN cytology is more commonly associated with malignancy in the postmenopausal group. Therefore, histopathologic examination is strongly recommended in these patients with AGC smears because of the high risk for malignancy in this group.Item Isolated jejunal metastasis in a patient with cervical cancer: A case report(2015) Onal, Cem; Nursal, Gul Nihal; Torer, Nurkan; Kayaselcuk, Fazilet; 25949229Background: In approximately 8% of cervical carcinoma patients, gastrointestinal tract is involved, most commonly the rectosigmoid portion, because of local extension. Isolated metastases to small bowel are exceedingly rare. Case report: We present a case of a 63-year-old woman with cervical cancer who developed isolated jejunal metastasis 8 months after postoperative chemoradiotherapy. The patient was alive with no evidence of disease 6 months after resection of metastasis. Very few cases have been reported concerning squamous cell carcinoma of the cervix with documented metastases to the small bowel. There is only one published case report of cervical cancer with multiple metastases to the small intestine and jejunum. To our knowledge, this is the first case of cervical cancer with isolated jejunal metastasis, which was initially demonstrated with positron emission tomography and confirmed histopathologically. Conclusion: Although the exact mechanism underlying the isolated metastasis is unknown, hematogenous spread or tumor seeding during surgery may play a role. (C) 2015 Greater Poland Cancer Centre. Published by Elsevier Sp. z o.o. All rights reserved.Item Adjuvant Small Pelvic Radiotherapy in Patients with Cervical Cancer Having Intermediate Risk Factors Only - Is It Sufficient?(2017) Onal, Huseyin Cem; Sari, Sezin Yuce; Guler, Ozan C.; Gultekin, Melis; Yildiz, Ferah; 0000-0002-2742-9021; 28848218; D-5195-2014Background: We sought to determine the outcomes of adjuvant small pelvic external beam radiotherapy (EBRT) and prognostic factors for survival and disease control. Patients and Methods: We retrospectively evaluated 113 cervical cancer patients treated with postoperative median 50.4-Gy small pelvic EBRT. We treated the surgical bed, bilateral parametria, paravaginal soft tissues, upper third of the vagina, and presacral lymphatics. Results: Median follow-up of all patients and survivors was 58 and 67 months, respectively. The 2-and 5-year overall survival (OS) and disease-free survival rates were 91 and 82%, and 85 and 74%, respectively. The locoregional failure rate was 10%. Age was a significant predictor for OS and distant metastasis-free survival (DMFS) on univariate analysis. The number of dissected lymph nodes being < 30 negatively affected the pelvic recurrence-free survival. The only independent predictor on multivariate analysis was older age for DMFS. Although no severe acute toxicity was observed, late grade >= 3 toxicity developed in 8 patients. Conclusion: Small pelvic EBRT produces satisfactory survival and locoregional control with acceptable toxicity, and can be an alternative to whole pelvic EBRT in selected cervical cancer patients. (C) 2017 S. Karger GmbH, Freiburg