Wos Kapalı Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10753
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Item Outcome and Safety Analysis of Endometrial Cancer Patients Treated with Postoperative 3D-Conformal Radiotherapy or Intensity Modulated Radiotherapy(2021) Onal, Cem; Sari, Sezin Yuce; Yavas, Guler; Oymak, Ezgi; Birgi, Sumerya Duru; Yigit, Ecem; Guler, Ozan Cem; Gultekin, Melis; Akyurek, Serap; Yildiz, Ferah; 33999750Background We sought to analyze the toxicity rates and the treatment outcomes in endometrial cancer (EC) patients treated with postoperative three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT). Material and methods The clinical data of 646 EC patients treated with postoperative adjuvant 3DCRT (265 patients, 41%) or with IMRT (381 patients, 59%) between April 2007 and August 2019 were retrospectively analyzed. The primary endpoints were treatment-related acute and late gastrointestinal (GI) and genitourinary (GU) toxicities. The secondary endpoints were LC and overall survival (OS) and disease-free survival (DFS). Results Median follow-up time was 37 months. The rates for acute GI and GU toxicities of any grade for the entire group were 55.6% and 46.8%, respectively. Acute grade >= 2 GI toxicity was significantly less in patients treated with IMRT compared to those treated with 3DCRT (11.0% vs. 19.2%, p=.004). However, no significant difference grade >= 2 GU toxicities was observed between the 3DCRT and IMRT groups (15.1% vs. 11.0%; p=.15). Acute grade >= 2 GI and GU toxicities were higher in patients receiving systemic chemotherapy, while paraaortic field irradiation increases only the risk of acute grade >= 2 GI toxicity. Estimated 3-year late grade >= 3 GI toxicity rates in the 3DCRT- and IMRT-treated patients were 4.6% and 1.9% (p= .03), respectively. The patients treated with adjuvant ChT had higher rates of late serious GI complications than those without adjuvant ChT. No significant difference in terms of survival and disease control was observed between the 3DCRT and IMRT treatment groups. No significant factor for LC was found in the multivariate analysis. Conclusion In this multicentric study involving one of largest patient population, we found that IMRT-treated EC patients showed comparable clinical outcomes but with a lower incidence of GI toxicities compared with those treated with 3DCRT.Item Impact of lymph node ratio in patients with stage IIIC endometrial carcinoma treated with postoperative radiotherapy(2021) Onal, Cem; Sari, Sezin Yuce; Yavas, Guler; Guler, Ozan Cem; Yiğit, Ecem; Oymak, Ezgi; Gultekin, Melis; Yildiz, Ferah; 0000-0002-2742-9021; 34355983; D-5195-2014Aim: To evaluate the prognostic value of the lymph node ratio (LNR) and other clinicopathological factors in patients with stage IIIC endometrial cancer. Methods: Factors affecting overall survival (OS) and progression-free survival (PFS) were assessed in 397 patients with stage IIIC endometrial cancer treated with postoperative radiotherapy. Patients undergoing the removal of at least ten lymph nodes were included in the study. Results: The 5-year OS and PFS rates were 58% and 52%, respectively, with a median follow-up time of 35.7 months. The LNR cutoff value was 9.6%. In the multivariate analysis, advanced age (>= 60 years), grade III tumor, presence of cervical stromal invasion, higher LNR and lack of adjuvant chemotherapy were independent predictors for worse OS and PFS. Conclusion: The LNR is an independent predictor for OS and PFS in patients with stage IIIC endometrial cancer treated with postoperative radiotherapy.Item Spinal Metastatic Disease Survival Analysis of 146 Patients and Evaluation of 4 Different Preoperative Scoring Systems(2020) Derincek, Alihan; Guler, Umit O.; Uysal, Mustafa; Ozalay, Metin; 0000-0002-5375-635X; 31393277; AAJ-4844-2021; O-7590-2017Study Design: This was a retrospective analysis. Objective: The objective of this study was to evaluate the predictive value of the 4 different scoring systems Tomita, Bauer modified, Tokuhashi revised, and Van der Linden and some parameters that are used in these scoring systems. Summary and Background Data: Prediction of the survival period before treatment for spinal metastasis is extremely important. A lot of scoring systems have been described to predict the survival periods and to select the ideal treatment modality in the literature. Materials and Methods: Retrospectively 146 patients with spinal metastasis were investigated between 2002 and 2011. The following parameters were analyzed: age, pathologic vertebra fracture, neurological deficit, visceral metastasis, diagnosis of primary tumor and its spinal metastasis interval, other skeletal metastasis, involved region of vertebra, and undergone spinal surgery. Patients were also scored by the 4 different scoring systems. The survival period was calculated from date of diagnosis of the spinal metastasis to the date of death or last follow-up (minimum: 12 mo). Cox regression, Kaplan-Meier survival test, and Cronbach alpha tests were performed for statistical analysis. Results: Median overall survival for all patients was 13 months (range: 1-68 mo). The primary tumor (P=0.015), existence of visceral metastasis (P=0.017), presence of pathologic vertebra fracture (P=0.009), and undergone spinal surgery (P=0.047) showed significant influence on survival. Each scoring system was reliable and concordant with the other scoring systems (Cronbach alpha=80%); however, after 2 years, Modified Bauer score appeared to be the most reliable system for predicting survival (Cronbach alpha=25%). Conclusions: According to this analysis, lung cancer, visceral metastasis, pathologic vertebra fracture, and undergone spinal surgery have shown a negative effect on survival. All 4 scoring systems were reliable for predicting survival of patients with spinal metastatic disease. However, modified Bauer scoring system seems to be more predictive after 2 years.Item Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study(2019) Lakadamyali, Huseyin; Kivanc, Tulay; 30942958Introduction Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. Objective It was aimed to determine relationship and survival between COPD and CIMT. Methods CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. Results There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT >= 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). Conclusion This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.