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    Cytoreductive Nephrectomy in the Targeted Treatment Era
    (2015) Yaycioglu, Ozgur
    To evaluate the role of cytoreductive nephrectomy (CRN) in the treatment of metastatic renal cell carcinoma in targeted therapy era in the light of contemporary data reported in the literature. Recent findings reported in retrospective studies indicate that although the CRN rates are lower than before, the procedure is related with improved survival. Several objective criteria have been proposed for proper patient selection. Results of ongoing prospective studies will help to clarify the role of CRN in the targeted therapy era. Level one evidence is lacking for the role of CRN in the targeted treatment era. However, current data show that the procedure has an essential part in the multidisciplinary treatment of metastatic renal cell carcinoma. Individualization of the treatment decisions is important since not all patients benefit from the operation.
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    Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus
    (2017) Haberal, Ali; Kocaman, Eda; Dursun, Polat; Ayhan, Ali; Korkmaz, Vakkas; Meydanli, Mehmet Mutlu; Yalcin, Ibrahim; Sari, Mustafa Erkan; Sahin, Hanifi; Gungor, Tayfun; 0000-0002-1741-7035; 0000-0002-1486-7209; 0000-0002-7869-9662; 29027396; AAI-9331-2021; AAJ-5802-2021
    Objective: To compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus. Methods: A total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity. Results: Systematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR-], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR-, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR-, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively. Conclusion: The ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.
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    Hepatosellüler karsinomda tedavi yaklaşımları
    (Hematoloji Onkoloji Dergisi ,18 ,4 ,248-253, 2008) Yıldırım, Yeşim; Özyılkan, Özgür; Karakayalı, Hamdi; Haberal, Mehmet
    Hepatosellüler karsinoma (HCC) özellikle viral hepatit insidansı yüksek olan Asya ve Uzak Doğu'da sık görülen bir tümördür. Viral hepatitlere bağlı kronik karaciğer hastalığı zemininde gelişen HCC da tedavi gerektiren sadece tümörün kendisini değil aynı zamanda altta yatan karaciğer hastalığıdır. Cerrahi rezeksiyon, küratif bir yöntem olmasına rağmen sirozun varlığı hastaların %90'nında rezeksiyona engel olmaktadır. Bununla beraber sıklıkla yaygın ya da çoklu lezyonlara rastlanıldığı için, hastalar küratif rezeksiyona uygun olmamaktadırlar. Karaciğer transplantasyonu hem altta yatan kronik karaciğer hastalığının tedavisinde hem de HCC tedavisinde kür sağlayıcı bir tedavidir, merkezimizde genişletilmiş kriterlerle yapılan karaciğer transplantasyonlarda oldukça başarılı sonuçlar alınmaktadır. Cerrahi girişime uygun olmayan hastalarda lokal ablatif tedaviler gündeme gelmektedir. Transarteriel kemoembolisazyon (TACE), perkütan alkol enjeksiyonu (PAE) ya da radyofrekans ablasyon (RF) sık kullanılan yöntemler olup, küçük solid lezyonlarda etkili olabilmektedir. Ekstrahepatik yayılım varlığında, cerrahi rezeksiyona uygun olmayan hastalarda sistemik kemoterapiler kullanılmaktadır. Sisplatin, doksorubisin, etoposit ve 5-Florourasil gibi pek çok ilaç tek başına yada kombine olarak kullanılmış ancak yanıt oranları %8-18 ile sınırlı kalmıştır. Sisplatin, interferon-alfa-2b, doksorubisin ve 5-florourasil (PIAF) kombinasyonu ile bu grup hastalarda yüksek yanıt oranı elde edilmiş olmasına rağmen doksorubisinle karşılaştırıldığında sağ kalım avantajı sağlamadığı görülmüştür. Ciddi morbiditesi olması nedeniyle bu kombinasyonun henüz standart olarak kabul edilmemektedir. Son yıllarda HCC da etkinliği gösterilen bir ajanda, Raf kinaz inhibitörü olan sorafenibdir. Faz III çalışmada plaseboya karşı anlamlı olarak sağ kalım avantajı sağladığı gösterildiğinden dolayı, sorefenib HCC'un tedavisinde umut verici gibi görünmektedir. Hepatocelluler carcinoma is common especially in Asia and Far East where the incidence of viral hepatitis is very high. Treatment of HCC includes the treatment of underlying chronic liver disease caused by viral hepatitis and the tumor itself. Although, surgical resection is the curative treatment procedure for the disease, presence of cirrhosis hinders the resection at about 90% of patients. Besides, owing to diffuse and multiple lesions, most of the patients are not suitable for the curative resection. Liver transplantation can cure both the underlying chronic liver disease and the HCC. Liver transplantation are performed according to expanded criteria and successful results have been obtained at our center. Local and ablative treatments are put on to the agenda in patients whom are not suitable for surgical intervention. Transarterial chemoembolisation (TACE), percutaneous alcohol injections (PAI) and radiofrequency ablation (RF) are the most common procedures that are effective in small solitary lesions. Systemic chemotherapies are used in the case of extrahepatic dissemination or in patients with unresectable disease. Cisplatin, doxorubicin, etoposite and 5-flourouracil have been used both as a single agent and in combinations but the response rates are limited between 8 to 18%. In this group of patients although the higher response rate was achieved with the combination of cisplatin, interferon-?-2b, doxorubicin and 5-flourouracil (PIAF), no survival advantage was obtained when compared with doxorubicin. This combination has not been accepted as a standard because of its severe morbidity. Recently sorefenib, a Raf kinase intibitor, was shown to be effective in HCC. Owing to survival advantage in a phase III trial when comparing to placebo, sorefenib seems to be proming agent in HCC.