Fakülteler / Faculties
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Item Comparison of Helical and TomoDirect Techniques with Simultaneous Integrated Boost in Early Breast Cancer Patients(REPORTS OF PRACTICAL ONCOLOGY AND RADIOTHERAPY, 2023) Onal, Cem; Bozca, Recep; Oymak, Ezgi; Guler, Ozan CemBackground: The aim of the study was to perform dosimetric comparisons of helical (H) and TomoDirect (TD) plans for whole-breast irradiation (WBI) with simultaneous integrated boost (SIB) in early-stage breast cancer patients undergoing breast conserving surgery.Materials and methods: Fifty patients, 25 with left-side and 25 with right-side tumors, were determined for a treatment planning system for a total dose of 50.4Gy in 1.8Gy per fraction to WBI, with a SIB of 2.3Gy per fraction delivered to the tumor bed. The planning target volume (PTV) doses and the conformity (CI) and homogeneity indices (HI) for PTV(breast )and PTVboost, as well as organ-at-risk (OAR) doses and treatment times, were compared between the H and TD plans.Results: All plans met the PTV coverage criteria for the H plan, except for mean V107 of PTVbreast for TD plan. The H plan yielded better homogeneity and conformity of dose distribution compared to the TD plan. The ipsilateral mean lung doses were not significantly different between the two plans. The TD plans is advantageous for mean doses to the heart, contralateral breast and lung, spinal cord, and esophagus than the H plans. In both the H and TD plans, the right-sided breast patients had lower heart dose parameters than the left-sided breast patients. The TD plan is superior to the H plan in sparing the contralateral breast and lung by decreasing low-dose volumes.Conclusions: While the OAR dose advantages of TD are appealing, shorter treatment times or improved dose homogeneity and conformity for target volume may be advantageous for H plan.Item Chemotherapy and Biological Treatment Options in Breast Cancer Patients with Brain Metastasis: An Update(2014) Arslan, Cagatay; Dizdar, Omer; Altundag, Kadri; 25032884Introduction: Breast cancer (BC) is the second most common cause of CNS metastasis. Ten to 20% of all, and 38% of human epidermal growth factor-2 (+), metastatic BC patients experience brain metastasis (BM). Prolonged survival with better control of systemic disease and limited penetration of drugs to CNS increased the probability of CNS metastasis as a sanctuary site of relapse. Treatment of CNS disease has become an important component of overall disease control and quality of life. Areas covered: Current standard therapy for BM is whole-brain radiotherapy, surgery, stereotactic body radiation therapy for selected cases, corticosteroids and systemic chemotherapy. Little progress has been made in chemotherapy for the treatment of BM in patients with BC. Nevertheless, new treatment choices have emerged. In this review, we aimed to update current and future treatment options in systemic treatment for BM of BC. Expert opinion: Cornerstone local treatment options for BM of BC are radiotherapy and surgery in selected cases. Efficacy of cytotoxic chemotherapeutics is limited. Among targeted therapies, lapatinib has activity in systemic treatment of BM particularly when used in combination with capecitabine. Novel agents are currently investigated.Item Predictors Determining the Status of Axilla in Breast Cancer: Where is PET/CT on That?(2015) Aytac, Huseyin Ozgur; Colacoglu, Tamer; Nursal, Gul Nihal; Nursal, Tarik Zafer; Bolat, Filiz Aka; Yabanoglu, Hakan; Yildirim, Sedat; Moray, Gokhan; 0000-0002-3583-9282; 0000-0003-0268-8999; 0000-0003-2498-7287; 0000-0002-5735-4315; 0000-0002-5302-4386; 0000-0002-3462-7632; 0000-0002-1161-3369; 0000-0003-2031-7374; 26537078; AAJ-7913-2021; AAK-2011-2021; AAE-1041-2021; AAF-4610-2019; R-3735-2016; IQV-1169-2023; AAJ-8097-2021; AAJ-7865-2021; HJZ-1654-2023Purpose: 18 F-FDG PET/CT has an acceptable specificity but a low sensitivity on the prediction of axillary lymph node (ALN) metastasis in breast cancer. We analyzed the factors that could possibly affect this prediction. Methods: The records of 270 patients with T1-2 invasive breast cancer who underwent surgery, 116 of whom had been evaluated by preoperative 18 F-FDG PET/CT were reviewed. Prediction of ALN status by PET/CT according to tumor stage, estrogen receptor (ER), progesterone receptor (PgR) and HER2 status, histology, age and sentinel node properties was assessed. Results: ALN metastasis was present in 62 of 131 T1 (43.7%) and 106 of 142 T2 tumors (74.6%), 20 of 46 (43.5%) ER(-) and 146 of 222 (65.8%) ER(+) tumors, 38 of 71 (53.5%) PgR(-) and 127 of 200 (63.5%) PgR(+) tumors. On multivariate analysis only the tumor size (>2 cm) independently correlated with ALN metastasis (Odds ratio/OR=3.1). None of the other parameters had statistical significance in terms of ALN prediction on FDG-PET/CT. Conclusion: Though T2 tumors showed increased tendency to metastasize to the axilla, prediction of ALN metastasis in preoperative FDG-PET/CT was not associated with any of the predictive factors.Item Using Machine Learning Methods in Early Diagnosis of Breast Cancer(2021) Erkal, Begum; Ayyildiz, Tulin Ercelebi; https://orcid.org/0000-0002-7372-0223; JBI-6492-2023Breast cancer is one of the most important health diseases to be treated in the world, and it is a subject that has a wide place in research subjects. In this study, results are provided by using seven different machine learning techniques for the classification of breast cancer. In order to obtain better results, the preprocessing method was applied. As a result, when compared with some studies in the literature, it was observed that the general performance of some of the methods improved. In the experimental results, BayesNet was found to be the best classification method with an accuracy rate of 97.13%.Item The Evaluation of Laparotomy Results in Breast Cancer Patients with Gynecological Pathologies(2020) Sahin Uysal, Nihal; Boyraz, Gokhan; Usubutun, Alp; Tuncer, Zafer S.; 0000-0001-5385-5502; 32779347; AAA-9475-2020Aim The aim of the study was to evaluate the results of the laparotomies due to gynecological pathologies in breast cancer patients and to assess the distribution of gynecological pathologies and the clinical and laboratory findings contributing to the diagnosis. Methods This study was conducted between years 2002 and 2011 at Hacettepe University Hospital. We obtained information about 86 consecutive breast cancer patients, including age, time of diagnosis and pathology of breast cancer, hormone receptor status, history of endocrine therapy, presenting symptoms, ultrasonography findings, CA 125 levels, endometrial biopsy results, type of gynecological surgery and pathology results. Data were analyzed with the use of SPSS software. Results Twenty-one (24.4%) out of 86 patients had endometrial pathology, and 24 (27.9%) had adnexal pathology. Fourteen patients (16.2%) had malignant pathology, and of them, 11 had ovarian cancer 3 had endometrial cancer. There were five abnormal cytological findings: 2 ASCUS, 1 LSIL, 1 ASC-H and 1 adenocarcinoma. The patient with the cytology report of adenocarcinoma had the final diagnosis of endometrial cancer. Of the patients, 67 (77.9%) used tamoxifen, whereas 19 (22.1%) did not. Thirty-three patients (38.4%) with gynecological pathologies were detected incidentally during routine follow-up of breast cancer. Conclusion This study supports the increase of the gynecological pathology incidence in breast cancer patients and the recommendation of close gynecological follow-up in these patients. Asymptomatic patients might also develop genital cancer. The ultrasonographic appearance of the adnexal masses or endometrial thickness and any abnormal vaginal bleeding or high CA 125 levels are important parameters for evaluating breast cancer patients.Item Is PET/CT Necessary in the Management of Early Breast Cancer?(2016) Nursal, Gul Nihal; Nursal, Tarik Zafer; Aytac, Huseyin Ozgur; Hasbay, Bermal; Torun, Nese; Reyhan, Mehmet; Yapar, Ali Fuat; https://orcid.org/0000-0002-5302-4386; https://orcid.org/0000-0002-3583-9282; https://orcid.org/0000-0002-5597-676X; https://orcid.org/0000-0001-8550-3368; https://orcid.org/0000-0003-1715-4180; 26914560; R-3735-2016; IQV-1169-2023; AAJ-7913-2021; AAE-2718-2021; AAJ-5242-2021; AAI-8973-2021Purpose Advanced imaging methods in early breast cancers are not recommended before surgery. In contrast to the accepted guidelines, some recent studies have shown some benefits with the use of PET/CT in early-stage breast cancer. In this study, we aimed to document the efficacy of PET/CT in detection of distant metastasis as well as other primary cancers. Patients and Methods In this retrospective study, we reviewed the records of all women patients diagnosed with early breast cancer between March 2012 and December 2014. Besides demographics, we recorded the clinical TNM stage, histology of the tumor, and hormone receptor status. As PET/CT imaging is a routine procedure in our center for early breast cancer, tumor size, lymph node status, distant metastasis, and possible other primary malignancies detected by PET/CT were also recorded. Results Of the 419 women included in the study, 24.8% were clinically staged as stage I while the rest were stage II. Distant metastases were detected in 42 patients (10%). The yield of PET/CT in detecting metastasis was significant in stage II patients compared with stage I patients (12.4% vs 2.9%). In subgroup analysis of stage II patients, the performance of PET/CT in detecting metastasis was still evident in stage IIA patients (9.5%). In logistic regression analysis of the significant and near-significant factors (as detected by univariate analysis) effecting PET/CT detected distant metastasis, only nodal status (P = 0.053) was found to be significant. Conclusions We suggest the use of PET/CT in investigating metastasis in axilla positive and clinically stage II early breast cancer patients.Item Response Rates of Taxane Rechallenge in Metastatic Breast Cancer Patients Previously Treated with Adjuvant Taxanes(2016) Kucukoztas, Nadire; Oguz, Arzu; Rahatli, Samed; Altundag, Ozden; Altundag, Kadri; 0000-0003-0197-6622; 0000-0001-5588-0306; 0000-0003-3163-7429; 0000-0001-6512-6534; 27837607; W-9219-2019; AAM-3226-2021; AAJ-3047-2021; W-8004-2019Purpose: This study was conducted to determine the efficacy of taxane-based regimens in patients with metastatic breast cancer pre-treated with taxanes in adjuvant treatment and also to assess the response rates of taxanes in each treatment line. Methods: The data of 939 breast cancer patients, who had received adjuvant taxane-based chemotherapy, were reviewed retrospectively. In 191 of them local/distant recurrences were detected. The treatments that were given when metastases occurred and the responses were recorded. Response rates (RRs), clinical benefit rates/CBR (complete response/CR + partial response/PR + stable disease/SD) and progression-free (PFS) and overall survival (OS) values were determined. RRs to the most frequently used protocols in our institutes (capecitabine-based and taxane-based regimens) were compared. Results: Of 191 patients, 11 didn't receive treatment and for the remaining 180 patients 45 (24%) received taxane-based therapies, 89 (49.4%) received capecitabine-based therapies, 28 (15.6%) received hormonotherapy and 18 (10%) received other chemotherapeutics. The RR for first-line taxane regimen was 58.5%, consisting of 5 CRs (12%) and 19 PRs (46%). Menopausal status, histological grade, estrogen/progesterone receptors, cerbB2 status, having PFS > ors 2 years and the site of metastases did not predict response to first-line taxane treatment. For the 2nd and 3rd or later line therapies, RRs of taxane rechallenge were above 40%. Conclusion: Rechallenging with taxanes after (neo)adjuvant taxane exposure seems to be a reasonable option even in 3rd or further line treatments with high response rates.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 Management of MRI-Detected Benign Internal Mammary Lymph Nodes(2022) Gunes, Gozde; Crivellaro, Priscila; Muradali, Derek; 0000-0003-0991-1380; 35924122; G-4374-2017Introduction In this retrospective study, we aimed to evaluate benign internal mammary lymph nodes (IMLNs) in terms of frequency, number, size, long axis/short axis (L/S) ratio, intercostal location, presence of fatty hilum, and stability using breast magnetic resonance imaging (MRI) and discuss the findings by reviewing existing literature. Methods This single-center study consisted of 130 women between the ages of 24 and 76 years, who had at least two breast MRI examinations in our institution, with the latest exam performed between January 1, 2019 and November 1, 2019, were eligible for the study. MRIs of the study group were independently reviewed by two radiologists. Results IMLN was detected in 31.1% of the 427 MRIs, with a total number of 256 nodes. The most common indication for breast MRI was high-risk screening (66.2%). The median number of nodes per patient was 1 (range: 1-6). The median follow-up time was 19.5 months (range: 6-141 months). None of these benign nodes showed significant interval growth. Mean L/R ratio of the nodes was 1.9. One hundred and four nodes (n = 104, 40.6%) had a L/S ratio less than 2 and 43.2% (n = 45) of the nodes with a L/S ratio less than 2, had a long axis measuring less than or equal to 3mm. IMLN of patients with breast implants had the largest mean long axis. The fatty hilum was identified in 34.3% (n = 68) of the 256 nodes. The size of the lymph nodes where fatty hilum was visualized was significantly larger than the ones where fatty hilum was not visualized (p < 0.001). Fatty hilum could be visualized in only 2.7% of the nodes with a long axis smaller than 3 mm. Conclusion IMLN is a frequent finding on breast MRI. We have shown that benign IMLNs might be large sized in specific cases like patients with breast implants. When small sized (<= 3mm), they are more likely to be rounded (1/S ratio <2). The fatty hilum that is a feature of benignity might not be visualized in nodes less than or equal to3mm.Item The Role of Combined Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced MRI for Differentiating Malignant From Benign Breast Lesions Presenting Washout Curve(2021) Tezcan, Sehnaz; Ozturk, Funda Ulu; Uslu, Nihal; Akcay, Eda Yilmaz; 32157892Purpose: The aim of this study is to evaluate the diagnostic performance of combined breast magnetic resonance imaging (MRI) protocol including dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in patients with enhancing lesions that demonstrated washout curve and to determine whether applying apparent diffusion coefficient (ADC) cutoff value could improve the diagnostic value of breast MRI. Methods: The retrospective study included 116 patients with 116 suspicious breast lesions, which showed washout curve on DCE-MRI, who underwent subsequent biopsy. Morphologic characteristics on DCE-MRI and ADC values on DWI were evaluated. Apparent diffusion coefficient values and morphologic features of benign and malignant lesions were compared. Diagnostic values of DCE-MRI and combined MRI, including DCE-MRI and DWI (applying an ADC cutoff value) for distinguishing malignancy from benign lesions, were calculated. Results: Of the 116 breast lesions, 79 were malignant and 37 were benign. The ADC value of malignant tumors (median ADC, 0.72 x 10(-3) mm(2)/s) was significantly lower than that of benign lesions (median ADC, 1.03 x 10(-3) mm(2)/s; P < .000). The sensitivity and specificity of an ADC cutoff value of 0.89 x 10(-3) mm(2)/s were 92% and 95%, respectively. Dynamic contrast-enhanced MRI alone presented 100% sensitivity and 59.4% specificity. Adding an ADC cutoff value of 0.89 x 10(-3) mm(2)/s provided 100% sensitivity and 81% specificity, which would have prevented biopsy for 21.6% of benign lesions without missing any malignancies. Conclusion: Applying an ADC cutoff value to DCE-MRI provides an improvement in the diagnostic value of breast MRI for differentiating among lesions presenting washout curve.