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    Cardiac angiosarcoma treated with 1.5 Tesla MR-guided adaptive stereotactic body radiotherapy-Case report and review of the literature
    (2022) Noyan, Asli; Yavas, Guler; Arslan, Gungor; Yavas, Cagdas; Onal, Cem; 0000-0002-2742-9021; 36027835; D-5195-2014
    Introduction: Cardiac angiosarcoma is a very rare disease. As a result of their nonspecific presentation symptoms, and the lack of consensus in treatment, caution should be taken in both diagnosis and treatment. The role of radiotherapy (RT) is debatable due to the continuous movement of the heart, which makes it difficult to safely deliver high radiation doses to the target volume.Presentation of case: The case of a 16-year-old boy with cardiac angiosarcoma that recurred one year after surgery and was treated with chemotherapy is presented. The patient received high field 1.5-Tesla (magnetic resonance) MR-Linac treatment in 5 fractions with a dosage of 25 Gy to the tumor bed and 30 Gy to the recurrent nodules using the simultaneous integrated boost technique. The patient tolerated the treatment well and had stable disease two months later. Discussion: MR-guided radiotherapy, particularly in the case of cardiac malignancies, allows for direct tumor visualization with high soft tissue image resolution capacity. Furthermore, modern RT techniques allow for the full therapeutic window to be used by achieving superior dose distributions, allowing for dose escalation stra-tegies with tolerable toxicity rates.Conclusion: Magnetic resonance guided RT allows direct visualization of the target during treatment delivery, allowing for higher-dose administration with less damage to healthy tissue near the tumor. This treatment strategy is a viable option in selected patients with cardiac angiosarcoma.
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    The utility of 1.5 tesla MR-guided adaptive stereotactic body radiotherapy for recurrent ovarian tumor - Case reports and review of the literature
    (2022) Yavas, Guler; Kuscu, Ulku Esra; Ayhan, Ali; Yavas, Cagdas; Onal, Cem; 36261943
    Introduction: Although epithelioid ovarian cancer (EOC) is a radiosensitive tumor and radiotherapy (RT) played a significant role in adjuvant treatment management in the past, the role of RT has evolved with the advent of platinum-based chemotherapy regimens. Nonetheless, modern RT techniques may be useful in certain patients particularly those with recurrent disease.Presentation of case: After surgery and chemotherapy, two patients, aged 57 and 70, presented with recurrent lesions in the parailiac region. The recurrent lesions were treated with high field 1.5-Tesla MR-Linac treatment in 5 fractions at a dose of 30 Gy. The patients tolerated the treatment well and were disease free after 12 and 20 months of magnetic resonance guided radiotherapy (MRgRT), respectively.Discussion: MRgRT is a novel and rapidly evolving technology that allows for the highly precise treatment of even mobile targets through direct visualization of the tumor. The majority of patients with EOC frequently present with abdominal-pelvic recurrences. It has been demonstrated that EOC requires high radiation doses for curative treatment. MR-Linac enables monitoring of organ motion during treatment, which is necessary for delivering higher doses to target volumes while sparing surrounding organs.Conclusion: To reduce radiation doses to nearby normal tissues, MRgRT allows for the delivery of hypofractio-nated RT with tight safety margins. Regardless of initial resistance or gradual development of intolerance to standard chemotherapy regimens, the role of RT in patients with persistent or recurrent EOC should be reconsidered.
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    Prognostic Value of Metabolic Response Measured by FDG-PET-CT in Patients with Breast Cancer Liver Metastasis Treated with Stereotactic Body Radiotherapy
    (2018) Guler, Ozan Cem; Torrun, Nese; Akkus Yildirim, Berna; Onal, Cem; 0000-0001-6908-3412; AAC-5654-2020
    OBJECTIVE To investigate the impact of metabolic response measured by 18-fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET-CT) in patients with breast cancer liver metastasis (BCLM) treated with stereotactic body radiotherapy (SBRT). METHODS The medical records of 17 patients with BCLM treated with SBRT between March 2013 and October 2017 were investigated retrospectively. Patients received SBRT for their liver metastasis, and thereafter, a second FDG-PET-CT was performed for response assessment in a median of 4.1 (2.2-8.2) months. A total of 54 Gy in three fractions were delivered to liver metastatic lesions. The standardized uptake value (SUV) and survival rates were evaluated. RESULTS After a median follow-up time of 11.5 (3.2-48.9) months, there was a significant difference between pre- and post-SBRT SUVs (p<0.001). Complete metabolic response was observed in 14 (82%) patients, partial metabolic response was observed in 2 (12%) patients, and stable metabolic disease/progressive metabolic disease was observed in 1 (6%) patient at post-treatment PET-CT. The 1- and 2-year overall survival rates were 68% and 57%, respectively, and the 1- and 2-year progression-free survival rates were 38% and 25%, respectively. CONCLUSION PET-CT is an effective tool for response monitoring in patients with BCLM treated with SBRT.