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OBJECTIVE We investigated the outcomes of radiotherapy (RT) combined with systemic chemotherapy (CHT) including carboplatin and paclitaxel in patients with locally advanced non-small-cell lung cancer. METHODS This retrospective study included 105 patients. Treatment involved concurrent carboplatin and paclitaxel with RT administered weekly followed by two cycles of consolidation carboplatin and paclitaxel administered triweekly. RESULTS Comorbid disease was present in 46 (48.6%) patients. At least four cycles of CHT in the concurrent phase and both cycles of CHT in the consolidation phase were able to be administered to 92.3% and 45.4% of patients, respectively. The most common type of toxicity in the entire treatment protocol was hematological toxicity (34.8%). The objective response rate was 71.4%. Overall, recurrence was found in 71 (67.6%) patients. The most common type of recurrence was distant metastasis, which occurred in 47 (66.2%) patients. The median progression-free survival was 14 months. The 1, 2, and 3-year progression-free survival rates were 59%, 30%, and 26%, respectively. The median overall survival was 27 months. The 1, 2, and 3-year overall survival rates were 81%, 57%, and 34%, respectively. CONCLUSION The survival outcomes in this study closely match those reported in the literature. This is notable because our study included a higher proportion of patients with additional health conditions and fewer concurrent CHT cycles during RT compared to randomized studies. These findings prompt us to consider what the ideal number of concurrent CHT cycles should be when using modern involved-field RT techniques after accurate disease staging. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We compared the survival outcomes of surgery within multimodality treatment regimens with the outcomes of definitive chemoradiation treatments in patients diagnosed with clinical (c) IIIB/N2 non-small cell lung cancer (NSCLC). We investigated whether surgery within multimodality treatment provides a survival advantage at this stage. MATERIAL AND METHODS: Data from 79 patients with cIIIB/N2 between 2009 and 2016 were analyzed retrospectively. While the surgery was performed after neoadjuvant therapy in 51 cases (IIIB/Surgery Group), definitive chemotherapy ± radiotherapy was applied in 28 cases (IIIB/Definitive Group). RESULTS: In cIIIB/N2 cases, the 5-year overall survival (OS) was 27.4%, with a median OS of 24.6 months. The 5-year OS of the IIIB/ Surgery Group was 27.3% (median survival 22.5 months), while it was 28.6% (median survival 29.1 months) in the IIIB/Definitive Group (P = .387, HR = 0.798, 95% CI, 0.485-1.313). Although there was a survival advantage in the group with a pathological complete response (PCR) after surgery (n = 14) compared to the group that did not (n = 37), the observed difference was not statistically significant. (5-year OS; 42.9% vs. 18.5%, P = .104). Additionally, there was no statistically significant difference between the survival of PCR patients and the IIIB/Definitive Group in terms of OS (P = .488). CONCLUSION: Surgery performed within multimodality treatment regimens in selected cIIIB/N2 cases did not provide a survival advantage over definitive chemoradiation treatments. [ABSTRACT FROM AUTHOR]

OBJECTIVE This study's objective is to assess the effectiveness of treatment and the prognostic factors that affect survival in 28 patients with epithelial thymic tumors who had adjuvant or definitive radiotherapy (RT) at our facility. METHODS The study comprised 28 patients who received RT at the Radiation Oncology Department of Eskişehir Osmangazi University Faculty of Medicine between 2010 and 2021. Each patient received RT (3DCRT/IMRT/VMAT). RESULTS The median overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) at a median follow-up of 74 months were 76 (3-201), 29, and 57 (0-198) months, respectively. The median RT dose was 50 Gy (44-66). While there was no statistically significant difference between DFS and RT doses (p=0.88), there was a statistically significant difference between PFS and OS and 50 Gy and higher doses (p=0.03 vs. p=0.02). CONCLUSION Post-operative RT has been proven to be beneficial in cases of incomplete resection, even if the role of adjuvant RT in patients with complete resection remains debatable. It is well established that primary unresectable thymic tumors can be treated safely and successfully with neoadjuvant or definitive chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated the effects of calreticulin (CALR) and JAK2V617F mutational status on clinical course and disease outcomes in Turkish patients with essential thrombocythemia (ET). Materials and Methods: Seventeen centers from Türkiye participated in the study and CALR- and JAK2V617F-mutated ET patients were evaluated retrospectively. Results: A total of 302 patients were included, of whom 203 (67.2%) and 99 (32.8%) were JAK2V617F- and CALR-positive, respectively. CALR-mutated patients were significantly younger (51 years vs. 57.5 years, p=0.03), with higher median platelet counts (987x109/L vs. 709x109/L, p<0.001) and lower median hemoglobin levels (13.1 g/dL vs. 14.1 g/dL, p<0.001) compared to JAK2V617F-mutated patients. Thromboembolic events (TEEs) occurred in 54 patients (17.9%), 77.8% of which were arterial. Compared to CALR mutation, JAK2V617F was associated with a higher risk of thrombosis (8.1% vs. 22.7%, p=0.002). Rates of transformation to myelofibrosis (MF) and leukemia were 4% and 0.7%, respectively, and these rates were comparable between JAK2V617F- and CALR-mutated cases. The estimated overall survival (OS) and MF-free survival of the entire cohort were 265.1 months and 235.7 months, respectively. OS and MF-free survival durations were similar between JAK2V617F- and CALR-mutated patients. Thrombosis-free survival (TFS) was superior in CALR-mutated patients compared to JAK2V617F-positive patients (5-year TFS: 90% vs. 71%, respectively; p=0.001). Age at diagnosis was an independent factor affecting the incidence of TEEs. Conclusion: In our ET cohort, CALR mutations resulted in higher platelet counts and lower hemoglobin levels than JAK2V617F and were associated with younger age at diagnosis. JAK2V617F was strongly associated with thrombosis and worse TFS. Hydroxyurea was the most preferred cytoreductive agent for patients with high thrombosis risk. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is the third most common and second deadliest cancer globally. Increasingly, early‑onset colorectal cancer is diagnosed in those under 50 years, leading to some countries advising screenings from ages 40 or 45 years. The ’position of the tumor, right or left, impacts the characteristics and prognosis of early‑onset colorectal cancer. Objectives: Investigating the 5‑year disease‑free and overall survival and histopathologic nature of left‑ and right‑sided early‑onset colorectal cancer. Design: Retrospective study. Setting: Koc University and VKF American Hospital. Materials (Patients) and Methods: Our population includes patients under 50 years with invasive colon cancer treated in two tertiary Turkish hospitals from 2014 to 2019. Of 178 patients, 74.3% had left‑sided tumors. Sample Size: One hundred and seventy‑eight patients. Main Outcome Measures: Histopathological features of left‑ and right‑sided colorectal tumors, and the 5‑year disease‑free and overall survival rate in patients under 50 years of age. Results: The 5‑year disease‑free survival was higher in right‑sided tumors(78.2% vs. 53.1%), but overallsurvival wassimilar. No significant histopathological differences were noted between left‑ and right‑sided tumors, but right‑sided tumors had more mucinous adenocarcinoma and high microsatellite instability (MSI). Conclusion: Our data did not show a difference in survival between right‑ and left‑sided tumors in the age group <50 years contrary to other published literature. Limitations: Retrospective nature and inclusion of a single center, which usually serves Turkiye population with a higher socioeconomic status. The retrospective nature of the study makes it susceptible to selection bias. The small sample size precludes robust group matching and diminishes the statistical power, increasing the risk of Type II errors. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease-2019 pandemic has shown us that postponing elective surgeries that include nephrectomy due to renal cell carcinomas (RCC) was undertaken by the physicians to use hospital facilities in a balanced way. However, both urologists and patients were concerned about postponements that may increase the risk of progression. To determine the optimal threshold of postponement time-period for surgery (PTP) and according to the clinical T stages in patients who underwent nephrectomy due to RCC, we used the Urologic Cancer Database-Kidney. Materials and Methods: Patients who underwent detailed clinical T stage analysis with admission and surgery dates were included in the study. PTP was calculated using the dates of definitive preoperative diagnosis and surgery date. Recurrence, overall mortality (OM), recurrence-free survival, and overall survival (OS) were evaluated. The effects of PTP on oncological outcome according to tumor diameter and clinical T stages were also evaluated. We also analyzed the optimal cut-offs of PTP based on clinical T stages. Results: Among 3.258 patients, in the evaluation of 2.946 clinically localized patients, PTP and tumor diameter were found to be important predictors of recurrence (p=0.037 and p<0.001). The optimal PTP of 30 days was found to be an important significant threshold time for the T1 stage and 20 days for T2-4 stage tumors. Patients with longer PTP according to the thresholds shown in this study had higher upstaging for clinical T1a, T2a, and T3 stages; higher recurrence rates for T1b and T2b stages; and higher OM for T2a and T3 tumors. The survival have also shown that more than 20 days of PTP affected OSs for clinical-stage T1 (p=0.019), T2 (p=0.021) and T3 (p=0.007) tumors. Conclusions: All patients with tumors, including clinical T1 tumors, had worsening oncological results as the PTP increased (>20-30 days). [ABSTRACT FROM AUTHOR]

Objective: The current study aims to evaluate the clinical presentation, treatment, and follow-up of children with Wilms Tumor (WT) who had been admitted to Erciyes University, Faculty of Medicine Department of Pediatric Hematology and Oncology hospital, a tertiary center in the central Anatolia region of Türkiye. The study assesses the survival data and features that have had an impact on survival. Materials and Methods: The current study has been planned as a retrospective observational evaluation of patients admitted to the Pediatric Hematology and Oncology Center between 1991-2021. Results: The study retrospectively evaluated a total of 48 patients in terms of demographic characteristics, presentation findings, tumor stages, histopathologies, and survival rates. Patients with an unfavorable histology had a 66.7% chance of both event-free survival (EFS) and overall survival (OS), which is lower than the respective 85.2% and 92.1% odds of EFS and OS for the favorable histology group. However, this is not statistically significant (p = 0.20 for EFS and p = 0.05 for OS). Regarding the impact of stage on survival rates, the EFS and OS for patients with the low-stage disease were 88% and 95.7%, respectively. These rates were significantly superior to those at an advanced stage of the disease, whose EFS and OS were 63.1% and 60.9%, respectively (p = 0.042 for EFS, p = 0.005 for OS). Conclusion: Wilms tumor at an advanced stage and with an unfavorable histology are the major factors resulting in poor survival rates. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite advances in treatment generated by clinical trials in metastatic breast cancer (MBC), their impact on routine daily practice and the reflection of the outcome within the community remains unclear. This study evaluates time-related differences in treatment patterns and outcome in a real-world patient population with MBC over a ten-year timeframe. Except for the HER2+ subgroup, which showed a significant survival benefit with the incorporation of novel agents, we failed to identify significant variations in outcomes for the remaining subgroups. A consistent feature we observed was the challenge in treating TNBC, which had the worst prognosis in both time-related cohorts. Elucidation of biologic characteristics to identify novel treatment options remains an unmet need to improve outcomes in TNBC. The favorable survival attained with routine endocrine agents in the luminal A subgroup suggests that barriers in access to CDK inhibitors may not have a negative impact on the outcome in subgroups of hormone receptor-positive patients, constituting an appealing strategy for communities with limited resources. This multicenter registry study aims to analyze time-related changes in the treatment patterns and outcome of patients with metastatic breast cancer (MBC) over a ten-year period. Correlations between demographic, prognostic variables and survival outcomes were carried out in database aggregates consisting of cohorts based on disease presentation (recurrent vs. de novo) and the diagnosis date of MBC (Cohort I: patient diagnosed between January 2010 and December 2014; and Cohort II: between January 2015 and December 2019). Out of 1382 patients analyzed, 52.3% patients had recurrent disease, with an increased frequency over time (47.9% in Cohort I vs. 56.1% in Cohort II, p < 0.001). In recurrent patients, 38.4% (n = 277) relapsed within two years from initial diagnosis, among which triple-negative BC (TNBC) was the most frequent (51.7%). Median overall survival (OS) was 51.0 (48.0–55.0) months for all patients, which was similar across both cohorts. HER2+ subtype had the highest OS among subgroups (HER2+ vs. HR+ vs. TNBC; 57 vs. 52 vs. 27 months, p < 0.001), and the dnMBC group showed a better outcome than recMBC (53 vs. 47 months, p = 0.013). Despite the lack of CDK inhibitors, luminal A patients receiving endocrine therapy had a favorable outcome (70 months), constituting an appealing approach with limited resources. The only survival improvement during the timeframe was observed in HER2+ dnMBC patients (3-year OS Cohort I: 62% vs. Cohort II: 84.7%, p = 0.009). The incorporation of targeted agents within standard treatment has improved the outcome in HER2+ MBC patients over time. Nevertheless, despite advances in early diagnosis and treatment, the prognosis of patients with TNBC remains poor, highlighting the need for more effective treatment options. [ABSTRACT FROM AUTHOR]

OBJECTIVE It is known that cancer patients are more prone to infections than the general population. We aimed to describe the risk factors affecting the survival of cancer patients infected with COVID-19 and clinical findings compared with a large COVID-19 patient population without cancer diagnosis. METHODS The clinical data of 61 cancer and 558 non-patients with COVID-19 infection who applied to the emergency room were compared retrospectively. Risk factors affecting overall survival in cancer patients were analyzed. RESULTS Gender and mean age were comparable in both groups. In the entire cohort, cancer diagnosis was found to be an independent poor prognostic factor (hazard ratio [HR] = 3.09, p<0.001) among other comorbidities. In univariate analysis; lung cancer, activated partial thromboplastin time >32 seconds, INR >1.1, N-terminal-pro-B-type natriuretic peptide (NT-proBNP) >400 pg/ml, C-reactive protein >100 mg/L, and procalcitonin >0.23 ng/mL were determined as prognostic risk factors. Lung cancer (HR=5.277, p=0.012) and NT-proBNP >400 pg/ml (HR=0.139, p=0.021) were determined as independent prognostic risk factors in multivariate analysis. CONCLUSION Cancer patients with COVID-19 infection have poor survival outcomes. Lung cancer diagnosis and elevated NT-proBNP levels were identified as the most crucial prognostic risk factors in cancer patients infected with COVID-19. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine factors affecting mortality and survival after Percutaneous endoscopic gastrostomy (PEG) in patients who were hospitalized in the neurology intensive care unit during the coronavirus disease-2019 (COVID-19) pandemic. Materials and Methods: The clinical and demographic data of 29 patients aged 18 years and older who received PEG tube insertion during hospitalization in the Neurology Intensive Care Unit of Bursa City Hospital, Turkey, between February 2020 and May 2021 were examined retrospectively. Patients' demographics, clinical characteristics, and survival status were recorded. Results: We included 29 patients (16 females and 13 males) into our study. Median age was 71 (33-89) years among survivors and 75.5 (48-90) years among those who died. The groups were similar with respect to age (p = 0.119) and sex (p = 0.806). Mortality rate after PEG insertion was 66%. Mean overall survival after PEG tube insertion was 129.49 days (95% CI: 91.21-167.78). Cox regression revealed that having multiple comorbidities was associated with increased the likelihood of mortality by 2.822-fold (95% CI: 1.001-7.968, p = 0.049). Conclusions: These findings show that having multiple comorbidities was the most important factor associated with mortality among PEG recipients who were admitted to the Neurology Intensive Care Unit during the COVID-19 pandemic. Since multiple comorbidities cause shorter survival, it appears that the decision to insert PEG tubes must be made extremely cautiously among these patients. However, more comprehensive studies should be conducted to clarify the effect of COVID-19 on mortality rates and survival time after PEG. [ABSTRACT FROM AUTHOR]

Background: Cancer is a significant health problem for refugees and host countries. Breast cancer is the most common cancer among refugees. The subject of our study is to examine the clinical and pathological features of Syrian refugees with breast cancer and compare them with Turkish patients with breast cancer. Methods: Data of patients with breast cancer between January 2018 and December 2020 were retrospectively reviewed. The clinical and histological features, treatment modalities and overall survival were collected and analyzed. Results: A total number of 338 women with breast cancer were included in this study. Ninety-nine of the 338 (29.3%) patients were Syrian refugees and 239 patients (70.7%) were Turkish. The median follow-up time was significantly lower in Syrian patients (P < 0.001). Median OS was 146 months in Turkish and 116 months in Syrian group (P = 0.022). Independent risk factors associated with long survival were receiving adjuvant chemotherapy (HR 0.465; 95% CI 0.234-0.926; P = 0.029), adjuvant radiotherapy (HR 0.372 95% CI 0.182-0.758; P = 0.007), and adjuvant hormonotherapy (HR 0.367; 95% CI 0.201-0.669; P = 0.001). The rates of receiving adjuvant chemotherapy, adjuvant radiotherapy, and adjuvant hormonal therapy were significantly lower in the Syrian group (P = 0.023, P = 0.005, P = 0.002, respectively). Conclusion: Syrian refugees with breast cancer are more likely to receive suboptimal treatments. They have inferior survival compared to local patients. Our findings highlight the need for the provision of cancer therapy in such vulnerable populations. We suggest that more attention should be paid to breast cancer, as it is the most common cancer among refugees. [ABSTRACT FROM AUTHOR]

Objectives: Advanced stage biliary tract cancers (BTC) are rare malignancies with poor prognosis. There are few prospective trials, but several retrospective studies regarding treatment options. In this study, we aimed to investigate the role of systemic inflammatory parameters (SIP) and other possible independent factors that may affect survival and treatment approaches and to determine the benefit of later-line treatments in these patients.Methods: A total of 284 patients, initially diagnosed with advanced stage or progressed after curative treatment of BTC, from different oncology centers in Turkey were included in this retrospective study. The prognostic significance of clinicopathological factors, SIPs and treatment options was analyzed.Results: At a median follow-up of 13 months, the median progression-free survival (PFS) was 6.1 months (95% CI:5.51-6.82), and the median overall-survival (OS) time was 16.8 months (95% CI: 13.9-19.6). Treatment choice (p < 0.001 HR:0.70 CI95% 0.55-0.9), performance status (p < 0.001 HR:2.74 CI 95% 2.12-3.54) and neutrophil-to-lymphocyte ratio (NLR) (p = 0.02 HR:1.38 CI 95% 1.03-1.84) were independent prognostic factors for PFS. For OS, the independent prognostic indicators were determined as The Eastern Cooperative Oncology Group Performance Status (ECOG PS) (p < 0.001 HR:1.78 CI 95% 1.5-2.3), Systemic Immune-inflammation Index (SII) (p < 0.001 HR:0.51 CI95% 0.36-0.73) and stage at diagnosis (p = 0.002 HR:1.79 CI 95% 1.24-2.59). Furthermore, second and third line treatments significantly prolonged OS in advanced BTC (p < 0.001 HR:0.55 CI 95% 0.38-0.79; p = 0.007 HR:0.51 CI95% 0.31-0.83, respectively).Conclusion: SII and NLR are useful prognostic factors and may be helpful in making treatment decisions. Additionally, second and later-line treatments in advanced BTC have a significant impact on survival under real-life conditions. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the changes in epidemiological and survival characteristics of malignant mesothelioma (MM) cases diagnosed in a 30-year period between 1990 and 2019. Methods: Data were analyzed considering three time periods (1990–1999, 2000–2009, 2010–2019) when treatment practices changed. The Join point Regression Program was used to analyze the change in clinical and epidemiological characteristics of the cases. Kaplan–Meier analysis was used to calculate the overall survival of the patients. Cox regression analysis was used to determine the effect of variables on survival. Results: The study group consisted of 928 MM patients. During the study period, the mean age of the patients and the percentage of epithelioid subtype increased, while the percentage of female and histopathologically unidentified cases decreased. The median survival (95%CI) of patients according to the study periods was 9.0 (7.2–10.9), 9.0 (7.6–10.4) and 12.0 (10.5–13.5) months, respectively. A significant increase in overall survival was observed in the time trend (p = 0.013). There was no significant change in overall survival in patients receiving best supportive care over the 30-year period (p = 0.060), but an improvement of 1.4 (95%CI 0.2 to 2.7) months (p = 0.027) was observed in patient receiving chemotherapy. An improvement in overall survival of 4.8 (1.2 to 8.4) months was also observed in patients receiving multimodality treatment during 2000–2019 (p = 0.014). MM patients who were younger, female, diagnosed after 2000, epithelioid subtype, early stage, and received chemotherapy or multimodal treatment had longer survival. Conclusions: It was found that histopathological diagnosis and treatment success in MM have improved over the years. [ABSTRACT FROM AUTHOR]

Background/aim: Perioperative FLOT regimen is a standard of care in locally advanced operable gastric and GEJ adenocarcinoma. We aimed to determine the efficacy, prognostic factors of perioperative FLOT chemotherapy in real-life gastric and GEJ tumors. Materials and methods: The data of patients who were treated with perioperative FLOT chemotherapy were retrospectively analyzed from 34 different oncology centers in Turkey. Baseline clinical and demographic characteristics, pretreatment laboratory values, histological and molecular characteristics were recorded. Results: A total of 441 patients were included in the study. The median of age our study population was 60 years. The majority of patients with radiological staging were cT3-4N(+) (89.9%, n = 338). After median 13.5 months (IQR: 8.5-20.5) follow-up, the median overall survival was NR (95% CI, NR to NR), and median disease free survival was 22.9 (95% CI, 18.6 to 27.3) months. The estimated overall survival at 24 months was 62%. Complete pathological response (pCR) and near pCR was achieved in 23.8% of all patients. Patients with lower NLR or PLR have significantly longer median OS (p = 0.007 and p = 0.033, respectively), and patients with lower NLR have significantly longer median DFS (p = 0.039), but PLR level did not affect DFS (p = 0.062). The OS and DFS of patients with better ECOG performance scores and those who could receive FLOT as adjuvant chemotherapy instead of other regimens were found to be better. NLR was found to be independent prognostic factor for OS in the multivariant analysis. At least one adverse event reported in 57.6% of the patients and grade 3-4 toxicity was seen in 23.6% patients. Conclusion: Real-life perioperative FLOT regimen in operable gastric and GEJ tumors showed similar oncologic outcomes compared to clinical trials. Better performance status, receiving adjuvant chemotherapy as same regimen, low grade and low NLR and PLR improved outcomes in real-life. However, in multivariate analysis, only NLR affected OS. [ABSTRACT FROM AUTHOR]

Radiotherapy is one of the main treatment modalities for rectal cancer. Neoadjuvant chemoradiotherapy has been accepted as the standard treatment in rectal cancer. Evaluation the treatment results in patients who underwent neoadjuvant chemoradiotherapy were aimed in this study. Between 2009 and 2019, patients with local advanced rectal cancer who underwent neoadjuvant radiotherapy and subsequent surgery in our clinic were retrospectively analyzed. The clinical pathological features, treatment responses and prognostic factors affecting survival of 99 patients were investigated. Radiotherapy dose was 25 Gy in 5 fractions in 11 patients and 50.4 Gy in 28 fractions in 88 patients. Thirty-three of the patients were female and 66 were male and the median age was 60 (30-80). According to tumor locations, 30.3% are located in the upper, 26.3% in the middle, and 43.4% in the distal rectum. The distribution according to clinical radiological stages before radiotherapy were 2% T2, 72.7% T3, 25.3% T4 and 52.5% N0, 47.5% N1-2. Pathological complete response (pCR) was determined in 10.2% of the patients who received long-term chemoradiotherapy. Eight patients developed local recurrence and 12 patients developed distant metastases. Five-year disease-free and overall survival rates were 66% and 76%, respectively. Stage and location of the tumor were found to be effective factors in overall survival. No grade 3 acute or late gastrointestinal and genitourinary system toxicities were observed. Neoadjuvant chemoradiotherapy is an effective treatment for rectal cancer. Determination of clinical pathological prognostic factors in larger series will be effective in treatment selection. [ABSTRACT FROM AUTHOR]

The successful results obtained in trials may not necessarily translate into prolonged survival of metastatic colorectal cancer (mCRC) patients in real life. This multinational registry study aimed to evaluate the real-life data effecting the survival of patients with mCRC. This is a multinational, retrospective registry study. Turkish and Greek mCRC patients diagnosed between 2005 and 2012, with at least 3 years of follow-up data or who died before 3 years of follow-up were included in the study. A total of 364 were included in the study. RAS and BRAF mutation rates were found to be 36% and 39%, respectively. As first-line therapy, 196 (54%) patients received bevacizumab and Anti-EGFR treatments in combination with chemotherapy. The objective response rate was 42% (n = 152) and 32% (n = 78) for 1st line and 2nd line treatments, respectively. While the median progression-free survival (PFS) with the 1st line treatment was 10 months, it was 7 months with the 2nd line treatments. In the total study population median PFS and overall survival (OS) were 10 (95% CI, 8.3–11.6) and 35 (95% CI, 30.7–39.2) months, respectively. In Turkish and Greek patients, median OS (36 months versus 29 months, p =.81) and PFS (10.2 versus 9.2, p =.42) were not different. In multivariate analysis, ECOG PS of ≥2 and having metastases in more than one region decreased overall survival (p =.002 and p =.003), it was found that wild RAS and BRAF mutations and second metastasectomy contributed to overall survival (p =.047 and p <.001). In conclusion, it seems that the patient's performance status, tumor location, number of metastatic lesions at the time of diagnosis affect the prognosis of mCRC. Although access to molecular tests and first-line treatments differ between Greece and Turkey, no significant difference was found in survival times. [ABSTRACT FROM AUTHOR]

Background/aim: Paget’s disease (PD) of the breast is a very rare presentation of breast malignancy, accounting for 1%–3% of all primary breast tumors. We aimed to evaluate and compare the clinicopathological features and clinical outcome of PD accompanied by in situ carcinoma and invasive cancer. Materials and methods: We used the archive of our pathology laboratory retrospectively for age, sex, history of surgery, histopathological findings, treatment modalities, and follow-up information. We used the Kaplan–Meier method for survival analysis. Results: There were 46 female patients diagnosed with PD. In 39 (84.7%) patients, invasive carcinoma accompanied PD, while 7 (15.3%) patients had ductal carcinoma in situ. The median age at diagnosis was 53.5 years. The median follow-up period was 47 months. Of the 39 invasive carcinoma, 10 (25.6%) died during the follow-up period. Invasive ductal carcinoma group had a mean overall survival of rate of 57.8 ± 6.6 months. According to univariate analysis, only the tumor type was found to impact overall survival (p < 0.001). Conclusions: The current study displayed the tumor type as the only parameter affecting overall survival in the invasive carcinoma group. Although it was not statistically significant, breast cancers accompanied by PD were found to be predominantly advanced stage tumors, high grade, hormone receptor negative, and HER2 positive. [ABSTRACT FROM AUTHOR]

Objective: Cytokines have been the mainstay of treatment in metastatic renal cell cancer (mRCC) for decades before the introduction of tyrosine kinase inhibitors (TKIs), which dramatically changed the therapeutic landscape in these patients. This observational study was designed to evaluate use of TKIs in the treatment of cytokine-intolerant mRCC patients. Methods: A total of 151 cytokine-intolerant mRCC patients who were treated with TKIs (sunitinib, pazopanib and sorafenib) were enrolled in this prospective, non-interventional, multi-center observational study at 16 oncology centers across Turkey. Mean (SD) age was 61.3 (11.1) years and 74.8% were males. Data on duration of TKI treatment was the primary outcome measure. Additionally, overall response rate (ORR), progression free survival (PFS), overall survival (OS) and safety data were recorded. Results: Median duration of treatment was 8.2 months at a median follow up of 17.9 months. ORR and disease control rate were 12.5% and 70.8%, respectively. Median PFS and OS were 7.5 months (95%CI: 6.4–10.4) and 27.3 months (95%CI: 17.6–27.3) with no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. The most common adverse events excluding progression-which was the protocol requirement were diarrhea (13.6%), asthenia (13.6%) and hand-foot syndrome (12.6%). Dose modifications were required in 30.5% of the patients and 15% discontinued TKIs because of toxicity. Conclusions: Our findings confirm the efficacy and safety profile of TKIs in the first-line treatment of mRCC patients intolerant to cytokine treatment. There was no significant difference among three TKI agents in terms of treatment duration, ORR, PFS and OS. Trial registration: TURCOS ClinicalTrials.gov Identifier: NCT01585974. Registered April 25, 2012. [ABSTRACT FROM AUTHOR]

Background/aim: The aim of this study is to assess the efficacy and safety of ruxolitinib in patients with myelofibrosis. Materials and methods: From 15 centers, 176 patients (53.4% male, 46.6% female) were retrospectively evaluated. Results: The median age at ruxolitinib initiation was 62 (28-87) and 100 (56.8%) of all were diagnosed as PMF. Constitutional symptoms were observed in 84.7%. The median initiation dose of ruxolitinib was 30 mg (10-40). Dose change was made in 69 (39.2%) patients. Forty seven (35.6%) and 20 (15.2%) of 132 patients had hematological and nonhematological adverse events, respectively. The mean spleen sizes before and after ruxolitinib treatment were 219.67 ± 46.79 mm versus 199.49 ± 40.95 mm, respectively (p < 0.001). There was no correlation between baseline features and subsequent spleen response. Overall survival at 1-year was 89.5% and the median follow up was 10 (1-55) months. We could not show any relationship between survival and reduction in spleen size (p = 0.73). Conclusion: We found ruxolitinib to be safe, well tolerated, and effective in real-life clinical practice in Turkey. Ruxolitinib dose titration can provide better responses in terms of not only clinical benefit but also for long term of ruxolitinib treatment. [ABSTRACT FROM AUTHOR]

In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statementWhat is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging. [ABSTRACT FROM AUTHOR]

Retroperitoneal sarcomas (RPS) account for approximately 15% of all soft tissue sarcomas (STS) and encompass a heterogeneous group of tumors with limited multimodality treatment options. Surgical resection with negative margins remains the standard primary treatment for patients with localized RPS. In this multicenter study, we aimed to demonstrate the real-world data on factors affecting survival in RPS treated with upfront surgery. We included a total of 197 patients who underwent curative-intent resection of a primary non-metastatic RPS between 2000-2020 at ten experienced medical oncology departments in Turkey. The median follow-up was 33 months. The median age of patients was 53 years, 57.4% of patients were female. Univariate analysis revealed that; tumor size, grade, necrosis, resection margin status, were factors affecting recurrence-free survival (RFS) (p= 0.002, p= 0.044, p= 0,024, p= 0.003 respectively). Age, tumor size, stage, resection margin status were factors affecting overall survival (OS) (p= 0.038, p= 0.001, p= 0.032, p< 0.001, respectively). In multivariate analysis, tumor size and resection margin status were independent factors affecting RFS and OS (all p-values < 0.05). Our study demonstrated that tumor size, and resection margin status were the main factors affecting survival in resected RFS. In comparison, adjuvant chemotherapy (CT), radiotherapy (RT), or multimodality treatment did not show OS and RFS advantages. We believe that advances in the molecular characterization of these tumors might help clinicians to detect the best candidates for adjuvant therapies in RPS. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Neuroendocrine tumors of the lungs are a clearly different group of tumors with definite ultrastructural, immunohistochemical, and molecular features. We reported and analyzed the incidence, clinicopathological features, surgery rates, responses to first-line therapy, and survival outcomes of this rare condition according to our lung cancer patient database. MATERIALS AND METHODS: We retrospectively collected the data of 62 patients who were histopathologically diagnosed with large cell neuroendocrine carcinoma of lung (LCNEC) between January 2010 and January 2016. RESULTS: The patients were predominantly (95%) men (male:female=59:3) with their average age being 60.3±8.6 years. Diagnosis was made by the fine-needle aspiration biopsy (NAB) in 7 patients, bronchoscopic transbronchial biopsy in 13, and surgery in 42. Nearly 43.5% of the patients presented with the tumor in the right upper lobe. Additionally, tumors of 46.8% patients could be observed in peripheral locations. Sixteen patients presented with stage 1, 17 with stage 2, 15 with stage 3, and 14 with stage 4. Median progression-free survival (PFS) was 29 months (SE: 12.2) (95% CI, 5.2-52.8 months). Progression-free survival (PFS) was significantly better in patients with low N, M0, early stage, p63 positive, and TTF-1 positive across the entire cohort. Overall survival (OS) was significantly better in patients with comparatively lower N, M0, low stage, and peripheral location. CONCLUSION: This study demonstrated a single-center experience with clinicopathologic factors and survival outcomes of LCNEC patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the prognostic value of tumor budding (TB) in rectal cancer patients. TB in the specimens of patients who received neoadjuvant chemoradiotherapy was specifically analyzed. Methods: This study was conducted on rectal cancer patients treated at Dokuz Eylul University Hospital, Turkey, between January 2000 and June 2010. Prospectively recorded clinicopathological data and the oncological outcomes of patients who received neoadjuvant chemoradiotherapy (CRT) (n = 117) and also patients who did not receive it (n = 113) were analyzed. TB was defined as an isolated single cancer cell or a cluster of cells composed of less than 5 cells of a "budding focus". Budding intensity was scored as follows: none (0), mild (1–5 buds), moderate (6–10 buds), and severe (> 10 buds). Two tumor budding intesity groups were created, TB-1 (none, few) and TB-2 (moderate, severe) for statistical analysis. Results: The median follow-up time was 40.12 ± 27.5 months. The 5-year overall and disease-free survival (DFS) rates were 66% and 62%, respectively. Multivariate analysis of overall survival in all patients showed that TB intensity (HR 2.64; 95% CI 1.46–4.77) and radial margin status (HR 2.16; 95% CI 1.18–3.96) were independent predictors of decreased overall survival. In patients who received CRT, TB (HR 4.87; 95% CI 2.10–11.28) and distant metastasis (HR 4.31; 95% CI 1.81–10.22) were predictive of survival while in patients who did not receive CRT, TB (HR 4.28; 95% CI 1.60–11.49), distant metastasis (HR 2.33; 95% CI 1.19–4.60), radial margin status (HR 2.53; 95% CI 1.09–5.91), and venous invasion (HR 4.48; 95% CI 2.14–9.39) were significantly independent predictors of survival. In multivariate analysis of all patients decreased DFS was correlated with lymph node involvement (HR 2.78; 95% CI 1.60–4.87), venous invasion (HR 1.76; 95% CI 1.00–3.09), and with radial margin status (HR 2.31; 95% CI 1.27–4.22). In multivariate analysis in the CRT group, decreased DFS was significantly associated with lymph node involvement (HR 4.39; 95% CI 1.70–11.33) and radial margin status (HR 2.56; 95% CI 1.12–5.90) while only lymph node involvement (HR 2.33; 95% CI 1.16–4.66) was a significant predictor of decreased DFS in patients who did not receive CRT. Conclusions: TB has prognostic value as important as lymph node involvement and radial margin status and it may be a helpful prognostic indicator even after CRT. TB should be included in the TNM classification and may be used in planning adjuvant therapy. [ABSTRACT FROM AUTHOR]

Introduction: The clinical benefit of regorafenib therapy in metastatic colorectal cancer (mCRC) patients, who were previously treated with 5-fluorouracil (5-FU), irinotecan, or oxaliplatine based regimens with or without a biologic agent such as vascular endothelial growth factor (anti-VEGF) or anti epidermal growth factor receptor (anti-EGFR), has been shown in several previous phase III studies. In this study, we aimed to analyze the efficacy and toxicity profile of regorafenib in patients with mCRC. Methods: This was a retrospective study of 23 mCRC patients from two different centers in Turkey. All patients were treated with regorafenib as third line setting after failure of two standard consecutive therapies including 5-FU, irinotecan, or oxaliplatine with or without anti-VEGF or anti-EGFR agent. Treatment outcomes along with drug efficacy and safety were analyzed retrospectively. Results: Of the 23 patients, 13 were male (56.5%). Median age was 62 (35-76) years. The rates of RAS wild-type and RAS-mutated tumor were 43.5% and 56.5%, respectively. Eighteen patients (78.2%) received bevacizumab as first-line setting, whereas only five patients (28.8%) were given a prior anti-EGFR agent. Among the 23 patients, only one patient (4.3%) had a partial response. Median progression-free survival was 3.02 (2.6-3.37) months and median overall survival was 6.4 (2.6-10.1) months. There was no prognostic factor associated with survival. Grade 3-4 toxicities were observed in 30.4% of the patients, with hand-foot skin reaction being the most frequent adverse event (42.8%). Conclusion: Although clinical and survival benefits of regorafenib have been demonstrated in previous studies, this advantage seems to be questionable in our study, with a significant toxicity profile making its use challenging. A treatment decision should be made considering the risk of mortality and toxicity profile. [ABSTRACT FROM AUTHOR]

Background: Triple-negative (TN) breast cancer is a subtype of breast cancer characterised by a loss of estrogen receptor (ER), progesterone receptor (PR) expression, and the absence of human epidermal growth factor (HER2) overexpression. Aims: To identify the relationships between clinicopathological characteristics of TN breast cancers in the northeast region of Turkey and disease free survival (DFS) and overall survival (OS). Study Design: Retrospective clinical study. Methods: Seven hundred and eighty non-metastatic breast cancer patients were enrolled in this study. The relationships between TN breast cancer and other breast cancers with respect to clinicopathological characteristics, as well as DFS and OS, were studied. Results: The triple-negative phenotype was detected in 204 patients (27.1%). Patients with triple-negative breast cancer had more grade 2-3 tumours compared to those with other types of breast cancer (92.5% versus 84.3%, p=0.004). Invasive ductal carcinoma histology, on the other hand, was less prevalent in patients with TN breast cancer (77% versus 84.5%, p=0.016). No significant differences were identified between the groups in other clinicopathological variables. Relapse and mortality rates were higher in the TN group during the follow-up of both groups [57 (27.9%) versus 89 (16.2%), p<0.001 for relapse; 27 (13.2%) versus 37 (6.8%), p=0.005 for mortality]. The univariate analysis demonstrated shorter DFS and OS for patients with TN breast cancer compared to those with other types of breast cancer. In the mul-tivariate analysis, patients with TN breast cancer were 2.21 times more likely to develop relapse, while the likelihood of death increased 3.21-fold(p<0.001 andp<0.001). Conclusion: Triple-negative breast cancers demonstrate a more aggressive clinical course compared to other breast cancers. More effective strategies should be developed for the treatment of this subgroup of breast cancer. [ABSTRACT FROM AUTHOR]

AIM: This paper presents a 14-year retrospective study evaluating the survival rates and prognostic factors of breast carcinoma patients treated in private treatment center in the west coast of Turkey. MATERIALS AND METHODS: The survival rates of breast cancer patients (n = 1746) who have been treated from 1995 until 2008 were analyzed. The clinical data include age, menopausal stage, oestrogen (ER) and progesterone (PR) receptor status, and C-erbB-2 status as well as histopathological evaluation. AJCC (2002) was used for clinical tumor staging. Survival rates were computed using standard Kaplan-Meier methods, and the difference in survival curves was analyzed with the log-rank test. RESULTS: The 14-year overall survival, disease-free survival, local failure-free survival, and distant failure-free survival rates were 77%, 95%, 77%, and 94%, respectively. Early-stage patients had higher overall survival rates compared to advanced-stage patients (stage IIIb and IIIc, AJCC 2002), and early-stage patients had higher survival rates than advanced-stage patients for disease-free survival, local failure-free survival, and distant failure-free survival. The risk for cancer development increases significantly for advanced-stage patients with positive ER and PR receptor as well as C-erbB-2 receptor. CONCLUSIONS: The incidence of breast cancer in Turkey is smaller compared to other European countries. Low advanced-stage patient numbers compared to high early-stage patient numbers; and very high median survival times could possibly be the result of the improvement of detection and treatment of breast cancer over the years. [ABSTRACT FROM AUTHOR]