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Background: the prediction of pathological responses for locally advanced rectal cancer using magnetic resonance imaging (MRI) after neoadjuvant chemoradiotherapy (CRT) is a challenging task for radiologists, as residual tumor cells can be mistaken for fibrosis. Texture analysis of MR images has been proposed to understand the underlying pathology. Objective: this study aimed to assess the responses of lesions to CRT in patients with locally advanced rectal cancer using the first-order textural features of MRI T2-weighted imaging (T2-WI) and apparent diffusion coefficient (ADC) maps. Methods: forty-four patients with locally advanced rectal cancer (median age: 57 years) who underwent MRI before and after CRT were enrolled in this retrospective study. The first-order textural parameters of tumors on T2-WI and ADC maps were extracted. The textural features of lesions in pathologic complete responders were compared to partial responders using Student’s t- or Mann–Whitney U tests. A comparison of textural features before and after CRT for each group was performed using the Wilcoxon rank sum test. Receiver operating characteristic curves were calculated to detect the diagnostic performance of the ADC. Results: of the 44 patients evaluated, 22 (50%) were placed in a partial response group and 50% were placed in a complete response group. The ADC changes of the complete responders were statistically more significant than those of the partial responders (P = 0.002). Pathologic total response was predicted with an ADC cut-off of 1310 x 10-6 mm2/s, with a sensitivity of 72%, a specificity of 77%, and an accuracy of 78.1% after neoadjuvant CRT. The skewness of the T2-WI before and after neoadjuvant CRT showed a significant difference in the complete response group compared to the partial response group (P = 0.001 for complete responders vs. P = 0.482 for partial responders). Also, relative T2-WI signal intensity in the complete response group was statistically lower than that of the partial response group after neoadjuvant CRT (P = 0.006).Conclusion: as a result of the conversion of tumor cells to fibrosis, the skewness of the T2-WI before and after neoadjuvant CRT was statistically different in the complete response group compared to the partial response group, and the complete response group showed statistically lower relative T2-WI signal intensity than the partial response group after neoadjuvant CRT. Additionally, the ADC cut-off value of 1310 × 10-6 mm2/s could be used as a marker for a complete response along with absolute ADC value changes within this dataset., NA

In this study we develop an efficient computational procedure that generates medically acceptable treatment plans for volumetric modulated arc therapy with constant gantry speed. Our proposed method is a column generation heuristic based on a mixed integer linear programming model, where the objective function contains minimization of total monitor unit of the treatment plan and dose-volume requirements are included as conditional value-at-risk constraints. Our heuristic generates a full treatment arc for the restricted master problem and calibrates the right hand side parameters of the conditional value-at-risk constraints in the first phase. In the second phase, this initial solution is improved by performing column generation. This is a fully automated procedure and produces treatment plans in a single call without any human intervention. We evaluate its performance on real prostate cancer data by comparing the quality of the generated plans with those obtained by a widely used commercial treatment planning system. Our analysis shows that the results are promising, and the generated plans satisfy the prescription restrictions and require [Formula: see text] fewer monitor units on average compared to the ones obtained using Eclipse.

This study was designed to evaluate the impact of a standardized laparoscopic total mesorectal excision (TME) on the long-term oncologic outcome. Unselected consecutive patients with rectal cancer underwent a standardized laparoscopic TME with medial to lateral approach encompassing 9 sequential steps. From 2005 to June 2012, laparoscopic sphincter-preserving TME was attempted in 217 patients. Mean follow-up of all patients was a median of 91 months (range, 3 to 164 mo). The local recurrence rate was 6.5%, and the distant recurrence rate was 19.8%. The 10-year disease-free survival (DFS) rates were 76.4% and overall survival (OS) was 67.1%. In the converted group, DFS and OS were 50% and 46.7%, respectively. In the laparoscopic group, DFS and OS were 78.3% and 68.5%, respectively. A standardized laparoscopic sphincter-preserving TME resulted in a favorable long-term oncologic outcome in unselected patients with rectal cancer. Conversion to open surgery has impaired OS and DFS.

Mounting evidence suggests that radiation stimulates the immune system and this contributes to the abscopal effect, which is defined as "response at a distance from the irradiated volume." Though identified more than 50 years ago, the abscopal effect is revisited today. One rationale is that the abscopal effect is often observed with efficient immunotherapy. Here, we give an overview of the clinical data on the abscopal effect, generated by a combination of immunotherapy and radiotherapy (RT). Only papers that included RT in combination with immunotherapy were evaluated according to four main categories including RT parameters, sequencing of therapies, the definition of the abscopal effect, and patient selection. Twenty-four cases in 15 reports were reviewed. The results varied. Patient ages ranged from 24 to 74. RT dose (median total dose 18-58 Gy) varied. Biologically effective dose (BED) 10 was calculated to be a median 49.65 Gy (28-151 Gy). The time to a documented abscopal response ranged from less than a month to 12 months. The large variation concerning fractionation and sequencing of therapies indicates that these conflicting points need to be resolved, to generate for the abscopal effect to be clinically significant.

Purpose: In this prospective observational study, we aimed to report the applicability and tolerability of neoadjuvant volumetric modulated arc therapy with simultaneous integrated boost (SIB-VMAT) and concurrent chemotherapy in patients with locally advanced rectal cancer (LARC), and to evaluate the correlation of pathological response with apparent diffusion coefficient (ADC) measurements on diffusion-weighted magnetic resonance imaging (DW-MRI) and apoptotic markers. Methods: The study enrolled 30 patients with T3 to T4 and/or N+ rectal cancer who preoperatively received SIB-VMAT and concurrent chemotherapy. Before and after the neoadjuvant treatment, apoptotic markers including the nucleosomes and cell-free DNA fragments in the serum samples were examined; DNA integrity was assessed by amplifying the ACTB gene; and the ADC measurements on the DW-MRI were analyzed. Results: No patients had acute or chronic grade III-IV toxicity. Pathologic complete response (pCR) was achieved in 8 patients (27%), while in 10 patients (33%) near-complete pathological response was obtained. Posttreatment ADC was significantly higher in patients with pCR compared with the others (1.28 vs. 1.10, p = 0.017). ROC curve analysis showed that posttreatment ADC values had a sensitivity of 75% and a specificity of 77.3% for distinguishing the patients with pCR from other responders. On the other hand, posttreatment DNA integrity values were revealed lower than the pretreatment values (p = 0.36). Also, the results revealed an insignificant increase in the posttreatment serum level of nucleosomes (p = 0.72). Conclusions: Neoadjuvant SIB-VMAT with concurrent chemotherapy was proved to be a feasible treatment regimen in LARC with tolerable side effects, and improved local control rate and pCR rate.

AIM To evaluate the efficacy and tolerability of neoadjuvant hyperfractionated accelerated radiotherapy (HART) and concurrent chemotherapy in patients with locally advanced infraperitoneal rectal cancer. METHODS A total of 30 patients with histopathologically confirmed T2-3/N0+ infraperitoneal adenocarcinoma of rectum cancer patients received preoperative 42 Gy/1.5 Gy/18 days/bid radiotherapy and continuous infusion of 5-fluorouracil (325 mg/m(2)). All patients were operated 4-8 wk after neoadjuvant concomitant therapy. RESULTS In the early phase of treatment, 6 patients had grade III- IV gastrointestinal toxicity, 2 patients had grade III-IV hematologic toxicity, and 1 patient had grade V toxicity due to postoperative sepsis during chemotherapy. Only 1 patient had radiotherapy-related late side effects, i.e., grade IV tenesmus. Complete pathological response was achieved in 6 patients (21\%), while near-complete pathological response was obtained in 9 (31\%). After a median follow-up period of 60 mo, the local tumor control rate was 96.6\%. In 13 patients, distant metastasis occurred. Disease-free survival rates at 2 and 5 years were 63.3\% and 53\%, and corresponding overall survival rates were 70\% and 53.1\%, respectively. CONCLUSION Although it has excellent local control and complete pathological response rates, neoadjuvant HART concurrent chemotherapy appears to not be a feasible treatment regimen in locally advanced rectal cancer, having high perioperative complication and intolerable side effects. Effects of reduced 5-fluorouracil dose or omission of chemotherapy with the aim of reducing toxicity may be examined in further studies.

Previous studies demonstrated survival benefits in association with the addition of chemoradiotherapy after surgery in gastric cancer. This study aimed to examine the efficacy in terms of loco-regional control and survival and safety of 5-FU-based adjuvant chemoradiotherapy after D2 curative surgery. This study included 228 patients (81 female, 147 male) treated for gastric cancer with curative surgery plus adjuvant chemoradiotherapy. Majority of the patients underwent at least D2 lymph node resection. Median three cycles of fluorouracil chemotherapy were administered, and 45-Gy radiotherapy was delivered at 1.8 Gy/fraction concomitantly during the second cycle of chemotherapy. Local control, regional control, distant metastasis and overall survival rates were estimated. The median age of the patients was 54 years (range 25–74 years). The most common grade III toxicities were nausea (10 %) and neutropenia (9 %). During radiotherapy, grade IV local skin reaction occurred in one patient. Median duration of follow-up was 47 months. Local, regional and distant recurrence developed in 9 (4 %), 41 (18 %) and 45 (20 %) patients, respectively. Overall 5-year survival rate was 57.2 %, and disease-free 5-year survival rate was 53.8 %. Multivariate analysis identified less than 15 lymph node involvement as an independent predictor of better survival (p

Purpose This study was designed to evaluate the impact of a standardized laparoscopic total mesorectal excision (TME) on the long-term oncologic outcome of unselected patients with rectal cancer (RC). Methods Unselected consecutive patients with histologically proven RC underwent a standardized laparoscopic TME with medial to lateral approach encompassing 9 sequential steps: (1) ligation of inferior mesenteric vessels, (2) mobilization of the left colon and sigmoid colon (medial to lateral), (3) posterior dissection of the rectum, (4) lateral mobilization of the sigmoid, left colon, and splenic flexure, (5) left and right side dissection of the rectum, (6) anterior dissection of the rectum, (7) transection of the rectum, (8) delivery of the specimen, and (9) colorectal anastomosis. Results From 2005 to June 2012, laparoscopic sphincter-preserving TME was attempted in 217 patients with a 6.5% conversion rate. There were 91 women and 126 men, aged 58.3 years (range, 22 to 84 y), with body mass index of 26.10 (range, 20 to 45), operative time was 150.4 minutes (range, 60 to 330 min), and 24.7 (range, 4 to 98) lymph nodes were harvested. Length of stay was 7.56 days (range, 3 to 32 d). Complication rate was 17.05%. The mean follow-up time of all patients was 36.12 months (range, 1 to 89 mo). Local recurrence rate was 3.6% and distant recurrence rate was 8.7%. The 5-year disease-free survival rates were 81.5%. Conclusions A standardized laparoscopic sphincter-preserving TME resulted in a favorable short-term outcome in unselected patients with RC.

Presently, there is no consensus regarding which chemotherapy regimen is best to administer with radiotherapy in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). Herein, our aim was to compare the outcome of patients treated with either etoposide–cisplatin (EP) or docetaxel–cisplatin (DP) in this curative setting. Patients treated with either EP or DP and concurrent radiotherapy from 2004 to2012 were identified and their detailed medical records and follow-up information were obtained for analysis in this retrospective study. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding parameters provided by propensity score methods. A total of 105 patients were treated with concurrent chemoradiotherapy for LA-NSCLC (stage IIB-IIIA-IIIB). The median ages were 54 years (range, 32–70 years) and 55 years (range, 37–73 years) in the EP (n = 50) and DP (n = 55) groups, respectively. The median follow-up time was 27 months (range, 1–132 months) in the EP group and 19 months (range, 1–96 months) in DP group. There was no significant difference in baseline clinicopathologic features including age, sex, performance status, histologic subtype, and clinical TNM stages between groups. In the univariate analysis, the median overall survival of patients treated with EP was higher than that of patients treated with DP (41 vs. 20 months, P = 0.003). Multivariate analysis further revealed a survival advantage with EP compared with DP (hazard ratio [HR], 0.46; 95% confidence interval: 0.25–0.83; P = 0.009). The toxicity profile of the 2treatment groups was similar except that pulmonary toxicity was higher in the DP group (grade 3–4: 0% vs. 6%, P = 0.024). Concurrent chemoradiotherapy with EP may provide more favorable outcomes than DP and with an acceptable safety profile.

Our aim was to evaluate clinical and pathological features in prognosis of thymoma patients with particular emphasis on patients with myasthenia gravis (MG). From 1995 to 2010, 140 thymoma patients (women/men: 63/77) with a median age of 46 years (11–80 years) were admitted to our institution. According to World Health Organization (WHO), there were 23 (17%) type A, 12 (9%) type AB, 24 (17%) type B1, 42 (31%) type B2 and 36 (26%) type B3. The distribution of Masaoka stages I, II, III and IV was 24 (17%), 71 (51%), 18 (13%) and 27 (19%), respectively. MG coexisted in 61% of patients. After a mean follow-up of 34 months (1–158 months), 102 (73%) patients are alive and well while 14 (10%) are alive with disease. Twenty-three patients (16%) have died, only 9 died of thymoma. In univariate analyses, completeness of resection (P

Background The main goal of this study was to evaluate the feasibility and effectivity of triweekly docetaxel/cisplatin followed by weekly docetaxel/cisplatin concomitantly with radiotherapy with or without surgery in locally advanced non–small-cell lung cancer (NSCLC) patients. Materials and Methods Thirty five patients with locally advanced NSCLC were enrolled. Combination chemotherapy with triweekly docetaxel/cisplatin (75 mg/m2) was administered as induction regimen. After induction chemotherapy, patients were evaluated for surgery if their disease subsequently downstaged. Six cycles of weekly docetaxel/cisplatin (20 mg/m2) concurrently with radiotherapy up to a 60 Gy were administered after induction chemotherapy with or without surgery. Response, toxicity, time-to-progression and overall survival were evaluated. Results Twelve patients with stage IIIA-N2 and 23 patients with stage IIIB-T4N0-2 were evaluated (median age, 54 years). After 94 cycles of induction chemotherapy, partial response was achieved in 20 patients, 9 patients had stable disease and six had progressive disease. After overall treatment, 6 patients achieved complete response, 19 patients had partial response, 8 patients had progressive disease, and 2 patients had stable disease. Two patients experienced grade 3-4 pulmonary toxicity and 1 patient experienced grade 3 esophageal toxicity. Six patients underwent surgery. Median overall survival for all patients was 15 months and time-to-progression was 13 months with a median follow-up of 22 months. Conclusion Triweekly docetaxel plus cisplatin followed by weekly docetaxel plus cisplatin concomitantly with radiotherapy is effective and feasible and seems to be an alternative option for patients who have locally advanced NSCLC. Surgery may provide additional benefit for patients whose disease adequately downstaged after induction chemotherapy.

The aim of this study was to evaluate efficacy and feasibility of a combination of weekly docetaxel and cisplatin administered concomitantly with radiotherapy followed by surgery in addition to consolidation chemotherapy with docetaxel and cisplatin administered every 3 weeks in stage III non-small cell lung cancer (NSCLC).A total of 31 histologically proven, locally advanced (stage IIIA-N2 = 9, stage IIIB-T4N0-2 = 22) NSCLC patients were investigated. After administration of 4-6 cycles of weekly docetaxel (20 mg/m(2)) and weekly cisplatin (20 mg/m(2)) concurrently with radiotherapy, patients underwent operation if their disease was appropriately downstaged. Combination chemotherapy with docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) every 3 weeks was administered as a consolidation regimen. The treatment response, toxicity, time to progression (TTP) and overall survival (OS) were evaluated.After concomitant chemoradiotherapy, complete response and partial response occurred in 16.1 and 67.7% of patients, respectively. Thirteen percentage of patients progressed on treatment, and 3.2% had stable disease. Grade 3-4 hematologic and skin toxicities did not occur, whereas 17.9% of them experienced grade 3-4 oesophageal toxicity. Grade 3 pulmonary toxicity and grade 3-4 emesis developed in 9.7 and 6.4% of patients, respectively. Thirteen responsive patients (41.9%) underwent surgery. The toxicity of consolidation chemotherapy was tolerable. Median OS and TTP were 22 ± 5 (range 13-31) and 12 ± 3 (range 7-17) months, respectively. Median follow-up was 22 (range 2-57) months.Weekly administration of docetaxel and cisplatin concurrently with radiotherapy followed by consolidation chemotherapy is an effective treatment with acceptable toxicity for patients with locally advanced NSCLC especially in combination with surgery.

Background: Colorectal cancer (CRC) is fourth most frequent cancer in men and third most common cancer in women in Turkey according to GLOBOCAN 2012 data. Its age-standardized incidence is 16.6 per 100,000 population in both sexes. CRC screening is globally accepted program and was shown that reduces CRC mortality. Aim: Public awareness is highly important to increase screening rate and to decrease mortality from CRC. Methods: We initiated a social program for patients with CRC, which is called “Colorectal Cancer Survivors”. Program contained interactive talks with patients and their relatives during cocktail and lunch in selected five stars hotels. We performed this activity in 2011 and 2012 in Istanbul. We invited patients with CRC who already diagnosed and successfully treated in Istanbul University Institute of Oncology. They were all 5 years or more survivors after surgery alone for stage I and II disease or last chemotherapy cycle for stage III or some stage IV cases. During meetings, surgeons, medical and radiation oncologists shared latest information about the risk factors, prevention and treatment modalities with participants. Media health correspondents were also participated to these activities. We monitored and compared screening rate before and after 2011. As a source, we used the nation-based data of cancer screening of Ministry of Health. Results: In April 30th, 2011, and in March 29th, 2012, 34 survivors joined to this program. We offered “Certificate of 5-Year Survivor” and “Blue Bead” to all patients. Blue Bead is a kind of symbol of hope in Turkey. In 2014, we observed significant increase in CRC screening compared with 2011 in Istanbul and all over the country. Conclusion: Since 2011 until present, there is a significant increase in CRC screening in Turkey. Among many positive factors, some social programs using media such as our “CRC Survivors” program that gives the message that CRC is a treatable and also curable in early stages, may stimulate screening.

Background: Non-HIV related Kaposi sarcoma (NHKS) is a rare indolent neoplasm which is more common around Mediterranean origin. Data concerning factors that influence progression-free survival (PFS) for NHKS are insufficient. The purpose of present retrospective analysis was to distinguish the factors affecting PFS in patients with NHKS. Methods: A hundred and twenty-eight consecutive patients with NHKS who were treated or observed between 1997 and 2014 at Istanbul University Institute of Oncology were included into the study. Treatment response and progression definitions were determined according to different treatment modalities administered at first line. Results: Majority of patients were male (n = 97, 75.8%). Median age of the whole group was 66 years (28-85). Of the patients, 15 patients were immunosuppressant, whereas 113 patients had no disease that caused immunosuppression. Patients were treated with local excision (n = 57, 44.5%), chemotherapy (n = 32, 25.0%) and/or radiotherapy (n = 13, 10.2%) or observed without treatment (n = 26, 20.3%). At a median follow-up of 28 months, 71 (55.5%) patients had progression, while 3 patients (2.3%) died of NHKS. On univariate analysis, patients who had hypertension (HT) had poorer PFS compared with others (19 +/- 12 versus 41 +/- 22 months; p = 0.03), whereas plaque formation was associated with better outcome (25 +/- 9 versus 54 +/- 12 months; p = 0.03). In addition, heavy smoking (>= 40 pack-years) had a borderline significance regarding better PFS time (23 +/- 24 versus 45 +/- 38 months, p = 0.06). On multivariate analysis, none of factors evaluated had any impact on PFS. Conclusions: HT was correlated with poorer outcome among NHKS patients. Patients with plaque formation and >= 40 pack-years of smoking had better PFS than others.

This study was designed to evaluate the tolerability and therapeutic activity of paclitaxel and carboplatin combination therapy followed by radical thoracic radiotherapy with a concomitant boost technique with concurrent weekly paclitaxel in good performance status of patients with stage IIIA and IIIB non-small cell lung cancer. Patients with newly diagnosed inoperable non-small cell lung cancer received paclitaxel (100 mg/m(2)) as a 1-h infusion on d 1,8,15,28,35, and 42. Carboplatin (area under the curve of 6) was given as a 30-min infusion on d 1 and 28. Radiotherapy commenced on d 49 and was delivered with accelerated fractionation with concomitant boost at 1.8 Gy/fraction/d, 5 d/week and 1.5 Gy/fraction/d to a boost field as a second daily treatment for the last 10 treatment days to 60 Gy/35 fractions/5 wk. During radiation treatment, paclitaxel (60 mg/m(2)) was given as a 1-h infusion once weekly for 5 wk. Twenty-four patients were enrolled in the study. Hematologic toxicities and alopecia were the major acute toxicities during induction chemotherapy; 8.7% of the patients experienced grade 3-4 neutropenia and alopecia. The main acute toxicity of concurrent chemoradiotherapy was esophagitis; grade 3 esophagitis was documented in 23.5% of the patients. No major late toxicity was seen. Overall response rate to the treatment was 65.2%. The median and 1-yr overall-survival rates were 24.9 mo and 63.8%, respectively. The median and 1-yr progression-free survival rates were 9.0 mo and 27.8%, respectively. The main acute toxicities were hematologic toxicity, esophagitis, and alopecia. The response rate and the survival rates achieved with this treatment regimen are particularly noteworthy, especially considering the advanced stage of the patients treated.

Definitive radiotherapy plays a major role in the treatment of locally advanced non-small cell lung cancer (LA NSCLC). After the impact of RT dose for lung cancer was established, a number of trials were structured with the aim of better local control and overall survival by either dose escalation or shortening the total treatment time through conventional/altered fractionation, even in combination with chemotherapy (CT) and other targeted agents. In spite of the increased number of these studies, the optimal dose or fractionation still remains to be determined. Another aspect questioned is the incorporation of these higher doses and shorter treatment times with chemotherapy or targeted agents. This review summarises the results of significant trials on dose and altered fractionation in the treatment of LA-NSCLC with an emphasis on possible future perspectives.

The clinical utility of magnetic resonance imaging (MRI) in judging therapeutic response of bone metastases was evaluated in 18 patients with advanced breast cancer. Treatment efficacy was assessed by MRI and conventional methods such as plain radiograph, bone scan, pain and analgesic scale, and serum CA15-3. The response by MRI was evaluated mainly on T1-weighted sequences by measuring the volume of the bone lesion and soft tissue component. The patient was assumed to be a conventional responder if a complete or partial response was observed in any of the conventional methods described above. Response was most concordant between plain radiographs and MRI findings (91%, 10/11, 95% confidence interval [CI]: 58.7-99.8). The rate of concordance was 61% (11/18, 95% CI 35.8-82.7) for all conventional methods and MRI. MRI revealed response in four patients in whom progressive disease was observed by bone scan and the marker response was not measurable. This pilot study suggests that posttherapy evaluation with MRI may provide useful clinical information in breast cancer patients with bone metastases and may be a valuable adjunct to conventional methods with conflicting results.

Background: To evaluate the patient and treatment characteristics of four radiotherapy centers with robotic systems (CyberKnife) in Istanbul. Materials and Methods: Five hundred and ninety-three patients treated with CyberKnife (CK) system during 2010 were included in this study. Data regarding their diagnosis, radiosurgery (SRS) indications, total treatment doses, and number of fractions were analyzed. Results: Patient numbers from each center were as follows: Acibadem University Maslak Hospital (186), Kartal Egitim ve Arastirma Hospital (161), Anadolu Saglik Merkezi (145), and Istanbul University Istanbul Medical Faculty Radiation Oncology Department (101). Median age of the patients (355 males (59.9%), 238 females (40.1%)) was 55 years (range: 8-87). Intracranial tumors (77.2%) were biggest group, according to location of the disease. Distribution in terms of diagnosis were as follows: metastasis to brain (36.6%), spinal and paraspinal tumors (8.8%), primary lung tumors (7.4%), head-neck tumors (6.1%), glial tumors (5.9%), meningioma (5.4%), other brain malignancies (4.6%), lung metastasis (4.2%), acoustic neuroma (3.9%), other intracranial lesions (3.9%), intra-abdominal malignacy and extracranial metastases (2.9%), liver lesions (2.4%), pituitary adenoma (2.2%), adrenal metastases (1.5%), uveal melanoma (1.3%), prostate cancer (1.2%), pancreatic cancer (0.5%), extracranial schwannoma (0.5%), and unclassified other tumors (0.8%). CK was used as primary treatment in 348 patients, for reirradiation in 209 patients, for planned boost in 26 patients, and in 10 patients for recurrence in previous field edge. Total median dose of whole group was 2100 cGy (800-7500 cGy), median dose per fraction was 800 cGy (200-3750), and median total fraction number was three (1-10).

The Wnt/b-catenin signalling pathway plays crucial roles in development and its aberrant activation is an initial and crucial event in the majority of colon cancers. The Dickkopf-1 (Dkk-1) gene encodes an extracellular Wnt inhibitor that blocks the formation of signalling receptor complexes at the plasma membrane. Here, we report the serum levels of Dkk1 in colorectal cancer patients without any therapy. The levels were determined by enzyme-linked immunosorbent assay (ELISA) in 135 colon and 160 rectum cancer patients, as well as 90 healthy subjects. Data analyses were performed using SPSS software (SPSS 16, Chicago, IL). There were no significant differences among the groups for Dkk-1 (p=0.363). In conclusion, the present study did not confirm that serum Dkk-1 levels could have any diagnostic potential in colon and rectum cancers.

The present study was conducted to investigate the sensitivity, specificity, predictive values and accuracy of serum MIF, CEA, CA 19-9 levels and their various combinations in patients with gastric cancer. Study group consists of pathologically verified, gastric cancer (n = 63) and apparently healthy controls (n = 50). Serum MIF concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Serum values of patients were significantly higher than the controls (p = 0.011). Diagnostic sensitivity and specificity, predictive values and accuracies were calculated for each marker and their various combinations. The best results were achieved with the marker combination of MIF-CEA-CA 19-9 and MIF-CEA combination. In our opinion, the combination of the markers MIF-CEA is a valuable diagnostic tool for gastric cancer.

Overexpression of the Bcl-2 protein was associated with a favorable prognostic factor for survival in lung cancer patients, especially nonsmall cell lung carcinoma. The present study was conducted to investigate the value of serum Bcl-2 levels in advanced lung cancer patients. Fifty patients with advanced lung carcinoma pathologically verified and 18 healthy controls were investigated. Serum samples were obtained on the first admission before the chemotherapeutic treatment were given. Serum Bcl-2 levels were determined by using anti-Bcl-2 monoclonal coating antibody. The baseline serum Bcl-2 levels were significantly higher in patients with lung cancer than in the control group (p

Paclitaxel (Taxol; Bristol-Myers Squibb) is one of the most active single agents for non-small cell lung cancer (NSCLC), and ideal in combination with radiation therapy. We designed a phase II study to determine the efficacy and toxicity of continuous hyperfractionated accelerated radiotherapy (CHART) and concurrent weekly Paclitaxel (T) in good performance status patients with unresectable stage III A and B NSCLC. T (60 mg/m2) was given as a 3-h infusion on days 1, 8, 15, 22, 29 and 36; CHART was started on day 15 with 150 cGy/fraction given three times a day for a total dose of 54 Gy in 12 days with no weekend break. Twenty patients were evaluable for acute toxicity. The major acute toxicities were esophagitis and pulmonary toxicity; 70% of the patients experienced grade 2-3 esophagitis and 50% experienced grade > or = 3 pulmonary toxicity. Grade 3 anemia developed in only one patient. Of the 17 patients evaluable for late toxicity, 12% of the patients had grade 3 pulmonary toxicity, one patient developed grade 4 esophagitis. Nineteen patients were evaluable response. The overall response rate was 84% (95% confidence interval, 60-97). CHART with concurrent weekly T seems to be an effective regimen, but tolerability needs to be documented with a larger number of patients and longer follow-up.

Purpose: A prospective phase II trial was conducted by the Institute of Oncology, istanbul University in December 1994 on patients with locally-advanced non-small cell lung cancer to assess acute toxicity and the feasibility of a combination of radiosensitizer and accelerated radiotherapy with concomitant boost. Materials and methods: Patients were irradiated using 'large' fields (primary tumour and locoregional lymph nodes) with 1.8 Gy per fraction, five fractions a week. Reduced 'boost' fields (primary and involved nodes only) were also irradiated twice-weekly 1.8 Gy per fraction in ten fractions concomitantly 6 h after the administration of large field. Total radiation dose was 63 Gy in 5 weeks (45 Gy 'large' fields and 18 Gy 'boost'). The maximum allowed dose to the spinal cord was 3750 cGy. Cisplatinum, 6 mg/m(2) was given daily just before 'large' field irradiation, Results: As of January1997, 15 patients were evaluated (median follow-up of 12.5 months with a range of 5.5-23 months). The overall acute toxicity rate was 38% and Grade 3 acute toxicity was 8%. Grade 4 or greater acute toxicities were not observed. The overall rate of cisplatinum-induced nausea and vomiting was 80% (severe in 60%), but all were easily treated with antiemetics. Complete response rate (clinical and radiological) was 40% and an overall response rate was 73%. Median survival was 16 months and progression-free survival was 5.5 months (range of 2.5-21 months). Conclusions: Toxicity was well tolerated and no treatment-related death occurred with this combined treatment regimen. Although it appears that better local control rates can be achieved, additional phase II/III studies are needed. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.

e14537 Background: Standard treatment of locally advanced gastric cancer (GC) has become chemoradiotherapy (CRT) after the results of Intergroup trial. However, there is no randomized trial compari...

4131 Background: Prospective randomized study has been designed to compare the efficacy of fourth week surgery (4WS) versus eighth week surgery (8WS) after concomitant neoadjuvant chemoradiotherapy (NeoadjCTRT) on local recurrence and overall survival (OS) in cT3–4/N0+, mid and distal localized (intraperitoneal) rectal cancers. Pathological regression grades (PRG;Dworak) were evaluated after neoadjCTRT. Methods: During Jan 2002- Nov 2007; 170 pts were randomized to the study in Istanbul University Oncology Institute and Medical Faculty. All rectal cancer pts are T3–4/N0+; distal and mid rectum and received 45 Gy conventionally fractionated RT in 25 daily fractions of 1.8 Gy combined with 225 mg/m2/day continous infusion 5-FU. Preoperative staging was performed by endorectal USG and /or MRI and abdominal CT.4cycles FUFA is standard as adjuvant treatment after surgery. Results: 17 pts have been removed (M1, frozen pelvis, refuse surgery, disease progression). Clinical T3N+ was 60.8% before surgery. 76 pts were operated at 4WS and 77 pts at 8WS. Median follow-up was 30 (2–71) months. APR was 31.4%. LAR was 68.6%. Surgical margin positiveness (SMP) and No significant financial relationships to disclose.

7270 Background: The aim of this study is to evaluate the efficacy of an induction regimen consisting of carboplatin and weekly paclitaxel followed by concomitant chemotherapy and thoracic irradiat...