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The optimal chemotherapy regimen for concurrent chemoradiation in locally advanced non-small cell lung cancer (NSCLC) remains unclear. Cisplatin-etoposide regimen related toxicity is high, weekly regimens have been investigating. We aimed to compare the efficacy and safety of different concurrent chemotherapy regimens in the context. A total of 225 patients with locally advanced, unresectable stage III NSCLC were included. Patients who were treated with weekly docetaxel-platin (DP), paclitaxel-platin (PP) and standard dose etoposide-platin (EP) chemotherapy regimens were selected and divided into groups for the comparison of toxicity, response rate, progression free survival (PFS), and overall survival (OS) times. There was a statistically significant difference between overall response rate of each treatment groups (DP: 96.1%, PP: 94% and EP: 76.7%, p

BackgroundAccess to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT.MethodsIn this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2018 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, gender, diagnosis, geographic location, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined.ResultsWe identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06 – 2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43 – 5.19, p < 0.001) were associated with noncompliance. Age, gender and treatment length were not significantly associated with noncompliance.ConclusionsNoncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.

Differentiation of idiopathic granulomatous mastitis (IGM) from carcinoma with routine imaging methods, such as ultrasonography (US) and mammography, is difficult. Therefore, we evaluated the value of a newly developed noninvasive technique called acoustic radiation force impulse imaging in differentiating IGM versus malignant lesions in the breast. Four hundred and eighty-six patients, who were referred to us with a presumptive diagnosis of a mass, underwent Virtual Touch tissue imaging (VTI; Siemens) and Virtual Touch tissue quantification (VTQ; Siemens) after conventional gray-scale US. US-guided percutaneous needle biopsy was then performed on 276 lesions with clinically and radiologically suspicious features. Malignant lesions (n = 122) and IGM (n = 48) were included in the final study group. There was a statistically significant difference in shear wave velocity marginal and internal values between the IGM and malignant lesions. The median marginal velocity for IGM and malignant lesions was 3.19 m/s (minimum–maximum 2.49–5.82) and 5.05 m/s (minimum–maximum 2.09–8.46), respectively (p

Methods: The patients undergoing radiotherapy (RT) because of the KS between the years 2005-2012 in Radiation Oncology Department of Dicle University Hospital were included. All patients underwent RT with different dose-fractionation schemes to increase quality of life and to palliate the symptoms. Patients with lesions in multiple regions underwent RT in the same or different dates. Responses to radiotherapy were recorded as complete or partial response. Results: Fourteen patients received radiotherapy because of f KS were evaluated retrospectively. Twenty two different regions of 14 patients underwent RT . Only one patient (4.5%) was performed RT to glans penis as a third region while performed to the two regions in six patients (27.3%). At irradiations, 6 MV and 10 MV photon energies with 6 MeV, 9 MeV and 12 MeV electron energy were used. Water phantom or bolus material was used to obtain a homogeneous dose distribution in the photon irradiation. RT dose administered to a total of 22 different regional was median 800 cGy (Range: 800-3000 cGy). Median number of RT fractions was 1 (Range: 1-10). When treatment response were evaluated stable disease was present in the 4 (18.1%) regions. Partial response was achieved in eight (36.4%) regions, complete response in 10 (45.5%). RT-related common lymphedema in the feet and legs was observed in the four (57.3%) regions in the acute period. Complication of pain was present in two (28.7%) regions. Conclusion: RT is an appropriate and effective treatment regimen in the palliative treatment of KS lesions. Excellent response rates of skin lesions may be obtained by RT. Lesions and symptoms such as itching may be lost after RT. Side effects such as edema and pain may be relieved by supportive treatment.

Aim of the study: The aim of this retrospective chart review was to determine the long-term outcomes and identify prognostic factors that impact the survival of patients with cervical cancer. Material and methods: A retrospective chart review of 739 patients with International Federation of Gynaecology and Obstetrics (FIGO) stage I–IV cervical cancer treated with surgery, radiation or chemoradiation was performed. Patient charts were evaluated in terms of demographics, clinical outcomes, and survival. Disease-free survival (DFS) and overall survival (OS) were calculated with the Kaplan-Meier method, and differences in survival were compared with the log-rank test. Multivariate analysis was performed with a Cox proportional hazards model to determine the estimated hazard ratios (HR) with 95% confidence inter vals (CI) for each prognostic factor. Results: The Cox proportional hazards model demonstrated that pelvic nodal metastasis (p = 0.018), parametrial invasion (p = 0.015), and presence of disease in the surgical margin (p = = 0.011) were all independent prognostic factors for OS. The 5-year OS rate of patients with negative pelvic lymph nodes was 67.1%, which was higher than the rate for those with positive nodes at 49.0% (p < 0.05). The 5-year OS rate was 54.3% for patients with metastasis to the parametrium, 79.2% with a cancer-free parametrium, 60.9% with a cancer-positive surgical margin, 85.4% with a cancer-negative surgical margin, and 64.3% with a 1–3 mm close surgical margin (p < 0.05). Conclusions: Assessing pelvic lymph nodes, the parametrium, and surgical margins is important for survival and may aid in better identifying patients who would derive greater benefits from receiving adjuvant therapies and more aggressive treatments.

AIM To investigate the clinical features, prognostic factors and survival times of cervical cancer patients with brain metastasis. MATERIAL AND METHODS We retrospectively reviewed the medical records of 820 patients with cervical cancer. Data were analyzed using SPSS version 12.0 statistical software (SPSS, Chicago, IL, USA). Overall survival, time interval from diagnosis of cervical cancer to identification of brain metastasis, and median survival time after diagnosis of brain metastasis were calculated using Kaplan-Meier curve analysis. The log-rank test was used to compare differences in survival. Differences were assumed statistically significant when p-values were < 0.05. RESULTS The incidence of brain metastases from cervical cancer in our institution was 1.82% (15/820) over a ten-year period. The median time interval from diagnosis of cervical cancer to detection of brain metastasis was 12.5 months (range: 2.9-91.9 months). Stage and tumor diameter were found to be significant relating to the interval from diagnosis of cervical cancer to detection of brain metastasis (p=0.001 for both). CONCLUSION This study provides much information about the prognosis of patients with brain metastases from cervical cancer and highlights the importance of initial stage and tumor diameter when determining the time interval until development of brain metastasis.

Objective: In this study, we aimed to investigate whether platelet lymphocyte ratio (PLR) and Mean platelet volume (MPV) values can be used as prognostic and diagnostic markers in laryngeal cancer.Methods: A total of 242 patients with laryngeal pathology were reviewed retrospectively. PLR, MPV and platelet values were compared in patients with benign and malignant pathologies. The correlation of PLR, MPV and platelet values of patients with malignant pathologies with their age, gender, smoking, alcohol use, degree of differentiation, and clinical stage was investigated.Results: The PLR values were significantly higher in smokers (p=0.009), alcohol drinkers (p=0.001), clinical stage IV patients (p=0.001), and patients with poor differentiated laryngeal cancer (p=0.001), compared to nonsmokers, non­alcohol consumers, clinical stage III patients, and patients with well-differentiated laryngeal cancer. MPV values were significantly lower in patients with clinical stage IV (p=0.018), and poor differentiated (p=0.010), laryngeal cancer com­pared to patients with clinical stage III and well-differentiated laryngeal cancer. The PLR value was significantly higher in the malignant group than in the benign group (p

Objective: In our study, we evaluated the clinical characteristics and outcomes of treatment in patients with Kaposi’s sarcoma (KS).Methods: The patients undergoing radiotherapy (RT) because of the KS between the years 2005-2012 in Radiation Oncology Department of Dicle University Hospital were included. All patients underwent RT with different dose-fractionation schemes to increase quality of life and to palliate the symptoms. Patients with lesions in multiple regions underwent RT in the same or different dates. Responses to radiotherapy were recorded as complete or partial response. Results: Fourteen patients received radiotherapy because of f KS were evaluated retrospectively. Twenty two different regions of 14 patients underwent RT . Only one patient (4.5%) was performed RT to glans penis as a third region while performed to the two regions in six patients (27.3%). At irradiations, 6 MV and 10 MV photon energies with 6 MeV, 9 MeV and 12 MeV electron energy were used. Water phantom or bolus material was used to obtain a homogeneous dose distribution in the photon irradiation. RT dose administered to a total of 22 different regional was median 800 cGy (Range: 800-3000 cGy). Median number of RT fractions was 1 .When treatment response were evaluated stable disease was present in the 4 (18.1%) regions. Partial response was achieved in eight (36.4%) regions, complete response in 10 (45.5%). RT-related common lymphedema in the feet and legs was observed in the four (57.3%) regions in the acute period. Complication of pain was present in two (28.7%) regions.Conclusion: RT is an appropriate and effective treatment regimen in the palliative treatment of KS lesions. Excellent response rates of skin lesions may be obtained by RT. Lesions and symptoms such as itching may be lost after RT. Side effects such as edema and pain may be relieved by supportive treatment, Amaç: Çalışmamızda Kaposi sarkomu (KS) tanısı nedeniyle radyoterapi (RT) uygulanan hastaların klinik özelliklerini ve tedavi sonuçlarını değerlendirdik.Yöntemler: Çalışmaya Dicle Üniversitesi Hastanesi Radyasyon Onkolojisi Kliniği’nde 2005-2012 yılları arasında RT uygulanan KS tanılı hastalar dahil edildi. Tüm hastalara semptomların palyasyonu ve yaşam kalitesini arttırmak için farklı doz-fraksiyonasyon şemaları ile RT uygulandı. Birden çok bölgesinde lezyonu olan hastalara aynı veya farklı tarihlerde RT uygulandı. Hastaların radyoterapiye cevapları tam veya kısmi yanıt olarak kaydedildi.Bulgular: KS nedeniyle radyoterapi uygulanan 14 hasta retrospektif olarak değerlendirildi. On dört hastanın toplam 22 farklı bölgesine RT uygulandı. Altı hastada (%27,3) iki ayrı bölge ışınlanırken, yalnız bir hastada (%4,5) üçüncü bölge olarak glans penisteki lezyona RT uygulandı. Işınlamalarda 6 MV ve 10 MV foton enerjileri ile 6 MeV, 9 MeV ve 12 MeV elektron enerjileri kullanıldı. Foton ışınlamalarında homojen doz dağılımı elde etmek için su fantomu veya bolus materyali kullanıldı. Uygulanan RT dozu toplam 22 farklı bölge için medyan 800 cGy (800-3000 cGy) idi. RT fraksiyon sayısı medyan 1’di (1-10). Tedavi yanıtları değerlendirildiğinde 4 (%18,1) bölgede stabil hastalık mevcuttu. Sekiz (%36,4) tedavi bölgesinde kısmi cevap sağlanırken, 10 (%45,5) bölgede de tam cevap elde edildi. Dört (%57,3) tedavi bölgesinde RT’ ye bağlı ayaklarda ve bacaklarda akut dönemde yaygın lenfödem gözlendi. İki (%28,7) bölgede ise ağrı komplikasyonu mevcuttu.Sonuç: RT, KS lezyonlarının palyatif tedavisinde uygun ve etkili bir tedavi rejimidir. RT ile cilt lezyonlarında mükemmel cevap oranları elde edilebilir. RT sonrası lezyonlar ve kaşıntı gibi şikayetler kaybolabilir. Ağrı, ödem gibi yan etkiler destek tedavi ile giderilebilir.Anahtar kelimeler: Kaposi sarkomu, radyoterapi, doz-fraksiyon şeması

Objective: Fecal diversion is often indicated in cases with fecal incontinence, Fournier’s gangrene, anal fistula, and inoperable obstructive anorectal cancer. Trephine colostomy can be performed without necessitating laparotomy. We present our experience related to the outcome of trephine sigmoid colostomy.Methods: The retrospective study included 14 patients who underwent trephine colostomy due to various conditions including Fournier’s gangrene, inoperable anorectal cancer, recto-vaginal fistula, and benign stricture due to radiotherapy at our clinic between January 2010 and January 2015.Results: Patients comprised 4 females and 10 males with a mean age of 52.07 years. The indications for stoma formation were Fournier’s gangrene in 7 cases, inoperable anorectal cancer in 5, rectovaginal fistula in 1, and benign stricture due to radiotherapy in 1 case. Eight patients underwent surgery under regional anesthesia. All the patients underwent trephine loop sigmoid colostomy. One patient had second operation on the postoperative period due to colostomy prolapse. The temporary stomas were closed in 3 months. Mean length of hospital stay was 14 days.Conclusion: Trephine stoma is a relatively simple, safe and rapid procedure and an effective alternative to colostomy formation without laparotomy indications. It can be performed under emergency or elective conditions with low morbidity. J Clin Exp Invest 2015; 6 (2): 87-90Key words: Fecal diversion, trephine stoma, outcomes, Amaç: Saptırıcı stoma sıklıkla fekal inkontinans, Fournier gangreni, anorektal fistüller ve tıkayıcı inoperable anorektal tümörler gibi durumlarda yapılır. Trefin stoma (TS) laparatomi yapılmaksızın yapılabilir. Biz bu çalışmada TS vakalarımızın sonuçlarıyla ilgili deneyimimizi paylaşmayı amaçladık.Yöntemler: Bu çalışma 2010 ile 2015 yılları arasında kliniğimizde Fournier gangreni, inoperabl anorektal kanser, rektovajinal fistül ve radyoterapi nedeniyle oluşan benign striktür gibi çeşitli nedenlerle TS yapılan 14 hastanın verileri geriye doğru incelendi.Bulgular: Hastalarımızın 10’u erkek, 4’ü kadın idi. Ortalama yaşları 52.07 yıl idi. Hastalarımızdan 7 tanesine Fournier gangreni, 5 tanesine inoperabl anorektal tümör, bir tanesine kompleks rekto-vajinal fistül ve bir tanesine de almış olduğu radyoterapiye bağlı gelişen tıkayıcı striktür nedeniyle TS yapıldı. Hastalarımızın 8 tanesine rejyonel anestezi uygulandı. Tüm hastalarımıza trefin loop sigmoid kolostomi uygulandı. Bir hastamız ostomi prolapsusu nedeniyle ikinci kez opere edildi. Geçici stomalar 3 ay sonra kapatıldı. Ortalama hastanede kalış süresi 14 gün idi.Sonuç: TS görece basit, güvenli ve hızlı yapılan bir uygulama olup laparatomi endikasyonu olmayan hastalarda etkili alternatif bir yöntemdir. Düşük morbidite oranıyla acil ve elektif şartlarda uygulanabilir

Objectives Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions. Methods We prospectively examined 141 breast lesions in 122 patients. All lesions were classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography, BI-RADS for sonography, and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA) pattern. Internal and marginal shear wave velocity (SWV) values for the lesions were noted. The sensitivity, specificity, accuracy, and positive and negative predictive values for VTI and Virtual Touch tissue quantification (VTQ; Siemens Medical Solutions) were calculated. Results The marginal SWV values were statistically higher in malignant lesions (mean ± SD, 5.41 ± 1.37 m/s) than benign lesions (2.91 ± 0.88 m/s; P < .001). When the SWV cutoff level was set at 4.07 m/s, and the higher of the internal and marginal values was adopted, the combination of VTI and VTQ showed 95.1% sensitivity, 99.0% specificity, and 97.8% accuracy. Conclusions Breast Imaging Reporting and Data System category 4 lesions are the main focus of research for early detection of breast cancer. Unfortunately, BI-RADS category 4 assessment covers a wide range of likelihood of malignancy (2%–95%). This wide range reflects the necessity for a more specific imaging modality. The combination of VTI and VTQ could increase the diagnostic performance of conventional sonography.

Due to the rarity and large diversity of the primary retrorectal tumors (RTs), the diagnoses are often difficult and they can be misdiagnosed. We present our experience in light of scarce information available on the clinical manifestations of RTs. The retrospective study included 17 patients diagnosed as RTs between January 2004 and January 2014. Demographic characteristics, length of symptoms, clinical findings, diagnostic methods, evaluations on the treatment procedures and postoperative periods, pathology, complications, and length of hospital stay were recorded. A mean of 1.7 of patients were diagnosed with RTs annually in our hospital. Patients comprised 12 females and 5 males. Pain and discomfort were the most common symptoms at presentation. All the lesions were evaluated by using magnetic resonance imaging (MRI) and computed tomography (CT), and all the patients were treated operatively. Based on the preoperative MRI or CT findings, an anterior approach was performed in 7 patients, a posterior approach in 6 patients, and combined approach in 4 patients. Mean size of tumors was 9.2 ± 4.3 cm. Epidermoid cyst (n = 8) was the most common tumor. Except for 1 case of liposarcoma, 16 tumors were confirmed to be of benign nature in histologic examination. Mean length of hospital stay 12.4 ± 6.8 days. Retrorectal tumors are heterogeneous and lead to diagnostic difficulties. A high index of clinical suspicion is needed for diagnosis. Preoperative imaging may be helpful in determining the course of treatment. Total excision of a retrorectal tumor may alleviate pressure symptoms and confirm the diagnosis.

We aimed to evaluate the effectiveness of the brain region imaging in FDG-PET/CT scanning of patients with suspected or diagnosed lung cancer. We performed the study retrospectively on the medical charts of 427 patients. We divided the FDG-PET/CT field of view (FOV) into four major imaging regions: brain, head–neck, abdomen and pelvis. Metastatic findings on these regions were checked and determined the potential of these findings to affect the chemotherapy or radiotherapy protocol or surgical management. If metastatic findings had a potential to modify these parameters, we named this situation as “clinical contribution”. Considering the number of bed positions of these regions, we calculated the clinical contribution of each region and named as “effective clinical contribution”. Then, we calculated the metastatic findings, clinical contribution, and effective clinical contribution ratios. We found different brain metastasis ratios for lung cancer, solitary pulmonary mass (SPM), and solitary pulmonary nodule (SPN) groups (8.7, 2.8 and 0.9 %, respectively). In addition, the clinical contribution and effective clinical contribution ratios in the brain region for these three groups were 6.4, 2.8, 0.0 and 6.4, 2.8, 0.0 %, respectively. The highest metastatic findings (30.6 %) and clinical contribution (9.8 %) ratios were found in the abdomen region of the lung cancer group. However, the highest effective clinical contribution ratio (6.8 %) was found in the brain region within the same group. The addition of the brain region to the limited whole-body FOV in FDG-PET/CT scanning seems to be effective in the lung cancer and SPM groups, but not in the SPN group.

Background: Fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/ CT) and bone scintigraphy (BS) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in hormone receptor positive (+) and negative (-) groups of breast cancer remains ambiguous. Materials and Methods: Sixty-two patients with breast cancer, who had undergone both 18F-FDG-PET/CT and BS, being eventually diagnosed as having bone metastases, were enrolled in this study. Results: 18F-FDG-PET/CT had higher sensitivity and specificity than BS. Our data showed that 18F-FDGPET/CT had a sensitivity of 93.4% and a specificity of 99.4%, whiel for BS they were 84.5%, and 89.6% in the diagnosis of bone metastases. κ statistics were calculated for 18F-FDGPET/CT and BS. The κ-value was 0.65 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the κ-values were 0.70 in the hormone receptor (+) group, and 0.51 in hormone receptor (-) group. The κ-values suggested excellent agreement between all patient and hormone receptor (+) groups, while the κ-values suggested good agreement in the hormone receptor (-) group. Conclusions: The sensitivity and specificity for 18F-FDG-PET/CT were higher than BS in the screening of metastatic bone lesions in all patients. Similarly 18F-FDG-PET/CT had higher sensitivity and specificity in hormone receptor (+) and (-) groups.

Background: The aim of this study was to evaluate the prognosis of patients with stage IA-IIB cervical carcinoma and to investigate a possible correlation of histology with prognosis. Materials and Methods: Two hundred fifty one patients with adenocarcinoma and squamous cell carcinoma (SCC) histology for FIGO (International Federation of Gynecology and Obstetrics) stage IA-IIB uterine cervical carcinomas at the Radiation Oncology Clinic of GH Okmeydani Training and Research Hospital between January 1996 and December 2006 were selected, analyzed retrospectively and evaluated in terms of general characteristics and survival. Disease- free survival (DFS) and overall survival (OS) was calculated using the Kaplan-Meier method and differences were compared with the log-rank test. Multivariate analysis using a Cox-proportional hazards model was used to adjust for prognostic factors and to estimate hazard ratio (HR) with 95% confidence interval (CI). Results: There was no differences between the two tumour types in age, stage, pelvic nodal metastasis, parametrial invasion, surgical margin status, DSI, LVSI, maximal tumor diameter, grade, and treatment modalities. 5-year OS and DFS were 73% and 77%, versus 64% and 69%, for SCC and adenocarcinoma, respectively (p> 0.05). Multivariate analysis revealed independent prognostic factors including pelvic nodal metastasis and resection margin status for OS (p=0.008, p=0.002, respectively). Conclusions: Prognosis of FIGO stage IA-IIB cervical cancer patients was found to be the same for those with adenocarcinoma and SCC.

Background Patients with brain metastasis (BM) usually suffer from poor quality of life (QOL), anxiety, depression, and sleep disorders in their reduced lifespan. Objectives The aim of this study was to evaluate QOL, anxiety, depression, and sleep characteristics in patients with BM at the beginning and end of whole brain radiation therapy (WBRT) and three months after treatment. Methods Thirty-three patients undergoing WBRT for BM were featured in this study. The authors used the Karnofsky Performance Status (KPS) scale to measure performance status, the Hospital Anxiety and Depression Scale (HADS) to evaluate anxiety and depression, the SF-36® to evaluate health-related QOL, and the Pittsburgh Sleep Quality Index to evaluate sleep disorders at the start of WBRT, the end of WBRT, and three months after WBRT. Findings Statistically significant improvements were noted in KPS scores from baseline evaluation to the end of WBRT and to three months after WBRT. No significant differences were observed in SF-36 and HADS scores between the start and the end of WBRT. Anxiety scores were negatively correlated with survival at the end of WBRT. Overall survival was better in those who reported better sleep. WBRT improves KPS scores and does not worsen sleep quality or mood, even in patients with poor performance status. When changes in mood and sleep quality are observed, survival and QOL may improve in patients with BM; consequently, nurses should be responsive to these changes.

e16502 Background: The aim of our study was to investigate the clinical features, prognostic factors and survival times of cervical cancer patients with brain metastasis. Methods: We retrospectivel...