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OBJECTIVE: The purpose of the study was to evaluate the impact of escitalopram co-prescription on plasma anastrozole levels in post-menopausal breast cancer patients. METHODS: A total of 24 post-menopausal operated breast cancer patients co-prescribed with escitalopram and anastrozole were included. Blood samples were collected, before and 1-month after the onset of escitalopram to analyze plasma anastrozole and estradiol levels. RESULTS: No significant difference was noted in basal plasma anastrozole levels with respect to age, body mass index (BMI), tumor stage, previous antineoplastic treatments, concomitant medications, and serum estradiol levels. Overall, 17 patients completed the 1-month escitalopram treatment, while 7 patients discontinued escitalopram within the 1st week of the treatment. Basal anastrozole levels of 24 patients were 26.1±2.4 ng/mL. Among 17 patients who continued 1-month escitalopram treatment was associated with significant increase in plasma anastrozole levels (24.5±2.3 ng/mL to 32.2±3.2 ng/mL, p<0.05). Notably, 1-month escitalopram use was associated with significant increase in plasma anastrozole levels only in the subgroup of obese (BMI >29 kg/m²) patients (23.1±2.8 to 35.9±4.7 ng/mL, p<0.01), while no such interaction was noted among non-obese patients. The estradiol levels of the patients were below =10 pg/mL in 75% of patients and no change occurred after escitalopram administration. CONCLUSION: Escitalopram co-prescription resulted in significant increase in plasma anastrozole levels without affecting the serum estradiol levels. Our findings emphasize the need for close monitoring in case of concomitant use of anastrozole and escitalopram, especially in obese patients and the potential role of therapeutic drug monitoring. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Oncology / Türk Onkoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Oncology / Türk Onkoloji Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE Brain metastasis can be seen in small cell lung cancer patients despite cranial radiotherapy. In case of intracranial recurrence after cranial radiotherapy, treatment choices are restricted. Cranial reirradiation may be an option. In our study, the role of stereotactic radiotherapy after relapse in patients undergoing whole-brain radiotherapy for prophylaxis or metastasis was investigated. METHODS Thirty-six small cell lung cancer patients who had intracranial recurrence after total cranial irradiation and who were treated with salvage SRT in our clinic between June 2010 and January 2019 were evaluated retrospectively in this study. The patients were treated using a frameless robotic radiosurgery system (CyberKnife-Accuray, CA, USA). Median 20 Gy (10-24 Gy) was administered in one to four fractions depending on the volume and relation of the tumor with critical structures. RESULTS Whole-brain radiotherapy was performed with cranial prophylaxis in 16 patients (44.5%) and brain metastasis in 20 patients (55.5%), in which patients underwent stereotactic radiotherapy (SRT) with recurrence/metastasis. Median follow-up time after SRT was 5.5 months. Median one and two years survival after SRT were %33 and %6,6, and median survival was 4,1 months. After SRT, one and twoyear cranial control rates were 57% and 15%, and the median cranial control duration was 12.8 months. In multivariate analysis, the only time interval between WBRT and SRT was found to be significant for survival after SRT p=0.014 (HR: 2.66 95% CI:1.21-5.82). CONCLUSION SRT should be considered as a treatment alternative, especially in patients with long time intracranial control after whole-brain radiotherapy and in patients with systemic disease control. [ABSTRACT FROM AUTHOR]

OBJECTIVE In this study, we aimed to analyze the results of stereotactic body radiotherapy (SBRT) in patients with adrenal gland metastasis due to different primary tumors. METHODS 26 patients with 29 adrenal gland metastases who were treated between 2011-2018 with Cyberknife Robotic System were evaluated retrospectively. RESULTS The origin of adrenal gland metastasis was lung in 22 patients, breast in 1 patient, parotid gland in 1 patient, and sarcoma in 2 patients. Fifteen patients (58%) had other organ metastasis in addition to the adrenal metastases. Six patients were treated for synchronous metastasis and 20 patients for metachronous metastasis. SBRT was performed in median 3 fractions (3-5 fractions), and the median prescription dose to PTV was 30 Gy (18- 45 Gy), with a BED10 (Biological Equivalent Dose) value of 60 Gy (28.8-112,5 Gy). The median follow-up time was 11 months (1-34 months), and median overall survival was 12 months after SBRT, 1,2-years survival rates were 49,7%, 21% respectively. Median time to local failure was not reached, and the 6-months, 1 and 2-years local failure free survival rates were 78,6%, 66,5% and 66,5% respectively. The presence of metastatic disease outside the adrenal gland was found to be a significant prognostic factor on survival after SBRT in both univariate and multivariate analyzes, (HR:3; 95% CI 1,06-8,55 p:0,04). In general treatment was well tolerated and no major acute toxicities were observed. CONCLUSION SBRT provides high local control rates and a well tolerated treatment in patients with adrenal gland metastases. Survival is particularly encouraging for patients with solitary adrenal metastasis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Stage III disease accounts for approximately one-fourth of all non-metastatic non-small cell lung cancer (NSCLC). The patients who are not candidates for curative resection are offered concomitant chemoradiotherapy. In this subgroup, which is difficult to manage, studies that address the role of PET-CT to predict outcome measures specifically for stage III NSCLC receiving concurrent chemoradiotherapy may help better risk stratification. This study aimed to assess whether baseline PET maximum standardized uptake value (SUVmax) value in stage III NSCLC treated with concurrent chemoradiotherapy would independently identify patients with high risk of progression and death. METHODS: The study population consisted of patients aged 18 years or more with unresectable stage III histologically or cytologically proven NSCLC who received concurrent chemoradiotherapy. From 2007 to 2014, medical records of patients admitted to our institution were retrospectively analyzed. Pretreatment PET-CT SUVmax values were recorded for each patient. These values were categorized as low or high according to the median SUVmax measure of the study population. RESULTS: A total of 175 patients were analyzed. The median follow-up time was 23 months (range 6-109). The PET-CT SUVmax values ranged from 3.5 to 46 with a median value of 14. The median overall survival was 25 months in SUVmax <14 and 18 months in SUVmax =14 group (p=0.023). The median progression-free survival was 16 months in SUVmax <14 and 11 months in SUVmax =14 group (p=0.033). Multivariate analysis revealed that both PET-CT SUVmax value (p<0.001) and age (p=0.016) were independent significant predictors for overall survival (OS). CONCLUSION: The results of this study involving patients with stage III NSCLC receiving concurrent chemoradiotherapy provide evidence that suggests that high values of pretreatment SUVmax, an indicator of metabolic tumor burden, predicted a higher risk of disease progression and death. [ABSTRACT FROM AUTHOR]

To evaluate the relation between expression of P-Akt and radiotherapy response, disease-free survival and overall survival in cervical cancer patients. A total of 50 patients with FIGO stage IIB locally advanced squamous cell cervical cancer treated primarily with chemoradiotherapy were included in the present study. All patients received external beam radiotherapy (EBRT; 46-50.4 Gy with 1.8-2 Gy of daily fraction, five times a week) followed by high-dose rate brachytherapy (HDR 26 Gy at point A, with 6.5 Gy per fraction a week for 4 weeks). Chemotherapy consisted of 40 mg/m2 cisplatin i.v. once a week for 5 weeks concomitant with external pelvic radiation. Paraffin-embedded, formalin-fixed primary tumor tissue was collected from each patient to identify P-Akt expression, retrospectively. The median follow up time for the study population was 30 (12-120) months. Expression of P-Akt was identified in 86% (43/50) of patients. Overall 3-years survival and disease free survival were 89.3% and 79% ; respectively in the study population. There was no significant association between P-Akt staining and survival (89% vs 85.7%, p= 0.641) and disease-free survival (80% vs 88.2%, p= 0.498). There was no relation between expression of P-Akt and treatment response, size of the tumor, lymph node status, age, local and distant failures. Univariate analysis revealed significantly reduced overall 3-years survival and disease free survival only for patients with poor treatment response (p= 0.001). In multivariate analysis, treatment response was found to be statistically significant parameter only for DFS ( p= 0.001 ). In conclusion, in our study, expression of P-Akt was detected in majority of cervical cancer patients. However no correlation was observed between P-Akt staining degree and treatment response. [ABSTRACT FROM AUTHOR]

Objective: Stage III disease accounts for approximately one-fourth of all non-metastatic non-small cell lung cancer (NSCLC). The patients who are not candidates for curative resection are offered concomitant chemoradiotherapy. In this subgroup, which is difficult to manage, studies that address the role of PET-CT to predict outcome measures specifically for stage III NSCLC receiving concurrent chemoradiotherapy may help better risk stratification. This study aimed to assess whether baseline PET maximum standardized uptake value (SUV max ) value in stage III NSCLC treated with concurrent chemoradiotherapy would independently identify patients with high risk of progression and death., Methods: The study population consisted of patients aged 18 years or more with unresectable stage III histologically or cytologically proven NSCLC who received concurrent chemoradiotherapy. From 2007 to 2014, medical records of patients admitted to our institution were retrospectively analyzed. Pretreatment PET-CT SUV max values were recorded for each patient. These values were categorized as low or high according to the median SUV max measure of the study population., Results: A total of 175 patients were analyzed. The median follow-up time was 23 months (range 6-109). The PET-CT SUV max values ranged from 3.5 to 46 with a median value of 14. The median overall survival was 25 months in SUV max <14 and 18 months in SUV max ≥14 group (p=0.023). The median progression-free survival was 16 months in SUV max <14 and 11 months in SUV max ≥14 group (p=0.033). Multivariate analysis revealed that both PET-CT SUV max value (p<0.001) and age (p=0.016) were independent significant predictors for overall survival (OS)., Conclusion: The results of this study involving patients with stage III NSCLC receiving concurrent chemoradiotherapy provide evidence that suggests that high values of pretreatment SUV max , an indicator of metabolic tumor burden, predicted a higher risk of disease progression and death., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Aim: To evaluate survival data in patients with gastric cancer in relation to postoperative adjuvant therapy and survival determinants, Methods: A total of 201 patients (mean±SD age: 56.0±11.9 years, 69.7% were males) with gastric carcinoma who were operated and followed up at Lutfi Kirdar Kartal Training and Research Hospital between 1998 and 2010 were included in this retrospective study. Follow up was evaluated divided into two consecutive periods (before 2008 and 2008-2010, respectively) based on introduction of 3-D conformal technique in radiotherapy at our clinic in 2008. Data on patient demographics, clinical and histopathological characteristics of gastric carcinoma and the type of treatment applied after surgery [postoperative adjuvant treatment protocols including chemoradiotherapy (CRT) and chemotherapy (CT), supportive therapy or follow up without any treatment] were recorded. The median duration and determinants of local recurrence free (LRF) survival, distant metastasis free (DMF) survival and overall survival were evaluated in the overall population as well as with respect to follow up years [1998-2008 (n=127) vs 2008-2010 (n=74)]., Results: Median duration for LRF survival, DMF survival and overall survival were 31.9, 24.1 and 31.9 mo, respectively in patients with postoperative adjuvant CRT. No significant difference was noted in median duration for LRF survival, DMF survival and overall survival with respect to treatment protocols in the overall population and also with respect to followed up periods. In the overall population, CT protocols FUFA [5-fluorouracil (400 mg/m2) and leucovorin-folinic acid (FA, 20 mg/m2)] (29.9 mo) and UFT®+Antrex® [a fixed combination of the oral FU prodrug tegafur (flouroprymidine, FT, 300 mg/m2 per day) with FA (Antrex®), 15 mg tablet, two times a day] (42.5 mo) was significantly associated with longer LRF survival times than other CT protocols (P=0.036), while no difference was noted between CT protocols in terms of DMF survival and overall survival. Among patients received CRT, overall survival was significantly longer in patients with negative than positive surgical margin (27.7 mo vs 22.4 mo, P=0.016) in the overall study population, while time of radiotherapy initiation had no significant impact on survival times. Nodal stage was determined to be independent predictor of LRF survival in the overall study population with 4.959 fold (P=0.042) increase in mortality in patients with nodal stage N2 compared to patients with nodal stage N0, and independent predictor of overall survival with 5.132 fold (P=0.006), 5.263 fold (P=0.027) and 4.056 fold (P=0.009) increase in the mortality in patients with nodal stage N3a (before 2008), N3b (before 2008) and N2 (overall study population) when compared to patients with N0 stage, respectively., Conclusion: Our findings emphasize the likelihood of postoperative adjuvant CRT to have a survival benefit in patients with resectable gastric carcinoma.

Background/aims: Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasms of the tubular gastrointestinal tract (GI). Here, we present a series of 32 patients diagnosed with a primary neoplasm in addition to GIST, from six different institutions in Turkey., Methodology: In total, 200 patients with GIST were evaluated; 32 patients with both GISTs and other primary malignancies were identified., Results: This study included 20 men and 12 women median age 66.5 years (range 43-78). GIST was incidentally found intra-operatively in 12 of the cases. All patients underwent surgery. Detection of the GIST was synchronous in 19 cases, metachronous in 7 cases and preceded the GIST diagnosis in 6 cases. The median time before follow-up evaluation ranged from 4 to 80 months., Conclusions: To our knowledge, no cases of GISTs co-existing with leiomyosarcoma of the spermatic cord and larynx tumors have been reported previously. The prevalence of malignancies in this subpopulation of GIST patients is significantly higher than the prevalence of malignancies in the healthy Turkish population. The high occurrence rate of additional primary malignancies in GIST patients has focused the attention of clinical oncologists on this problem, and may imply a common genetic mechanism for their etiology.

Aim: To evaluate late effects of chemoradiation on gastrointestinal mucosa with an endoscopic scoring system and compare it to a clinical scoring system., Methods: Twenty-four patients going to receive chemoradiation after gastric surgery underwent endoscopy four wk after surgery and one year after the chemoradiation finished. Upper gastrointestinal findings were recorded according to a system proposed by World Organisation for Digestive Endoscopy (OMED) and clinical scoring was done with RTOG-EORTC radiation morbidity scoring systems., Results: There was no significant endoscopic difference in gastric and intestinal mucosa after chemoradiation (P > 0.05) and there was no association between endoscopic scores and clinical scores. Endoscopic changes were minimal., Conclusion: Late effects after chemoradiation in operated patients with gastric cancers can be evaluated with an endoscopic scoring system objectively and this system is superior to clinical scoring systems.