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Today, as Chemical, Biological, Radiological and Nuclear (CBRN) weapons are generally used to cause terror and havoc, they are also used to bring about mass destruction and breach of the capacity. Since CBRN weapons are easily procurable, they became an untrammeled power supply in the hands of weak states. Despite all international judgments, treaties and pressures preventing production, storage and usage of chemical weapons, uncontrolled usage still has not been averted. Dual-use feature of some chemicals provides convenience in their trading permissions and their passing through customs. Because chemical detections are difficult and early warning systems are not prevalent in border crossings and customs entries, there is an increasing danger. Disregard of the agencies and institutions meant to be responsible from protecting human health and health of other species, jeopardizes the situation more.In terms of disaster medicine, management of injuries with chemical warfare agents and injured peoples require a multi-disciplinary approach, study and coordination. Unfortunately, academic studies regarding standard procedures and algorithms of rescue and health services provided to the injured peoples as from the initial contact, - especially in the case of injuries with chemical weapons- have a very limited availability. On the purpose of removing this uncertainty and remedying the current deficiency; scientists, forensic science experts, health care providers, chemists, engineers, search and rescue experts, firefighters, members of the managerial disciplines, legists, logistics specialists and experts related to the security field urgently need to determine required standard algorithms of prevention and response.In this study; the medical care processes of chlorine gas as chemical weapons wounded in Syria due to Syrian civil war are evaluated in terms of disaster medicine, Günümüzde Kimyasal, Biyolojik, Radyolojik ve Nükleer (KBRN) silahlar genellikle terör ve paniğe sebep olmak amacı ile kullanıldıkları gibi kitlesel yok etme veya kapasiteyi bozma amacıyla da kullanılmaktadır. KBRN silahlarının kolay elde edilebilir olması, güçsüz devletlerin elinde kontrolsüz bir güç kaynağı olmasına neden olmuştur. Kimyasal silahların üretimi, depolanması ve kullanımını önleyici uluslararası kararlara, anlaşmalara ve baskılara rağmen, halen kontrolsüz bir şekilde kullanılmasının önüne geçilememektedir. Bazı kimyasalların çift kullanım özelliklerinin olması da ticari izinlerinde ve gümrük geçişlerinde kolaylık sağlamaktadır. Sınır ile gümrüklerden geçişlerde kimyasalların tespitlerinin zorluğu ve erken uyarı sistemlerinin yaygın olmaması tehlikeyi daha da artırmaktadır. İnsanların ve diğer canlıların sağlığını korumaktan sorumlu olan kurum ve kuruluşların konuya önem vermemeleri ise durumu daha da tehlikeli hale getirmektedir.Afet tıbbına göre kimyasal savaş ajanlarıyla yaralanma ve yaralı yönetimi multidisipliner bir yaklaşımı, çalışmayı ve koordinasyonu gerektirmektedir. Özellikle kimyasal silahlarla yaralanma durumunda, yaralıya ilk temas anından itibaren sunulacak olan kurtarma ve sağlık hizmetlerine dair standart uygulamalar ile algoritmalar hususunda akademik çalışmalar ülkemizde ne yazık ki yok denecek kadar sınırlı sayıdadır. Bu belirsizliğin ortadan kaldırılması ve mevcut eksikliğin giderilmesi amacıyla; bilim insanları, adli tıp uzmanları, sağlıkçılar, kimyacılar, mühendisler, arama ve kurtarmacılar, itfaiyeciler, yönetim disiplini mensupları, hukukçular, lojistik uzmanları, güvenlikle ilgili uzmanların ivedilikle ortak çalışmalar yaparak gerekli standart önleme ve müdahale algoritmalarını belirlemeleri gerekmektedir.Bu çalışmada; örnek bir süreç yönetimi olarak Suriye iç savaşında kimyasal silah olarak kullanılan klor gazı yaralılarının ülkemizdeki tıbbi bakım süreçleri afet tıbbı açısından değerlendirilmiştir.

Objective In this study, we aimed to investigate whether there is any change in diffusion tensor imaging (DTI) parameters in ipsilateral and contralateral auditory pathways after Gamma Knife radiosurgery (GKR) in patients with vestibular schwannoma (VS) and the relationship between radiosurgery variables. Methods Sixty-six patients were evaluated with MRI and DTI before and after GKR. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were measured from the bilateral lateral lemniscus (LL), inferior colliculus (IC), medial geniculate body (MGB), and Heschl's gyrus (HG). Results There was no significant difference in ADC and FA values obtained from bilateral LL, IC, and MGB before and after radiosurgery. However, there was a significant difference between pretreatment and post-radiosurgery contralateral HG ADC values. The ADC values obtained from the contralateral HG and IC positively correlated with the duration after radiosurgery. As the duration after radiosurgery increases, the difference between the ADC values obtained from ipsilateral and contralateral HG also increases. Conclusion The high ADC values in the contralateral HG after radiosurgery may indicate microstructural alterations such as demyelination and axonal loss. Radiation exposure doses to the brainstem and cochlea are the most important factors that can cause microstructural damage to the auditory pathways. When planning radiosurgery, extreme care should be taken to prevent the harmful effects of radiation on the auditory pathways.

Purpose: The purpose of this study is to investigate the optimal radiotherapy technique for postoperative irradiation of gastric cancer treated with total gastrectomy. Materials and Methods: The database of ten patients was used for this study. Three-dimensional (3D) conformal radiotherapy, intensity-modulated therapy (IMRT), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) plans were created for each dataset. The prescription dose was 45 Gy in 25 fractions. Comparative analyses of the target volume coverage and the doses of organs at risk were performed. Results: HT was significantly provided more homogeneity. The best conformal plans were achieved with VMAT. Both kidneys were better preserved with HT and VMAT. HT significantly lowered the V13 of the left kidney and VMAT significantly lowered V20. However, the mean left kidney doses were not statistically different. The lowest liver V30 was obtained with VMAT but not with statistically different than IMRT and HT. Mean liver doses were statistically inferior with 3D. The worst spinal cord doses were seen with 3D. The integral dose of the body did not differ among the techniques. Conclusion: In comparison of the four techniques, 3D seems to be the most unsuitable method regarding sparing the normal tissues. According to availability, HT and VMAT should be primarily preferred. IMRT can also be used with carefully paying attention to the clinical condition of the patient.

Objective:Some previous studies have shown that low-dose radiotherapy (RT) can increase tumor invasion and metastasis. Multiple RT fields are usually used to prevent the damage to the organs at risk. We performed a clinical study with a concern that low-dose RT might increase invasion or metastasis. Ionizing radiation (IR) can enhance the potential tumor micro-environment by modifying the host micro-metastatic cancer cells.Methods:We conducted a retrospective study on 50 patients aged between 45 and 87 years, who were applied RT and/or chemotherapy, had the Eastern Cooperative Oncology Group performance status (ECOG) between 1 and 3 and stage II–III lung cancer, and were without any metastasis. RT was applied at daily fractions of 180–200 cGy (5 days/week) and a 54–66 Gy total dose. V5, V10, V20, V40, V50, and V60 values of the lung in a disease-free life, and general life effects statistically analysed with Mann-Whitney U and L Par testS.Results:A lower RT dose range, which produced V5, V10, and V20 volume values of the lung, was analyzed. It was observed that the V5, V10, and V20 RT volumes of the lung provided a minimal positive effect on relapse-free and general survival according to the R-correlation values.Conclusion:Larger studies are necessary according to these results to evaluate the impact of low-dose radiation and to increase the survival rates.

Background: There is lack of data on the effect of stereotactic radiosurgery in modulation of the immune system for cancer patients with metastatic brain tumours. Therefore, we investigated the change in levels of immunoregulatory molecules after Gamma Knife radiosurgery (GKR) and whole brain radiation therapy (WBRT) in patients with brain metastases. Methods: Peripheral blood samples were collected from 15 patients who received GKR, nine patients who received WBRT for brain metastases and 10 healthy controls. Samples were obtained at three time points such as before, 1h after and 1 week after the index procedure for patients treated with GKR or WBRT. All patients- demographic data and radiosurgical parameters were retrospectively reviewed. We analyzed the change in the levels of T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death ligand-1 (PD-L1), and cytokines such as IL-2, IL-10, IFN-gamma, TNF-alpha after GKR and WBRT using Enzyme-linked immunosorbent assays (ELISA). Results: Baseline level of IFN-gamma was found to be lower and that of PD-L1 was higher in the GKR group compared to WBRT group and healthy controls (p < 0.05 and p < 0.01, respectively). Levels of IFN-gamma and IL-2 were increased (p < 0.01 and p < 0.01, respectively), while CTLA-4 and PD-L1 were decreased (p = 0.05 and p = 0.01, respectively) after GKR compared to pre-GKR levels, while there was no change after WBRT. Conclusion: GKR regulates immunoregulatory molecules towards enhancing the immune system, while WBRT did not exert any effect. These findings suggested that treatment of metastatic brain lesion with GKR might stimulate a systemic immune response against the tumour. Bezmiâlem Vakıf Üniversitesi

The goal of this study was to demonstrate the effect of radiotherapy (RT) on nasal mucosa in rats and to evaluate the radioprotective effects of the topical application of black seed oil (Nigella sativa [NS]) to treat acute radiation-induced nasal mucositis.A total of 18 rats were randomized into 3 groups, with 6 animals per group. The rats in group 1 were topically administered saline in the nasal cavity after sham irradiation. Group 2 received saline at the same dose after irradiation. Group 3 was given NS after irradiation. The rats in groups 2 and 3 were irradiated with a single dose of 40 Gy to the nasal and paranasal area. Only one drop of saline (0.05 mL) was applied to each nostril in the first, second, and third days after RT in groups 1 and 2. One drop of cold press NS (0.05 mL) was applied to each nostril in group 3. Fourteen days after irradiation, the nasal mucosal tissues were excised for histopathological evaluation. Vascular dilatation, inflammatory cell infiltration, superficial erosion, and formation of exudates were classified according to the severity.No evidence of mucositis was observed in group 1. Of all the parameters the only statistically significant difference between groups 2 and 3 were observed for "superficial erosion' (P < 0.05). Overall microscopic observations in the NS-treated group were better than in group 2.The preliminary results of our study have shown that local application of NS to the nasal mucosa may be an effective treatment of acute nasal mucositis due to RT.

The cancer treatments cause many side effects in patients. This is more important in pancreatic cancer (PCa) than other types of cancer because the PCa patients already suffer from abdominal pain, nausea, and loss of appetite. Therefore, it is necessary to focus on new treatment ways that decrease the toxicity and increase the survival time in PCa patients. A retrospective study was performed with 20 PCa patients who had non-metastatic locally advanced inoperable PCa. Patients were divided into 2 groups. Group 1 (n=9) included patients who received chemoradiotherapy and, taken Nigella sativa(NS) and pure honey (H) (NS+H+CRT group). Group 2 (n=11) consisted of patients who treated with concurrent chemoradiotherapy (CRT or control group). The median survival time was 15months, and %11.11 of patients (n=1) had a survival time of 36months in group 1. In control group (Group 2), the median survival time was 10months. Results revealed that chemoradiotherapy supported by NS and pure honey consumption increased the survival time when used before and during treatment of PCa patients.

Background: Locoregional recurrence is a major problem in esophageal cancer patients treated with definitive concomitant chemoradiotherapy. Approximately half of the patients fail locoregionally. We analyzed the impact of enlarged radiation field size and higher radiation dose incorporated to chemoradiotherapy on oncologic outcome. Methods: Seventy-four consecutive patients with histologically proven nonmetastatic squamous or adenocarcinoma of the esophagus were included in this retrospective analysis. All patients were locally advanced cT3-T4 and/or cN0-1. Treatment consisted of either definitive concomitant chemoradiotherapy (Def-CRT) (n = 49, 66 %) or preoperative concomitant chemoradiotherapy (Pre-CRT) followed by surgical resection (n = 25, 34 %). Patients were treated with longer radiation fields. Clinical target volume (CTV) was obtained by giving 8-10 cm margins to the craniocaudal borders of gross tumor volume (GTV) instead of 4-5 cm globally accepted margins, and some patients in Def-CRT group received radiation doses higher than 50 Gy. Results: Isolated locoregional recurrences were observed in 9 out of 49 patients (18 %) in the Def-CRT group and in 1 out of 25 patients (3.8 %) in the Pre-CRT group (p = 0.15). The 5-year survival rate was 59 % in the Def-CRT group and 50 % in the Pre-CRT group (p = 0.72). Radiation dose was important in the Def-CRT group. Patients treated with > 50 Gy (11 out of 49 patients) had better survival with respect to patients treated with 50 Gy (38 out of 49 patients). Five-year survivals were 91 and 50 %, respectively (p = 0.013). Conclusions: Radiation treatment planning by enlarged radiation fields in esophageal cancer decreases locoregional recurrences considerably with respect to the results reported in the literature by standard radiation fields (18 vs > 50 %). Radiation dose is as important as radiation field size; patients in the Def-CRT group treated with = 50 Gy had better survival in comparison to patients treated with 50 Gy.

Radiation therapy is one of the most common treatment ways for cancer. It is important to maintain patients’ general health and quality of life during the treatment. It is known that radiation-related complications have impact on the quality of life in patients. Researches revealed that a balanced diet and regular physical activity could increase quality of life in cancer patients receiving radiotherapy. In addition, determining the lifestyles in terms of health behaviors of cancer patients is indeed important in terms of optimizing their treatment outcomes and welfare. The aim of the study was to determine dietary and physical activity habits in patients receiving radiotherapy using the questionnaire. The questionnaire was composed of five sections: socio-demographic data, type of cancer, anthropometric measurements, dietary and physical activity habits. One hundred eighty-eight patients were reached during the study. Patients included in this study had different type of cancer. Only 35% (n=45) of patients reported being physically active. Sixty-eight percent of patients (n=89) skipped meal where as 31% of these patients (n=28) have skipped meals due to lack of appetite. Daily water consumption was 2 litres for 17% (n=22) patients. Most patients consumed protein foods (meat, fish, egg and beans) with 89% (n=116) and fruit-vegetables with 72% (n=93). In this study cancer-related and worse prognostic factors were determined. Our results suggested that cancer patients may require professional support and practice for nutrition and physical activity.

Various radiotherapy planning methods for T1N0 laryngeal cancer have been proposed to decrease normal tissue toxicity. We compare helical tomotherapy (HT), linac-based intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT), and 3-D conformal radiotherapy (3D-CRT) techniques for T1N0 laryngeal cancer. Overall, 10 patients with T1N0 laryngeal cancer were selected and evaluated. Furthermore, 10 radiotherapy treatment plans have been created for all 10 patients, including HT, IMRT, VMAT, and 3D-CRT. IMRT, VMAT, and HT plans vs 3D-CRT plans consistently provided superior planning target volume (PTV) coverage. Similar target coverage was observed between the 3 IMRT modalities. Compared with 3D-CRT, IMRT, HT, and VMAT significantly reduced the mean dose to the carotid arteries. VMAT resulted in the lowest mean dose to the submandibular and thyroid glands. Compared with 3D-CRT, IMRT, HT, and VMAT significantly increased the maximum dose to the spinal cord It was observed that the 3 IMRT modalities studied showed superior target coverage with less variation between each plan in comparison with 3D-CRT. The 3D-CRT plans performed better at the Dmax of the spinal cord. Clinical investigation is warranted to determine if these treatment approaches would translate into a reduction in radiation therapy-induced toxicities. (C) 2016 American Association of Medical Dosimetrists.

To evaluate the relation between expression of P-Akt and radiotherapy response, disease-free survival and overall survival in cervi- cal 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 frac- tion 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 expres- sion, retrospectively. The median follow up time for the study population was 30 (12-120) months. Expression of P-Akt was identi- fied 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 dis- ease 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

larindan kaynaklanan ve bazal membrani asmamis (invazyon yapmamis) kanserlerdir.[1] DKIS insidansi 1980’lerde %2’lerde iken, tarama mamografilerinin ozellikle son 10-20 yilda yayginlasmasi ile bugun icin tum meme tumorlerinin %20’sini, mamografik olarak saptanan tum meme tumorlerinin ise %30’unu olusturmaktadir.[2-5] DKIS memenin non-invaziv bir tumorudur ve dogal davranisi tumorun derecesine ve histolojik tipine gore degismektedir. Tedavisiz birakildiginda dusuk dereceli olanlarin ucte biri 30 yil kadar sonra invaziv kansere donusmekte, yuksek dereceli olanlarda ise bu sure bes yila kadar inmektedir.[6-8] Tedavide mastektomi yerini meme koruyucu cerrahi (MKC) ve ardindan radyoterapiye birakmistir.

WOS: 000313141700008, The prolongation of survival in cases with nasopharynx cancer has made quality of life after treatment more important. The aim of this study is to consider late toxicity developing after treatment in order to maintain a high quality of life. Thirty-two patients receiving radiotherapy (RI) to the neck region 1-10 years ago due to nasopharyngeal carcinoma were included in the study. Neck ultrasonography (USG), thyroid function tests and dynamic brain magnetic resonance imaging (MRI) were carried out for carotid artery stenosis, hypothyroidism, and necrosis of the temporal lobe. Obtained data were analyzed with the SPSS 11.5. Intima-media thickness of below 60 Gy and above 60 Gy doses administered to the neck were similar. Intima-media thickness was greater in patients with a period longer than 5 years after RT than with a period shorter than 5 years (p< 0.001). lntima-media thicknesses of the patients above 40 years, with high cholesterol values, a history of smoking and hypertension were higher than those without them (p< 0.001). There was hypothyroidism in five (15%) of the 32 patients. Necrosis of the temporal lobe was not seen in any of the patients. Carotid artery stenosis after treatment depends more on the duration of the period after treatment and the patient's being in the age group when atherosclerotic risk factors are present than on the amount of dose administered.

Concomitant administration of chemotherapy and radiotherapy is currently recognized as the standard of treatment in locally advanced inoperable non-small cell lung cancer (NSCLC). Our study aimed to compare the efficacy and toxicities of three different chemotherapy regimens delivered concurrently with radiotherapy. We retrospectively reviewed the clinical records of patients who received the PE (cisplatin, 50 mg/m(2), on days 1, 8, 29, and 36 plus etoposide, 50 mg/m(2), on days 1 to 5 and 29 to 33), PD (docetaxel, 20 mg/m(2), on day 1 plus cisplatin, 20 mg/m(2), on day 1, every week), and PC (carboplatin, AUC 2 plus paclitaxel, 45 mg/m(2), on day 1, every week) regimens concurrently with radiotherapy. A total of 227 patients were evaluated in the study. Median follow-up time was 13 months (2-101). There were 27 females (11.9 %) and 200 males (88.1 %) with a median age of 61 (38-82) years. The PD group had higher rates of esophagitis, mucositis, and anemia (p

Purpose: Akt, also known as protein kinase B (PKB), is an intracellular signal transduction protein activated by growth hormones. PKB/Akt is frequently activated in a variety of cancer types, but its role in the development and progression of lung cancer has not been completely elucidated yet. The aim of the present study was to determine the prognostic value of PKB/Akt in non-small cell lung cancer (NSCLC). Methods: A total of 32 tumor samples from NSCLL patients were examined before treatment. The staining characteristics of the cases were evaluated in terms of age, stage (T and N), response to therapy, histological type, tumor size, and ECOG performance status (PS). Results: No statistical correlation was found between PKB/ Akt expression and gender, ECOG PS and stage (T and N), while significant correlation between cytoplasmic PKB/akt expression and age was detected (p

This study describes the early clinical results and dosimetric parameters of intensity-modulated radiation therapy (IMRT) using a tomotherapy device in patients with primary bilateral synchronous breast cancer (PSBBC).Fourteen patients with bilateral breast cancer were treated with tomotherapy between January 2011 and October 2014. The treatment planning objectives were to cover 95% of the planning target volume using a 95% isodose, with a minimum dose of 90% and a maximum dose of 107%. The organs at risk (OAR), such as the lungs, heart, esophagus and spinal cord, were contoured. Acute toxicity was recorded during and after radiation therapy.The advantages included better treatment conformity with lower dosages to minimize the risk to susceptible organs, such as the lungs, heart and spinal cord. There was improved coverage of the planning target volume, including the regional nodes, without any field junction problems. The median homogeneity index was 0.13 and the median conformity index 1.32. The median V20, V15, V10 and V5 for the total lungs were 18.5, 23.3, 24.2 and 60%, respectively. Skin acute toxicity was grade 1 in 72% and grade 2 in 14% of the patients. Esophageal acute toxicity was grade 1 in 43% of the patients.Tomotherapy delivers treatment that is well-tolerated, with high homogeneity and coverage indexes and the capability to reduce the irradiation dose received by the lungs and heart in PSBBC patients. This technique is therefore feasible and safe for the treatment of bilateral breast cancer.

Objective:We evaluated different treatment results reported and showed the effect of treatment at single and multiple clinics for small-cell lung cancer (SCLC). We attempted to show a decreasing impact of chemotherapy (CT) and thoracic radiotherapy (RT) treatment results when implemented at different clinics for SCLC compared to the treatment results at a clinic.Methods:We conducted a retrospective study on 54 non-metastatic SCLC patients who underwent treatments at various clinics. Patients underwent 1–12 courses of CT before they came to the clinic for thoracic RT. RT was performed at 180–400 cGy dose per fraction for a total of 30–52 Gy doses, and patients were followed for 12–60 months.Results:When the study was reviewed, the results showed that the median disease-free survival and survival rates were 8 and 9 months and that the 2-, 5-, and 5-year survival rates were 8%, 6.3%, and 1.8%, respectively. The median progression-free survival rates for 2 and 3 years were 4%, and for 5 years, it was 1.8%. Weight loss for disease-free survival (p=0.01) and superior vena cava syndrome for overall survival (p=0.02) were considered as bad prognostic factors. In this study, acceptable toxicity values were found when the results were compared with those from other studies.Conclusion:We obtained worse results than those from literature data on our SCLC patients who came to our clinic after the progression of their disease. The main causes were identified as insufficient staging and different treatment protocols applied at different clinics. Therefore, we argue that CT and thoracic RT for SCLC must be performed at the same clinic and that the same protocols and staging methods must be used.