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Amaç Lokal ileri rektum kanserlerinde neoadjuvan kemoradyoterapi(NAKRT) standart hale gelmiş olup patolojik tam yanıt (pCR) alınan hastalarda cerrahi yapılmadan izlem seçeneği tartışılmaktadır. Bu çalışmada NAKRT’ye yanıtı predikte edecek faktörleri araştırmayı amaçladık. Materyal ve metod 2011-2021 yılları arasındaki 18 yaş üstü rektum kanseri tanılı 184 hasta retrospektif olarak tarandı. Histopatolojik olarak rektum kanseri olduğu konfirme edilen ve lokal ileri evre olup neoadjuvan tedavi alan 79 hasta mevcuttu. 18 hasta çalışma dışı bıraklıdı, çalışmaya 61 hasta dahil edildi. TNM evrelemesi pelvik MRG (manyetik rezonans görüntüleme) ile yapıldı. Prediktif faktörleri belirlemek için SPSS’de lojistik regresyon modeli kullanıldı. Bulgular Çalışmaya 61 hasta dahil edildi. Median yaş 45 (44-89) idi. Hastaların 42(%68.9) si erkek idi. Klinik T evresi 34 (%55.7) hastada T3 ve 23 (%37.7) hastada T4 idi. Klinik N evresi 0, 1 ve 2 olan hastaların sayısı sırasıyla 5(%8.2), 28(%45.9) ve 28(%45.9) idi. Ortalama CEA(karsinoembriyojenik antijen) ve CA 19-9 değerleri sırasıyla 9.69 (std. Deviation:14.95) ve 12.32 (std. Deviation:12.61) idi. 49 (%80.3) hasta kapesitabin eşliğinde, 12 hasta 5-FU(5-Fluorourasil) eşliğinde RT(Radyoterapi) aldı. 40 (%65.6) hastaya LAR(Low anterior rezeksiyon) yapılmıştı. 57 (%93.4) hastanın patolojisi adenokarsinom idi. Patolojik yanıt durumuna bakıldığında 8 (%13.1) hastada tam yanıt ve 48 (%78.7) hastada kısmi yanıt varken 5 (%8.2) hasta tedaviye yanıtsız olarak görüldü. Sonuç Bazı çalışmalarda NAKRT ile tedavi yanıtını predikte edecek birtakım faktörler olduğu belirtilmiş olsa da henüz kılavuzlara yansımış ortak kabul edilmiş parametreler yoktur. Bizim çalışmamızda değerlendirilen parametreler arasında patolojik tam yanıtı predikte eden bağımsız bir faktör bulunamadı. ‘Neoadjuvan tedavi alan rektum kanseri hastalarında tedavi yanıtını predikte eden parametreler var mı?’ sorusuna cevap verecek daha çok sayıda ileri araştırmaya ihtiyaç duyulmaktadır.

Aim: To evaluate the immunogenicity and safety of the CoronaVac vaccine in patients with cancer receiving active systemic therapy. Methods: This multicenter, prospective, observational study was conducted with 47 patients receiving active systemic therapy for cancer. CoronaVac was administered as two doses (3 μg/day) on days 0 and 28. Antibody level higher than 1 IU/ml was defined as ‘immunogenicity.’ Results: The immunogenicity rate was 63.8% (30/47) in the entire patient group, 59.5% (25/42) in those receiving at least one cytotoxic drug and 100% (five of five) in those receiving monoclonal antibody or immunotherapy alone. Age was an independent predictive factor for immunogenicity (odds ratio: 0.830; p = 0.043). Conclusion: More than half of cancer patients receiving active systemic therapy developed immunogenicity., Tweetable abstract Immunogenicity developed with CoronaVac in 25 (59.5%) of 42 patients who received at least one cytotoxic drug and in all patients (n = 5) who received monoclonal antibody or immunotherapy alone.

Amaç : İskelet kas kaybı mide kanseri tanısı almış hastaların prognozu ile yakın koreledir. Çalışmamızda iskelet kas dansitesinin bilgisayarlı tomografi ile ölçümünün sağkalım üzerine etkisini araştırmayı amaçladık. Gereç ve yöntemler: Çalışmaya toplam 62 hasta dahil edildi. İskelet kas dansitesi (HUAC) ölçümü yapıldı. Sağkalım üzerine etki eden faktörleri saptamak için ünivariate ve multivarite cox regresyon analizi yapıldı.Bulgular: Evre, lenfovasküler invazyon, perinöral invazyon ve adjuvan tedavi alıp almama durumu ile sağkalım arasında anlamlı ilişki saptandı. HUAC değeri düşük olan erkek ve kadın hastaların sağkalımları hem ünivariate hem de multivariate analizde anlamlı olarak kötü tesbit edildi. Sonuç: çalışmamızda erken evre mide kanserli hastalarda operasyon öncesi HUAC ölçümünün sağkalım ile bağımsız olarak ilişkisini gösterdik. İskelet kas dansitesi düşük olan hastalarda sağkalımlar anlamlı olarak düşük saptandı., Aim :Skeletal muscle wasting is closely correlated with the prognosis of patients diagnosed with gastric cancer. In our study, we aimed to investigate the effect of measuring skeletal muscle density with computed tomography on survival.Materials and Methods:A total of 62 patients were included in the study. Skeletal muscle density (HUAC) was measured. Univariate and multivaritecox regression analyzes were performed to determine the factors affecting survival.Results:A significant correlation was found between survival and stage, lymphovascular invasion, perineuralinvasion, and whether or not to receive adjuvant therapy. The survival of male and female patients with low HUAC values was significantly worse in both univariate and multivariate analysis.Conclusion:In our study, we demonstrated the independent association of preoperative HUAC measurement with survival in patients with early stage gastric cancer. Survival rates were found to be significantly lower in patients with low skeletal muscle density.

Purpose: Taxane-containing combinations are recommended for the first-line therapy of advanced gastric cancer. It is not known which chemotherapy regimen is the best with trastuzumab for HER2-positive patients. The aim of this study was to compare taxane-containing intensified chemotherapy versus standard chemotherapy in combination with trastuzumab in the first-line treatment of HER2-positive advanced gastric adenocarcinoma. Methods: This study is a retrospective multicenter study of the Turkish Oncology Group. A total of 130 HER2-positive patients with inoperable locally advanced, recurrent, or metastatic gastric adenocarcinoma being given chemotherapy plus trastuzumab as the first-line treatment were included from 16 different oncology centers. Trastuzumab combination with intensified chemotherapy including taxane or standard chemotherapy was compared in terms of progression-free survival (PFS), overall survival (OS), and toxicity. Results: There were 108 patients in the standard and 22 patients in the intensified chemotherapy group. PFS of the standard and intensified group were 5.6 months (95% confidence interval [CI] 4.8–6.4) and 5.3 months (95% CI 2.6–8), respectively ( p = 0.70). OS of the standard and intensified group were 11.1 months (95% CI 8.3–13.9) and 15.2 months (95% CI 12.7–17.7), respectively ( p = 0.03). Repeated analysis excluding patients given any previous therapy revealed similar results. The intensified group had more fever and febrile neutropenia. Conclusion: Trastuzumab combination with intensified chemotherapy provides better OS in first-line treatment of HER2-positive advanced gastric cancer. Further large-scale studies should be performed in HER2-positive patients.

Aim: It is known that approximately 10% of breast cancers are hereditary, and BRCA1/2 genes are responsible forapproximately 20% of these. Studies have shown that mutations of many genes other than BRCA1/2 in breast cancer alsocause this predisposition. In this study, it was aimed to investigate other causative cancer susceptibility genes in womenwith breast cancer.Material and Methods: In this retrospective study, 66 female patients who were evaluated in Ankara Dışkapı YıldırımBeyazıt Training and Research Hospital Genetics Department between 2016-2020 were included. Cancer susceptibilitygenes of the patients were examined using next-generation sequencing technique (NGS).Results: Mean age at diagnosis of the patients was 43 ± 8.0. By genetic analysis, causative genes were identified in 9(13.63%) of 66 patients. These genes are ATM (%11), BRIP1 (%11), CHEK2 (%34), FANCC (%11), MUTYH (%11) and PALB2(%22). Patients with a causal variant and others were grouped, and compared in terms of parameters such as age atdiagnosis, tumor localization, histopathological type of tumor, estrogen/progesterone receptor status, c-erbB2, stage,metastasis at diagnosis, and number of relatives with cancer. No statistical relationship was found between the groups.Conclusion: This study determined the rate of detection of causal variants of cancer susceptibility genes other thanBRCA1/2 in women with breast cancer who applied to the medical genetics department as 13.63%. Performing multiplegene tests with the NGS in cancer individuals will allow carrier individuals to receive correct diagnosis and appropriatetreatment and to be directed to necessary screenings., Amaç: Meme kanserlerinin yaklaşık %10'unun kalıtsal olduğu ve bunların yaklaşık %20'sinden BRCA1/2 genlerinin sorumlu olduğu bilinmektedir. Yapılan araştırmalar, meme kanserinde BRCA1/2 dışındaki birçok genin mutasyonlarının da yatkınlığa neden olduğunu göstermiştir. Bu çalışmada meme kanserli Türk kadınlarda diğer kanser yatkınlık genlerinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: Bu retrospektif çalışmaya Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Genetik Bölümü'nde 2016-2021 yılları arasında değerlendirilen 66 kadın hasta dahil edildi. Hastaların kansere yatkınlık genleri, yeni nesil dizileme tekniği (NGS) kullanılarak incelendi.Bulgular: Hastaların ortalama tanı yaşı 43 ± 8.0 idi. Genetik analiz ile 66 hastanın 9'unda (%13,63) nedensel gen tespit edildi. Bu genler ATM (%13), CHEK2 (%36), FANCC (%13), MUTYH (%13) ve PALB2'dir (%25). Nedensel varyantı olan hastalar ve diğerleri gruplandırılarak tanı yaşı, tümör lokalizasyonu, tümörün histopatolojik tipi, östrojen/progesteron reseptör durumu, cerbb2, evre, tanı anındaki metastaz ve kanserli akraba sayısı gibi parametreler açısından karşılaştırıldı. Gruplar arasında istatistiksel bir ilişki bulunamadı.Sonuç: Bu çalışmada meme kanserli Türk kadınlarında BRCA1/2 dışındaki kansere yatkınlık genlerinin nedensel varyantlarının saptanma oranı %13,63 olarak belirlendi. Kanserli bireylerde NGS ile çoklu gen testlerinin yapılması, taşıyıcı bireylerin doğru tanı ve uygun tedavi almalarını ve gerekli taramalara yönlendirilmelerini sağlayacaktır.

Purpose: In the ToGA trial for HER2-positive advanced gastric cancer, cisplatin plus fluoropyrimidine was given for 6 cycles; trastuzumab was given until disease progression. However, there is a lack of real-life data about trastuzumab maintenance after 6 cycle chemotherapy. This study aims to present real-life data of trastuzumab ± capecitabine maintenance after 6 cycles of platinum, fluoropyrimidine, and trastuzumab in non-progressive patients. Methods: This is a retrospective multicenter study of the Turkish Oncology Group. A total of 35 HER2-positive, inoperable locally advanced, recurrent, or metastatic gastric adenocarcinoma patients being non-progressive at the end of 6 cycle chemotherapy and being given trastuzumab ± capecitabine as maintenance treatment were included from sixteen oncology centers. Baseline characteristics, objective tumor responses, progression free and overall survival data, and toxicities were determined. Results: About 68% of the patients were given CF, and 32% were given FOLFOX with trastuzumab as the first-line treatment. The best response in 6 cycle chemotherapy was complete 8 (22%), partial 24 (68%), and stable disease 3 (8%). All patients had trastuzumab maintenance (median cycle 13; range 7–51), and 49% of the patients had capecitabine with trastuzumab (median capecitabine cycle 6; range 2–30). The median PFS of the patients was 12.0 months (95% CI 10.3–13.7), and median OS was 17.4 months (95% CI 15.2–19.5). There were 2 patients with grade 1 cardiotoxicity. Conclusion: Trastuzumab maintenance ± capecitabine after 6 cycles of trastuzumab plus combined chemotherapy treatment revealed efficacy and safety in non-progressive HER2-positive advanced gastric cancer. © 2021, Springer Science+Business Media, LLC, part of Springer Nature.

Introduction Colonic wall thickening (CWT) is frequently observed incidentally via abdominal computerized tomography (aCT). Although the general approach to evaluating incidental CWT is a colonoscopic examination, there is a lack of definitive recommendation guidelines. Thus, we aimed to determine neoplasia rates and identify the factors predictive of neoplasia via colonoscopic examinations of patients with CWT incidentally diagnosed via aCT. Methods We retrospectively reviewed 5,300 colonoscopy reports. A total of 122 patients who had CWT incidentally observed via aCT were included in the study. CWT was graded as mild (3-5 mm), moderate (6-12 mm), or severe (≥12 mm). A logistic regression model was used to determine the predictive factors for neoplasia. Results The mean age of the patients was 60 years, and abnormal findings were noted in 52% of the colonoscopies. Neoplastic lesions were detected in 24 patients (19.6%), while colon adenocarcinoma was detected in 8 patients (6.5%). Multivariate analysis showed that moderate-severe, focal, and asymmetric CWT were independent factors for predicting neoplasia (p=0.049, p=0.033, and p=0.018, respectively). Conclusion Pathological findings can be noted via colonoscopic examination in cases of incidental CWT; therefore, patients with moderate-severe, focal, or asymmetric CWT require colonoscopic examination for the purpose of detecting neoplasia.

Objective:Weaimed to compare the neutrophil lymphocyte ratio(NLR), which is a simplemethod, to determine whether the difference between the right colon and theleft colon tumors in our study is related to the inflammatory process betweenthe two regions.Materialand Method: We retrospectivelyreviewed the files of 142 patients who were diagnosed with stage 1-3 colorectalcancer between July 2011 and June 2015 at Medical Oncology Department, DışkapıYıldırım Beyazıt Education and Research Hospital. We examined whether tumorlocalization correlates with neutrophil lymphocyte ratio (NLR) and disease-freesurvival.Results:Thepatients were divided into right and left colon based on splenic flexure. Therewere 35 patients (24%) defined as right colon and 107 (76%) patients defined asleft colon. 85 (60%) of the patients were male and 57 (40%) were female. Theratio of neutrophil and lymphocytes at diagnosis was compared. The mean NLR valuesof the left and right colon were calculated as 4.43 and 5.05, respectively. Nostatistically significant difference was found between the right and left colon(p = 0.234). The disease-free survival rates were lower in the right colontumors than in the left colon, but not statistically significant (0,88 / 0,8440th and 60th at 20th month) 0.80 / 0.77 and0,80/0,77; p = 0.064)Conclusion:Inour study, we could not find any relation between the NLR and the localizationof the disease in patients with early stage colorectal cancer. Disease-freesurvival rates were calculated to be lower in right colon tumors, although theydid not reach statistical significance with respect to left colon., Amaç:Çalışmamızda sağ kolon ile sol kolon yerleşimli tümörler arasındaki farkın ikibölge arasındaki inflamatuvar süreçle ilişkili olup olmadığını basit bir yöntemolan nötrofil lenfosit oranına bakarak karşılaştırmayı amaçladık.Gereçve Yöntem: Dışkapı Yıldırım Beyazıt Eğitim veAraştırma Hastanesi Tıbbi Onkoloji bölümüne Temmuz 2011-Haziran 2015 tarihleriarasında başvuran evre 1-3 kolorektal kanser tanısı almış 142 hastanındosyalarını retrospektif olarak inceledik. Tümör lokalizasyonu ile nötrofil lenfosit oranı (NLO) ve hastalıksız sağkalım arasında ilişki olup olmadığını araştırdık.Bulgular:Hastalar splenik fleksura baz alınarak sağ ve sol kolon şeklinde ikiye ayrıldı.Sağ kolon olarak tanımladığımız 35 (%24), sol kolon olarak tanımladığımız 107(%76) hasta vardı. Hastaların 85’i (%60) erkek, 57’si (%40) kadındı. Tanıanındaki NLO karşılaştırıldı. Sağ ve sol kolonun NLO ortalama değerlerisırasıyla 4,43 ve 5,05 olarak hesaplandı. Sağ ve sol kolon arasında NLOaçısından istatiksel olarak anlamlı farklılık saptanmadı (p=0.234). Hastalıksız sağ kalım oranları sağ kolon tümörlerinde solkolona göre istatiksel anlamlılığa ulaşmasa da daha düşük olarak hesaplandı (20.ayda 0,88/0,84; 40. ve 60. ayda sırasıyla 0,80/0,77 ve 0,80/0,77; p =0,064).Sonuçlar:Yaptığımız çalışmada metastatik olmayan kolorektal kanserli hastalarda tanıanında bakılan NLO ile hastalığın lokalizasyonu arasında ilişki bulamadık. Hastalıksızsağ kalım oranlarını sağ kolon tümörlerinde sol kolona göre istatikselanlamlılığa ulaşmasa da daha düşük olarak hesapladık.

Amaç: Onkolojik hastalıkların erken tanı ve tedavisinde yeni gelişmeler hayatta kalma oranlarının artmasına neden olsa da, artmış sağ kalım oranlarına bağlı olarak gelişen uzun takipler sırasında ikinci primer maligniteler ortaya çıkabilmektedir. İkincil primer tümörlerin gelişimi için birçok faktör vardır. En önemlisi, yaşlı hastalar ın uzun vadede kanserojenlere maruz kalma olasılıkları daha yüksektir. Çoklu primer tümörler, genellikle iki malignite tanısı arasındaki zaman çizelgesine bağlı olarak metakron veya senkron olarak görülür. Senkron hastalıklar sıklıkla benzer karsinojenlere maruz kalma sonucu oluşsa da, metakron olanlar daha çok primer tümörün tedavisine bağlı advers etkilerle ilişkili olabilir. Bu tek merkezli çalışma, Ocak 2007 ile Aralık 2016 arasında multipl primer tümörlü hastaların klinikopatolojik özelliklerini araştırmayı amaçladı ve bunlardan 20'si senkron, 36'sı metakron olarak toplam 56 hasta dahil edildi. En yaygın kanser çiftlerinin erkeklerde kolon-akciğer ve prostat-mesane, kadınlarda meme-kolon ve meme-tiroid olduğu tespit edilmiştir. Yöntemler: Ocak 2007 ile Aralık 2017 tarihleri arasında merkezimizde takip edilen ÇPT’ lü hastaların dosyaları retrospektif olarak incelendi, 56 hastada multiple primer tümör olduğu tespit edildi. Hastaların cinsiyetler, yaşları tespit edildi. Tümörün hangi organlarda oluştuğu, ne zaman geliştiği, bulunabilen etyolojik veriler, sağ kalım oranları araştırıldı. Tüm istatistiksel analizler Package for Social Sciences (SPSS v 15.0, SPSS Inc., Chicago, IL, USA) ile yapıldı. Sonuç: Senkron hastalıklar genellikle benzer kanserojenlere maruz kalmanın bir sonucu olarak ortaya çıkarken, metakronöz hastalıkların primer tümörlerin tedavisinin yan etkileri ile ilişkili olması muhtemeldir

Due to the cytotoxic effects of old chemotherapy regimens used in the islet cell tumors, capecitabine plus temozolomide combination has now become the first choice in the treatment of malignant insulinoma (MIoma). We present this case to emphasize and remind that a durable complete response in advanced stage MIoma may be achieved with a short course of streptozotocin plus doxorubicin combination.

AIM: Patients with cancer die not only from the primary cancer disease, die also from many of reasons like bleeding, thromboembolism and sepsis. We aimed to research death reasons and major factors which affects survival who die from cancer in our clinic.MATERIAL AND METOD: 46 patient ( 34 men and 12 women) are included to our research whom death comfirmed with hospital registers in last two years. Statical analysis practiced with SPSS 18 version (SPSS inc., Chicago, IL)RESULTS: Patients in our assessment were stage 4 cancer in the percentage of %91.3 and %84.4 with III and over performance status in their last hospitalizations. %76.1 of these patients practiced chemotherapy and %41.3 of them had radiotheraphy. %31.4 of patients undergone to surgery. There is no difference in survival of patients regardless to their stages and performance scores although women have a long survival compared with men (p, Amaç: Kanser hastaları, kanser dışında kanama, tromboemboli, sepsis gibi bir çok nedenden dolayı ölürler. Bu çalışmamızda kanserden kaybettiğimiz hastalarımızın ölüm nedenlerini ve sağ kalımlarını etkileyen başlıca faktörleri araştırmak istedik. Hasta ve Yöntem: Çalışmaya iki yıl içinde hastanede ölmüş olduğu dosya kayıtlarından saptanan 34 erkek ve 12 kadın toplam 46 hasta dahil edildi. İstatistik analizi SPSS versiyon 18 (SPSS inc., Chicago, IL) programında yapıldı. Bulgular: Değerlendirmeye alınan hastalarımız son yatışlarında %91.3 oranında evre IV hastalık ve %84.4 oranında performans statüsü (PS) III ve üzerinde idi. Ölen hastaların %76.1'i kemoterapi (KT) ve %41.3'ü radyoterapi (RT) almış idi. Hastalar %31.4 oranında cerrahi geçirmişti. Hastaların sağ kalımları evrelere ve performans skorlarına farksız çıkarken kadın hastalar erkeklere kıyasla daha uzun yaşamışlardır (p

Anti-epidermal growth factor receptor (EGFR) antibodies are mainly used in the treatment of advanced stages of solid tumors as a targeted therapy to inhibit tumor proliferation. They cause many dermatological adverse reactions through inhibition of EGFR pathway in the skin. A 39-year-old female patient diagnosed with metastatic colon adenocarcinoma received oxaliplatin, fluorouracil, and folinic acid regimen with cetuximab. The patient noticed increase in fairy hair especially at facial area as well as in the whole body beginning after the first few cycles of treatment, after 3 months. Obvious hypertrichosis, androgenic alopecia, and trichomegaly were observed. Blood tests for androgenetic alopecia and hirsutism were studied. Hormonal levels were in normal range. Upper abdominal imaging to rule out any adrenal lesion was also normal. Previous studies reported found that cetuximab may cause alopecia, hypertrichosis on face and body, and trichomegaly. We have not encountered a combination of hypertrichosis, androgenic type alopecia, and trichomegaly in the literature.

Background: In Muslim majority countries (MMC) opioid use for pain management is extremely low. The underlying factors contributing to this are not well defined. Aim: The aim of this study was to survey the attitudes of cancer patients towards morphine use for pain management in a MMC and identify the factors that influence patient decisions to accept or refuse morphine as treatment for cancer pain. Settings/participants: Patients were questioned whether they had pain or not, the severity and the medications for pain management. Questions included what type of medication they thought morphine was, whether or not they would be willing to take morphine if recommended for pain management and the basis for their decision if they were against morphine use. Results: Four hundred and eighty-eight patients participated in the study. Some 50% of the patients who refused morphine use and 36.8% of the patients who would prefer another drug, if possible, identified fear of addiction as the basis for their decision. Reservation of morphine for later in their disease was the case for 22.4% of the patients who refused morphine use. Only 13.7 % of the patients refusing morphine and 9.7% of the patients who preferred another drug, if possible, cited religious reasons as the basis for this decision. Conclusions: Identifying the underlying factors contributing to low opioid use for pain management in MMC is important. Once the underlying factors were identified, all efforts should be taken to overcome them as they are barriers to improving patient pain management.

We present a patient with uncommon metastases of lung cancer. The patient has been followed-up for early stage laryngeal carcinoma in the remission and has had dyspeptic complaints as well. A 62-year-old male patient had epigastric complaints for three months. In the upper endoscopy, a biopsy specimen taken from the polyp in the second region of the duodenum was reported as squamous cell cancer. Immunohistochemical staining of tumor cells were positive for CK5/6, p40, and p63. A mass in the right lung was detected on thorax tomography. The result of the transthoracic needle biopsy indicated squamous cell cancer. Duodenal metastasis of lung cancer is highly unlikely. Lesions below 1 cm can be safely removed endoscopically. Duodenal metastasis of primary lung cancer can be considered in the differential diagnosis of resistant dyspepsia. Keywords: Dyspepsia, Squamos cell lung cancer, Duodenal metastasis

Diskapi Education & Research Hospital, Department of Medical Oncology, Ankara, Turkey *Author for correspondence: Tel.: +90 312 596 2854; Fax: +90 312 318 6690; m_f_karatas@hotmail.com

The more metastatic sites and bone marrow metastasis in small cell lung cancer (SCLC), the worse the prognosis. Diagnosing the bone marrow invasion at the beginning of the therapy is important for determining of the prognosis and planning the treatment. Abnormalities of some blood parameters may help to estimate the extent of bone marrow invasion by cancer cells. In this retrospective review, the changes in routine laboratory tests that may indicate bone marrow invasion, the predictive values of these tests, and the prognostic importance of bone marrow invasion were evaluated in SCLC patients who were being followed up according to a protocol. One hundred and forty-four patients with SCLC were enrolled in this study. Retrospectively, it was evaluated that 25 (17.4%) of the patients had bone marrow metastasis. According to univariate analysis, there was a significant difference between hemoglobin, white blood cell count, platelet count, lactate dehydrogenase, alkaline phosphatase and uric acid of the patients with and without bone marrow involvement. Among the biochemical parameters, the elevated LDH and AP had the highest sensitivity and specificity as indicators of bone marrow invasion (0.80–0.82 and 0.84–0.78, respectively). The median overall survival of extensive-stage disease with and without bone marrow metastasis were 4.0 ± 1.0 months (95% CI 2.2–5.7) and 7.0 ± 1.2 months (95% CI 4.7–9.3), respectively (P = 0.03). Bone marrow metastasis was found to be an indicator of a bad prognosis. Bone marrow biopsy, that is an invasive procedure, can be performed on selected patients who have changes of routine laboratory tests suggesting bone marrow invasion.

Background: Renal cell carcinoma is the most common malignancy of the kidney in adults. The treatment of metastatic disease remains a particularly difficult problem given the resistance of this disease to most treatment options and usually requires hospitalization. This prospective study aimed to determine the efficacy and systemic toxicity of outpatient Chemoimmunotherapy (CIT) in metastatic renal cell cancer (MRCC) patients. Methods: The patients with MRCC received a combination of 5-fluorouracil 400 mg/m2 intravenously on day 1 once a week, interferon-α 10 MU on days 1,3,5 during weeks 1 and 3, interleukin-2 18 MU on days 1,3,5 during weeks 2 and 4 subcutaneously. Results: Twenty-three MRCC patients were enrolled into the study. The performance status was ECOG 0–2. The median age was 60 years. Twenty patients were evaluable. Chemoimmunotherapy was administered for a median of 10 weeks (range 2–32). Partial remission was obtained in two patients, stable disease in five and no complete response was detected. Median overall survival (OAS) was 10.0 months (95% CI 5.5–14.5 months), progression-free survival (PFS) 7.0 months (95% CI 5.1–8.9 months). The 1-year OAS and PFS rate was 27% and 7%, respectively. Median OAS for patients with and without nephrectomy was 10.0 months (95%CI 7.2–12.8 months) and 6.0 months (95%CI 1.4–10.5 months), median PFS 7.0 months (95% CI 4.1–9.9 months) and 5.0 months (95% CI 3.7–6.2 months), respectively, and there was no statistical significant difference (P = 0.27 and P = 0.20). Most common complaints were fatigue, fever and nausea. Grade 3–4 side-effects were not observed. Conclusion: This CIT scheme showed a low objective response rate, but when combined with stable disease, clinical benefit is favorable. Outpatient administration with mild toxicity is advantageous.

Summary. Background Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression. SCLC is associated with alterations in the coagulation system. The present randomized clinical trial (RCT) was designed to determine whether addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) would improve SCLC outcome compared with CT alone. Methods Combination CT consisted of cyclophosphamide, epirubicine and vincristine (CEV) given at 3-weekly intervals for six cycles. Eighty-four patients were randomized to receive either CT alone (n ¼ 42) or CT plus LMWH (n ¼ 42). LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT. Results Overall tumor response rates were 42.5% with CT alone and 69.2% with CT plus LMWH (P ¼ 0.07). Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH (P ¼ 0.01). Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH (P ¼ 0.01). Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages. The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 (95% confidence interval 0.30, 0.86) (P ¼ 0.012 by log rank test). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths. Conclusions These results support the concept that anticoagulants, and particularly LMWH, may improve clinical outcomes in SCLC. Further clinical trials of this relatively non-toxic treatment approach are indicated.

PubMedID: 24338610 Background: Optimal duration of adjuvant trastuzumab in early breast cancer is an unresolved issue. In this observational study, we compared the outcome of 9 weeks and 1 year adjuvant trastuzumab in early breast cancer patients in Turkey. Methods: Records of 680 patients with HER2-positive early breast cancer who received adjuvant trastuzumab plus chemotherapy were obtained and patients were followed up to compare the disease-free survival (DFS) outcome of 9 weeks versus 1 year trastuzumab. Results: Nine weeks and 1 year trastuzumab was given to 202 (29.7 %) and 478 (70.3 %) patients, respectively. There was a significantly lower rate of patients with negative lymph nodes in the 9-week trastuzumab group. At median 3 years of follow-up from the date of starting trastuzumab, the DFS rates were 88.6 and 85.6 %, respectively (p = 0.670). When adjusted for all the prognostic factors that were significant on univariate analysis, again there was no significant difference in DFS between the groups (HR 0.675; 95 % CI 0.370–1.231; p = 0.200). Cardiac toxicity defined as a ?15 % decrease in LVEF was significantly higher in the 1-year trastuzumab group (1.88 % versus none for 1-year and 9-week trastuzumab groups, respectively; p = 0.050). Conclusion: The results of this observational study suggest that DFS outcome of 9 weeks of adjuvant trastuzumab may be comparable to 1 year adjuvant trastuzumab: this needs confirmation by randomized trials. © 2013, The Japanese Breast Cancer Society.

Tumor-induced pancreatic damage or insulin resistance may be responsible for diabetes in pancreatic cancer (PC) patients, but the exact cause of association remains controversial. In this study, we aimed to investigate the prevalence of diabetes in patients with PC in central Anatolia, Turkey, and to evaluate whether diabetes is caused by PC. A total of 40 patients with primary PC were enrolled in the study. 13 (32.5%) of the patients had diabetes before PC diagnosis. Oral glucose tolerance test was performed in the remaining 27 patients. The period between the diagnosis of diabetes and detection of PC was less than 1 year in seven (17.5%) patients who had previous diabetes. Recent-onset diabetes and impaired glucose tolerance were detected in 13 (32.5%) and two (5%) of the PC patients, respectively. The prevalence of recent-onset and shortly-before-diagnosed diabetes has been found very high (50%) in our patients with PC. Interestingly, we determined higher levels of insulin and C-peptide in PC patients having abnormal glucose tolerance than patients having normal glucose tolerance. In conclusion, as it has been reported in other population, we determined high prevalence of diabetes in PC patients in central Anatolia. High insulin and C-peptide level indicate that different mechanisms such as insulin resistance may be responsible for abnormal glucose tolerance in PC patients other than the tumor caused insulin deficiency. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Although several advancements have been achieved in treatment of cancer patients, bacterial and fungal infections are still the most important cause of mortality. In this study, we aimed to determine factors associated with bacteremia and fungemia in cancer patients. In 71 hospitalized patients with cancer who were admitted to Hematology-Oncology department between January 1996 and May 1998, 54 (52%) neutropenic and 50 (48%) nonneutropenic febrile episodes were evaluated. In 22 (21%) of the cases bacteremia or fungemia was present. There was no relation between bacteremia or fungemia and age, sex, neutrophil counts, focus of infection, underlying disease, diarrhea and renal or liver dysfunction. For the cancer patients having central venous catheter, severe mucositis and platelet count lower than 20000/mm3, it was observed that the probability of fungemia or bacteremia was higher than the others. Twelve patients died during febrile episodes. The cause of death was related to infections in nine cases, and bleeding or other complications of the primary disease in three cases (infection related mortality rate: 8.7%). Gram-negative bacteria were causative organisms in five of the nine patients who died from infection. In conclusion; we determined that mucositis, central venous catheterization, and low platelet count in cancer patients increased the probability of bacteremia or fungemia, while neutropenia did not have any effect on there. On the other hand, gram-negative bacterial infections have been found as the most important cause of mortality in cancer patients.

AIMS AND BACKGROUND: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor and associated with alterations in the coagulation system. Addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) had resulted in increase in survival. The present retrospective trial was designed to determine whether the duration of dalteparin usage has an effect on progression and survival. MATERIALS AND METHODS: The medical records of 67 patients with SCLC who were given cisplatin-etoposide and concomitant LMWH (dalteparin) was evaluated retrospectively. RESULTS: Median follow-up of patients was 11.3 months. Outcome: 10.6% complete response, 3.0% good partial response, 36.4% partial response, 10.6% stable disease, and 39.4% progressive disease. Side-effects were seen in 40.3% of the patients. Median dalteparin duration was 6,1 months. According the duration of dalteparin patients were grouped in three: who took dalteparin less than 4 months (Group A), 4-6 months (Group B) and more than 6 months (Group C). Mean overall survival (OS) in Group A was 6.5 months, in Group B 11.8 months, and Group C 14.6 months. Mean OS in Group B and C were statistically significantly (P < 0.001) longer than Group A, between Group B and C there was not any significant difference (P = 0.037). Mean progression free survival (PFS) was 9 months. CONCLUSIONS: The CT plus LMWH minimum 4 months long is well-tolerable, and may improve PFS and OS in patients with SCLC. For treatment of patients with SCLC CT plus LMWH may be considered as effective future-therapy, and further multi-centre randomised prospective clinical trials must be done to determine the new standard treatment approach for SCLC.

In this study, we aimed to evaluate the prognostic value of pretreatment blood count values, particularly WBC counts, in patients with advanced non-small cell lung cancer (NSCLC). The records of 186 patients with advanced stage (stage IIIB and IV) NSCLC were assessed retrospectively. Patients were divided into 3 subgroups according to WBC levels; 10000 and 15000/mm(3) as Group 3. Patient and tumor characteristics as well as outcomes in terms of overall survival (OS) were evaluated. Median OS was 13.3 months in the whole population, 25.7 months in stage IIIB and 8.9 months in stage IV patients. According to the pretreatment leukocyte values, median OS was 17.9 months in Group 1, 11.2 months in Group 2 and 8.4 months in Group 3 (p= 0.003). Median OS values in WBC groups according to stages IIIB and IV were significantly different (p< 0.001). In multivariate analyses, ECOG-PS 2 or 3, stage IV disease, anemia and high WBC levels were associated with poorer OS. In this study, higher pretreatment WBC levels were associated with poorer OS in patients with advanced stage NSCLC. Pretreatment WBC counts may represent a simple prognostic factor and may aid in tailoring treatment in patients with advanced NSCLC.

Aim: To evaluate efficacy and tolerability of topotecan treatment for recurrent small cell lung carcinoma. Patients and Methods: A total of 62 patients were evaluated retrospectively. Statistical analysis was performed using GraphPad Instat (version 3.05). Results: DFifty five of patients (89%) were male and 7 (11%) were female. Median age was 56.7 +/- 9.3 (34-75). Forty eight of patients (80%) were extensive stage (ES) at the time of diagnosis. Fifty of the patients (80.6 Medical Oncology Clinic) were given median 5.36 cycles of cisplatin-etoposide (2-8 cycles). Time to recurrence was 15.6 +/- 6.13 weeks in patients with limited stage (LS) and 6.3 +/- 3.82 weeks in extensive stage (ES) (p

Aim: Human epidermal growth factor receptor 2 (HER2) overexpression is associated with poor prognosis and the frequency of HER2 positivity in breast cancer patients varies among different regions of the world. We studied HER2 expression in Turkish breast cancer patients. Methods: HER 2 expression was evaluated immunohistochemically in 107 breast cancer patients. HER2 expression was reported as negative or positive (3+) according to cellular membrane staining characteristics. The frequency of HER2 overexpression, distribution according to clinical characteristics, effect on survival and effect of chemotherapy on survival in relation to HER2 overexpression was evaluated. Results: The median age of patients was 49 years (range 27–76). HER2 was 3+ in 34 patients (31.8%). There was no significant difference in age, menopausal status, histopathology, lymph node involvement, stage and estrogen and/or progesterone receptor positivity in relation to HER2 expression. Forty-three patients (40.2%) relapsed and 21 patients (19.6%) died during the follow-up period. There was no significant difference in the relapse rate, distribution of relapse sites and death rate in relation to HER2 expression. The 3- and 5-year disease free survival rates were 67.1 and 40.5%, and the overall survival rates were 87.5 and 66.1%, respectively. Survival rate and calculated survival time were relatively shorter in HER2 3+ patients than in non-HER2 3+ patients, but these differences were not statistically significant. HER2 status did not affect survival period according to chemotherapy group. Conclusion: Immunohistochemistry findings of HER2 expression in Turkish breast cancer patients were similar to those found in the published reports. A shorter survival period was observed in HER2 3+ patients, but the difference was not statistically significant.

Aims and Background We aimed to evaluate the prevalence of and factors related to the use of complementary/alternative medicine among cancer patients undergoing or following conventional treatment at the Erciyes University Oncology Hospital in Central Anatolia. Study Design and Patients Face-to-face interview and a questionnaire were carried out with cancer patients attending the outpatient clinic of Medical Oncology. Questionnaire items included patients’ demographic data, treatment, use of complementary/alternative medicine and possible related factors. Multivariate analysis was performed to compare the factors related to use of complementary/alternative medicine. Results A total of 268 consecutive cancer patients were enrolled in the study. Overall, 43% of the patients were using or had used complementary/alternative medicine. Totally, 90% of the patients using complementary/alternative medicine utilized herbs, and most of the herbs used were stinging nettle. Nearly half of the patients using complementary/alternative medicine (46.1%) were aiming to fight the disease. Among users, nearly half of them regarded the method used as effective and 54 (50.5%) suggested the use of complementary/alternative medicine to other patients. Only 23.1% of the patients discussed the use of complementary/alternative medicine with their physician. In logistic regression analysis, younger age, higher educational status, advanced stage of the disease, longer duration of the disease and current treatment status were significantly associated with the use of complementary/alternative medicine. In our regression model, the predictivity rate of these variables was 72.2% for use of complementary/alternative medicine according to the backward Wald test. Conclusions Use of complementary/alternative medicine among cancer patients in our center is modestly high, and the most common method is herbal therapy. Communication between the patient and the physician shouldbe improvedon this subject.

Rectal carcinoids comprise 12.6% of all carcinoid tumors and represent the third largest group of the gut carcinoids. A 64-year-old woman was diagnosed as high-grade neuroendocrine carcinoma. She had liver, bone, and bone marrow metastasis. Carcinoid syndrome was diagnosed due to diarrhea, nausea, vomiting, tachycardia, and high level of 24-hour urinary 5-hydroxyindoleacetic acid (160 mg/24 hours). No response was obtained by octreotide treatment. Rectal carcinoid tumors usually show favorable prognosis; however, poorly differentiated tumors might have unusually aggressive behavior and resistance to treatment. Bone marrow involvement might be a poor prognostic factor in carcinoid tumor as has been the case in many other tumors.

We have performed a prospective evaluation of the efficacy, safety and convenience of the transdermal therapeutic system - fentanyl (TTS-F) in Turkish cancer patients when it was newly available in Turkey. Ninety-nine patients with historically confirmed malignancy and pain entered the study; the mean age was 55.1 (16-58) years. The study duration was 28 days. Transdermal therapeutic system - fentanyl was used in opioid-naive or pre-treated patients. Most patients reported a decrease in pain severity. Use of rescue medication decreased from day 4 to day 28. The majority of patients rated patch convenience of use as excellent. A total of 22.2% of patients experienced adverse events that were either probably related or very likely to be related to the study drug. The majority of the adverse events mentioned were related to the digestive system. Eighteen serious adverse events were reported by 13 patients. Six events were doubtfully related, and 12 events were not related to the study drug. Four patients died during the trial. None of these deaths was attributed to the study drug. In conclusion, the trial showed that TTS-F is easily managed, effective and will help to enable the appropriate opioid administration to patients who are suffering from cancer pain in Turkey.

The aim of this study was to determine the incidence and role of c-erbB-2 overexpression as a predictive/prognostic marker in small-cell lung carcinoma (SCLC). We performed a retrospective study on subjects with a biopsy-proven diagnosis of SCLC. A chart review for demographic and clinical data was performed on patients with SCLC diagnosed between 1998 and 2004. c-erbB-2 overexpression was evaluated using immunohistochemistry performed on archival paraffin-embedded specimens. Sixty-seven patients with SCLC were identified (6 females, 61 males; median age- 56.5 yr, range-34-75) all of whom had adequate tissue specimens available for c-erB-2 testing. Of the 67 specimens, 12 (17.9%) showed c-erbB-2 overexpression. Seventy-five of the cases were positive for c-erbB-2, had extensive disease. The median overall survival of patients with SCLC whose tumors were positive and negative for c-erbB-2 were 8 +/- 0.9 months (95%CI 6.3-9.7) and 11 +/- 1.5 months (95%CI 8.0-14.0), respectively. c-erbB-2 overexpression detected using immunohistochemistry is observed in 17.9% of patients with SCLC and has statistically significant prognostic value. Our findings suggest that c-erbB-2 may be a potential target for site-specific immunotherapy in SCLC. Considering one technique examined, further molecular investigation is needed to confirm these preliminary findings.

In this phase II study, we aimed to detect efficacy and toxicity of the combination of CPT-11 and cisplatin administered to patients with metastatic gastric carcinoma. On d 1, CPT-11, 100 mg/m2, was administered by intravenous infusion for 90 min, followed by a 2 h infusion of cisplatin, at 70 mg/m2 every 3 wk. Forty-one patients were enrolled into the study. Twenty-eight patients were chemotherapy naive. The total number of chemotherapy cycles administered was 165, and the median number of cycles received was 4 (range, 1-8 cycles). The median follow-up time was 12 mo (range, 4-34 mo). There were 4 complete responses (9.7%) and 14 partial responses (34.2%), which result in a response rate of 43.9% (18 of 41 patients). The median time to progression was 8.0 +/- 0.8 mo with 56% and 13% of patients progression free at 6 and 12 mo, respectively. The median overall survival was 9.0 +/- 1.1 mo, with 68 % and 32% of patients alive at 6 and 12 mo, respectively. Grade 3-4 nausea and vomiting was observed in five patients (12%) and grade 3-4 neutropenia in five patients (12%). Grade 3 infection was observed in only one patient (2%). Grade 2 transient liver dysfunction related to chemotherapy was observed in one patient (2%). Chemotherapy was stopped due to nephrotoxicity in one patient (2%). There was no treatment-related death. In conclusion, administration of CPT-11 and cisplatin in this particular dose every 3 wk is effective and well-tolerated treatment regimen.

Background Solitary plasmacytoma localised to bone or soft tissue without myeloma. Aim Clinical features and survival was analysed in patients from Central Anatolia. Methods Twenty-three solitary plasmacytoma (18 male, 5 female) were evaluated retrospectively. Median age was 58 years (46-72). The major localisation was vertebral column. Results All patients but one (larynx) had surgical resection and 21 patients received radiotherapy postoperatively. Multiple myeloma developed in eight patients (35%) and local relapse was detected in one patient. Eight patients died, causes of death were multiple myeloma progression in six patients, local relapse of intracranial plasmacytoma in one patient and cranial trauma in one patient who was in complete remission. Three and 5 years progression free survival were 45.6% and 22.8% respectively and overall survivals were 54.4% and 27.2% respectively. Conclusion Solitary plasmacytoma cases should be followed carefully regarding local relapse and progression to myeloma.

PubMedID: 15726120 Our objective was to determine whether oral etoposide and cisplatin combination (EoP) is superior to paclitaxel in the treatment of advanced breast cancer (ABC) patients pretreated with anthracyclines. From December 1997 to August 2003, 201 patients were randomised, 100 to EoP and 101 to paclitaxel arms. Four patients in each arm were ineligible. The doses of etoposide and cisplatin were 50 mg p.o. twice a day for 7 days and 70 mg m-2 intravenously (i.v.) on day 1, respectively, and it was 175 mg m-2 on day 1 for paclitaxel. Both treatments were repeated every 3 weeks. A median of four cycles of study treatment was given in both arms. The response rate obtained In the EoP arm was significantly higher (36.3 vs 22.2%; P = 0.038). Median response duration was longer for the EoP arm (7 vs 4 months) (P = 0.132). Also, time to progression was significantly in favour of the EoP arm (5.5 vs 3.9 months; P = 0.003). Median overall survival was again significantly longer in the EoP arm (14 vs 9.5 months; P = 0.039). Toxicity profile of both groups was similar. Two patients in each arm were lost due to febrile neutropenia. The observed activity and acceptable toxicity of EoP endorses the employment of this combination in the treatment of ABC following anthracyclines. © 2005 Cancer Research UK.

A 59-year-old woman who had dyspnea and neck swelling for 10 days was admitted to the hospital. Malignant peritoneal mesothelioma was diagnosed previously. According to the clinical findings, and laboratory and pathologic examination, the patient was found to have disseminated venous thrombosis and antiphos pholipid syndrome, which is treatment-resistant autoimmune paraneoplastic syndrome.

High-grade gliomas are the most common primary brain tumors in adults. Twenty-seven patients with histopathologically proven anaplastic astrocytoma and glioblastoma multiforme were enrolled in this study from November 1998 to August 2002. Radiotherapy was administered after surgery and fotemustine (100 mg/m(2)) was sequentially administered every 3 weeks for 6 cycles. Overall, 111 cycles were administered to the 27 patients (median, 5 cycles; range, 1 to 6 cycles). Myelosuppression was mild to moderate. The median overall survival and progression free survival were 11 +/- 3.1 months (95%CI, 4.9-17.1) and 8 +/- 0.5 months (95%CI 7.1-8.9), respectively. One-year and two-year survivals were calculated at 48% and 7%, respectively. Significant prognostic factors (P

The purpose of this study was to evaluate the impact of granulocyte-colony stimulating factor (G-CSF) on the therapy for febrile neutropenia (FN). Our patient population differed significantly from those of previous studies as no patients received antimicrobial or CSF prophylaxis before randomization and all were solid tumor patients. When the diagnosis of FN was established, patients were started on intravenous meropenem 1 g every 8 hours and randomly assigned to receive G-CSF (5 microg/kg body weight per day subcutaneously) or not. Twenty-eight patients with 30 FN episodes received G-CSF and 25 patients with 30 FN episodes did not receive G-CSF according to randomization. The time to resolution of fever, recovery of neutrophil count over 1000/mm3, duration of hospitalization, need for erythrocyte and platelet transfusion and mortality rate were similar in both study groups. Side effects of therapy were mild. These results provide preliminary evidence that G-CSF administration, in addition to effective antibiotic therapy as treatment of febrile neutropenic patients with solid tumor, does not help improve infection-related morbidity and mortality.